How taking control increases happiness and health despite financial stress

I just read something fascinating about how believing that you can control your life is linked to less depression and better physical health.  People with a high sense of control and mastery agree with statements like:

• ·         I can do just about anything I set my mind to;
• ·         When I really want to do something I usually find a way to succeed at it;
• ·         Whether or not I am able to get what I want is in my own hands; and
• ·         What happens to me in the future largely depends on me.

Those who have a high belief in their ability to overcome obstacles to achieving their goals tend to disagree with items such as:

·        

•       Other people determine most of what I can and cannot do;
• ·         There is little I can do to change most of the important things in my life;
• ·         I often feel helpless in dealing with the problems of life;
• ·         What happens in my life is often beyond my control; and
• ·         There are many things that interfere with what I want to do.

What I found most fascinating is that having these beliefs seems to protect people against the ravages of low income.  People with lower incomes are much more likely to get depressed and physically ill and die early than those with higher incomes.  Those of us suffering financial hardship are also less likely to believe that we can control our lives and overcome obstacles to achieving goals.

But this study found that even when income is low and realistic obstacles to achieving goals are high, believing one can control personal circumstances and overcome constraints is associated with better health and less depression.  Those people with low incomes (below US$25,000) who believed they could control aspects of their lives and overcome barriers were less likely to be depressed than low-income people who had a low sense of control.  In fact, their level of depression was similar to medium (US$25,000-49.999) or even high income (US$50,000+) folks.  The same was true for physical health.

Who was most likely to be depressed?  Those with incomes under US$25,000 who believed their lives were controlled by others and they could not overcome external barriers to achieving their goals and dreams.  Who was most likely to feel satisfied with their life?  Those who felt a high level of mastery and control, regardless of their income.  That means that a high sense of control cancels out the negative effects of low income.

As someone on a low income due to ill health, I find this study heartening.  It’s just a snapshot at one point in time, and I’d like to see a study that followed people over a period of years to be sure that one thing really led to another.  But I know from personal experience that when money is tight, life can be very stressful and small problems become magnified out of all proportion.  This study confirms my strategy of trying to control what I can in my life, and work hard to achieve my dreams despite the barriers that ill health and low income create.

I find this study particularly interesting because it reminds me of a discussion I had with fellow students in a psychology class at university years ago.  We were studying locus of control, that is, the degree to which people believe that ‘I control me’ or ‘they control me’.  Believing ‘I control me’ is associated with many life benefits.  Despite this, many of my classmates, and even our lecturer, wondered if people who were poor and disadvantaged might not be better to accept their current reality and not aim high.

After the class I mused on people who have grown up in poverty, even homeless, and made their way to a better kind of life.  It seemed to me that if one is poor and disadvantaged in other ways, it is EVEN MORE important to believe that it’s possible to control at least some circumstances and overcome barriers, because you need even more motivation than the average person to work hard enough to do so.

What do others think? Is it possible to overcome barriers of poverty and disadvantage to achieve dreams and goals with hard work?  Do you have any inspiring stories of people who have done this?

P. S. For those interested in reading the original study it’s by Lachman and Weaver, published in 1998, called ‘’The Sense of Control as a Moderator of Social Class Differences in Health and Well-Being”.  If you search on Google Scholar there’s a free pdf version available.  For more on health and positive psychology, there is a very good chapter in ‘Applied Positive Psychology’ by Donaldson et al, which is where I first read about this study.

What is recovery?

‘Recovery’ means getting well, doesn’t it? Not necessarily.  Many people with personal experience of mental illness have reacted against this model of recovery.  They argue that it is too difficult to achieve, and have instead produced their own definition.  It goes something like:

                Recovery = living a full and meaningful life whether in the presence or absence of symptoms.

I like this definition, because it focuses on what I do with my life, rather than whether I’m having symptoms or not.  But despite this, I still aim to be symptom-free.  Not only that, I want to be positively happy, and that’s what I work towards.  Most of the time I am, despite some major life adversities such as being too physically to ill to work many hours, and it’s one of my greatest achievements.

But I still think it’s important to say that a person doesn’t need to be symptom-free to see themselves as recovered.  Depression and other mental illnesses can be crippling, robbing the sufferer of the will or ability to do the simplest daily tasks.  So being able to get up each day and carry out purposeful activities is a real achievement – believe me, I speak from experience!  I can still remember the dark days decades ago when simply getting dressed seemed beyond me.

