Posts tagged depression

A common question asked of clinicians is, “What’s the difference between bipolar depression (also known as manic depression) and plain old depression? It’s a simple question to answer, because depression can either be a stand-alone diagnosis, or a part of another disorder, like bipolar. Therefore a mental health professional is going to examine whether there are other symptoms present (or have occurred in the past), to see if the depression is just depression, or whether it’s a part of a larger disorder.

Bipolar Includes Mania & Depression

If bipolar disorder includes a depressed mood, what else does bipolar include? We can find the answer to this question by looking at the old name for bipolar disorder, manic depression. The old name is pretty descriptive — bipolar is a combination of mania and depression, alternating in cycles.

What is mania? If we examine symptoms associated with mania, we see that it includes the following:

· Inflated self-esteem or grandiosity

· Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)

· More talkative than usual or pressure to keep talking

· Flight of ideas or subjective experience that thoughts are racing

· Attention is easily drawn to unimportant or irrelevant items

· Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

· Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

If three or more of these symptoms are present, then a person is considered to have a “manic episode” (or, if it is of less severity and length, a “hypomanic episode”). A manic episode also needs to have lasted for at least a week (a hypomanic episode, just four days) in order to be diagnosed. If an individual has signs that suggest he or she is having or has had a manic or hypomanic episode, in addition to episodes of severe depression, then typically that individual will quality for a bipolar diagnosis.

Depression Has no Mania

In ordinary depression, which clinicians refer to as “major depression” (sorry, there’s no equivalent “minor depression”), no manic or hypomanic episode is prevalent and the individual has no record or indication of having a manic or hypomanic episode in the past. A depressive episode is characterized by the following symptoms:

· Depressed mood most of the day, nearly every day

·  No interest or pleasure in all, or almost all, activities most of the day, nearly every day

· Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

· Insomnia (inability to sleep) or hypersomnia (sleeping too much) nearly every day

· Psychomotor agitation or retardation nearly every day

· Fatigue or loss of energy nearly every day

· Feelings of worthlessness or excessive or inappropriate guilt nearly every day

· Diminished ability to think or concentrate, or indecisiveness, nearly every day

· Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Five or more of these symptoms for longer than two weeks are needed in order to qualify for a depressive diagnosis, with no accompanying manic episode.

Source: http://psychcentral.com/lib/2007/whats-the-difference-between-bipolar-disorder-and-depression/all/1/

Adjustment disorder is a short-term condition that occurs when a person is unable to cope with, or adjust to, a particular source of stress, such as a major life change, loss, or event. Because people with adjustment disorders often have symptoms of depression, it is sometimes called “situational depression.” The type of stress that can trigger adjustment disorder varies depending on the person, but can include:

- Ending of a relationship or marriage

- Losing or changing job

- Death of a loved one

- Developing a serious illness (yourself or a loved one)

- Being a victim of a crime

- Having an accident

- Undergoing a major life change (such as getting married, having a baby, or retiring from a job)

- Living through a disaster, such as a fire, flood, or hurricane

Adjustment disorder can have a wide variety of symptoms, which may include:

- Feelings of hopelessness

- Sadness

- Frequent crying

- Anxiety

- Worry

- Headaches

- Stomach aches

- Heart palpitations

- Withdrawal or isolation from people and social activities

- Absence from work or school

- Dangerous or destructive behavior, such as fighting, reckless driving, and vandalism

- Changes in appetite, either loss of appetite, or overeating

- Problems sleeping

- Feeling tired or without energy

- Increase in the use of alcohol or other drugs

Adjustment disorder can occur in anyone, and at any age.

In terms of treatment, counseling or psychotherapy are the most common approaches.  Therapy helps the person understand how the stressor has affected his or her life. It also helps the person develop better coping skills. Support groups can also be helpful by allowing the person to discuss his or her concerns and feelings with people who are coping with the same stress. In some cases, medication may be used to help control anxiety symptoms or sleeping problems.

Most people with adjustment disorder recover completely. In fact, a person who is treated for adjustment disorder may learn new skills that actually allow him or her to function better than before the symptoms began.

Source: http://www.webmd.com/mental-health/mental-health-adjustment-disorder

Depression can often be difficult to fight as it usually drains you of your energy. And though you can’t overcome it by willpower alone, you still have some control, no matter how you feel. The suggestions below can help you with this.

1. Keep doing the activities you previously enjoyed (even if you don’t enjoy them as much when you’re depressed).

2. Try and build some exercise into your day as it releases endorphins – the body’s “feel good” hormones.

3. Know what your triggers and your risk factors are. For example, loneliness, stress, disappointment and pain are common triggers and risk factors for depression.

