8 Reasons Why Your Depression May Not Be Getting Better

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You’ve been to four psychiatrists and tried over a dozen medication combinations. You still wake up with that dreadful knot in your stomach and wonder if you will ever feel better.

Some people enjoy a straight path to remission. They get diagnosed. They get a prescription. They feel better. Others’ road to recovery isn’t so linear. It’s full of winding bends and dead-ends. Sometimes it’s entirely blocked. By what? Here are a few impediments to treatment to consider if your symptoms aren’t improving.

1. The Wrong Care

Take it from the Goldilocks of mental health. I worked with six physicians and tried 23 medication combinations before I found the right psychiatrist who has kept me (relatively) well for the last 13 years. If you have a complex disorder like I do, you can’t afford to work with the wrong doctor. I would highly recommend that you schedule a consultation with a mood disorders center at a teaching hospital near you. The National Network of Depression Centers lists 22 Centers of Excellence located across the country. Start there.

2. The Wrong Diagnosis

According to the Johns Hopkins Depression & Anxiety Bulletin, the average patient with bipolar disorder takes approximately 10 years to receive the proper diagnosis. About 56 percent are first diagnosed incorrectly with major depressive disorder, leading to treatment with antidepressantsalone, which can sometimes trigger mania.

In a study published in the Archives of General Psychiatry, only 40 percent of participants were receiving appropriate medication. It’s pretty simple: if you’re not diagnosed correctly, you won’t get the proper treatment.

3. Non-adherence to Medication

According to Kay Redfield Jamison, Ph.D., Professor of Psychiatry at Johns Hopkins University and author of An Unquiet Mind, “The major clinical problem in treating bipolar illness is not that we lack effective medications. It is that bipolar patients do not take these medications.” Approximately 40 to 45 percent of bipolar patients do not take their medications as prescribed. I’m guessing the numbers for other mood disorders are about that high. The primary reasons for non-adherence are living alone and substance abuse.

Before you make any major changes in your treatment plan, ask yourself if you are taking your meds as prescribed.

4. Underlying Medical Conditions

The physical and emotional toll of chronic illness can muddy the progress of treatment from a mood disorder. Some conditions like Parkinson’s disease or a stroke alter brain chemistry. Others like arthritis or diabetes impact sleep, appetite, and functionality. Certain conditions like hypothyroidism, low blood sugar, vitamin D deficiency, and dehydration feel like depression. To further complicate matters, some medications to treat chronic conditions interfere with psych meds.

Sometimes you need to work with an internist or primary care physician to address the underlying condition in tandem with a mental health professional.

5. Substance Abuse and Addiction

According to the National Institute on Drug Abuse (NIDA), people who are addicted to drugs are approximately twice as likely to have mood and anxiety disorders and vice versa. About 20 percent of Americans with an anxiety or mood disorder, such as depression, also have a substance abuse disorder, and about 20 percent of those with a substance abuse problem also have an anxiety or mood disorder.

The depression-addiction link is both strong and detrimental because one condition often complicates and worsens the other. Some drugs and substances interfere with the absorption of psych meds, preventing proper treatment.

6. Lack of Sleep

In a Johns Hopkins survey, 80 percent of people experiencing symptoms of depression also suffered from sleeplessness. The more severe the depression, the more likely the person will have sleep problems. The reverse is also true. Chronic insomnia creates a risk for developing depression and other mood disorders, including anxiety, and interferes with treatment. In persons with bipolar disorder, inadequate sleep can trigger a manic episode and mood cycling.

Sleep is critical to healing. When we rest, the brain forms new pathways that promote emotional resilience.

7. Unresolved Trauma

One theory of depression suggests that any major disruption early in life, like trauma, abuse, or neglect, may contribute to permanent changes in the brain. According to psychiatric geneticist James Potash, M.D., stress can trigger a cascade of steroid hormones that likely alters the hippocampus and leads to depression.

Trauma partly explains why one-third of people with depression don’t respond to antidepressants. In a study recently published in Scientific Reports, researchers uncovered three subtypes of depression. Patients with increased functional connectivity between different brain regions who had also experienced childhood trauma were categorized with a subtype of depression that was unresponsive to selective serotonin reuptake inhibitors like Zoloft and Prozac. Sometimes, then, intensive psychotherapy needs to happen alongside medical treatment in order to reach remission.

