If you go to Amazon.com and search for “depression,” you’ll be presented with more than 50,700 choices in the book category alone (as of late August). For someone looking to learn more about the disease, that number in itself can be a bit, well, depressing.
US News & World Report asked a handful of mental health professionals to help trim that number down to a more manageable amount by recommending some of their favorite books about depression. Find their suggestions here.
People Magazine reports that supporters of “Project Semicolon”, a group that is dedicated to presenting hope and love to those who are struggling with depression, are getting the grammatical symbol tattooed on their body to show solidarity with the project’s mission. Read the News
Many of us have experienced the instantaneous connection between food and mood. We may find ourselves crunching nervously through bags of potato chips when under pressure for example, or slurping down containers of cool and silky chocolate ice cream in distracted attempts to soothe our sadnesses. However, while an occasional hankering for sweet or starchy “comfort foods” is both normal and expected, for some, the link between negative feelings and out of control eating is far more profound. Recent studies suggest that the suspicious overlap in symptoms of major depression and food addiction may be due to deep biochemical connections that have gone largely ignored in treatment programs until now.
The coexistence of psychiatric diagnoses and problems with appetite is shocking common. One research study concluded that approximately 80 percent of patients with binge eating disorder (BED) and 95 percent of patients with bulimia met the criteria for at least one other diagnosis outlined in the Diagnostic and Statistical Manual of Mental Disorders. Overweight men and women are 25 percent more likely to suffer from mood disorders than the rest of the population. Between 15 percent and 40 percent of patients with eating disorders also struggle with substance abuse.
Strikingly, 75 percent of patients with eating disorders also suffer from depression. For those individuals with binge eating disorder who are overweight, one study found that rates of depression are even higher than for individuals who are overweight but do not have binge eating disorder. In this particular study, researchers found that symptoms of depression led to binge eating episodes. Other studies have found that depressive symptoms, including low self-esteem, predicted increases in binge eating, demonstrating further evidence of the relationship between depression and binge eating. These results suggest that for some binge eating is a way to regulate emotion, however they also reveal that there is something more to the association between food addiction and depression than previously thought—something disruptive, persistent, and physiological.
A look into the intricate neurochemical underpinnings of depression and binge eating disorder provides a clearer understanding of the biological nature of their troubling comorbidity. Interestingly, depression and food addiction both involve alterations in neurotransmitters, the substances that relay messages from one brain cell to another and then to the rest of the body. We know that imbalances in any of the neurotransmitters can wreak havoc with brain circuitry and predispose individuals to mental and physical distress. Normal levels of serotonin, the neurotransmitter linked most closely to satisfaction, lead both to emotional satisfaction and a sense of fullness after a meal. Low levels, on the other hand, can lead to depression and a tendency to binge on sweet and starchy foods. In fact, one study looking at how depression and a gene associated with lower levels of serotonin related to binge eating found that depressed children and older females who carried this gene were more likely to engage in binge eating behaviors.
In the context of a biochemical perspective on binge eating, this correlation makes sense. For some binge eating foods begins as a way to find a moment of much needed relief from depressive tendencies, and to fill the emotional void left by a lack of serotonin. However, what begins as a seemingly innocent attempt to self-soothe, quickly gives way to a complex cycle of addiction in the body. The flood of endorphins from eating large amounts of food only temporarily alters the neurochemistry of the brain, providing brief periods of solace from emotional distress; but these are not lasting. Ultimately, the demand for food intake to achieve such pacifying effects only increases over time and the coping mechanism completely fails, exacerbating instabilities with mood.
More research is needed to examine the precise mechanisms by which a serotonin deficiency can affect food, appetite, weight gain, and mood, and the causal nature of this overlap. However it is evident from the current body of scientific literature, that a holistic approach to investigating the interplay between an individual’s relationship to food and co-existing mood disorders is essential in order for successful recovery opportunities to exist. Treating one problem in isolation is not enough. It is only by comprehensively assessing the neurochemical commonalities underlying such complex psychological conditions that sustainable treatment solutions become possible.
