Living with Depression: Why Biology and Biography Matter along the Path to Hope and Healing

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Her advice extends beyond the usual. Find more info about Victoria Maxwell and her performances at www. Article contains all useful information. It helps in depression topic's study. Have you ever tried the battle depression pill? Wabi-sabi has nothing to do with wasabi or sushi but may decrease self-judgement. My experience with virtual co-working eased my depression. Back Psychology Today. Back Find a Therapist. Back Get Help. Back Magazine. Subscribe Issue Archive.

Back Today. Making Sense of Nutritional Psychiatry. Educating for the Future. Victoria Maxwell Crazy for Life. Follow me on Twitter. Friend me on Faceook. Connect with me on LinkedIn. What are your book recommendations for living with depression? Post a comment below. Post Comment Your name. E-mail The content of this field is kept private and will not be shown publicly. Notify me when new comments are posted. All comments. Pharmacotherapy is one of the most rapidly developing fields in modern science. Adding medication to your treatment regime requires confidence in the professional with whom you are working.

So, having someone who knows the latest research, trends, and side effects is critical. The pharmacotherapy process involves a thorough medical history, one that will take up your entire first consultation. At first, you will have scheduled appointments within weeks of starting your medication. As time progresses, dosage may remain the same or increase based on your reported symptoms. If side effects are intolerable, a change in medication may be necessary.

Modern pharmacotherapy typically uses these six medicinal categories for healing 1. Antipsychotics: Medications that are generally used in the treatment of schizophrenia or extreme states of agitation. Antidepressants: A class of medications used to treat depression. These include selective serotonin reuptake inhibitors SSRIs , serotonin norepinephrine reuptake inhibitors SNRIs , norepinephrine and dopamine reuptake inhibitors 35 Mood Stabilizers: Medications that treat symptoms of mania, hypomania, mixed states of mania, and issues related to rapid cycling.

Anxiolytics: Medications that address anxiety and tension. Your unique experiences will help determine in what direction pharmacotherapy will progress. Try to refrain from comparing your medical regime to others or placing a negative spin on the kinds of medication you are taking. What works for one, does not work for all. The important thing is to find what works for you. Personally, I found a medication that worked well for me the first go-round. As previously mentioned in chapter 1, fluoxetine, generic Prozac, affords me symptom relief with tolerable side effects.

Sometimes this took months, even years. The hardest cases of all are when patients experience a depression so problematic that alternative treatments have to be sought. This type of depression is treatment resistant depression TRD. Keep in mind that many elements are required when undertaking pharmacotherapy. You need to have trust in a skilled professional, confidence in your own ability to evaluate the status of your medica36 Hospital wards for those with mental illness vary.

Generally speaking, private and parochial hospitals tend to have a more residential feel to their psychiatric departments than do state, community, or government-run hospitals. Find out the quality of hospitals in your neighborhood. If you want, use guidance from a mental-health professional. This way, you can be informed should you need this type of intervention. This can ease the transition for you and help professionals on staff to be prepared.

Many inpatient hospital wards are more like college dormitories than the sterile-white secure units portrayed in movies. Single or double rooms with beds and desks are the norm. These precautions keep you and others safe and enable the staff to manage the floor with continuity. The purpose of seeking inpatient treatment is to intensify all aspects of therapy. Medication is monitored more closely. Talk therapy occurs on a daily basis, either individually, in group, or with family members. Long stays in hospital settings are rare. When you leave, you may have the ability to continue care in a partial hospital program.

In this kind of treatment, you go on with your 37 Electroconvulsive therapy ECT is an often misunderstood medical intervention for severe, treatment-resistant depression. It is usually the technique of choice when numerous medications and long-term use of psychotherapy have not been successful. Refined from its early beginnings, Fink reminds us that ECT is no longer the fearsome treatment pictured in television and films. A team of skilled professionals oversee the procedure. Those involved are anesthesiologists, nurses, and medical doctors. Essentially, ECT is the process by which electrical currents are passed through the brain to create a brief seizure.

This procedure affects signal pathways and neurotransmitters in the brain, and reduces the severity of depression. ECT treatments are generally given every other day for up to twelve treatments. The treatment takes about fifteen minutes to perform. There can be side effects, which include periods of confusion after the procedure, forgetfulness, memory loss, nausea, and muscle soreness. Some reported confusion and memory loss, and were frustrated by these side effects. Others, though, were willing to live with side effects because their depression lifted. The stigma attached to ECT appears to be the greatest obstacle, but education and visits to ECT therapy suites can give way to more acceptance.