8. Lack of Support

review of studies published in General Hospital Psychiatry assessed the link between peer support and depression and found that peer support helped reduce symptoms of depression. In another study published by Preventive Medicine, teens who had social support were significantly less likely to become depressed after experiencing work or financial stress in early adulthood than those without support. Depression was identified among conditions affected by loneliness in a paper published in the American Journal of Public Health. Persons without a support network may not heal as quickly or as completely as those with one.

 

Social Anxiety & Substance Use Disorder Were Linked In A New Study & Here’s What You Should Know

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At one point or another, you’ve probably met someone who identifies as “a social drinker” — you may even identify as one yourself. People drink casually for a host of reasons: to help them unwind, because they enjoy the taste, and even as a “social lubricant” to help feel less awkward and make socializing a little easier. While there’s nothing wrong with responsibly sipping some wine or beer at a party, alcohol also has the potential to be misused, particularly when it comes to dealing with social anxiety. A new study found that social anxiety disorder may be linked to substance use disorder, and specifically alcohol use, that weren’t reflected in other types of anxiety disorders.

Lots of people feel nervous when meeting someone new or entering new social situations, but social anxiety disorder is distinguished by a constant fear towards a variety of social situations where the person “is exposed to unfamiliar people or to possible scrutiny by others,” the National Institute of Mental Health (NIMH) writes. A person with the disorder may be anxious about embarrassing themselves to the point where it interferes with their ability to live their life, and NIMH estimates that roughly 12 percent of American adults experience social anxiety disorder in their lifetime. The new research, published in the journal Depression and Anxiety, focused on understanding how the disorder might affect an individual’s relationship with alcohol and their drinking patterns.

Ashley Batz/Bustle

Researchers interviewed roughly 2,800 adult twins, assessing level of alcohol consumption and mental health factors including panic disorder, specific phobias and agoraphobia, generalized anxiety disorder, and social anxiety disorder. People with the disorder were associated with a higher risk for potentially developing alcoholism later in life, while the other studied anxiety disorders didn’t appear to be risk factors. Alcohol abuse also had the most significant link with social anxiety disorder.

This link is significant because of how it could affect treatment for both disorders. “Many individuals with social anxiety are not in treatment. This means that we have an underutilized potential, not only for reducing the burden of social anxiety, but also for preventing alcohol problems,” study author Dr. Fartein Ask Torvik said in a statement. “Cognitive behavioral therapy with controlled exposure to the feared situations has shown good results.”

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Cognitive behavioral therapy, otherwise known as CBT, is a type of psychotherapy that helps patients by altering patterns of harmful and unhelpful thoughts, behaviors, and emotions. The therapy largely focuses on solutions that help patients question and confront “distorted cognitions and change destructive patterns of behavior,” according to Psychology Today, as well as to develop coping skills. It’s been proven effective as a treatment for a several mental health issues, including anxiety disordersdepression, and eating disorders.

Based on the study results, treating social anxiety and helping prevent it with therapies like CBT could potentially have the benefit of limiting alcohol abuse in patients. The relationship the study pinpointed between excessive drinking and social anxiety suggest further research on the topic is necessary, especially if people are drinking to deal with their mental health instead of seeking mental health treatment.

If you or someone you know is seeking help for substance use, call the SAMHSA National Helpline at 1-800-662-HELP(4357).

The Many Conditions that Mimic Depression

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Finding the right diagnosis for any disorder requires a comprehensive evaluation. Indeed, many illnesses share many of the same symptoms.

Take symptoms such as headache, stomachache, dizziness, fatigue, lethargy, insomnia and appetite loss. There are countless conditions with these exact indications.

Similarly, many mental illnesses share the same symptoms, said Stephanie Smith, PsyD, a psychologist in practice in Erie, Colo., who specializes in working with individuals with depression. Which makes “the process of diagnosing mental illness tricky, to say the least.”

For instance, attention deficit hyperactivity disorder (ADHD) and bipolar disorder can look like depression. All three cause difficulty concentrating, trouble sleeping, and increased worry, Smith said.

