8 Reasons Why Your Depression May Not Be Getting Better

Psych Central Article Here

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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.

 

Childhood trauma scars the brain and boosts depression risk

Author Article Here

Childhood trauma such as neglectful parenting causes physical scarring to the brain and increases the risk of severe depression, a new study has found.

For the first time, scientists have linked changes in the structure of the brain both to traumatic early-years experiences and poor mental health in later life.

Published in the Lancet, the study found a “significant” link between adults who had experienced maltreatment as children with a smaller insular cortex, part of the brain believed to help regulate emotion.

It focused particularly on a phenomenon known as “limbic scarring”, which previous research has hinted is linked to stress.

It involved 110 patients admitted to hospital with major depressive disorder who were then monitored for relapses over the following two years.

They were subjected to a detailed childhood trauma questionnaire, which retrospectively assessed historical incidents of physical abuse, physical neglect, emotional abuse, emotional neglect and sexual abuse.

The patients were then given MRI brain scans, which looked for changes to brain structure.

Dr Nils Opel from the University of Münster, Germany, who led the research, said: “Given the impact of the insular cortex on brain functions such as emotional awareness, it’s possible that the changes we saw make patients less responsive to conventional treatments.

“Future psychiatric research should therefore explore how our findings could be translated into special attention, care and treatment that could improve patient outcomes.”

The findings suggest that the reduction in the area of the insular cortex due to limbic scarring could make a future relapse more likely, and that childhood maltreatment is one of the strongest risk factors for major depression.

All participants in the current study, aged 18 to 60 years, had been admitted to hospital following a diagnosis of major depression and were receiving inpatient treatment.

6 Ways Depression Changes As You Get Older, According To Science

Bustle Article
By JR Thorpe

It was my birthday yesterday (thank you, thank you), and this year marks a decade since my diagnosis with Major Depressive Disorder, or MDD. A lot has changed in the intervening ten years, but realistically, it’s likely that I’ll have MDD for the remainder of my life — and that’s an interesting situation, because research reveals that depression itself doesn’t remain static. As we get older, depressive symptoms can change, both in relation to life events (grief, upheaval, breakups) and natural physiological shifts. However, a lot of the time depression is still depicted as a monolith: a diagnosis with the same symptoms and treatments throughout your life. The truth is a lot more dynamic.

There are various types of depression, and it’s important to note that my diagnosis is distinct from situational depression, which is depression that develops in response to trauma and sad events. MDD sticks around even when there’s nothing apparently triggering it. It’s not more or less serious than other kinds of depression. However, it’s important that anybody with a depression diagnosis — and anyone who may have noted it in their family — knows how age can cause flare-ups and change symptoms. Here are six ways depression can change as you age.

1. Depression Can Change The Way Your Body Ages

Giphy

In 2018, scientists discovered that depression ages both our bodies and our brains. One study found that having depression prematurely ages your DNA, making it appear older by an average of around eight months, which has a series of knock-on effects on cells and chromosomes. Depression not only changes as we age; we physically change in response to it.

2. It Can Change Your Brain, Too

Another 2018 study of 71,000 people found that if you have depression, your brain ages faster, experiencing cognitive decline, memory loss, and slowdowns in processing information at an earlier age. “Cognitive function may need to be monitored closely in individuals with affective disorders, as these individuals may be at particular risk of greater cognitive decline,” the scientists wrote. Unfortunately he more cognitive decline experienced, the worse depressive symptoms can get.

3. Depressive Symptoms Can Appear For The First Time As You Age

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While depression can crop up when we’re young, it can also turn up for the first time past the age of 50. A 2015 study found that depression diagnoses increase from the ages of 65 to 85. Part of this is likely due to the issues of aging in general; the Cleveland Clinic has noted that an increase in health issues, loneliness, and grief as we age can be the trigger for depression and depressive feelings.

It’s not just about old age, though. A study in 2014 found that middle-aged women, between 40 and 59, had the highest proportion of depression diagnoses in the United States. There was a slight dip in diagnoses after the age of 60 before an increase again.

4. Age At Menopause Can Affect Depression, Too

Menopause may feel like a long way off, but studies show it seems to affect depressive symptoms too. A study in 2016 published in JAMA Psychiatry found a link between the age at which people hit menopause and their level of depression symptoms. The later they experienced menopause after the age of 40, the less likely they were to have depression.

The scientists said in a press release that “a potentially protective effect of increasing duration of exposure to endogenous estrogens […] as well as by the duration of the reproductive period” might be responsible for lowering depression risk; in other words, the longer we menstruate throughout our lives, the more we’re protected against hormonal-induced depression when menstruation ends.

5. Your Response To Anti-Depressants Can Change Over Time

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Many people with depression will take anti-depressants for a long time, but it’s possible that as we age, our reactions to those medications changes. “It may be that over time certain medications lose their effectiveness or there could be biochemical changes that occur with age,” Dr. Kristina Randle wrote for Psych Central in 2018. “It is important to report your symptoms to your prescribing physician so that he or she may make the necessary adjustments.”

The Mayo Clinic identifies age as a potential reason for antidepressants losing their effectiveness, noting, “As you get older, you may have changes in your brain and thinking (neurological changes) that affect your mood. In addition, the manner in which your body processes medications may be less efficient. You’re also likely to be taking more medications.” Those factors combined can make antidepressants less useful as you age, requiring dosage changes.