Sometimes called winter blues, seasonal affective disorder SAD occurs when a person is exposed to shortened daylight hours. The retinas of the eyes register light when exposed to sunshine, sending impulses to the pineal gland. In turn, the pineal gland produces melatonin, which regulates our circadian rhythm and body clock. During the darker days and nights, the retinas register less light and overproduce melatonin.

These higher hormone levels increase depressive symptoms. Depression with seasonal onset affects women more than it does men, and children can experience SAD as well. Light boxes are available for purchase with and without a prescription. Research says the success of light therapy depends on finding a bulb that provides a balanced spectrum of light equivalent to being outdoors. Also necessary is to have exposure to this light between twenty and thirty minutes a day. Research has found that omega-3 works in conjunction with the neurotransmitter serotonin, helping to regulate its distribution in the brain.

Several studies indicate that supplemental omega-3 may be helpful in the management of depression. Of interest were findings using omega-3 as a supportive treatment, not as a singular intervention, which yielded the most significant decrease in depression. Dietary supplements can also be used, but be mindful of the recommended dosages for optimal benefits. Low folate and vitamin B12 deficiency have been linked to depression.

Studies show that depressed patients often have low levels of red-cell folate, serum folate, and vitamin B Vitamin B12 can be found in seafood like snapper, shrimp, and scallops, and in fermented vegetables like miso and tofu. Just like omega-3, folate and vitamin B12 dietary supplements can be useful.

The botanical extract from this plant has been used as an herbal antidepressant for over two thousand years. Side effects are generally well tolerated and include gastrointestinal distress, allergy to the sun photosensitivity , and fatigue. With mild depression, St. SJW can be purchased in grocery stores, drugstores, and health-food stores. I take my medication daily, but use light therapy as a supplemental treatment in the winter months.

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What I do most days, though, is read or meditate in a sunny spot. I enjoy the warmth of the sun and the color of its hue better than sitting in the vicinity of an artificial light. I have difficulty metabolizing them. Given that I had a major depressive disorder, SJW provided little relief for me, so I went back to prescription antidepressants. As a clinician, I endorse the use of alternative measures and encourage patients to learn about them. I think well-being is an art form. It involves the understanding of science, embracing of the holistic, and finding the balance that works uniquely for you.

As with anything you choose to undertake, be an educated consumer by learning all you can about these treatments. Become familiar with their risks and benefits, pros and cons, short-term versus long-term benefits, and cost and accessibility, so you can make an informed decision. Psychotherapy Trends Behavioral activation BA therapy proposes that the act of avoidance leads to depression. BA teaches activation strategies—behaviors that get you involved and engaged with others. You and your therapist will monitor your progress with charts and rating scales during this ten-to-twelve-week therapy.

The aim of MBCT is to teach you about thoughts, feelings, and bodily sensations by using cognitive therapy and meditation practices. The purpose of this approach is to help you detect and respond to the warning signs of relapse. This treatment is presented in class format for eight weeks by licensed professionals trained in MBCT.

This program is in its research stage at the University of Kansas under the direction of Dr. Stephen Ilardi. Less invasive that ECT, studies report minimal side effects, such as headache, tingling, and light-headedness. These side effects were reported to decline quickly, however. Some individuals report discomfort with the clicking sounds the magnetic coil makes, so earplugs can help. The treatment takes about forty minutes, and daily treatments are recommended for a month.

There is no down time, so you can drive home the same day and carry on with your daily routine. Like ECT, you will come back from time to time for additional treatments if your depressive symptoms return. Magnetic seizure therapy MST is a novel brain-stimulation method using high intensity repetitive transcranial magnetic stimulation in order to induce a therapeutic seizure. The procedure is done under general anesthesia and performed in an electroconvulsive therapy suite with a team of professionals.

MST enables doctors to target specific brain areas in a more focalized fashion than is possible with ECT. Individuals who have undergone MST reported a decrease in their depressive symptoms with no side effects—no memory loss, confusion, forgetfulness, or muscle strain.


Similar 42 Vagus nerve stimulation VNS involves the surgical implantation of a device that sends electrical pulses through the vagus nerve, a nerve pathway that sends information to and from the brain. VNS is a treatment that relies on pulses that originate from a small battery that is surgically implanted under the skin in the collarbone area. Electrical leads are threaded from the battery, under the skin, into the vagus nerve.