Anxiety also mimics depression. According to psychotherapist Colleen Mullen, PsyD, LMFT, like individuals with depression, people who struggle with anxiety might not want to get out of bed. They might stop going to work. They might withdraw socially. However, depression isn’t driving the person’s behavior. Anxiety is.

“An anxious person may stop engaging in their outside world because of the level of anxiety they experience when they try to leave their home.” Because of this, they might, understandably, become depressed, as well. Still, it’s important to treat the anxiety symptoms first (which, in turn, will help to diminish the depression), said Mullen, founder of the Coaching Through Chaos private practice and podcast in San Diego.

Post-traumatic stress disorder (PTSD) is another condition that’s hard to distinguish from major depression. According to Mullen, “PTSD and depression share the following symptoms: memory problems, avoidant behaviors, reduced interest in activities, negative thoughts or beliefs about self or others, inability to concentrate, feeling disconnected from others, irritability and sleep disruptions, and of course, mood changes towards negative emotions.” The biggest tell-tale sign of PTSD is that a person experiences or is exposed to a traumatic or tremendously emotionally straining situation, she said.

Medical conditions mimic depression, too. Two examples are chronic fatigue syndrome and low blood pressure, Mullen said. In this piece Psych Central blogger and author Therese Borchard discusses six conditions that feel like clinical depression but aren’t: vitamin D deficiency; hypothyroidism; low blood sugar; dehydration; food intolerance; and even caffeine withdrawal.

Gary S. Ross, M.D., believes all patients diagnosed with depression should be screened for thyroid dysfunction. As he writes in his 2006 book, Depression & Your Thyroid: What You Need to Know:

There may be rare cases of depression that cannot benefit from thyroid treatment. Nevertheless, in every case of depression, it is optimal practice to test very thoroughly for thyroid dysfunction, much more thoroughly than is usually done in initial screening examinations. When the testing is thorough, then if anything is found in keeping with a low thyroid function, it is crucial to include some kind of thyroid treatment protocol in the overall treatment plan for maximum benefit to the patient.

(Learn more about testing and diagnosis in this piece.)

Having the correct diagnosis is vital. “[I]t leads to a more precise, effective treatment plan,” Smith said. “If we don’t know what we’re dealing with at the beginning of treatment, our interventions can be like shooting arrows in the dark: not very accurate and possibly dangerous.”

Indeed, an accurate diagnosis is life-saving. Literally. Mullen has heard horror stories of primary care physicians diagnosing women with depression when their sluggishness, depressed mood, and weight gain were actually symptoms of cancer. Similar symptoms also may be due to a heart condition, which if undiagnosed, puts a person at risk for severe medical consequences, she said.

This is why it’s so important to have a comprehensive evaluation. See your primary care physician for a series of tests to rule out medical conditions. Ask for a referral to a therapist who specializes in mood disorders, so you can receive a psychological evaluation.

What does a thorough psychological assessment look like?

“[A] good clinical interview includes lots and lots of questions,” Smith said. She asks everything from how long clients have been experiencing their low mood to whether they’ve recently had any changes in their life. Mullen takes into account the person’s current stressors and psychosocial history. The latter involves assessing social support—or lack thereof—and work, education, legal, medical and family history. “It helps us understand the person in the full context of their life thus far.”

Smith also might give objective screening measures such as the Beck Depression Inventory. “It can take one to four sessions to get all the information I need to make a fully informed diagnosis.”

You may or may not be struggling with depression. As Smith said, “depression is a condition almost everyone is familiar with, so it can easily become a catch-all phrase or diagnosis. But there are literally hundreds of other mental health disorders, one of which may better capture the symptoms you are experiencing.”

Either way, take your symptoms seriously and seek second opinions, Mullen said. Because you know yourself better than any professional who spends several hours assessing your symptoms. “Advocate for yourself and ask questions so that you understand what [the professional] recommends for a treatment plan and why.” This is your body. Your mind. Your health and well-being. Advocating for yourself in all areas of your life is one of the best things you can do.

Does Anxiety Cause PTSD or Does PTSD Cause Anxiety?

