Tag Archives: depression

Gratitude and Mental Health: On Thankfulness and Depression

Last year, my client bawled at the Thanksgiving table. She reported being met with disapproval, and later being told that she had ‘upset the children’ (teens).

Gratitude is not a magic act. You can experience gratitude and other feelings simultaneously. It’s important to understand that you can experience feelings of sadness, anger, grief, anxiety, and loneliness alongside gratitude. A societal message is that just because something terrible happens in your life, that doesn’t mean you can’t also be grateful (look for the silver lining/it could’ve been worse/thoughts and prayers). But this rule applies in reverse. Just because you’re grateful doesn’t mean your negative emotions aren’t valid.

While practicing gratitude alone won’t “cure” depression, it does positively impact your life. Several studies have shown that mindfully practicing gratitude may diminish symptoms of mood and anxiety disorders OVER TIME. There are measurable benefits to practicing gratitude (see research from the Positive Psychology Center at the University of Pennsylvania ).

Gratitude is associated with:
better sleep quality
a greater likelihood of seeking help for health concerns
increased self-esteem
feeling more optimistic
improved relationships
greater emotional resilience during difficult times
higher self-efficacy expectations (your own belief that you can do well at a task)

Focusing on positive aspects of your physical and mental health requires mindful decisions. While depression can do a number on both your body and mind, it is possible to exercise your gratitude muscle to strengthen it. Gratitude takes time, practice, and self-compassion.

How to have gratitude when you’re depressed:
Recognize that it’s okay if you struggle with feeling grateful. Your feelings are neither “good” nor “bad.” Feelings just are. So if you find yourself feeling ungrateful, it’s okay. You’re not doing anything wrong. Attempting to focus on things that foster gratitude is a practice.

Authenticity
This isn’t a fake-it-till-you-make-it situation. Pretending you’re grateful when you’re actually not will just serve to bury your feelings. You don’t need to force yourself to think about your life in a way that isn’t true to you.

Stones Across the River
If you’re struggling to find things you’re authentically grateful for, then try to think little over big. In my practice, I have termed this stones across the river. What are the things on a daily basis that get you across the rapids without tumbling in?

Validation of the Gestalt
The German term gestalt means an overall wholeness that is bigger than the singular elements contained within. Practice validation alongside gratitude. Don’t think you must choose gratitude or being upset. Think of it as feeling distressed/anxious/depressed and you also practice gratitude.

Comparisons
Your experience can exist at the same time as others who “have it worse” and be equally worthy of receiving help. This doesn’t mean you’re ungrateful. Some of my clients are told they should have more gratitude, that low moods stem from a cup-half-empty perspective. Being compared to others who have less can make a depressed individual feel guilty and even more depressed.

Practice Self-Compassion
A client told me something that has stayed in my head for years; “that gratitude actually contributed to the pain because, while I could intellectually see all of this goodness before me, I was incapable of enjoying it.” The dichotomy was heart-wrenching for him and led to further self-bashing.

Connect with others
When learning how to practice gratitude when depressed, you have to make a conscious effort to spend time with others who are important to you. Doing so can help you combat loneliness and depression. Obviously, it would be best to spend time with supportive people, not people who drain or criticize you.

Focus on something that doesn’t hurt
Depression can manifest itself as physical discomfort. You may get headaches, body aches, or stomach pain. One client sleeps with her soft, favorite blanket and wakes up to her dog staring at her and joyfully wagging his tail. It gets her going for the day. Another looks in the mirror and notices that her eyebrows are perfect. A third gets a good morning text from a dear friend every day. Focusing on things that feel loving and nurturing IS gratitude.

Write an ingratitude list
Yes, an ingratitude list. Sometimes, separating out the things you’re not grateful for can help determine what you are grateful for. Do you do things out of sheer obligation? Do you have piles of possessions or clothing you don’t use? When you determine the things you’re ungrateful for, remove them, so you don’t have to feel ungrateful every time you see or do them.

