Effective Treatments for Depression – Part One

Last month I discussed the symptoms of depression. So, what if you’ve accepted you may be “depressed” in the clinical sense, which means you need to pursue treatment for it? For most people, this is a scary step. When you have depression it’s hard to get motivated to do things. To do something new which involves making yourself very vulnerable, feels impossible. But, going forward without doing something different, feels even more impossible. You are ready to “suck it up” and talk to a professional about your symptoms. Good for you!

People have varying opinions about what type of provider to see first. Research has repeatedly concluded that the most effective treatment for depression usually involves a combination of both psychotherapy and medication. Some people are more afraid to talk about their feelings and prefer to start by taking medication. Others want no part of this, and would prefer just talking to someone.

In my opinion, where you start is less important than making sure you take a positive step forward to get help…from anyone. If you want to try medication first, most primary care physicians are willing to prescribe meds for depression and do so frequently. If you want to go straight to an expert, psychiatrists are the physicians who specialize in treating mental health issues with medications.

There is relatively little risk involved in trying one of the newer antidepressants. If there are any side effects that become intolerable, gradually decreasing and stopping the medicine will almost always resolve them. Most importantly, these meds tend to be quite effective in alleviating both depression and anxiety symptoms, although it takes several weeks for them to work.

If you prefer to try overcoming your depression symptoms without medication, the best option is to find a good psychotherapist. There are psychologists, social workers, counselors, and marriage and family therapists among others who practice psychotherapy. Lots of people will say one or the other of these professions is superior to the other. In my experience, whether someone is an effective psychotherapist has less to do with their degree and more to do with their experience and about who they are as a person. It helps to find someone who has a license in their given profession, as this means they have had at least a minimum amount of supervised experience. It helps to get referrals from other people about who the good therapists are. If you don’t want to tell friends or family you are looking, ask your primary care physician for a referral. They usually have therapists in their community who they collaborate with (and if they don’t, they should).

The advantage to starting with psychotherapy is that your therapist can help to figure out whether medication is likely to be a necessary step for you, or not, depending on your individual symptoms and issues. Depression is usually caused by a combination of biological factors and psychological or situational factors, which is why treatment often (but not always) needs to involve a combination of approaches. A good psychotherapist should be able to help sort this out. Next month, I will give my opinion about the best way to sort out these issues.

Next Month:  Effective Treatments for Depression – Part Two

See this post on “Review Tales”

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Robin Settles in Florida–Part Two

In August of last year, I finally got a new job after nearly a year of looking. I was hired as a cashier at a local Goodwill store. I’ve never been a retail cashier, but I have worked at Goodwill and I think that helped me get the job. Not surprisingly, this was a stressful position for me. Having lots of people waiting in line, staring at me and sometimes getting frustrated with the wait, on top of having to be friendly and social while stressed, was difficult. Goodwill gets very busy at times, and it was made worse by the fact that we were short several cashiers due to firings and transfers to another store.

To add to the stress, the staff shortage meant I was being scheduled for too many hours, which resulted in me earning too much money. I can only make a certain amount each month and still retain my disability benefits. When I am job hunting, it is always a dilemma for me in terms of whether to disclose this issue during the interview process. While Goodwill is very supportive of hiring people with disabilities, the stigma still exists and I’m hesitant to broadcast that I’m mentally ill before people get to know me. In this case, I had followed this strategy. So, the managers did not know I could only work a certain number of hours. They just thought I preferred part-time work, and that scheduling me for more hours temporarily wouldn’t be an issue. Worrying about losing my disability benefits just added to the already intolerable stress of being a cashier.

I was at a point where I was clear I couldn’t continue in this situation. I was quite relieved when, three months after starting the job, an opening came up for a “store clerk” in the same store. I told my manager about my disability, and that I was making too much money. I used this to justify my need to change jobs, rather than saying I couldn’t handle the stress. The store clerk position pays fifty cents an hour less than the cashiers earn. She was supportive, made it clear she didn’t want to lose me as an employee, and agreed to give me this position and limit my hours to twenty-six per week.