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This question came up in conversation when I was speaking with someone who has experienced severe panic attacks to the point of calling them “debilitating”, requiring inpatient care.  As they were sharing about the ordeal, they told me that when they contemplate the time spent seeking treatment and the aftermath, it ramped up both the anxiety and PTSD symptoms. Even as a career therapist with decades of experience treating people with stand-alone anxiety, with no overt PTSD symptoms, I had not considered that remembering the anxiety was re-traumatizing. I have heard clients share that anticipating panic attacks was in and of itself anxiety provoking. For this person and so many others, it is hard to determine the line between the two.

As is the case for many who struggle with this condition, they experienced body memory, flashbacks and tremors, as if the events of the past were recurring. Reminding themselves, “I am here and now, not there and then,” alleviated some of the more intense indicators.

This person is also intent on taking on challenges and resilience is one of their superpowers. Overcoming life changing physical conditions were part of the symbolic exercise equipment that helped them to become stronger and more flexible. They were aware that life events happen, unbidden at times and all they can do is ride the waves, sometimes treading water, until things settle back into place. Having solid support from family, friends and professionals keeps them afloat.

Although it might be hard to acknowledge an upside to anxiety or trauma, this person and others I have encountered in both personal and professional realms have been grateful for accompanying lessons. Keep in mind, that no one is sugar-coating it, nor are they denying the pain. They are making a conscious decision to face what comes their way. Paradoxically, the one certainty of life is uncertainty. A catch-22, since anxiety thrives on unpredictability.

The field of Positive Psychology, which offers a strengths-focused perspective to recovery from traumatic experiences, was pioneered by psychologist Martin Seligman, who directs the Positive Psychology Center at the University of Pennsylvania. One concept in this approach is post-traumatic growth, which reflects counterintuitive responses to horrific circumstances. Research from Lawrence G. Calhoun and Richard G. Tedeschi of the University of North Carolina Charlotte found that survivors of trauma often experienced profound healing, a stronger spiritual faith and philosophical grounding. One powerful reframing is referring to the outcome as Post Traumatic Growth.

The 21-item Post-Traumatic Growth Inventory examines responses to painful event in five areas:

  • Relating to others
  • New possibilities
  • Personal strength
  • Spiritual change
  • Appreciation for life

When survivors view themselves in that light and additionally as thrivers who give back or pay it forward, rather than as victims who have no choice but to feel as they do, healing is possible. One such thriver is Michele Rosenthal, a keynote speaker, award-winning blogger, award-nominated author, workshop/seminar leader and certified professional coach. Michele is also a trauma survivor who struggled with posttraumatic stress disorder (PTSD) for over twenty-five years. She calls herself Chief Hope Officer (CHO) of Your Life After Trauma, LLC.

Her trauma came in the form of a condition called, ToxicEpidermal Necrolysis Syndrome (TENS), which she describes as “a freak allergy to a medication that turned me into a full-body burn victim almost overnight.” This horror was followed by a series of physiological and psychological conditions that would flatten even the strongest of people. It took years of determination to recover that led her to be symptom free and now she guides others to overcome their own trauma-trials.

What helped her see her way clear to the other side of suffering is what she refers to as a “healing rampage.”

Rosenthal says, “It is an approach to recovery that is, 1) committed — we keep going no matter what; 2) consistent — we work at it every day; 3) creative — we look for new options and healing opportunities; and, 4) complex — we do the deep work rather than skim the surface as we seek relief.

These are important resiliency building skills regardless of diagnosis or symptomology, whether it falls under the umbrella of anxiety or PTSD.

  • Learn relaxation and breathing techniques to center yourself in the here and now.
  • Do grounding exercises such as walking barefoot on the grass or sand or tapping the bottoms of your feet.
  • If possible, avoid people, places or things that may overtly trigger reaction. Some PTSD survivors may steer clear of fireworks or large numbers of people if loud noises or crowds are related to the initial events.
  • Contemplate an exit strategy if you get inadvertently triggered.
  • Breathe in relaxing aromas, such as lavender, chamomile, vanilla or bergamot.
  • Listen to music that is soul soothing.
  • Seek support from family and friends who may understand your situation and if not, offer a listening presence.
  • Engage in therapy with a licensed professional.
  • If medications are indicated, work with a Psychiatrist or CRNP (Certified Registered Nurse Practitioner) who can prescribe.
  • Attend a self-help group.
  • Utilize the therapeutic modality of EMDR (Eye Movement Desensitization and Reprocessing).
  • Exercise, whether it is in a gym, or a dance floor or basketball court assists in moving the energy. I think of emotion as ‘e-motion’ or ‘energy in motion’.
  • Spend time in nature which is restorative.
  • Dig in the dirt, and plant seeds for new beginnings.
  • Avoid self-medicating with drugs, alcohol, gambling, work, shopping or food.
  • Indulge in healthy hobbies, such as reading, crafts, music, playing board games, putting together puzzles or models.
  • Volunteer your time in your community.
  • If you have a spiritual practice, use it as an additional therapeutic modality.
  • Determine your passion and live it as fully as you can.
  • Spend time with children and learn how to be silly from them.
  • Lighten up by experiencing Laughter Yoga.
  • Enjoy a pampering therapeutic massage.