After implantation, your surgeon programs the device to deliver small electrical bursts every few minutes. You generally remain in the hospital overnight for monitoring. Individuals who have undergone this treatment report almost immediate reduction in depressive symptoms with no side effects in memory or thinking. Typically, complaints are soreness, irritation, or infection at the surgical site. Sometimes called neuromodulation, deep brain stimulation activates specific brain areas instead of the vagus nerve. In this treatment, a surgeon implants two tiny electrodes directly into brain structures such as the basal ganglia, thalamus regions, Brodmann Area 25, or the medial prefrontal cortex.

Similar to VNS, wires connect to a battery-powered pulse generator near your collarbone; however, since DBS involves two electrodes, you will also have two battery packs. You and your doctor will personalize the electrical pulse settings, which can take some time to hone in on. Wound infections, complications from hardware malfunction, numbness, and confusion have been reported. In time, improvements and modifications may make this alternative treatment safer, and with fewer complications. Treatments work for some, but not for all. Medications work for others, while many find no relief.

Research tells us that the future of treating mental illness will move from a universal approach to a more personalized one. Coming down the pike is the field of personalized medicine. Researchers promise the creation of artificial neural systems and artificial brain structures to help alleviate depression. Already in test and delivery stages are gene therapy which alters or replaces defective genes , stem cell therapy which helps replacement cells take the form of defective or missing cells , and nanomedicine which sends treatment to the brain directly through the bloodstream.

Breakthroughs in science come from creative minds that think out of the box—and from courageous individuals who participate in the research and development of these technologies. The gratitude we owe them is enormous. This chapter will highlight the often unwritten and unaddressed aspects of depression. To understand the full depressive experience, you need to know details about psychotherapy, medication, and healthcare coverage.

The good, the bad, and the ugly of them all. Be it in pictorial cave drawings or at a local Starbucks, social intervention continues to thread itself into the fabric of human life. Talking to another about issues became more scientific with the discovery of the talking cure in the s by neurologist Sigmund Freud, physician Josef Breuer, and patient Bertha Pappenheim. Since Freud, numerous types of psychotherapies have been born, with some emerging as more modern in 45 All of these forms of talk therapy have the same goal, which is to reduce symptoms and develop well-being.

With regard to depression, the treatment of psychotherapy can offer great success, but there are some fundamentals you need to know. Psychotherapy cannot be successful unless you want to be there. Out of concern and love, parents sometimes force children and teens into therapy before they are ready. The same goes for adults when partners, friends, or relatives pressure them to get into treatment. If you feel coerced into going to therapy, express your discomfort to the therapist. Often, I detect when this has happened and rework the session to give the decision-making power back to the patient.

Psychotherapy will not fix you. You will fix you. Teach a man to fish, you feed him for a lifetime. The goal of psychotherapy is to empower you with ways to deal with life issues, learn the triggers for your depression, and build resiliency, so you can find well-being. Psychotherapy does not always make you feel better. Making a breakthrough in therapy is always exciting and meaningful.

However, achieving awareness sometimes requires you to be brave and fearless. Recalling memories and experiences, or changing a behavioral style, can be trying, upsetting—even overwhelming. So, for psychotherapy to be a successful, you have to crave change, possess a curiosity of your inner world and an interest in understanding what motivates you, and tolerate a moderate degree of frustration.

This is 46 Talk therapy is a valiant undertaking. And anyone who says otherwise is foolishly misinformed. Psychotherapy will not work if you have unrealistic expectations. Setting realistic goals can make psychotherapy a winning experience. Change does not happen overnight. Nor does the development of insight. Hardest of all is replacing old behaviors with new ones. It takes time. My suicidal thinking was reduced and my despair lifted in just a few sessions. Why did I have to wait until next semester to get back to classes?

Talking with my therapist helped me realize that I was being unrealistic—and that I needed time to recover from my depressive episode. Once I realized that I had other hurdles to cross, talk therapy took on a deeper meaning to me. When it comes to your depression, make sure you and your therapist center therapy with sensible and realistic objectives, specific to your needs. As time progresses, you can review these targeted goals and redefine them if necessary. Remember, yard by yard is hard, inch by inch a cinch. Psychotherapy is not like talking to a friend. Therapy is the forming of an alliance to bring about change in your life.

Psychotherapists train many years in the art of listening and, unlike a friend or family member, listen not only with the intent to just understand but also with the goal to identify and analyze. Being an active listener enables a therapist to use theory and techniques to stir your observations as treatment proceeds. Something friendship often blurs. Psychotherapy requires you to be comfortable with your therapist.