6. Your Levels Of This Vitamin May Lead To Greater Depression Risk

For women, a particular consequence of aging can change our depression: folate. “Recent studies suggest that lower concentrations of folate in the blood and nervous system may contribute to depression, mental impairment and dementia,” notes the American Psychological Association. Folate is a B vitamin, and pregnant women are often told to take more folic acid to reduce the risk of miscarriage, but it also has a role in mental health more generally.

Some of us may naturally have lower folate levels, which can lead to problems with antidepressants, depression and anxiety expert Christine Borchard wrote for Everyday Health: up to 40 percent of the U.S. population has a genetic modification that makes folate conversion difficult. However, folate deficiency also increases with age. Studies have repeatedly found that the older you are, the more likely you are to have low folate levels, across numerous populations around the world. As we age, our dipping folate levels may contribute to more depressive symptoms over time.

Depression and age make for a powerful and difficult combination. One thing’s clear: there’s no such thing as a fixed, unchanging depression diagnosis. As we change and age, so does depression.

If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Health (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.

 

6 Mistakes to Avoid in Your Recovery from Depression and Anxiety

Psych Central Article Here

By Therese J. Borchard
Associate Editor Last updated: 10 Apr 2019
~ 3 MIN READ
Recovering from depression and anxiety call for the same kind of shrewdness and amount of perspiration as does running a 4,000-person company. I say that having never done the latter. But hear out my logic: great leaders must master impeccable governing skills, develop the discipline of a triathlete, and build enough stamina to manage multiple personalities. And so does anyone wanting to get outside of her head and live a little.

So I think it’s fitting to translate the insight of a book about business success, The Wisdom of Failure: How to Learn the Tough Leadership Lessons Without Paying the Price by Laurence Weinzimmer and Jim McConoughey, to victory over a mood disorder, or even mild but annoying anxiety and depression.

Weinzimmer and McConoughey describe their “taxonomy of leadership mistakes,” or nine common ways an executive falls flat on his face and is made fun of by his peers. The business world is replete with calculated risks. It’s a chess game, and a few too many wrong moves will have you packing up your stuff from the corner office.

As I read through them, I kept thinking about my main job — managing my depression as best I can — and the pitfalls that I so often run into. Many are the same listed in this book. Here are six mistakes business leaders make that are appropriate for our purposes:

Mistake one: Trying to be all things to all people.
The “just say no” problem that I have all the time. If you think of requests from friends, families, bosses, co-workers, and golden retrievers as customers asking you for all kinds of products that you can’t simultaneously produce, then you see the logic in your having to draw the line at some point. You must hang on to your resources to stay well.

Mistake two: Roaming outside the box.
Clarification: thinking outside the box is good. Hanging out there, strolling around in pursuit of some meaning that you keep finding in everything that passes by — that’s dangerous. When it comes to recovery, this is very important to remember. I like to try new things: yoga, new fish oil supplements, a new light lamp, different support groups.

What gets me in trouble is when I start to think that I don’t have bipolar disorder and can go off all meds, healing myself through meditation alone. I tried that once and landed in the hospital twice. Now I double check to make sure the box is still in my peripheral vision.

Mistake three: Efficiencies before effectiveness.
This has to do with seeing the forest behind the trees, and subscribing to a policy of making decisions based on the view of the forest, not the trees that are blocking everything from your sight. The authors cite the example of Circuit City’s CEO who cut 3,400 sales people to decrease costs despite the fact that their research said that customers want knowledgeable sales people to help them make decisions when buying electronics. His approach was efficient, but not all that effective.

When you are desperate to feel better, it’s so easy to reach for the Band-Aid — booze, cigarettes, toxic relationships — that might do an efficient job of killing the pain. Effective in the longterm? Not so much.

Mistake four: Dysfunctional harmony.
Like me! Like me! Please like me! Dysfunctional harmony involves abandoning your needs to please others, which jeopardizes your recovery efforts.

“Being an effective leader [or person in charge of one’s health] means that sometimes you will not make the most popular decisions,” the authors explain. “By doing what is necessary, you will sometimes make some people angry. That’s okay. It’s part of the job. If you are in a leadership role and you try to be liked by everyone all of the time, you will inevitably create drama and undercut your own authority and effectiveness.”

So think of yourself as the CEO of you and start making some authoritative decisions that are in the best interest of You, Inc.

Mistake five: Hoarding
I’m not talking about your sister’s stash of peanuts and Q-Tips. This is about hoarding responsibility. For those of us trying like hell to live a good and happy life, this means giving over the reins now and then to other people, persons, and things that can help us: doctors, husbands, sisters, even pets. It means relying on the people in your life who say they love you and letting them do the small things so that you can try your best to be the best boss of yourself again.

Mistake six: Disengagement
Burnout. It happens in all recovery. I have yet to meet someone who can continue a regiment of daily meditation, boot camp, and spinach and cucumber smoothies for more than three months without calling uncle and reaching for the pepperoni pizza. That’s why it is so critical to pace yourself in your recovery. What’s a realistic number of times to exercise during the week? Are you really going to do that at 4:30 am? Why not allow yourself one day of hotdogs and ice-cream in order to not throw out the whole healthy living initiative at once?

