A Mindful Way Thoughts

Depression is one of the most profound challenges of our time. We know that 25% of women and up to 12% of men will suffer a clinical depression in their lifetime and many more will suffer with mild depression. Author and professional blog writer, Therese Borchard writes a wonderful blog about personal experiences with depression. Whether you or someone you know is suffering from depression or some psychological pain like sorrow or grief, it can feel like a burden on the mind and heart. Maybe we hold the feeling in and we become numb, walking around like a zombie, or maybe we feel like if we actually let the tears flow they would never end. Perhaps there is another way, a more gentle way to approach the pain inside. IN an earlier blog I mentioned a way we can work with the tormented mind through acknowledging the reality of the present moment and then sending a message internally to calm the distressed mind.  For example, the mind can seem fragmented, thrashing, anxious, fuzzy, numb, or any number of other ways. These states of mind can be uncomfortable and our automatic struggle with them or judgments of them only serves to feed the depression. The problem is, this struggle and avoidance of it leads to disconnection of what we are truly feeling and so the mind begins to get the better of us. Here is another approach: When we notice the struggle, we want to breathe in and acknowledge the mind and while we breathe out we can say to ourselves “It’s Ok.” So if the mind is anxious, just breathing in and saying “anxious mind”, breathing out “it’s ok”.As you do this the mind may eventually change to a different feeling. See if you can notice this and then shift with it. It may start feeling fuzzy and so you can switch now to “breathing in, fuzzy, breathing out, it’s ok.”Tip: Notice any judgments arising right now when reading this, “this will never work for me” or “nothing is going to change how I feel, how stupid.” These judgments are likely well known to you and have become automatic. If they arise, just see if you can acknowledge them as just thoughts, let them be, and gently bring your attention back to the page. If this happens while you practicing, again, just acknowledge the thoughts as thoughts, let them be, and come back to the practice. To deepen: When practicing, you may or may not notice tears come. However, you may feel a sense that tears are about to come, but there is a holding back. If you feel safe enough, see if you can tell yourself “Whatever is here is ok…let me feel it.” You can do this with the practice by saying “breathing in, acknowledging what is here, breathing out, let me feel it.” As the feeling comes, just continue to breathe with it and let it be. Let your body lead, if it feels like moving to the bed or laying on the couch, go ahead and do that and just stay with it, without judgment. You can tell yourself that you can be with these emotions and “this too shall pass.” Sometimes allowing our true emotions to arise, allowing them to be, and letting them come and go can have profound implications on the safety we feel with them and ourselves.  This way of relating to our pain differently is not meant to be a panacea for depression, but is mean to change the way we relate to our pain and plant the seeds of recovery. The more we practice the more we sew these seeds. However, don’t take my word for it, please, try it for yourself. May you be safe, healthy, happy, and free from fear. 

When a loved one dies, grief can feel like a dagger in your heart. Often, grief triggers raw, intense emotions. You might wonder how you'll ever pick up the pieces and heal your wounds — yet not feel as if you're betraying your loved one's memory.

There are no quick fixes for the grief and anguish that follow a loved one's death. As you face your grief, acknowledge the pain and know that it's part of the healing process. Take good care of yourself, and seek support from friends and loved ones.

Although your life will never be quite the same, the searing pain of grief will eventually become less intense. Accepting your new "normal" can help you reconcile your losses and move on with your life.

Continue to see out assistance from your local Primary Care Mental Health Provider and you are to contact Dr. Nicholas Losito, Ph.D, CISM, at Hand of Compassion.

What Every Woman Should Know - Cultural Considerations

Major depression and dysthymia affect twice as many women as men. This two-to-one ratio exists regardless of racial and ethnic background or economic status. The same ratio has been reported in ten other countries all over the world. Men and women have about the same rate of bipolar disorder (manic-depression), though its course in women typically has more depressive and fewer manic episodes. Also, a greater number of women have the rapid cycling form of bipolar disorder, which may be more resistant to standard treatments.
A variety of factors unique to women's lives are suspected to play a role in developing depression. Research is focused on understanding these, including: reproductive, hormonal, genetic or other biological factors; abuse and oppression; interpersonal factors; and certain psychological and personality characteristics. And yet, the specific causes of depression in women remain unclear; many women exposed to these factors do not develop depression. What is clear is that regardless of the contributing factors, depression is a highly treatable illness.

