Monday, August 22, 2011

Sleep (Step 6 of 6)

Finally, the last step to the Therapeutic Lifestyle Change (TLC) six step program to beat depression without drugs.  Sleep.
How is your sleep? Do you toss and turn and struggle to get to sleep at night?  Do you wake up throughout the night, disturbing you from getting the essential slow-wave sleep your body needs?  Do you wake up too early and can't seem to fall back asleep?  Do you have anxiety at night?  Are you tired all day long but then can't sleep at night?  If you said yes to any of the above, then keep reading!
Sleep disturbances is one of the major symptoms of depression, but it is also a trigger for the illness. When our bodies are deprived of sleep, even for a night, our memory and concentration wanes, we get more irritable, our judgement is poor (I find that I eat unhealthy food when I'm tired), reaction time slows down, coordination and energy say bye bye and we get sick easier. (194)  Sick as in colds and flu's but also as in depression. Anything we can do to improve our sleep will help fight off depression, and also prevent a future episode from occurring.
Fortunately, most of the steps in the TLC program can help with your sleep.  Exercise, as well as bright light in the morning (or at night depending on your sleep problems), help your internal body clock and sleep drive stay balanced.  Even our Omega 3s, anti-ruminative activity and social connection our beneficial - "by helping slam the brakes on the brain's stress response circuits - improving both the quality and quantity of sleep" (194).
So how much sleep do we need?  "Most adults need about eight hours of sleep each night for optimal physical and emotional well being" (195).  However, some people can manage perfectly on six or seven, while others might need nine.  Dr. Ilardi recommends starting with eight hours of sleep and after a few weeks, adjusting those hours to your needs.
Okay, so sleep is good, but it's not as easy as it sounds. I will go to bed and then toss and turn until 3 or 4 in the morning, Sleep sometimes feels impossible for me. What's my problem?  Dr. Ilardi discuss three variations of sleep disturbances.
The most common form in depression is known as terminal insomnia: waking up too early, usually an hour or two before intended, and being unable to fall back to sleep.  Middle insomnia, is marked by frequent awakenings throughout the night, is also fairly widespread.  The final variety-onset insomnia-is a hallmark of seasonal affective disorder and many forms of anxiety; it refers to an initial inability to fall asleep at night.
I have the last one, onset insomnia.  Remember how in my first blog I talked about some of my symptoms of depression.  "I still have anxiety off and on for no apparent reason at all.  For example, I will be laying in bed at night and my heart will start to flutter and race, but I have no idea what thought triggered me to start freaking out."  I never knew it actually had a name.  Onset insomnia.  I used to think it was because I had a lot on my mind and couldn't turn my brain off, but maybe it had something to do with my depression the entire time.  However, there is hope without Ambien, and all last week I took the following "Habits of Healthy Sleep" into consideration and was falling asleep within 30-40 minutes, which is a record for me.

