Depression Therapy

People are unreasonable, illogical, and self-centered.
Love them anyway.

If you are kind, people may accuse you of selfish ulterior motives.
Be kind anyway.

If you are successful, you will win some false friends and true enemies.
Succeed anyway.

The good you do today will be forgotten tomorrow.
Be good anyway.

Honesty and frankness will make you vulnerable.
Be honest and frank anyway.

What you spend years building may be destroyed overnight.
Build anyway.

People need help, but may attack you if you try to help them.
Help them anyway.

In the final analysis, it is between you and God.
It was never between you and them anyway.

This beautiful quote speaks to the rich truth that our behavior should be unconditional and independent, not conditional and dependent upon responses or external praise.  This speaks to the core of what the golden rule really is “do unto others as you would have them do unto you.”  Unfortunately most people today don’t follow the golden rule, they follow the bronze rule “treat others how you are being treated.”  Do you see the difference?  What does it take to build this kind of emotional and psychological strength?  Faith, Commitment, and action.  Now go quit being a parrot of others moods and tantrums, and decide to be your very own person, choosing whom you will be today!

Happy Day!

Lord, make me an instrument of your peace; where there is hatred, let me sow love; where there is injury, pardon; where there is doubt, faith; where there is despair, hope; where there is darkness, light; and where there is sadness, joy

– Francis of Assisi

Let us never forget that at any given time or space, we have intrinsically embedded in us the ability to take some form of action, be it large or small, that can impact our surroundings.  Choose now to impact your surroundings in a positive manner… I mean NOW, do it!

Assumption #7: Poor nutrition, lack of sleep, and lack of exercise, can precipitate or contribute to a depressed mood.

That all of these things can contribute to a depressed mood I think is pretty clear, and most would look at such a statement and agree to the truth of it.  I’m unsure whether lack of exercise or poor nutrition can precipitate a depressed mood, yet research has clearly shown that both poor nutrition and lack of exercise can fuel or contribute to a depressed mood.  What is more clear is the impact that lack of sleep has on our minds and also on our moods.  Sleep is absolutely essential to our well-being, and with only a few nights of sleep-deprivation we begin to observe the adverse effects.  Here are some of the areas that are affected:  memory and concentration wane; mood turns irritable; judgment grows poor; reaction times slow; coordination deteriorates; energy dims; and immune function declines.  If the deprivation continues the symptoms can become even more severe.  Research has shown that sleep disturbance and depression go hand in hand.  Not only can lack of sleep precipitate periods of depression, but depression often affects the patterns of sleep (usually over sleep or under-sleep).  Studies have shown that 4 out of 5 individuals suffer from some form of sleep disturbance, prior to the onset of depression.  What does this mean?  It means that finding some tools that will help you combat sleeplessness, will also help you combat depression!  What about sleep medication… should I take it?  I’m not opposed to you taking medication, yet something in your mind has to be absolutely clear – Medication is helping me to stabilize, and I need to work on my sleeping patterns and sleeping skills, so that I can learn how to do it without it.  Once again the focus is independence not dependence, and that statement is true for all medications including anti-depressants, which is why i sometimes get so frustrated when Doctors just prescribe the meds without any additional follow up or education.

Knowing this is powerful, but only in that it allows you to also see what steps you need to take to overpower your feelings of depression.  Like we have discussed before, exercise can have a dramatic influence on your mood and confidence.  I’m not a huge nutrition guy, yet there appears to be clear research out there about supplements (Omega 3′s and Vitamin D) that seem to have a significant positive effect upon people who are struggling with depression.  Sleep, of course has a tremendous ability to assist someone in rejuvenating their system, and also in helping their mood and clarity of thought.  So go do a little research and begin to get on top of these things.

Happy Day!

Assumption #6: Significant events or traumatic incidents can trigger periods of depression.

Many individuals seem to experience significant events that end up transforming into periods of depression.  The list is probably too long to list, but here are a few examples:

• A death of a family or close friend
• An assault, car accident or painful physical event
• painful mental or emotional event
• Marriage breakup, or love lost suddenly
• Constant physical, mental or emotional pain that goes on for a length of time
• Developing a disease or illness that will not get better
• Major financial setbacks
• Substance Abuse
• Rape, sexual assault, or other kinds of abuse