Imagine yourself a great leader of your mind, body, and spirit — managing a staff of personalities inside yourself that need direction. Take it from these two corporate leaders, and don’t make the same mistakes.

Some People Can Thrive After Depression, Study Finds

Author Article
We may think of depression as a recurring condition with a gloomy prognosis, but findings from one study indicate that nearly 10% of adults in the United States with major depression were thriving ten years later. The findings, which appear in Clinical Psychological Science, suggest that some people with depression experience more than a reduction in depressive symptoms over time – they can achieve optimal psychological well-being.

Writing for The Conversation, lead investigator Jonathan Rottenberg, a researcher at the University of South Florida, discusses how clinical scientists often neglect the potential for positive outcomes among individuals with depression.

“Depression can be a lifelong problem. Yet as we dug deeper into the epidemiological findings, we also saw signs of better outcomes – an aspect that we found is rarely investigated,” he says.

Although current clinical practice emphasizes symptom reduction and achieving an absence of stress, evidence indicates that patients prioritize other measures of well-being.

“They want to love and be loved, be engaged in the present moment, extract joy and meaning, and do something that matters – something that makes the pain and setbacks of daily life worthwhile,” says Rottenberg.

Rottenberg and his colleagues found that a substantial percentage of those with depression can achieve just that.

Using data from the Midlife Development in the United Stated (MIDUS) study, the researchers examined outcomes in a nationally representative sample of middle-aged adults. The participants completed phone interviews and questionnaires, including a measure of depression and a battery of nine facets of well-being including autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, self-acceptance, life satisfaction, and negative and positive affect.

A total of 239 participants in the sample met the criteria for depression, meaning that they experienced depressed mood most of the day or every day, as well as additional symptoms, for at least 2 weeks out of the previous 12 months. The researchers reviewed data from the initial screening and a follow-up survey completed 10 years later.

At the 10-year follow-up, half of the participants reported experiencing no major symptoms of depression in the past 12 months, and almost 10% of the participants with a history of depression were thriving. To count as thriving, a participant had to show no evidence of depression and score higher than 75% of nondepressed MIDUS participants on the nine factors of psychological well-being.

Higher well-being at beginning of the study predicted thriving 10 years later, but severity of depression did not. Specifically, depressed adults who reported higher well-being at the beginning of the study had a 30% chance of thriving, compared with a 1% chance for participants who had low well-being when they began the study. Depressed participants with higher well-being at the beginning of the study and who were thriving at the end of the study had larger increases in well-being over time than did other depressed participants.

These findings could influence how mental health professionals think about the prognosis associated with depression, as well as how they communicate this prognosis to patients. The study suggests that treatment could focus on strategies for optimizing well-being optimization that go beyond just managing symptoms.

“The task now for researchers is to follow these encouraging signs with systematic data collection on how people thrive after depression,” says Rottenberg.

Reference

Rottenberg, J., Devendorf, A. R., Panaite, V., Disabato, D. J., & Kashdan, T. B. (2019). Optimal well-being after major depression. Clinical Psychological Science. https://doi.org/10.1177%2F2167702618812708

The Powerful Link Between Insomnia and Depression

Author Article

When one has difficulty sleeping, the waking world seems opaque. On top of feeling tired and fatigued, those who experience sleep disturbances can be irritable and have difficulty concentrating. When one has more severe cases of insomnia, one also faces a higher risk of developing heart disease, chronic pain, hypertension, and respiratory disorders. It can also cause some to gain weight.

Sleep disruptions can also have a major impact on one’s emotional well-being. A growing body of research has found that sleep disturbances and depression have an extremely high rate of concurrence, and many researchers are convinced that the two are biconditional—meaning that one can give rise to the other, and vice-versa. A paper that was published in Dialogues in Clinical Neuroscience concluded, “The link between the two is so fundamental that some researchers have suggested that a diagnosis of depression in the absence of sleep complaints should be made with caution.” The paper’s lead author, David Nutt—the Edmond J. Safra Chair in Neuropsychopharmacology at Imperial College London—found that 83 percent of depressed patients experienced some form of insomnia, which was more than double the amount (36 percent) of those without depression.

Bei Bei, Dpsych, PhD, from the Monash School of Psychological Sciences in Clayton, Australia, said the inverse was true, as well: “If a person does not currently have depression but goes through extended periods of time with sleep disturbances or insomnia, the sleep disturbances can potentially contribute to a mood disturbance or to even more severe depression.”

The Mechanisms Behind the Two Diseases

The sleep-wake cycle is regulated by what is known as the circadian process. When working properly, the circadian process operates in rhythm with the typical cycle of a day. One gets tired as the light of the day fades and the body prepares for sleep. One awakes as it becomes light again. The internal mechanisms behind the circadian cycle involve a complex orchestration of the neurochemical and the nuerophysiological presided over by the hypothalamus.

Depression, meanwhile, is a medical condition and a mood disorder. While there are several possible antecedents to depression, as genetic and environmental factors can lead to a depressive episode, the neurophysiological causes of depression pertain to a deficiency of chemicals in the brain that regulate mood: serotonin, dopamine, and norepinephrine.

