You Can Recover From Depression

I am 57 years old. I am a lawyer. And I struggle with depression.

I was diagnosed when I turned forty.  I didn’t know what was happening to me. But I knew something was wrong. I was crying quite a bit.  My sleep became disrupted. It became difficult to concentrate.  I felt no joy in my life.

Ultimately, my family doctor diagnosed me with major depression and provided me with the help I needed. I started going to therapy and was put on anti-depressants. This saved my life.

Since being diagnosed all those years ago, I have learned to live with depression as have many of the 20 million people who are living with this illness right now in this country.

5 Good Ways to Boost Your Mood

Depression makes everything harder: motivation is low, we get little pleasure from things we normally enjoy, we have no energy, and relationships tend to be strained. Small wonder it’s the leading cause of disability in the world, according to the World Health Organization.

Several treatment options are effective in reducing depression. The majority of psychological treatments with strong research support are cognitive-behavioral (CBT) and focus on changing thoughts and behaviors to improve mood. Some forms of medication, such as the selective serotonin reuptake inhibitors (SSRIs), can be as effective as CBT, at least for as long as a person takes them.

So, which treatment option should a person choose? Obviously, it’s an individual choice and one that should be made in consultation with one’s doctor. For those who prefer to start with a psychological treatment—either because they’ve not found medications to be helpful and/or the side effects weren’t tolerable—CBT is a good candidate given the strong research support.

A recent study, the largest of its kind—showed that a simple treatment requiring less

The Blues Is Depression. Should You Treat It With Pills?

What people refer to as the blues is usually depression.  Depression, or the blues, is an unpleasant emotional state characterized by what therapists refer to as “the negative cognitive triad.”  That’s 1) negative thoughts about oneself, which are the voices of your inner critic harping on you for what you supposedly have done wrong, should have done differently, and on and on 2) negative thoughts about others that lead you to see what you don’t like in them instead of heeding their virtues and enjoying them, creating relationship problems and 3) negative thoughts about the future.

Some people describe the blues, and also depression, as feeling like there’s a dark cloud over you.  Others refer to depression as seeing the world through dark glasses.  Feelings of hopelessness and helplessness are another indicator.

How can you get rid of your blues and your inner critic by treating the underlying depression?

There are four main strategies:

  1. Change your feelings.Take pills or use one of the newer treatment methods that change your bluesy mood by changing your inner body chemistry and brain functioning.
  2. Change your thoughts.  Eliminating the inner critic may get rid of the depressed, bluesy feelings.
  3. Change your actions. Get exercise.  Go out and be with people.  Express more gratitude.  Do acts of kindness.
  4. Identify and address the problem that initially triggered your depressed feelings and thoughts.  Find a new solution and both the negative feelings and the negative thoughts will evaporate.

Why do people take antidepressant medications?

There are four main reasons why people who may be distressed by something in their lives end up defining their depression as an illness and taking medication.

First and foremost, depression is a terrible feeling that sufferers sorely want to get rid of.

Second, most folks have not been fully informed of the medications’ downsides. I’ll elaborate on drug dependency below.  In addition, these medications can cause serious weight gain, a significant drop in libido (ability to enjoy sex), hazy thinking, and a general emotional numbness that blocks feelings of joy in addition to feelings of depression.

Third, people who take the medications may not have been informed of their relatively low rate of effectiveness.  They can be effective if they work, but they only work for something like about 60% of people who use them.

Fourth, most people who take anti-depressant medications have not been informed by their doctor about alternative treatment options.  To a man with a hammer, the world is a nail.  Physicians know about illness and prescribe medications.  As psychologist Martin Seligman has explained, depression is a relatively normal, if quite unpleasant and often self-defeating, response of giving up in response to a challenging life circumstance.

What are the downsides of assuming that depression is an illness and therefore needs pills? 

As mentioned above, two particularly negative side effects of medication that doctors do not sufficiently explain include potential weight gain and decreases inability to experience sexual arousal. Doctors may mention them but often do not clarify that both extra pounds and decreased interest in sex can have strongly negative impacts on personal self-esteem, on attracting a mate and on sustaining a marriage.

