depression advice

One of the Best Panic Books of All Time!

101 Ways to Conquer Teen Anxiety made it to the Best Panic Attack Books of All Time

We are happy to announce that 101 Ways to Conquer Teen Anxiety: Simple Tips, Techniques and Strategies for Overcoming Anxiety, Worry and Panic Attacks, made it to BookAuthority’s Best Panic Attack Books of All Time.

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The book is available for purchase on Amazon and everywhere the best books of all time are sold. 🙂

How do You Know if You’re Depressed or Just Sad?

You might think you’re feeling lazy or unmotivated, but here are the signs that it’s something more serious

Is your two-day, Netflix binge of “Black Mirror” and “Stranger Things” a bout of laziness and apathy, a case of “the melancholies,” or … clinical depression?

Maybe you think you’re depressed, or you’re just using depression as an excuse to be lethargic – only to realize this itself might be a symptom of depression. It’s tough trying to figure-out your head with your own mind, right?

The brain is an organ that can malfunction like any organ. Mental illnesses are illnesses of that organ.

Brain scans show that there is a physical difference between a healthy brain and a sick brain. Telling someone with depression, “You don’t have an issue, it’s all in your head” is as inane as telling someone with diabetes, “You don’t have an issue, it’s all in your pancreas.” Any organ is susceptible to disease or disorder.

When you’re feeling down, it’s imperative to distinguish feelings of sadness versus depression because confusion can lead you to avoid evaluation and treatment of a serious condition. Alternatively, you might overreact to a normal emotional state of sadness.

“And, here’s why the distinction is crucial: If we (or a loved one) are depressed, it has huge implications for our long-term mental health, physical health, and longevity,” says NYC Psychologist and author Dr. Guy Winch. Sadness and apathy are normal emotions. “Sadness is usually triggered by a difficult, hurtful, challenging, or disappointing event, experience, or situation,” says Winch. This also means that when something shifts, or we’ve gotten over the hurt or event, the sadness also wanes.

“Whereas depression is an abnormal emotional state; a mental illness that affects our thinking, emotions, perceptions, and behaviors in pervasive and chronic ways,” says Winch. Depression can occur in absence of any of the triggers that cause sadness. Sadness is about something and depression is about … nothing.

Criteria for Depression

Depression is classified into different types using a book with diagnostic criteria for mental health disorders. Now in its fifth edition, the book is called the Diagnostic and Statistical Manual of Mental Health Disorders. But, everyone just calls it the DSM-5. Think of it as the owner’s manual for the brain but – like an iPhone user guide – you must make an appointment with an accredited genius to see one.

The DSM-5 outlines the following criterion to make a diagnosis of depression.

Note: These serve only as a guideline. You need to see a mental health professional for a conclusive diagnosis. The individual must be experiencing five or more of the following 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.

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 weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
A slowing down of thought and a reduction of 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 or excessive or inappropriate guilt nearly every day.
Diminished ability to think or concentrate, or indecisiveness, 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.

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. The symptoms must also not be a result of substance abuse or another medical condition. Afterall, a bottomless mimosa brunch or afternoon of beers is enough to spur a days-long depressive spell, as booze and other substances are known depressants.

Anxiety and depression disorders are often interlinked.

“It’s very hard to find patients who are depressed who don’t also have anxiety. It’s equally hard to find people with anxiety that don’t have some depression,” says Charles Goodstein, MD, a professor of psychiatry at New York University School of Medicine. So, don’t berate yourself if you’re feeling anxiety on top of everything else. It’s more likely than not to occur. And though signs of depression, anxiety disorder, and even bipolar disorder have similarities, each requires different treatments right down to the therapy and medications used. This is why a professional diagnosis is so important to obtain the correct treatment regimen.

A Quick Lesson in Sourcing the “Why” in Your Life…

One of the most poignant examples of suffering and sadness is the story of Viktor Frankl, a physician and psychiatrist who survived four Nazi concentration and death camps, including the infamous Auschwitz. Frankl epitomized the words of Nietzsche: “He who has a Why to live for can bear almost any How.” As a prisoner, Frankl kept himself and his hopes alive by a desire to see his wife again and one day teach about man’s quest for meaning.

Sadly, Frankl’s parents, brother, and pregnant wife were killed; but he was able to cope, source the importance of it all, and move forward with a renewed life purpose to include writing one of the most moving and significant books of our time, Man’s Search for Meaning. Frankl teaches us that “if there is a meaning in life at all, there must be a meaning in suffering. Suffering is an eradicable part of life, even as fate and death. Without suffering and death human life cannot be complete.”