Despite this, I do believe it’s realistic and worthwhile to aspire to be symptom-free, if that’s something you want.  Someone made the point to me the other day that some people don’t want to lose some of their symptoms, especially mania, which can be so useful for getting things done! 

I read somewhere recently that the people most likely to move into normative scores on depression questionnaires are those who most want to get over their depression.  I would think everyone would want to, as it’s such a noxious, unpleasant illness, but maybe that’s not true.  In the end it’s a personal choice.  I do think though that the twisted thinking that goes with the illness can mean it’s easy to get bogged down in thinking that happiness is not possible or you don’t deserve it, which can decrease the motivation to change.

Which brings me to the take home message of this blog.  It's that experiencing lasting happiness is a real possibility for people with experience of depression, even when it’s been severe, life-threatening and/or gone on for decades.  I've achieved it and I believe others can too.

What about you?  Do you want to be symptom-free or is it not an important goal for you?  Do you think it's possible?

5 simple ways to reduce painful feelings

Happiness happens when a person experiences three times as many positive emotions as negative emotions (or more). Building up positive emotions is reasonably simple. But how do you reduce the negative emotions like sadness, anger and anxiety that so easily undermine them?

Here are some simple tips, based on research and my experience:

1. Notice negative thoughts or feelings. Sounds simple, but it works. You can count them, put a rubber band on your wrist and snap it when you realize you’re having one or simply say to yourself ‘that was a negative thought’. Research shows that simply noticing you’re having a thought that ma
kes you feel bad is enough to decrease them
2. Accept negative feelings. Again, a very simple sounding technique but one that I’ve found amazingly effective. This involves not panicking, but just feeling the feelings. I say to myself ‘just feel it’. This stops me catastrophizing about feeling bad, which makes the bad feelings spiral out of control. It also stops me trying to deny that I’m feeling bad, which usually makes me feel worse.
3. Do something. As long as it’s not self-destructive, doing almost anything will lift your spirits and reduce negative emotions

4. Exercise. A brilliant, free way to reduce negative emotions. A walk, swim or workout can not only distract you but change you physically, so you feel less sadness, anxiety or anger.

5. Spend time with people. Make sure they’re people you actually like and get on with or you could feel worse! But this is a very effective way to

lift your spirits.

What makes you feel better when you’re feeling down or worried or irritable or any other kind of negative emotion?

How to create positive emotions

To be happy, you need to experience three times as many positive emotions as negative emotions (or more).  What amazes me is how simple it can be to create a positive emotion.  These include things like joy, awe, compassion, amusement, hope and love.  (Negative emotions are what you’d expect – anger, sadness, hate and anxiety, among others.)

I was reading an experiment by happiness researcher Barbara Fredrickson recently while working on my book on transforming depression into happiness.  She made people feel positive emotions simply by showing them short film clips of a puppy or waves.  I was surprised that this works, because these seem like such bland images.

Obviously, to get to the magic ratio, it makes sense to do as many things as possible to create positive emotions.  Here are a few of the things I’ve found that work:

• ·         Writing down the good things that happen each day or week – reliving them gives me a lift
• ·         Watching youtube clips or TV programmes that amuse or inspire me, like America’s Funniest Home Videos or Saturday Night Live.  As I write this I’m smiling over a heart-warming story on Luke Gamble’s Vet Adventures about a young street kid caught illegally selling puppies who was caught and given a job at an animal shelter which helped him get his life together
• ·        Getting out in nature and savouring the beauty
• ·         Playing ball with my dog (the non-lazy one who actually likes to chase balls!)
• ·         Meeting friends for a walk or coffee
• ·         Exercise
• ·         Doing something I get lost in, like writing, and
• ·         Cooking – not fun for everyone I know, but I love trying out new recipes, whether they work or not!

If you keep a note of the things that lift your emotions, you’ll quite soon have a good idea of what to build into your life to increase your good feelings.  The other part of getting the magic ratio is decreasing negative emotions – more on that in another post!

What lifts your spirits?  I’d love to hear.

Using creative procrastination to get things done

I know the conventional wisdom is to identify the top priority on your to do list and do it first. But if you're like me you may have sat, paralysed, staring at that top priority and feeling unable to get started on it. Well, I have two tried and true techniques for getting past that paralysis. Here's one of them.