The Perverse Link Between ADHD and Addiction

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Credit: Marine Corps.

While the exact number of adults with ADHD is unknown, it is estimated that 4% of the U.S. adult population is affected by ADHD. While most people can function very well and become successful despite their condition, ADHD is also associated with life-long impairments in several facets of life, including educational and professional achievements, self-image and interpersonal relationships. But one of the darkest sides of ADHD is its propensity for addiction.

Why ADHD can lead to substance abuse

Addiction is a global problem that affects people from all walks of life, irrespective of gender, financial status, skin color, sexual orientation, religion, or spiritual practice. According to the American Society of Addiction Medicine (ASAM), addiction is “a primary, chronic disease of brain reward, motivation, memory, and related circuitry,” which leads to dysfunctional behavior in order to provoke relief in spite of the negative consequences a person may attract.

“Addiction is an inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death,” according to a characterization on the ASAM website.

It’s these changes in the brain that make addiction so dangerous, causing a person to lose control over his or her use of substances. This also leads to subsequent problems at work, in relationships, and with one’s sense of self-worth and esteem.

Some people are more vulnerable to addiction than others. One primary factor which specialists have identified are adverse childhood experiences, which create their own brain changes. Research has also identified neurological conditions that make people prone to addiction, ADHD being one of them.

Attention-deficit hyperactivity disorder (ADHD) is a syndrome characterized by persistent patterns of inattention and/or impulsivity and hyperactivity that is inappropriate for a given age or developmental stage. The exact causes of ADHD are still unknown but the evidence so far suggests that dopamine neurotransmission dysfunction is at least partially responsible for the disorder’s symptoms. This dopamine link may also explain why ADHD often co-occurs with substance use disorders.

Symptoms of ADHD across lifespan. Credit: ADHD Institute.

The risk of drug and substance abuse is significantly increased in adults with persisting ADHD symptoms who have not been receiving medication.According to one study, ADHD is associated with a twofold increase in the risk of psychoactive substance use disorder. In addition, it is estimated that more than 25% of substance-abusing adolescents meet diagnostic criteria for ADHD. A 2004 survey found that 60% of the adults with ADHD have been addicted to tobacco while 52% have used drugs recreationally.

“One of the strongest predictors of substance use disorders in adulthood is the early use of substances, and children and teens with ADHD have an increased likelihood of using substances at an early age,” Dr. Jeff Temple, a licensed psychologist and director of behavioral health and research in the department of obstetrics and gynaecology at the University of Texas Medical Branch, told Health Line.

Bearing all of this in mind, clinicians working with patients that suffer from both ADHD and substance abuse may need to use a different approach than they would normally. While the treatment literature for ADHD in patients with substance use disorder is not well developed, the emerging trend is that medications effective for adult ADHD may be effective for adults with ADHD and co-occurring substance use disorder. Exercising regularly and having behavioral health checkups during treatment are also important.

The key seems to be starting ADHD treatment as early as possible, before a person has the chance to develop a substance use disorder during his or her teens. Although there is no “cure” for ADHD, there are accepted treatments that specifically target its symptoms. However, it is essential that ADHD treatment begins when the patient is sober, so some drug or alcohol detox may be required before treatment.