However, these neurotransmitters do far more than just regulate mood. They have also been found to be integral to sleep efficiency. Disruptions in these brain chemicals can lead to disturbances in sleep, particularly REMsleep, and can also lead to more restlessness during typical times when one should be in bed. This can create a vicious cycle wherein the more severe one’s depression becomes, the more severe one’s insomnia becomes. The inverse can also true: The more severe one’s insomnia becomes, the more severe one’s depression becomes.

Evaluation and Treatment

Because these concurrent afflictions reinforce one another, medical professionals need to address both simultaneously for optimal treatment. However, there is not one cookie-cutter response that can eliminate both depression and insomnia. Many variables, including improper medication, can contribute to insomnia and different symptoms indicate different causes, which is why it is important to provide your mental health professional with any information that can give them with more insight about your condition. Describing your symptoms to your doctor allows them to narrow down the list of likely culprits and prescribe medications with greater precision. For example, letting your doctor know that you wake up in the middle of the night, and then have difficulties falling back to sleep is a distinct symptom from having difficulties falling asleep in the first place.

Though depression and insomnia are commonly linked, they can be independent of one another. Then again, they may be part of a larger array of comorbid disorders that require specific treatment plans to resolve. To determine the best course of action, your doctor may recommend a sleep study, medication, or a behavioral therapy.

Sleep Study

A sleep study is a test that measures how much and how well you sleep. During this test, you will be monitored by a team of sleep specialists who will be able to determine if there are any other disorders, such as restless leg syndrome or sleep apnea, that may be causing your insomnia. Even if the study does not reveal a definitive culprit, the sleep study will also allow your doctor to get a better picture about what is behind your insomnia.

Medication

Sleeping pills may help you fall asleep, but they are not long-term solutions to mental health. If you are suffering from a bout of insomnia that is related to a psychiatric disorder, you need to address that disorder to address your insomnia. Oftentimes, this will require a treatment plan that includes a pharmaceutical component. This component will be unique to each patient, as there is not a one-size-fits-all regimen of medication for optimal mental health. Furthermore, there are numerous comorbidities with depression, such as anxiety, that may be contributing to your insomnia and that may not be resolved by certain types of anti-depressants alone.

Another potential treatment involves a combination of medication, light treatment, and melatonin, a hormone that helps regulate the circadian process. The conditions of patients who receive light therapy in conjunction with antidepressant therapy tend to show more improvement than those who are prescribed antidepressants alone. This is true for patients with seasonal and nonseasonal depression.

Cognitive Behavioral Therapy for Insomnia

In other cases, some mental health professionals may recommend you see a sleep specialist to receive cognitive behavioral therapy for insomnia. Cognitive behavioral therapy for insomnia (CBTI) involves numerous non-drug techniques to induce sleep and it can be utilized before resorting to the use of pharmacological sleep aids with surprisingly good results.

Several studies have shown CBTI to be quite effective in treating insomnia and some forms of depression. A paper published in the Journal of Clinical Sleep Medicine in 2006 concluded that “The benefits of CBTI extend beyond insomnia and include improvements in non-sleep outcomes, such as overall well-being and depressive symptom severity, including suicidalideation, among patients with baseline elevations.” A paper published in the International Review of Psychiatry in 2014 found that CBTI may help with other comorbidities beyond depression. These include anxiety, PTSD, and substance abuse issues.

The National Sleep Foundation notes that this type of therapy can still be quite intensive. CBTI requires regular visits to a clinician for assessment, keeping a sleep diary, and, perhaps most importantly, the changing of behaviors that may be felt as though they are firmly part of one’s routine. CBTI may also include some sleep hygiene education, where patients learn how different settings and actions can inhibit or promote sleep. It may also rely on relaxation training, where patients learn methods of calming their bodies and minds.

Concluding Thoughts

If you are struggling with either depression, insomnia, or both, treatments are available. The above studies demonstrate that there are holistic approaches, as well as pharmaceutical remedies, that can help induce sleep without the aid of sleeping pills. It is also a reminder that the most effective treatment plans are tailored to both the individual patient and the patient’s concurrent illnesses.

LinkedIn Image Credit: Kleber Cordeiro/Shutterstock

11 Habits That Can Actually Be Signs Of Mental Illness

Author Article

Ashley Batz/Bustle

While the signs and symptoms of different mental illnesses can be tricky to spot, it helps to consider how they might show up in the form of certain daily habits. By knowing what to look for, it can be easier to see these habits for what they really are, and even get some help. Because if they’re holding you back, or negatively impacting your life, then they very well may be something worth treating.

“A habit becomes a sign of mental illness once it hijacks your physical and/or mental well-being and interferes with your [life],” Dr. Georgia Witkin, Progyny’s head of patient services development, tells Bustle. “For instance, constant worry [can lead you] to make life-altering changes, such as not leaving the house,” which can impact your career, relationships, and hobbies.

These habits can take many forms, and will be different for everyone. But what you’ll want to keep an eye out for are habits that seem out of character, or ones that are making life more difficult. When that’s the case, “it’s worth a visit to a healthcare provider who can help to identify and address the underlying issue(s),” Susan Weinstein, co-executive director of Families for Depression Awareness, tells Bustle.

With that in mind, read on below for some habits that can be a sign of a mental health concern, according to experts.