The other significant risk that doctors may or not fully explain is that users may have a hard time getting off these medications.  When a drug company says that their anti-depressant medication is not addictive, strictly speaking, they are telling the truth.  A strict clinical definition of an addictive substance or activity is one that induces both dependency and craving.  Antidepressants do not induce craving.  Over time they do, however, make users drug dependent.

Craving is a familiar feeling to anyone who has fallen in love.  The intense sexual desire that drives someone in love to find every way possible to be near the object of their desire is a craving.  Someone who craves alcohol similarly may wake up in the morning already urgently wanting a drink.

What does “drug dependent” mean?   Drug dependency is the state a body goes into when it has adapted to the presence of a chemical to the point that the body requires steady doses of the substance to maintain normal functioning. We are all, for instance, chemically dependent on water.

Our society is highway-dependent.  Many of us have become accustomed to having highways that enable us to drive to work from the suburbs.  Having bought a house in the suburbs on the assumption that we can take the highway to work, we have become highway dependent.  It’s unlikely that anyone has a craving for highways.  Many of us though have become highway dependent.

If you for some time have been taking an antidepressant medication, the odds are that your body has become drug dependent.  That means that if you should decide today that as of tomorrow you will no longer take the medication, starting tomorrow, you are likely to discover that without the pills that you normally take your body will plunge into a serious depressive state.

Does this depression mean that you need after all to stay on your meds because the pills are all that have stood between you and the depths of despair?   Not at all.  To the contrary, this depression means that your body has become dependent on the antidepressant pills.  Is this addiction?  No, but it is drug dependency.

I am not saying that no one should ever take antidepressant medication.  They do help some people.  Some people experience relatively few to zero negative side effects.  My point is just that if you are considering taking these medications, or have for some time been using them, you deserve accurate information about the factors to take into account in your decision, including information about other treatment options.

Here are six vital points to consider.

1) There now are multiple excellent alternatives to medication for working your way out of depression, including various kinds of talk therapies such as CBT, energy therapies such as Bradley Nelson’s Emotion Code and Body Code, acupuncture, exercise, electrical stimulation of the brain, the visualization you can download for free from my website, or read about how to do on one of my other blogposts, couples therapy, and more.

2) Depression is induced by a situation in which you have experienced insufficient power. If you close your eyes and picture whom or what you may feel angry at, you will see an image of the trigger person or situation. Fix that situation, and your depression will be likely to go away.

3) If your doctor is recommending medication as a short-term fix, use the pills until you feel better. Use your renewed energy to address the power-loss situation. Then begin the medication-weaning process asap.

4) Wean slowly. Consult your prescribing doctor for an appropriate weaning schedule for the particular medication that you are taking.

5) Be aware that research has shown that the most powerful way to overcome depression and keep it far from you, in the long run, is the combination of therapy and medication. Medication alone and psychotherapy alone have very similar effectiveness rates, but medication has an impact more quickly, and psychotherapy tends to have more longer-lasting impacts.

6) There is a visualization exercise that you can do with a therapist, a friend, or on your own that may help you conquer the depression in just a few minutes.  See my posting on A New Treatment for Depression.

6) In my clinical experience, I find that most depression is a response to relationship problems. Look into marriage educationcouples counseling, or a combination of both to upgrade your relationship. These treatment routes can make you a double winner.  You can both end the depression and simultaneously gain a vastly more gratifying marriage or romantic partnership.

Susan Heitler, Ph.D., a Denver Clinical psychologist, is an author of multiple publications including From Conflict to Resolution for therapists, The Power of Two and poweroftwomarriage.com for couples who want to strengthen their relationship. Dr. Heitler’s most recent book is Prescriptions Without Pills, with a free companion website at prescriptionswithoutpills.com.