It's pretty simple - if you can't do the top priority, do something else from your to do list. This is a situation where the best really is the enemy of the good. The great thing about this approach is that instead of reaching the end of the day filled with guilt and self-recrimination about not getting anything done, you at least feel good about what you did achieve. As getting active is a proven way of feeling better, this should mean you end the day feeling happier (or at worst, less depressed) than if you'd sat staring at the list all day.

If you find you end up feeling bad because you didn't do the 'right' thing, then I've found talking back to those voices is helpful, with comments like:

• at least I did something
• I made progress today
• I can do that other task when I'm feeling fresher, and
• the best is the enemy of the good.

I had an experience like this last week. My top priority was editing an article I'd just got feedback on. But I felt totally demotivated about doing that, especially as I had to make it shorter and editing is not my strong suite! So instead, I changed gears and worked on drafting a new article. I promised myself I'd go back to editing next week, when I feel fresh and have some perspective. At the end of the day, I felt good about what I'd achieved - much better than if I'd done nothing. That really would have resulted in self-recrimination!

My other tip? It's 'just aim to do five minutes on it' - and that's one I'll be using this coming week to get the editing done! I'll do a post on this in future, but if you want to read more about it now look at my other blog, under 'older posts - 'my best anti procrastination technique' (note to self - must learn how to add links to other websites!)

Using positive psychology to lessen the pain of cognitive therapy for depression

Sometimes using cognitive techniques can make you feel worse to start with, until you find good answers to talk back to your painful thoughts.  Here’s a simple technique I happened on that takes some or all of the pain out of challenging depressing thoughts.  I know some people avoid looking at their thoughts because it hurts, so I thought this might help.

I came up with this when I was doing background research for the book I’m writing on transforming depression into happiness.  Positive psychology researcher Barbara Fredrickson’s found that one of the good things that happiness brings is increased creativity.  ‘D’oh’ I thought.  ‘What if you did something that made you feel good before you wrote down your thoughts?  It could provide a buffer zone of good feelings against the potential down when you look at thoughts like ‘I’m a failure,’ or ‘I can’t get on with people’.  Feeling better could also make it easier to come up with new ways of thinking because your mind is more open to new ideas.’  I tried it out and it seemed to work.

So here are the simple steps:

• ·         Pick an activity that routinely lifts your spirits – going for a walk, meeting up with friends, watching an uplifting movie, driving round and listening to music, surfing, cooking a great meal – whatever floats your boat!  Set a time and do whatever organising you need to
• ·         Just before you do the activity, write down some of the thoughts that have been flitting round your head like annoying little grey clouds (or huge overwhelming tornadoes!)  It may be a bit painful to focus on these thoughts, but that pain is about to be eased!
• ·         Go off and have fun
• ·         When you feel better after the activity, pick up the page and look at your thoughts again.  You may find it easier to see the gaps in logic and evidence, and come up with some good answers, in a relatively painless way.

The other good thing about this technique is that there seems to be some evidence that we are more able to remember things that fit with our current mood.  So when you’re feeling sunnier, you may be more able to access sunny memories that give the lie to your gloomy prognostications.

'Why bother with using cognitive techniques when you’re already feeling better?' I hear you ask  That’s a good question.  If you no longer feel depressed, then it may well not be worth the effort.  There is research that shows that activity can be just as effective in changing depressing thoughts as cognitive techniques.  I do it either when the activity wasn’t enough on its own to make me feel good, or as a way of buffering myself against future depression by coming up with some snappy answers I can use in the future.  Totally up to you!

How to choose a therapist

The first thing to remember is - you don't have to keep seeing a therapist or counselor just because you see them for one session. In fact, you don't even have to finish that session! If they feel wrong for you it's OK to politely excuse yourself before the hour (or 50 minutes!) is up and leave, provided you pay the bill for the full session. Warmth is a biggie for me so if the person concerned is cold and critical, I don't sign on for another session.

However, I would recommend seeing someone face to face even if they sound off-putting on the phone. My favorite ever counselor sounded awful on the phone but was lovely in person.

How do you know whether it's worth staying? Here's some tips:

• you feel listened to and understood
• you feel respected
• you feel safe
  
• the therapist wants to take the same approach as you.

