Managing Your Depression (2 page)

Timothy J. Petersen, Ph.D.
Jonathan E. Alpert, M.D., Ph.D.
Andrew A. Nierenberg, M.D.
The Massachusetts General Hospital
Department of Psychiatry
Boston, Massachusetts

Acknowledgments

This book is dedicated to a team of exceptional people who have made my life and this book possible. The superior clinical skills, extraordinary kindness, understanding, and perseverance of these professionals have been invaluable and have kept hope alive for me when I believed there was none. I owe my deepest thanks and gratitude to Drs. Andrew Nierenberg, Jonathan Alpert, Timothy Petersen, John Winkelman, Karen Carlson, and David Mischoulon. Additional thanks and appreciation go to Drs. Jeffery Huffman, Michelle Jacobo, and Marc Zuckerman for knowing just what to say and do during the darkest moments and for keeping me safe during those times. Last, I would like to recognize the remarkably skilled and caring nursing staff of Blake 11 for exceeding all expectations.

My family, father and brother, have been particularly generous and supportive in their own way, and for that I am most grateful. And my friends are the ones who have sustained me throughout. They deserve the highest praise for strength in friendship over a lifetime marked with a fluctuating illness. Special thanks and appreciation go to Sandi, Bernice, Eileen, Ginger, JoAnn, Cindy, Joe, Dave, David, and Carlo for their dear friendship and support.

No book is published alone, and the amazing, insightful team of Jacqueline Wehmueller and staff of the Johns Hopkins University Press deserve special recognition, including Juliana McCarthy, Kathy Alexander, Claire McCabe Tamberino, and Sara Cleary. I would also like to extend my thanks and appreciation to copyeditor Melanie Mallon for her perceptive and thoughtful care of the manuscript.

Managing Your Depression

Introduction

Some call it the blues or a storm in their head. William Styron called it darkness visible. Whatever the description, depression is a disorder of the mind and body that affects approximately 15 percent of the population at some point in their lives. Mood disorders such as major depression and bipolar disorder are conditions of the brain that involve a disturbance in one’s mood or frame of mind. These conditions affect a person’s thoughts, feelings, behaviors, relationships, activities, interests, and other aspects of life. It can be quite overwhelming. The symptoms of major depression and bipolar disorder are often remitting and relapsing. This means that the symptoms come and go; they may improve or go away and then return at some later time. The pattern is unique for each person and difficult to predict. You may experience symptoms for a long time, just as people who have diabetes or high blood pressure often do. The important thing to remember is that mood disorders are treatable and that you can learn to manage yours.

One of the most common symptoms of major depression and bipolar disorder is difficulty with concentration and focus. In his book, Styron eloquently described a state of confusion, failure of mental focus, lapse of memory, and muddied thought processes, familiar to many with depression. This may make it challenging for you to read, pay attention to a conversation or TV show, or remember simple things. Although advice on how to manage a mood disorder can be found in many textbooks, self-help books, and Web sites, a person with depression may find some of these resources difficult to follow and absorb. Books and articles with long, involved text can be overwhelming to a person in the midst
of depression. These are symptoms of the disease, not indications of your intelligence. Because of these symptoms, learning to manage depression requires a different approach.

Managing Your Depression
was designed with this idea in mind. Its main focus is on practical, day-to-day ways to manage your illness. The book provides you with core information in a concise form. It is brief and to the point. The basics of managing your depression or bipolar disorder are broken down into several sections, with skill sets and exercises that can be done one at a time. My perspective in writing is that of a physician who has treated many patients and who also has personal experience living with the illness. Having been in the depths of a mood disorder, I have an understanding of what information is most helpful to manage the illness and how it is best received.

The information presented here was gathered over time from various educational resources, psychoeducational programs, seminars, expert health care providers, and personal patient experience. If you suffer from mood disorders, you can use this book as:

• an educational source to better understand and manage your illness. You need to have specific knowledge and skills to respond to an illness like depression so that you can avoid its worsening, recover, and prevent recurrences. Managing your mood disorder in an informed way can help you function better and stay well. People who participate actively in their own care and who work to manage their mood disorder have a better chance of recovery and of staying well.

• a workbook, a set of skills and exercises to use along with input, advice, and treatment from your therapist and treatment team. This book is not intended to replace your treatment professional(s).

The reader is advised to go slowly. Review one section at a time and keep in mind that you may need to review it more than once. People with depression have various clinical signs and symptoms in
a pattern that is unique to each of them. Look for the material that applies to your own experiences over time. You may find some of the exercises to be starting points for discussions in your therapy sessions. Work with your therapist to determine the most helpful educational and exercise tools for you. It’s worth repeating—people who participate actively in their care have a better chance of recovery and staying well.

I begin in
chapter 1
with the mental health basics, the essential things we all need to do daily to maintain emotional health and stability. The basic steps include maintaining a regular pattern of sleep, diet, exercise, medications, and social contacts; keeping a routine and structure to your day; and avoiding isolation. These fundamentals can be especially challenging when you are managing a mood disorder because the symptoms of depression often interfere with your ability to do them.

In the second chapter, I give an overview of the mood disorders called major depression and bipolar disorder. This chapter also includes a brief discussion of depression in women, depression and anxiety, the stigma of mood disorders, and fatigue and depression. There is a comprehensive table of the real-life symptoms of major depression and bipolar disorder and a daily Mood Chart to track your symptoms.