Conditioning Your Body to Sleep
  • Habit #1:  Use the Bed Only for Sleeping (200-201)
    • Anytime you've been lying awake for fifteen minutes, get up, leave the bedroom, and do something relaxing until you feel drowsy enough to return to bed.
    • Avoid getting into bed anytime you aren't already drowsy. If you go to bed just after watching a scary movie, surfing the Internet (bright light), or exercising, your throwing yourself into bed just to hop right back out.  Instead do activities that are relaxing, not arousing.
    • Anything you do to increase your drowsiness should be done somewhere other than the bedroom.  For example, I used to play games on my phone at night to increase my drowsiness, or read.  Now I do this all on my couch, not in my bed.  Your bed should be associated only with sleep, not the state of being awake.
    • You can make an exception in the case of sex.  Of course you were wondering, right?  Sex apparently helps you sleep and is associated with positive happy feelings, which in turn will help you associate sleep with good feelings, not anxiousness.
    • Avoid sleeping anywhere other than your own bed.
  • Habit #2: Get Up at the Same Time Every Day (201-202)
    • All of us have a sleep meter in our brain that helps set our sleep drive.  You can boost your sleep drive by getting up at the same time every day, which is hard, especially on the weekends, but it's essential to help sleep disturbances.
  • Habit #3:  Avoid Napping (202-203)
    • "Simply put, anytime you nap, it strongly reduces the brain's sleep drive, which then sets you up for potential insomnia later that night.  There is also evidence that napping can cause a reduction in restorative slow-wave sleep" (203)  Though if you have healthy sleep already, napping doesn't seem to harm your sleep pattern.
  • Habit #4: Avoid Bright Light at Night (203-205)
    • If you are around bright light at night, your sleep drive can't kick in unless its around night time light (low light settings).  Do not use your computer an hour before bed time.  Do not watch TV in bed, and keep your bed room pitch black while you sleep.  If you use a light box, make sure you use it in the morning (unless otherwise directed).
  • Habit #5: Avoid Caffeine and Other Stimulants (205)
    • Stimulants like caffeine and nicotine really screw with your sleep drive.  "Caffeine has a typical half-life in the body of about four hours. (This means that every four hours, your blood level drops by 50%.)  So, let's say you have a strong cup of coffee-with 200 milligrams of caffeine-at noon.  By 4:00 in the afternoon, you still have 100 mg of caffeine in your body, and at 8:00 pm, there's still 50 mg in your system.  Even at midnight, you're left with 25 mg of caffeine coursing through your veins; that's about the equivalent of a cup of green tea, and it's enough to disrupt your sleep" (205).
  • Habit #6: Avoid Alcohol at Night (205)
    • A lot of people use alcohol as a way to get drowsy at night, but it will interfere with your sleep, causing you to wake during the night and feeling exhausted all day.
  • Habit #7: If Possible, Keep the Same Bedtime Every Night (205)
    • By going to sleep at the same time every night, your sleep drive will kick in about 30-40 minutes before bed time habitually.
  • Habit #8: Turn Down the Thermostat at Night (205-206)
    • "There's evidence that a mild drop in temperature at night helps increase sleep drive" (206).  Dr. Ilardi suggests dropping your thermostat 5 degrees an hour before bed time.
  • Habit #9: Avoid Taking Your Problems to Bed with You (207-209)
    • For most people, and especially depressed people, bed time is when you dwell on negative thoughts or worries you have.  When you ruminate, it stirs your brain's stress response circuits, and in turn, makes it super hard to sleep.  Dr. Ilardi suggests mental activities, (no not counting sheep, but kind of), to help get to sleep at night.  I actually tried a few of these and they work!
      • Replay scenes from a favorite movie in your head.  I keep replaying scenes from Love Actually.  It's a happy movie, nothing scary or stressful about it.
      • Visualize a relaxing scene.  I did this one too.  I took myself back to Costa Rica on the beach.  Oh how I love it there!
      • Play a round of golf in your mind's eye.  Um, no thanks.
      • Use progressive muscle relaxation.  This is a technique that I actually learned in high school for volleyball.  Simply tightening and then relaxing each major muscle group in the body, somehow relaxes you and distracts your mind from rumination.
      • Use another proven relaxation technique.  Diaphragmatic breathing involves learning how to inhale and exhale slowly and deeply from the diaphragm.  Autogenic training  makes use of guided imagery to create a pleasant feeling of warmth in each party of the body.
    • There are also things you can before you actually get into bed.
      • Talk things through with a trusted confidant.
      • Write down your ruminative thoughts.
      • Fill your mind, right before you go to bed, with explicitly positive thoughts and images.
  • Habit #10: Don't Try to Fall Asleep
    • This has actually been the number one thing that has helped me.  Before I would stress about sleep.  I would anxiously watch the clock as my sleep hours would tick away and the more stressed I got, the harder it was to sleep.  "Sleep can never be stalked and caught - like some sort of wild animal -  when you hunt it with intense, focused effort.  Instead, it will appear unbidden, sneaking up on you gently after you've fully let go of the struggle" (209).  These two sentences are something I remind myself of every night.  If I just let go of my worry for sleep, my less worried self, falls asleep much faster.
I highly encourage you to get the book if what you read here has peeked your interest.  It seems like a lot to take in, a lot of changes you must do, but the nice part about the book is the week by week implementation process.  Dr. Ilardi doesn't think anyone should just do all of these six steps at once, but instead invite each step in every week.  I'll be blogging at least once more about The Depression Cure and I will go over this guided process, as well as, road blocks that might occur.  

Thursday, August 18, 2011

Get Connected (Step 5 of 6)

