Here’s A Way To Protect Yourself When You Feel The Depression Coming

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As someone diagnosed with ADD who, without medication, has been able to accomplish some truly focus-dependent projects (like writing a 250-page book, for example), here are 10 ways I have found to increase productivity:

1. Prepare before you get started

Productivity doesn’t just happen “in the moment.”

It happens long before you even sit down and get to work. The more you prepare ahead of time, and get clear on exactly what it is you want, need, or should do, the easier and faster you will move once you start.

The reason why so many people struggle with “being productive” is because they skip this step, and when they sit down, they expect to start flying even though they haven’t even decided where it is they want to fly to.

2. Turn off all distractions

It doesn’t take a genius to realize that every time your phone buzzes, your e-mail pops up on your screen, your office door opens, your train of thought is ruined.

We like to believe we can both participate in a group chat via text and write our best-selling novel, but the truth is, we can’t — and to think we can is wishful and naive.

Your best work comes in silence.

It’s why people retreat and take vacations away from the busyness of life — to distance themselves from distraction.

3. Make your expectations flexible

The hardest part about “productivity” is that we want it to exist on a static playing field.

We want there to be one formal definition for “being productive” and we want that definition to mean we got from point A to point B. But, depending on what you’re working on, sometimes you have to take the scenic route.

Sometimes the most productive thing you could possibly do right now is to brainstorm a million random ideas, play with a few of them, watch them fail before your eyes, and then come to a more refined conclusion of what it is you’re actually trying to build or “get done.” In many cases, people would see this as an afternoon failure. But on the contrary, it is necessary in order to better understand whatever it is you’re doing.

Don’t fight yourself when that happens.

4. Measure, measure, measure

“If you can’t measure it, don’t do it.”

This is something my own mentors have gone to great lengths to teach me, and rightfully so. If you can’t measure it, you don’t know how to improve it — or worse, you spend too much time on the “scenic road” and you never actually reach a point of conclusion. Measurement doesn’t always have to do with time, or money, or something tangible.

Sometimes, the best way to measure is to simply look back at old pieces of work and see how and where you’ve improved stylistically. But be conscious of measurement, so that you can tweak as you go along and see where you can become more efficient.

5. Share what you’re working on — for feedback

For the longest time, I never wanted to share or talk about anything I was working on.

I thought it was “bad luck” or would take me out of my flow. And I’ll admit, there are those moments when your ideas are best left to ruminate in your own head, but you should not be hesitant to share what you’re working on. Feedback is extremely important, and a lot of time can be saved by a single conversation where someone points out, very clearly, something that isn’t “working.”

It might not be easy to hear in the moment, but you will be thankful for it later.

6. Practice In public

When we talk about productivity, we often think of ways to seclude ourselves in our bedroom or office, alone, in the dark, with only the light of our laptop to keep us illuminated.

But sometimes that approach actually ends up netting a poor return on your time investment because you aren’t getting outside feedback. Find ways to practice in public.

Use the digital tools we have access to, like social media, to release test versions of whatever it is you’re working on: Whether that’s a book, an album, a startup, a comedy sketch, anything.

Practicing in public gives you feedback, and feedback speeds up the learning and development process.

7. Caffeine

Need we really explain the productivity benefits of a black coffee with an extra shot of espresso?

8. Music

To some, this would be a distraction, but I have always found light instrumental music in the background (Beethoven and Mozart, especially)to be quite the productivity booster.

As long as it isn’t filled with catchy melodies that take you out of the task at hand, music can be like that whirring fan in the background that acts as a subtle cue to your subconscious to stay on the task at hand.

9. Take Breaks

Again, being “productive” does not necessarily mean sitting still for eight straight hours.

You might be able to swing that for a day or two, but you are not a robot. You will burn out. Productivity is all about flow. It’s about knowing your limits and being conscious of how to move within your own constraints.

Maybe you need to take 10-minute breaks after every 50 minutes of focus

Great. Do that.

Or maybe you can work for four hours no problem, but then you need to take the afternoon before diving into another four-hour work session at night.

Great. Do that.

Do what works for you, and you only.

This isn’t about being productive based on someone else’s habits or way of doing things.

This is about knowing yourself, and using your habits to your advantage.

10. Create a routine

It is said the best musicians, athletes, innovators, etc., follow a daily routine that trains their subconscious to know when it is time to work and when it is time to relax.

There is absolutely something to be said for always practicing at the same time, or always going to the gym at the same time, or always writing at the same time, every day. You train yourself to know, as soon as that hour strikes, to fall into that mode of focus required to do your best work.

Trying to be productive when one day you are working in the morning, the next day you’re working at night, the next day you’re working in the middle of the day, it gets exhausting. Routine is extremely helpful, and inherently removes the distraction of adjustment to something “new.”

Consistency is what you’re after.

This article originally appeared on Inc Magazine.

On The Days Depression Makes You Feel Nothing At All

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Today is a blah day. It isn’t that there is anything terribly wrong today. There are issues looming, yes, but there are always issues of late. There is nothing pressing, though.

It is just a blah day, a day where I lay in bed, struggling to find a reason to get up. I’ve had to pee for a couple hours now. Yet, the dull ache in my bladder is not enough to pull me from under my covers. I should probably brush my teeth. Maybe get dressed and get a bite to eat. I have been awake for more than five hours now, even before the sun rose. Yet, here I still lay.

I feel blah. While the world around me continues with its hustle and bustle, I have no motivation, no desire to do anything. Nothing seems interesting or important. Nothing is pressing enough to pull me from this funk.

I would go back to sleep if I could, call in sick from life itself. I feel like nothing, not myself. I feel numb.

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Days like this are common with depression. Those who have never struggled often assume that depression is all bouts of random sadness and tears. Yes, I have those days, too, and it is draining when everything and anything feels heart-wrenching and makes me want to cry. Yet, even worse, perhaps, than the days when I feel everything too strongly are the days I feel nothing at all.

On these days, I have trouble pulling myself up or doing anything. I’m not being lazy. I just don’t see the point. I am pulled into a gray abyss, where there’s no purpose, no joy, no motivation, no will to live. It isn’t that I’m suicidal and actively want to die, either. I just have no will to live. The emptiness is all-consuming.

People suggest I should just “try” to be happy or to be positive. If only it were this simple. Again and again, the “should be” and “could be” options roll around in my mind but I’m numb to them all. Deep down, I know I should be getting up, doing something, living life.

Yet, my brain has me in a death lock. “What’s the sense?” and “Why bother?” it parrots to me again and again. Its voice is booming and deafening. I can hear nothing else. I would love to just smile, think a happy thought and have it vanish away like a puff of smoke but it’s solid and real to me. It takes the form of four solid walls, caging me in, holding me hostage, refusing to budge or listen to reason.

