Managing Your Depression (7 page)

Next, fatigue can be a
side effect
of antidepressant medications, particularly some SSRIs (selective serotonin reuptake inhibitors). Sometimes this requires a change in medication to a different drug with fewer side effects, one that you tolerate better. This requires a discussion with your treating psychiatrist. Remember to be specific about your side effect symptoms and how they affect the quality of your life.

Fatigue can also be
related to insomnia
and poor sleep patterns, which often occur along with depression. If this is a cause of your fatigue, adhering to good Sleep Hygiene practices will benefit you. Finally, fatigue may be
related to other medical problems
you may have. These problems may include diabetes; low thyroid condition; kidney, liver, lung, or heart disease; and others. These conditions do not necessarily cause the fatigue; there is just a potential association. In these cases, work with your treating physician to optimize your other medical conditions as best as possible.

What Helps with Fatigue?

Begin by investigating the conditions that may be contributing to your fatigue and work with your treatment team to modify what you can. You may need to avoid those antidepressant medications
that are likely to worsen sleepiness and fatigue, choose antidepressant medications more likely to help resolve the symptoms, and consider using an additional medication that targets fatigue. Discuss these options with your psychiatrist.

Next, stick to the Basics of Mental Health covered in the first chapter of this book. Remember to have regular nutritious meals, follow a regular sleeping and waking pattern (with a goal of getting 8 hours sleep per night), take your medications as prescribed, avoid alcohol and illegal substances, maintain a daily routine and schedule, and keep up with social contacts. Then, even though it sounds difficult, get out and exercise a little every day, at a moderate level, based on your current ability. Yes, even when fatigued! You will be surprised how much exercise will improve your energy level.

Symptoms of Depression

Depression affects your thoughts, feelings, and behaviors, which can interfere with the quality of your life. The most common symptoms include a deep feeling of sadness, loss of interest and pleasure in your usual activities; changes in appetite, weight, and sleep; loss of energy; fatigue; irritability; feelings of worthlessness, hopelessness, and guilt; difficulty thinking, concentrating, and making decisions; and thoughts of suicide.

The form on
page 43
provides examples of common thoughts, feelings, and behaviors related to depression. Check off those you can relate to and share this information with your treatment team.

Symptoms of Elevated Mood

The extremely elevated mood of bipolar disorder affects your thoughts, feelings, and behaviors, which can interfere with the quality of your life. The form on
page 44
provides examples of common thoughts, feelings, and behaviors related to elevated mood. Check off those you can relate to and share this information with your treatment team.