As humans, we are not meant to be alone.  We are born to connect.  Even as babies, we cried when we needed touch, or as Dr. Ilardi tells in the book, "...babies instinctively know it's (being alone) a recipe for biological disaster" (163).  If we are left alone for a few days, not only do we feel lonely, but all sorts of negative effects start happening.  "Our stress hormones escalate, mood and energy plummet, and key biological processes quickly fall out of balance" (163/64).  Hundreds of years ago, people ate together, played together, talked together, and lived together.  Today we are living more disconnected than we ever did in our past.  We text, instead of talk, chat online with people we don't even know (which is better than not chatting to anyone at all), stay in doors, eat alone, live alone, sleep alone, and recreate alone.  "Nearly 25% of Americans have no intimate social connections at all, and countless others spend the bulk of their time by themselves" (164).  Sad, isn't it?  I like knowing my neighbors, and being able to knock on the door to borrow a cup of sugar, but how many of us really KNOW our neighbors?  I have lived in my Seattle condo for 10 years and only know the neighbors below me, but the other 8, not a clue.  I wouldn't even recognize them if I saw them on the street.  GAH!
As Dr. Ilardi discusses in the book, isolation is a major risk factor for depression.  Since depressed people tend to withdraw from others, their social connections get deprived, heightening their depression even more.  Why do depressed people withdraw?  I only bring up this point because he quoted my exact feelings when I was at rock bottom in my depression.  I remember telling my counselor, and a few friends that I just wanted to "crawl into a hole and wait for it all to go away".  Dr. Ilardi said the same thing, but he wasn't talking about depression, he was talking about having the flu.  With any illness, even the common cold, we naturally withdraw from others to get better.  No one feels like socializing when they want to vomit or have a fever of 101, and depressed don't either.  They are embarrassed of how they feel, they think they are being selfish for thinking of themselves, they have no energy to contribute to the conversation, they don't feel they are worth others time...the reasons can go on and on.
When I was in the summer of my deep sadness, I upset a lot of friends, but I didn't know how to fix that nor did I really want to at the time.  The problem was, a lot of my friends had no idea what I was going through, they just assumed I stopped calling cause I didn't like them, or was a bad friend.
For those friends who don't understand the seriousness of depression, the disorder's characteristics withdrawal can become a source of great pain and frustration.  Simply put:  It's hard to watch someone pulling away and shutting down, especially when you can't figure out why in the world it's happening.  Even friends who know that social withdrawal is a core symptom of depression may find themselves feeling rejected" (169).

I remember having dinner with Hans-Eric.  I didn't realize it at the time, but during dinner we hadn't said a word to each other.  Now that I look back, I barely remember even being there, my mind was completely somewhere else.  After we left the restaurant, he stopped us from walking, took my shoulders to face him and said "Where are you?  I can't find you, or reach you.  It's like you are lost in your own head."  The look on his face killed me.  I didn't know where my mind was, but I also didn't want to keep hurting him.  I came to the conclusion that he was better off without me.  He deserved a happy girl who talks with him.  This is just one of the many examples of how I... excuse me, how my depression, hurt my relationships.  So what do we do to help find the motivation to keep our relationships intact and to continue connecting with loved ones?  The book kindly told me the following advice.

  • Disclose.  This sounds so easy, but it's not.  So many people hide their depression by putting on a mask and going through the day with a fake smile and fake laugh.  "No one wants to risk being viewed as "crazy" (or weak, or lazy, or any number of other qualities mistakenly attributed to those suffering from depression)" (170).  But if your friends don't know what is going on with you, then they are left in the dark and only have room to guess.  You would be surprised at how supportive people are.  When I blogged about rumination the other day, I told everyone I made my list of friends to call when I needed to talk, and the next day I got a few texts saying "I'd better be on that list".  I couldn't have done this without support.  It's similar to having a broken leg, and trying to hide it from people and walk on your own.  It's impossible.
  • Educate.  "Friends and family need to know three things:  Depression is an illness-one that robs people of their ability to function; like many other forms of illness, depression typically leads its victims to withdraw from friends and loved ones; nevertheless, social support can play an important role in the recovery process" (170).
  • Ask.  ASK FOR HELP.  Call up a friend and tell them your situation.  "Hey friend, I haven't been feeling well the past few weeks, and I'm sorry I haven't called you back.  I'm going through a depression and seeing you would really help.  Do you think we could have lunch tomorrow?  I also might have trouble taking the initiative on other outings, so if you don't hear from me, would you please check in on me?"  Any friend who wouldn't do that for you is no friend at all.
  • Avoid Negativity.  Having negative conversations can trigger an episode of rumination.  Try to stay clear of upsetting topics and instead plan outings that are around shared activities. 
Let's also not forget friends at a distance.  In my current situation, I do have friends here in Skagway but my super close friends and family all live in other places. When I was going through my summer of ugliness, I luckily had Rosie here at my side.  I did, however, cut friends off that lived in other cities.  For example, Barbie in Seattle.  After my sad summer, she and I were talking about hanging out, and she made a comment that I never call her back.  Of course I never called her back, I didn't want to bring her down too!  Now that I'm out of my deep sadness, I use video chats (Skype), to keep in contact with loved ones.  It's a great tool, especially if you are a seasonal worker away from friends and family.
There are other ways, besides friends and family, to get connected.  "One of the surest paths to boosting mood is giving to someone else in need.  Such giving can take many forms" (186).  For example, building houses for Habitat for Humanity, helping in a soup kitchen, being a Big Brother or Big Sister, caring for a pet, babysitting, etc etc.  www.volunteermatch.org is a helpful site.  If you live in smaller towns, check the local paper, or call city hall.
Dr. Ilardi has an entire section on "Finding Community".  Being from a small town in Ketchikan, I always felt apart of my community, but tragically, I have never felt that way about Skagway.  However, I haven't done any of the things he suggested.  Church, Volunteer organizations (as previously mentioned), social organizations (Eagles, Moose, Elks), self-help groups (Depression and Bipolar Support Alliance, DBSA), interest groups (book clubs, running club, etc), sports leagues, and/or work.  For the most part, I'm too busy for any of the above, except church, but I have never found one here that I love.  I think I'll stick with interest groups and volunteering where I can.
If you still are having trouble making connections, or just can't seem to take the first step, there is always internet friends.  Dr. Ilardi recommends a few websites: depressionforums.org/forums/healingwell.combeatingthebeast.com