Those blah days are the worst because I feel trapped in this numbness. I cannot escape. I never know whether it will last one day or one week. There is never an end in sight, never a scheduled sweet release.

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Blah days drag on and on until at some point I begin to feel everything too strongly again. On blah days, I would welcome the tears, the anguish, the pain and the struggling just to feel anything at all.

It has been more than hours now, and I’ve barely managed to write a few paragraphs. Yet, those feel like a tremendous accomplishment. I call it a victory. I have done something, which is more than I am able to achieve on most blah days. I still have to pee, though the dull ache has grown into a steady cramp. Breakfast time has come and gone, and lunch time has arrived. Yet, I still don’t have any desire to eat anything, let alone get up.

There are calls I should make and things I should be doing. Yet, my depression still echoes in my head that I shouldn’t bother, that nothing is worth the effort. It tells me to stay in bed, just let this day drift on by, that it doesn’t matter.

Nothing matters. It is all I can hear. It is deafening. I am adrift in a sea of hopelessness and emptiness. I feel paralyzed.

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I swear I am not being lazy. I’m just trapped in a battle with my own mind. I feel lost and alone. I feel trapped in this emptiness. I feel nothing. I feel numb. I feel blah. This is what depression feels like.​

This Comic Sums Up Exactly What It’s Like Living With Depression

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This article was originally published at The Mighty. Reprinted with permission from the author.

Smiling Depression: Are You Suffering? Take Note Of The Symptoms, Causes, Treatment

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Depression is a serious medical illness that negatively affects how you feel, the way you think and how you act. Over the years, it has affected millions across the globe. For some people, the death of a loved one can bring on major depression. Losing a job or being a victim of a physical assault or a major disaster can lead to depression for some people. When grief and depression co-exist, the grief is more severe and lasts longer than grief without depression.

Do you appear happy but feel numb and vacant inside? Recently, another term “smiling depression” seems to have gained momentum among youngsters all across the globe. Google has recorded an upswing in the number of searches for the mental ailment.

Spot the symptoms

So, how to find out if you or a close one is suffering from the mental disorder? Dr Kedar Tilwe,consultant psychiatrist at the Department of Mental Health and Behavioural Sciences, Fortis Healthcare, reveals how to spot the symptoms.

“Pervasive sadness may be felt but is often wilfully disregarded by the person and they may make a sustained, conscious and emotionally tiring effort to appear ‘happy’ in public,” he says, adding, “Often a person may appear cheerful in public, not giving even a hint of deep inner personal turmoil.”

Shedding light on the behavioural changes, Dr Tilwe adds, “There may also be a decreased interest in previously pleasurable activities, altered sleep patterns, reduced appetite or difficulty in concentration.”

Major causes

“Like depression, causes are usually multifactorial and have a bio-psycho-social model of causation. However a major life event such as loss of a spouse, the breakdown of a marriage or loss of a job can act as a precipitating factor,” he says.

“Stigma associated with mental illness or the ‘need to be stable’ and ‘not showing any sign of weaknesses’ is a major reason why the person continues to suffer silently,” Dr Tilwe adds.

How to help treat the patient?

Spotting the symptoms and encouraging the person to seek professional help is the most crucial part of treatment. Dr Tilwe suggests “psychotherapy like CBT, REBT, supportivecounselling” and adds, “at times, necessary pharmacological interventions such as anti-depressants are safe and recommended modality of treatment that can be initiated.”

So, if you or someone close to you is suffering from “smiling depression”, the first step is to accept the problem, recognise the need for professional help and speak to experts. After all, you can’t tell just by looking at someone what they are dealing with inside.

Nearly Half Of People With Depression Appear Happy – This Is Why Ignoring That Can Be So Dangerous

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The term “smiling depression” – appearing happy to others while internally suffering depressive symptoms – has become increasingly popular. Articles on the topic have crept up in the popular literature, and the number of Google searches for the condition has increased dramatically this year. Some may question, however, whether this is actually a real, pathological condition.

While smiling depression is not a technical term that psychologists use, it is certainly possible to be depressed and manage to successfully mask the symptoms. The closest technical term for this condition is “atypical depression”. In fact, a significant proportion of people who experience a low mood and a loss of pleasure in activities manage to hide their condition in this way. And these people might be particularly vulnerable to suicide.

It can be very hard to spot people suffering from smiling depression. They may seem like they don’t have a reason to be sad – they have a job, an apartment and maybe even children or a partner. They smile when you greet them and can carry pleasant conversations. In short, they put on a mask to the outside world while leading seemingly normal and active lives.

Inside, however, they feel hopeless and down, sometimes even having thoughts about ending it all. The strength that they have to go on with their daily lives can make them especially vulnerable to carrying out suicide plans. This is in contrast to other forms of depression, in which people might have suicide ideation but not enough energy to act on their intentions.

Although people with smiling depression put on a “happy face” to the outside world, they can experience a genuine lift in their mood as a result of positive occurrences in their lives. For example, getting a text message from someone they’ve been craving to hear from or being praised at work can make them feel better for a few moments before going back to feeling low.

Other symptoms of this condition include overeating, feeling a sense of heaviness in the arms and legs and being easily hurt by criticism or rejection. People with smiling depression are also more likely to feel depressed in the evening and feel the need to sleep longer than usual. With other forms of depression, however, your mood might be worse in the morning and you might feel the need for less sleep than you’re normally used to.

Smiling depression seems to be more common in people with certain temperaments. In particular, it is linked to being more prone to anticipate failure, having a hard time getting over embarrassing or humiliating situations and tending to ruminate or excessively think about negative situations that have taken place.

Women’s Health magazine captured the essence of smiling depression – the façade – when it asked women to share pictures from their social media and then to recaption them on Instagram with how they really felt in the moment they were taking the picture. Here are some of their posts .

It is difficult to determine exactly what causes smiling depression, but low mood can stem from a number of things, such as work problems, relationship breakdown and feeling as if your life doesn’t have purpose and meaning.

It is very common. About one in 10 people are depressed, and between 15 per cent and 40 per cent of these people suffer from the atypical form that resembles smiling depression. Such depression often starts early in life and can last a long time.

If you suffer from smiling depression it is therefore particularly important to get help. Sadly, though, people suffering from this condition usually don’t, because they might not think that they have a problem in the first place – this is particularly the case if they appear to be carrying on with their tasks and daily routines as before. They may also feel guilty and rationalise that they don’t have anything to be sad about. So they don’t tell anybody about their problems and end up feeling ashamed of their feelings.

So how can you break this cycle? A starting point is knowing that this condition actually exists and that it’s serious. Only when we stop rationalising away our problems because we think they’re not serious enough can we start making an actual difference. For some, this insight may be enough to turn things around, because it puts them on a path to seeking help and breaking free from the shackles of depression that have been holding them back.