The Many Dimensions of Depression in Women

Investigators are focusing on the following areas in their study of depression in women:

The Issues of Adolescence

Before adolescence, there is little difference in the rate of depression in boys and girls. But between the ages of 11 and 13 there is a precipitous rise in depression rates for girls. By the age of 15, females are twice as likely to have experienced a major depressive episode as males. This comes at a time in adolescence when roles and expectations change dramatically. The stresses of adolescence include forming an identity, emerging sexuality, separating from parents, and making decisions for the first time, along with other physical, intellectual, and hormonal changes. These stresses are generally different for boys and girls, and may be associated more often with depression in females. Studies show that female high school students have significantly higher rates of depression, anxiety disorders, eating disorders, and adjustment disorders than male students, who have higher rates of disruptive behavior disorders.

Adulthood: Relationships and Work Roles

Stress in general can contribute to depression in persons biologically vulnerable to the illness. Some have theorized that higher incidence of depression in women is not due to greater vulnerability, but to the particular stresses that many women face. These stresses include major responsibilities at home and work, single parenthood, and caring for children and aging parents. How these factors may uniquely affect women is not yet fully understood.
For both women and men, rates of major depression are highest among the separated and divorced, and lowest among the married, while remaining always higher for women than for men. The quality of a marriage, however, may contribute significantly to depression. Lack of an intimate, confiding relationship, as well as overt marital disputes, have been shown to be related to depression in women. In fact, rates of depression were shown to be highest among unhappily married women.

Reproductive Events

Women's reproductive events include the menstrual cycle, pregnancy, the postpregnancy period, infertility, menopause, and sometimes, the decision not to have children. These events bring fluctuations in mood that for some women include depression. Researchers have confirmed that hormones have an effect on the brain chemistry that controls emotions and mood; a specific biological mechanism explaining hormonal involvement is not known, however.
Many women experience certain behavioral and physical changes associated with phases of their menstrual cycles. In some women, these changes are severe, occur regularly, and include depressed feelings, irritability, and other emotional and physical changes. Called premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), the changes typically begin after ovulation and become gradually worse until menstruation starts. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.
Postpartum mood changes can range from transient "baby blues" immediately following childbirth to an episode of major depression to severe, incapacitating, psychotic depression. Studies suggest that women who experience major depression after childbirth very often have had prior depressive episodes even though they may not have been diagnosed and treated.
Pregnancy (if it is desired) seldom contributes to depression, and having an abortion does not appear to lead to a higher incidence of depression. Women with infertility problems may be subject to extreme anxiety or sadness, though it is unclear if this contributes to a higher rate of depressive illness. In addition, motherhood may be a time of heightened risk for depression because of the stress and demands it imposes.
Menopause, in general, is not asssociated with an increased risk of depression. In fact, while once considered a unique disorder, research has shown that depressive illness at menopause is no different than at other ages. The women more vulnerable to change-of-life depression are those with a history of past depressive episodes.

Specific Cultural Considerations

As for depression in general, the prevalence rate of depression in African American and Hispanic women remains about twice that of men. There is some indication, however, that major depression and dysthymia may be diagnosed less frequently in African American and slightly more frequently in Hispanic than in Caucasian women. Prevalence information for other racial and ethnic groups is not definitive.
Possible differences in symptom presentation may affect the way depression is recognized and diagnosed among minorities. For example, African Americans are more likely to report somatic symptoms, such as appetite change and body aches and pains. In addition, people from various cultural backgrounds may view depressive symptoms in different ways. Such factors should be considered when working with women from special populations.

Victimization

Studies show that women molested as children are more likely to have clinical depression at some time in their lives than those with no such history. In addition, several studies show a higher incidence of depression among women who have been raped as adolescents or adults. Since far more women than men were sexually abused as children, these findings are relevant. Women who experience other commonly occurring forms of abuse, such as physical abuse and sexual harassment on the job, also may experience higher rates of depression. Abuse may lead to depression by fostering low self-esteem, a sense of helplessness, self-blame, and social isolation. There may be biological and environmental risk factors for depression resulting from growing up in a dysfunctional family. At present, more research is needed to understand whether victimization is connected specifically to depression.