By Stephen B. Jones, M.D., psychiatrist.
One study found that as many as eighty-percent of all people in this country that suffer from clinical depression don’t get any treatment.
Given that depression is the leading cause of disability in the U.S. and that over 20 million people are afflicted with it, that’s a lot of people – about 16 million.
However, many of the law students, lawyers and judges with depression that I’ve met tell me that they don’t need to be told to get help because there are already getting it. They’re already in therapy, taking medication or both. They get it. They know that depression is an illness and they have to deal with it.
Some of them have been coping with it for a very long time. I call these people “depression veterans”. I have met many such veterans and their courage and determination to recover and stay well inspires me.
As I wrote in a prior blog, these people are really my “heroes”.
I also have met many in the legal biz who say they’re at the end of their rope. They’ve been in and out of therapy over the years with little or negligible improvement in their depression. Others have started and stopped a number of antidepressant and/or other mood stabilizing medications tired of to little impact on the mood and too many side effects. But the depression always returns for them.
For most of them, it’s not a relapse into major depression. Rather, a mild or moderate depression interspersed with fatigue, a lack of pleasure and a glum outlook on life. What they are experiencing is a fact about depression and its course. That it often a chronic and life-long illness for those so afflicted.
Then there are many who go through long stretches of feeling pretty well most of the time, but still have pockets of depression.
I put myself in this camp.
Most days, my depression, on a scale of “1” through “10” is a 1 or 2, if it’s present at all. If it gets worse, it’s less often, not as strong and has a much shorter duration is much shorter – maybe a 3 or 4. This seems to be especially so during the dark days of winter.
What worked for me to reign in the beast of depression was a change in lifestyle, which included regular therapy, medication, a support group, prayer and exercise. While there is no one thing that is a panacea for depression sufferers, I am convinced that such the positive changes have a direct, lasting an significant alleviation of depression’s worst symptoms.
To make a lifestyle change, I develop a depression “toolkit”. A game plan that I’ve pretty much stuck to for a number of years. The value of such a toolkit is that it provides a map for us to stay on course. It gives us a sense of structure and a sense of hope.
If you thinking about how to really recover from depression stay healthy, it’s important to come up with your own depression toolkit. There are lots of ways to go about it. The two best examples of depression toolkits I’ve found come from the University at Michigan’s Depression Center and the Depression and Bipolar Support Alliance.
So pick up your pen and start building your own toolbox today.
Copyright 2014 by Daniel T. Lukasik
I started a depression support group seven years ago. It’s one of the most meaningful things I’ve ever done. We started out with ten people. It met once a month. Over time, it evolved into every-other week. We now gather once a week. I’ve been asked many times about how to start a depression support group. Here are a few pointers to help you get going. They’re in no particular order of importance.
1. Be clear about what a support group is
A support group is a regular gathering of folks suffering from depression who share their struggles with fellow sufferers to gain insight, strength and hope. These meetings are less structured and more open-ended and the content doesn’t come from a mental health professional. In constrast, group therapy is more structured, focused on teaching, and has a clear outcome that the group is trying to reach. They’re led by a therapist.
2. Picking a place
I suggest you seek out a place to meet at a school, college, church, community center, library or other free space in your community. I guess you could have it in your home. I have never done that. I don’t know anyone else who has. In my view, the problem with this spot is that you must be prepared to have it there every single time. It may put a lot of responsibility on you. What happens if you’re sick or on vacation and can’t host the gathering? I also don’t suggest rotating the location of the meetings to different members’ homes. This doesn’t work because it becomes just too complicated for people to remember where the meeting is being held. Pick one place and stick with it.
3. Determine a schedule
With the help of initial support-group members, decide how often to meet and for how long. For example, every two weeks for 60 to 90 minutes. My experience has been not to fiddle with the day and time you ultimately pick. Members in my group know, come hell or high water, meetings start at 12:30 sharp and end at 1:30 every single Friday. They need not think about it. If they miss some meetings, they’re not left hanging about when the next meeting is.