I only have one more step to discuss with you, sleep. I also just got my light box in the mail today.  Do you know how excited I am!??!?!  I have implemented 4 of the steps so far.  Omegas, exercise, engaging activity and sleep.  4 points me (for each step I am doing currently), 0 points depression.  Once I am finished discussing the last step, I will blog a little of what changes I have done in my life the last two weeks.

xo

Tuesday, August 16, 2011

Skagway 2011 Party

I'm taking a break from the depression blogging because I am getting so behind in all the other fun stuff I'm doing.  Last week we had our 2011 Seasonal party for Skagway Mining Co.  24 of us, (all 11 employees, me and our dates), took a bus up to Fraser, BC to Lake Bernard for some kayaking.  It was a bit windy that day, and cold, but nothing was going to get in our ways.  Packer Expeditions provided four awesome tour guides to take us around the lake.  The head wind wasn't as bad as I thought, and when you got into the little coves it was so relaxing and gorgeous.  Canada is so beautiful!

Left to Right: Me, Erin Jakubek, Jen Funhauser, MJ Phillips, Teslyn Korsmo, Jon Sey, Sarah Dudley
Kristin Moore, Marcos Cruz Diaz, Unknown, Unknown 2 (i'm horrible with names), Jared Foland, Katie Williams
Will Dudley, Jason ?, Jene Foland, and Brittany Snell.
Guess who?  (No it's not me.)
Marcos and the bus driver, who was a very quiet man.
Brittany Snell and Katie Williams enjoying a cove.
Erin and I.  She's such a pro at kayaking.
Afterward we drove down to the Klondike Gold Dredge and had ourselves a wonderful barbecue.  The cooked us up quite the spread, including salmon, corn bread and some yummy salads.  They even gave us dessert.  In the last few years the Klondike Gold Dredge has really expanded, and they now have dog sled puppies and dogs on site.  Since I can hold puppies without an allergic reaction (no dander yet), they allowed me to play with a few.  I fell in love with one and didn't want to give him back.






10 years!  10 SMC end of the year parties!  I can't believe this season is almost over!  YEAH!!!

Monday, August 15, 2011

Let there be Light (Step 4 of 6)