The last cannot be guaranteed, even if you're seeing someone who specializes in the type of therapy you want to do. I once went to great lengths to get an appointment with a psychologist who did cognitive behavioral therapy, back in the days when it wasn't that common. But despite me telling her over and over again that this was the type of therapy I found helpful and wanted to do, she insisted I needed what she called 'supportive therapy'.

You would think 'listening' was a no brainer but no - I did see one person who couldn't stop telling me irrelevant and annoying stories about herself. Obviously you want the therapist to say something - just not too much! And you also want responses that acknowledge what you just said and how you're feeling.

As for 'safe' and 'respected', that means things like - the person doesn't insult you, patronise you, jump to conclusions about you or come onto you. (It happens!) I saw one psychologist who was very angry and aggressive towards me, because she was also seeing a friend of mine and didn't like the way I'd acted towards her. I lasted the hour, but after talking it over with my partner decided not to go back again! (N.B. while the therapist is long gone, my friend and I are still going strong!)

It may take a while of seeing different therapists before you work out what works for me. It took me a couple of disastrous people to work out I needed someone very warm and accepting to work with. One good way to work out what kind of therapist you might get on with is to think about what types of people you most like in every day life = and what sort of people you avoid!

As for what type of therapy to choose for depression, that's a big question that it will take me quite a few posts to answer.

Has anyone reading this post had an interesting experience trying to choose a therapist?

5 ways to feel better quickly

Here are my top 5 ways of feeling better quickly:

1. accept my emotions and just feel them - they tend to fade away
2. focus on what's happening around me - noises, smells, the temperature of the air on my skin
3. do something - it doesn't have to be grand, it can be doing the dishes, but taking action almost always makes me feel better. Going for a walk is a good one because it's a triple whammy - you get action, exercise and bright light all in one hit!
   
4. do something pleasurable - whether it's watching a favorite TV program or a funny movie, going for a walk, meeting a friend for a coffee or taking the dogs for walk in a beautiful park, this will almost always life my spirits
5. notice the good things in my life - whether it's once a day or less often it doesn't really matter, it can be written down or just in my head. The key thing is to focus on them.

Extra tip: reflecting on the good things in my day when I go to bed helps me get a good night's sleep!

Thinking myself happy

Sometimes I wonder if I can truly say I’ve transformed my depression into happiness, especially when I have a week or two when I feel low. At times like that I feel a fraud, and my motivation to write goes way downhill. I had one of those times recently, and thought seriously about throwing in the towel (on my book – not on my life!)

But then I took myself in hand and asked myself two questions. They were:

1. Why do I want to be happy? and

2. What is stopping me from being happy?

The answer to question 1 was pretty easy. I want to be happy because it feels good. I know from the work of Barbara Fredrickson and others that there are lots of positive downstream effects of happiness, like heightened creativity, more success at work and better relationships. But in those moments when I’m experiencing life through a filter of misery and emotional pain, feeling good becomes my overwhelming motivation for taking action.

The answer to the second question was also reasonably obvious. While it’s true that living away from my home town of many years and my close friends means I have less social support than previously, and being chronically ill and on a low income creates a lot of stress, I know that I can still be happy despite these things. What was clear to me from my journaling was that the main thing stopping me from being happy was my thinking.

I did some more journaling and isolated the two major thought patterns that were resulting in misery. They were oldies but baddies! One was about how hard life was. ‘Yes, it is,’ was my response, ‘but it’s even harder when I’m depressed! When I’m happy I can cope with the difficulties life throws at me and still enjoy it.’

Having worked on these thought patterns many times in the past I had some answers to them already. Over the period of a few days I kept jotting them down, looking for the ‘heavy hitters' - the answers that delivered the best payload in terms of making me feel better. Then I did my best to turn them into easy to remember catch phrases. One was ‘life is hard but full of opportunities’, another ‘the steps I’m taking now will make my future a lot easier’. That helped me re-frame my current circumstances.

The effect wasn’t instant, but over time I gradually started to feel better. After a week I was feeling pretty good indeed. I was enjoying my own company again, rather than trying to run away from the painful thoughts by reading, watching TV and working to an unhealthy degree. It gave me a lot of confidence to know I could get on top of painful feelings when they surfaced. It also reinforced my desire to write about how to do this so I can share the message with others who are depressed that it is indeed possible to transform depression into happiness.

How do you know you're happy?