If others tend to come late to the meeting, always start it on time anyways. My experience is that people appreciate this. Everyone has busy schedules and other things to do. Meetings should be no less than once every two weeks because interest can wane if the group doesn’t meet often. If the meetings are too far apart, people forget each other’s stories.
4. Talk with your therapist
If you’re in therapy, talk with him or her about what you plan on doing and why. They know you well and can offer some suggestions. They’ve either run groups and/or been trained in how to do so. Get some ideas.
5. You don’t have to rebuild the wheel
Depression support groups happen everyday around the country. They’re run by various organizations such as the Depression and Bipolar Support Alliance. Check out their website to see where these groups meet in your community and go to a few to see how they function.
6. How Do I Find Support Group Members
You need to get the word out. Develop a flyer that briefly describes your group, where and when it meets, and contact information. You may also want to contact other support groups and ask if they can refer people to you or market your group on Facebook and other social networking sites. One thing I did was to write columns in my local paper about my own experiences with depression and the support group. This helped enormously. People connect with personal stories. It also helps people overcome the stigma of attending a meeting. If you’re comfortable with it, ask to speak at your local church or other social organizations you might be a part of. Another way to find members is to search for therapists who have offices within a 10-mile radius of where the meetings are going to be held. I’d send them flyers so that could refer people in need of support. Most therapists aren’t even aware of such groups. So educate them!
7. Have and opening and closing ritual
Early on, our group crafted an opening that we read before every meeting. I have typed out the opening we use at my group at the end of this blog. Towards the end of the meeting, I will say, “We’ve got about ten minutes left, is there anyone who hasn’t shared that would like to speak?” I’ll then conclude, “See you all next Friday at 1:30.” A consistent structure to the meetings helps a lot.
8. Arrange for refreshments.
Ask support-group members to take turns providing snacks and drinks if desired.
9. Create a confidential list-serve
It’s a good idea to get everyone’s email address to communicate with the group in the event of a meeting cancellation due to the weather or other problems. Sometimes, your usual location needs to be changed on a particular date because the building is closed for the holidays, etcetera. Send out an e-mail the day before the group meets to remind them there’s a gather the next day. People get busy and like these little pokes. I also forward onto members of group activities – sometimes we meet for dinner or breakfast. I also pass along depression blogs or news I’ve come across that might be interest. A confidential list-serve is easy to create. Check out this webpage about how to create a list-serve through Goggle. This is what I use. To make it confidential, I e-mail myself notices and blind copy the rest of the group. It works.
10. Leaders
A support group leader(s) is responsible for maintaining the structure of the group and keeping the group on topic. Leaders also set up meetings and clean up afterwards. They must be a bit assertive; if you are not comfortable being assertive, look for this quality in a co-leader.
11. Asking others to join the group – be sensitive to their concerns
Because of the stigma associated with depression, people are sometimes resistant to join a support group. They don’t know what to expect. “Will other people attending the group know me? Will this be embarrassing? Would this really help?” Then there are others who have attended other depression support group meetings and found them lacking. One of the most common things I hear is that many of the folks who attend these meeting aren’t working, are on disability and aren’t planning to go back into the work force. Let me be clear on this point: in no way am I criticizing people who are in this situation. In fact, I feel deep compassion for them. But for people who are in the workforce or those temporarily out of it who want to get back in, it isn’t always good fit. Be aware and sensitive to this issue. If I sense that people would like to come to the group, but are apprehensive, I meet them for coffee. Believe me, it helps to reassure them. Maybe a perspective member might not be a good fit for your group. If so, be honest with them and refer them to another.
12. Remember that it takes time to start and keep a group going
I have known other people who have felt the passion and courage to start groups only to see them fizzle out because of a lack of members or organization. That can be discouraging, no doubt. When I first started the group, I’d worry about how many people would come. For example, I’d be disappointed if 4 people came. I somehow felt like a failure (why can’t I get more people to come?) or a big success if 15 came (“Wow, this is great. People think this is important!”) But in the past seven years of running my group, I learned that numbers don’t count for much. It’s the quality and depth of sharing that counts. Some of the best meetings I’ve attended have been with small numbers of people. It allows more time for each person to share more details of their struggles that they otherwise may not been able to do in with a larger group setting because of time constraints. Commit to keep the group going for at least one year. It will have its ups and downs. You need to be persistent.