Now many or maybe even all of these events can cause anxiety or even feelings of sadness, yet depression is somewhat different than just a feeling of sadness.  I would even suggest that sadness, stress, and a disruption in your emotions is perfectly normal, yet depression is much more powerful and seems to rob people of motivation, emotion and can  create a substantial amount of pain.  I also feel that depression has more to do with the interpretation or judgment about the event.  Maybe I’m being a little too extreme when I say that all events are “neutral” by nature, and that we then color them according to our values, beliefs, fears, etc…  Is that too extreme??  Think that through for a minute though, what if events (things that happen to you) were by nature really just “neutral”?  What would that mean to you?  What kind of accountability and responsibility would that mean for you and for me?  It’s a difficult idea to swallow, that somehow we have to allow or honor (choose) a certain judgment of the event, and in that choice (our ultimate choice) lies our potential for happiness or misery!  Anyhow, just something to think about, yet the most important part to get out of this small article is your potential… your ability to read your events and transform what has happened to you… what is happening to you… and what will ultimately happen to you.  One quick last word, I feel that one of our ultimate purposes in this life is to grow, and with that in mind, I can color events as growth promoting.

Happy Day!

Assumption #5: Inactivity, avoidance, and escapist behaviors are core issues that can lead and exacerbate your depressive symptoms.

Okay, this is probably the very best picture i have ever seen describing most people’s attempts at avoiding or escaping depression.  Notice how his escape effort is about to lead to a big pile of POOP (sorry about the potty language)!  This is often what happens when we use avoidant or escapist behaviors, they only lead to more, and stinkier, problems.  No one has ever beat depression, at least long term, by laying in bed thinking about how to beat it!  Just like no one has ever ran a marathon or ironman by daydreaming about how they are going to do it.  Inactivity, avoidance, and other escapist (not sure if that’s a word or not… but i like it) behaviors almost always create additional problems, increase guilt, and like an untreated wound, they fester and sap confidence from your soul.  The challenge with depression and the symptoms of depression is that they specifically target our motivation and drive.  Like a smart-bomb, that can be laser focused on it’s target, so it is with depression.  When engaged in depression therapy I often find that individuals complain of a loss of interest in activities, lack of energy, fatigue, lack of sleep, loss of a sense of purpose.  Depression, like a thief in the night, seems to rob individuals of exactly what they need to defeat it.  I have found that medications can often be helpful in this area, yet… and this is a big YET… medication can ONLY BE AN ADDITIONAL TOOL!  This is critically important, because we are not trying to foster a dependency here, what we are looking to increase is your ability to choose and effect changes in your life.  So medication only serves its purpose as far as you are willing to work on the issues and improve the skills that in the long run will help you to overpower depression on your own.  If you remember the article that I wrote about exercise, and why it proved to be more effective than pills in the long run.  The power is in the realization that you are exacting the change, and more importantly, that you can do it again and again.  Now, back to inactivity, avoidance, and other escapist behaviors.  I find that people who are depressed are masters of avoidance.  Stay with me, these statements are not made to derail you, they are made to help you to see that some of the fog that surrounds you is man made… more specifically made-by-you!  It’s okay, don’t fret because knowledge in and of itself is powerful, yet it is not as powerful as action.  At the bottom of all my emails and business cards is one of my favorite quotes “the best way out is always through,” and that is exactly what you have to do to overpower depression and depressive symptoms in your life.  Drinking, drugs, pain pills, procrastination, excessive rumination, obsessive behaviors, irritation, anger, and lack of hope, often fuel depression.  These behaviors, at times, are only avoidance mechanisms, that perpetuate the problem of depression and feed it’s parasitic friend, anxiety.  So, what do you do?  Just like Steve MacQueen in the movie “the great escape” there is a way to escape, to successfully leave behind the behaviors that feed depression and anxiety.  First, you have to recognize that you are actually doing it, and then implement the already proven techniques to battle and eventually overpower feelings of depression.

Action Now:  Build your awareness by identifying when you are avoiding or escaping the things that you really need to do in your life.  identify the behaviors.

Happy Day!

Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened, vision cleared, ambition inspired, and success achieved.

— Hellen Keller

There are many who are keenly aware and have been through tremendous trials.  Few have written about it and given us the opportunity to see that in the midst of terrible adversity there are jewels… pearls of great price that can be obtained if we are aware that they are there.  Depression is one of the conditions that can not only reveal some of our character, but more importantly, help us to build it.  Hurray for Hellen Keller, her story of triumph and perseverance has stood the test of time, and now lives as a testament of one’s ability to transcend challenges.  Also of significant importance is her instructor/teacher who patiently withstood Hellen’s struggles.

Assumption #1:  Depression is a symptom that your life is “out balance.”  A red flag or a warning signal that needs to be addressed.

