State of Anxiety

Providing humorous perspective during & after a breakup or divorce

depression advice

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.

  1. Depressed mood most of the day, nearly every day.
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
  3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
  4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
  5. Fatigue or loss of energy nearly every day.
  6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
  7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
  8. 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

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:

  1. Why can’t he get that huge mole on his back removed?
  2. Does her nose-have to whistle whenever she chews? Could I do better?
  3. I just saw a hot guy at Starbucks, so am I in the wrong relationship?
  4. Is he even smart enough for me?
  5. Why aren’t we shmoopy like other couples?
  6. 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?
  7. 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.

If you’re in a place where you’re ready to reach out for help, consider online therapy.

What’s Under His Suit? Depression and Anxiety (as featured at PsychCentral.com)

Let’s get candid about male mental health.

Men don’t get a lot of compassion — not as a gender, not toward one another, and not toward ourselves. We are the more impulsive, less refined gender that has not progressed much since our cave-dwelling days. We’ve learned to use a salad fork since then, however, and we pretend to enjoy chivalry.

Sadly — and perhaps due to our ruffian status — men are often perceived as an expendable lot, regularly sent to do life’s dirty work like unclogging municipal sewers, diffusing IEDs, repossessing tractors, or mining for coal and ore miles below Earth’s surface. When duty calls, somewhere a willing man answers.

It is our own culture that depicts men as the stronger sex.

This might be true when it comes to opening new bottles of ketchup, or scaling a tree to save a kitten. But when it comes to our mental health, men are subjected to a culture where the standards of masculinity are literally making us sick. Men make up most suicides, and the minority of mental health service users.

It’s a misnomer that men have only two feelings: hungry and horny. Male anxiety, depression, and suicide has become a silent crisis, and one of the biggest challenges in combating mental health disorders in men is that they are difficult to reach through traditional methods, like physicians or mental health programs. Moreover, the condition is often masked by risky behaviors, self-harm, and substance abuse.

Anxiety and depression run feral and cloaked within men everywhere. Most just channel or compartmentalize it while it individually displays as forms of fatigue or apathy; insomnia or lethargy; substance abuse; irritability; conflict and anger; isolation; impulsivity and risky behaviors; mood swings; relationship and job problems; denial; self-criticism; aches, pains, or digestive problems; indecision; and suicidal thoughts.

I personally distracted from my anxiety and depression with feats of athleticism and binge drinking, resulting in 13 orthopedic surgeries and countless broken bones. I had no choice but to become a writer. My hands were the only thing not in a cast or physical therapy.

Emotions have no gender.

Most men are too obstinate or ashamed to seek help for anything involving our head except a nail from a pneumatic gun or balding. Sadly, men must hide behind the facades they feel pressed to create. Men have come to accept many things, but being considered weak isn’t one of them. Yet forms of anxiety like PTSD are diseases of the tough-minded.

Mental disorders and illness don’t care if you’re a war vet, foreman, or florist. They’re an indiscriminate mind sweeper. It can happen to anyone, any age and any gender. And it’s not just “all in your head.” It’s a medical problem that can wreak havoc 24/7 like any other ailment on any other organ.

How to Mind Your Mind:

JUST DO IT … LATER. Mental breaks increase productivity, replenish attention, solidify memories and encourage creativity. Schedule downtime to do nothing. Consider practicing some relaxation techniques. This can include simple meditative breathing exercises, or guided meditations available on YouTube or via smartphone apps. The best way to get your brain and body to work at their peak is to take rest breaks.

RADICAL ACCEPTANCE IS THE NEW DENIAL. One option you have for any problem is Radical Acceptance (Linehan, 1993). Radical acceptance is about radically accepting life on life’s terms and not resisting what you cannot change. Radically and mindfully accept that you cannot control everything, and let life live you.

COFFEE AND BOOZE LIE TO YOU. Caffeine sets unrealistic expectations of your daily productivity and can spike anxiety. Though low doses (200 mg) of caffeine is known to improve cognitive performance, studies revealhigher anxiety levels in moderate and high caffeine consumers versus abstainers.

On the other hand, alcohol is a depressant which slows down the brain and the central nervous system’s processes. Alcohol may help deal with stress in the short term, but long term it can contribute to feelings of depression and anxiety and make stress harder to deal with.

LET ME HEAR YOUR BODY TALK. Exercise is a phenomenal antidepressant and anti-anxiety tool. Channel nervous energy, stress, and even depression into a regular exercise program. More than the physical upside, there is the social aspect in structure, and seeing regulars and friends. Exercise improves mental health by reducing anxiety, depression, and stress, while improving self-esteem and cognitive functioning (Richardson CR, Faulkner G, and McDevitt J. Et al. Psychiatric Serv. 2005 56:324–331).

YOUR BED IS A TIME MACHINE TO PANCAKES. Serial killers are just regular people on too little sleep. Promote good sleep hygiene. Get to bed early and at the same time each night. Turn off the electronics to turn off your brain. Sleep problems greatly exacerbate stress and anxiety. Research indicates that REM sleep may play an especially significant role in maintaining emotional well-being and psychological balance.

YOUR CHEAT MEAL SHOULDN’T BE A MONTH LONG. Some say that you can’t spell “salad” without “sad.” But there is a direct correlation between a healthy diet and a positive mindset. During times of stress, we often turn to traditional “comfort” foods like fast food, pizza, and ice cream, which make us feel sluggish and less able to deal with stress. Brain food such as the antioxidants in fruits and vegetables, is thought to improve cognitive function, and can be used at preventing or treating many stress-related mental disorders (The Journal of Medical Investigation, Vol. 51, 2004).

