Entries in depression (13)


How Can You Tell if Someone You Love is Suicidal?

As a mental health professional, it is not uncommon for people to ask me this question.  Given the recent, very public news of the suicide deaths of Kate Spade and Anthony Bourdain, this question seems to be at the forefront of many peoples’ minds.  Hearing family and friends of a suicide victim talk about being completely shocked by the suicidal act is a scary reminder that it is hard to detect suicidal ideation.  You might think that those loved ones that are closest to a person suffering from depression might easily recognize the warning signs, but that’s not always the case. The truth is that while there are typically warning signs, they do not always take the form that we expect. 

Certainly, things like the loss of interest in activities, an increase or decrease in sleep or food intake, withdrawal from social support, lack of basic self-care, and extreme sadness or hopelessness are often present in suicidal individuals.  However, other warning signs could include increases in substance use, uncharacteristic irritation and anger, reckless behavior or a noticeable peace and happiness after a long bout of turmoil.  While the signs are not always easy to spot, you should pay attention to any large marked shifts in mood.  Verbalized feelings of helplessness and hopelessness or feelings that the individual is damaged and will never recover should also raise red flags.  In addition, the giving away of prized possessions or a reconnection with a lot of important people from the past, as if to resolve relationships, are major indicators of suicidal ideation.

So what should you do if you suspect that someone you love may be suicidal?  Some people say that talking to someone about suicide “puts the idea in their head”.  That’s a myth.  My advice is to be direct and ask your loved one if they are thinking of committing suicide.  Express your concern and your sincere desire to help.  Approach the conversation with as much empathy as possible, even if you do not understand the desire to end their life.  A person who you suspect of being suicidal should not be left alone.  If you cannot stay with them, try to arrange for someone else to stay with them.  You cannot assist a suicidal loved one alone.  Seek professional help to get them through this crisis.  The National Suicide Prevention Lifeline is 1-800-273-8255 (TALK).  They have the resources and suggestions to help your loved one and you in an immediate crisis.  It is always better to call for help and potentially anger your loved one than to do nothing and potentially lose them forever.



Dealing with Holiday Depression

It has always been amazing to me that the time between mid-November and the start of January is my busiest period of my professional year.   The holidays are always painted in stories and movies as an idyllic time full of love and happiness.  Even on social media, such as Facebook and Instagram, the highlight reel of everyone’s holiday celebrations displays a skewed representation of the holiday season as a non-stop joyous celebration.  Unfortunately, the truth is far less joyous than you might suppose.  The reality is that many people struggle during this season.  They struggle with feelings of loss and isolation that are only exacerbated by the messages and images of happy family celebration that surround them. 

When you really think about it, there is no surprise that depression rates are higher during this time of year.  Families are often complicated and the holidays can force more time with your extended family than you are accustomed to.  Pair this with an increase of alcohol consumption and there are bound to be hurt feelings and old frustrations bubbling to the surface.  If families are far away and you are unable to spend time with them you may miss them and feel isolated.  In some instances you may be shamed or experience guilt over your inability to participate in family traditions.  For many, this time of year also comes with a reminder of the loved ones they have lost.  Additionally, you may spend time comparing this holiday to previous ones or measuring what actually happened with what you hoped would occur.  Furthermore, omnipresent  social media may cause  you to compare your decorations, gatherings, food, or experiences to those of your acquaintances and friends.  The outcome of such comparisons is often dissatisfaction with something that we might otherwise have found extremely satisfying. 

So the question becomes how can you keep yourself from sinking further into a depressive state this time of year?  There are a few simple ideas that may help you achieve that goal.  First, stay off or limit your exposure to social media.  Spend a few minutes every day instead focusing on what you like about the holidays and thinking about things for which you are grateful.  Learn how to kindly say no to things that consume too much time and energy and take away from the experiences that are important to you.  If you find yourself losing focus of your priorities, ask yourself what you value about this time and stay focused on that.  If you value your children having the experience of being doted on by their grandparents, hold onto the thoughts of that occurring and let go of the parenting criticism that might come with that visit.  Most of all, make time for the people who value you and who you enjoying being around, even if those are not the people with whom you feel obligated to spend time.   Honor anyone you may have lost.  Tell stories about them or create a tradition that keeps them alive in your heart. Remember that nobody has a perfect life or everything that they want but what they are showing you is often their best.  Give yourself (and others) permission to be human and imperfect.  You may be amazed how much more enjoyable the holiday season can be!


The Importance of Exercise for Mental Health

Very rarely do people take into account how their physical health and mental health are connected.  I talk with every patient that seeks my help about setting not just goals for their mental health improvement but goals for their physical health as well. Both our physical and emotional well-being is important for our overall health.  Therefore, it is important to evaluate improvement options as a whole person solution. 


I am never surprised when I hear that someone has gotten into bad sleeping patterns, unhealthy eating patterns, or tapered off on their exercise regimen.  I have written previously about how poor sleep disrupts emotional regulation abilities and how poor nutrition can cause an emotional roller coaster.  However, the importance of exercise is often overlooked in mental health discussions.  We have a tendency to think of exercise in terms of weight loss or cardiovascular health.  However, regular exercise has enormous benefits for our mental health as well.


