Support For Depression

CREATING MOOD MAPS

Mood Changes: Looking for Signs

The sign reads, “You are now leaving Utah. Welcome to Colorado!”  The map on the front seat of the car and the sign tell us that we are leaving one state and entering another. If only we could have a guide to mood changes that were so clear.

People with mood disorders often describe symptoms “sneaking up on them,” something like this: I think I’m okay, don’t feel depressed, just tired, gee my family drives me wild, I wish my coworker would be quiet, OhMyGod – I am depressed. How did that happen?

Mood changes are by nature tricky. We are trying to assess ourselves with the organ of perception itself. In the midst of depression, folks often cannot recall feeling well. They may intellectually know but can’t remember the feeling of well being. The same is true regarding well being. When symptoms subside, people often doubt themselves. Was I really depressed? Maybe I exaggerated how bad I was feeling. It is at this point that people may decide to go off their medication because “it isn’t doing anything.”

In acute phases clients may be asked to fill out daily mood charts in detail. Keeping up this degree of record keeping can be cumbersome. So what works? How can a person check in with themselves in a way that is effective and increasingly so with practice?

Idiosyncratic Mood Change Indicators

That’s a mouthful isn’t it? And what the heck does it mean?

It means that most people with a mood disorder can report subtle changes specific to them.

Changes in relating to everyday activity:

Examples: I stop making my bed, procrastinate about doing the laundry, forget to feed the fish, stop answering the phone, can’t stand to listen to music while driving.

Physical quirks:

Examples: some people report jaw tension, a particular feeling of clumsiness, changes in diet, cravings or digestion, a flatness/tightness to facial expression. A number of people have told me that there is a distinct change in the tone and quality of their voices that they and loved ones can recognize almost immediately. Some folks notice changes in their visual perception- the world literally looks grayer, less vibrant.

Activities that are only engaged in during a mood change:

Examples: conflict with particular people that only tends to happen under the stress of symptoms, driven behavior that isn’t easily interrupted (like playing computer solitaire for endless hours, to the exclusion of a regular rhythm of sleeping, eating, and engaging), stopping at a convenience store for candy bars, buying Red Bull.

The Short List

I often encourage clients to write this mood change indicators on an index card and carry it in their wallets or tape inside their medicine cabinet. When the question comes up “how am I doing, am I getting depressed?” the index card is a place to start.

Self assessment in the middle of change is difficult.

The ability to pull out a good map and take a quick look can be immensely helpful.

Recognizing mood changes sooner can promote empowerment. “I see what is taking hold and can be proactive.”

It is another step to taking the symptoms less personally and be able to work with and master them.

The Short List can be shared with practitioners. It can become a tool for clear, short hand communication about the flow of mood states.

It can decrease the float time of feeling isolated and confused about what is happening and hasten the mobilization of support.

Pulling it all together

Sara has had numerous bouts of depression. When she is feeling well she is a wonderful free lance writer, enjoying her work and the connections it brings. Her short list looks something like this:

Changes in everyday activity: I stop washing my face and brushing my teeth before bed because I feel too tired and it just feels like too much work. I wear three or four outfits over and over.

Physical quirks: My jaw feels tight and it is effortful to smile. My smile feels false in a particular way.

Activities that are only engaged in during a mood change: I go to fast food drive thrus.

I close the curtains in the living room.

Now when Sara has the thought that she might be getting depressed she uses her list as a quick look in the depression symptom mirror.  She brings consciousness to subtle changes that she was able to rationalize and sweep away in the past. Those cues are now her call to self care and action. (See article called Sitting Small)

Take a moment to consider and begin your short list of mood change indicators. Add to it as you notice these subtle cues.

Working with Bipolar Disorder and Depression: Routine, Rhythm, and Reflection

Part 3 of a 3 Part Series

Reflection: Coming to Stillness

“So Frank, how was your week?”

“I don’t know. The day or two after our meeting I thought a lot about what makes a good day and what is important to me but I don’t feel like I got much done. I don’t even remember what I did exactly.”