13. Remember to stay on topic.
You’ll notice some participants drift into other topics like buying a new car, gossip or recent things in the news. Help keep the group focused and on task. It’s a depression support group, plain and simple. The majority of people are there for that reason. It’s simply not fair to others who need the support to listen to others who want to talk about things other than their depression-related issues. If people want to talk about these issues, they can do so before or after the group.
14. Be careful not to let someone dominate the talk
This is a common and tricky problem I’ve had to deal with over the years. We address this in the opening ritual, but people need to be reminded of this for the benefit of the group. An individual member may sometimes need a bit more time to talk than usual. That’s okay. But if it becomes a chronic issue, take the person aside after the group and gently address it with them.
15. Share resources
Many people who come to groups have read books about depression that have “spoken” to them in a meaningful way. I’ve shared my own favorites in a blog, Dan’s Top Ten Depression Books. Group members can also create such a list and distribute it. From time to time, my group has also come up with a list of recommended therapists and psychiatrists in our area. Again, a very helpful thing for people who don’t have one or are thinking of switching (a very common issue).
16. Hire a therapist to attend the group
Our group has hired a therapist to facilitate our meetings during different times in our history. It’s absolutely not necessary to have successful group, but may be helpful. How to find one? Send out a letter to local counselors that you’re group is looking for one. How do you pay for it? Take up a collection from the group. For example, if you have 10 people (an ideal number of members for a support group, by the way, is 8 to 10 folks), ask that they each kick in $10 per group meeting to pay for the therapist. The psychologist in our group didn’t talk much during the meeting, except at the end. He would sum up some of the themes he heard and offer a few helpful tips and observations. I thought this worked well and was a real benefit to the group. You can also ask a local therapist to volunteer their time to this worthy effort.
17. Get trained as a peer support person.
There are different organizations that offer such training. Check out DBSA. Attend other depression support groups in your community to see how they run it.
18. Commit to confidentiality.
Make sure everyone in your group understands that what’s shared in the support group stays within the group. I can’t stress this issue strongly enough. People need to feel safe. Without that, the group just won’t succeed.
Ritual Opening for a depression support group
Welcome to the {insert group name] support group for people coping with depression.
Depression is a bio-psychosocial phenomenon meaning that it affects people in their biological, psychological, and social areas of daily function. Depression is a health problem that does not discriminate by gender, race, religion, occupation, or intellectual ability. It is not a moral weakness any more than asthma, diabetes, or hypertension are. But, similar to these other illnesses, depression is highly treatable and can be managed effectively. Interpersonal support is an important part of depression management.
This group is anonymous and confidential. Here is a forum to share your stresses and your experiences in coping with depression. We ask that group members suspend judgment of others, refrain from direct advice giving, and allow adequate time for all participants to share their respective stories.
We seek the serenity to accept the things we cannot change, the courage to change the things we can, and the wisdom to know the difference.
Have you ever taken part in a depression support group? What have your experiences been? Do you have any additions to this list that would help someone form a group? Please share.
Lawyers aren’t naturally overcritical, risk-adverse people who are emotionally dead inside. It’s stress that makes lawyers behave this way according to a survey in the ABA Journal. Read the Blog
Are you waking up just feeling “blah”? Like you don’t want to do anything except lie like a couch potato and watch TV, and even that is unsatisfying? You not only feel low energy, but kind of miserable. Perhaps you’re mad at yourself for not getting the house cleaned or not getting your work done and papers filed. Perhaps you’re feeling a bit lonely, left out by friends or unsupported by family. You may dwell on mounting bills or the fact that you’re 10 or 20 pounds overweight. You may feel aches and pains in your neck or back. Or you may just may feel grouchy and want to remain undisturbed by life’s demands and conversational opportunities. You may compare yourself unfavorably to your friend, roommate, cousin, or neighbor, who always seems to be on time, well-groomed, and on track to meet her goals. We all have those “blah” days, but why do they happen and what can we do about them?