4. Stay in touch with your friends. Often those who are depressed start to isolate themselves – but that leads to loneliness - which makes depression worse.

5. Try and maintain some kind of routine, especially when it comes to getting up and going to bed. Taking naps in the daytime can cause insomnia and leave you feeling drained, so you have no energy.

6. Try to get a handle on how much you tend to worry. Take note of your thought patterns; don’t dwell on negatives. Instead, challenge faulty thinking so it’s much less pessimistic … and try to be thankful … and look for positives.

7. Make sure you do things that make you feel more relaxed. Often people who’re depressed feel uptight and agitated. So it’s important that you find things that help you to relax.  

8. Resist the temptation to self-medicate (especially through alcohol or substance abuse.) That will lead to greater problems - and make you feel much worse.

9. Seek out support. Talk to a good friend, or someone that you trust. You’ll usually find there’s someone who genuinely cares.

10. Talk to your doctor. It may be medication is the answer for you so don’t be afraid to try and get professional help.

We all have an automatic stream of thought – an unconscious commentary of what is going on, and how we are performing compared to other people. This commentary’s often harsh and negative. For example, we criticise ourselves for not being good enough, or saying something stupid, or doing something dumb. This increases our stress levels, and lowers self esteem. Thus, we need to try and notice and interrupt these ANTS – so we break the harmful patterns that are ruining our lives. Below are some steps that can help you with this:

1. First, try to get into the habit of noticing all the different thoughts that are passing through your mind. Some of these will be neutral or positive but many will be negative and damaging. These are the thoughts that you’re going to address.

2. Next, objectively look at how you are assessing yourself, and the situation. Try and identify your internal commentary or monologue. Notice the personal attacks, negative judgments and harsh criticisms.

3. Some specific questions you could ask yourself here include: What does this stressful situation mean to me? What does it say about me as a person? What does it say about my self-esteem? What is the message it is sending about my future? What negative images or tapes are playing in my head? What am I assuming, in terms of consequences?

4. Instead of ruminating on these negative thoughts, decide to interrupt the flow by saying “STOP” out loud, or by visualising a red stop sign. Use that as a trigger to put a stop to the self criticisms.

5. At this point, you need to make a conscious effort to find something distracting to do to keep your mind off your negative thoughts. This should be something you find interesting, or something that engages your full attention. Work on finding something that’s effective for you. The crucial thing is: you need to deliberately get your mind off the patterned negative thinking track.  

6. Try and come up with as many distractions as you can, so you’ve different options for resisting these ANTS. Some possibilities include: listening to music, humming along to music (or music in your head), exercising (going for a jog, cycle ride or swim), reading, surfing the internet, phoning a positive and upbeat friend, watching a funny video, playing with a pet, and so on.

Controlling your emotions doesn’t mean ignoring them. It means you recognize them and act on them when you deem it appropriate, not randomly and uncontrollably.

1.    Know your emotions. There are a million different ways you can feel, but scientists have classified human emotions into a few basics that everyone can recognize: joy, acceptance, fear, surprise, sadness, disgust, anger, and anticipation. Jealousy, for example, is a manifestation of fear - fear that you’re not “as good” as something else, fear of being abandoned because you’re not “perfect” or “the best”.

2.    Recognize that emotions don’t just appear mysteriously out of nowhere. Many times, we’re at the mercy of our emotions on a subconscious level. By recognizing your emotions on a conscious level, you’re better able to control them. It’s also good to recognize an emotion from the moment it materializes, as opposed to letting it build up and intensify. The last thing you want to do is ignore or repress your feelings, because if you’re reading this, you probably know that when you do that, they tend to get worse and erupt later. Ask yourself throughout the day: “How am I feeling right now?” If you can, keep a journal.

3.    Notice what was going through your mind when the emotion appeared. Stop and analyze what you were thinking about, until you find what thought was causing that emotion. Your boss may not have made eye contact with you at lunch, for example; and without even being aware of it, the thought may have been in the back of your mind, “He’s getting ready to fire me!”

4.    Write down the evidence which supports the thought that produced the emotion or against that thought. When you begin to think about it, you might realize that since nobody gets along well with this particular boss, he can’t afford to actually fire anyone, because the department is too short-staffed. For example, you may have let slip something that you should not have said which angered him, but which it is too late to retract.

5.    Ask yourself, “What is another way to look at the situation that is more rational and more balanced than the way I was looking at it before?” Taking this new evidence into account, you may conclude that your job is safe, regardless of your boss’s petty annoyances, and you’re relieved of the emotion that was troubling you. If this doesn’t work, however, continue to the next step.