Focus on when you experienced kindness
Depression and gratitude may not seem to go together, especially when you have feelings of self-depreciation and worthlessness. Perhaps you feel like nobody does anything for you because you don’t feel worth it right now. Try to visualize a time when someone extended a kindness to you and made you feel special or happy. Think about mentors, family members, friends, or even the kindness of strangers. Focusing on these memories and being grateful for them can help you feel a sense of love and worth. See also The Kindness of Strangers.

Do something nice for someone
Most people are familiar with the term “pay it forward.” Finding the energy or desire to do something nice to help someone else can be challenging. But helping others is a great mood-booster. The gratitude of others can help us be kinder to ourselves.

Neural Pathways Take Time
Gratitude affects the parasympathetic nervous system and can rewire neural pathways through breathing exercises, meditation, cognitive-behavioral therapies, and mindfulness strategies. This takes time and practice.

988lifeline: Big News in Mental Health

In two days, states will roll out 988 as the new National Suicide Prevention Lifeline number, similar to how people can call 911 for emergencies. When calling, the individual will be connected to a trained mental health professional.

All phone service providers will be required to connect callers who dial 988 to the lifeline starting July 16. The existing lifeline uses a 10-digit number, 1-800-273-8255. This important change has been in the works for years, and many mental health professionals say it will help expand much-needed services and make them more accessible to people seeking help.

At the same time, it is important to note that the mental health industry has been overwhelmed, especially in the past two years. With a surge in phone calls, availability of resources is crucial. Another area of concern is ongoing financing. Congress has allocated one time funding; after that it is up to individual states.

Some Myths about suicide
Myth 1: Talking about suicide increases the chance a person will act on it.
Fact: Talking about suicide may reduce, rather than increase, suicidal ideation. It improves mental health-related outcomes and the likelihood that the person would seek treatment. Opening this conversation helps people find an alternative view of their existing circumstances.

Myth 2: People who talk about suicide are just seeking attention.
Fact: People who die from suicide have often told someone about not wanting to live anymore or they do not see the future. It’s always important to take seriously anybody who talks about feeling suicidal.

Myth 3: Suicide can’t be prevented.
Fact: Suicide is preventable but unpredictable. Most people who contemplate suicide, often experience intense emotional pain, hopelessness and have a negative view of life or their futures. Suicide is a product of genes, mental health illnesses and environmental risk factors.

Myth 4: People who take their own lives are selfish, cowards or weak.
Fact: People do not die of suicide by choice. Often, people who die of suicide experience significant emotional pain and find it difficult to consider different views or see a way out of their situation.

Myth 5: Barriers to bridges, safe firearm storage, and other actions to reduce access to lethal methods of suicide don’t work.
Fact: Limiting access to lethal means, such as firearms, is one of the simplest strategies to decrease the chances of suicide. Many suicide attempts are a result of impulsive decisions. Therefore, separating someone from a lethal means could provide a person some time to think before doing harm to themselves.

Myth 6: Suicide always occurs without warning.
Fact: There are almost always warning signs before a suicide attempt.

Here are a few common signs:

  • Talking about suicide — making statements such as “I’m going to kill myself,” “I wish I were dead” or “I wish I hadn’t been born.”
  • Withdrawing from social contact and wanting to be left alone.
  • Having mood swings, such as being emotionally high one day and deeply discouraged the next.
  • Being preoccupied with death, dying or violence.
  • Feeling trapped or hopeless about a situation.
  • Increasing use of alcohol or drugs.
  • Changing normal routine, including eating or sleeping patterns.
  • Doing risky or self-destructive things.
  • Giving away belongings or getting affairs in order when there is no other logical explanation for doing this.
  • Saying goodbye to people as if they won’t be seen again.

Myth 7: Talk therapy and medications don’t work.
Fact: Treatment can and does work. One of the best ways to prevent suicide is by getting treatment for mental illnesses and learning ways to cope with problems and emotional pain.

