What to say to someone who is depressed

I fully intended to post yesterday, but I kept thinking 'I'll do it after this', then 'after this', then suddenly it was bedtime and I realised I hadn't posted. Oh well, there's always today! Here is the post I intended to put up yesterday.

Knowing what to say to someone who is depressed is a toughie. You know your friend (or partner, or brother, or workmate) is feeling down. You may even suspect they are suicidal. But what do you say to make them feel better, or check out they are not going to hurt themselves (and others)? Strangely enough dealing with the possibility of suicide is the easiest part of it. The common fear is that asking something as blunt as ‘are you thinking of killing yourself?’ may bring on a suicide attempt. But in fact it is pretty well established that this is not the case. Often it can be a relief for the person who is feeling so desperate to have a chance to talk about it, and actually make them feel less hopeless and miserable.

Speaking from personal experience I’ve found that the human contact involved in talking to someone who cares enough to ask the question can be enough to lift me out of that dark place. Counselling can help but it’s a gamble whether the counsellor (or psychologist or whatever brand of helper is available) will be someone the person feels able to confide in or finds supportive. As someone who is already close and trusted a friend, or partner, or relative may have more impact. (Although an established, trusted counsellor is also very useful.)

If someone is suicidal, the key thing to do is talk about things that give hope for the future. Suicidal feelings are about thinking there is nothing to live for, that everything has gone wrong or will go wrong. If the person is not suicidal but just feeling low, then human contact again is the most important thing. The average person is not going to be able to provide professional help but what they can give is the feeling of being genuinely cared about and accepted. I know that having someone make it clear that they still care about me whatever my mood makes a big difference. They don't need to talk about what's troubling me - just asking 'are you not feeling so good?' or even commenting 'you seem pretty down' and then showing they care is enough. The other thing that really works is encouraging me to go out and do something that will take my mind off my troubles and lift my spirits, like going to a movie or a walk. In dark times, people who really care can make a huge difference.

Good things for the last week

• Falling asleep in the sun in the Hamilton Gardens, such a luxurious feeling just drifting away in the warmth

• Getting back to my own home after a weekend away
• Brunch at Metropolis with friends from Hamilton Pride and beyond to celebrate a successful Pride week 09
• Great conversations with friends, in person and on the phone – enjoyable, funny and intimate
• Watching Susan Potter’s documentary ‘An ordinary person’ about the use of the partial provocation defence (the one used by Clayton Weatherston) in cases where the victim is gay
• Watching my silly dog go nutty trying to eat the water from the hose
• Rocky Horror Show at the movies with audience participation and prizes – so much fun!
• I have a lovely new dog who is affectionate and easy and takes care of my lunkhead dog by playing with him and exercising him – life is easy since Sophie the staffy came to live here!
• Stimulating workshops at Hamilton Pride week, including a very funny one on queer humour, which I’m still telling jokes from (Don’t Let your Son go down on Me, that well known hit by Elton John as sung by Miss Tess Tickle)
• Half a glass of delicious Stone Hill Sauvignon Blanc, a real treat for me as I don’t usually drink and I don’t usually like dry white wine
• Feeling better physically after a restful week last week
• Staying the weekend with my friend’s parents and catching up with them
• Finally cancelling broadband (which I’ve never used in the whole time I’ve been paying for it)

Things I’m looking forward to

• My cough being completely gone
  
• Brunch with friends
• Seeing the dogs again
• Taking them for a walk on Monday morning
• Doing more writing this week
• Going to stay with my friend in Tauranga and hanging out with her and another writing buddy and going to the hot pools
  
• My last overdue DVD going back to the video shop
• Going to a couple of writing workshops with them
• Sleep in on Wednesday
• Seeing my Mum
• Reading another novel
• Watching the end of the DVD ‘American Cousins’ which I’m enjoying so far
• Having a little more time to myself
• Getting the dishes all finished – one day!
• Hamilton Pride meeting next Wednesday – going over Pride Week and basking in how well it went
• Losing the last two kilos that will put me under 90kg – soon!
• Introducing two of my Tauranga friends to each other

Can meditation change your mind?