Growing up in the beautiful southern coast of Portugal, I got to experience incredible storms that would roll in every time there was a southwest wind.  These storms were wonderful for two reasons:  One, the water always became a few degrees warmer, and two,  it was time to grab the body board and hit the waves.  Without fail, we would arrive at the beach and see the Red Flag flapping in the wind, letting us know that swimming was restricted due to wave size and the difficult currents that were created.  Of course nobody listened and within a few minutes my friends and I were carving up waves and having the time of our lives.  This small story is meant to suggest a different approach to your depressive thoughts, feelings and symptoms.  Instead of continually avoiding or running from depression (the stormy ocean and difficult currents), I would like to help you dive in and “carve” through these periods of turmoil and unrest.   In addition to the intro, I would like to once again throw out a quick preface to this entry; this assumption is not meant to minimize the symptoms of depression and the tremendous chaos that they can cause to an individual, or a family.  My purpose in addressing this assumption is to suggest a different way of looking at depressive symptoms.  This is a common technique in Dialectical Behavior Therapy (DBT) or Acceptance & Commitment Therapy (ACT), where a trained professional attempts to guide a client toward viewing his thoughts, feelings, or other symptoms in a healthier, less threatening way.  They often refer to this as “mindfulness” or “radical acceptance.”  Let me explain how this would apply in your current circumstance.  Often people who suffer from depression do much of what the sign at the right suggests, they “run like hell.”  They are constantly in a state of reaction, often emotionally reacting to whatever stimulus just presents itself.   Stimulus happens (criticism, negative event, argument, rejection, lack of integrity or follow through), and immediately there is an emotional response, usually driven by fear, insecurity, or old patterns.  This, somewhat, subconscious, hypnotic suggestion-like type of response is almost like a blind spot, and often times, cannot be perceived by the individual itself.  Aaron Beck (Cognitive Therapy Powerhouse) described it as someone attempting to look at the back of his head… it just doesn’t work.  Well, the time has come for you to look over your shoulder, or grab two mirrors to finally get a look at the back of your head, and realize that these symptoms, feelings, and thoughts are attempting to tell you something.  Could this be true?  What if instead of running “like hell,” you moved toward the feelings?  Mindfulness based theories suggest that as you come to accept, or move toward the feelings you are experiencing  (like a scientist looking for clues, patterns, solutions), that over time, the feelings lose some of it’s power… some of it’s control over you.  Taking the “run like hell” example, this pattern of avoidant behavior has more likely than not created much grief, misery, and continued states of depression.   Although “run like hell” behavior often provides short-term relief, it often guarantees that future bouts of depression will return with renewed guilt, and shame.  In addition, they often serve to perpetuate the state of darkness (blind spots) in which persons who are suffering from symptoms of depression, find themselves in.   The solution begins with the realization (mindfulness) that your state of depression is a message to you that something is wrong.   Next you must move toward depression inquisitively in an effort to find answers.  Once aware of negative thinking habits, behaviors, and patterns, you must acquire new skills and tools that will help you address the issues at hand.  Lastly, you must take action with the understanding that the wonderful process of change is exactly that… a strengthening process.  Begin today to look at depression differently.  Stop the running and begin to move confidently towards it.

Action Now:  Next time you begin to feel sad, or happy, or angry, or humble, or grateful, take some time to indulge in that moment.  Become aware of the thoughts, feelings and circumstances that surround you.  Ask yourself whether the behavior (your response) assists you in the long run or not.  Learn new skills and move forward.  Oh yeah, never give up!

Happy Day!

“Everything can be taken from a man or a woman but one thing: the last of human freedoms to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

–Viktor E. Frankl

If you have not had the opportunity of reading “Man’s search for meaning” you are missing out on a book that can literally alter your perception and influence the rest of your life.  For that mater, “The hiding place” is equally powerful and meaningful.  This specific quote was written at a time when Viktor found himself in a most abusive, denigrating, position, and came to the realization that even though his liberty had been taken, his freedom to act, to choose his response could not… neither can yours!

Happy Day,

According to the DSM IV-TR(Diagnostic and Statistical Manual of Mental Disorders) depression is described as a disorder with at least five of the following symptoms.  At least one of them must be symptom 1 or 2:

1. Sadness or depressed mood
2. Loss of interest or pleasure in all or most things that you usually enjoy
3. Significant weight loss or gain
4. Difficulty sleeping (too much or too little sleep)
5. Feeling very restless (unable to sit still) or feeling very slowed down
6. Being tired all the time
7. Having feelings of worthlessness or guilt
8. Difficulty thinking or concentrating
9. Having repeated thoughts of death or dying

These symptoms need to be present for a period of at least two weeks and occur most of the day nearly every day.  Furthermore you must rule out other factors such as medical illness or the effects of drugs, alcohol, or certain medications, which could cause these symptoms.