Being that I was raised in Alaska, I always knew the importance of light for one's mental health.  Growing up I always heard about Seasonal Affective Disorder, or SAD, but never once contributed it to my diagnoses of clinical depression.  Did you know that America is less happy and more sluggish in the winter and that the rate of clinical depression goes up?  "An estimated 20% of the population battles the "winter blues", with at least some clinically significant depressive symptoms between November and March" (140). Considering that most Americans work 8-10 hours a day, finding the time to be outside can be a struggle.  Our ancestors spent the majority of the day outside, farming, hunting, gathering, playing, yet I am barely getting an hour a day, and the few minutes I do get outside, it's usually overcast and raining.
Why is light so important?  Bright light stimulates the brain's production of serotonin.  It's the neurotransmitter that helps with stress, depression, well being and social activity.  A recent study also showed that people under the influence of bright light are less likely to argue or fight with others (138).  I find this fascinating.  So fascinating that I'm sorta testing that study.  Lately I feel very irritable and on edge with people, arguing a lot.  (Did I say lately? Okay, so more like off and on my entire life!)  I feel like I constantly have that crows feet scowl, and "I just want to scream and push you off a cliff you are driving me so nuts" attitude.  I told this to my doctor and she of course prescribed me a mood stabilizer.  Go figure, another drug.  Did she once ask me, "are you getting enough light, exercising, sleep?"  No.  I haven't taken the prescription yet.  I am going to use the light first (as well as the other 5 steps) and see if my irritability goes down.
Another benefit from natural light is that it helps with our "body clock", our chronometer, and when our body clock gets out of sync, "hormones get out of whack, sleep grows erratic, and energy ebbs and flows at all the wrong times."  This alone cane trigger a full blown episode of depression.  No bueno.
So why can't we just sit in front of a light bulb?  For many reasons.  "Natural light from a sunny day is over a hundred times brighter than typical indoor lighting" (136).  And because our brain has special light receptors that respond only to natural light, most people need to get 15-30 minutes of morning sunshine a day (139).  But what happens if you live in the Tongass National Rain Forrest where it is overcast more days out of the year than it is sunny?  Dr. Ilardi discusses brightness in lux.  Indoor lighting gives out about 100 lux of brightness, whereas, outdoor lighting on a sunny day can give out 10,000 to 100,000 lux.  You can purchase light boxes that give out 10,000 lux, sit in front of it every morning as you eat your breakfast and read your paper and get your light fix in that way.  That's my plan at least.  I ordered my light box and plan on doing 30 minutes in the morning while I eat breakfast, blog, email etc.  I also might, on sunny mornings, incorporate step 3, exercise, with getting my light in by walking 30 minutes in the morning outside. (I did this today even though it was overcast, and it felt great, though I am a bit sleepy right now.)  If you decide to buy a light box in the near future, I advise you to read the book.  He gives many suggestions depending on your sleep pattern, eye color and skin tone, as well as, light box tips, i.e., do not look directly into the light box.
But what about vitamin D from the sunshine?  We all know Vitamin D is important, and if one becomes deficient, it can cause a handful of health problems.  Rickets, multiple sclerosis, colon cancer, Crohn's disease, and depression are just a few diseases that are linked to vitamin D deficiencies. Some of us our fortunate to live in sunny places, where you can sit outside at a cafe, and get your 30 minutes of vitamin D from the sunshine, while sipping a coffee and eating your lunch.  However, here in southeast Alaska, that is usually not an option.  That's what the supplement of vitamin D is for.  Dr. Ilardi recommends 2000 IU of D3 each day, but up to 4,000 IU.  (I'm currently taking 3,200 IU.)  Always consult your doctor, and again, if you are still reading this blog and are interested on boosting your mood, buy the book and follow along.  He gives so much more amazing information on the benefits of light and vitamin D.
2 more steps to go!

Thursday, August 11, 2011

Exercise is Medicine (Step 3 of 6)

Okay friends, on to step three: Exercise.

Everyone knows that exercise is beneficial for our physical health, but many don't realize how equally important it is for our mental health. "Exercise is medicine-one that affects the brain more powerfully than any drug" (117).  The great Dr. Ilardi mentions clinical studies that has even proved that quote, comparing Zoloft with exercise among depressed patients, and the conclusion was that in the long term, the exercisers remained depression-free.
I remember I used to love working out.  Even before I lost my weight (when I was 27, I lost 16-20lbs), I used to enjoy exercise on a weekly basis, at least.  Then when I started on my weight loss program, I loved it even more.  I became a machine... running more than I ever thought I could, and even called myself a "runner".  I remember feeling the best I ever have, mentally and physically.  My workouts, however, came to a stop when I pulled a hamstring, and ever since then have had aches and pains while out on the road.  Then I started making more excuses, and before I knew it, my work outs went from five times a week to one, if that.
When you are depressed, exercise isn't even in your vocabulary.  Depression robs you of your energy and motivation.  Your body actually feels heavy, as if your bones were weights, and the last thing you feel like doing is going to the gym!  So how in the heck do you get motivation and energy to even start this "medicine"?  You start slow.  Instead of working out, do an activity that gets you out of the house and walking, like shopping for example.  "As it turns out, whenever we're caught up in enjoyable, meaningful activity, our tolerance for exercise goes up dramatically" (118).  If you do an engaging activity every day, your energy goes up a little bit more and you can move on to other activities/exercises.
There are seven things the book discusses about exercise and it working as an anti-depressant.