 

Behavioral Activation is Effective, Less Expensive Therapy for Depression

A new large-scale study has found that a simple and inexpensive therapy called behavioral activation may be equally as effective at treating depression as Cognitive Behavioral Therapy (CBT). Behavioral Activation is relatively simple, meaning it can be delivered by more junior staff with less training — making it a cost-effective option. It is estimated to be approximately 20 percent less expensive than CBT, meaning it could help ease current difficulties in accessing timely and affordable treatment. Read the full article.

Depression and Anxiety in Later Life

file0tt4iKI’m Dan Lukasik from Lawyerswithdepression.com. Today’s guest is Dr. Charles F. Reynolds, III, co-author of the book, “Depression and Anxiety in Later Life: What Everyone Needs to Know.” He is a professor in Geriatric Psychiatry at the University at Pittsburgh School of Medicine and Director of its Aging Institute and Center of Excellence in the Prevention and Treatment of Late Life Mood Disorders. Dr. Reynolds is internationally renowned in the field of geriatric psychiatry. His primary interests focus on mood, grief, and sleep disorders in later life.  Thanks for being here with us Dr. Reynolds.

I think the first place to begin for our audience and listeners is to have an understanding of what clinical depression is.

Dr. Reynolds:

The term clinical depression really refers to a syndrome or collection of symptoms which are debilitating and cause suffering and distress. At the core of the notion of clinical depression are two symptoms. The first is a lack of pleasure or interest in usual activities. The clinical term for that being anhedonia and the other core aspect of depression is a persistent lowering of mood – a sense of sadness and pessimism or even of hopelessness. These symptoms occur most days for at least two weeks and typically for a longer period of time and then as the full syndrome of depression develops, Dan, you also see other changes, for example, in sleep, concentration, or appetite, or energy levels and of great importance is the emergence, in many people, of suicidal feelings as part of the clinical syndrome of major depression.

Dan:  

Part of the title of your book is anxiety – what is clinical anxiety?

Dr. Reynolds:

Well, like depression, clinical anxiety refers to a syndrome or collection of symptoms that are both distressing and impairing in day-to-day function. The principle types of anxiety are first, excessive worrying such as we see in generalized anxiety disorder or panic attacks such as we can see in panic disorder with or without agoraphobia. Like depression, anxiety disorders can be quite debilitating and distressing. It is also important to understand that anxiety and depression can co-occur in the same patient and often represent risk factors for each other.

Dan:

In the book title you say depression and anxiety in later life.  When you talk about “later life,” what does that mean?

Dr. Reynolds:

Later life generally refers to folks sixty and older. That varies somewhat according to the study that you’re reading, but most of us accept age sixty or sixty-five as a threshold for beginning the later years of life. That being said, Dan, it’s important to understand that the later years of life can and often do cover several decades. And so we often speak of “young old,” say sixty-five to seventy to eighty, and “old-old” as covering the years beyond seventy-five or eighty. That distinction, young-old and old-old is important for clinical practice because the various benefits and risk of the treatments that we have may shift gradually with the age of the patient.

Dan:

When we think of depression in our society, how common is depression statistically and is there any difference in the older population?

Dr. Reynolds:

If you look, Dan, at primary care medicine clinics where most people get treatment for depression, older adults, if they get treatment at all, at any one point in time six to ten percent of the patients attending primary care clinics will have major syndromal depression and then another ten percent or so will have a clinically significant level of depressive symptoms. So this is by no means a rare disorder.  The other important thing to remember, and this is to your point about depression’s occurrence in older adults, it frequently coexists with medical issues and often with cognitive issues as well. The depression typically doesn’t exist in pure culture, but rather is an “unwanted co-traveler” of many of the common medical problems that afflict older adults and thereby amplifies the disability and distress of those disorders.

Dan:

What causes depression, Dr. Reynolds?  When we think of depression – and we’ve come a long way in understanding some of the causes – many people don’t know the difference between sadness or “the blues” and clinical depression. What are we talking about? What are the causes?