1. Wanting To Spend More Time Alone

Ashley Batz/Bustle

“No longer wanting to see loved ones or participating in hobbies is indicative of mental illness,” Dr. Witkin says, with depression being one of the most likely culprits, since it can make it difficult to go about your usual routine.

That said, it’s always OK to take time for yourself, and hang out alone. But if you used to go out, see friends, or enjoy certain hobbies, it may be a good idea to reach out to a therapist, if you can no longer find the energy to do so.

2. Missing Work Or Appointments

Hannah Burton/Bustle

If you’re generally on top of your schedule, but have developed the habit of showing up late to work, calling out, or blowing off appointments, take note.

“Individuals [that] frequently disengage could be dealing with high anxiety, which often leads to avoidance, or possibly depression, which can lead to an inability to reach out,” Reynelda Jones, LMSW, CAADC, ADS, tells Bustle.

Even things like bipolar disorder, and other mental health issues, can make it difficult to get to work on time — or even get there at all.

3. Spending A Lot Of Money

Hannah Burton/Bustle

There’s nothing wrong with going shopping, or treating yourself to something nice. But for many people, excessive spending can be a sign of a health concern.

For example, “spending large amounts of money often manifests in an individual whose experiencing a manic episode,” Jones says, which is an aspect of bipolar disorder.

“Often the individual spends money beyond [their] financial means,” she says, only to feel really guilty or hopeless about how much they spent, once they come down from this phase. If this has become an issue for you, it may be time to ask for help.

4. Feeling Irritated & Picking Fights

Andrew Zaeh for Bustle

While it’s fine to have the occasional disagreement, acting in an excessively angry or cranky way, or picking little fights with others, isn’t a habit that should be overlooked.

“Anger and irritability, such as flying off the handle or constant grousing, can be signs of depression or bipolar disorder, particularly when they seem unprovoked and unusual for that person,” Weinstein says.

If these habits sound familiar, reaching out to a therapist may be a good next step, so you can figure out what’s going on.

5. Starting New Projects And/Or Businesses

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This is another habit that’s common among people who have bipolar disorder. But unlike folks who are starting businesses because they’ve thought it through and are thinking clearly, someone with this disorder might go forth with no concern to the risks they’re taking on, Jones says.

When someone is manic, they might also talk rapidly or jump from topic to topic, Dr. Indra Cidambi, psychiatrist and addiction expert, tells Bustle. Or they’ll take on too many things at once. Oftentimes, manic episodes are followed by periods of depression, which is when these grandiose plans can fall apart.

While it’s always great to learn new things, start new projects, and get excited about business ideas, this habit could mean something isn’t quite right.

6. Developing New Mannerisms

Hannah Burton/Bustle

“A shifting posture or gesture or even how we walk throughout our day can signal shifts in mood, which can often be a sign of mental health concerns or maybe even mental illness,” therapist Erica Hornthal, LCPC, BC-DMT, tells Bustle.

It could, for example, point to a mood disorder, since movement can be a “reflection of our emotional state and mental health,” she says. Think along the lines of new mannerisms, and other habits that seem out of character.

7. Misplacing Things

Andrew Zaeh for Bustle

Not being able to find belongings in a messy room, along with an inability to make decisions and forgetting things, can be a sign of depression, Weinstein says.

If this is a problem you’re struggling with, let a doctor know. They can help you figure out if it is, in fact, stemming from depression, and set you on the right course of treatment.

8. Staying Up All Night

Andrew Zaeh for Bustle

“Sleeping either too little or too much can be a symptom of a mental disorder,” Dr. Witkin says. “Often times, anxiety disorders cause insomnia or restless sleep, while depression causes oversleeping and eventual fatigue.”

In general, it’s healthy to sleep about seven to nine hours a night. If this is something you struggle to do, you may want to look into reasons why, including possible mental health issues.

9. Worrying About The Day Ahead

Ashley Batz/Bustle

While it’s common to feel a bit stressed or worried as you think about the day ahead, it might be a sign of anxiety if you worry to the point of distraction, avoid certain situations, or play out worst-case scenarios.

As Dr. Cidambi says, “Excessive worrying that is disproportionate to normal, everyday events is one important sign that one may be suffering from an anxiety disorder.”

10. Repeating Small Daily Rituals

Andrew Zaeh for Bustle

“Normal rituals we might all partake in that are a way to mark a change of pace for the day — such as kissing a [partner] goodbye, or checking to make sure that we have our keys or phone — are normal, and can be helpful rituals,” licensed clinical psychologist Dr. Scott Hoye, PsyD, tells Bustle.

But for folks with obsessive compulsive disorder (OCD), these habits can take over. Instead of locking your front door once, for example, you might lock it ten times, or even drive back home to lock it again.

That’s because this disorder can cause you to doubt yourself, perform rituals over and over again, or experience magical thinking. So when a habit has turned into an obsession, Dr. Hoye says it may be a sign of a mental health concern.

11. Needing A Drink After Work

WAYHOME studio/Shutterstock

There’s nothing wrong with getting a drink after work, having wine with dinner, or hanging out at the bar. But if this habit has turned into something you need to do in order to relax, consider how it might be a way to mask symptoms of anxiety or depression, Dr. Hoye says.