6.    Consider your options. Now that you know what emotion you’re dealing with, think of at least two different ways you can respond. Your emotions control you when you assume there’s only one way to react, but you always have a choice. For example, if someone insults you, and you experience anger, your immediate response might be to insult them back. But no matter what the emotion, there are always at least two alternatives, and you can probably think of more: (i) Don’t react; do nothing. (ii) Do the opposite of what you would normally do.

7.    Make a choice. When deciding what to do, it’s important to make sure it’s a conscious choice, not a reaction to another, competing emotion. For example, if someone insults you and you do nothing, is it your decision, or is it a response to your fear of confrontation? Here are some good reasons to act upon:

• Principles - Who do you want to be? What are your moral principles? What do you want the outcome of this situation to be? Ultimately, which is the decision you’d be most proud of? This is where religious guidance comes into play for many people.
• Logic - Which course of action is the most likely to result in the outcome you desire? For example, if you’re being confronted with a street fight, and you want to take the pacifist route, you can walk away—but, there’s a good chance that burly drunk will be insulted if you turn your back. Maybe it’s better to apologize and keep him talking until he calms down.

Source: http://www.wikihow.com/Gain-Control-of-Your-Emotions

It’s hard to break free from the cycle of self-harm – but a good place to start is by sharing how you feel with a counsellor or therapist. The following guidelines can help with this:

1. First, it takes a lot of courage to talk about self-harm - so be patient and understanding with yourself, and share in a way that is comfortable for you. For example, if talking face-to-face feels too threatening right now then start by writing your experiences down – in an email, a letter, or a journal you can share. Also, only share with others what you’re ready to share, and only answer questions that you feel you want to answer.

2. Second, bear in mind that it’s often very stressful to talk about something as deeply upsetting as self-harm - so you may feel even worse after sharing in a session. Realise that this is normal, and it doesn’t mean you’re worse. Also, old patterns and habits can be difficult to break – but in time you will feel better, less empty and alone.

3. It is often very helpful to isolate the triggers that lead to the feeling that you want to self-harm. Next, brainstorm better ways of dealing with the pain.

4. For example,

(i)  If you turn to self-harm to express how you feel, experiment with using the following instead:

· Art (painting, drawing, and so on)

· Writing (journaling, song writing, poetry, and so on)

· Writing down your feelings - then destroying the paper

· Listening to music that expresses how feel.

(ii) If you use self-harm to calm and soothe yourself

· Try relaxing in the bath, or wrapping yourself up in a cosy, warm blanket

· Spend time playing with your favourite pet

· Talk to a friend

· Listen to relaxing music

(iii) If you cut because you can’t access your feelings

· Talk to a friend (and maybe try to laugh together)

· Try placing an ice cube on different parts of your body

· Eat something with a strong taste, like a grapefruit or salsa

· Find an online self help chat room, and talk to someone there

(iv) If you use self-harm as a means of releasing tension or anger

· Try some vigorous exercise (such as running, dancing or swimming)

· Punch a cushion or mattress or scream into your pillow

· Rip up magazines or sheets of paper

· If you’re musical, play your instrument (piano, guitar, drums, and so on)

Some possible substitutes to replacing the cutting sensation include:

· Instead of cutting yourself, use a red pen to “mark the spot”

· Try rubbing ice cubes along the area of skin where you would normally cut, or

· Put rubber bands on your arms, wrists or legs and snap them instead of harming yourself.

These are just a few suggestions – and everyone is different – but keep on working and fighting to get free.

Depression is a difficult experience to deal with and the support of a friend can be invaluable. It can shine a ray of hope, make you feel you’re not alone, and help to bolster your faltering self-esteem. However, a healthy balanced friendship has some healthy boundaries, too, and knowing what those are can make us more effective friends. For example:

1. There are times when we need guidance or some tips from others as we want to learn new skills, or to change and grow. For example, if it’s a poor assignment grade, or we keep losing friends then a friend who knows us well can sometimes share what they’ve observed. But before you dive in and give unwelcome advice, make sure your friend’s receptive and will take it the right way! Don’t just blurt out your opinion without being asked.

2. Related to this, ask your friend what they need, or what they’d like from you – as they may not even know, and this will help focus their thinking. You can then decide if you can give them what they need (like practical help or some tips for studying). If they can’t answer your question, you may end up being used - and become a dumping ground for their negativity. This is clearly detrimental for both of you.   

3. If you’re asked to share your thoughts, do it tentatively … Like “This worked for me … but we’re all different …” Or, ask her what has worked, and what hasn’t worked, before – as we often have the answers … It’s just hard to face the truth!