Meditation and physical activity have also been shown to have tremendous mental health benefits. In fact, a study done by Rutgers University in the US showed that people who had done meditation and physical activity twice a week experienced a drop of almost 40 per cent in their depression levels only eight weeks into the study. Cognitive behavioural therapy, learning to change your thinking patterns and behaviour, is another option for those affected by this condition.

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And finding meaning in life is of utmost importance. The Austrian neurologist Viktor Frankl wrote that the cornerstone of good mental health is having purpose in life. He said that we shouldn’t aim to be in a “tensionless state”, free of responsibility and challenges, but rather we should be striving for something in life. We can find purpose by taking the attention away from ourselves and placing it onto something else. So find a worthwhile goal and try to make regular progress on it, even if it’s for a small amount each day, because this can really have a positive impact.

We can also find purpose by caring for someone else. When we take the spotlight off of us and start to think about someone else’s needs and wants, we begin to feel that our lives matter. This can be achieved by volunteering, or taking care of a family member or even an animal. Feeling that our lives matter is ultimately what gives us purpose and meaning – and this can make a significant difference for our mental health and well-being.

When Smiling Hurts: 10 Reasons People with Depression Feign Happiness

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Depression, also known as major depressive disorder or clinical depression, is an all too common mood disorder. Individuals who suffer from depression experience ongoing persistent feelings of profound sadness and hopelessness, he or she often loses interest in activities they once enjoyed. In additional to the negative emotions and problems caused by depressive symptoms somatic issues are more likely to be present. Somatic issues associated with depression can include migraine headaches, chronic fatigue, body aches, digestive issues, etc. To be diagnosed with clinical depression, symptoms must be present for at least two weeks.

According to the DSM-5 the following criterion must be present to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure. To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. Organic as well as substance abuse concerns must also be ruled out in order to make a formal diagnosis of clinical depression.

• Depressed mood most of the day, nearly every day.
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
• Significant fluctuations in weight, e.g., significant weight loss or weight gain not associated with changes in diet or exercise.
• Significant change is appetite, e.g., significant decrease in appetite, or significant increase in appetite
• Interruptions in cognitive functioning
• Marked change or slowdown in physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
• Fatigue or loss of energy nearly every day.
• Feelings of worthlessness/hopelessness or excessive or inappropriate guilt nearly every day.
• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

According to the National Institute of Mental Health (NIMH), risk factors for depression can include a family history of mood disorders and other significant mental health disorders, major life changes, past trauma, significant physical illness (such as cancer), or a side effect of certain medications.
Depression symptoms can appear differently from sufferer to sufferer, no two people with depression will look or behave exactly the same. Persons suffering from depression may not always appear sad to others. In fact, some sufferers feign happiness in an attempt to fool others, to avoid “letting others down”, or being “pitied”.

When someone suffers from depression it takes a lot of physical and emotional strength to “put on a happy face” or convince others “everything is fine”. For some sufferers, disclosing to others That he/she suffers from depression can be akin to admitting a weakness, flaw, or vulnerability. More often than not, individuals struggling with depression symptoms wear a mask of happiness to hide the true emotions that are stirring inside of them.

Potential Reasons with Depression Feign Happiness Include:

• Feeling they may be letting others down if they aren’t doing well
• Not wanting to alarm or cause others to worry about him/her
• Fearing disclosure of depression conveys weakness, personal flaw, or vulnerability
• Feeling if they act the part of “being happy” they will be happy
• Feeling like they are alone in their unhappiness, e.g., others will not understand
• Feeling they need to live up to other people’s expectations of who they are
• Intense need or desire to make other people happy, although, they do not feel happy
• He/she is ashamed of being depressed
• He/she doesn’t recognize they are clinically depressed but hide behind a façade of normalcy
• He/she is concerned about what others may think of them or view them, e.g. personal image.

When persons with depression acknowledge and accept that depression is an issue, rather than trying to hide it, the suffer becomes better equipped to manage depression symptoms. By finding appropriate ways to manage depression and developing appropriate coping skills, individuals can work towards not having to prove to everyone else how they feel, but actually feel the way he/she deserves to feel. Suffers that find themselves having to force a smile or put on a façade of happiness are creating additional stressors in their life as it takes a lot of work to portray and convince others of something he or she is not feeling.

Reasons why Wearing Mask Does Not work Include:

• You have to force yourself to convey a feeling/emotion you do not feel genuinely
• You have to put it on and take it off often, it does not stay in place
• Wearing a mask becomes more difficult to wear over time
• The reasons behind the need to wear the mask still exist
• Putting on the mask becomes increasingly exhausting
• The only person we are fooling are ourselves
• Whatever we are trying to hide will eventually come to light
• We are not able to live to our fullest potential because we are hiding, form others including ourselves
• By pretending to feel or be anything other than ourselves we are living an inauthentic life
• When you attempt to escape from depression without actually dealing with it you are feeding it
• Once the sufferer removes the mask or feels he/she no longer needs it at that particular time feelings of anger and anxiety typically follow
• Unresolved negative feelings will eventually catch up with you
• Suicidal thoughts or ideations can increase

It is important to understand that untreated depression can lead to an exacerbation of symptoms. Negative emotions typically do not resolve themselves on their own but require assistance. To treat clinical depression, a mental health professional should be consulted to help the sufferer manage symptoms and emotions he/she has been avoiding. Professionals can also assist sufferers with identifying and developing appropriate coping skills to manage negative emotions and build skills to manage future problems should they arise.

When Depression Makes Me Numb, Not Sad

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When depression makes me numb, the lack of feeling anything is, paradoxically, a terrible feeling.

People who don’t experience or understand depression are often told it’s not as simple as feeling sad. This is truer than I can adequately describe; there are many facets to depression. One symptom I wish more people understood is feeling numb. A sense of hollowness — like a dull, numb lump — often defines me when I’m really down. It’s a shitty, zombie state of gray flatness. Life passes by and you won’t bother to wave at it because you don’t really care. In fact, you just don’t really feel anything.

How does numbness link to depression? Well, one explanation I find helpful is that, when the strain of depression is extreme, experiencing emotions feels exhausting. There is no joy in my favorite activities or excitement in making plans. I don’t feel the same outrage at things that should anger me, nor do I bother to get annoyed at gripes. It’s all too much.

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From numbness to nothingness.

The frightening thing about feeling numb is that it’s the cruel cousin of despair. A deep indifference to oneself and to the world is a step towards believing neither is worth fighting for. Your existence feels detached; you think you’re inconsequential. This is a dangerous, fragile space, because your perspective on the value of life is horribly distorted. The consequence can be a sense of inertia and apathy, or even worse, self-destructive behavior and thoughts.

When nothing in life feels meaningful or worthy, it is alienating and dreadful. Your relationships and work may suffer, as those around you may interpret your attitude as being deliberately indifferent or distant.