  • One: Make it aerobic.  "A workout is aerobic whenever it gets your pulse between 60%-90% of your maximum heart rate" (120).  An easy way to do find your heart rate while working out is to count your pulse in 6 seconds, take that number and multiply it by 10 and you have your heart rate, or buy a heart rate monitor watch.
  • Two: Choose an activity.  Walking, gardening, sports, anything that gets your heart rate up.
  • Three: Determine how much, how long and how often.  "The best research suggests that it takes only ninety minutes of aerobic activity each week to provide an antidepressant affect" (124).  That's it.. and here I was, after my depression, trying to make myself work out everyday and then quitting cause it was too much.  Three thirty minute aerobic workouts a week is perfect (plus extra 5 minutes before to warm up).
  • Four:  Make it enjoyable.  Stop making yourself do something you don't want to do.  Make it social by hiring a personal trainer, or working out with a buddy.  Make it absorbing by playing your favorite music or listen to audio books while you are on the treadmill.  Make it purposeful, for example, an activity in your own backyard: gardening, raking, shoveling, etc.  Or just the mere fact that you are fighting depression is your goal, use that as a purpose.
  • Five: Create a schedule.  Set aside an hour and make it a routine.  Having it written down in your schedule, to work out every two/three days, will make it a habit and it will start to stick.
  • Six:  Make your workout specific but flexible.  If you aren't enjoying what you are doing at first, you have to change it up or you will quit.
  • Seven:  Be accountable.  Find someone who will keep you accountable.  Even if you have to call a friend from another state and have them call you and say "did you get your work out in?", it will help.
I have started my omega-3s and this week has been a good week (though omega-3s can take up to a few weeks to feel a difference).  Tuesday I felt a little crappy, but I went to the gym and worked out and guess what?  My mood was much better afterward.  Literally, I had no energy, a little sad, didn't want to work out at all, but I pushed myself to do just 30 minutes and I left the gym feeling lighter.  After reading this chapter, I think I might actually challenge myself and make my work outs in the morning, that way I will be in a good mood all day :o)

Wednesday, August 10, 2011

Ruminate This... (Step 2 of 6)

Did you know that cows regurgitate grass in the form of cud, "a bolus of semi-digested food"?  Then they eat up that cud and chew on it for hours, breaking it down into smaller pieces so it can be fully digested.  Why am I talking about cows and their digestive systems?  Dr. ILardi, author the The Depression Cure, uses the cows digestive process, which is also known as rumination, as a metaphor for how us humans ruminate on thoughts.  We chew on them for hours.  Eh, let me rephrase that.  Most people dwell on something maybe 5-10 minutes, find some clarity in the situation or if none, move on. Depressed people, however, think about things for hours, mostly negative thoughts and then break down and have what I call "a bad day".  I have had way too many "bad days" for me to count, but my mother can vouch, as she is the one I call when I can't pick myself back up.
When a person mulls over things "way past the point when enough is enough", several damaging effects can occur.  One is that it "tends to amplify negative emotions" (93).  I'll give you an example of what might go on in my head.... from thought to thought:
I wonder why she didn't invite me out to dinner with her and her friends?  What is so wrong with me that I can't get an invite?  Does no one like me in here? (Anxiety sets in, pulse goes up, heart starts to race) They must not.  I mean, why else would they not want me there?  I haven't done anything wrong to her, or have I?  Crap, I probably did.  What did I do?  I will never have any friends.  No one will ever love me.  I will always be alone... I hate it here... why am I even living?

Thoughts like this can stew in my head from ten minutes to hours, throughout the entire day, leaving me wanting to climb into a hole and hide from the world.  Which leads me to the second negative effect, it makes you less active and withdraw from others.
When we are brooding, we're especially inclined to avoid activity, as it would force us to shift attention away from our internal machinations and out onto the world around us instead. (93)
And it's true.  When I ruminate, I withdraw.  I withdraw because I feel so sad that I don't even like myself anymore, so why would anyone else like me?  I have no energy.  The last thing I want to do is be social with people.
Another thing I noticed about myself, and the book mentions it as well, is that when I am in phase of negative thoughts, I don't hear what others are saying.  I'll go through a conversations saying "uh huh, yeah, OK" but if they were to say "Cole, what did I just say?" I wouldn't be able to tell them. (Sorry for those I have done that too!!)  It's hard to connect to people when you are in the habit of rumination.
The third negative effect is that "rumination sends the brain's stress response circuits into a flurry of sustained activity" (93).  Which is most likely why I also have a lot of anxiety and trouble breathing when I finally hit rock bottom, call Mom crying, and her saying "just breath, take a deep breath.... breeeeaaath!"
So how do you break the habit?  It's hard.
During an episode of depression, dwelling on negative thoughts is so effortless and automatic - its possible to spend long stretches of time doing so without any awareness of what's happening. (96)
This explains why, in the past, I wouldn't remember any of the drive from Seattle to my house (30 minutes), and then suddenly I'm driving into my garage (crying or on the edge of tears).  So, the first step to stopping this ugly habit is to become aware. Dr. Ilardi recommends doing a "mental inventory", an hour by hour thought journal of your day.  Literally, set your watch and have it beep every hour.  Write down what you were doing, i.e., watching TV, working, making dinner.  Then estimate how much ruminating you did in that hour, i.e., 25 minutes.  Finally, rate your negative mood with 1 being low and 10 being high.  Doing this will allow you to see what part of your day is a risk factor for setting yourself up to mentally abuse yourself.  If you find that you are doing the majority of your ruminating while watching TV, then find a new activity. The hard part for me is that I live alone.
People typically ruminate-and feel the worst-when they have nothing else to occupy their attention.  And, given the depressed mind's inexorable drift inward upon itself, the single biggest risk factor for rumination is simply spending time alone.
Gulp. I am not panicking though.  Dr. Ilardi discusses common risk factors: watching TV (I don't have cable), spending time with other negative dwellers, listening to sad music, driving, doing mindless chores, daydreaming, lying around the house.  The solution is to turn our attention to more doing than thinking.  "By simply engaging in activity-any activity-we can change the brain in a way that helps reverse depression" (101).  Before I discuss activities, I want to also mention that he says that a certain amount of rumination is productive.  Like I mentioned before it can help us a resolve a situation or come to a better understanding of what just happened.
When you're ruminating, how long does it take to hit the point of diminishing returns, when any more fresh insights are unlikely to emerge?  The consensus answer: five to ten minutes.  So, I make a deal with them:  When you catch yourself ruminating give yourself permission to continue thinking about things for a maximum of ten minutes.  But be sure to set a timer, and then resolve it to shut the process down as soon as the timer goes off (if not sooner). 
So with all that being said.  Here are activities that he suggests to turn to when ruminating.