Meditation is a form of mindfulness, which means focusing more on what you are experiencing (for example, the feeling of breathing or sounds around you) and less on what you are thinking. People who are more mindful tend to feel more positive emotions, be more optimistic and suffer less from depression. Brief training in mindfulness techniques is followed by less depression and fewer cognitive distortions.

Mindfulness is pretty easy to practice. If you are walking somewhere, you can switch your attention away from the thoughts running through your head and listen to the sound of your footsteps, or look at the scenery you are passing. If you are chopping vegetables you can focus on the feelings in your body as you do this, or on your breath. Some people find it helpful to look at a candle or say a mantra, like ‘om’ or ‘love’ to take the focus away from their conscious thoughts.

It’s a very simple concept, but what’s amazing about it is that it appears to actually change the brain if you do it enough. Brain imaging shows that people who meditate show more activity in the parts of the brains associated with positive feelings. Monks who spend many hours meditating apparently show extreme activity in these parts of the brain, specifically the front left of the brain, the site that is most active during positive emotions. There is also more activity across the whole brain when the person is stimulated during meditation than when someone is not meditating. Brain waves also change – monks who have done 10 to 15 thousand hours of meditation show extreme levels of gamma brain waves compared to people meditating for the first time. Scientists say this shows the brain is more plastic –able to be changed down to its inner workings and circuitry – than anyone had previously realized. Not only this but people who do even a brief mindfulness course show more antibodies in their blood, which means they are more resistant to disease. So mindfulness is good for body as well as brain.

1. Davidson R et al (2003) Alterations in Brain and Immune Function Produced by Mindfulness Meditation Psychosomatic Medicine 65:564-570.
2. Brown K W and Ryan R M (2003) The Benefits of Being Present: Mindfulness and its Role in Psychological Well-Being, Journal of Personality and Social Psychology, 84(4): 822-848
3. Shapiro S L, Schwartz G E and Bonner G (1998) Effects of Mindfulness-Based Stress Reduction on Medical and Premedical Students, Journal of Behavioral Medicine, 21(6): 581-599.

The delicate art of musturbation

This morning I found myself musing about when was best to take the dogs for a morning run. I’d just read a book that said dogs should have two walks a day so had decided to try to fit a morning run into my schedule. ‘Maybe I should have taken them when I first got up instead of walking round the yard with them,’ I thought. ‘Maybe I should have taken them before I made my breakfast.’ When I heard the ‘should’ word popping up more than once my mental ears pricked up. This is often a sign that I’m ‘musturbating’ – putting pressure on myself to meet a high standard or finding fault with what I’ve done, something I experienced all too often when I was growing up.

I’m not automatically opposed to using the word ‘should’. Most of the time it’s fine, just a recognition of something that happened, like ‘I should have brought the washing in when the sky clouded over and it wouldn’t have got wet’. I think it’s easy to get too religiously strict about using ‘should’, like the friend of mine who once told me ‘that woman says ‘should’ all the time – she should know that she shouldn’t say ‘should’ ‘! When it gets that prescriptive the point is lost. Which is that ‘shoulding’ can be a way of beating myself up that makes me feel bad.

So this morning I asked myself ‘have I crossed the line into self-criticism here?’ The answer seemed to be ‘no, not quite’. I could tell this because I didn’t feel bad or harassed. I was still at the stage of thinking about things in a neutral way, trying to work out what time would work best for the dogs’ run. In the end I decided that it did make more sense to take them after breakfast. But it reminded me how easily ‘should’ can slip into ‘musturbation’ and become a stick we beat ourselves up with.

Getting access to therapy – not always easy

Sorry for the late posting – Telstra kindly cut my internet service off and I’ve only just managed to get it reinstated. Carrying on from yesterday’s post on how difficult it is to get help when you don’t want people to know you are depressed, it’s been my experience that it can be difficult to get therapy even when you do tell your doctor how you feel. In my case, way back in 1982, I was diagnosed with major depression after I became so unwell I couldn’t continue working. My family doctor put me on antidepressants, which took a while to kick in. After talking to a friend about how someone she knew had found therapy helpful for depression I went back to my doctor and asked to be referred to a psychologist.