For something that feels like nothing, numbness is a godawful thing.

Finding feeling again.

When you’re in a dark place, try to remember that it will get better. I know you probably bully this thought into a corner of your mind. I know it can sound patronizing or glib. Numbness is a hard nut to crack, because it inherently defies the will to feel.

There might be one special thing that gets you out of the numbness prison — whether it’s seeing a friend, watching South Park or baking biscuits. I hope you find it.

Staying Awake: The Surprisingly Effective Way to Treat Depression

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The first sign that something is happening is Angelina’s hands. As she chats to the nurse in Italian, she begins to gesticulate, jabbing, moulding and circling the air with her fingers. As the minutes pass and Angelina becomes increasingly animated, I notice a musicality to her voice that I’m sure wasn’t there earlier. The lines in her forehead seem to be softening, and the pursing and stretching of her lips and the crinkling of her eyes tell me as much about her mental state as any interpreter could.Angelina is coming to life, precisely as my body is beginning to shut down. It’s 2am, and we’re sat in the brightly lit kitchen of a Milanese psychiatric ward, eating spaghetti. There’s a dull ache behind my eyes, and I keep on zoning out, but Angelina won’t be going to bed for at least another 17 hours, so I’m steeling myself for a long night. In case I doubted her resolve, Angelina removes her glasses, looks directly at me, and uses her thumbs and forefingers to pull open the wrinkled, grey-tinged skin around her eyes. “Occhi aperti,” she says. Eyes open.This is the second night in three that Angelina has been deliberately deprived of sleep. For a person with bipolar disorder who has spent the past two years in a deep and crippling depression, it may sound like the last thing she needs, but Angelina – and the doctors treating her – hope it will be her salvation. For two decades, Francesco Benedetti, who heads the psychiatry and clinical psychobiology unit at San Raffaele Hospital in Milan, has been investigating so-called wake therapy, in combination with bright light exposure and lithium, as a means of treating depression where drugs have often failed. As a result, psychiatrists in the USA, the UK and other European countries are starting to take notice, launching variations of it in their own clinics. These ‘chronotherapies’ seem to work by kick-starting a sluggish biological clock; in doing so, they’re also shedding new light on the underlying pathology of depression, and on the function of sleep more generally.“Sleep deprivation really has opposite effects in healthy people and those with depression,” says Benedetti. If you’re healthy and you don’t sleep, you’ll feel in a bad mood. But if you’re depressed, it can prompt an immediate improvement in mood, and in cognitive abilities. But, Benedetti adds, there’s a catch: once you go to sleep and catch up on those missed hours of sleep, you’ll have a 95 per cent chance of relapse.The antidepressant effect of sleep deprivation was first published in a report in Germany in 1959. This captured the imagination of a young researcher from Tübingen in Germany, Burkhard Pflug, who investigated the effect in his doctoral thesis and in subsequent studies during the 1970s. By systematically depriving depressed people of sleep, he confirmed that spending a single night awake could jolt them out of depression.

Benedetti became interested in this idea as a young psychiatrist in the early 1990s. Prozac had been launched just a few years earlier, hailing a revolution in the treatment of depression. But such drugs were rarely tested on people with bipolar disorder. Bitter experience has since taught Benedetti that antidepressants are largely ineffective for people with bipolar depression anyway.

His patients were in desperate need of an alternative, and his supervisor, Enrico Smeraldi, had an idea up his sleeve. Having read some of the early papers on wake therapy, he tested their theories on his own patients, with positive results. “We knew it worked,” says Benedetti. “Patients with these terrible histories were getting well immediately. My task was finding a way of making them stay well.”

So he and his colleagues turned to the scientific literature for ideas. A handful of American studies had suggested that lithium might prolong the effect of sleep deprivation, so they investigated that. They found that 65 per cent of patients taking lithium showed a sustained response to sleep deprivation when assessed after three months, compared to just 10 per cent of those not taking the drug.

Since even a short nap could undermine the efficacy of the treatment, they also started searching for new ways of keeping patients awake at night, and drew inspiration from aviation medicine, where bright light was being used to keep pilots alert. This too extended the effects of sleep deprivation, to a similar extent as lithium.

“We decided to give them the whole package, and the effect was brilliant,” says Benedetti. By the late 1990s, they were routinely treating patients with triple chronotherapy: sleep deprivation, lithium and light. The sleep deprivations would occur every other night for a week, and bright light exposure for 30 minutes each morning would be continued for a further two weeks – a protocol they continue to use to this day. “We can think of it not as sleep-depriving people, but as modifying or enlarging the period of the sleep–wake cycle from 24 to 48 hours,” says Benedetti. “People go to bed every two nights, but when they go to bed, they can sleep for as long as they want.”

San Raffaele Hospital first introduced triple chronotherapy in 1996. Since then, it has treated close to a thousand patients with bipolar depression – many of whom had failed to respond to antidepressant drugs. The results speak for themselves: according to the most recent data, 70 per cent of people with drug-resistant bipolar depression responded to triple chronotherapy within the first week, and 55 per cent had a sustained improvement in their depression one month later.

And whereas antidepressants – if they work – can take over a month to have an effect, and can increase the risk of suicide in the meantime, chronotherapy usually produces an immediate and persistent decrease in suicidal thoughts, even after just one night of sleep deprivation.

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Angelina was first diagnosed with bipolar disorder 30 years ago, when she was in her late 30s. The diagnosis followed a period of intense stress: her husband was facing a tribunal at work, and they were worried about having enough money to support themselves and the kids. Angelina fell into a depression that lasted nearly three years. Since then, her mood has oscillated, but she’s down more often than not. She takes an arsenal of drugs – antidepressants, mood stabilisers, anti-anxiety drugs and sleeping tablets – which she dislikes because they make her feel like a patient, even though she acknowledges this is what she is.

If I’d met her three days ago, she says, it’s unlikely I would have recognised her. She didn’t want to do anything, she’d stopped washing her hair or wearing make-up, and she stank. She also felt very pessimistic about the future. After her first night of sleep deprivation, she’d felt more energetic, but this largely subsided after her recovery sleep. Even so, today she felt motivated enough to visit a hairdresser in anticipation of my visit. I compliment her appearance, and she pats her dyed, golden waves, thanking me for noticing.

At 3am, we move to the light room, and entering is like being transported forward to midday. Bright sunlight streams in through the skylights overhead, falling on five armchairs, which are lined up against the wall. This is an illusion, of course – the blue sky and brilliant sun are nothing more than coloured plastic and a very bright light – but the effect is exhilarating nonetheless. I could be sitting on a sun lounger at midday; the only thing missing is the heat.