“A conservative approach for treating co-occurring ADHD and SUD would be to begin treatment with a non-stimulant pharmacotherapy, but if an adequate response is not obtained, consider stimulant pharmacotherapy. The decision regarding the use of stimulant medications for a patient with ADHD and a co-occurring substance use disorder should be made on the basis of a broad clinical assessment and an individual risk-benefit analysis. For many patients, psychostimulants can be used safely and effectively; however, careful monitoring during treatment is essential to ensure prescribed stimulants are being used in a therapeutic manner, and in the case of worsening substance use or when faced with evidence of the diversion of prescribed medication, treatment should be discontinued,” according to researchers at the New York State Psychiatric Institute.

What Psychotic Episodes Really Look and Feel Like

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When we hear someone is psychotic, we automatically think of psychopaths and cold-blooded criminals. We automatically think “Oh wow, they’re really crazy!” And we automatically think of plenty of other myths and misconceptions that only further the stigma surrounding psychosis.

In other words, the reality is that we get psychosis very wrong.

For starters, psychosis consists of hallucinations and/or delusions. “You can have one or both at the same time,” said Devon MacDermott, Ph.D, a psychologist who previously worked in psychiatric hospitals and outpatient centers, treating individuals experiencing psychosis in various forms.

“Hallucinations are sensory perceptions in the absence of external triggers,” MacDermott said. That is, “the trigger comes from inside [the person’s] own mind,” and involves one of their five senses. The most common is hearing voices, she said. People also can “see or feel things that aren’t there.”

“Delusions are persistent beliefs without sufficient evidence to back up those beliefs—and often with substantial evidence to refute the belief,” said MacDermott, who’s now in private practice where she specializes in trauma and OCD.

Psychologist Jessica Arenella, Ph.D, describes psychosis as a disruption in meaning-making: “The person may be finding meaning in otherwise random or inconsequential things (e.g., license plate numbers, TV ads), while minimizing or failing to grasp the importance of basic needs (e.g., showing up for work, changing one’s clothes).”

The signs of a psychotic episode differ depending on the person, because the symptoms are “an extension of each person’s unique thinking patterns,” MacDermott said.

Generally, people’s speech can be tough to follow or not make sense (because the person’s thoughts are disorganized); they might mutter or talk to themselves; say extraordinary, often unlikely things (e.g., “An actor is in love with me”), she said.

During a psychotic episode, it’s common for individuals to act in ways that are strange or out of character for them, MacDermott said. “This can range from something small like wearing more layers of clothes than is appropriate for the temperature all the way to sudden bursts of emotion that seem to come out of nowhere.”

What Psychotic Episodes Feel Like

Original Artwork by Michelle Hammer

“[During a psychotic episode], I zone out. I’m gone. I leave reality,” said Michelle Hammer, who has schizophrenia. She’s the co-host of Psych Central’s A Bipolar, a Schizophrenic, and a Podcast and founder of Schizophrenic.NYC, a clothing line with the mission of reducing stigma by starting conversations about mental health. “I can be thinking of anything. A past conversation. A made-up conversation. A weird dreamlike situation. I lose reality of where I actually physically am.”

“I mainly just feel ‘off,’ Things just aren’t right,” said Rachel Star Withers, who has schizophrenia and is an entertainer, speaker and video producer. She creates videos documenting her schizophrenia and ways to manage it, and aims to let others like her know they are not alone and can still live an amazing life.

“The biggest tell for me is that I start talking to myself and thinking in third person,” Withers said. She’ll tell herself things like:”OK Rachel, just walk; be normal.”

A patient once described psychosis in this way to MacDermott: “Imagine that you summon a picture in your mind like, say, a baseball. Imagine a baseball. Now imagine what it would be like to have the knowledge that you put that image in your mind taken away. Now, all you are left with is a thought having no idea how it got there. That’s what it’s like to be psychotic.”

MacDermott’s patients also have told her that they struggle with interpreting situations and see special meaning in everyday things. “That same patient once saw a family member put a knife down while they were cooking and had the thought that the family member was trying to send the patient a message that they were going to be killed because a knife represents death.”

In this piece on The Mighty individuals shared what it’s like to experience psychosis. One person wrote, “For me, it felt like I was watching a movie that was my life. I knew bad things were happening and I couldn’t stop it.” Another person described having an “out of body experience,” along with “excruciating sensations amplified by 1,000 at the tip of every sensor in my body.”