The kind in which you and your therapist click, and you find a sense of ease. Without this connection, it may be difficult to feel comfortable talking about difficult issues and to feel safe letting go of fears or trying out new behaviors. Many times, you can get a sense of how a therapist conducts him- or herself with this initial phone contact.

Thereafter, let your gut instincts take over at the consultation. In this section, you will learn about the limitations of prescription medication, safety issues coming off medication, and how to obtain medication if you cannot afford it. This information, though, is kept out of the mainstream by the pharmaceutical companies. Only about 40 percent of children and adults with depression see a reduction of their symptoms with medication.

Many of the new medications that are being promoted are actually remnants of older ones with a contemporary spin. Most of the time, Big Pharma extends the life of a blockbuster drug that is going off-patent by making another mock-up version of it. Often called a me-too drug, it is structurally similar to alreadymanufactured medications. Big Pharma saved me. Without Prozac, I know that depression would consume me and that despair would cloud my judgment. But, that is the sad truth here.

Let me explain. There are over thirty drug-metabolizing enzymes in the human body—with many having unique genetic variations from person to person.

Again, one size does not fit all here. Research in the field of pharmacogenomics, the study of genetic variations in drug metabolism, reveals that individuals who are nonresponders to medication possess 49 Evidence-based data has identified four metabolizing categories. Poor, intermediate, extensive, and ultrarapid. A poor metabolizer PM is a person whose metabolism takes in the medication very slowly, resulting in increased levels of the medicine in the bloodstream. This sluggish process causes significant side effects, and poses toxicity risks such as serotonin syndrome—a potentially life-threatening condition caused by toxic levels of serotonin.

An intermediate metabolizer IM is a person whose metabolism of a drug occurs at a slower rate than normal. People in this category experience side effects and mild toxicity but not as intensely as do poor metabolizers. As you might expect, medication success is guarded in this category. Extensive metabolizers EM have an average expected range for metabolism. Herein, you absorb medication effectively and are able to experience symptom relief with few if any side effects. I fall into this category with my fluoxetine.

Ultrarapid metabolizers UM quickly process medication, rendering drug treatment virtually ineffective. Because your genetic metabolism synthesizes the medication too fast, you cannot experience its therapeutic effects. Pharmacogenomics research also observes differences in genes that regulate the entire serotonin system. Known as DNA microarray tests, they usually require a blood sample or cheek swab. For me, the simplest way to understand this data is to view metabolism and the target delivery systems for medicine as being variable from person to person.

Big Pharma needs to work alongside pharmacogenomic experts to create medications that address these issues. Until then, the rate of medication success for those with depression will remain at this low rate. Stopping medication abruptly can cause serious health issues. Often, professionals prescribing medication will take you through a very detailed list of how to take your medications. This is a very important process, and one that you should follow with regularity. Medication success has a great deal to do with timing of your doses and consistency in taking them as prescribed.

Usually, you will begin your antidepressant medication at a low dose, with a possible increase over time to reduce symptoms. At this stage, your neurochemistry is gently shifting, working slowly to bring you closer to well-being. It generally takes approximately fourto-six weeks for medication to reach its full effect. Hopefully, at this point, you are experiencing a reduction in your depressive symptoms. If so, you will remain at this dosage. If not, another increase may be recommended to find your optimal dosage.

As described earlier, many children and adults may not find relief after a prolonged period of taking medication. Additionally, others can experience intolerable side effects. Usually at this juncture, frustration leads to a decision to stop taking medication. It is crucial that you use the same care and consistency coming off medication as you did when you started it.

Not many people are aware, some health professionals included, that there is a need to come off medications in a specific way. If not, a variety of physical 51 This is known as antidepressant discontinuation syndrome. Unlike withdrawal effects from addictive drugs or alcohol, there is no drug craving. Antidepressants are not addictive. If you come off your prescription s carefully, your neurochemistry slowly returns to its original functioning. However, hastily stopping medication jars your system—and your body takes the hit. Coming off medication in a controlled way, overseen by your health professional, avoids this uncomfortable experience.

The decision to take medication can be a very positive step in treating your depression. Here are some tips to avoid antidepressant discontinuation syndrome: 1. Never stop taking your medication s without talking with your nurse practitioner or doctor. An open and honest forum can ensure that you come off your dosage in a safe manner. If lowering your dosage, follow the instructions given by your prescribing healthcare professional to the letter. If you begin experiencing symptoms of discontinuation syndrome, immediately contact her or him.