When I’d interviewed her seven hours earlier, with the help of an interpreter, Angelina’s face had remained expressionless as she’d replied. Now, at 3.20am, she is smiling, and even beginning to initiate a conversation with me in English, which she’d claimed not to speak. By dawn, Angelina’s telling me about the family history she’s started writing, which she’d like to pick up again, and inviting me to stay with her in Sicily.

How could something as simple as staying awake overnight bring about such a transformation? Unpicking the mechanism isn’t straightforward: we still don’t fully understand the nature of depression or the function of sleep, both of which involve multiple areas of the brain. But recent studies have started to yield some insights.

The brain activity of people with depression looks different during sleep and wakefulness than that of healthy people. During the day, wake-promoting signals coming from the circadian system – our internal 24-hour biological clock – are thought to help us resist sleep, with these signals being replaced by sleep-promoting ones at night. Our brain cells work in cycles too, becoming increasingly excitable in response to stimuli during wakefulness, with this excitability dissipating when we sleep. But in people with depression and bipolar disorder, these fluctuations appear dampened or absent.

Depression is also associated with altered daily rhythms of hormone secretion and body temperature, and the more severe the illness, the greater the degree of disruption. Like the sleep signals, these rhythms are also driven by the body’s circadian system, which itself is driven by a set of interacting proteins, encoded by ‘clock genes’ that are expressed in a rhythmic pattern throughout the day. They drive hundreds of different cellular processes, enabling them to keep time with one another and turn on and off. A circadian clock ticks in every cell of your body, including your brain cells, and they are coordinated by an area of the brain called the suprachiasmatic nucleus, which responds to light.

“When people are seriously depressed, their circadian rhythms tend to be very flat; they don’t get the usual response of melatonin rising in the evening, and the cortisol levels are consistently high rather than falling in the evening and the night,” says Steinn Steingrimsson, a psychiatrist at Sahlgrenska University Hospital in Gothenburg, Sweden, who is currently running a trial of wake therapy.

Recovery from depression is associated with a normalisation of these cycles. “I think depression may be one of the consequences of this basic flattening of circadian rhythms and homeostasis in the brain,” says Benedetti. “When we sleep-deprive depressed people, we restore this cyclical process.”

But how does this restoration come about? One possibility is that depressed people simply need added sleep pressure to jump-start a sluggish system. Sleep pressure – our urge to sleep – is thought to arise because of the gradual release of adenosine in the brain. It builds up throughout the day and attaches to adenosine receptors on neurons, making us feel drowsy. Drugs that trigger these receptors have the same effect, whereas drugs that block them – such as caffeine – make us feel more awake.

To investigate whether this process might underpin the antidepressant effects of prolonged wakefulness, researchers at Tufts University in Massachusetts took mice with depression-like symptoms and administered high doses of a compound that triggers adenosine receptors, mimicking what happens during sleep deprivation. After 12 hours, the mice had improved, measured by how long they spent trying to escape when forced to swim or when suspended by their tails.

We also know sleep deprivation does other things to the depressed brain. It prompts changes in the balance of neurotransmitters in areas that help to regulate mood, and it restores normal activity in emotion-processing areas of the brain, strengthening connections between them.

And as Benedetti and his team discovered, if wake therapy kick-starts a sluggish circadian rhythm, lithium and light therapy seem to help maintain it. Lithium has been used as a mood stabiliser for years without anyone really understanding how it works, but we know it boosts the expression of a protein, called Per2, that drives the molecular clock in cells.

Bright light, meanwhile, is known to alter the rhythms of the suprachiasmatic nucleus, as well as boosting activity in emotion-processing areas of the brain more directly. Indeed, the American Psychiatric Association states that light therapy is as effective as most antidepressants in treating non-seasonal depression.

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In spite of its promising results against bipolar disorder, wake therapy has been slow to catch on in other countries. “You could be cynical and say it’s because you can’t patent it,” says David Veale, a consultant psychiatrist at the South London and Maudsley NHS Foundation Trust.

Certainly, Benedetti has never been offered pharmaceutical funding to carry out his trials of chronotherapy. Instead, he has – until recently – been reliant on government funding, which is often in short supply. His current research is being funded by the EU. Had he followed the conventional route of accepting industry money to run drug trials with his patients, he quips, he probably wouldn’t be living in a two-bedroom apartment and driving a 1998 Honda Civic.

The bias towards pharmaceutical solutions has kept chronotherapy below the radar for many psychiatrists. “A lot of people just don’t know about it,” says Veale.

It’s also difficult to find a suitable placebo for sleep deprivation or bright light exposure, which means that large, randomised placebo-controlled trials of chronotherapy haven’t been done. Because of this, there’s some scepticism about how well it really works. “While there is increasing interest, I don’t think many treatments based on this approach are yet routinely used – the evidence needs to be better and there are some practical difficulties in implementing things like sleep deprivation,” says John Geddes, a professor of epidemiological psychiatry at the University of Oxford.

Even so, interest in the processes underpinning chronotherapy is beginning to spread. “Insights into the biology of sleep and circadian systems are now providing promising targets for treatment development,” says Geddes. “It goes beyond pharmaceuticals – targeting sleep with psychological treatments might also help or even prevent mental disorders.”

In the UK, the USA, Denmark and Sweden, psychiatrists are investigating chronotherapy as a treatment for general depression. “A lot of the studies that have been done so far have been very small,” says Veale, who is currently planning a feasibility study at Maudsley Hospital in London. “We need to demonstrate that it is feasible and that people can adhere to it.”

So far, what studies there have been have produced mixed results. Klaus Martiny, who researches non-drug methods for treating depression at the University of Copenhagen in Denmark, has published two trials looking at the effects of sleep deprivation, together with daily morning bright light and regular bedtimes, on general depression. In the first study, 75 patients were given the antidepressant duloxetine, in combination with either chronotherapy or daily exercise. After the first week, 41 per cent of the chronotherapy group had experienced a halving of their symptoms, compared to 13 per cent of the exercise group. And at 29 weeks, 62 per cent of the wake therapy patients were symptom-free, compared to 38 per cent of those in the exercise group.

In Martiny’s second study, severely depressed hospital inpatients who had failed to respond to antidepressant drugs were offered the same chronotherapy package as an add-on to the drugs and psychotherapy they were undergoing. After one week, those in the chronotherapy group improved significantly more than the group receiving standard treatment, although in subsequent weeks the control group caught up.

No one has yet compared wake therapy head-to-head with antidepressants; neither has it been tested against bright light therapy and lithium alone. But even if it’s only effective for a minority, many people with depression – and indeed psychiatrists – may find the idea of a drug-free treatment attractive.

“I’m a pill pusher for a living, and it still appeals to me to do something that doesn’t involve pills,” says Jonathan Stewart, a professor of clinical psychiatry at Columbia University in New York, who is currently running a wake therapy trial at New York State Psychiatric Institute.