Dr. Reynolds:

The causes are many, Dan, and I think it’s very helpful to think in terms of there being many pathways to depression in older adults. In some cases, it’s possible that there is a genetic cause because depression can run in families.  Although in late life, depression, we think that genetic factors are maybe less important than they are in younger adults or kids who develop depression. Depression also occurs in the context of the life events that can occur in later life such as bereavement or other major transitions in social role functions. It’s also not unusual to see depression in the wake of certain medical events like a heart attack, or a stroke, or depression to develop in the context of things like age-dependent macular degeneration which results in a decreased ability for a person to see. These are important contextual factors and a good treatment plan will take these contextual social and medical factors into account.

Dan:

When we think of depression, once it’s been diagnosed, what can older adults do to manage depression?

Dr. Reynolds:

I think there are many things that older adults can do, Dan, but also they can be helped by family members and caregivers as well. This is a key point. I almost always will try to see family members and caregivers as well as the adult with depression themselves. Adopting a healthy lifestyle is very important set of strategies, Dan, both for preventing and treating depression and among these healthy lifestyles are physical activity, maintaining good social connections, and social support, and getting primary medical problems attended to such as blood pressure, blood fat, and blood sugar levels and having your immunizations and cancer screenings done on time.  Behaviorally, it’s very important for people to engage in the activities that give them pleasure. Behavioral activation, as we call it, is at the core of many psychosocial treatments for depression including problem-solving therapy, cognitive and behavioral therapy. Medications are also very helpful. There are antidepressant medications now available which are safe and generally well tolerated by older adults. I would say that upwards of eighty percent or eighty-plus percent of older adults with depression can be successfully treated to good response if not remission particularly using a combination of counseling and medication and then we have other treatments for other people whose depressions are difficult or resistant to treatment.

Dan:

Let’s turn our attention now to the topic of anxiety and that’s certainly an important topic you address in your book where you talk about anxiety in later life. For our audience, what is anxiety? We talk about it. A lot of people talk about being “stressed out”. We’re a stressed-out culture. But what is the difference between stress, being stressed-out, and true clinical anxiety?

Dr. Reynolds:

That’s good, Dan. You’ve made an important distinction there. All of us can experience stress, for example, in relation to life events which feel threatening to us or which seem to turn our worlds upside down, but there is a difference with anxiety disorders.  Anxiety disorders are constituted by specific symptoms that often last for months and months and months and can be disabling and distressing.  Principal among these things are obsessive worry or panic attacks which seem to come out of nowhere. These constituent actual distinct mental disorders and there are useful treatments for them. We rely heavily, for example, on teaching people relaxation techniques as well as better problem solving skills. There’s a good deal of literature also to support the use of medications called Selective Serotonin Reuptake Inhibitors. These are medications that have shown to be effective in the treatment of anxiety disorders in older adults. The reasons you want to treat these disorders is that the symptoms are burdensome, they cause distress and impairment, they undermine the quality of life, and also increase the risk for depression.

Dan:

When we talk about clinical depression and clinical anxiety, and you’ve just done a wonderful job of distinguishing them from everyday sadness and everyday stress, do they ever happen together?  Can we have a person who has both clinical depression and anxiety?

Dr. Reynolds:

We see that, Dan, in really about a third of our patients. So at any one point in time, probably a third of our patients with major depression, also can be diagnosed with one or another anxiety disorders. So they do co-occur and they need to be treated. Sometimes it can be challenging to treat that combination, but we learned how to do that. The other thing to remember though is that people living with anxiety disorders are at risk for the subsequent onset of depression.  So it’s important for that reason to address anxiety disorders. The other part of this constellation that I like to pay a lot of attention to is sleep disturbance. Sleep disturbances themselves represent a risk factor themselves for the onset of common mental disorders. Sleep disturbances are also a symptom of common mental disorders and when I’m treating depression or anxiety and my patient continues to have sleep disturbance, then I focus additional effort on helping them to get a better night’s sleep because if their sleep disturbance isn’t addressed independently, then it constitutes a risk factor for an early relapse or recurrence of depression or anxiety.