First, taking time out regularly to exercise is good practice in devoting the time to prioritize your needs before all of the other demands in your life.  Even if it is only twenty to thirty minutes a few times a week, it is a wonderful commitment you are making to your own well-being.  Often for those who struggle with mental health issues, making time for their own well-being is not a habit they have formed, so exercise offers a good reason to form this important habit.


Second, exercise releases endorphins, which help raise your overall sense of happiness and helps combat depressive hopelessness and the overwhelming sensation that comes with anxiety.  The physical activity forces you to be present in the moment giving you practice in keeping yourself focused.  This can be tremendously helpful when combatting mental health issues.  Physical movement helps your body function at its optimal levels, thus enhancing your attention and memory.   Plus, if you stick with it past the initial shock to your body, your energy level will increase.


Finally, exercise opens up new ways to create a sense of mastery.  When you take up a new activity, over time you will see the improvements of practicing that activity such as changes in your body, improved strength, increased endurance, higher energy level, or just strictly the ability to do something better. It makes you feel good about yourself and improves self-esteem. 


Give it a try.  I promise you are worth the 20-30 minutes of your day that it will take to see improvements!


Fighting Depressive Helplessness with the Power of Choice

One of the worst feelings a person can experience in their life is a feeling of total helplessness.  Unfortunately for people who suffer from depression, this is a feeling with which they are all too familiar.  Negative thinking, and the tunnel vision it creates, causes those suffering from depression to view the landscape of their lives as devoid of choices.  A strong way to fight back against helpless feelings is to reclaim the power of choice even when the alternatives are not necessarily good ones.


Practically speaking, when you look at most of the decisions that you make in your life, one choice is the clear favorite.  As a result, you may fall into the pattern of seeing that choice as your only option.  However, there are often many alternatives that you automatically discarded without giving them much thought.  This automatic thought response leaves you feeling as though you had no choice.  For people who suffer from depression, this process often leaves them feeling as though they have little to no control over their lives. 


Often, when battling depression, the smallest changes in thinking can have large impacts.  Much like a stone creating ripples in a pond, shifts in perspective can have much larger scale ramifications.  This shift in perspective gives you the sense that you have a choice in the direction of your life and having choices makes you feel powerful instead of helpless.  I urge people to take back a sense of control over their lives by changing their perspective on choice.  This perspective removes the feeling that life is happening to you and replaces it with a feeling that your life is created by your own design.  When making decisions for your life, no matter how small, consider all of your options.  Do not discard options no matter how undesirable they may be.  The power of feeling like you have actively made those choices could completely change the emotional landscape of your life.


Letting Go of Regret

So many people seem to struggle with regrets about their lives.  On any given week in my office I will encounter someone struggling with a decision they have made for their life that they know was wrong for them, yet they made it anyway.  Regret about the decisions we “should” have made are at the foundation of our guilt and shame.  While I do not believe that it is possible to live a life completely devoid of regrets, it is possible to live one without the debilitating guilt and shame associated with those regrets. 

Throughout my years of practice I have come to realize that while it is easy for people to say (with all good intentions) that you will never do something (i.e., drugs, an affair, etc.) that they will regret, the reality is typically much more complicated.  People do not just wake up one day and decide to make destructive decisions that ruin their lives.  Those decisions usually result from the culmination of complicated situations and many minute decisions that lead them to a place where they thought they would never be.  If it was just a matter of making amends for poor decision making, I do not believe that so many people would harbor guilt and shame.  Instead, the hurt and shame often derives from the realization that the poor decision has caused pain to others in your life for whom you care.  It becomes difficult to reconcile the good person you believe that you are with the person who hurt others in a way of which you never imagined you were capable.  The truth is that good people sometimes make bad decisions when they lose perspective and we have all been there in some way, and to some degree, in our lifetimes.  Whether it is a matter of something we said that we wish we could take back or developing a problem with addiction, we all have regrets.

The question becomes: how do we move past these feelings of shame and guilt caused by our actions?  My answer is forgiveness.  Moving past shame and guilt comes from forgiving yourself.  You must acknowledge your own humanity and forgive yourself for being fallible.  I have been providing therapy long enough to know that regret is a loop that will continue to play over and over in your mind until you let it go.  So change the way that you talk to yourself about it.  Acknowledge your mistakes and take responsibility for them.  Make amends.  Learn from them and move forward.  You cannot change the past, all you can do is honor those that you have hurt by not repeating the same mistake.  When you do finally get to a better spot in your life, accept that we are made up of the sum of all of our experiences.  Therefore, every negative experience in which you’ve been involved has contributed to the good person you are today.  Whether an experience teaches you an important life lesson or provides you a new perspective on yourself or relationships, it changes you in some way.  Own it, but don’t let it control the sum of who you are.  Be patient with yourself as it may take weeks or months of forgiving yourself regularly when it comes up before positive effects are noticed.  Repeated refocusing of your energy toward the future is the best way to move past it and shed the guilt and shame that you are experiencing.  Ultimately, life will throw difficulties in your path and you will be more adept at traversing them without guilt and regret holding you back.  Use these experiences to make you a better person and you can turn that regretful decision into a tool for personal growth.