Unlike Benedetti, Stewart only keeps patients awake for one night: “I couldn’t see a lot of people agreeing to stay in hospital for three nights, and it also requires a lot of nursing and resources,” he says. Instead, he uses something called sleep phase advance, where on the days after a night of sleep deprivation, the time the patient goes to sleep and wakes up is systematically brought forward. So far, Stewart has treated around 20 patients with this protocol, and 12 have shown a response – most of them during the first week.

It may also work as a prophylactic: recent studies suggest that teenagers whose parents set – and manage to enforce – earlier bedtimes are less at risk of depression and suicidal thinking. Like light therapy and sleep deprivation, the precise mechanism is unclear, but researchers suspect a closer fit between sleep time and the natural light–dark cycle is important.

But sleep phase advance has so far failed to hit the mainstream. And, Stewart accepts, it’s not for everybody. “For those for whom it works, it’s a miracle cure. But just as Prozac doesn’t get everyone better who takes it, neither does this,” he says. “My problem is that I have no idea ahead of time who it’s going to help.”

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Depression can strike anyone, but there’s mounting evidence that genetic variations can disrupt the circadian system to make certain people more vulnerable. Several clock gene variations have been associated with an elevated risk of developing mood disorders.

Stress can then compound the problem. Our response to it is largely mediated through the hormone cortisol, which is under strong circadian control, but cortisol itself also directly influences the timing of our circadian clocks. So if you have a weak clock, the added burden of stress could be enough to tip your system over the edge.

Indeed, you can trigger depressive symptoms in mice by repeatedly exposing them to a noxious stimulus, such as an electric shock, from which they can’t escape – a phenomenon called learned helplessness. In the face of this ongoing stress, the animals eventually just give up and exhibit depression-like behaviours. When David Welsh, a psychiatrist at the University of California, San Diego, analysed the brains of mice that had depressive symptoms, he found disrupted circadian rhythms in two critical areas of the brain’s reward circuit – a system that’s strongly implicated in depression.

Staying awake: the surprisingly effective way to treat depression
© Eva Bee for Mosaic

But Welsh has also shown that a disturbed circadian system itself can cause depression-like symptoms. When he took healthy mice and knocked out a key clock gene in the brain’s master clock, they looked just like the depressed mice he’d been studying earlier. “They don’t need to learn to be helpless, they are already helpless,” Welsh says.

So if disrupted circadian rhythms are a likely cause of depression, what can be done to prevent rather than treat them? Is it possible to strengthen your circadian clock to increase psychological resilience, rather than remedy depressive symptoms by forgoing sleep?

Martiny thinks so. He is currently testing whether keeping a more regular daily schedule could prevent his depressed inpatients from relapsing once they’ve recovered and are released from the psychiatric ward. “That’s when the trouble usually comes,” he says. “Once they’re discharged their depression gets worse again.”

Peter is a 45-year-old care assistant from Copenhagen who has battled with depression since his early teens. Like Angelina and many others with depression, his first episode followed a period of intense stress and upheaval. His sister, who more or less brought him up, left home when he was 13, leaving him with an uninterested mother and a father who also suffered from severe depression. Soon after that, his father died of cancer – another shock, as he’d kept his prognosis hidden until the week before his death.

Peter’s depression has seen him hospitalised six times, including for a month last April. “In some ways being in hospital is a relief,” he says. However, he feels guilty about the effect it has on his sons, aged seven and nine. “My youngest boy said he cried every night I was in hospital, because I wasn’t there to hug him.”

So when Martiny told Peter about the study he had just started recruiting for, he readily agreed to participate. Dubbed ‘circadian-reinforcement therapy’, the idea is to strengthen people’s circadian rhythms by encouraging regularity in their sleep, wake, meal and exercise times, and pushing them to spend more time outdoors, exposed to daylight.

For four weeks after leaving the psychiatric ward in May, Peter wore a device that tracked his activity and sleep, and he completed regular mood questionnaires. If there was any deviation in his routine, he would receive a phone call to find out what had happened.

When I meet Peter, we joke about the tan lines around his eyes; obviously, he’s been taking the advice seriously. He laughs: “Yes, I’m getting outdoors to the park, and if it’s nice weather, I take my children to the beach, for walks, or to the playground, because then I will get some light, and that improves my mood.”

Those aren’t the only changes he’s made. He now gets up at 6 every morning to help his wife with the children. Even if he’s not hungry he eats breakfast: typically, yoghurt with muesli. He doesn’t take naps and tries to be in bed by 10pm. If Peter does wake up at night, he practises mindfulness – a technique he picked up in hospital.

Martiny pulls up Peter’s data on his computer. It confirms the shift towards earlier sleep and wake times, and shows an improvement in the quality of his sleep, which is mirrored by his mood scores. Immediately after his release from hospital, these averaged around 6 out of 10. But after two weeks they’d risen to consistent 8s or 9s, and one day, he even managed a 10. At the beginning of June, he returned to his job at the care home, where he works 35 hours a week. “Having a routine has really helped me,” he says.

Staying awake: the surprisingly effective way to treat depression
© Eva Bee for Mosaic

So far, Martiny has recruited 20 patients to his trial, but his target is 120; it’s therefore too soon to know how many will respond the same way as Peter, or indeed, if his psychological health will be maintained. Even so, there’s mounting evidence that good sleep routine can help our mental wellbeing. According to a study published in Lancet Psychiatry in September 2017 – the largest randomised trial of a psychological intervention to date – insomniacs who underwent a ten-week course of cognitive behavioural therapy to address their sleep problems showed sustained reductions in paranoia and hallucinatory experiences as a result. They also experienced improvements in symptoms of depression and anxiety, fewer nightmares, better psychological wellbeing and day-to-day functioning, and they were less likely to experience a depressive episode or anxiety disorder during the course of the trial.

Sleep, routine and daylight. It’s a simple formula, and easy to take for granted. But imagine if it really could reduce the incidence of depression and help people to recover from it more quickly. Not only would it improve the quality of countless lives, it would save health systems money.

In the case of wake therapy, Benedetti cautions that it isn’t something people should try to administer to themselves at home. Particularly for anyone who has bipolar disorder, there’s a risk of it triggering a switch into mania – although in his experience, the risk is smaller than that posed by taking antidepressants. Keeping yourself awake overnight is also difficult, and some patients temporarily slip back into depression or enter a mixed mood state, which can be dangerous. “I want to be there to speak about it to them when it happens,” Benedetti says. Mixed states often precede suicide attempts.

A week after spending the night awake with Angelina, I call Benedetti to check her progress. He tells me that after the third sleep deprivation, she experienced a full remission in her symptoms and returned to Sicily with her husband. That week, they were due to be marking their 50th wedding anniversary. When I’d asked her if she thought her husband would notice any change in her symptoms, she’d said she hoped he’d notice the change in her physical appearance.