4. Whereas it’s good to listen and to be understanding, we also need to know when it’s time to withdraw. For example, if your friend is always negative and never seems to change then you may, inadvertently, be helping keep her stuck (by always being there, so she doesn’t have to change). Yet at the end of the day, we each choose the life we’ll live … We can stay a helpless victim or we can take up the reins, and assume control of our lives and destiny.

5. True friendship is based on meeting both parties’ needs. And though at times we will give more if a friend has a real need, if one person’s always taking then the friendship is unhealthy. That is, you’re not their personal therapist or human dumping ground. You need to recognise what’s happening and put up boundaries – like limiting the time you make available to them. To find solutions to their problems and move on with their life, your friend needs the skills of a detached professional …. And that is very different from being a good friend.       

According to Cognitive Behavioural Therapy, we often feel anxious, upset and annoyed because of certain errors in our thinking. These are faulty ways of looking at life which are automatic - and also very common. However, if we identify and change our way of thinking then our feelings are reactions will be much healthier. These errors in thinking include the following:

1. All –or – Nothing Thinking: Where the person evaluates themselves, others, situations and the world in extreme categories. It doesn’t allow for grey areas in thinking.  “I’m a terrible parent.”

2. Overgeneralizing: Thinking that because a bad experience happened once, then that’s the way it’s always going to be. For example, “I know I’ll fail my driving test. I’ve already failed it three times”.

3. Discounting the Positives: Ignoring the positive aspects of a situation and saying that they don’t count. For example, generally getting  good marks in school – but not praising yourself for that. One paper gets some negative feedback and you tell yourself you’re a useless student. The positive results are ignored.

4. Jumping to Conclusions -This has two aspects to it: mind reading and fortune telling.

(i) Mind reading is thinking you know what others are thinking without any evidence. For example, a person with social anxiety assumes her colleagues think she’s useless at her job.

(ii) Fortune telling is predicting that the future will turn out badly. For example, going for a routine mammogram and concluding that you have cancer.

5. Magnifying / Minimising: Evaluating the importance of a negative event, or the lack of evidence of a positive event, in a distorted manner. (Blowing things out of proportion.) For example, concluding that your sister doesn’t like you anymore because she forgot to send a  birthday card.

6. Emotional Reasoning: Believing that something must be true because it feels true. For example, when your boyfriend is an hour late in arriving for a film, you conclude that he isn’t interested in you. You discount the fact that, maybe, the bus was late, or he was delayed at work.

7. Labelling: Using a label (bad mother, idiot) to describe a behaviour - and then taking on board everything associated with that label. Seeing things is global terms. For example, a friend says or does something thoughtless. You label then them as “a terrible friend” and now you interpret anything they say in a hostile and negative way.

8. Personalization and blame: Where a person totally blames themselves for something that’s gone wrong when it is not their fault. For example, a soccer team member thinks she’s “put the coach in a bad mood” because she missed a goal. She discounts the fact that the coach may have been annoyed before the game started. The opposite is to totally blame another for something. For example, a wife may blame her husband for the break up of their marriage and not admit that she had any part in it.

9. Catastrophizing: (Similar to fortune telling) Dwelling on the worst possible outcome. For example, an employee had to do a presentation. He became obsessed with thoughts of performing badly, letting the company down, losing his job, then losing his home and family.

10. Making “should” or “must” statements:  Where the person has a fixed idea of how they, others or life should be. These become “rigid demands”. When they person is disappointed (as will inevitably happen) they become very upset and overestimate how bad this will be for them. For example, a student berates themselves for only getting 89% in an exam – when they wanted all their results to be in the 90s.

11. Selective abstraction: Dwelling on one negative detail instead of seeing the bigger picture. For example, a girl gets a haircut and 8 of her friends say they love it. One person says they preferred her old style. The girl thinks about that for hours and hours and wonders if she should have changed her hairstyle.

Depression is a recognised clinical condition. You can’t just “try and pull yourself together” … or “snap out of it” … or “get over it”. However, there are a few things that may help improve your mood so it may be worth giving them a try. For example,

 1. We know that exercise changes brain chemistry and acts a natural antidepressant - so why not go for a walk or a run.

 2. Hanging out with people who accept and love us is often a comfort when we’re feeling depressed. But make sure it’s someone who’s generally upbeat as a critical person will make you feel worse!

3. Make yourself do something you used to enjoy as often this can stir buried pleasant feelings. It shifts your focus from pain and emptiness to something that may give you a sense of joy (even it’s muted or relatively mild).

4. Make sure you go outside, and your surroundings are well lit, as this helps to lessen our feelings of depression (especially if you suffer from SAD).

5. Take a bath or shower, and put on some clean clothes. Surprisingly, this often can improve our mood.             

6. Tidy up or clean – even if it’s just one corner – as that can bring a sense of accomplishment.