Dan:   

Can you tell us a little more about your work at the Aging Institute at the University at Pittsburgh Medical College and the Center and Treatment of Late Life Mood Disorders?

Dr. Reynolds:  

For the last five years I’ve served as Director of the Aging Institute at the University at Pittsburgh Medical Center.  The Aging Institute was created by the UPMC Health System and its health plan and also by the six schools of the Health Sciences at the University at Pittsburgh and by the Provost at the University at Pittsburgh.  Basically, Dan, we do three things.  We geriatricize the work force.  That is to say we teach the skills of caring for older adults to clinicians across all parts of medicine: doctors, nurses, pharmacists, social workers, etcetera.  The second thing that the Aging Institute does is to develop new models of care to improve the long-term delivery of care to older adults and their family members. And finally, the third thing we do is to sponsor research. We are very interested in innovative pilot research that can lead subsequent National Institute of Health and other federal support. The other thing I do at Pitt is to direct the Center for Depression Prevention and Treatment Research. This is a Center of Excellence, one of only two or three in the United States funded by the National Institute of Mental Health. We have been working now since 1995 and are in our twenty-first year. We do a great deal of intervention research. We also train the next generation of younger scientists, both physicians and Ph.D.’s, to do intervention research in older adults at risk for living with mood disorders like major depression or bipolar disorder.

Dan:

One of the things you mention in your book, and by the way, it’s a remarkable, insightful read, “Depression and Anxiety in Later Life,” one of things you mention in your book, you talk about the importance for older people to find and maintain a sense of purpose.  Why is that so important and how do older people go about finding a sense of purpose if it’s lacking?

Dr. Reynolds:

Yea, it’s a really key point, Dan, and I think that all of us need to have a sense of purpose; a sense that our lives matter to other people to help us get up in the morning.  Feeling a sense of connection, feeling a sense of belonging is very strong medicine to preserving a sense of wellbeing throughout all of the years of life. There’s also a substantial body now of research, of epidemiological research, that shows that being a member of a community of faith may both help buffer depression and but also help to recover from depression and keep it at bay. So I think that’s one key strategy to create a sense of belonging and purpose. Those are two key words that I like to use – belonging and purpose.

Dan:

And in closing Dr. Reynolds, for those in our audience that are interested in this, interested in being evaluated and treated at your center, how do they go about doing that?

Dr. Reynolds:

You can give us a call in Pittsburgh.  We are happy to take calls. We’re also happy to help callers find local resources from wherever they may be calling because we’re part of a network of colleagues around the country. One good way to seek help though is to call the help desk at the University at Pittsburgh Medical Center because we’re able to connect callers with all kinds of resources they may need. We typically get over 600 calls per year now, both from family caregivers and health care professionals.  I recommend that people visit our website or call us at 866-430-8742.

Dan:

Dr. Reynolds, thank you so much for taking the time to talk with us today. It’s been very informative, insightful and encouraging. I’m Dan Lukasik with Lawyerswithdepression.com.  Join us next week for another interesting interview.

 

Treating Anxiety & Depression With a Smartphone App

Two English universities have joined forces to assess how a new smartphone app can help people manage their psychological issues. The Catch It app uses some of the key principles of psychological approaches to mental health and well-being, specifically cognitive behavioral therapy (CBT), according to researchers.  Read the News

“Plop, Plop, Fizz, Fizz” – Oh, What a Relief it is? Our Relationship with Antidepressants

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Most folks with depression have a complicated relationship with their antidepressant medications.

I certainly do.

While these pills saved my life years ago when major depression struck, years later, I often wonder if I still need to take them, or, if they’re still effective.

If I feel tired and flat on a particular afternoon, is it depression, the side effects of my meds or a jumble of both? Or maybe, it’s just my persistently pensive nature?

I think about this a lot these days – and maybe you do as well.