We all face the opportunity to achieve something through our own suffering. Our unique opportunity lies in the way we bear our burden, and in our attitude toward difficulty while pondering our meaning. Make no mistake; you have a decisive and purposeful meaning in this world. For many of us – myself included – it takes suffering and hardship to find it.

We are supposed to feel like we can’t handle things alone sometimes. That’s when we find the grace or help through others. In times when life becomes unmanageable, we must be willing to ask for help and support one another. It’s by design. We can be with one another amid suffering, helping each other bear the weight. Part of life is the realization that sometimes we can’t make it on our own. For some, a spiritual leader is a person to whom you can turn and say, “I have a burden that I cannot bear.” All it takes is walking into a local church, mosque, synagogue, or temple and asking for help.

Live to the point of tears. -Albert Camus

Why Do Depressed People Push Others Away?

Having friends is cool, but have you ever cut everyone off and disappeared for like three months?

Depression manifests differently for each person. It’s no more the forlorn, incapacitated person with bedhead seen in antidepressant commercials, than the polished and high-functioning attorney having liquor for lunch. While some depressed people might feel deep despair, others may be riddled with anxiety, insomnia, or anger. Haphazardly pushing people away is a common side-effect of depression.

While experiencing a bout of depression, it’s often easiest to detach from others for a while. It’s nothing personal – it’s about self-preservation. And, it’s about avoiding the barrage of armchair psychiatry by well-wishers who dispense platitudes like, “What’s wrong with you?” “Things aren’t that bad!” or, the timeless, “Just snap out of it!”

When you’re depressed you lack the energy to make a ham sandwich. The last thing you want to do is explain your low mood to others – even to loved ones.

It takes copious vigor to keep up appearances and sustain your otherwise stable persona during a depressive episode. People can be stunned to see you in an emotionally bleak state when it’s such a radical contrast from your homeostatic “norm.” Such is the pattern of depression.

Most people aren’t depressed 100% of the time. And, tricking people into thinking you’re not depressed is draining. There are few things worse than ‘smiling depression.’ The constant attempts at concealing one’s mental pain only increases the overall burden. And, by avoiding others, we avoid their judgement.

In rarer cases, pushing people away can be a form of self-harm. In such instances, we shun those we most care about because we want to punish or simply hurt ourselves. Sometimes we even want to penalize others for having the audacity to care for this woeful version of ourselves.

But, those of us who unconsciously use this tactic, risk losing people for good. Not everyone understands what depression feels like or how it might play-out. From their perspective, getting blown-off or spurned despite our rationale for doing so isn’t justification for how we’ve made them feel. People aren’t playground swings.

Is there a Healthier Option for the “Pusher?”

Practice Self-Care. This includes simply taking time for yourself. From a mental health perspective, when we push people away is often when we need them most. However, you also need to honor your intuition and feelings. If you know that attending a friend’s BBQ on a Sunday when you feel intolerable is too emotional or unpredictable – even possibly casting you in a permanently negative light – then heed that instinct.

Nurture with Nature. A 2015 Stanford study found quantifiable evidence that walking in nature can reduce stress and lead to a lower risk of depression. Through a controlled experiment, participants who went on a 90-minute walk through a natural environment reported lower levels of rumination (repetitive thought focused on negative aspects of the self) and showed reduced neural activity in an area of the brain linked to risk for mental illness compared with those who walked through an urban environment. Exercise is a phenomenal antidepressant.

Give Props. Being grateful by focusing on gratitude improves physical health. According to a 2012 study published in “Personality and Individual Differences,” grateful people experience fewer aches and pains and report feeling healthier. Not only does gratitude do the obvious work of increasing how much positive emotion we feel, it just as importantly robs the negative energy that is the driving force of why we feel so bad. Cite three things for which you are grateful each day, no matter how small.

Phone a Freud. There is no shame in seeking help. If stress, anxiety or depression disrupts your life or daily activities, get a mental spotter. It is imperative to know when to seek professional help. The easiest index to use is if your emotions are starting to interfere with your ability to function in daily life. Make an appointment with your doctor or a mental health provider because you may need treatment to get better.

What To Do if You’re the “Pushed?”