His response was quite amazing. He told me that in his experience therapy didn’t help anyone and he wouldn’t refer me to it. So I had to find someone who would take me on without a doctor’s referral and pay for it myself. I found this therapy immensely helpful, but after doing research decided to change to a psychologist doing cognitive behavioural therapy as that was proven effective. I made sure to tell my doctor what I was doing. I later heard that this same doctor had refused to refer another young patient to therapy, much to the distress of his family, so I wasn’t the only one.

This story has a surprising ending. A few years after I started doing therapy I started seeing a new psychologist. Somehow we got on to the topic of my doctor. Then my psychologist dropped a bombshell. ‘He’s the highest referring doctor to our psychological service in the region,’ she told me. I was so shocked I asked her to say it again. Surely it couldn’t be the same doctor? But when I next visited him he told me it was true.
‘What changed your mind?’ I asked him.
‘I’ve seen such a change in you with therapy that now I refer a lot of my patients to the psychologists,’ he told me. He was a convert! I even lent him my copy of Feeling Good by Dr David Burns, and when I got it back it was clear from pages he’d marked that he’d actually read it. The upshot of this is that doctors may be more comfortable prescribing meds than referring a patient to therapy, but it’s worth getting therapy anyway and telling the doctor just how helpful it is. They may end up a convert too!

Putting a good face on it

In front of me is a picture of a smiling woman hugging a gorgeous blond headed little boy. Both of them are dead now – the woman by her own hand, the little boy – her son – killed by her. She left behind her two older sons and a husband. This can’t have been the future she imagined when she had her children or married, or the future she wanted for any of them. It shows that depression is a potentially deadly illness. But what I find saddest is that this woman could have so easily been helped. As I’ve discussed in previous posts there are so many effective therapies out there. Any one of them could have made the critical difference. But the difficulty is getting to them.

In this woman’s case she read self-help books but didn’t seek other help. In fact she pretended to her doctor and others that everything was fine. Meanwhile the illness was eating away at her. In some ways it would have been better for the family had she stopped coping and had a complete breakdown so she had to have treatment. But because she went on with the basics day to day it was possible for her to deny the seriousness of her condition, and difficult for anyone to make her get help. I’ve been through this with someone myself – knowing that they are very ill and need professional help, but having them refuse to seek treatment even though their life was at risk. Thankfully in that case a group of people who cared got together and wrote a letter to the person’s GP that led to him getting treatment. As a result he’s still around to care for his children today. But it could have been different.

The reason he didn’t want to seek treatment? The stigma of admitting he had a mental illness. So many of us with depression learn early on that people don’t like to hear about it. Pretending things are fine becomes our way of being accepted, and after a while it becomes second nature. But pretending things is fine makes it hard to seek help. What saved me was becoming so depressed that I couldn’t function normally, so I couldn’t pretend any more. The shame was huge, but not as big as the relief of getting professional help. That was the start of a change in my life that led to my current happiness. I’m just sad that this poor mother didn’t get that chance.

Good things for the last week

• Turning over on my day off and going back to sleep
• The boy from across the road made a banana chocolate chip cake and it was fabulous – especially considering it was the first cake he’d ever made
• Bubble bath with the Radox mix with calendula and rose – yummy
• I got the rubbish out two weeks in a row – now for the recycling that is threatening to bury me!
• Having three people who regularly comment on my blog and encourage me to keep writing it
• The warmth of a fire on a cold winter morning
• A writing buddy who helps me work out where to go when I’m stuck and gives me encouragement
• A short haircut - nice and cool for the warm weather and much easier to manage
• I had a great chat with my hairdresser about the boy across the road who is doing kickboxing with him – I’m so grateful he is so supportive
• Dry firewood!
• A day off from the dog, so restful and relaxing
• Being adored by the dog next door who wags her tail so hard when she sees me her backside is in danger of coming off. Yes – I am the centre of the universe. I knew it!
• I got the sheets changed on the bed
• I got some of the dishes done
• Two quiet, relaxing days with no dog and no local kids coming round
• The annual Pride picnic, which I organised, went really well with lots of people coming along with their dogs and having a great time