  • Engage in conversation - Make a list of people you can call, your comfortable level with them (1-10) and their availability level (1-10).  I made my list!
  • Pursue shared activities - There is some things that are just more fun doing with people than alone.  From mundane tasks of hammering nails (i.e. building a home for a volunteer project) to joining an exercise group.  Go volunteer, join a knit and bitch group... anything!!  Just as long as it's with PEOPLE!
  • Play - Sports, board games, card games, online games, WII games... anything!
  • Listen to music - Avoid the downer singers though... the ones who sing about loved loss, being lonely and ... well country music basically.
  • Listen to books on tapes - This is something that always sounded cool for me, but I have never bought one.  What a great way to drive in traffic!
  • Watch Videos - Be careful.  If you are single looking for love, do NOT watch a romantic movie. Watch a drama, or a comedy, anything but "Oh love is so easy and I found the most awesome guy (that doesn't exist), and I'm going to live happily ever after... muhahah and you my little lonely depressed girl on the couch, WON'T!)  I sometimes want to tell Katherine Heigl and Kate Hudson to shove it.
  • Brainstorm - Here are some that I am adding to the list: Gardening (I plan on turning a piece of land beside my house into a wonderful flower garden!), baking, shopping, volunteering, exercising, dancing, study Spanish, bike ride (with someone), read a book, clean (very therapeutic for me), writer a letter, hike.
I hope this blog is helping you or giving you perspective on depression.  If you like what you reading, a highly advise you to get the book.  The next few steps will be much shorter blogs.  I felt the need to write a lot about rumination because I feel this is the biggest depression trigger for me, and one that most don't notice they are even doing.  It's the one thing that pulls me back down continuously and I am determined to break the habit.

If you don't want to leave a comment, but instead want to email me directly, my email is nichollechandler@gmail.com

Tuesday, August 2, 2011

Omega 3 Fatty Acids

Thank you for the feedback to those who wrote to me about my last blog.  I received a lot of emails, phone calls, and support from friends and family and I just love that you are all behind me.  I had only planned on talking about my experience with the program, if I feel better, or worse, etc... but the more I read, and from comments by you, I want to share a little bit more.  I want to share what is getting me excited, what is giving me hope, the clinical research that Dr. Stephen Ilardi reports, because I think it is important.  Knowledge is power and the more you know, the better you can take care of yourself and your health.  I am not getting my hopes up, or putting any expectation into this program, but when I get excited about something, I just have to share it with all of you.

