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 1

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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“Sharon, I Have Something to Tell You.”

At the time Sharon and I finished writing our book together, my life was stable and I was content. My mom and I had been living together for almost eight years and had settled into a routine that worked well for us both. I had a job that worked for me, doctors that I liked and felt comfortable with, and friends who offered a steady social life. Unfortunately, while I was content, my mom was not.

Mom was in her sixties and still working part time at a stressful job. She really needed to retire. I had sensed for a long time that she was feeling like she was in a rut, and needed to make some changes. Mom was ready to move out of the home we had moved into in when I was a child, as keeping up with the landscaping maintenance on the large property and making the necessary repairs was becoming too much, even with my help. She wanted to move into a condo, so she wouldn’t have to worry about yard care and other home maintenance. We had been talking about this for several years, but never seriously starting looking for new places.

Five or six years ago, one of my mom’s friends re-connected with her via Facebook. My mom and Betty had been friends since my mom was nine years old. They had been close enough that Mom was a bridesmaid in Betty’s wedding. Life intervened, and they had lost touch until Betty found Mom on Facebook nearly fifty years later. Betty lives in Florida and after a couple years of communicating via phone calls and Facebook, my mom went to Florida to visit her in February 2015.

During this visit, Betty campaigned to have my mom move to Florida to live near her. Mom came back from that trip and started talking to me about that possibility. We talked about it, but at that time neither of us was ready to consider a huge move.

Mom had really loved the town in Florida where Betty lives, and immediately made plans to return for another visit in February 2016. Because she was thinking about moving there she really wanted me to see it, so I accompanied her on this trip. While we were there, Betty took us around town and showed us different neighborhoods that would be nice to live in.

I loved the area too, and it was great being in Florida in February. The weather was perfect, and we were able to go to the beach and lay out by the pool. When we returned from the trip my mom and I started talking about the possibility of actually moving there.

We discussed the pros and cons of moving to Florida ad nauseum. We talked about getting a condo in the town where we were living, close to family and friends. We talked about the fact that neither of us likes change, and moving to Florida would be a huge change. We made lists of the things we would have to do in order to move out of state, like get new doctors and arrange for long distance movers. Of course, whether we moved to a condo in our current town or to a place in Florida, there would also be the huge job of downsizing our belongings to move to a smaller home.

Even though it seemed like an overwhelming idea to move to a new town, a thousand miles away from loved ones, it was also exciting and energizing. Mitigating the fear about changing our lives so drastically was the assistance of Betty, who supported us and cheered us on through the whole process.

We were going to move out of our current house whether we moved to Florida or not. We discussed it over a period of several weeks. And we both kept remembering how nice it was to be in Florida in February. I don’t remember what made us both finally decide. Neither of us is very decisive. My mom made it very clear she would not move unless I was okay with it, as she was concerned about how I would manage the enormous stress involved. So, I guess I was the one who made the final decision.

It was completely out of character for me to want to move to Florida, given my discomfort with change. I wasn’t in a rut like my mom (or if I was, it was a good rut). I shouldn’t have needed to make a drastic change. I was a little worried, along with my mom, about remaining stable with the enormity of the change I had agreed to. I didn’t really know what to expect from myself. However, I have a streak of impulsivity that battles with my fear of change. I think back to my decision to go to college in Arizona as an 18 year old, which nobody could’ve predicted.

I have to be honest, and admit that my love of the sun and dislike of snow played a part in my decision. I was tired of Midwestern winters and loved the idea of laying in the sun year round. Of course, this is also the biggest reason why I shouldn’t have moved to Florida, given my propensity for skin cancer.

So, in March 2016 I called Sharon and asked if she would meet me for lunch. I had to tell her about my decision…

 

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We Have a Book. We Think It’s Pretty Good. Now What?

We now have a book. We’ve gotten good feedback from people who’ve read it. Recent reviews have been very positive. So now what? People who are experienced in the book publishing world will probably laugh at us, but when Robin and I started writing our book we did not think about getting it in front of the people who would actually want to read it. I know that makes no sense. What is the point of writing a book if you don’t have a plan to promote it?

The truth is, Robin and I actually never thought beyond writing the book and self-publishing it. The goal was just to get it finished. Many good things have come from this process. Most importantly, Robin has told her story. She has done her part in fighting the stigma of mental illness by courageously making herself completely vulnerable. She has shared the most embarrassing details of the way in which her illness has affected her life and continues to do so. At times, this has been difficult for her. Sometime I should ask her to write about this (sorry Robin, you can say no). But she has received incredibly supportive and amazingly positive feedback from her friends and family. I firmly believe that the process of telling her painful story has helped Robin achieve a new level of healing. She remains stable and content.

For me, writing this book helped me become a better writer. I have journaled since I was ten years old. But writing in a journal and writing for an audience are two different things. It was foreign for me at the start of this process to think about being descriptive or focusing on telling a story. I actually had fun working on learning to write in a new way.

Another positive outcome has been sharing a project with Daniel, my nephew who edited our book. He is now in graduate school, but it was fun to learn how good he is at writing and editing. It was a connecting experience for Daniel and I to work together on this book. So for different reasons, whether we ever find our audience and sell lots of books or not, Robin and I are both viewing this project as a complete success.

Robin is working on a blog post or two in which she is telling the story of what made her decide to move to Florida, and how she is doing now. I will be commenting on my own reaction to her announcement that she was planning to make this major move! It is important for our readers to know that she is still doing well. Robin is mostly done with spending time on our book, this blog, and the painful reality of her mental illness. Instead of living in her past, she is now focused on enjoying her new life. I don’t blame her for wanting to put the most painful years of her illness behind her. It is very healthy for her to move on.

I, on the other hand, am feeling compelled to try my best to get our book in the hands of the people who can be helped by it. So without any previous planning, I have found myself immersed in the foreign world of book promotion. I am a psychologist. I am not a book promoter. Talk about a learning curve! To make matters worse, I am in my fifties and have no clue about the whole social media thing. I’ve never been on Twitter, Instagram or Pinterest. Do I really need to be? Yikes! We will see…

I will continue to update our readers about my feeble efforts to promote the book, but for now I just want to thank everyone who has bought or read it. If you have read it and are willing to post a review on Amazon, Goodreads or both, Robin and I would be eternally grateful!

Stay tuned for Robin’s update!

 

 

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