It’s not uncommon for folks experiencing excessive worry, for example, to develop ways to relax, such as reaching for a drink. So if you’re concerned, don’t hesitate to let a doctor know.

It can be tough to spot these habits, and see them for what they are. But if you or someone else notices them, it doesn’t hurt to seek out the help.

By speaking with a therapist, you may realize that one of your habits was, in fact, a sign of a mental health concern. And in doing so, you’ll be starting the process of getting help and support, so you can get back to feeling better.

Editor’s Note: If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Health (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.`

The Deceitful Voice Of Depression

Author Article

Teenage Depression

I never considered myself the sort of person who would take their own life…

That’s an awful lot of people, but I never expected to become one of them. I have always been known for my sunny, cheerful nature and natural ease in social situations. Neither was I an anxious person. How could someone like me become so anxious and depressed I actually contemplated taking my own life? The truth is I don’t know the answer. On paper, there’s nothing in my life that could make me feel this bad. I have a good marriage, a job I love and am financially secure. I have a decent group of friends and time to indulge in my hobbies. But some of the resources online that talk about depression are less than helpful.

“Focus on the positives,” they say. “Think of all the good things in your life.”

But that doesn’t make me feel better. It makes me feel worse because if I concentrate on the good things in my life, I feel selfish and overprivileged. Other people have far worse problems than I do. The truth is depression is common and is not always situational (e.g. a response to trauma or a bereavement). And the thing about depression is it lies to you, tells you you’re worthless and a burden and it’s not easy to ignore its insidious voice.

So after months of trying medication after medication, I was getting progressively worse to the point where I had completely lost hope.  The crushing feeling of despair that things were never going to get better was overwhelming, and what had been fleeting thoughts of suicide suddenly crystallized into a plan. I even had the music I wanted to play. It was a stupid and dangerous plan, one that could have inadvertently hurt other people and it was that thought that stopped me. I had no desire for anyone to be hurt because of me. Instead, I called the National Suicide Prevention Lifeline3 (1-800-273-8255, or text the 2-letter abbreviation for your state to 741741).

I was in my car in a parking lot and they told me to stay where I was until the crisis team found me. The police showed up and asked me a few questions before taking me off to a crisis center for evaluation. At the crisis center, I was handcuffed to be taken inside. My shame and humiliation, already at a high level, increased dramatically.

Inside the crisis center, it was a chaotic scene. Most of the people there were either drunk or high. The staff were nice but seemed harried and overstretched. Eventually, I was assessed and referred to a local hospital for inpatient treatment. The whole thing took hours and I got no sleep that night. The next day I was distressed and scared and nobody was telling me what was happening. My husband was desperately trying to get in contact with me but they had my cellphone and nobody would tell him anything or let him see me. I understand why, but it was very difficult for him.

Despite the rough beginning, it was exactly what I needed. Enclosed in this cocoon where the outside world could not penetrate, I could concentrate on myself for a while. I spent about a week in the hospital, and now I am out again, I’m looking at the world with new eyes.

Maybe you’d argue I’m oversensitive, but every time someone uses suicide hyperbolically in casual conversation, it hurts me. My throat clogs and my eyes burn. Because now I understand what it means to truly want to die.

If someone you know (or a celebrity) dies by suicide:

Don’t say you never expected it. The truth is, you have no idea. Some people, like me, are very good at faking it.

Don’t tell a suicidal person they have so much to live for. It’s not as helpful as you might think.

Don’t call suicide selfish. I used to think this but that’s because I didn’t understand. A depressed person often believes their death would be beneficial to the people in their life because they feel like a burden.

If someone in your life has depression:

Be supportive. That means being understanding if they don’t want to socialize, or aren’t feeling chatty. Be willing to listen if they want to talk, but don’t ask them how they’re feeling every 5 minutes.

Encourage them to seek help. There are resources out there, although they’re terribly overstretched. Reference 3 can help you find local resources.

Things have gotten better for me. My psychiatrist has added another medication, I’m going to start attending group therapy as well as my weekly individual therapy sessions and I’m going to try transcranial magnetic stimulation4. The new medication is already helping, and I’m investing in some wellness measures as well. I’m grateful to everyone who has been helping me. It’s still a daily battle and I’m a long way from winning this war, but now at least, I have hope.

  1. www.nimh.nih.gov/…
  2. afsp.org/…
  3. suicidepreventionlifeline.org
  4. www.mayoclinic.org/…

Why Using The Words ‘Committed Suicide’ Is Only Making Things Worse

Author Article

Someone sitting on the ground holding their head, mental health

By using the word ‘committed,’ we cast suicide in an immoral or illegal light. (Photo: songpholt/Shutterstock)

There’s little doubt that language — the words we use and how we use them — has a profound influence on culture. Over time, some words even burrow so deeply into our collective mindset that they change the way we think.

As Antonio Benítez-Burraco writes in Psychology Today, “Languages do not limit our ability to perceive the world or to think about the world, but they focus our perception, attention, and thought on specific aspects of the world.”

Different words spoken in different languages don’t just dress the same concept. They shape and often redefine that concept — imparting meaning as much as they describe it.

When it comes to language, we’ve got a lot wrapped up in the wrapping, particularly when it comes to very sensitive concepts like the taking of one’s own life.