While the one-two punch of Cymbalta and Lamictal have kept me out of the dungeon of major depression for years, its comes with a cost. I have interludes of passivity, numbness, and fatigue. Maybe a low-grade depression at times, as well. If I ditch the drugs, maybe I will feel more “alive,” I think. I fantasize that cutting my ties with meds could lessen the days lost to the deadening grayness of a medically induced sense of normalcy I sometimes go through.

But I also feel anxiety. If I went cold turkey and lived medication-free, would it end, well, in disaster? A return to the swampland of depression? A deadman’s land if ever there was one. Can I take that chance? Should I?

There’s scary research that suggests once you stop antidepressants that work (or sort-of-work) for you and try to go back on the same ones because being off of them caused your depression to return (or you just couldn’t tolerate the horrible side effects that can come with discontinuation), there’s a good chance they won’t be as effective.

So, what’s a depressed person supposed to do? What should I do?

There are two camps that offer some guidance on this issue. Both have persuasive arguments about why those afflicted should or shouldn’t stay on meds.

The Stay on the Meds Camp

If depression is an “illness,” like diabetes or heart disease, I need these meds to balance out my of whacky neurochemistry. Given my risk factors: a family history of depression (genetics), a crazy childhood with a nutty, abusive and alcoholic father, and a high-pressure job with too much stress, I should stay on the pills.

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In his insightful essay in the New York Times, In Defense of Antidepressants, psychiatrist, Peter Kramer, author of the best-selling books, Listening to Prozac and Against Depression, suggest that studies show this: for mild or moderate depression, talk-therapy is as or more effective that medication. But for the Moby Dick sized sucker called Major Depression? Medications are warranted, and, indeed, lifesavers. They help many to function and live productive lives, albeit with a range of mild to more severe side effects.

The Get off the Meds Camp

Some people (including psychiatrists) see meds as the devil’s handiwork: supposed chemical solutions to emotional problems that flat-out don’t work. Many psychiatrists’ (and family doctors who write the overwhelming majority of scripts for these drugs in the U.S.), they maintain, are “pill pushers” who do the bidding of “BigPharma”, a multi-billion dollar industry in this country. Antidepressants aren’t so much a cure as a curse.

Irving Kirsh, Ph.D., author of The Emperor’s New Drugs: Exploding the Antidepressant Myth, writes:

“Putting all [the research] together leads to the conclusion that the relatively small difference between drugs and placebos might not be a real drug effect at all. Instead, it might be an enhanced placebo effect, produced by the fact that some patients have broken [the] blind and have come to realize whether they were given drug or placebo. If this is the case, then there is no real antidepressant drug effect at all. Rather than comparing placebo to drug, we have been comparing ‘regular’ placebos to ‘extra-strength’ placebos.”

The remedy from this group? Psychotherapy. They see depression as the result of off-kiltered, negative thinking patterns. The way out of these ruminative, pessimistic thoughts involves working with a therapist who uses, most often, Cognitive Behavioral Therapy, to challenge and encourage patients to replace such thoughts with more realistic and positive ones.

In his book Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You, Richard O’Connor, Ph.D. argues that both therapy and medication are effective, but limited in certain respects.  He advocates an additional factor often overlooked in depression recovery: our own habits. Unwittingly we get good at depression. We learn how to hide it, how to work around it. We may even achieve great things, but with constant struggle rather than satisfaction. Relying on these methods to make it through each day, we deprive ourselves of true recovery, of deep joy and healthy emotion.

The book teaches us how to replace depressive patterns with a new and more effective set of skills. We already know how to “do” depression-and we can learn how to undo it.

Some Recent News on the Meds and Therapy Conundum

The New York Times reports that a large, multicenter study by Dr. Charles Nemeroff, then a professor of psychiatry at Emory and now at the University of Miami, found that for depressed adults without a history of abuse, there was a clear ranking order of treatment efficacy: Combined psychotherapy (using a form of cognitive behavior therapy) and an antidepressant (in this case, Serzone) was superior to either treatment alone. But for those who had a history of childhood trauma, the results were strikingly different: 48 percent of these patients achieved remission with psychotherapy alone, but only 33 percent of these patients responded to an antidepressant alone. The combination of psychotherapy and a drug was not significantly better than psychotherapy alone.