The importance of goals

Working on a goal has saved me from despair many a day. I suspect it’s part of why paid work is such a great antidepressant - because it involves setting and reaching goals every day. When I was first depressed in the early 1980’s my goal was often researching therapy for depression. That gave me a reason to get up in the morning and something I could get absorbed in. Nowadays it’s often a writing project. Some days it’s something little, like getting some dishes done or getting the recycling out.

Part of the reason I am so dogged about setting and working on goals is that it feels so good. And it’s not only me. Researcher Richard Davison has found that people who score high on mastery and purpose are more likely to feel positive emotions than those who don’t. People also report feeling very positive emotions when they are in a state of ‘flow’, concentrating deeply on working towards a goal. Flow involves setting goals that are challenging but ‘do-able’ in areas of interest, so you become absorbed in what you are doing until you lose track of time.

On days when I am struck fresh by my losses (house, health, career, to name a few) and start to panic about how I’m going to manage when my dwindling savings are all gone and I’m forced to live solely on disability, working on a goal provides the uplift that helps me stay happy most of the time despite my woes. My fears and sorrows just drift out the window – it’s as if I’m too busy and focused to feed them with my attention. Feelings like hope, enjoyment, satisfaction and competence spring up in their stead like lovely flowers.

Can pets make you happy?

Can spending time with a pet make you happy? I know I feel happy when I just look at my very special brain damaged white cat (except when he wakes me up at 4.30am meowing to have his jellymeat refreshed). But I hadn’t thought about pets as an antidote to depression until a friend (none other than the anonymous Mr F) handed me a chapter from Healing without Freud or Prozac the other day. In it author Dr David Servan-Schreiber quotes studies showing that people are happier when they have contact with animals. One study found that older people had much better psychological resistance to life’s difficulties when they had a pet. Another discovered that Aids patients were much better protected from depression if they had a cat or dog. Lastly, people who were housebound due to a disability and virtually unable to move round unaided were much happier if they had a dog as a companion. Not only that, but they had more friends and more contact with relations than people in similar circumstances who did not have a dog. Apparently just having an animal by your side makes you more attractive to others. (Daters take note!)

Dr Servan-Schreiber also went into the benefits of animal companionship for physical health, which were considerable – lower death rates after heart attacks, going to the doctor less often, and lower blood pressure. Intellectually, people with pets and health problems were sharper too, doing better on stressful activities like mental arithmetic and public speaking, and making fewer mistakes in their work. Overall, it appears you just can’t lose owning a pet. I know that every day one of my three pets does something that makes me laugh. Barney barndog has just discovered that if he plonks his paw down in the water of a stream it splashes up and he can drink it. Watching him work this out had me laughing out loud. India, the dog next door, a Staffy-Ridgeback cross built like a tank and made of muscle (very like the dog in the picture to the left), likes to climb into my lap and be pampered and groomed like a little poodle. The look of bliss on her ugly mutt makes me smile all over. The cats do that classic cat thing of going to jump on something and missing, then getting a look on their faces that says ‘oh that was completely deliberate – I meant to do that’. And it’s delightful on a cold morning to have my special cat snuggle down under the blankets and purr by my side. So do pets make you happy? Apparently the answer is yes.

Light and happiness

Feeling blue during winter is a common experience. (Even looking at the photo to the left brought my mood down!) It’s easy to put it down to cold or rain or lack of holidays. But research over the last few decades has shown that it’s a lot to do with not getting enough sunlight. Light actually affects our moods so that if we get too little we feel miserable. Someone with a knack for acronyms has called it SAD, short for Seasonal Affective Disorder. But it doesn’t have to be winter for SAD to kick in – being stuck inside in summer can have the same impact.