How do you know you're happy? And what is happiness anyway? I'd been thinking about these questions in my own life when I found them repeated in a very interesting book by Harvard psychology lecturer Tal Ben-Shahar, called Happier. The reason I'd been thinking about them is because I recently started using a couple of measures of happiness to track my mood (more on the reasons for this in another post). The content of the measures included the obvious things like finding life more pleasurable than painful, and enjoying one's daily routine, along with less obvious things like finding life meaningful and one's perception of how quickly time passes. I scored quite high on things like finding life meaningful and loving my work (in fact I scored the highest you can score). But for me this is not what happiness is about. The first day I did the test (called Authentic Happiness Inventory, from the Authentic Happiness website) I scored reasonably high but actually felt slightly unhappy. The next time I did the test, a few days later, I felt very happy, but actually scored lower than the previous time. All this made me think about what happiness means to me, and how I know I'm happy.

Tal Ben-Shahar, looking mildly happy!



So when Tal Ben-Shahar asked 'How would you define happiness?' and 'What does happiness mean to you' I was ready!! I quickly replied (to myself, silently!) 'it means contentment, serenity, enjoying my daily routine, and having pleasurable feelings'. By the last comment I don't mean pleasurable feelings from having an orgasm, buying a new pair of shoes or eating chocolate. I mean the more difficult to define pleasurable feelings that feel like they occur in the cranium, and that any depressed person will tell you are lacking. Not only lacking, but replaced by painful feelings. It's not about the highs, not about bliss, but about feeling comfortable in myself, able to enjoy the many pleasures in life without experiencing them through a filter of painful emotions. I think it's great that I find life meaningful, that I love my work and that I feel like I make a positive contribution to the world. But these things do not constitute happiness to me. They help my happiness, but to me, happiness is in the pleasant, stable feelings that allow me to enjoy life to the full.

So back to the question, 'how do you know you're happy?' which Ben-Shahar also asks. While it's interesting and useful to track my happiness using the Authentic Happiness Inventory and General Happiness Scale (also from the Authentic Happiness website), I've decided to add another measure - one I invented myself. I've called it My Happiness Scale. Ben-Shahar says in his book that he doesn't think happiness is dichotomous, that is, that you're either happy or not happy. Based on my experiences I disagree. I do tend to feel either happy or not happy (although some days I can switch from one state to the other and back again). But it does differ in intensity. My scale recognises this by using 9 points. It goes like this:

Right now I feel:

9 Extremely happy
8 Very happy
7 Pretty happy
6 Slightly happy
5 Neither happy or sad (I know I said this doesn't happen to me, but I felt I should put in a neutral option to be thorough and fair!)
4 Slightly sad
3 Quite sad
2 Very sad
1 Extremely sad

My scores are based entirely on my subjective feelings at that moment. And guess what? I feel happy with my measure of happiness!

UPOs - happiness out the blue

What is a UPO? Not an Unidentified Plying Object, but an Unexpected Positive Occurrence! It's something that makes you feel good that happens completely out of the blue. For example, finding $10 on the sidewalk, or a phone call from a friend you haven't heard from in a while.

I came up with this concept during a long and dark depression many years ago. It helped me remember that - no matter how gloomy my current circumstances seemed - there was still hope of good things happening completely out of the blue to make my life much better.

Over the years I've gotten into the habit of writing down the UPOs that happen, whether small or big, in the section at the back of my journal dedicated to tracking the good things in my life. I also swap lists of UPOs with friends by email. Here is a list of my recent UPOs.

• a friend rang out of the blue to offer me a whole swag of veges from her garden, which meant I needed to buy almost none in my weekly grocery shop
• my neighbour, who I've not always got on wonderfully well with, offered me a bag of fresh plums from the tree in his garden
• a friend rang up to say she'd bought me a jar of the delicious red pepper dip I like from a discount deli shop for $1 when I hadn't even known she was going there. Bonus!
• I took my dogs to a different place to walk from usual because our normal park was being used for sports. We had a wonderful time across the other side of town walking beside a stream lined with gorgeous trees. The dogs had a ball in the different surroundings and I found all the stresses of the day just floated away
• a friend rang out of the blue when I was feeling ill and was incredibly supportive, even offering to pick up some groceries if I needed her to
  
• I left home in the rain and was dreading driving over a range of hills in the wet weather but just before I reached them the bad weather cleared up and I was able to drive over them in bright sunshine
• a friend rang and invited me and another friend round to afternoon tea, something she's never done before, and
  
• I got an email from someone interested in coming to the writers' group I coordinate.