Brain Chemicals
Some of us have brains that are more sensitive to the effects of stress. Researchers are just beginning to uncover the biochemistry behind this differential. The most common forms of antidepressants target the neurotransmitters serotonin and norepinephrine because research shows that low levels of these chemical motivators are part of what makes us depressed. However, only some people respond well to the most common forms of antidepressants, while others try drug after drug with no substantial mood improvement. A recent research study may reveal the reason why. A study published earlier this year in Proceedings of the National Academy of Sciences suggests that differences in the way our brain’s process a chemical called galanin makes some of us less resilient and able to bounce back after difficult experiences.
The Weather
Less sunshine during the winter months can give us the blues, and this effect is more pronounced for some people than others. Researchers Keller and colleagues studied hundreds of people and found that during the spring, moods improved along with doing more outdoor activities. We are also more cognitively flexible and able to think creatively about solving our problems in the spring, compared to winter. A subgroup of us suffer from Seasonal Affective Disorder in which the winter blues turn into full-blown depression along with associated changes in sleep, appetite, and motivation. Sufferers are more likely to be women. Exposure to outdoor sunlight also provides us with vitamin D; a substance with clear links to depressed mood.
Vitamin D
Most people in the US have insufficient or deficient levels of Vitamin D. The reasons are not clear, but could be related to nutrition and insufficient sun exposure. People with dark skin are more vulnerable to vitamin D deficiency, due to a decreased ability to process vitamin D from sunlight. Vitamin D deficiency has been statistically linked to depression. In a large Dutch study by Hoogendijk and colleagues (2008) of over 1,200 persons aged 65 and older, levels of vitamin D were 14% lower in persons with minor depression or major depressive disorder when compared to those not showing depressed mood.
Hormones are substances produced by the endocrine glands that influence many bodily functions, including growth and development, mood, sexual function, and metabolism. Levels of certain hormones, such as those produced by the thyroid gland, can be factors in depression. In addition, some symptoms of depression are associated with thyroid conditions. Hormones fluctuate during the menstrual cycle and may create vulnerability to sad or depressed mood in the premenstrual period, as well as during peri-menopause, and menopause. There are individual differences in how much our moods are vulnerable to the effects of hormones. If you are more vulnerable, you may want to consult a physician to see if medications are needed to help regulate your hormones. Or you could try alternative medicine treatments, such as acupuncture to reduce hormone-related mood imbalance.
Expectations
Our moods are not only a function of what happens to us, but also of how we view the events in our lives and the meanings we assign to them. There are stages in most of our lives in which we seem to be working hard and doing all the right things, but don’t see many external rewards coming our way. We may not be paid what we feel we are worth or be able to afford as nice a house, car, or vacation as our friends. We may struggle to find the right partner while our friends or siblings seem to have no problem finding love. We may have to work longer and harder than our friends to get the same grade on a test or earn a living. We may experience a difficult breakup or loss. Life just naturally isn’t fair and periods of struggle, suffering and loss are inevitable. If we expect fair or special treatment all the time or expect things never to change, we are bound to be disappointed. So if you’re feeling sad because of recent events, remind yourself that hard times are part of life and will pass. Or deliberately broaden your view and focus on the good parts of your life or the experiences you are proud of.
Childhood Adverse Events
Stressful life events can wear down our physical and mental resources, making us more vulnerable to both depression and physical illnesses. A history of childhood trauma, including abuse, poverty, or loss of a parent, can reset our developing brains to be less cognitively flexible. It seems that our brains naturally go into a “fight, flight, freeze” response to stress or threat and we often have to use our prefrontal cortex or executive center to get out of this state. Prolonged stress in childhood can make our brains less interconnected and resilient.. Our brains can more easily get “stuck” in negative thinking patterns or stressed out states and we become less able to change tracks.