See also this, post on how to speak to friends and family about depression.

National Wear Red Day: Depression, Women, and Heart Health

Many of us are wearing red today to raise awareness about women, cardiovascular disease, and I’m going to add mental health. Women are twice as likely as men to develop depression. Depression is a risk factor for heart disease.

While the exact relationship between depression and heart disease is still being studied, enough is known to raise awareness about the dangers of depression on heart health. Research shows that even mild forms of depression or its symptoms increase the chance of heart disease in women by two to three times.

Women are at greater risk for depression than men for a variety of reasons, including certain biological, hormonal and social factors that are unique to women. Research shows that people with depression are more likely to have poor heart health. A study by the American Heart Association found depression could be a barrier to living a heart healthy lifestyle. Some of the symptoms of depression make it challenging for women to take care of themselves and make healthy choices. Often, women with depression sleep too much or not enough, feel fatigued, have little interest in doing things and lack energy – none of which are conducive to sticking with a healthy diet or cardiovascular exercise program. In a large number of households, women are still the primary caregivers for children and the main source of house work and meal preparation, whether or not they work outside of the home.

Women may try to deal with their depression through self-soothing but harmful behaviors, such as smoking, drinking alcohol, or comfort eating. In fact, women with high levels of depression are more likely to be obese, abuse alcohol and other substances, or smoke.

Knowing the symptoms of heart disease in women can help especially in deciding when to seek medical care. Women often show a subtle presentation of heart related problems, including fatigue, aches and pains, headaches, nausea and stomach upset, and an overall feeling of malaise. Knowing the symptoms of depression is also crucial even though they may get less attention at first. It’s extremely important to be under the care of a physician or mental health professional who understands the interactive role of depression and heart health.

See goredforwomen.org for more information.
Also see my post about high functioning depression, a common phenomenon for women: Smiling Depression.

Personal Prescriptions

One of the questions I get asked most frequently by patients: What can I do, if I don’t want to or cannot take medication for anxiety or depression? I say: even if you’re taking medication, you need these. I actually write a prescription for the following recommendations.

* Sweat. Whatever exercise you love or can tolerate, do it most days of the week. Move.

* Sleep. Rest fiercely. We live a life with more obligations and responsibilities than one could imagine. The internet stole the rest. Sleep is the friend we take for granted, but forget that it needs tending. Constantly. For more info see Making Sleep Your Best Friend

* Sunlight/Earth. Get outside, every single day. Even when you cannot, bring nature inside. For more info see The Sun and Mental Health and The Psychology of House Plants.

* Bark/Purr. Spend as much time as possible with companion animals. It lowers your blood pressure, creates oxytocin, and beats loneliness. See also Mental Health and Companion Animals.

* Help. Innately, we need to help others. Whether it’s a neighbor, charity, volunteer opportunity, or community service, giving creates feel-good hormones.  See also The Mental Health Benefits of Random Acts of Kindness.

* Eat. Food is medicine. There is no diet that works for everybody, but figuring out what gives you maximum energy, nutrition, and satisfaction is key. Master cooking a few delicious dishes. See also Turmeric and Mental Health.

* Express. Dance, sing, write, draw, create. Give voice to your experience. Depression stifles our feelings. Anxiety makes it hard to even express them. See also Relaxation Place.

* Play. Watch your favorite shows. Read for pleasure, not work. Play your favorite game: board game, word game, video game. Work on a puzzle. Have regular chats or Zooms set up with your besties if you cannot see them in person. Our brains need downtime. It is essential, not a waste. See also Why It’s Hard to Say Goodbye to Our Favorite Shows.

*Breathe. Martial arts, meditation, yoga, breath work. These activities performed regularly drop tension and stress, empirically. See also Meditation For Troubled Times.

*Pray. Personal spirituality or prayer improves mental health, with robust findings for reductions in anxiety and depression. See also Personal Praying May Boost Mental Health.