Has something nice happened to you out the blue and boosted your spirits? If so I'd love to hear about it. To post a comment, just click on the 'x comments' line at the bottom of this post.

When one door closes, another one opens

Sometimes it seems like the bottom has fallen out of your life. I know it felt like that when I got so sick I had to give up my much-loved career. It felt like the end of my dreams.

For a while it was. I was too ill to work more than a few hours a week, and couldn’t find anyone who wanted to hire me for that little time. But I knew it was important to focus on a goal, to have a sense of purpose so that I didn’t get depressed. Luckily, I had the book I’d been working on in my spare time for some years.

I started a routine of trying to work each day on my book. I turned the period of illness around and looked at it as a chance to write. Some days I couldn’t manage it at all, other days I wouldn’t feel well enough to write until evening. But I kept on with it, and got an enormous amount of satisfaction and pleasure out of it.

It took me a while to find work. After a couple of short-term jobs I hit the jackpot. I got a job writing articles for a national website. Over a year later I’m still doing the job, and loving it. Writing articles was the kind of work I’d been wanting to do for a while, but had found it difficult to break into. So while getting ill was stressful and unpleasant, and closed a door to one successful career, it has opened one new door for me that I feel very happy about.

Have you had an experience where as one door has closed, another one opened? If so, I'd love to hear about it.

All the techniques that make me feel good

Wine is not on this list, much as I love a glass of good merlot! Neither is chocolate, even though I consider it one of the essential food groups. Instead this is a list of all the strategies and techniques I use to keep my mood positive, and lift it when it drops.

I'm always interested when I hear one thing being recommended as the answer to depression, whether it's an antidepressant, cognitive therapy or exercise. That's because my experience is that I needed a whole range of things to transform my depression into happiness. I kept adding one thing after another until I reached a critical mass that pushed me over the edge - in a good way! I still use all these things to maintain and protect my good mood. They include:

• writing down the good things that happen to me most days, three or more things, or however many I want. (If I don't feel like doing it, I don't.) Some people prefer to do this once a week and doing it that often seems to work just as well
  
• writing down the things I am looking forward to and ticking them off when they happen, especially small, predictable things, like my delicious fruit smoothie for breakfast
  
• planning social times with friends, acquaintances, and family
  
• getting as much exercise as I am able without making the chronic physical illness I suffer from worse, particularly walking with my dogs
• getting out in the daylight, even when it's raining, even if it's just sitting in the car with the window rolled down while the dogs run around in the park!
• taking 6000mg of fish oil each day (half in the morning, half at night)
• planning my day and week so it doesn't seem overwhelming, I keep on top of chores and finances, I get some work done each week, and I have fun times
• listening to my thoughts and being alert to any of the cognitive distortions, particularly a focus on the negatives and ignoring the positives
• talking back to them in my head, and if that's not working, writing them down and looking for holes in my logic or facts that I can correct
  
• doing things that build my positive emotions, such as watching TV programs that are funny or inspiring (like Monk, about the annoying but brilliant obsessive compulsive detective), or reading books that make me feel good (although these are harder to find than visual media), spending fun times with people, working on my book or blogs, going for walks
• mindfulness - now this is a challenge as I find it pretty boring! My best technique so far has been a recorded grounding meditation which doesn't focus on breathing (my pet hate - not breathing per se, but focusing entirely on it, especially through my nose. I just don't find my nose that interesting!). I like mindfulness because it focuses on what I hear, feel, see, smell and taste inside me and outside me, and I can open my eyes and even move around while I'm doing it
  
• when I feel a painful or negative emotion just accepting it and feeling it, not panicking or rushing to try and change it
• eating a diet that's low in sugar and caffeine, and reasonably high in protein and fibre, with less omega 6 and more omega 3 essential fatty acids than the average diet contains (that means avoiding processed foods and eating fresh food and wholegrains as much as possible)
• doing things that are creative and put me in a state of flow, where I lose myself in the activity, like cooking a new dish or writing
• and one of my favorites, work, whether paid or unpaid. There's a lot of research showing that people who are depressed and unemployed feel much better when they find work, as long as it's not too stressful (i.e. with more demands than they can realistically manage). Work involves so many things that are useful in themselves - planning, social contact, flow, the satisfaction of achieving goals. I call it the therapy I get paid to do
• savoring the enjoyable sensations and events in my life by noticing them when they happen and celebrating them with others
• building up my relationships by responding very positively to the good things that happen to others and keeping mainly to positive topics in the conversation as well as asking questions and finding things to agree with in what people say
  
• using problem solving skills to deal with practical problems so they don't become overwhelming and de-rail me
• noticing the danger signals that my mood is likely to go down (poor sleep, crying, conflict in relationships, irritation) and acting quickly to make sure it doesn't happen
  
• there are probably a few things that I've left out but that's enough for now!