The role of store clerk is to stock the clothing on the racks, assist customers at the jewelry counter, clear the clothing from the fitting rooms, and keep the store looking nice (I spend a lot of time picking clothing off the floor and re-hanging it). It’s an active job. I’m constantly moving around. I used to wear my Fitbit activity tracker to work, and it was common for me to walk five miles on the concrete floors during my shift. Early on, when I left work I could barely walk because my feet hurt so badly. I’ve gotten used to it since then and my feet only hurt a little when I leave work.

So, about a year and a half after our big move to Florida, I finally felt settled into a job that works for me. It was a long haul, but I am relieved and glad to not have to worry about this anymore. It is helpful to have structure, social contact, and most importantly more income.

Soon after I began working at Goodwill, in September 2017, we had our first major hurricane since we had moved to central Florida. The weather people start following potential storms way early, so we had plenty of time to prepare. About six days before the actual hurricane was supposed to hit, all the stores in town were out of bottled water and other supplies. Hurricane Irma was predicted to hit our town sometime on Sunday, so my mom and I spent Saturday moving her plants from the yard to the carport area, under a roof. That afternoon we packed some clothes and our dog, Otis, and went to our friend Betty’s house.

We added Otis to our family in December 2017. He’s a young Maltese and Yorkshire Terrier mix. He’s very cute and energetic. Anyway, we went to stay at Betty’s house because her home is more secure in the event of tornadoes. Betty has a dog also, a year older than Otis, named Jojo. Jojo and Otis did well together while we were there, considering Otis is very playful with other dogs and Jojo is, not so much.

We started following Hurricane Irma’s progress on Sunday, as it moved toward Florida and changed in intensity. It was very windy and rained heavily all day and evening. At one point we got a tornado warning for our area and had to huddle in the hallway, which was scary for a bit. Of course, with two dogs, we had the joy of taking them outside in the storm to go to the bathroom. Both dogs hate rain, so our trips outside were brief. It was cute though, that Betty had two little doggie rain jackets which we put on them. At about three a.m. or so Irma came through central Florida as a Category 3 hurricane. Betty and I were both still up at that point, but my mom had gone to bed. I think the stress and tension had drained her, and she just needed a break.

I didn’t have to work on Sunday or Monday, as Goodwill closed due to the hurricane. On Monday we went home to assess the damage. We had learned from a neighbor who stayed home through the storm that our neighborhood had lost power on Sunday. We saw why when we got close to home. There were trees down along the street next to our entrance, and electrical wires were down. The only entrance to our community was flooded and impassable, so we had to drive through an empty lot to get into the community. We finally got near our home, passing several others that had roofs ripped off. My mom cried with relief when she saw that our home had only minimal damage to some trim around the roof. We were very fortunate!

Our neighborhood was without electricity for a week after the storm, so we stayed with Betty during that time. I think we got through the whole experience well, all things considered. It was stressful and scary at times, but we were lucky (again) to have Betty. It would have been worse had we come home the day after the hurricane and had no power for a week. We were very glad to have someplace cool to go…our neighbors had to deal with the heat and humidity of September in Florida without air conditioning. I was quite happy to get through our initiation to Florida hurricanes. It was something I had been nervous about when we made the decision to move.

(Continued in Part Three)

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You May Have Depression and Not Know It

For people who are unfamiliar with mental illness, the term “depression” usually applies to someone else. The stigma about mental illness causes people to be uncomfortable identifying with this concept. They may not even think about it, but amazingly, they could have it but not know it.

What is depression? It is a change in the biochemistry of the brain caused by stress. It is consistently estimated that 20-25% of people become clinically depressed at some point in their life. That’s one out of every four or five people. Think about how many people that is!

I worked as an outpatient psychotherapist at a large mental health center for almost 20 years. It was not an infrequent occurrence to have people arrive for treatment after having waited for their depression symptoms to get bad enough to seriously impact their functioning. They would present with issues including insomnia, relationship problems, job-related difficulties, or physical symptoms that had no medical explanation.