*Forgive. Yourself and others. We collect wounds through our years. We often can’t let them go. As important as letting go of the aggression sent our way by others, we MUST let go of self hatred, self blame, and self denial. See also Why Self-Compassion is More Important Than Self-Esteem.

Depression Is:

Depression Is:
Emotional: Your baseline enjoyment of life decreases. In other words, you start constantly feeling a sense of suffering, or emotional pain, for no clear reason. Your are more negatively impacted by set-backs, and find it harder to enjoy the things that bring you pleasure and joy.

Physical : You have less energy. Just about anything feels like a tiresome undertaking, and you often feel like just lying down and doing nothing. It may seem impossible to do the smallest of tasks. Getting out of bed, taking a shower, brushing your teeth, cleaning up, or checking your email can feel like Herculean tasks.

Mental: Your thinking becomes distorted and negative. Your self esteem decreases, so that you feel worthless. Thinking and concentraing becomes harder, as if trying to see something through a fog. It’s hard to imagine things becoming better, or to form a positive idea of the future in general. You have a variety of intrusive negative thoughts; these thoughts can happen regardless of however much you believe or agree with their content.

Additional resources:

What Not to Say to Someone with Depression.

National Emergency Helpline

 

Depression and Parenting

I was recently the speaker on The Zebra School, a parenting podcast, on pregnancy and mental health. Depression, both during pregnancy, and postpartum, are very serious concerns that can affect the entire family. The podcast and blog interview will be officially LIVE May 1, 2021. You can listen to the full interview on iTunes, Spotify, Google, and a few other audio platforms. Just search for The Zebra School on the desired platform.

Zebras are ungulates with an acute sense of hearing. Like a horse, a zebra can turn their ears in almost any direction – capturing the sounds of its environment with keen precision. Similarly, The Zebra School programs promote content committed to keeping our ears to the ground to stay abreast of relevant information taking place in the childhood space.

Smiling Depression

The term “smiling depression” – appearing happy to others while internally suffering significant depressive symptoms is receiving more research attention. While smiling depression is not a technical term that psychologists use based on ICD or DSM criteria, it is certainly possible to be depressed and manage to successfully mask the symptoms. The closest technical term for this condition is “atypical depression”. In fact, a significant proportion of people who experience a low mood and a loss of pleasure in activities manage to hide their condition in this way.

These people might be particularly vulnerable to suicide.

It can be very hard to spot people suffering from smiling depression. They may seem like they don’t have a reason to be sad – they have a job, popularity, and maybe even children or a partner. They smile when you greet them and can carry pleasant conversations. In short, they put on a mask to the outside world while leading seemingly normal and active lives. Tony Bourdain and Robin Williams are good examples.

Inside, however, they feel hopeless and down, intermittently having thoughts about ending it all. The strength that they have to go on with their daily lives can make them especially vulnerable to carrying out suicide plans.

Although people with smiling depression put on a “happy face” to the outside world, they can experience a genuine lift in their mood as a result of positive occurrences in their lives. For example, getting a text message from someone they’ve been craving to hear from, volunteering or doing community service to help others, or being praised at work can make them feel better for a few moments.

Other symptoms of this condition include under or overeating, substance abuse, irritability, feeling a sense of heaviness in the body, insomnia, and being easily hurt by criticism or rejection. People with smiling depression are also more likely to feel depressed in the evening, also known as sundowning, and feel the need to sleep longer than usual. Smiling depression is exhausting, because a great deal of mental effort is required for them to put forth the semblance that everything is fine.

Recently, Women’s Health magazine captured the essence of smiling depression – the façade – when it asked women to share pictures from their social media and then to recaption them on Instagram with how they really felt in the moment they were taking the picture.

It is difficult to determine exactly what causes smiling depression, but low mood can stem from a number of things, such as work problems, financial hardship, relationship breakdowns, and feeling as if life doesn’t have purpose and meaning. It is very common. About one in ten people are depressed, and between 15% and 40% of these people suffer from the atypical form that resembles smiling depression.

