10 Things You SHOULD Say to a Depressed Loved One - Beyond Blue

Therese Borchard, one of my favorite bloggers, shared 10 Things You SHOULD Say to a Depressed Loved One - Beyond Blue. 

In short, the 10 things are:
1. Can I relieve your stress in any way?
2. What do you think might help you feel better?
3. Is there something I can do for you?
4. Can I drive you somewhere?
5. Where are you getting your support?
6. You won’t always feel this way.
7. Can you think of anything contributing to your depression?
8. What time of day is hardest for you?
9. I’m here for you.
10. Nothing.

I have a number of friends who suffer from the challenges of depression, even bipolar. I feel for them. I know, at least for me, to what it is like to go through some of the struggles of dealing with emotions that are out of control. However, there are still a lot of times when I just don't know what to say.

Maybe Therese's suggestions will help to know what to say.

Forgiving Myself

One of the challenges of living with bipolar disorder is the fact that life sometimes doesn't turn out the way we expect. In a baseline state we have plans and goals that we intend to keep but then depression creeps in and the drive to accomplish diminishes. This time last year I was pushing forward diligently on completing my CPA certification. It was something that I wanted to accomplish. I've now let that slip by the wayside. It seems like my life is littered with broken dreams.

That is not to say that I want to go back and complete my CPA. I'm not sure that is the case. I neither want to do audits or taxes so my thoughts are that is something I don't want to do.

I do want to move forward with my life but I've stepped back from some of the commitments I've made. At some point, I expect I'll be ready to go back and attack some of the aspirations I've had. As for now, though, I am just learning to deal with the day to day.

About a month ago I wrote on my daily chart that I was stressed, and losing sleep, over being concerned about a new report that I had to develop. I was concerned about my ability to do it. Since then I've been able to accomplish that task to some very positive remarks from management. That gives me hope that by keeping on I'll be able to accomplish some of the other tasks I have on my plate that I'm concerned about.

I think the trick is to keep moving forward while giving myself room to breathe and to keep myself well.

Back at Work

So many of the questions I had about going to work have been answered since I've gone back to work. My role at work has changed. I'm no longer as deeply involved in the close process. Part of me feels like I'm being protected or that others at work are being careful to not give me too much responsibility for fear that I may have a remission.

But for the most part, people are treating me well. A couple people, with whom I had a good relationship before I left, have been really nice and stated how glad they are to see me back at work. It's nice to know that I was missed and that people care.

One of the things that has been surprising is how few questions I've had about what happened. I'm sure part of that has to do with people not knowing how to inquire about the situation. I'm OK with that. I'm not sure I would do any differently if I were in their shoes.

I definitely don't feel like I'm back to normal yet. But it is comforting to know that I'm back to work and things are on the mend.

Tomorrow's the big day

I start back to work in the morning. Actually, I already began today by going through my 450 emails I had waiting in my inbox. It took me a few hours to go through that but at least I don't have that waiting for me when I walk in the door tomorrow.

I am a little concerned about going back to work. I don't know how supportive of an environment I'm walking into. Am I walking into a hornets nest where I'll be bashed for taking a "holiday" for four months? Will I get the silent treatment where everybody's too nervous or unsure of what to say? Or will there be a few souls who have been where I've been and are willing, and able, to offer a kind word of encouragement and empathy?

I guess I'll see tomorrow.

I know I was starting to get myself a little anxious worrying about how things will play out tomorrow. My work environment has been a sore spot for me so it's not like I'm returning to a favorite pastime. But I decided I would take it moment by moment to breathe, take in some fresh air and not dwell on the sometimes unpleasantness of the job. After all, it's not all bad.

Keeping my fingers crossed.

Back to Work

I am, to be honest, more than a little excited to be able to state that I am heading back to work next week. After being out on disability for what will be just a few days short of four months, I am relieved to know that there is a job waiting for me.

As I described in my last post, I was feeling quite anxious about not knowing how I was going to provide for my family. Thankfully, I'm not being thrown out on the street to fend for myself. I'm sure it's also a relief to my family. (The kids have started asking recently when I would be going back to work. I now have an answer for them.)