PLUG YOUR BEAK. By controlling your breathing, you will slow your heartbeat and eliminate anxiety and panic. Try alternate nostril breathing (aka, yogic breathing). This is a simple, natural breathing technique from Ayurvedic medicine that brings the body and mind into a state of balance and neutrality. Close one nostril by placing your thumb gently over it. Exhale; then inhale through the uncovered nostril. After each inhale/exhale (a breath cycle), switch sides. Then, leading with your out-breath, do one out-breath followed by one in-breath through each nostril. Repeat this series, alternating nostrils after each inhalation. It will likely be easier to breathe through one nostril than the other. You’re not deformed. It’s normal.

I WILL FIND YOU, AND I WILL THANK YOU. 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.

BECOME A FREAK OF NATURE. A 2015 Stanford study found quantifiable evidence that walking in nature can reduce stress and lead to a lower risk of depression. By 2050, 70% of people will live in urban areas. Urbanization is associated with increased levels of mental illness, but it’s not yet clear why.

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 daily life functioning. Make an appointment with your doctor or a mental health provider because you may need treatment to get better. Cognitive Behavioral Therapy (CBT) is an effective treatment for anxiety. Self-medicating is not. You can find a trustworthy mental health professional HERE.

Don’t believe everything your mind tells you.

ANXIETY: Find the Humor, Find the Cure (as featured at ADAA.com, March 2018)

The first time I saw a flameless cigarette lighter anywhere but a car was on an enclosed patio wall of the Oakland psychiatric facility where my therapist had sent me due to anxiety and depression. Smoking was the only vice afforded to us. Though even while despondent, I wasn’t interested in adding nicotine to a budding alcohol addiction. Perhaps I had hope after all.

He who has a why to live can bear almost any how. – Friedrich Nietzsche

I left triage a few days later, knowing the next bout of crippling anxiety or profound depression was a breakup or mere bad day away. I had no more coping skills than I did before arriving. Beyond therapy and medication, I needed to find a motive to get right with the world and somehow thrive.

I began to journal and noticed a subtle pattern throughout my anxious behaviors. Humor. Many of my anxiety-related mannerisms are dysfunctional, but laughable and cathartic. By way of example:

  1. I have never sat on a public toilet – including hotel rooms. I now have sturdy quads.
  2. I wear medical exam gloves during gym workouts. Dumbbells and people are filthy.
  3. I have extraordinary ability (aka, Spidey-sense) to detect and avert imminent danger. Though not exactly crucial in my quiet suburb.
  4. I go to notable lengths to avoid shaking hands with someone – like feigning leprosy, or resorting to casual fist-bumps in formal situations.
  5. I will walk 50-yards around anyone that coughs or sneezes indoors, or leave the building and my reason for being there entirely.
  6. When someone in my condo complex recently reported bedbugs, I immediately packed and moved. I no longer share walls. Or the potential for vermin.

Mark Twain was prescient in stating, “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. These endorphins counter the adrenaline and cortisol that fill the anxious. The calmer we are, the more we remain in rational or positive mind.

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.

Our thoughts affect our body, and vice versa. Anxiety in the mind creates a stress response in the body. Conversely, calming the body will yield positive cerebral results. All physiological functions are linked, and the mind-body connection is especially strong.

Perhaps most impactful to the sufferer, however, is that humor provides a unique and unrivaled perspective that shifts our thinking away from despair and toward the awareness that a radically different outcome is possible. Humor is the most accessible form of relief. It may initially feel counterintuitive to associate humor with misery. But sourcing the comical manifestations can separate you from your affliction. It’s also how I salvaged my life.

So how do you find the lighter or even amusing side of a debilitating disorder? First recognize that what you’re feeling might be an irrational anxiety. Now dig a bit deeper. What are the potentially laughable nuances of your anxiety? Maybe you occasionally freak-out when you text someone about something seemingly dire and don’t hear back for a while. Your rumination and worry churns into resounding panic, yielding a volley of additional texts – all met with successive silence. Next you concoct a series of worst-case scenarios about why they’re not responding to you; not limited to them driving off a bluff while reading your original text, or deciding they just don’t like you anymore. And just as you’re texting a coup de gras, they reply. It’s like the Heavens opened and gossamer-winged angels descend upon you because it came with a heart emoji.

Alternatively, perhaps you get uncomfortable during long pauses in a conversation. Even a few moments feel far too angst-ridden, so you fill the void with a non-sequitur about your husband’s botched hysterectomy, or you ask your boss how her divorce is going. Your attempts at social stimulus are met with chirping crickets. And, now scorn. Embrace your angst with a cozy smattering of acceptance, and remember that Humor = Calamity + Time. Gain some intellectual distance from your anxiety, and you’ll start to perceive the humor within your anxious thoughts, feelings, and behaviors.

When you acknowledge your anxiety, and detach yourself from it (i.e., you are not your anxiety), you can then take note of the humor. In turn, you will feel a sense of control over your anguish. Find the humor, and you’ll feel the hope for a better state of mind.

 It is well known that humor, more than anything else in the human make-up, can afford an aloofness and an ability to rise above any situation, even if only for a few seconds. – Viktor Frankl