You may need to take a higher dosage for a longer period of time before weaning your body off of the medicine completely. If not being on medication causes previous psychological or psychiatric issues to resume, consider returning to medication as a treatment. There is no shame in having neurobiology that requires pharmacological help. If your health professionals or therapists have never heard of discontinuation syndrome, shake a finger at them, and then drag them to the nearest computer.

Other avenues that you can use to obtain prescription medication are available. Prescription medications come in two categories: brandname an original medication that is patented by a pharmaceutical company and given a trade or brand-name and generic a medication that is a biochemical equivalent to a brand-name one and may be produced by any manufacturer. If you have no health insurance coverage, you may be eligible to get brand-name medication for free directly from pharmaceutical companies.

You can have your prescribing healthcare professional call on your behalf as well. Here are several resources: Patient Assistance Telephone: Website: patientassistance. For example, if you are taking Depakote, a medication for bipolar disorder manufactured by Abbott Laboratories, you can contact their patient assistance program to make a request. Taking Cymbalta for depression? Contact Eli Lilly 53 Does your teenager have a prescription for Zoloft?

Get in touch with the prescription program at Pfizer. You get the idea. If you are not eligible for free medication and are paying for brand-name prescriptions, there are some avenues that can help defray costs. You can ask pharmaceutical companies if they have special discount programs or rebates for your brand-name medication. You can look into discount prescription cards, which are made available by organizations independent from insurance companies. Once you fill in your name and address, your card is ready. Click, print, and begin using it at cooperating pharmacies. My local pharmacies, Target and CVS, both participate—which makes me happy and pocket-change wealthy.

Money saved is money earned. Another avenue to obtain affordable medication is to go the generic route.

Living with Depression ( Foreword INDIES Winner) — Foreword Reviews

As mentioned earlier, generic medications have similar compounds as brand-name, but cost significantly less. Though active ingredients in generics are considered to be bioequivalents of their brand counterparts, there can be variations in the inactive compounds fillers and binders. Generics are not identical medications to brand-name medications. When the patent for Prozac expired in , I waited to see how its generic equivalent, fluoxetine, fared the medical field. Noting that it was well received and tolerated by most first-time users, I decided to join the generic bandwagon. Luckily, I felt no difference whatsoever as I made the switch.

Whereas little or no side effects were seen with brand-name antidepressants, the taking of generic equivalents for some of my patients resulted in many new complaints—headaches, stomachaches, and, worst of all, insufficient reduction of depressive symptoms. A swift return to brand-name medication brought back the needed equilibrium and well-being. In the industrialized countries of the United Kingdom, New Zealand, and Australia, coverage is funded through various government-subsidized programs.

Canada, Taiwan, and France use private-sector providers and privately-run hospitals that are paid by government-run insurance. The best-rated healthcare coverage occurs in Switzerland, Germany, the Netherlands, and Japan, where nonprofit insurance companies and government subsidies ensure all citizens receive healthcare. Those who do receive healthcare benefit from either governmental programs, subsidies, or out-of-pocket payment for private coverage. Report complaints regarding your healthcare. In whatever country you reside, you can register complaints if you experience difficulties getting medication or psychotherapy for your depression.

For example, consumer watchdog organizations, ombudsman services, and state departments are available to investigate and arbitrate issues. For specific information for your country, see appendix B at the end of this book. In addition to having these resources at the ready, you need to do the following: 1. Do your homework. Before you lodge any complaints or queries, know your healthcare coverage. This means reading through 55 Keep a folder on all your healthcare issues.

Create a main folder— be it old school with paper and pen, or geek chic with a computer file—that includes all your medical records. Medication, treatments, reports, and so on should be included in this folder for easy access. Start a journal record of your contacts. Whenever you make an inquiry regarding your healthcare, record every contact you have and with whom you speak. When speaking to anyone, get her or his full name. Ask the customer representative to spell his or her name for you—first and last. Request their direct telephone number as well. And what exactly are your job responsibilities?

Ask why your claim was denied. Sometimes healthcare denials or late processing of claims are clerical errors. This is usually an easy fix. Access outside agencies to lodge complaints or arbitrate on your behalf. If everything described above fails to work, this is the time to seek appeals outside of your healthcare program. I will summarize five key issues reported by Dr.

Linda Peeno, former medical director of a managed-care company and healthcare whistle-blower.