1. 1. Avoid the Urge to Advise. Don’t try to be the person’s therapist. If the depressed individual hints at self-harm or suicide or has been ruminating on the same negative things for weeks, they should consult a therapist for help. Mental disorders can be difficult to appreciate unless you’ve experienced one yourself. Functioning when you’re depressed isn’t about using the right hack, summoning or the gods of willpower. And, your motivational clichés will probably be met with resentment and middle fingers.
1. 1. Empathize and Fortify. Listen to the depressed person’s feelings nonjudgmentally. Just listen and show empathy. But, then set appropriate boundaries for the benefit of you both. Depressed people can be intensely despondent and tough to support. Do not meet your friend in their depression. Moods are highly contagious. Penn State University, Chair of Psychiatry Alan Gelenberg, M.D. says, “When disappointed, we usually feel sad. When we suffer a loss, we grieve. Normally these feelings ebb and flow. They respond to input and changes.” While depression tends to feel heavy and constant. “People who are depressed are less likely to be cheered, comforted or consoled,” adds Gelenberg. Encouraging them to repeat negative feelings will only worsen their misery. Instead, inspire them to do something other than stagger in their own sadness. Ask them what they need and tell them how you are willing to help.
1. Make Them Laugh. Mark Twain knew it best: “The secret source of humor itself is not joy but sorrow.”Studies confirm that laughter lowers blood pressure and releases beta-endorphins, a chemical in the brain that creates a sense of joy. Moreover, humor is clinically validated to reduce stress long-term by improving the immune system through the release of neuropeptides, relieving pain, increasing personal satisfaction, and lessening depression and anxiety (source: Mayo Clinic, April 21, 2016). The simple act of smiling causes the brain to release dopamine, which in turn makes us feel happy. Humor = Calamity + Time. If you’re not funny, that’s okay – that’s what Netflix and cat videos are for.

If You’ve Ever Thought These 7 Things, You Might Have Relationship OCD (as featured at YourTango.com July 2018)

And the 10 Steps to Take if You Do.

The power of the human mind is wonderful and boggling – except when it turns on you while peppering your psyche with a staccato of queries about your relationship.

One minute your partner’s grandeur is so intense, it’s cartoonish. How did you ever land such a splendid fish? The next you’re spun into a vortex of doubt, placing them under intense analysis, and scrutinizing every nuance of the relationship, including their questionably thick eyebrows.

This barrage of errant thoughts and questions commonly arise in otherwise healthy relationships. The obsessions include judgments around their imperfections as a person and partner, or about the rightness of the relationship itself:

Why can’t he get that huge mole on his back removed?
Does her nose-have to whistle whenever she chews? Could I do better?
I just saw a hot guy at Starbucks, so am I in the wrong relationship?
Is he even smart enough for me?
Why aren’t we shmoopy like other couples?
There are times I’d rather look at Instagram than have sex with him. Am I staying in this relationship just to avoid hurting him?
Why don’t I miss her even though I’ve been at Coachella for three days?

The form of anxiety that comes with liking someone is so common that it has its own acronym: ROCD (relationship obsessive compulsive disorder). The seemingly sublime onset of ROCD has led to many brain-worm Taylor Swift songs and vodka tonics pondering if you’re with the right person. You may avoid taking the next step in your relationship because you can’t get past their perceived flaws, or you might even quit dating altogether because no one seems good enough. You met them on a free dating app, after all.

ROCD has been receiving increasing research and clinical attention as a form of Obsessive Compulsive Disorder (OCD) in which the sufferer experiences intrusive, unwanted and distressing thoughts about the strength, quality, and nature of their love for their partner. As with other forms of OCD, the fixations in ROCD focus on issues of doubt and an intense discomfort with uncertainty.

These obsessions often contain responding compulsive behaviors to include seeking reassurances or gauging one’s own feelings, comparing characteristics of one’s partner with those of other potential mates, or avoidance actions. The compulsions, which are intended to lessen the distress caused by unwanted thoughts, can take forms such as regularly asking friends or family if you have made the “right” choice in your partner; comparing your relationship to a previous exciting (often unhealthy) relationship, Internet searches about “the one,” finding that sex is a chore or eating a sandwich during sex, while fixated on that back mole or eyebrow shrub.

Relationships in which one partner has ROCD can be chaotic, ending in the sad, ironic twist that the dread of hurting or losing one’s partner often results in both.

From Where Does ROCD Arise?

You position your companion against idealistic projections of “real” love from episodes of The Bachelor, royal weddings, or the seething sexual chemistry in Trojan™ personal lubricant commercials. This is exacerbated by dating apps like Tinder and OK Cupid which have created an atmosphere of seemingly endless options, short-attention-span-dating, and The BBD (bigger, better, deal). We have commoditized ourselves, and dating has become transactional. It’s no wonder that our anxiety surrounding relationships, commitment, and marriage has shot up, while the principles of love and marriage run askew.

Add to this the notion of “soulmates,” which further ups the relationship anxiety ante. There’s a fantasy that guides many into seeking idyllic partners or soulmates. If you could find that perfect match you’ll be guaranteed a lifetime of relationship bliss, right?

Nope.