Often this set of beliefs and feelings, lead us to withdraw; to isolate; to become hypersensitive; to become resentful of others; to procrastinate; to avoid (a key element in depression) situations or individuals;and to lose a sense of purpose and direction.  Of course these behaviors or actions in turn create more depression (behavior-mood links, more on this later).  This is a very important cycle that you need to be aware of immediately.  It is a negative feedback loop, that won’t stop or alleviate, unless you snap out of that muddy rut.  This is why we suggest that depression is more than just feelings or symptoms, it is a way of responding to the thoughts and feelings you are having at any given point.  I often tell friends that “the problem with people who are depressed, is that they always do what they feel like doing!”  For example they’ll say: “I don’t feel like getting out of bed… so they don’t;” “I don’t feel like exercising… so they don’t;” “I don’t feel like going to work… so they don’t;” the problem of course is that they are living their life in a state of reaction, not action.  It is time for you to stop allowing fear, sadness, and insecurity to drive your daily actions.  It is time for you to live deliberately, and to make choices that coincide with a higher purpose or meaning.  Henry David Thoreau spoke eloquently and powerfully when he stated the reason for why he went to live in the woods - “I went to the woods because I wanted to live deliberately, I wanted to live deep and suck out all the marrow of life, To put to rout all that was not life and not when I had come to die Discover that I had not lived.” Yes, let us live deeply, and suck out all the marrow of life.

Action Now:  Ponder and consider which behaviors and thinking habits maintain your symptoms (or worsen) of depression.  Determine to learn new ways to respond, and “bust out” of the muddy ruts that you find yourself in.

Happy Day!

Serious!!  Yeah, really.  It’s somewhat interesting how most people feel that the only effective form of “therapy” for depression is anti-depressants.  Many longitudinal studies have now show conclusive evidence that medication is not a very effective long term form of treatment.  I would be ridiculous (I might be anyway) to assume and declare that medication does nothing, because many of my clients are on anti-depressants, and many report feeling a significant improvement in mood… BUT… Depression isn’t just about moods!!  Depression has more to do with how we respond to our moods.  Anywho, that is food for another quick tip.  Let me state the research article and what was found:

The researchers studied 156 older adults diagnosed with major depression, assigning them to receive the antidepressant Zoloft (setraline), 30 minutes of exercise three times a week, or both. According to Blumenthal “Our findings suggest that a modest exercise program is an effective, robust treatment for patients with major depression who are positively inclined to participate in it.  The benefits of exercise are likely to endure particularly among those who adopt it as a regular, ongoing life activity.”

In September 2000 the team released the results of a follow-up study.  Blumenthal and his colleagues continued to follow the same subjects for six additional months and found that the group who exercised but did not receive Zoloft did better than either of the other two groups.

A very interesting finding concerns the group that received both Zoloft and exercise.  These subjects were more likely to again become depressed than the subjects who only exercised.  Blumenthal and colleagues speculated as to why the combination group had higher depression relapse rates than the exercise-alone group. “It is conceivable that the concurrent use of medication may undermine the psychological benefits of exercise by prioritizing an alternative, less self-confirming attribution for one’s improved condition,” said Blumenthal. He speculated that patients might have incorporated the belief, “I took an antidepressant and got better” instead of incorporating the belief, “I was dedicated and worked hard with the exercise program; it wasn’t easy, but I beat this depression.”

Now, let’s get real… we all know that exercise is super healthy, so why do we not follow through?  More importantly, why are you not following through right now?  If someone told you that a pill would provide all of the benefits of exercise, none of us would think twice about it… what does that say about us?  Anyway, enough of the guilt trip, let’s figure out how to see it, think it, and make it happen.   So here’s what you need:  90 minutes per week (what??? yeah you heard me right) of a brisk walk, and a schedule to let you know when you are going to do it.  So get out your little planner right this instant, and schedule it in.  It’s not real until you schedule it.  Be realistic, but think about it, this is completely accomplishable, so no wining or lame excuses.  Even better, get a friend, son, daughter, husband, neighbor to do it with you, unless they are totally toxic.  Begin this week!

Action Now:  Begin tonight or tomorrow morning.  You can do anything for 30 minutes!!!  Anything.

Happy Day!