Hope. After she has spent more than half her life without it, I suspect its return is the most precious golden anniversary gift of all.

This article first appeared on Mosaic and is republished here under a Creative Commons licence.

How Familiar with High-Functioning Depression Are You?

Author Article

Amanda Leventhal who is an undergraduate student at the University of Missouri has recently explained in an article how depression is underdiagnosed and overlooked in high functioning individuals. Her article has inspired a host of online discussions regarding the complex nature of depression and why it is so important to talk about this epidemic problem. Even in today’s societies, the causes of depression remain unknown and mental disorders such as manic-depression (bipolar disorder) are still unfairly stigmatized making mental health still a taboo topic that needs to be clarified and brought to light.

What is Depression?

Most guidelines today define depression as a mental disorder marked by low mood, aversion to activity and that also affects a person’s thoughts, behavior, and well-being. The exact causes of depression are unknown but possible triggers are stress, trauma, low self-esteem, chemical imbalances in the brain, prolonged illness, loneliness, and lack of light. Brain scans of depressed persons show that certain regions of the brain such as the frontal and temporal cortex, the insula, and the cerebellum are hypoactive. Furthermore, a growing number of studies have found a link between illness-caused inflammation and the development of depressive symptoms. What this means is that depression can no longer be considered an invisible illness but a very much palpable disorder that definitely requires treatment.

Depression in High-Functioning Individuals

Depression, just like the majority of all illnesses manifests with many symptoms. The most common symptoms of depression are low mood, apathy, a lack of motivation, troubles concentrating, problems with memory, sleepdisturbances, etc. The symptoms of depression tend to affect almost every aspect of a person’s life making this illness quite debilitating. An article published in the Canadian Journal of Psychiatry found that 79% of people with depression report that their illness has interfered with their ability to function at work. Since depression is considered a disorder that affects a person’s ability to function in life, we have to wonder if it is possible for people to be high-functioning and depressed at the same time? The short answer is yes as there are different types of depression. According to Harvard Health Publications, there is such a thing called dysthymia which is low-grade depression that lasts five years on average. The disorder is not as crippling as major depression but is a risk factor for episodes of major depression and it is probably under diagnosed in the general population.

The Stigma of Mental Illness and Why It Is a Problem

The stigma of mental illness causes a great deal of suffering and missed opportunities for those afflicted. Unfortunately, the invisibility of mental illness makes it harder for people to emphasize with a person suffering from mental disorders such as schizophrenia, major depression or manic-depression, and many often see the illness as made up or all in their head. The stigma may make it harder for people with mental illness to find employment, housing, and build secure relationships. People struggling with depression are very well aware of the stigma that surrounds mental illness and those going through depression may ignore their symptoms believing they have everything under control. This creates a problem that could lead to depression becoming worse with time and leading to poor health and even suicide if left untreated.

What You Can Do

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Knowing the nature of depression can help friends and family recognized atypical symptoms in loved ones. High functioning depressed persons may be better at hiding their symptoms, but behavioral and personality changes are usually good indicators something is going on. Irritability, anger, and a morose attitude is a good sign a person is depressed. Another sign could be increased sleepiness, weight gain, moodiness, and excessive fatigue. Asking the person that you believe is depressed about how they feel may help them understand that their behavior and mood is not normal but a result of depression. We have to understand that depression tends to skew a person’s view of themselves and the world and they may not recognize this as a sign of illness but rather as a normal reaction to a seemingly gloomy reality.

Conclusion

Although we tend to associate depression with low levels of functioning, some people may develop atypical symptoms of depression that can make it harder for them to believe they need help. The problem with mental illnesses such as major depressive disorder and manic-depression is that they often go unrecognized until a person develops severe symptoms that interfere with everyday functioning. The stigma attached to mental illness complicated matters further by making people already struggling with their mental disorder deal with feelings of shame and guilt. The result is often missed opportunities and low quality of life. Recognizing the symptoms of depression even in high-functioning individuals is something we need to take notice of today.

The Most Dangerous Form of Depression Hides Behind a Smile

Author Article

The term “smiling depression”—appearing happy to others while internally suffering depressive symptoms—has become increasingly popular. Articles on the topic have crept up in the popular literature, and the number of Google searches for the condition has increased dramatically this year. Some may question, however, whether this is actually a real, pathological condition.

While smiling depression is not a technical term that psychologists use, it is certainly possible to be depressed and manage to successfully mask the symptoms. The closest technical term for this condition is “atypical depression.” In fact, a significant proportion of people who experience a low mood and a loss of pleasure in activities manage to hide their condition in this way. And these people might be particularly vulnerable to suicide.

It can be very hard to spot people suffering from smiling depression. They may seem like they don’t have a reason to be sad—they have a job, an apartment and maybe even children or a partner. They smile when you greet them and can carry pleasant conversations. In short, they put on a mask to the outside world while leading seemingly normal and active lives.

Inside, however, they feel hopeless and down, sometimes even having thoughts about ending it all. The strength that they have to go on with their daily lives can make them especially vulnerable to carrying out suicide plans. This is in contrast to other forms of depression, in which people might have suicide ideation but not enough energy to act on their intentions.

Although people with smiling depression put on a “happy face” to the outside world, they can experience a genuine lift in their mood as a result of positive occurrences in their lives. For example, getting a text message from someone they’ve been craving to hear from or being praised at work can make them feel better for a few moments before going back to feeling low.

Other symptoms of this condition include overeating, feeling a sense of heaviness in the arms and legs, and being easily hurt by criticismor rejection. People with smiling depression are also more likely to feel depressed in the evening and feel the need to sleep longer than usual. With other forms of depression, however, your mood might be worse in the morning and you might feel the need for less sleep than you’re normally used to.

Smiling depression seems to be more common in people with certain temperaments. In particular, it is linked to being more prone to anticipate failure, having a hard time getting over embarrassing or humiliating situations, and tending to ruminate or excessively think about negative situations that have taken place.

Women’s Health magazine captured the essence of smiling depression—the façade—when it asked women to share pictures from their social media and then to recaption them on Instagram with how they really felt in the moment they were taking the picture. Here are some of their posts.

Burden and treatment

It is difficult to determine exactly what causes smiling depression, but low mood can stem from a number of things, such as work problems, relationship breakdown, and feeling as if your life doesn’t have purpose and meaning.

It is very common. About one in ten people are depressed, and between 15% and 40% of these people suffer from the atypical formthat resembles smiling depression. Such depression often starts early in life and can last a long time.

If you suffer from smiling depression it is therefore particularly important to get help. Sadly, though, people suffering from this condition usually don’t, because they might not think that they have a problem in the first place—this is particularly the case if they appear to be carrying on with their tasks and daily routines as before. They may also feel guilty and rationalize that they don’t have anything to be sad about. So they don’t tell anybody about their problems and end up feeling ashamed of their feelings.