I find that building these things into my daily and weekly routine results in a more stable and positive mood, and much more happiness.

Do antidepressants make depression worse?

I just read a book that made me wonder about the adverse effects of antidepressant meds even more than I usually do. I've had my own terrible experiences with them, but I thought that once I was off tricyclics and on St John's Wort my problems with harmful (and in my case, life threatening) med side effects were over. But apparently that might not be the case.

The book that got me wondering is Anatomy of an Epidemic by Robert Whitaker (the link above will take you to his website if you want to find out more about it. The madinamerica link takes you to his blog and a whole lot of other interesting stuff). The book is about the impact psychiatric drugs have on a whole range of mental illlnesses, including depression. The author (whose smiling face appears to the right - this is the look a best selling author wears!) investigates how much these drugs actually help and harm the people who take them in the long term. His conclusions make disturbing reading, but I didn't expect them to apply to my life. It appears I might be wrong.

As I read about people with schizophrenia developing tardive dyskinesia (uncontrollable twitching), intellectual decline, and the inability to hold down a job, while getting progressively worse than people not taking antipsychotic drugs, I thought 'those poor people'. As I read about people who took tranquillizers becoming addicted, developing depression and ending up worse off than anxious people who didn't take the meds I again thought 'those poor people'. But when I read about how taking antidepressants - tricyclic or SSRI - can result in worse and more frequent symptoms of depression compared to not taking the drugs, I thought 'that's outrageous!' Because that's about me. I took a tricyclic for the best part of 16 years. I've been on St John's Wort, which has some SSRI type properties, for the best part of 14 years. That's 30 years of antidepressant medication all up. Just what has this been doing to me?

What Robert Whitaker said about the long-term effects of antidepressant use truly shocked me, and made me re-evaluate my experiences of depression. He said that prior to the introduction of antidepressants, in the 1950's and 60's, an episode of depression usually cleared up by itself within a year and the majority (around 70%) of people went back to their normal lives. This rang a bell because I remember reading this when I first got seriously depressed, in 1982. The reason I had forgotten it is because my experience for many years was of chronically relapsing depression. I had assumed that this was just the way it went, and this assumption was echoed by what I read. What did I know?

But according to research cited in Anatomy of an Epidemic, people who use antidepressants are likely to relapse more, and have less relief from their symptoms than those who don't use meds (62% decrease in symptoms over 6 months for those off meds vs 33% decrease for those on meds). An international study by the World Health Organisation found that the people who did best after an episode of depression were those who didn't take any meds. The people who did worst were those who did as recommended and kept taking the pills.

All this has made me wonder whether the continual relapses I suffered during the 80's and my 'nightmare years' during the early 90's, when I was almost continously depressed and suicidal for 4 years, were due less to the natural progression of the illness and more to the fact that as soon as I was diagnosed with major depression, I was prescribed tricyclic antidepressants. The irony is that they didn't stop the depression. If anything, they made it harder for me to feel happy - things became a lot greyer and less fun while I took them.

My personal triumph is that I persisted with learning and using cognitive and behavioral techniques, along with other approaches proven to reduce depression, and succeeded in becoming happy despite any ill effects the meds might have had. But what I'm wondering now is...if I had never taken antidepressants would have I avoided a lot of that misery? Would the full impact of CBT unimpeded by meds have led to a consistent happiness? If so, that's a terrible thing. That means all those years of misery were unnecessary and avoidable, and that I was robbed of a huge part of my life. I'm only glad I got off tricyclics and onto St John's Wort. But now I'm wondering...is even that safe? I'm pondering the wisdom of taking a drug holiday and seeing what happens. But I've learnt my lesson - if I do I will cut down my meds very slowly and carefully because I know if I stop too quickly, disaster could be waiting - but more on that in a future post.