Such depression can often start early in life and can last a long time.If you suffer from smiling depression it is particularly important to get help. Sadly, though, people suffering from this condition usually don’t, because they might not think that they have a problem in the first place – this is particularly the case if they appear to be carrying on with their tasks and daily routines as before. In short, they get used to feeling bad. More than ever, it’s very important to check in with people who seem like they’re doing well, during difficult times.

How to help a loved one with depression

Depression doesn’t happen in a vacuum. It causes a ripple effect that touches everyone surrounding the person. Family members and friends often feel helpless, not knowing how to reach out or what to do to help their suffering loved one.

It would be nice if the depressed person could specifically vocalize their needs, so that friends and families knew exactly what to say and do. However, the paradox of depression can be immobility and lack of motivation. Vegetative symptoms are disturbances of a person’s functions necessary to maintain life. These disturbances are most commonly seen in mood disorders, and are part of the diagnostic criteria for depression.

Vegetative symptoms in a patient with typical depression include:
Weight loss and anorexia (loss of appetite) or overeating
Insomnia or hypersomnia.
Fatigue and low energy
Inattention and memory problems
Poor communication

1. Educate Yourself About Depression and Other Mood Disorders.
You may not be able to cure your loved one. But you can better understand their condition by educating yourself about depression or mood disorder. Reading up on your loved one’s illness will help you feel more in control of the situation and give you more patience to tolerate the confusing or frustrating symptoms.

2. Ask Open-ended Questions
Do not go in with the attitude that you know better, and you know what’s going to work to help them feel better. Listen to their personal experience.

3. Help Them Identify and Cope With Sources of Life Stress
It’s no secret that stress is a significant contributor to depression. Chronic levels of stress pour cortisol into your bloodstream and cause inflammation in your nervous system and every other biological system. In a study in Scientific Reports, a neuroscience journal, stress was shown to reduce the brain’s innate ability to keep itself healthy. The hippocampus, which regulates mood, shrinks, negatively impacting our short-term memory function and learning abilities.

4. Remind Them That They’re Incredibly Strong
When you’re depressed, you don’t believe that you’re worthy of love. I call this the secret symptom of depression, the feeling that you are unimportant and don’t matter in the universe. That’s what makes relationships and communication so difficult. One way of helping is by reminding them of their strengths. Use concrete examples. Cite times in their lives they exemplified courage, stamina, compassion, integrity, and perseverance. One colleague of mine will say, remember your name, who are you?

In a series of studies that I conducted at the Catholic University of America, in Washington, DC, I found that people with depression literally do not remember positive aspects of a singular activity. For example, when shown movies that had a range of affect from joyful to traumatic, the more painful and traumatic memories in the films were later most remembered on memory tasks given to individuals identified as depressed.

5. Make Them Smile, Because Laughter Helps.
Humor can help us heal from a number of illnesses, including depression. In Darkness Visible, the writer William Styron described his journey through severe depression. Humor was one of the things that helped him survive. Watch a favorite show or listen to a shared podcast with your depressed loved one. You don’t have to fake laughter, let it emerge on its own.

6. Let Them Know They Won’t Always Feel This Way.
This is a powerful message. When combined with helping them remember past struggles that they mastered, it shows that there is hope.

7. If You Do Only One Thing, Let It Be Listening
Listen. Suspend all judgments, save all interjections … don’t be a know it all. Do nothing more than make excellent eye contact, reflect on what you are hearing, and open your ears. It’s the most powerful wisdom.

Mental health and Corona

Prior to the COVID-19 pandemic, nearly one in five of U.S. adults (47 million) reported having a mental illness in the past year, and over 11 million had a serious mental illness, which frequently results in functional impairment and limits life activities. Please remember that these are only the reported numbers, because many people do not seek help or endorse symptoms.