Once I identified that a client was depressed, I would say to them:

“Many people walk around with a moderate level of depression without knowing it. They drag themselves out of bed and go to work, because that’s what they need to do. They are able to ‘fake it’ and do okay through the day, but it takes an enormous amount of energy to do this. By the time they get home, they are exhausted from using all their energy to fake it through the day, and they collapse and don’t get done what they want to get done in the evening. Things pile up. Because they aren’t getting things done, they beat themselves up. They may or may not be able to sleep at night, but regardless they are exhausted. They may do things they would normally enjoy to try to cheer themselves up, but they have difficulty enjoying anything. They start to feel like things will never get better, and if it goes on long enough they don’t even remember that this isn’t the way life is supposed to be. It feels normal to them.”

More often than not, the depressed client could completely relate to this description. For the first time in a long time they became hopeful that things could get better. After appropriate treatment, they would often come back and say “Sharon, I can’t believe how much better I feel. I must have been depressed for years without knowing it. I should have sought help a long time ago.”

Unfortunately, for many of these people the next focus of treatment became working through their grief over the years they wasted due to living with depression unnecessarily.

The symptoms of clinical depression include sadness or irritability, lack of interest in activities, sleep or appetite increases or decreases, weight changes, low energy, feelings of restlessness, difficulty concentrating or making decisions, increased feelings of guilt or worthlessness, and feelings of hopelessness. Suicidal thoughts may be present if depression is particularly severe.

If you or anyone you know is experiencing some of these symptoms, please get help. Talk to your primary care physician, and ask for a referral for a psychotherapist.

Next month: Effective Treatments for Depression

 

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Check it Out…

When our book was first published, I spent quite a bit of time trying to promote it on-line. One of the methods I used was to contact book reviewers and ask them to review our book.

One of the reviewers who kindly agreed to do so, was Jeyran Main, whose blog “Review Tales” is wonderful. Here’s a link to her review of our book on her website:

Jeyran Main’s Review of Our Book on Review Tales

Robin and I were thrilled with her review, and grateful to her for taking the time to write it, and to post it on Amazon. But, as I have said, promoting the book has not been a recent focus as I am working on new ways of getting the word out about it.

So imagine my surprise and delight when, about a month ago, Jeyran Main contacted me and asked if I wanted to be a guest host on her website on a monthly basis! I jumped at the chance. I will be writing short blog posts about topics related to mental illness. Here is the link to the first of these posts, which was just published on “Review Tales:”

You May Have Depression and Not Know It

I am going to publish the articles on our blog as well. I’m happy to be able to continue to help decrease the stigma!

 

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Robin Settles in Florida-Part One

It’s been nearly two years since my mom and I moved to central Florida, and for the most part it’s been a smooth transition. We were able to take care of most of the changes in the first month, with the assistance of Betty, my mom’s childhood friend. We obviously didn’t know our way around town initially, so Betty took us to the license branch to get Florida driver’s licenses and to the library to get library cards. She also drove us to the utility office so we could have the electricity and water set up, and all of the other little things that have to be done when you move to a new state. She referred us to her family physician, and I was referred to a psychiatrist. It didn’t take long for us to learn our way around the area, and many things are located close by our home, like the doctor, my bank, grocery store, etc.

The logistics of moving were much less stressful for me than I expected, probably because of Betty’s help. It was more stressful for my mom, since she was the one buying the home, with all that buying property involves. In spite of it being a major change and the fact that change freaks me out, I managed the move relatively easily. It actually surprised me how well I was able to handle the stress. I think initially it didn’t feel real. Since I didn’t have to work, it felt like we were on a lengthy vacation. I didn’t look for a job for the first couple of months, since I wanted to get used to my new surroundings before I took on the stress of job hunting.

I began by looking for work online. Mostly I applied at retail places, even though I’m not keen on retail work. I applied at a nearby fabric and craft store, only because it was five minutes from home. I was hired as a stocker during my interview, and began working the following week. My job responsibilities included putting merchandise on shelves, unloading delivery trucks, and setting up displays. Had this been the extent of my job tasks, I might have been able to manage it. However, I had to be cross-trained as a cashier and fabric cutter. This proved to be too much for me, as too much contact with people stresses me, and I didn’t feel comfortable cutting fabric while multiple customers were waiting. I only lasted two weeks at the job. I probably shouldn’t have even applied there, since I know nothing about fabric or crafts. I was unfamiliar with the store and was not very efficient at cutting fabric. Their way of stocking and back-stocking merchandise was totally different from how we did it when I worked at Target. I felt overwhelmed, and eventually quit.