According to The Depression Cure by Stephen S. Ilardi, PhD, there are 6 steps in his program to beat depression without using drugs.  They are:
  • Dietary omega-3 fatty acids
  • Engaging activity
  • Physical exercise
  • Sunlight exposure
  • Social support
  • Sleep
This blog entry, however, is just going to point out some of the amazing things I read about the first step:  dietary omega-3 fatty acids.  Dr. Ilardi calls it brain food.  As an Alaskan, I immediately thought of wild salmon.  I never would have guessed though, how much omega-3s impact our brain.  Did you know that our brain is mostly made up of fat?  60% of the human brain is fat by dry weight.  Most of the fat molecules in our brain are made up by the body, but some we have to get through diet.
Omega-3 fatty acids are found mainly in fish, wild game, nuts, seeds and leafy vegetables, all things found in abundance in the hunter-gatherer diet. Our distant ancestors ate five to ten times more omega-3 fat than we do.  In fact, omega-3s have gradually disappeared from the American diet over the past century. (10)
Why has the American diet changed so much from our ancestors?  Well, first let me tell you that omega-3s come from algae, grasses, plants, where omega-6s come from plant seeds, nuts, grains.  A healthy ratio of omega-6s to omega-3s, to maintain a healthy chemical balance, is anywhere between 3:1 to 1:1.  Our ancestors had an outstanding ratio of 1:1, but today in America we have a horrible 16:1 ratio!! (pg 67)
To explain why this drastic change has happened, lets look at our farming history.  The majority of livestock in America today is corn or seed fed (omega-6s), instead of in the past, where they were grass fed (omega-3s).  Fish and other meats in chain restaurants and in super markets are mostly all farmed, not wild.  Also corn is in almost anything nowadays.
The shift to industrial agriculture or “factory farming” did not happen overnight, but it has monopolized American farming practices mainly because it is highly efficient in producing massive quantities of food at a relatively low cost. And one of the biggest culprits fueling the factory farm movement? You guessed it…CORN! Corn is a food that is heavily subsidized by the government, essentially meaning it is overproduced and incredibly cheap. So cheap, in fact, that it is chemically altered and used as a replacement for thousands of more costly ingredients. Corn is not only used as a sugar replacement (high fructose corn syrup) but also found in unsuspecting household products like chewing gum, craft glue, plastic bottles, and cell phones, just to name a few..  source: http://www.oneresult.com/articles/nutrition/great-beef-debate
Therefore, we are getting way too many omega-6s, and not enough omega-3s.  If you learn anything from this blog, I hope it is that you only eat wild fish/game and grass fed livestock or no meat at all.

So how does consuming too many omega-6s and not enough omega-3s effect my mood, my sadness, and/or my will to live?  Dr. Ilardi goes into great detail about the chemical imbalance it causes on our brain.  I am not going to go into detail, but I do find it really important, so if you want the answer to that question, buy the book. Not only does the chemical imbalance effect mental illness, such as depression, but other wide spread diseases in the industrialized world: diabetes, atherosclerosis, Alzheimer's disease, heart disease, allergies, asthma, stroke, metabolic syndrome, and even many types of cancer. (pg 71)

Dr. Ilardi writes about the different groups of people in the world and their depression rates.  This gives an example, and more proof, of how our diet is effecting our brains.  For example, he brings up the Amish in America, who still live in their eighteenth-century way of life, but have the lowest rate of depression than any other group in our general population.  Another example is the modern day hunter-gatherer, such as the Kaluli people of New Guinea highlands.  One would assume that because they have a hard life, with no material comforts or medical advances that we have, they would suffer at least a little depression.  Researchers that have studied these people have come to find that clinical depression is almost completely nonexistent among such groups. (pg 4-5)

Dr. Ilardi is not anti-medication, but he is a researcher and writes about many clinical studies that suggest that "omega-3s are among the most effective antidepressant substances ever discovered" (11).
British researchers recently studied a group of depressed patients who had failed to recover after taking medication for eight weeks.  All study patients stayed on their medication as prescribed, but some also took an omega-3 supplement.  About 70% of those who received the supplement went on to recover, compared to only 25% of patients who kept taking only the medication. (10)
He also mentions there are many clinical studies that have been done on anti-depressant medication versus the placebo effect, and the comparison of the patients recovery rate.
Irving Kirsch, a clinical researcher at the University of Connecticut, petitioned the FDA for the results of every drug-company study submitted over a thirteen-year period (1987-1999) for six commonly used antidepressant medications: Zoloft, Effexor, Prozac, Celexa, Paxil, and Serzone.  Incredibly, he found that in 56% of these studies, depressed patients taking an antidepressant drug fared no better than those who took a placebo.  Not surprisingly, the drug companies have never published most of these studies.(46)
I could go on and on with more examples that he gives about medication, omega-3s and the brain, but I think you get the point. Omega-3s are essential to the human diet and clearly help a good % of depressed people.  I have ordered the prescribed dose he discusses in his book, and I can't wait to start my regimen.  I hope I will feel a difference, but again, no expectations.  Just like the Dr. says "When it comes to treating depression, there is no one size-fits-all cure" (61).  There is so much more that I read that I want to share, but if you have read this far into my blog, then you are obviously interested and should just buy the book.  The information Dr. Ilardi writes is not just for depressed people, but for people who want to live a healthy lifestyle.  Amazon reviews have said the same thing, but it's true.  I am giving it a 5 star and I am only on page 88 of 278 pages.