The COVID-19 pandemic and the resulting economic recession have negatively affected many people’s mental health and created new barriers for people already suffering from mental illness and substance use disorders, who were previously substantial in number. In polls conducted in mid-July, 53% of adults in the United States reported that their mental health has been negatively impacted due to worry and stress over the coronavirus. This is significantly higher than the 32% reported in March. Many adults are also reporting specific negative impacts on their mental health and wellbeing, such as difficulty sleeping (36%) or eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%), due to worry and stress over the coronavirus. As the pandemic wears on, ongoing and necessary public health measures expose many people to experiencing situations linked to poor mental health outcomes, such as isolation, health worries, evictions, and job loss.

Some takeaways:
A broad body of research links social isolation and loneliness to poor mental health, and data from late March shows that significantly higher shares of people who were sheltering in place (47%) reported negative mental health effects resulting from worry or stress related to coronavirus. In particular, isolation and loneliness during the pandemic may present specific mental health risks for households with adolescents and for older adults. The share of older adults (ages 65 and up) reporting negative mental health impacts has very significantly increased since March. Polling data shows that women with children under the age of 18 are more likely to report major negative mental health impacts than their male counterparts.

Research also shows that job loss is associated with increased depression, anxiety, distress, and low self-esteem and may lead to higher rates of substance use disorder and suicide. Recent polling data shows that more than half of the people who lost income or employment reported negative mental health impacts from worry or stress over coronavirus; and lower income people reported much higher rates of major negative mental health impacts compared to higher income people.

Poor mental health due to burnout among front-line workers and increased anxiety or mental illness among those with poor physical health are also concerns. Those with mental illness and substance use disorders pre-pandemic, and those newly affected, will likely require mental health and substance use services. The pandemic spotlights both existing and new barriers to accessing mental health and substance use disorder services.

In my practice, many people do not have access to consistent Wi-Fi or Internet service. During this unprecedented time of uncertainty and fear, it is likely that mental health issues and substance use disorders among people with these conditions will be exacerbated.

Embolden remains dedicated to providing access and services for medical professionals and front line personnel. The long-term effects that we are experiencing cannot be minimized.

Some thoughts on depression – Q&A

I was honored to be recently named as a Top Doc. It’s always gratifying to be recognized for good work, and this kudo comes with the bonus of having an active Q&A section on their website, where readers (and potential patients) can anonymously ask questions.  I’ve tried to find time to answer a bunch of these, and thought it might be helpful to share some of those questions, and answers, here.

This first batch all deal with depression.

Will my depression go on its own?
Hello, it really depends on how long you’ve been depressed, and what the other circumstances are that may be occurring. If you’ve had recurrent episodes- Therapy, possible medication consultation, and a self care regimen are absolutely essential to address it. The good news is that there are proven strategies that do work to help with distress and symptoms.

Can social workers suffer from depression?
Yes absolutely. Mental health workers have some of the highest burn out and that includes rates of depression, substance abuse, and anxiety. Self-care is crucial. It used to be done that social workers and psychologists were required to be in therapy as part of their training, and although that cannot be mandated by programs, I believe it’s a good thing to be in treatment at various stages of our own professional and personal lives.

Will my depression go on its own?
Hello, it really depends on how long you’ve been depressed, and what the other circumstances are that may be occurring. If you’ve had recurrent episodes- Therapy, possible medication consultation, and a self care regimen are absolutely essential to address it. The good news is that there are proven strategies that do work to help with distress and symptoms.

Can a divorce drive people toward depression?
In psychology there is a list of daily stressors or daily hassles. Going through a divorce or separation is one of the top stressors. Unfortunately, divorce is usually also combined with financial stress, location changes, shifting of social groups, family related issues, and at times issues related to children. It’s essential to make sure that you fit in time for self-care, and do some consults with a therapist to come up with a plan for coping and support.

There are many more questions on the site, on a variety of topics including stress management, OCD, anxiety and more. I’ll share more of those here, sometime in the near future.

Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

Thank you for contacting us.