Have you ever called to inquire about a claim or coverage only to get different answers along the way? Denying you care keeps money in their accounts. And money in their accounts balloons their profits. It is more cost-efficient to let you die than to treat you for a serious condition. Healthcare companies can get into legal trouble for denying you proper care. Remember, denying you payment boosts their profits. Waiting for a reimbursement, but it never comes in the mail? Healthcare lingo is used as a tool to deny coverage.

Healthcare companies use ghost networks. Have you found yourself feeling 57 Consider yourself haunted by a ghost network. A Ghost Network, also called a phantom Network, is a collective list of health professionals and specialists that your insurer insists are contracted providers for your medical or mental-health needs.

However, these identified individuals are not members of the network. Remember, the goal of most insurance carriers is to take your money and limit your coverage. Instead, arm yourself with knowledge, resources, and tools to get what you deserve. Instead of getting discouraged, these negative experiences spur me on. The following are tactics I use and encourage you to do the same.

Fill out every section of a claim form. Consider sending claims via registered or certified mail. This postal strategy officially documents that your claim has been 58 It also begins the time clock as your insurance carrier has a deadline to return your claim. Copy all documents. I make copies of every claim I submit personally and professionally. Then, I kindly inform how I will be contacting the state attorney and insurance departments if the claim is not cleared for payment immediately.

No one wants to be the responsible named party in a lodged complaint. Know your state attorney general. Every U. Know your state insurance department contact information. You should also have this information at your fingertips when you query your insurance carrier. Remember, follow through and file your complaint. Sliding Scale and Pro-bono Services. Many, but not all, psychotherapists make accommodations to see children and adults at low fees sliding scale or no fee pro bono.

When seeking therapy, you should ask during the initial phone call if slidingfee or pro-bono services are available. You may also contact your local psychological, social work, and psychiatric societies to see if any members provide these services. My first experience in psychotherapy was at a low fee, something that was helpful, since I was in college and making very little money. When I was older and able to afford more, I paid full fees to my therapists and supervisors.

When hard times fell again, they accommodated me and lowered their fees. Professionally, I set aside time to provide sessions at low fees and no fees. University Programs. Many university and college programs offer psychotherapy to children and adults at low fees. Generally staffed by graduate students earning degrees in related psychotherapy fields, the treatment takes place in the university setting. If you are interested in pursuing this possibility, make inquiries at local colleges and universities to find out which ones have community psychotherapy centers.

Keep in mind that these are student therapists and that continuity of treatment could be interrupted should the student be required to move on to other training assignments. Postdoctoral or Postgraduate Psychotherapy Centers. Another avenue to obtain low-cost therapy is to consider working with an already-licensed mental-health expert who is pursuing a postgraduate degree in psychotherapy.

By and large, these professionals have a desire to become even more specialized in the field of psychotherapy—and they seek training programs to hone their skills. Similar to university centers, they offer low-fee 60 Generally speaking, long-term therapy with the same therapist is the norm here. To learn more, research local postdoctoral or postgraduate psychotherapy programs in your area. Contacting local psychological, psychiatric, and social work organizations can also help point you in the right direction.

State and County Clinics. There are over fifteen hundred free clinics in the United States, providing health services to children and adults who have no healthcare coverage. As a rule, you go through a clinic screening, where your overall health is evaluated. Most clinics have case managers that will help you find mental-health services. The National Association of Free Clinics is a great satellite organization that catalogs clinics in every state.

As mentioned earlier, if you have no health insurance, you may be eligible to get medication from patient assistance programs and prescription assistance programs. Get hold of a discount prescription card, which will help defray costs of medication. Once you move through your initial screening, a case manager will help you obtain free medication.

Remember, there is no shame in not having healthcare insurance. And if this undertaking is too much to bear, rally friend, family, or resource hotlines to help you. But now we come to the most important chapter of all. The chapter about you and your depression. Though we may share symptoms and diagnostic markers, your depression has its own distinctive feel—as does my depression. The factors that make your depression unique—and my depression unique—include biology genetics and biography life experience. The nature and nurture of my existence craft a life of my very own as well.

I believe that the unexamined life is a perilous one. If you fail to understand the inner workings of who you are, what strengths you have, and what weaknesses you own, your life becomes a featureless 63 Awareness, on the other hand, empowers you with facts, details, and specifics. And these experiences not only bring substance and uniqueness to your life, they also become data to be used in the management of your depression.

You see, they had the medical or the psychological training. However, this belief has been upended by the modern attitude that you are an expert as well, having firsthand knowledge of your own body and mind. I know a great deal about my biology and biography and call upon that knowledge when I work with any healthcare professional.