Chapter 3
presents the concept of
defining your baseline
. Your baseline is your healthy inner self, something that appears to be lost during severe depression, even if only temporarily. In managing depression, you have to find a way to stay connected to your baseline healthy person, your inner sense of yourself. This baseline can be extraordinarily helpful to draw on during your recovery. This chapter also includes exercises to help you identify and define your baseline self.

Chapter 4
begins with an overview of treatment for mood disorders and your relationship with your therapist, followed by what you need to know to manage your depression and bipolar disorder. It is important to use both professional treatment and
self-management techniques to achieve the best recovery from your illness. Managing depression means that you learn about the illness and its symptoms and develop effective strategies to respond to your symptoms. It requires that you monitor your symptoms, challenge negative thoughts, use problem-solving techniques, make adjustments, and avoid negative behaviors.

In
chapter 5
, you will find an overview of Relapse Prevention. Relapse Prevention is an effective daily approach to help you minimize the chance of a relapse (return of symptoms) and help you stay well. This chapter also provides ways to help you identify your depression Warning Signs and Triggers and an intervention Action Plan for Relapse Prevention to use when an important change in your emotional health happens.

Chapter 6
is a presentation of cognitive behavioral therapy (CBT), a specific type of talk therapy that addresses the connection between your thoughts, feelings, and behaviors. CBT is particularly useful in depression when your thoughts are distorted, negative, and causing you distress. This form of therapy helps to identify and change distorted thinking patterns, inaccurate beliefs, and unhelpful behaviors that are common in depression. Included here are sample CBT exercises for you to use to challenge and change dysfunctional thinking patterns.

I explore in
chapter 7
some life strategies to get you through the tough times. These skills often fade during depression, so you may need to review and polish up on them. This chapter covers Coping and Stress, Mindfulness, Distress Tolerance, Communication Skills, Dealing with Family and Friends, Talking with Your Doctor, and Tips for Families and Friends.

Chapter 8
describes how it looks and feels to manage your depression by incorporating the recommendations throughout this book into your daily life.
Chapter 9
is a collection of thoughtful advice and resources for your review, including reliable and recommended Internet sites and books of interest. Next is a concluding chapter, which is rounded out by references, a glossary of important terms used in the book, and an index.

CHAPTER 1
Mental Health Basics

The Basic Steps

The Basics of Mental Health are the essential actions we all need to engage in every day to maintain emotional health and stability. They are especially important when you are trying to manage a mood disorder. The basic steps include maintaining a regular pattern of sleep, a healthy diet, and regular physical exercise; taking prescribed medications; keeping up social contacts; and having a routine and structure to your day. The steps are your foundation for a healthy emotional life, and on them you will build the components of your treatment plan. These may feel like common sense recommendations, but they are essential to controlling your symptoms. Controlling your symptoms in this way improves the quality of your life. When you follow these steps regularly, you will decrease your vulnerability to fluctuations, or changes, in your mood disorder symptoms. Taking care of your overall self is important to your general health and to preserving your emotional balance and strength. It also boosts your resilience. This helps you to recover more quickly from setbacks or episodes of depression if they do occur.

Following these fundamental steps can be especially challenging when you are struggling to manage a mood disorder because the symptoms of depression often interfere with your ability to actually do them. For example, the symptoms of fatigue, poor appetite, and lack of interest can make it difficult to do the grocery shopping and cooking necessary to follow a healthy diet. To meet this challenge, you may find it helpful to break down the tasks of daily life into small steps, to plan for what you have to do, and to pace yourself. In the current example, you could write down your grocery list, shop at a time of day when you have more energy, and cook healthy foods in large batches so that you can freeze some for later meals when you are too fatigued to cook. You will learn more about these techniques in the following chapters. The key is not to wait until you feel like doing something. Just do it as best as you can now and the motivation for doing it will follow. Many people with depression have found that to be so. It is crucial that you keep trying despite the difficulty and that you give yourself credit for the effort.

The Basics of Mental Health

• Treat any physical illness.

• Sleep

– Aim for 7 to 8 hours of sleep each night.

– Keep a regular sleep routine.

– Follow Sleep Hygiene principles to promote restorative, restful sleep.

– Use a Sleep Diary to track sleep patterns.

• Diet and nutrition

– Eat balanced, healthy meals regularly, 3 times a day.

– Do not use alcohol, street drugs, or excessive caffeine.

• Medications

– Take all medications as prescribed, even if you are feeling better.

– Discuss with your physician all over-the-counter medications, herbs, and other supplements you take.

• Exercise regularly (as able); balance cardiovascular, stretch, and strengthening activities.

• Maintain regular social contacts and connections with others.

• Avoid isolation.

• Have a daily routine and structure your time.

The Basics of Mental Health are summarized on
page 6
. A more detailed discussion of these steps follows below.

Sleep and Depression

Sleep problems often occur during an episode of major depression or bipolar disorder. When depressed, you may sleep a lot but still feel tired. You may sleep too little or have interrupted sleep, with frequent awakenings during the night. Or you may wake up too early. The quality of your sleep may be affected so that you don’t feel rested or restored the next day. Without enough sleep you become irritable and have difficulty concentrating and doing small tasks. In contrast, in bipolar disorder with mania or hypomania you may feel that you don’t need very much sleep at all, that you are energized and awake during normal sleep times.