I will be working part-time for a couple of weeks in the process of easing my way back into a full-time work schedule. My responsibilities also look like they are changing somewhat, which in my case looks like it's going to be a relief. I'm sure I'll still feel the pressures of working in Corporate America, but not the same pressures I was feeling before.

One of the things I've learned through this process is that bipolar disorder has both a biological component as well as a psychological component. In other words, my biochemicals work against me but so do the factors of the environment in which I find myself.

I am working on overcoming the biological factors by working with my psychiatrist and being diligent in following my medication regime—which in itself is a major leap forward for someone who really dislikes taking medicine.

I have been working on the psychological factors by learning to give myself space through meditation and positive self-talk. In addition, I am following closely a number of fellow bloggers and reading books on the subject—currently Bipolar Disorder Demystified by Lana Castle.

I'm sure there are still things ahead of me to learn how to adjust to going back to work. But I feel more prepared and hopeful that I have some resources to help me cope. (FYI, I found a great resource for those of you looking for work accommodations particularly with some specific information on those with bipolar disorder.)

I'd love to hear your experiences in going back to work. What worked for you? What didn't?

A Brand New Year

Well, it's time to start thinking about what the new year will bring--if you haven't been already. I know with the challenges I've faced since my major depressive episode began in September I've been thinking almost constantly about what the new year holds for me. I've got to say, at present, I'm more than a little concerned.

As the sole provider for my family of six (me, my wife, and four kids), I feel the pressure to be able to pull in a decent income. Prior to the last episode, I was doing a pretty decent job. I had a decent position--though admittedly a high pressure one I did not enjoy--making a fairly good salary. I knew how much I was making and where the next paycheck was coming from.

However, I've now been on short-term disability going on four months. While I am very glad to have the disability insurance and the resulting income, I'm getting to the point in my recovery where I'm feeling the need to get back to work.

There are two problems: 1.) I have a release from my doctor to go back to work on a part-time basis. Unfortunately, my employer indicated they were unable to accommodate that request pending a further review in the beginning of the year. 2.) My sleep schedule is still really messed up. The last several nights I have been unable to get to sleep well. Last night was particularly bad with me finally getting to sleep around 4am which resulted in me sleeping in to around 11:30am. Obviously, such a schedule is going to make it difficult for me to work a normal 9-to-5 schedule.

I am hoping that by the end of 2010--preferably much sooner--I'll have a much better handle on what I'm doing to provide for my family.

Chronic Pain

In June of 2002, I left work in order to have wrist surgery. The doctor, who was highly recommended, indicated that the recovery would only be about two weeks and I would be able to return to work without further complications. Unfortunately, it didn't work out that way. It was actually the beginning of a long and difficult journey through chronic pain.

The human hand is composed of 27 bones. One of the three primary wrist bones, the lunate, in my hand disintegrated due to lack of oxygen. The condition, known as Kienbock's Disease, is rare and is not clearly understood.

The things I learned from this experience are:

1. Importance of relationship with doctor. Bedside manners make a huge difference. This was true when dealing with my issues with my hand. It is even more critical when dealing with the ups and downs of bipolar disorder.
2. Importance of others who have gone through the same experience. One of the most memorable experiences I had while recovering from the pain and lack of mobility in my hand was talking to someone else who had gone through a similar experience. Doctors and therapists could share all kinds of knowledge and played a vital role in the healing/coping process but they could not fully empathize as they had never been there themselves. Talking to someone who had validated the experience for me and helped me cope a little better.
3. Time has a way of making things better. It has been over seven years since I had the operation that fused my wrist. Over the course of that time, the pain in my hand has subsided. It's not totally gone but I'm no longer writhing in pain at the slightest bump. I don't expect it to ever go entirely away, and at some point it may even get worse but for now I'm able to deal with it.
4. My time schedule is not the same as God's. Corollary to number 3 is the fact that I had no idea what the time schedule was for going through the ordeal of having my wrist fused. In fact, I had no idea that it was going to be an ordeal.
5. I had to learn to be flexible. Part of the process for me was not having use at all of my right, dominant hand for a period of six months or so. As a result, I had to learn how to do much with my left hand that I was used to doing with my right hand. Today, I am still much more ambidextrous than I would have been otherwise, i.e. I learned skills that I wouldn't otherwise have.