Poverty

Women and children represent seventy-five percent of the U.S. population considered poor. Low economic status brings with it many stresses, including isolation, uncertainty, frequent negative events, and poor access to helpful resources. Sadness and low morale are more common among persons with low incomes and those lacking social supports. But research has not yet established whether depressive illnesses are more prevalent among those facing environmental stressors such as these.

Depression in Later Adulthood

At one time, it was commonly thought that women were particularly vulnerable to depression when their children left home and they were confronted with "empty nest syndrome" and experienced a profound loss of purpose and identity. However, studies show no increase in depressive illness among women at this stage of life.
As with younger age groups, more elderly women than men suffer from depressive illness. Similarly, for all age groups, being unmarried (which includes widowhood) is also a risk factor for depression. Most important, depression should not be dismissed as a normal consequence of the physical, social, and economic problems of later life. In fact, studies show that most older people feel satisfied with their lives.
About 800,000 persons are widowed each year. Most of them are older, female, and experience varying degrees of depressive symptomatology. Most do not need formal treatment, but those who are moderately or severely sad appear to benefit from self-help groups or various psychosocial treatments. However, a third of widows/widowers do meet criteria for major depressive episode in the first month after the death, and half of these remain clinically depressed 1 year later. These depressions respond to standard antidepressant treatments, although research on when to start treatment or how medications should be combined with psychosocial treatments is still in its early stages.













Even severe depression can be highly responsive to treatment. Indeed, believing one's condition is "incurable" is often part of the hopelessness that accompanies serious depression. Such individuals should be provided with the information about the effectiveness of modern treatments for depression in a way that acknowledges their likely skepticism about whether treatment will work for them. As with many illnesses, the earlier treatment begins, the more effective and the greater the likelihood of preventing serious recurrences. Of course, treatment will not eliminate life's inevitable stresses and ups and downs. But it can greatly enhance the ability to manage such challenges and lead to greater enjoyment of life.
The first step in treatment for depression should be a thorough examination to rule out any physical illnesses that may cause depressive symptoms. Since certain medications can cause the same symptoms as depression, the examining physician should be made aware of any medications being used. If a physical cause for the depression is not found, a psychological evaluation should be conducted by the physician or a referral made to a mental health professional.

Types of Treatment for Depression

The most commonly used treatments for depression are antidepressant medication, psychotherapy, or a combination of the two. Which of these is the right treatment for any one individual depends on the nature and severity of the depression and, to some extent, on individual preference. In mild or moderate depression, one or both of these treatments may be useful, while in severe or incapacitating depression, medication is generally recommended as a first step in the treatment.³ In combined treatment, medication can relieve physical symptoms quickly, while psychotherapy allows the opportunity to learn more effective ways of handling problems.