Being an expert in who I am and where I came from makes me an important team member. My feelings count. My sensibilities matter. I encourage you to measure your experiences. Find words to describe them. Keep track of the subtlest of sensations as well as the pronounced ones. Learn about your family history and dwell in your own life narrative.

Without them, the treatment and management of your depression becomes a boilerplate arrangement. Making use of the Two-B Factor will aid significantly in the treatment of your depression. The more you know, the better things go. Rates for relapse fall between 60 and 80 percent for children and adults with depression.

Gaps in maintaining effective treatment are a major healthcare issue, with relapse causing personal, social, and economic strains in industrialized countries. However, children and adults whose depressions are more intensive and serious require greater care. When you yearn to feel better, you attend every therapy session and take your medications regularly. As things improve, many individuals remain resolute in their treatment plan. Others, though, become casual as they start feeling better.

Their commitment to treatment becomes more laid-back. They begin skipping sessions or call to cancel at the last minute. Slowly, there is less formality in dealing with their depression. Soon the ability to monitor warning signs for depression gets blurred. If adjustments in the frequency of sessions are warranted, you and your therapist can make changes. Missing sessions on a whim can arouse feelings of guilt, which can set into motion self-defeating thoughts. Personally, the times I skipped sessions with my therapist showed me that I was avoiding profound subjects—or that I was reacting defensively to something in my life.

Talking instead of walking showed me how self-defeating patterns were operating and that I needed to address these tendencies. Together, we explore the reasons for these behaviors and take steps to address issues. Be consistent with your medication. Missing doses interrupts the efficiency of your neurobiology, which can impede the therapeutic success of your medication—or cause depressive symptoms to return. Stopping medication suddenly could launch discontinuation syndrome, a most uncomfortable and precarious withdrawal-like experience. If you feel your depression has lifted and you want to stop your medication, do so with the help of your prescribing healthcare professional.

Together, you can look into the possibility of being medication-free on a trial basis and what to do should your depressive symptoms return. I carry a pillbox with spare doses to use when I forget to take my medication, which happens from time to time. I read overthe-counter labels when taking other medications and maintain a good working relationship with my pharmacist.

When I decided to come off medication, I did so in a planned manner with the help of my psychiatrist. After a full recovery from my depression occurred, my doctor and I waited six more months before slowly stopping antidepressant treatment—the guidelines recommended by the American Psychiatric Association.

I was hopeful that my neurobiology self-corrected, but, unfortunately, my depression returned. Be attentive to your sleep cycle. Sometimes adjusting your medication, changing the dosage or time you take it, can help create a healthy sleep cycle. Be vigilant of your caffeine intake from soda, chocolate, coffee, and tea—and modify the timing of their consumption.

Avoid stressful activities like paying bills or making big decisions at night. And for goodness sake, unplug from electronics, especially from computers and cell phones in the evening! I had a variety of side effects that bothered me, including insomnia, when I first started taking Prozac. My psychiatrist suggested moving my dosage from the morning to the evening, which relieved my sleeping problems straight away. Fatigue, a residual symptom of my depression, is an everpresent experience for me so I catnap daily. More than that interferes with my nighttime sleep.

The tackling of administrative, financial, and social decisions is done in daytime hours because I need nighttime to be as calm as possible. Adjust your routine so you can get the kind of rest that keeps depression manageable. If sleeping issues remain difficult to manage consult with your healthcare professional to consider holistic measures i.

Move your body. The lethargy of depression can make exercise seem like impossibility. I know, I grew roots and collected dust when I was anchored to my depression.

Living with Depression

I can still recall how getting out of bed was a feat in and of itself. I could barely fight gravity to sit up. My body was so heavy and everything hurt. But the truth is, moving your body is a key element in keeping depression at bay. Just move your body—stretch, breathe, get yourself into a bath or shower. Tend to things around the house—chores that may have fallen to the wayside. If you can do more, start by accelerating your heart rate by doing low impact activities like walking, yoga, or swimming. Take the dog out for a walkabout or play catch with the kids. I needed a great deal of support getting myself out of the frozen state of depression.

I still do. I call neighbors to set up walking dates, and I call friends for social calisthenics. Eat wisely and well. Poor nutrition plays a significant role in depression. Eating too little or too much can worsen fatigue, effect cognition, and influence mood states. The more balanced you make your meals, the more balanced will be your brain function68 The bottom line is to make sure you nourish yourself on a regular basis. If cooking wisely and well is not your forte, call on friends and family to help you do so. Also, local churches, temples, and community organizations offer Mealson-Wheels programs, which deliver nutritious foods right to your doorstep at no cost.