Although I realize that the similarities between the chronic pain in my hand/wrist and the chronic illness of bipolar disorder only go so far, I am expecting that there will be similar lessons learned from dealing with this challenging disorder.

Reasons to Live

When we are depressed, it can be difficult to remember the reasons we have to live. The following are some of the reasons that I keep in mind when I have those uncomfortable thoughts creeping into my head. It's a bit of a taboo subject but with some 30,000 cases of suicides annually in the United States, we cannot afford to keep this hidden. (That doesn't take into account the fact that there are 30 to 50 times as many attempted suicides as there are actual suicides.)

1. I have a responsibility and commitment to my family.
2. I believe I can learn to adjust to, or cope with, my problems.
3. I want to watch my children as they grow.
4. No matter how bad I feel, I know that it will not last.
5. I am afraid of death.
6. I love and enjoy my family and could not leave them.
7. It would not be fair to leave the children for others to take care of.
8. The effect on my children could be harmful.
9. It would hurt my family too much and I would not want them to suffer.
10. I am afraid that the method of killing myself would fail.
11. I consider it morally wrong.
12. I would not want my family to feel guilty afterward.

Source: Linehan, et al(PDF)

Clinical Depression Myths

In a recent post Therese Borchard outlined "10 Common Myths About Clinical Depression". As I read the post, I found myself nodding in agreement that the myths are prevalent in society. It wasn't until later in the evening as I was struggling to come to grips with my own depression—yep, it's back :(— that I began to realize that a lot of those myths are things I believe myself. I found that I was trying to control my depression as if it were just something I could shake off. I was getting frustrated with myself that I was unable to do so.

I've always considered myself a person of strong character. Besides the mental health issues I've encountered there have always been other significant challenges. (Isn't that true for us all?) But I've always been able to push my way through.

I'm finding that I'm not so easily able to push through this challenge. And I'm going back to meet with my psychiatrist tomorrow to discuss the possibility of my going back to work at least on a part-time basis as early as next week. I've got to say, I don't feel ready for that. Especially in light of the fear and struggles with depression and suicidal tendencies I've encountered in the last few days.

I find the image of an adult male cowering in a corner in fetal position disconcerting but I feel that way myself too often. It is not where I want to be!

Perhaps, it's good to be able to write this out and get this on the screen. On the surface I think I find myself putting on a good show. Something about the writing process allows me the freedom to get my feelings out.

Mood and Diet Connection

With the holiday season upon us, many of us are enjoying the feasts without putting on too much weight. For those of us with depression issues, we can experience the double whammy of not only adding pounds but also dipping into a blue funk.

There are many sources for depression at this time of year--from painful reminders of who's no longer around to seeing all the festivities are involved in but somehow we're left out. Those can be difficult to bear.

Another reason we may be experiencing the doldrums though may be all the extra food that is available at this time of year. From the extra helpings of turkey, stuffing and mashed potatoes at Thanksgiving to the extra cookies and candies that are shared at Christmas parties. It's a festive time of year and all the great food adds to the experience.

Dr. Barry Sears in an article on the Christian Broadcasting Network site provides some great neurology background into how the brain works and how it is affected by diet. He suggests that we reduce the amount of sugar we intake and supplement with a high-quality fish oil.

I don't know if it is from following this type of advice the last couple weeks but since watching more closely what I eat and supplementing with fish oil my mood has definitely lifted--thankfully!

Therese Borchard, in her Beyond the Blues blog posts, also gives some great tips to eating healthily during the holidays:

• 5 Tips for Eating Healthy Through the Holidays
• 7 Ways to Manage Your Diabetic (or Sugar Sensitive) Waistline During the Holidays

Bipolar, ADHD and Depression

Both people with bipolar disorder and those with ADHD often experience depression. This depression may be primary–i.e. due to biochemical reasons the individual becomes depressed without apparent reason–or secondary–i.e. due to external forces such as relationship or work issues. Both primary and secondary forces can work together to exacerbate the depression as has been my case with my latest major depressive episode.