 
SYMPTOMS OF DEPRESSION 

NEGATIVE THOUGHTS

__ I deserve this.

__ I am being punished.

__ It’s all my fault.

__ I can’t make decisions.

__ I can’t remember anything.

__ Nothing good will ever happen.

__ Things will never get better.

__ I never do anything right.

__ I am not as good as everyone else.

__ Nobody will ever care about me.

__ I am worthless.

__ People are against me.

__ I should do/be _____________.

__ I have wasted my (life, education, opportunities).

__ There is no hope for me.

__ I think about dying or suicide a lot.

FEELINGS

__ I feel sad for no reason.

__ I don’t feel good even if good things happen.

__ I feel worthless.

__ I feel bad, inferior to other people.

__ I feel guilty about everything.

__ I feel easily annoyed or irritable.

__ I fear that something terrible will happen.

__ I feel tired all the time.

__ I am not interested in anything.

__ I am not interested in sex.

BEHAVIORS

__ I cry a lot for no reason.

__ I sleep too much.

__ I sleep too little.

__ I eat too much.

__ I eat very little.

__ I drink too much alcohol.

__ I recently gained a lot of weight.

__ I recently lost a lot of weight without trying.

__ I stay in bed or on the couch all day.

__ Sometimes I don’t take a shower, wash my hair, or shave.

__ I have trouble starting or finishing projects.

__ I avoid people and isolate myself.

__ I do not return telephone calls.

__ I have stopped my previous activities, hobbies.

__ I stopped exercising.

__ I argue and fight with people for no good reason.

__ I am fidgety and restless.

__ I move or speak slowly.

__ I have trouble concentrating.

__ I have difficulty reading the newspaper or following shows on TV.

__ I can’t keep track of my thoughts well enough to have a conversation.

__ My house is more disorganized than usual.

__ I forget to pay bills.

__ I forget or don’t do laundry or other household duties.

__ I call in sick to work or school a lot.

 
SYMPTOMS OF ELEVATED MOOD 

ELEVATED THOUGHTS

__ I have special abilities.

__ I have a lot of good ideas.

__ My thoughts are really great.

__ Many people are interested in me and my ideas.

__ Many people are against me.

__ I get very focused on a project or cause.

__ My thoughts jump around quickly from one topic to another.

__ Other people say they can’t follow what I’m saying.

__ The rest of the world is too slow.

__ It takes others a really long time to do things.

FEELINGS

__ I feel good even when bad things happen.

__ I feel happy without reason.

__ I am very self-confident.

__ I have lots of energy even when I get less sleep than usual.

__ I feel optimistic about everything.

__ I feel great, on top of the world.

__ I feel that everything will go my way.

__ I feel that nothing bad can happen to me.

__ I am easily annoyed or irritable.

__ I am very impatient.

__ I feel more interested in sex than usual.

BEHAVIORS

__ I sleep less than usual and don’t feel tired.

__ I laugh a lot or for no reason.

__ I am more talkative than usual.

__ I am fidgety and restless, and I pace a lot.

__ I have trouble concentrating.

__ I am easily distracted.

__ I start lots of new projects and activities.

__ I have increased my activities, work, hobbies.

__ I don’t finish projects before starting new ones.

__ I am much more sociable than usual.

__ I make more phone calls than usual.

__ I spend money, go on shopping sprees.

__ I make impulsive decisions.

__ I tip excessively, gamble.

__ I take more risks than usual.

__ I do more risky or dangerous activities.

__ I start arguments or fights for no reason.

__ I drive fast.

__ I increase my use of alcohol or drugs.

__ I dress more flashy than usual.

__ My handwriting is larger and messier.

Mood Chart

Use the chart on
page 46
to record your mood every day, then share it with your provider. Check the box that best estimates your mood for that day, such as a depressed or elevated mood that is severe, moderate, or mild in intensity. Doing this will help you track fluctuations or identify a pattern in your moods. Use the Notes column to record anything that might have affected your mood—stressful events, medication changes, or (in women) your menstrual period.

CHAPTER 3
Defining Your Baseline

What Is Your Baseline?

With depression, you may have difficulty remembering what you were like before the episode. You may often struggle to differentiate the symptoms of depression from “just me, my regular self.” Depression can take away your sense of who you are as a human being (your inner sense of self). It feels like there is nothing
but
depression in life. You forget what you are like, or used to be like, and you may not feel familiar to yourself. You may forget what your basic competencies are, your baseline skills and accomplishments. In managing depression, you have to
find a way to stay connected to your inner sense of self
, to your baseline person. Having your baseline healthy self to draw on is an important aid during your recovery. This will help you envision what you are working toward.
You
are not your depression.

How do you do that?

One way is with the following exercise …

Step 1

Create a list of your strengths and weaknesses, personal preferences, beliefs, values, skills, and competencies. Be realistic when you assess your strengths and weaknesses.

Include your personal preferences, your likes and dislikes, needs, wants, skills, values, beliefs, opinions, sense of purpose, what nourishes you, energizes you, gives you pleasure and enjoyment, a sense of perspective and calm. Identify what makes life rich and full for you.

 
STRENGTHS AND WEAKNESSES 

This exercise is one of several steps to help you connect with your sense of self. In each column below, list your personal strengths and weaknesses. Be honest with yourself. Get feedback from others who know you well if you have difficulty doing this exercise.