Someone else explained it in this way: “Every sense is heightened and colors are especially bright. The world is on a giant flat screen TV. Everything seems more crystal clear than you ever knew, but then it all becomes confused and muddled. You make your own realities, constantly decoding messages that seem extremely important, but are ultimately meaningless. They further the storyline in your head that seems so real.”

Arenella’s clients have described their psychotic episodes as “disorienting, overwhelming, frightening and isolating. They often describe heightened sensitivity, believing that there are no boundaries, that everything is related and transparent, and there is no privacy.”

Some might believe that they’re part of, or at the center of, a critical life-altering mission or plan, Arenella said. Which might lead to intense activity or the complete opposite: a feeling of paralysis.

Myths about Psychotic Episodes

One of the biggest and most harmful myths about psychosis is that people are dangerous and violent. Both MacDermott and Arenella emphasized that individuals in the throes of psychosis are much more likely to be victimized than to victimize.

Similarly, psychosis is not the same as psychopathy, MacDermott said. “Psychopaths are people who don’t feel empathy, are thrill seeking, and often are parasitic, aggressive, or manipulative to others. Psychosis is completely different and unrelated.”

Another misconception is that psychosis is always indicative of schizophrenia. Sometimes, psychotic episodes occur on their own, or as part of a different mental illness, such as depression, Arenella said. Most people only experience one or a handful of psychotic episodes in their lifetime, she said. (“Only approximately one third of people who experience psychotic episodes go on to have persistent psychotic states.”)

And if someone’s psychotic episodes are part of schizophrenia, it’s important to understand that people can and do recover from this illness, Arenella said.

Arenella, a founding board member of Hearing Voices NYC, also noted that eliminating voice hearing isn’t an essential part of treatment. “How a person interprets and interacts with their voices is more important for recovery than hearing them or not hearing them.” (This TED talk from Eleanor Longden, who has schizophrenia, provides more insight.)

Moreover, even many mental health professionals believe the widespread myth that medication successfully treats psychosis, said Arenella, the president of the United States chapter of the International Society for Psychological and Social Approaches to Psychosis. While medication can decrease the intensity of symptoms, many people still hear voices and have difficulty in social relating, she said. Many also experience bothersome or serious side effects.

“Medication works for some people, some of the time, but it is not a cure all.” Psychosocial treatments, such as cognitive behavioral therapy for psychosis (CBT-p), have been shown to be effective in treating psychosis.

What Causes Psychotic Episodes

MacDermott noted that there’s a lot we still don’t know about psychosis, and that includes its causes. Genetics likely plays a role. “People with an immediate family member with schizophrenia are much more likely to have schizophrenia themselves than someone who doesn’t have an immediate family member with the disorder,” she said.

Adverse childhood events and trauma can contribute to psychosis, as well, even though the episode can occur years later, Arenella said. She also identified other common factors: loss, social rejection, insomnia, illegal and prescribed drugs and hormonal changes.

“A lot of antipsychotic medication reduces the amount of certain neurotransmitters, like dopamine, in the brain,” MacDermott said. This suggests that too much dopamine (and other neurotransmitters) might be involved in psychosis. But, as MacDermott noted, “People and brains are so complicated that we can’t know for sure exactly what triggers psychosis in each person.”

A big reason psychosis scares and confuses us is because it seems so out of the realm of “normal.” But in actuality, “psychosis is part of the normal range of human experience,” Arenella said. “While it is unusual, it is not fundamentally different from other human experience.”

That is, she said, “people who hear voices actually hear them and they sound just as real as all of the other voices of people. Imagine if someone were talking to you all day long while you’re trying to have a conversation with someone else; you might be distracted, confused, irritable, and want to avoid conversations. This is a normal response, albeit to an unusual stimuli.”

Also, many people hear voices, and aren’t having a psychotic episode. Arenella noted that after a loved one dies, some people report hearing the person talking to them. “Musicians and poets often hear tunes and verses in their heads and may not feel as if they created them, but more like they received them somehow.” Many people also talk about hearing the voice of God or Jesus during pivotal moments in their lives.

We tend to be taught, both implicitly and explicitly, that psychosis is unlike any other mental health issue—such as anxiety or depression, and “is not amenable to regular therapeutic techniques,” Arenella said. “This fosters a profound othering and harmful stigma toward people who experience psychosis.”

And such teachings simply couldn’t be further from the truth.