Lately, there has been a lot of advertising on electronic and print media touting anti-depressants. I, personally, don't have experience with taking anti-depressants, but when I'm battling deep depression I sometimes wish I could take something more that would help me out of it. Unfortunately for those with bipolar disorder, anti-depressants can have serious negative side effects: They can bring on hypomanic, manic, and mixed affective states and can cause rapid cycling. (The Bipolar Disorder Survivor Guide, David J. Miklowitz Ph.D., 2002)

To make matters worse, even after negating the side-affects of anti-depressants, there are some clinical studies that show that they are not the panacea the ads purport. (I'd love to hear from those who have taken anti-depressants with good affect.)

For more information on antidepressants, see this informative article on depression medication.

As always, consult your medical professional before making any change to your medication regimen.

ADHD and Bipolar Disorder

I've always struggled to maintain a daily routine. There are definitely routines to my life but they often do not follow a day-to-day pattern. Instead it's more hit and miss. This has been frustrating at times as the routines support my goals but in order for them to work they have to be followed in a non-linear fashion.

As I've come to grips with the idea that there might be biological reasons behind this, I've been in the habit of associating this with ADHD symptoms. It seems, however, that ADHD and bipolar disorder have a lot of similarities and a similar root. That is "Twin and family studies of ADHD show a substantial genetic heritability with little or no family environmental effect. Linkage and association studies have conclusively implicated the dopamine transporter gene (DAT1). DAT1 has also been confirmed as being associated with bipolar disorder." (Source: PubMed.gov article)

In layperson's terms I believe this is saying that in studies of twins and families excluding factors of nurture rather than nature the neurotransmitter dopamine transporter gene (DAT1) is implicated in both ADHD and bipolar disorder.

In a not as scientific article, ADHDNews.com outlines the similarities and differences between ADHD and bipolar disorder.

The similarities include:
• impulsivity
• inattention
• hyperactivity
• physical energy
• behavioral and emotional lability (behavior and emotions change frequently)
• frequent coexistence of conduct disorder and oppositional-defiant disorder
• and learning problems

For more information on determining the difference between ADHD and bipolar disorder, see this short article by Dr. William Dodson in ADDitude magazine.

Gratitude Day 3

Today, my wife and I headed south to Columbia, SC. We were able to visit some dear relatives of my wife. I am grateful for my family--both immediate and extended.

Gratitude Day 2

Today, I got in an accident when a car pulled in front of me and stopped along a busy road. It happened so quickly there was little I could do other than hit the brakes as quickly as I could. Too late.

The air bags deployed and there was glass and plastic all over the road. Two of the side windows shattered in the impact.

Thankfully, nobody was hurt. I am grateful for air bags and seat belts.

Bipolar Connections - Serendipity

Today, I read my Weekly Challenge from Manage Your Muse. As the title suggests, this is a weekly challenge distributed by Lynn Cutts of Manage Your Muse. Lynn specializes in life coaching for right-brained individuals. I find the weekly challenge a great way to reassess how I look at life.

On today's challenge, there was a link to the 30 Days of Thanks. This is simply an opportunity to blog about what we are grateful for. That seemed fitting to me due to the season of the year here in the United States and also because I think remembering the things for which we are grateful helps us to feel better about our situation.

While I was on the 30 Days of Thanks site, I saw a banner ad for Free Rice which helps develop a stronger vocabulary while providing rice for the world's hungry. That is a combination I can support! The vocabulary is challenging, too.

So today, I'd like to say I'm thankful for the serendipitous experiences that can be found on the internet. (I'm also thankful that I'm feeling better than I have in days. Yeah!)

Comedies

Last night I was (am!) still in a depressed funk but I had the opportunity to spend some time with my wife. I try to keep going despite how I'm feeling. We ended up watching "Father of the Bride 2" with Steve Martin. It was a lot of fun and the laughing helped lift me, at least momentarily, out of my funk.

Daily accomplishments

Since starting my recovery from my latest depressive episode, I have begun to keep track of various things: my moods for the day, whether I've taken my medicine, any physiological concerns, and a short sentence or two on the major events of the day as they relate to having bipolar disorder.

In addition to these, one thing that helps me keep moving forward is making a mental note of what I accomplished during the day. Some days it may be something very simple: I did the dishes and picked up in the living room. Other days I may have gotten a lot done in the yard. Either way, I know that I accomplished something. I'm not terribly concerned about how much I've accomplished at this point just that I've moved the ball forward.

I long to accomplish a great and noble task, but it is my chief duty to accomplish small tasks as if they were great and noble. - Helen Keller

By the way, Julie Fast has a great article in today's blog about how to move forward when feeling down.