To describe that act, we’re still using the term “committed suicide.”

And while the words may sound cold and clinical, they are, in fact, anything but sterile.

They’re loaded with meaning — in the worst possible way. Think about things that are “committed”: fraud, adultery, murder, sin.

In our society, when something is committed, that something by default is a bad thing. (When was the last time you heard about two people falling in love and “committing marriage?”)

Suicide, while inarguably a bad thing, is a lot more complex than tax evasion. It’s more like life evasion. Or at least, the need to escape from overwhelming stress and trauma. It’s often inextricably entwined with mental health.

So why heap more scorn on people battling those devastating issues? Why frame suicide as an immoral act?

“The term ‘committed suicide’ is damaging because for many, if not most, people it evokes associations with ‘committed a crime’ or ‘committed a sin’ and makes us think about something morally reprehensible or illegal,” Jacek Debiec, a professor at the University of Michigan’s department of psychiatry, tells the Huffington Post.

There are alternatives. Mental health professional suggest skirting the stigma-fraught word “committed” entirely. Some lean towards the term “completed suicide,” although that seems to introduce another wholly unwelcome meaning.

“Think of the sense of accomplishment you feel when you complete a big project. Then think of the disappointment you feel when you don’t,” writes University of Denver professor Stacey Freedenthal.

“Completion is good, and suicide isn’t.”

Indeed, that may swing the pendulum too hard in the destigmatizing direction. Freedenthal, like many mental health experts, suggests simply getting rid of the troublesome “committed” and simply saying “killed by suicide.”

Makes sense, doesn’t it? And yet, we’re still largely stuck on that victim-blaming classic: committed suicide.

The irony here? We all agree that mental health is something that improves when we talk about it. But the acme of mental distress — suicide — is so steeped in immorality and even criminality, who dares talk about it?

Someone holding up a sign that reads, 'Help'Stigmas surrounding mental health often prevent people from seeking the help they need. (Photo: Srdjan Randjelovic/Shutterstock)

And maybe that’s why the suicide rate is surging. It’s the affliction that dare not speak its name — even as we need to talk about it now, more than ever. In the U.S., suicide was the 10th leading cause of death in 2016, claiming some 45,000 lives, according to the Centers for Disease Control and Prevention. More alarmingly, suicide was the second leading cause of death among individuals between the ages of 10 and 34.

But suicide may also be the only major disease that’s entirely preventable. Communication can be a powerful vaccine.

“Suicide is not a sin and is no longer a crime, so we should stop saying that people ‘commit’ suicide,” concluded researcher Susan Beaton in a 2013 paper. “We now live in a time when we seek to understand people who experience suicidal ideation, behaviours and attempts, and to treat them with compassion rather than condemn them.”

So maybe it’s time we stopped stigmatizing the act, and, by doing so, encouraged the kinds of conversations that save lives.

No one is perpetrating a crime here. The only crime, in fact, is that we’re still using language to cast it as one.

If you’re struggling with thoughts of self harm or suicide, there is help. For a list of phone numbers and resources across the U.S., visit the U.S. National Suicide & Crisis Hotlines webpage.

Sometimes Depression Means Not Feeling Anything At All

Author Article

Lobo Studio

This article originally appeared on Tonic in the US.

I never realized how little I knew about depression until I became depressed. I didn’t know, for instance, how depression can snatch away your sex drive, leaving you feeling newly—and involuntarily—asexual. I didn’t know that depression attacks your attention span, your energy, and your ability to finish things. During a recent bout, I had trouble finishing magazine articles and movies. The number of emails I sent plummeted. Everyday errands felt like Herculean tasks.

But perhaps most surprising was the emotional numbness. Nothing about hearing the word “depression” prepares you for having a moment of eye contact with your two-year-old niece that you know ought to melt my heart—but it doesn’t. Or for sitting at a funeral for a friend, surrounded by sobs and sniffles, and wondering, with a mix of guilt and alarm, why you’re not feeling more. 

During my recent depression spell, I experienced this kind of numbness for weeks. Political news that would have previously enraged me left me cold. Music had little effect beyond stirring memories of how it used to make me feel. Jokes were unfunny. Books were uninteresting. Food was unappetizing. I felt, as Phillip Lopate wrote in his uncannily accurate poem “Numbness,” “precisely nothing.”

And this was new to me. Because while I had been in and out of depression before, I still, like many people, didn’t fully grasp an illness that affected 16 million Americans in 2015. (That’s more than the combined populations of New York City, LA, and Chicago.) “It’s ubiquitous,” the author of The Noonday Demon: An Atlas of Depression, Andrew Solomon, tells me. “[And yet] I think the public doesn’t really understand it well at all.”

The Diagnostic and Statistical Manual of Mental Disorders says, for a person to be diagnosed with Major Depressive Disorder, they need to experience “Depressed mood most of the day, nearly every day” or “markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day” for a period of two weeks. But this is just the baseline. For a diagnosis to be made, the person must also report at least four additional symptoms from a list that includes significant weight loss or weight gain, an inability to sleep or excessive sleepiness, physical restlessness or slowness (“psychomotor agitation or retardation,” in clinical terms), frequent fatigue or energy loss, feelings of worthlessness or excessive guilt, indecision or a diminished ability to concentrate, and recurring thoughts of death or suicide.