So what’s a depressed person supposed to do?

I don’t know, really.

We’re in a pickle, aren’t we?

Maybe there’ll be a soon-to-be discovered test that can guide us on precisely what to do. But for now, many of us will stay-the-course and, for better or worse, stick to the “plop, plop, fizz, fix”.

I see myself somewhere in the middle of all this. I’ve never been hospitalized or tried to commit suicide. But I have known depression’s scorching winds, gales that have torn the flesh from my body. I will never forget this pain. It’s scarred me. And I never want to return to it.

If you’re thinking of discontinuing your meds, here’s a great article on how to do it safely.

I welcome your comments about your depression journey with or without medicaton.

Copyright, 2017

by Daniel T. Lukasik

Perfectionism and Depression: Nobody’s Perfect

We often mix-up a drive to excel and perfectionism; they’re not the same thing. A drive to be your very best can leads to a sense of self-satisfaction and self-esteem. It feels good to give it all we got. Perfectionism? It’s a horse of a different color. People who feel driven in this direction tend to be more motivated by external forces – such as the desire to please others rather than themselves. Common and recurring thoughts of perfectionists include:

  • Anything short of excellent is terrible
  • I should be able to do/solve this quickly/easily
  • I am best handling this myself
  • I must find the one right answer
  • Errors, failure, and mistakes are unacceptable
  • I have to do it all at once

One depression/perfectionist suffer writes:

My name’s Paul and I am a recovering perfectionist.

I am also recovering from depression. The two are connected.

I’d been trying to do too much, too well, trying to please too many people, expecting too much of myself for too long, putting too much pressure on myself, creating too much stress. That’s a lot of ‘too muches’ for one person. My self-esteem took a battering, I stopped looking forward to anything and I felt like I was useless and hopeless.”

Psychologist Dr. Gordon Flett has studied perfectionists and found that they set excessively high personal standards for themselves and others then harshly evaluate their performance on these benchmarks. Often, perfectionists believe it’s their parents, bosses, or spouses who expect them to be perfect. They believe that such people will value them only if they’re perfect. The constant demand to appear as if they have it all tougher is draining.

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Others tend to see them as harsh and unforgiving – rigid and unkind – though the truth on the inside is they are vulnerable people who lack resilience. Flett fund that physicians, lawyers, and architects, whose occupations demand precision, are at higher risk for perfectionism, depression and suicide.

Causes of perfectionism run from parenting to a genetic link, but whatever it’s origins, try these fixes:

Separate self-worth from the requirement to do things perfectly.

Dr. Nicholas Jenner writes: Perfectionism is addressable by using and applying cognitive tools. Positive change can be had when thinking is changed and self worth is separated from the requirement to do things perfectly. If you constantly hear your inner critic berating you for not getting or doing that extra 20%, you have noticed your perfectionist beliefs. Discrediting and disputing these values and finding realistic evidence to prove them wrong is a key part of recovery. As humans, we are inherently imperfect. We have the ability to fail without ever being a failure. We sometimes just need to think it and believe it.

Put people first.

Before tasks and “stuff,” put your heart into connecting with the people you love.

Come out as a human being.

Authenticity, although messy, is required for the pleasure of love, joy, fun and overall happiness.

Pay attention to your own signs of trouble.

Perfectionists get more anxious and rigid when they are hungry, angry, lonely or tired. Use prevention strategies to manage this tendency.

Let go of high expectations. Try to accept people as they are. We are all unique and flawed as human beings.

The great songwriter and poet Leonard Cohen once wrote and sang, “Ring the bells that still can ring. Forget your perfect offering. There is a crack, a crack in everything. That’s how the light get’s in.”

We’re cracked open when stress, anxiety and depression become just too painful and perhaps begin to see this eternal truth about others and ourselves:

Nobody is perfect.

 

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