It was back to job hunting, unfortunately. It took a while for me to find another job, which was really stressful. I can only work part-time, and I am limited in how much money I can earn each month (because I’m on Social Security Disability Income). As a result, the job pool is pretty much limited to retail and food service for me, and I don’t want to work in food service. It seems like every job I applied for, a hundred others applied for too, and my job history has been spotty for the past fifteen years. Let’s face it, I’m not an ideal candidate even if I don’t tell them I have a disability.

Being unemployed created major stress, financially and emotionally. I was unable to contribute money toward living expenses and didn’t have funds to do fun things without borrowing from my mom, which led to guilty feelings. I began to get increasingly depressed about the situation as time went on. Pretty much all I did was lay in the sun daily. My sleep began to be less dependable and I was watching depressing music videos on YouTube at night while I waited to fall asleep. It became clear that I was beginning to destabilize again.

Fortunately, I was seeing my new psychiatrist, and he prescribed Seroquel after I explained that it’s always worked in the past to alleviate the onset of my bipolar symptoms. I stabilized fairly quickly, but with Sharon’s encouragement I decided to look for a therapist so I would have a relationship with someone who I could rely in during future periods of increased stress. I called my insurance company and got names of several therapists in my area who were covered by my insurance.

I chose a female therapist and made an appointment. I didn’t click with her at all and decided not to continue with her. For one thing, she questioned my diagnoses and suggested that I get off some of my meds. This is not an idea I wanted to pursue, as I have had bad results just trying to decrease dosages in the past. Someday I may be willing to try eliminating a drug, but I’ve done well for fifteen years on my current drug regimen and I’m afraid to mess with it.

Aside from this issue, I just didn’t feel like I would be comfortable working with this therapist. The fact that she was questioning my diagnoses in the first session was very unsettling. Frankly, I’ve been out of therapy long enough now, that it’s hard to start over again. I have a long and complicated history that is hard to relay to someone new. And, now that I’ve been mostly stable and easily re-stabilized for a number of years, I’m not sure I even need a therapist. The Seroquel quickly addressed my symptoms again this time, and I am back to being okay. I may look for a new therapist who I can be comfortable with at some point in the future, but it is not a top priority right now.

At the same time that I was looking into therapy options I was considering changing psychiatrists. I liked my psychiatrist and his office was only five minutes from home. However, I changed from regular Medicare to a Medicare Advantage plan. When I just had Medicare, I paid $60 for my fifteen minute appointments. My psychiatrist insists on meeting with me every three months, which I don’t feel like I need since I’m stable. I was doing it anyway, because I liked him and he was close by. However, when I switched to a new insurance plan, they began charging me $100 for the fifteen minute sessions. This is the self-pay amount because they don’t accept my insurance plan. This seemed like a lot of money to pay every three months, especially since I don’t even see him for fifteen minutes. He asks how I’m doing, we talk briefly, and then he refills my prescriptions.

Although these kinds of issues are the kinds of things that usually cause stress for me (any change in my routine), I didn’t want to be spending more money than I needed to. I called my insurance and got the names of psychiatrists who are on my new plan. I chose one that is close by and made an appointment. However, as it got closer to the appointment date I decided to stay with my current psychiatrist (due to convenience and a desire to minimize stress). I’d already been with this doctor over a year by this point, and didn’t feel like starting over again with someone new. I sucked it up and paid the $100, just to get refills. This still irritates me every three months when I see him, as it seems like a lot of money for access to my meds. I still need to find out why I have to see him every three months. It wouldn’t bother me as much if I could go every six months as I was doing prior to moving from Indiana.

So, my mental illness continues to cause the symptoms of anxiety and obsessive-compulsive tanning. But, the medications I take, including Seroquel as needed, have kept me out of the hospital since 2008. While I was not sure what would happen when I changed my whole life and moved to Florida, I am happy to say I now feel settled and content again. I did finally manage to find myself a new job that works for me.