“That’s fine. Let’s take a look at your schedule from the week. It’s a perfect opportunity to work with reflection. That’s when we pause before moving forward to see where we’ve been.

“In this high speed, high activity world of ours it is easy to feel like we are being swept away or flooded. After a week of activity it is helpful to take the time to come to stillness to appreciate our journey and to correct our course as needed. Interestingly enough it is a time of self acceptance.”

Read the rest of this entry »

Working with Bipolar Disorder and Depression: Routine, Rhythm and Reflection

Part 2 of a 3 part series

Rhythm: Weaving together Meaning and Every Day Life

Frank came into his next session both excited and frustrated.

“I am actually doing pretty well with the basics at this point. My sleep has improved a lot since I first started meeting with you. My wife is great about taking care of meals so I have a lot of support. But this feels so kindergarten to me. Just keeping up with the basics isn’t enough,” Frank said.

Routine is the foundation. Let’s spend some time today talking about rhythm.
Rhythm can feel like graceful movement thru the course of a day. You’re not expecting too much or too little of yourself. There tends to be a variety of activity: taking care of the ordinary details like washing the dishes, having some sense of connection with others, activity that is infused with personal meaning, time to relax, time to play. Let’s look at this together. Read the rest of this entry »

SURVIVAL MODE*

Betty says to herself, “Oh lord, I am so behind on things.  How do other people stay on top of everything?  Today I’ll get as many items checked off my list as I can whether they are top priority or not.  Oh God, I never got around to the taxes, and it’s April 14th!  I always put them off because I’m afraid I won’t do them perfectly.  I’ll be up most of the night again…”

A name for this way of living is …
“Survival Mode”

Mood issues affect the frontal lobes of the brain.  The frontal lobes help us envision the future, and they control planning skills.  People with mood challenges or those of us who grew up in a chaotic environment often have time management problems.  Being late to appointments, procrastinating, or feeling constantly too busy are all natural brain symptoms of depression.  They aren’t symptoms of being lazy or bad.  It’s not personal.??Survival Mode’s mantra is:  “I’m doing the best I can.  I’m doing the best I can.”  Doing the best you can is more about coping and getting by than choosing how to spend that day, or week, or year.  Choosing feels a lot better than coping. Read the rest of this entry »

Working with Bipolar Disorder and Depression: Routine, Rhythm and Reflection

Part 1 of a 3 part series

Routine: Creating a Container for Mood Changes

Frank groaned and rolled his eyes when I suggested that we work with his schedule.
Schedule almost qualified as a dirty word in Frank’s personal dictionary.

“I don’t want to write down the stuff I am not doing. It’s bad enough that I am not doing it.  I don’t want to hit myself over the head with my failures.”

“Frank,” I say, “we’ve got to start somewhere and we’ll be in this together. We are not looking for success or failure but we are looking for WHAT WORKS.  And specifically what works for you. You are being dragged around daily if not hourly by your mood changes and reactions. Let’s start building a container for all of that. Let’s start working with ways to soothe your brain and help you to stabilize.”

“It kind of scares me,” Frank says. “If we schedule every minute of every day I think I’ll just shut down.”

“Good point Frank, So would I ! So let’s start with some basic pieces and adjust and correct our headings each week.  You have already started, in fact. You’re sleeping better, getting up earlier instead of at noon. That’s the most basic and perhaps the most important routine – night and day. Sleep and wake.”

“Yeah, I don’t feel like I am falling apart all of the time now – just some of the time.
Big progress,” Frank says, almost rolling his eyes again.

“It is progress. You don’t have to believe me right now, but good sleep is the foundation for everything else in your life. Let’s look at your morning routine. How do you start your day?” Read the rest of this entry »

Medication Reminders:

Making med taking easy at the beginning of the year.