“It’s truly amazing to me, the longer I’ve been in the field, how many manifestations of depression there can be in the body,” says Jennifer Payne, a professor of psychiatry and director of the Women’s Mood Disorders Center at Johns Hopkins School of Medicine. These can range from headaches to GI issues to various pain syndromes, and depression can also exacerbate existing conditions, like diabetes or high blood pressure. “If you take two women with the same breast cancer, one’s depressed [and] one’s not, the woman who’s depressed has twice the chance of dying from her breast cancer,” Payne says.


During my conversations with Payne and other medical experts, I began to understand just how vast and multifaceted this illness can be. Depression can be visible or invisible to a person’s loved ones. It can last for weeks, years, or even decades. It can affect sleep, concentration, appetite, energy, memory, movement, and—as I know well from trying to write while depressed —a person’s facility with language.

A particularly scary aspect is the fact that hopelessness and helplessness are actually symptoms of the illness. Stanford University’s David Spiegel, a professor of psychiatry and behavioral sciences and director of the school’s Center on Stress and Health, tells me that depression is a common, treatable mental disorder, but people it afflicts can blame themselves for things that aren’t their fault. “And so depressed people often feel guilty about being depressed and not performing the way they should,” he says. “And that’s part of the disease…[that] keeps them from digging their way out, or getting help from people to dig their way out.”

And the causes of the illness can be as varied as the symptoms. Emory University’s Nadine Kaslow, a professor of psychiatry and behavioral sciences, tells me that, with some people, depression is more genetically driven, while others experience it as reaction to external stress. She runs off a long list of the circumstances that can trigger depression: loss of a loved one, job, or key identity; things that cause feelings of failure, shame, or humiliation; a natural disaster that overturns your life, like the recent hurricanes in Texas, Florida, and Puerto Rico; financial woes and anxiety; child abuse; domestic violence.

We also know that depression can be devilishly impervious to happy events. Readers of William Styron’s Darkness Visible: A Memoir of Madness, may remember how he describes receiving a prestigious literary prize in Paris, a check for $25,000, and royal treatment from his hosts, all while feeling what he describes as “panic…dislocation, and a sense that my thought processes were being engulfed by a toxic and unnameable tide that obliterated any enjoyable response to the living world.”

The more I dug into my reporting, it also became clear how many things depression is not. It is not the fault of the person afflicted, nor is it necessarily in their control to “snap out of it” or “pull themselves up by their bootstraps.” (These two points really can’t be stressed enough.) And it certainly is not merely feeling sad. “People who have never experienced depression think, ‘Well, I pulled myself together after a rough time,’ and they don’t understand the intense physicality, the immediacy, and the incontrovertibility of the condition,” Solomon says. It’s tempting to envision depression as an extreme point on a mood spectrum, he adds, but it’s really the mood spectrum shutting down altogether. The word he used frequently in our conversation was a feeling of “nullity.” And in his TED talkon depression, he repeats the sentence, “The opposite of depression is not happiness, but vitality.”

The British author Matt Haig recently tweeted, “Everyone is comfortable so long as you talk about mental illness in the past tense.” And I admit, it’s easier for me to write this piece after my recent bout of depression passed. When I share it with people I know, I can truthfully say, “I feel much better now,” and spare us both a less comfortable conversation. But being outside of a depressive spell (at least for now; I have little doubt I’ll return at some point) also allows me an interesting journalistic perspective.

One point worth making—and I say this as a mostly non-religious person—is that emotions are a sacred, miraculous thing. You realize this when you lose them. I don’t think I’ve ever felt so happy to feel angry as the recent day when, after reading about some recent political horror, I felt my first stirrings of moral outrage in months. I was offended again—and it was beautiful. Other revelatory moments followed, like household appliances flickering back on after a power outage: the return of that almost-crying lump in my throat during emotional movies, or the burst of spontaneous laughter when I heard a joke. A few weeks ago, I drove home after an errand and stayed in my car for a minute just to soak in the old-but-new joy I from a song I had recently discovered.

But even as I exit my latest depressive spell, I remain mindful of the people who are still there. I know what it means to smile for a photo and feel like you’re lying. I know what it means to feel a vague sense of sadness over not feeling sadness. I know what it means to comb the Internet for a video, an article, a book, that explains what’s going on inside your seemingly broken brain. To know depression is to become familiar with one of its paradoxes: the feeling that you’re missing out on the full human experience is, in fact, a large part of the human experience.

This is where friends and family can help. Odds are that you know someone who has been, or will be, depressed at some point. And so being a vigilant friend and family member means keeping an eye out for the person who’s less and less socially active. Stay aware of the co-worker for whom it appears, as one expert told me, “like the light in their eyes is gone.” Check in with them. Call them. Visit with them.

The brain is a complex and crucial organ that represents humans’ major evolutionary advantage over other animals, Spiegel tells me. And sometimes it has problems working. When this happens, it’s not a judgment on the person affected, he says. “It’s a problem that sometimes comes up when you’re dealing with using a complex organ to deal with complex problems in life.”

It’s easy to fix a bike or a car when they break, he continues, but your brain is complicated. “So get help with it if it’s not working right.”

 

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