Research by Aurora University psychologist Renae Franiuk who studies people’s beliefs about their intimate partnerships, called “Implicit Theories of Relationships,” says “People who believe in soul mates may be setting themselves up for a lifetime of heartache and failed relationships. If you operate according to the soulmate theory of relationships, you constantly evaluate your dating partners against the idealized image of the man or woman who will be the one true love of your life. Once you’re in a relationship, even without your knowing it, you perform constant comparisons between the actual person you’re with and that ideal one-true-love model in your mind.”

There is a persistent idea that when we choose someone to be a long-term partner, s/he will be an incredible lover, hold fireside chats about Tolstoy, and take long beach saunters while sharing kale smoothies. OCD demands that there be no doubt in a person’s mind whether s/he has chosen the right person. To the ROCD sufferer, their obsession is, “I must know unequivocally that my partner is the absolute one for me.” This belief is steeped in anxiety. The anxiety, in turn, compels the person to engage in the compulsive behaviors in a vain attempt to arrive at certainty.

How to Counter ROCD:

The goal is to reduce ROCD symptoms enough to reach an informed decision regarding your relationship. Implement any of the following skills to move toward inner peace:

1. Let go or be dragged.

Radically accept that there is no way to know with 100% certainty whether any relationship will work out for the long-haul. If they make you happy, and you share similar values and goals, then Yahtzee! We all have flaws, and no relationship is perfect.

2. Remember thoughts and feelings do not equal facts.

Remind yourself that all OCD is rooted in irrational fears and lies to you with baseless obsessions, rituals, and ruminations. Just because you think it or feel it, doesn’t mean it’s true. And, if you have experienced past OCD symptoms, a relationship can easily become the new focus.

3. Expose yourself.

The most effective form of treatment for ROCD is called Exposure and Response Prevention (ERP). This entails exposing yourself to the thoughts, images, objects, and situations that make you anxious and cue your obsessions, while not engaging in a compulsive behavior in attempts to alleviate the angst. For example, if you’re claustrophobic, take the elevator, not the stairs.

4. Daisy chain your obsessions.

If you mentally play-out the calamitous beliefs causing you distress, you will negate their power over you. For each obsession, ask “And what’s the worst that can happen?” until you get to the end and see that the worst result is not catastrophic. ROCD includes a gross overestimation of the negative consequences of staying in relationships or being alone.

5. Stop the comparisons.

Comparison is the fastest route to misery. Stop researching or collaborating with others about the fit of your partner. Check-in with yourself whenever you find you’re ruminating about the relationship. This includes comparing your real relationship with those nauseating social media versions that you can “thumbs-up” later when they inevitably split.

Attraction and arousal wax and wane. Expecting yourself to always find your partner attractive, or to always be interested in sex is setting yourself up for discontent.

6. Realize that risk is scary, but regret is scarier.

Be willing to sit with the anxiety caused by the thought that you may not be committing to the “right” person. To live life fully one must take risks, or face regrets. Once you stop pursuing a futile quest for certainty, you can move forward. Seeking assurances is a compulsion that increases OCD thinking patterns.

7. Give yourself the present of presence.

Mindfulness is a skill that is practiced and perfected little by little … like using chopsticks to eat a salad. Mindfulness meditation encourages the practitioner to observe wandering thoughts as they drift through the mind. The intention is not to get involved with the thoughts or to judge them, but simply to be aware of each mental note as it arises. With practice, an inner balance and peacefulness develops and you become Yoda-like.

Don’t worry — meditating is easier than you might think.

Sit or lie comfortably in a quiet setting. Close your eyes. Make no effort to control the breath; just breathe naturally. Maintain your focus and attention on your breath and on how your body moves with each inhalation and exhalation. Each time your mind drifts to your thoughts, refocus back to your breaths.

8. Grab a pen and get mighty.

Research has shown that journaling helps reduce stress, solve problems more effectively and even improve your health. University of Texas at Austin psychologist and researcher James Pennebaker found that regular journaling strengthens immune cells, called T-lymphocytes. Writing about stressful events helps you accept them, thereby reducing the impact of the stressors on your mental and physical health.

9. Remember that you cannot control your thoughts.

And that’s okay! It may appear that you can, but it only backfires with more obsessions and compulsions. What matters is what we do with our thoughts. Pay attention to your breathing and notice where in your body you are feeling the melee. Stay with that for a few minutes. Then notice where you feel the most comfortable. Then stay with that. Shift back and forth slowly for about 15 minutes. Do this every day.

10. Get by with a little help.

Notice your past relationships. How often have similar doubts shown up in your life? If there is a pattern, do not break off the relationship until you have practiced these skills, or consulted with a professional therapist. Like other OCD symptoms, relationship OCD symptoms require psychological intervention if causing significant distress.