(Continued in Part Two).

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Why Robin and I Have Been Absent So Long

I just looked and realized we have not posted anything on our blog since September, and only four times in the last year. I’m not sure any of our followers even remember us at this point, but I want anyone out there who still has an interest to know what’s happening.

Robin moved to Florida in June 2016. It’s been almost two years since she moved! Time certainly does fly. Robin is working on a series of blog posts that will update our readers in terms of what has happened for her during the past two years, and how she is currently doing. Those will be coming soon. They are currently being delayed by technological issues. I hate that!

Why have the updates we keep promising not happened earlier? Well, Robin has been caught up in her new life, and I have been caught up in some significant life changes of my own. I want to explain what I’ve been up to and a plan I have for going forward. It does relate to the book, and to some ideas I have about shifting the focus of this blog.

Those who read our story know that a major component of what helped Robin evolve from a place of despair to a place of stability and contentment, was that we actively worked together to shift her world view. In other words, I made a conscious decision to do what most psychotherapists do not typically do. I introduced Robin to a new spiritual belief system, with the hope that she might adopt it.

This is not typically done in therapy because we are taught to respect our clients’ beliefs and not to impose our own beliefs onto them. But, as I said in the book, desperate times with Robin called for desperate measures. Shifting her world view became a significant focus of treatment. And, Robin and I remain convinced that this was a major factor in terms of her being able to achieve and maintain stability, and to remain mostly content despite her severe mental illness.

I did not emphasize my own spiritual journey in the book, because it was Robin’s story. But there were so many profound ways in which witnessing Robin’s painful meltdown and recovery impacted me on a deep level. I truly believe it brought my spiritual development to a whole new level and changed me permanently and positively.

As I have said, I felt compelled to write the book for years. I believe this was driven by my spiritual guidance. I had no idea why we needed to write the book, I just knew it needed to be written. I didn’t know what to expect once it was actually done. There is no doubt that writing the book and being so completely open with all her friends and family has been a healing experience for Robin. But, I can’t believe we put all that effort into writing it just for that reason. I still believe it is supposed to reach a bigger audience.

How did promoting the book go? It was a miserable failure. I paid several different companies to blast it all over the internet. They did. It led to very few sales. I am not a sales person. Robin certainly isn’t either. And, I was not prepared to spend thousands of dollars to pay a professional promoter. I thought about trying to get a publisher, but eventually I got clear about what needs to happen with the book.

This leads me back to my new life path. During the last year I have been actively working on stepping up my spiritual evolution, which has led to a plan for some significant life changes. I am working on putting together a workshop for psychotherapists on how to integrate spirituality and psychotherapy. Robin’s story will be part of that workshop, and hopefully some of the workshop participants will be interested in buying and reading the book. (The plan is still for all profits from the book to go to Robin, by the way).

I am currently working on coursework to become a Certified Spiritual Counselor. And, in April I will start an intensive on-line class with a psychologist who is also a Spiritual Life Coach. This class is a prerequisite to her Life Coach training program, and requires people to do their own intensive, internal, spiritual work. We never stop evolving, and I am looking forward to digging deeper than ever before and continuing my own spiritual process.

There are some specific differences between psychotherapy and coaching. Unlike psychotherapy which focuses on helping people heal wounds, recover from painful experiences, manage mental illnesses or deal with stressful life circumstances, coaching focuses on helping people achieve their specific life goals. When spirituality is the focus, a life coach helps people navigate their own spiritual evolution which then translates to positive changes taking place in their lives. Coaches do not bill insurance companies, which makes life dramatically easier. No worrying about being an approved provider, getting precertification, or having to bill a reduced rate dictated by the insurance company. I can set my own fees.

Most importantly, however, coaching can happen over the phone. So, it will expand my reach from just South Bend, IN (where there is definitely not a big enough market for spiritual life coaches), to the entire world. This opens up so many exciting possibilities!

At this point in my career I am ready to make this transition. I’ve spent the last five years working in nursing homes, which has been a great job for me during this stage of my life. I find myself talking about spirituality with people almost daily. But, it’s a sad environment. Need I say more? It is time for a change.