Teach yourself to monitor thoughts and feelings that result from various experiences. If certain situations leave you agitated, upset, or helpless, see if you can minimize your exposure to them. Analyze why this is happening. Could their presence be toxic? Know your triggers. Triggers are experiences that weaken your current state of functioning.

Sometimes called stressors, triggers are powerful emotional and physical responses that can be set off by external events, interactions with others, and even by our own negative self-statements. Becoming familiar with what pushes your buttons, sets you off, or presses heavily on you can help minimize relapse or recurrence of depression. Discovering triggers requires you to put your needs first.

This can be a straightforward exercise if that comes easy to you. I learned in therapy to put myself 69 Self-important or high maintenance? The same goes for my work and teaching schedule. I learned this the hard way and now balance my calendar with great care. But I can read books that delve into these issues without it triggering me.

I adjust, accommodate, or avoid things in my life to minimize the trauma of triggers and encourage you to do the same. Make them known to yourself, and make them known aloud to others. Insist that people in your life honor and respect them. Do your best to adjust your lifestyle, but be careful not to let your world become too narrow. Avoid toxic people.

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Individuals who are well-defined characters are easy to spot. The juicy gossiper always has a tale to tell. The spoilsport can be counted on to harsh your mellow. The selfrighteous prig will wave a flag of superiority without fail. The bitch-on-wheels screeches her presence like a call to war. When you know the behavioral predictability for a person, you can modulate your responses.

Most toxic people, though, are not as easy to see coming. Their toxicity is cloaked, hidden beneath the surface of an ordinary average-Joe personality. Initially, you find your time with this person easy and enjoyable—but slowly notice difficult and 70 Toxic people come armed with envy, competition, control, and judgment, just to name a few. They monopolize your time and energy and leave you feeling wornout. Like emotional vampires, they suck the life out of you. You need to disentangle yourself from toxic people once you discover these fully operational characteristics. They will compromise your recovery and remission, and even worsen the likelihood for relapse.

Stay connected through social support. Depression is an introverted experience with social isolation being a most serious symptom. I have also worked long and hard at reminding myself that too much seclusion is dangerous for me, too. I tell myself that the sense of dread I feel when I have social plans often fades as soon as I connect to others. There are other times that I have to force myself out of bed and out the door over and over again. I think the energy it takes to call or disappoint another works to combat my depressive tendencies.

I make sure to have healthy people in my life by avoiding toxic ones and minimize my exposure to relatives and friends that I cannot avoid. Steer yourself toward people instead of maneuvering away from them. They will nourish you, even though it may take time for you to realize their value. Should you have difficulty finding social connections consider volunteering, joining a 71 Ask friends and family members to look in on you—and to encourage you to socialize when you drag your feet. Create a nurturing space. Depression can often feel like an experience of depletion.

Your senses are faint, perhaps dulled to the point of not taking in anything at all. Open the shades, part the curtains, or draw the blinds to let the sun in. During my depressive episodes, I made a habit of sleeping at night with the shades up so the morning sunshine would swathe me and the room in natural light. It also prevented me from lingering in bed and in darkness for too long. Continue reawakening your senses with inviting fragrance. I have an assortment of candles, essential oils, and soaps that I use for relaxation and for invigoration.

Lavender, lilac, vanilla, and mango are scents that work for me. Follow your nose, find what aromas work for you, and let that be all the proof you need. They have strong medicinal effects to lift your mood. Remind 72 De-clutter your home, and take care of disorganization. Depression makes it hard to tackle everyday chores. Tidy up messes, or do something as easy as tend to the mail. Before you know it, you have a physical and emotional mountain of mess to climb.

Clean and clear a little at a time, or, if this is beyond the realm of your abilities, ask others to help you out. Coming home to an unruffled setting can do wonders for your mood. Empower yourself. With regard to depression, selfempowerment signifies that you not only manage your illness, treatment, and care, but that you also advocate and educate yourself.

The manner in which you gain this empowerment is by moving through all of the above-mentioned experiences. Instead of avoiding struggles, you learn from them. You trust your own instincts and abilities because they are uniquely yours. If you experience a setback, you summon learned skills and seek help from others to get back on-point. All of these empowering experiences lead to the psychological state called resilience.

Children and adults who are resilient are less likely to feel helpless and more likely to stretch their comfort zones. Resilience boosts problem solving as well as the capacity to deal with stress.