Antidepressant Medications

There are several types of antidepressant medications used to treat depressive disorders. These include newer medications-chiefly the selective serotonin reuptake inhibitors (SSRIs)-and the tricyclics and monoamine oxidase inhibitors (MAOIs). The SSRIs-and other newer medications that affect neurotransmitters such as dopamine or norepinephrine-generally have fewer side effects than tricyclics. Each acts on different chemical pathways of the human brain related to moods. Antidepressant medications are not habit-forming. Although some individuals notice improvement in the first couple of weeks, usually antidepressant medications must be taken regularly for at least 4 weeks and, in some cases, as many as 8 weeks, before the full therapeutic effect occurs. To be effective and to prevent a relapse of the depression, medications must be taken for about 6 to 12 months, carefully following the doctor's instructions. Medications must be monitored to ensure the most effective dosage and to minimize side effects. For those who have had several bouts of depression, long-term treatment with medication is the most effective means of preventing recurring episodes.
The prescribing doctor will provide information about possible side effects and, in the case of MAOIs, dietary and medication restrictions. In addition, other prescribed and over-the-counter medications or dietary supplements being used should be reviewed because some can interact negatively with antidepressant medication. There may be restrictions during pregnancy.
For bipolar disorder, the treatment of choice for many years has been Lithium, as it can be effective in smoothing out the mood swings common to this disorder. Its use must be carefully monitored, as the range between an effective dose and a toxic one can be relatively small. However, lithium may not be recommended if a person has pre-existing thyroid, kidney, or heart disorders or epilepsy. Fortunately, other medications have been found helpful in controlling mood swings. Among these are two mood-stabilizing anticonvulsants, carbamazepine (Tegretol^®) and valproate (Depakene^®). Both of these medications have gained wide acceptance in clinical practice, and valproate has been approved by the Food and Drug Administration for first-line treatment of acute mania. Studies conducted in Finland in patients with epilepsy indicate that valproate may increase testosterone levels in teenage girls and produce polycystic ovary syndrome in women who began taking the medication before age 20. ¹¹ Therefore, young female patients should be monitored carefully by a physician. Other anticonvulsants that are being used now include lamotrigine (Lamictal^®) and gabapentin (Neurontin^®); their role in the treatment hierarchy of bipolar disorder remains under study.
Most people who have bipolar disorder take more than one medication. Along with lithium and/or an anticonvulsant, they often take a medication for accompanying agitation, anxiety, insomnia, or depression. Some research indicates that an antidepressant, when taken without a mood stabilizing medication, can increase the risk of switching into mania or hypomania, or of developing rapid cycling, in people with bipolar disorder. Finding the best possible combination of these medications is of utmost importance to the patient and requires close monitoring by the physician.

Herbal Therapy

In the past few years, much interest has risen in the use of herbs in the treatment of both depression and anxiety. St. John's wort (Hypericum perforatum), an herb used extensively in the treatment of mild to moderate depression in Europe, has recently aroused interest in the United States. St. John's wort, an attractive bushy, low-growing plant covered with yellow flowers in summer, has been used for centuries in many folk and herbal remedies. Today in Germany, Hypericum is used in the treatment of depression more than any other antidepressant. However, the scientific studies that have been conducted on its use have been short-term and have used several different doses.
To address increasing American interests in St. John's wort, the National Institutes of Health conducted a clinical trial to determine the effectiveness of the herb in treating adults who have major depression. Involving 340 patients diagnosed with major depression, the eight-week trial randomly assigned one-third of them to a uniform dose of St. John's wort, one-third to a commonly prescribed SSRI, and one-third to a placebo. The trial found that St. John's wort was no more effective than the placebo in treating major depression.¹³ Another study is looking at the effectiveness of St. John's wort for treating mild or minor depression.
Other research has shown that St. John's wort can interact unfavorably with other medications, including those used to control HIV infection. On February 10, 2000, the FDA issued a Public Health Advisory letter stating that the herb appears to interfere with certain medications used to treat heart disease, depression, seizures, certain cancers, and organ transplant rejection. The herb also may interfere with the effectiveness of oral contraceptives. Because of these potential interactions, patients should always consult with their doctors before taking any herbal supplement.

Psychotherapy for Depression

Several types of psychotherapy-or "talk therapy"-can help people with depression.
In mild to moderate cases of depression, psychotherapy is also a treatment option. Some short-term (10 to 20 week) therapies have been very effective in several types of depression. "Talking" therapies help patients gain insight into and resolve their problems through verbal give-and-take with the therapist. "Behavioral" therapies help patients learn new behaviors that lead to more satisfaction in life and "unlearn" counter-productive behaviors. Research has shown that two short-term psychotherapies, interpersonal and cognitive-behavioral, are helpful for some forms of depression. Interpersonal therapy works to change interpersonal relationships that cause or exacerbate depression. Cognitive-behavioral therapy helps change negative styles of thinking and behaving that may contribute to the depression.

Electroconvulsive Therapy

For individuals whose depression is severe or life threatening or for those who cannot take antidepressant medication, electroconvulsive therapy (ECT) is useful.³ This is particularly true for those with extreme suicide risk, severe agitation, psychotic thinking, severe weight loss or physical debilitation as a result of physical illness. Over the years, ECT has been much improved. A muscle relaxant is given before treatment, which is done under brief anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a brief (about 30 seconds) seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. At least several sessions of ECT, usually given at the rate of three per week, are required for full therapeutic benefit.