Keep On Keeping On

This week, for whatever reason, has been really difficult for me.  It started out on Sunday evening, which is definitely part of a pattern that is appearing over the last several weeks. I'm fine Sunday day, then as the evening approaches, my mood starts to slide down into depression. By Monday, I'm typically into a deep depression.  Tuesday the depression starts to lift and by the end of the week I'm on my way, at least, to stable.

This week, Tuesday was as bad as Sunday and Monday. I'm curious, does anyone else have a cycle of depression/moods that follow a pattern over the course of a week.

Some of the thoughts on why I'm experiencing this are two-fold. First, my major depressive period that I'm in recovery from started out in the same pattern: Sunday evening then deep into depression on Monday. Of course, it didn't start lifting until I started getting some help and working on getting better.  So every week on Sunday as the work week begins to edge closer, I'm heading into depression.

The second thing that may be causing my depressive cycle this week is that I suggested to a co-worker, who is filling in for me while I'm out, that we have lunch this week. In retrospect, that may not have been such a good idea. It's not him but rather the situation that is the problem. (Of course, he is constantly asking when I will be back to work which does drive me a little crazy.)

I'm afraid I have effectively canceled the lunch appointment this week by ignoring the suggestion I made last week. I hate to not honor my commitments (really, I do!), but recovering from my illness at this point takes precedence. I guess the honorable thing to do would be to tell him.


When I'm feeling down, like I have been, I often feel that I just want it to end. Not suicidal thoughts necessarily just that I want to get past this. Sometimes this illness seems interminable.

I found two articles on psychcentral.com that give ideas for how to combat the blues:

1. Six Ideas for Beating Winter Blahs
2. 12 Winter Depression Busters

These are definitely not comprehensive lists.  For me, I'm finding that at this time of year that I'm grateful that my yard has been covered with leaves.  The repetitive and mindless motion of raking leaves allows me the escape where I can just be without having to think or plan or talk to anyone. The task is defined and I can complete it at my pace.  Having my children helping can make it even better.

What do you do when you're feeling down to keep on keeping on?

Fellow Sufferers

This weekend, I had the opportunity to converse with some family members who also have bipolar disorder. I've got to say, it's comforting to be able to talk to people who know what I'm going through.

How about you? Do you have people in your life who can relate to what you're going through in fighting this disorder? You can find support groups.

Guilt

Recently, I have begun to notice how often I am feeling guilty in association with my illness and recovery. I have felt guilty about the things I haven't done. Namely, that I denied the presence of my disorder and consequently did nothing to gain more insight into it. 

Instead, I focused on my career and my family. I don't think that is a bad thing. It was a shifting of priorities. Perhaps guilt is just a way to acknowledge the possibility of a different path.

I have also felt guilty that I have been away from work as long as I have. Not everyone is able to take off a couple months and spend time with family. It has been a real blessing to be able to do so and one that I can continue to do in some fashion.

Finally, I have felt guilty because I have spent so much time recovering from my illness while there are others I know of who are fighting for their lives as their bodies are physically ravaged with cancer. Their illnesses seem to be so much more serious and real. My illness has been all in my head (though yesterday's post shows that there are definite physiological effects as well.)

In fact, I struggle to legitimize my illness.  This is where guilt becomes particularly burdensome. I wonder if part of it has to do with the stigma that is associated with mental illness. Too often, the thinking is "If people would just take some responsibility for themselves, there would be fewer people living on the streets." Part of that may be true. But I can tell you, the need to fight tooth and nail over the past couple months for me has been very real. There were definitely times that all I wanted was to cease to exist and I was willing to do what was necessary to do so.

In trying to think of an example that would show this, I would point to the feelings that smokers have when they are craving a cigarette. It takes strength to overcome that temptation. Similarly, overcoming suicidal thoughts can also be extremely challenging. I am glad that I am beginning to get past those feelings because I have many wonderful reasons to be alive and most of them are my family. Then there are the things I care about: art, music, church service.

So, I am recognizing the guilt that I have been passing through. In doing so, I strive to embrace those things I haven't done that I would like to do and I acknowledge those that I have done that I can leave behind now.

What a powerful opportunity for growth!