So, in the near future, I will be making some changes to this blog in preparation for all of my plans. And, I will be telling the story of my spiritual evolution, for anyone who might be interested.

Thanks to all who have bought and read our book. There are some of you out there. We are so grateful!

 

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“Robin, What? You’re Moving?”

I’m sorry it’s taken so long to continue the story. Life got in the way. As we all know, it happens. I’ve been working on a whole new plan for marketing our book, which I will discuss in a different update soon. Tonight though, in honor of Robin who is hunkered down and sitting through Hurricane Irma in Florida (she is safe, I promise, and I will be trying to talk her into writing a special post at some point about her experiences), I am ready to continue the story that left our readers hanging so many months ago…

When Robin asked me to go to lunch in March 2016, I didn’t think anything of it. We hadn’t seen each other in awhile, and it was time to catch up. She and her mom had gone to Florida for a vacation and I was anxious to hear about their visit.

We talked about how things went, and talked about how things were generally going in my life. Then, Robin said, “Sharon, I have something to tell you.” Somewhat nervously, but definitively, she said, “My mom and I are planning to move to Florida.”

Okay, I have to back up before I talk about my response to this announcement. After Robin’s mom went to visit her friend Betty in Florida the previous year, she had come home and told Robin she wanted to consider moving there. When Robin told me this at that time, I have to admit I did not respond in the best way. As anyone who has read this story knows, I had been through hell and back with Robin in terms of her mental illness and it’s effects. Robin was finally stable and settled. Honestly, I was very concerned about the impact a major change like moving to Florida would have on her mental health. Her stability had been longstanding, but had never been tested to such a huge extent. I was very concerned about the ramifications of her destabilizing in general, but also having it happen so far away from all the mental health providers who were familiar to her.

I was deeply affected by the year in 2003 when Robin was so suicidal for so long. It’s hard to fully describe the sense of responsibility I felt to keep her alive during that year, no matter how stressful it was for me. Years later I cared for my mother-in-law, who had significant dementia. There were some similarities in terms of the need for me to just keep going, no matter how bad it got, until things changed one way or another. It was stressful, and exhausting.

In the case of my mother-in-law, I had to just keep going until she died. Thankfully, in Robin’s case it was until she was stabilized and didn’t need me to be her caretaker any longer. Years later we were eventually able to navigate the complicated transition from therapist/client, to friends and co-authors. But, I obviously remained very protective of her. And, I am still the person who knows better than anyone else in the world, how quickly and dangerously she can destabilize, given the right circumstances.

So, I have to admit that when Robin told me in 2015 that her mother was talking about the possibility of moving to Florida, I did not react as her friend. I reacted as her ex-therapist who was worried. She had gotten to a point where she was stable, and happy. She had a good job, friends, and was as content as she had ever been as an adult. My reaction came from a place of significant concern about how a major life change might cause her to destabilize. If I’m being totally honest, I was partly worried about getting drawn back into feeling compelled to be her caretaker. We had navigated the transition to me not needing to be in this role any longer. I did not want to deal with the complications of blurring the roles should she become seriously suicidal again. I expressed my concern about all of this to Robin. We had endlessly processed all the complications of the role changes through the years, so none of this surprised her. She seemed to hear me.

Because it was going to be a whole year before her mom returned to Florida for another visit, the topic was dropped. It became a non-issue. But, when Robin made her sudden announcement to me in March 2016, I knew completely why I had not been consulted during the decision making process. I knew why she waited until the decision was final before telling me.

I didn’t blame her. She knew how I would feel. She knew I would be worried, for all the reasons I had verbalized a year earlier. So this time, when she told me the decision had been made, I knew I needed to support her. My concerns were the same as they had been previously. Robin does not deal well with change, under the best of circumstances. I couldn’t imagine how stressful it would be for her to navigate all the significant changes that would be involved in re-locating to a whole new state, far away from her family and friends.

So, what was my response to Robin’s announcement?

My outside voice said, “Wow, Robin! I’m shocked. I didn’t see this coming. You know my concerns, but I am really happy for you.”

My inside voice? What was it saying? “Oh shit! I hope this works for her. God help us both if it doesn’t!”

 

 

 

 

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