Treating Recurrent Depression

Even when treatment is successful, depression may recur. Studies indicate that certain treatment strategies are very useful in this instance. Continuation of antidepressant medication at the same dose that successfully treated the acute episode can often prevent recurrence. Monthly interpersonal psychotherapy can lengthen the time between episodes in patients not taking medication.

The Path to Healing

Reaping the benefits of treatment begins by recognizing the signs of depression. The next step is to be evaluated by a qualified professional. Although depression can be diagnosed and treated by primary care physicians, often the physician will refer the patient to a psychiatrist, psychologist, clinical social worker, or other mental health professional. Treatment is a partnership between the patient and the health care provider. An informed consumer knows her treatment options and discusses concerns with her provider as they arise.
If there are no positive results after 2 to 3 months of treatment, or if symptoms worsen, discuss another treatment approach with the provider. Getting a second opinion from another health or mental health professional may also be in order.
Here, again, are the steps to healing:

• Check your symptoms against this list.
• Talk to a health or mental health professional.
• Choose a treatment professional and a treatment approach with which you feel comfortable.
• Consider yourself a partner in treatment and be an informed consumer.
• If you are not comfortable or satisfied after 2 to 3 months, discuss this with your provider. Different or additional treatment may be recommended.
• If you experience a recurrence, remember what you know about coping with depression and don't shy away from seeking help again. In fact, the sooner a recurrence is treated, the shorter its duration will be.

Depressive illnesses make you feel exhausted, worthless, helpless, and hopeless. Such feelings make some people want to give up. It is important to realize that these negative feelings are part of the depression and will fade as treatment begins to take effect.

Self-Help for Treatment of Depression

Along with professional treatment, there are other things you can do to help yourself get better. If you have depression, it may be extremely difficult to take any action to help yourself. But it is important to realize that feelings of helplessness and hopelessness are part of the depression and do not accurately reflect actual circumstances. As you begin to recognize your depression and begin treatment, negative thinking will fade.
To help yourself:

• Engage in mild activity or exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed. Participate in religious, social or other activities.
• Set realistic goals for yourself.
• Break up large tasks into small ones, set some priorities and do what you can as you can.
• Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself, and let others help you.
• Expect your mood to improve gradually, not immediately. Do not expect to suddenly "snap out of" your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.
• Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
• Remember that positive thinking will replace negative thoughts as your depression responds to treatment.

 

5 Easy Ways to Combat Overthinking

Do you ever become trapped in an overanalyzing rut?
I tend to think a lot in general, but sometimes, I find myself looking at a subject way too closely and way too much, and the ruminating takes on a life of its own. (It might even revolve around an abstract concept as opposed to an actual event that’s occurring.)
When introspection becomes stressful, there are antidotes. Here are some of my personal suggestions…

1. Adopt a hobby.

Maybe if your spare time is filled with an activity that you love, overthinking spells will be pushed to the curb. I’ve started to re-immerse myself in the French language since I’m a total Francophile. Weekend hours are set aside for verb conjugations and charming vocabulary. Oui, oui, oui.

2. Write it down.

I have journaled to lighten my mental load, where I can flesh out thoughts and feelings. (I find that the physical act of writing into a notebook is a more effective cathartic release than an online diary, but to each his or her own.) For someone who isn’t interested in writing, journaling may be viewed as a burden, so it certainly comes down to individual preference.

3. Keep your hands occupied.

According to this article, the psychological theory proposes that when we’re stressed, we absorb information through two channels. “One is the basic, primal sensory channel: the sights, sounds, sensations, and smells of the situation. The other is an intellectual channel: our brains are trying to make sense of what’s going on, and put it into words and a context that we can talk about.”
Researchers explain that if the sensory channel is occupied, the intellectual channel is muted; therefore, stress relief techniques that incorporate the hands “will use up more ‘brain cycles’ and pull processing power away from intellectual activities.” A stress ball may do the trick, along with drawing or knitting. (I’ve experimented with colorful rugs via latch hook!)
The article also presents another theory, which states that large muscle groups contract in preparation for flight when we’re consumed with stress. Muscle fibers in your arms relax and reduce tension when squeezing stress balls or keeping your hands busy with objects of a similar nature.