The trick to feeling less SAD is to get exposed to direct daylight for 30 to 60 minutes each day. One study showed that this worked even in grey weather. On cooler days when it’s not so nice to be outside I sometimes open the window while I’m writing or reading and sit inside wrapped in warm clothes and blanket with the heater on! If I’m driving I have a window open so that the light can hit my eyes. You don’t have to look directly at the light – it’s a matter of looking at surfaces that are reflecting light. But it doesn’t seem to work through windows, which is a shame. Having a walk in the open air gives you a double whammy, combining bright light with exercise, also proven to improve mood. If you don’t find bright light enough to lift your mood on its own I suggest combining it with one or two or three other approaches, until you hit the magic ‘feel good’ zone.

For people who experience very dark, long winters or find it difficult to get outside for health reasons there’s an easier way – using a light box. This emits light at 10,000 lux, proven to reduce seasonal depression. Some firms are selling boxes with light at the blue end of the spectrum but the research still seems a bit mixed so personally I would stick with boxes that use full spectrum light. Light boxes are even helpful for people who suffer non-seasonal depression according to recent research. A commercial light box from a reputable firm is most likely to be effective with minimal side effects because it’s made to strict specifications. You can set it up on your kitchen table and turn it on for 15 to 60 minutes a day while you eat or read. For useful and reliable information on light boxes visit www.cet.org , a nonprofit website on all kinds of environmental therapies. Unfortunately they don’t ship to New Zealand but if you want to know who does I can give you details. I thought I might need one to get through the long Waikato winter as I wasn’t well enough to exercise, but I found that sitting with the window open or sitting outside when it was sunny was enough combined with everything else I do.

Good things for the last week

A bit later than usual this week - I had a vague day yesterday and forgot to do the blog!

• lovely afternoon at a local reserve paddling in the river with a neighbour's kids, paddling in the river under the hot sun, playing ball with the dog
• that wonderful moment of putting my head down on the pillow and drifting off to sleep
• making a new cookie recipe that's really yummy
• grooming the neighbour's dog with my zoom groom (unlike my dog, she actually likes it!)
• nice talk with my friend from the UK
• yummy egg salad roll for lunch
• watched Burn after Reading with George Clooney, Brad Pitt and Frances McDormand again and liked it just as much as the first time
• talking with mates from Hamilton Pride about games we can play at the picnic this weekend, including 3 legged races and egg and spoon races
• I got another section of fence up to stop the dog escaping
• another week of feeling happy every day.
  

More feel good movies

Here are some more movies that can lift your spirits when you feel down. They may not work for everyone but they work for me! Remember - research shows that watching these kinds of movies can not only make people feel better but help them see things in a more positive and realistic perspective.

Lars and the Real Girl – a sweet fairy tale like story about a man who finds it hard to relate to others until he starts a meaningful relationship with a life size plastic doll. Very funny with a wonderful ending – makes you see the nice side of the human race

Burn after Reading – another great film from the Coen brothers, with Brad Pitt managing to look and sound stupid – quite a feat! Very funny and slightly crazy

Art School Confidential – one of the few movies I’ve seen recently where I didn’t have any idea what was going to happen from one minute to the next. Crazy, hilarious, and very original

Stepbrothers – another delightfully silly film starring Will Ferrell, with a moral buried under all the slapstick, bad jokes, and unlikely scenarios. Will does his normal great job as a huge, hairy child but the real treat are his bizarrely ambitious brother and severely repressed sister in law.

Starter for 10 – I picked this DVD up and put it down again several times before getting it out, but was glad I saw it. It’s an engaging and frothy with a serious side. Great performances from James McAvoy and Rebecca Hall. The plutey girlfriend is great fun, and watching the working class boy react to the vagaries of the upper class is painful but hugely funny.

Unexpected Positive Occurences (UPOs)

The reason that Unexpected Positive Occurences are so important to me is that they remind me that life often turns out to be far more positive than I assume it will. Noticing the positive things that actually happen despite my sometimes dire expectations helps me to remember that lots of things in my life do go well. So even when things are a bit stressful or life throws a curly one at me, I can be comforted by the thought that at any time, out of the blue, something really nice could happen.