For folks who take medication for depression (and just about any other condition) there are some important ways to take care of yourself. It’s estimated that about half of us have a difficult time taking medication as prescribed for a variety of reasons. The beginning of the year is a fine time to look at your systems and backups for taking medication regularly. Read the rest of this entry »

Some rough days may be coming. Paula sits on her couch pulling a pillow to her chest. She makes a mental list:
My sleep hasn’t been so great for about a week.
I just want to lay on the couch during the day,
I’m not walking Charlie (her collie).
I felt super awkward at the potluck with friends and couldn’t connect.

She feels worried and guilty about all that is not getting done and at the same time wants to watch old sit com reruns for about a year and forget everything. Oh man, it looks like it’s time to sit small.

Paula has lived with bipolar disorder for a number of years. She recognizes that she is moving into a period of depressive symptoms.  Paula does well most of the time, but stress, a new relationship, seasons and light changes- who knows maybe even the alignment of the stars- can throw her moods off balance. She has learned over time, and painfully, that these mood changes weave in and out of her life. She used to hope that she would simply one day be cured. She still hopes that deep inside.

In the meantime she has strategies.  Paula has become a master of recognizing these changes and putting her sitting small plan into action. Read the rest of this entry »

UNIFYING PRINCIPLES 2:  BIG ROCKS FIRST

Big Rocks First

A teacher puts a gallon jar on the desk and sets a pile of fist sized rocks next to it. She asks the class how many rocks they think will fit. As they call out their guesses, she places one rock after another in the jar. When she asks the class if it is full, they reply with a resounding “Yes!”

But wait she says. Then she brings out a container of gravel. The smaller bits of gravel lodge amongst the larger rocks. Next, sand poured into the jar slides into the spaces between the rocks and gravel. Finally water is poured in to fill the jar to the brim.

What’s the point ? If you were to do it in reverse the big rocks wouldn’t fit.

(*please note: after writing this article I saw this time management story attributed to Steven Covey in his book First Things First)

What does this have to do with Unifying Principles? The big rocks represent what is most important to us. The gravel, sand and water are the activities of daily living that surround the more deeply meaningful activity.

This simple demonstration encourages us to plan and prioritize the important stuff first. The dishes will get done, the garbage will get taken out. But your exercise routine, time to paint, write poetry, practice piano, take a hike with a friend, meditate, play crazy eights with your kids….

I invite you to take a moment for reflection. Think of a week when you were able to put the big rocks first.  Usually there is a sense of bodily satisfaction from engaging in what holds meaning.  As an added bonus, the “filler” material is often more satisfying as well.

For me, writing this newsletter is a big rock. And I fully expect that grocery shopping and cooking later today will be enhanced by having taken the time to be creative, to be of benefit and to express myself through writing. Read the rest of this entry »

Susan is befuddled. She feels awful. She is tired all of the time, she is unnecessarily cranky with her kids, and there is no excitement about her life. Her husband wants her to take some classes at the local college, thinking the stimulation might be good for her. Her mother tells her to count her blessings and quit taking things so seriously. Her friend, Tina, is worried about her. Her family doctor wants her to take vitamins and exercise. Susan feels a tinge of recognition and panic when she hears the ads on tv for all of the antidepressants. The lady at the health food store told her those medicines are poison. At the end of the day Susan still feels befuddled and awful

What does the word depression mean? Read the rest of this entry »

Unifying Principles: What’s the glue that holds your life together?

Who am I? Where am I? And what do I want?

The roar of competing demands is loud, excruciatingly loud in our culture. Work, family, primary relationships, friendships,  maintenance of ourselves and everything we own all require our attention.  We have more access to more information, choices and things than we can possibly process.  I heard an informal survey on a morning radio program that more than 70% of us think we will “have more time next week.”

Most of us are externally driven. I often ask clients and students to show me their schedule books. Invariably, they first list the places they have to be, where someone else is expecting them to show up. Work, dental appointments, classes- all of  this is  listed first and often it is the only type of material in a day timer. Take a random sampling. Ask ten people if you can have a look at their appointment book. I’ll bet nine of ten will only record the “have to’s”. It’s a never ending ride of one commitment to the next and the next and the next and all of the in between spaces are a blur of filler. Read the rest of this entry »