Stresses Piling Up
As Robert Sapolsky argues in his book Why Zebras Don’t Get Ulcers, our human stress response systems were designed to respond to acute, time-limited stressors that normally require a physical response. When our ancestors had chased off that marauding tiger, they could relax and eat. The stressors in today’s world are much more chronic and less controllable by taking action, and we often don’t get the break afterwards to recover and regroup. Financial stress, loneliness, constant fighting with loved ones, being bullied, long commutes, academic or job demands, or unemployment can drag on and have a cascade of effects across many areas of our lives. When stresses hit us one after the other without time for recovery, they can leave us depleted and despondent, with insufficient pep to bounce back.
Negative Ruminations
You may be feeling bad because you’re sitting around brooding about life’s disappointments or trying to find a reason why things aren’t going your way. Research studies by University of Michigan psychologist Susan Nolen-Hoeksema and colleagues show that sitting around thinking about your negative mood or negative events just makes everything worse! One negative thought leads to another until you get buried in a mountain of problems and negative predictions. This leads to a loss of perspective and motivation that interferes with actually doing something about the problem! If you find yourself in a negative thinking cycle, get up immediately and do something else pleasant or neutral to engage your mind. This can be as simple as emptying the dishwasher, rearranging your closet, going for a walk, talking to a friend or getting on with a work project.
Your Inner Critic
Do you have a critical inner voice constantly judging and criticizing everything you do, especially when things don’t go your way? The inner critic compounds the effect of anything negative in your life by blaming you for it. It keeps drawing your attention to the negative and spoils your pleasure when something positive happens by telling you ”it won’t last” or “you don’t deserve it”. This negative dialogue takes you out of the moment and makes you feel depressed. Negative thinking is, at minimum, a symptom of depression, and may be a causal factor in interaction with negative life events. The first step to combat an inner critic is to become aware of what it’s saying. Second step is to externalize it. You could give your critic a name and imagine what it looks like (e.g., a grumpy old crone or a vicious barking dog). Then begin telling it to back off or talk back to it. The inner critic generally has a negatively biased perspective and overestimates your responsibility for and control over outcomes in your life. It also often has perfectionistic expectations. Tell it to give you a break for a change!
Loneliness
Our human brains are wired of be part of a social group, and we experience loneliness as chronically stressful and depressing. Unfortunately, some of us have toxic or neglectful families that don’t provide support or presence when we need it. Or we may feel that our friends are moving on in finding romantic relationships or having kids and leaving us behind. Research using fMRI brain scans shows that even minor social rejection lights up the same areas of our brains as physical pain. Feeling left out, rejected, or excluded makes us sad and can also lead to rumination about what is wrong with us that further darkens our moods. We become scared of further rejection and isolate ourselves, perpetuating the negative cycle. While there may not be a immediate cure for loneliness, it helps to get out in the world and pursue your natural interests, which can lead to expanding your social network. Staying in touch with old friends or family and deliberately seeking opportunities to connect may help as well.
Final Thoughts
The reasons for a down mood may be multifaceted and difficult to determine. If you feel depressed for two weeks or more, seek a medical consult to rule out or treat underlying biological factors. Consider consulting a mental health professional for help in managing stress and expectations, negotiating life changes, or dealing with the emotional aftereffects of past traumas and dysfunctional families. If you can’t afford therapy, antidepressants may help to change the underlying biology. Exercising outdoors can provide both sunlight and mood elevation. Develop a toolkit of stress-reducing activities, such as regular exercise, yoga or meditation, watching funny movies, playing team sports, doing something creative or novel, hanging out with and/or confiding in understanding friends.
By Melanie Goldberg, Ph.D.
Dr. Goldberg is a clinical psychologist with a private practice in Mill Valley, California.
Self-medicating with too much food, drugs, TV or other junk is destructive. We need to think about practical things we can do to soothe or depression, not mask or feed it. Read this blog to find out some ideas.
Blog from a Chicago trial lawyer about what he’s learned in his life in courtroom. Read the Blog.
According to the blog Beyond Blue, more suicides occur in the month of April than any other month. Read the Blog.
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