4. Move around.

I revel in long walks around the neighborhood – preferably in beautiful weather – and have found that walking unleashes mental chatter and induces clarity. Exercise, rolling blade, or any other movement can help as well.

5. Talk to someone.

Sometimes, being honest and vulnerable with someone you’re comfortable with will clear your mind. After exposing your overanalysis to others, it suddenly doesn’t appear as daunting. And who knows, maybe they can relay insight about the topic at hand, which could provide further guidance. With this further guidance contact Dr. Losito 24/7 to receive the reassurance of what is on your mind.

Overthinking can be unpleasant, draining and debilitating, but hopefully, the tips noted above can disrupt these incessant cycles.

Relief and Resolve

There is always something on TV to scare us. Hysterical articles in the media sell papers and attract eyeballs to websites, but usually exaggerate facts. If you listen without evaluating what you’re being told, it’s easy to become frightened. There’s a reason why I don’t usually waste time and energy on panic and drama.
I see the negative results of panic every day. People get upset, they’re afraid of emotional consequences and they overreact, which can actually create the consequences they fear.
Panic is an overreaction to a real (or even imagined) problem. Frightening yourself beyond the real need to deal with a problem puts your body into fight or flight mode as though your life were immediately threatened.

Emotional panic can create a shutdown of feelings, so you’re in a state of shock. You cannot think clearly, make good responses or decisions. In panic, we do not retain information, absorb what we hear or accurately assess the situation. Panic is the worst thing you can do in a real emergency, and if the situation is not dire, panic will make it worse.
Panic is a natural startle reaction that gets exaggerated and becomes prolonged. People often learn to panic because, in early childhood, panic can get us out of responsibilities. Freaking out, crying, throwing temper tantrums, or shutting down are all panic responses small children use which cause some competent adult to take over and become the hero.
This can be okay once in a while, but as this pattern repeats, it becomes rescuing and codependency. Panic creates drama, unnecessary and damaging exaggeration of the problem, which leads to dysfunctional responses and overblown family drama.

Resolve Your Anxiety Today
To learn to let go, you may find these few steps can help resolve your fear and anxiety.


1. Learn to recognize the signs of your own panic.
If you feel the telltale signs of panic, which include a racing or pounding heartbeat, flushing of the face or body and mental confusion, you are in a state of panic. If you are shouting, saying unreasonable things, or just saying whatever comes out of your mouth, without thinking about consequences, you are also in a state of panic.


2. Take some deep breaths.
Deep breathing will calm your body and burn off the adrenaline that’s been released in the panic. Slow down, count to ten and focus on thinking clearly and factually rather than reacting emotionally.
If you don’t understand how to do deep breathing, you can learn how to do a deep breathing exercise here.


3. Take responsibility to figure out what you’re afraid of.
Unless you’re in immediate, direct danger, what’s scaring or upsetting you is probably not as urgent as you think. Make a list of what you’re afraid of that help you move beyond free-floating anxiety and you will begin to think more clearly.


4. Check the facts.
Is what’s on the news really true? Do we have an epidemic, or only 11 confirmed cases in Calfornia? Does the source you’re listening to have something to gain by putting you in a panic? Are they trying to sell you something, get federal funding, or get elected? Are you reacting to someone else’s panic? Get some facts about whatever is frightening you. Is there a real, immediate threat or is it just wise to be cautious? Is your partner actually going to abandon you, or is he or she just angry about something?


5. Make a decision and take some action tackling each fear.
If it’s a health fear, perhaps better hygiene or a talk with your doctor will resolve it. If it’s a relationship fear, finding out what your partner is really thinking, instead of guessing, will probably make more sense.


Get a flu shot, go for relationship therapy or have a good talk with your partner or family member.


6. Sell yourself on a positive outcome.
Think of all the possible great outcomes of the changes you’re making. Consider what you will learn, and how much better your life and relationships will be without the panic.
With a calmer outlook, you’ll be able to make better decisions and create a more successful outcome. I wish you peace, within yourself, within your family, within the world.