Like the other day when I stopped to walk the dog at a reserve we both like. When we got there we had the large grassy area to ourselves. As the dog romped and I walked sedately beside the stream under the budding trees another car drew up. Out of it climbed a woman and a huge brown and black dog. They walked the opposite way to us but then we both turned so we were on a collision course. I put my dog back on the chain. As we neared she called out ‘she’s quite friendly’ and I replied ‘my dog is well socialised’. We let them do the doggy small talk of sniffing each other, then when they behaved well let them off their leads to romp around. The two dogs had a wonderful time splashing through the stream and bounding over the grass. The two humans also got on well and had a great chat. In the end we exchanged cards and agreed we’d meet again at the reserve to walk our dogs some other day.

As I drove away I reflected on how totally unpredicted that pleasant meeting had been. No one had ever so much as spoken to me at the reserve before. It gave me a warm glow thinking of all the unexpected positive things that might be just about to happen to me.

The impact of protein on my mood

A few years ago I had a horrific relapse of depression. It was brought on by a difficult relationship that ended badly. My mood swings were huge and some days I feared for my life. Even worse, all the things that normally worked to stabilise my mood had no impact. It took me quite a few months to work out that maybe the hormonal instability that comes with menopause was part of the problem. Even when I did, the treatment options seemed limited. I didn’t want to do Hormone Replacement Therapy even if I could have found a doctor to prescribe it.

Luckily I stumbled on something that helped quite by accident, looking for a book on how to lose weight (again!) The book I picked up recommended a diet very low in sugar and pointed out that the body processes any refined carbohydrate (such as flour) as if it’s white sugar. The author put forward evidence that this not only affects blood sugar levels but also serotonin levels in the brain, making it a double whammy for sending mood sky high and then dropping it through the basement again. This is particularly a problem for people who are very sensitive to sugar.

I did the sugar sensitivity test and found I scored very highly. Figuring I had nothing to lose I started the diet. Some aspects of it were not so helpful, but gradually my moods started to stabilise. I was also doing a lot of other things (see my post yesterday for details of the whole list) but the change in diet made a real difference. Finally I worked out that I didn’t need to do the whole, complicated diet – all I really needed was to eat protein as part of every snack and meal. The acid test was when I forgot and just had carbs on their own. I usually realised I’d done this when my mood plummeted for no apparent reason and I could trace it back to the moment I last ate something. Now I’m religiously careful about eating protein with everything. I can’t provide any stunning scientific evidence to support it but for me it really seems to work. As an added bonus not only did I get more emotionally stable and less depressed, but on this diet I feel calmer and get angry far less often than I used to.

One type of therapy may not be enough to get happy

Call me greedy but I’ve found that I need more than one type of therapy to make a difference and keep me happy. This is because I’ve found that just doing one thing – like taking antidepressants, exercising or using cognitive techniques – is not enough to push me over the edge into happiness. So I’ve kept adding more and more things until my mood has hit happy and stabilised.

This is a list of the techniques I use:
• behavioural techniques (activity schedules, rewarding myself for doing difficult things, doing pleasurable activities)
• cognitive techniques (recognising errors of fact or logic in my thinking and correcting them, focusing on good things that could happen)
• noting good things that happen each day or few days, as well as what I’ve achieved, no matter how small
• savoring the enjoyable and pleasurable things that happen
• trying to get half an hour at least of outside light each day
• doing some exercise (limited due to my health although having a dog helps)
• taking 6000mg of omega 3 fatty acids (in the form of fish oil) each day
• taking St John’s Wort daily as well as a mix of vitamins and minerals proven to affect mood
• social contact with positive, supportive people
• eating protein with every meal and drinking caffeine free beverages after noon
• resting when I’m tired and getting enough sleep each night, with a hot bath and good book at night to help me off to sleep
• using problem solving techniques
• talking regularly to a trusted counsellor.

I’ve found this mix really works to keep me happy.