So how can you break this cycle? A starting point is knowing that this condition actually exists and that it’s serious. Only when we stop rationalizing away our problems because we think they’re not serious enough can we start making an actual difference. For some, this insight may be enough to turn things around, because it puts them on a path to seeking help and breaking free from the shackles of depression that have been holding them back.

Meditation and physical activity have also been shown to have tremendous mental health benefits. In fact, a study done by Rutgers University in the US showed that people who had done meditation and physical activity twice a week experienced a drop of almost 40% in their depression levels only eight weeks into the study. Cognitive behavioral therapy and learning to change your thinking patterns and behavior is another option for those affected by this condition.

And finding meaning in life is of utmost importance. The Austrian neurologist Viktor Frankl wrote that the cornerstone of good mental health is having purpose in life. He said that we shouldn’t aim to be in a “tensionless state,” free of responsibility and challenges, but rather we should be striving for something in life. We can find purpose by taking the attention away from ourselves and placing it onto something else. So find a worthwhile goal and try to make regular progress on it, even if it’s for a small amount each day, because this can really have a positive impact.

We can also find purpose by caring for someone else. When we take the spotlight off of us and start to think about someone else’s needs and wants, we begin to feel that our lives matter. This can be achieved by volunteering, or taking care of a family member, or even an animal.

Feeling that our lives matter is ultimately what gives us purpose and meaning—and this can make a significant difference for our mental health and well-being.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

 

Help For Introverts Who Have High-Functioning Anxiety

Author Article

IntrovertDear.com high-functioning anxiety help
High-functioning anxiety is often called a “secret” anxiety, because on the outside, people who have it seem to be doing just fine. What no one knows is that on the inside, they’re driven by nervousness and fear.Although high-functioning anxiety is not an official diagnosis, it’s something that many people identify with. It’s closely related to Generalized Anxiety Disorder, a condition affecting 6.8 million adults in the U.S., with women being twice as likely to suffer from it as men. Although both introverts and extroverts experience anxiety, introverts are more prone to it, according to Dr. Laurie Helgoe, author of Introvert Power.

Living With — and Controlling — Your Anxiety

Anxiety is a normal part of life, and having some measure of it can actually make you perform better and keep you safe. But, for some introverts, it’s debilitating. Anxiety shrinks your world and makes you miss out on opportunities that would be really good for you.

Personally, I’ve struggled with anxiety in many forms throughout my life, from panic attacks to the hidden “high-functioning” kind. Once, I snuck out the back door of my office when my anxiety exploded over an upcoming meet-and-greet with a returning coworker. Other times, I’ve checked and re-checked my luggage almost obsessively before a flight to make sure everything I would need was there.

So, how do you get rid of anxiety? Research suggests that people who have anxiety see the world differently and can’t just “turn it off.” But, even though it may always be a part of your life on some level, there are ways to control your anxiety — and feel better.

If you’re struggling with high-functioning anxiety, here are seven ways to calm it, based on recent research and my own experiences.

How to Calm High-Functioning Anxiety

1. Know the symptoms of high-functioning anxiety.

Symptoms include being over-prepared, constantly feeling the need to stay busy, being deeply afraid of disappointing others, perfectionism, and more. To determine if you have it, check out my article, 15 Signs That You’re an Introvert With High-Functioning Anxiety. The more signs you identify with, the more likely it is that you suffer from anxiety.

2. What’s the real reason behind your fear?

Before anxiety strikes again, take some time to reflect. As an introvert, self-analysis probably comes naturally to you. Journal about the last time you felt anxious, or if you feel comfortable, talk to a trusted friend or therapist. For me, I’ve determined that my anxiety often stems from wanting others to like and approve of me. If I can do everything perfectly, no one can criticize me! (At least that’s what my anxious brain thinks.) If you can get to the root of your anxiety, it will have less power over you.

3. Observe your mental state like you’re someone else.

This one will take time to master, but you can train yourself to look at your mind from the perspective of a neutral observer. As your yoga teacher might say, “bring your awareness” to your mind. What’s happening in there right now? Are you having dark thoughts? Negative thoughts? Anxious thoughts? Rather than labeling those thoughts as good or bad, beating yourself up about them, or choosing to act on them right away, simply become aware of what you’re experiencing. 

Then, name those feelings. Is it anxiety? Sadness? Worry? Fear? Research shows that you can lessen what you experience simply by recognizing a negative emotion and calling it what it is.

4. Your inner thermostat isn’t always right.

The heating/cooling system in my apartment drives me crazy, because it isn’t always accurate. It can say that it’s 70 degrees in the room, but it feels much, much cooler. I suspect that due to its location in the apartment, the thermostat sometimes produces false readings.

Many times, our brains are like my apartment’s thermostat — they produce false readings. They tell us to be afraid or anxious in situations that aren’t actually threatening. This response likely has something to do with the amygdala, the primitive part of the brain associated with processing emotion. Studies have found that animals subjected to chronic stress developed larger and more connected amygdalae, and that in children and adults, a large amygdala is a predictor of anxiety.

It doesn’t mean that we should never trust what our feelings tell us. On the contrary, our emotions provide us with valuable data. But sometimes, the data is off, through no fault of our own. When you feel anxious, remind yourself that your feelings may not be accurately reflecting the situation.

5. Change your surroundings or your activity.

Sometimes, no matter how much mental effort I put into soothing myself, my body refuses to calm down. My brain gets stuck in a loop of anxious thinking, playing frightening scenarios or negative thoughtsover and over. That’s when I need a change. And by that, I mean a change in my environment or the activity I’m doing.

Making a change will force your brain to move down a different track. Stop whatever you’re currently doing, get up, listen to a podcast, go to your favorite coffee shop, do a household chore, or run some errands. If you’re at work or school, if possible, take a break, go to the bathroom, put on your headphones and listen to music, start working on a different task entirely — or anything that’s different from what you’re doing at the moment.

When your schedule allows, do some aerobic exercise, like fast walking or jogging. After only five minutes of aerobic exercise, your brain will start to stimulate anti-anxiety effects. Some studies have even found that regular exercise works just as well as medication for some people to reduce anxiety symptoms — and it has long-lasting effects.

6. Have a mantra, and use it regularly.

You might try:

“I’m doing my best.”

“It’s only a moment. This too shall pass.”

“I may not be okay right now, but I’ll be okay soon.”

“I’m calm. I’m loved. I’m at peace.”

Mine is, “Things will not be as bad as you think they’ll be.”

7. Spend a little time each day unwinding and relaxing.

As an introvert, you already know that you need downtime to feel at your best. If you’re an introvert who has anxiety, that downtime is even more crucial. According to psychotherapist Linda Esposito, you can proactively tackle anxiety by intentionally setting aside time each day to relax. This will help you practice calming techniques before your anxiety gets the best of you.

 

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