September 29, 2011

On drinking and depression

So this is the blog that might scare away men I’m hoping to help. Not a popular subject. Depression and alcohol.

The bottom line? A lot of one can lead to a lot of the other. Depression can make you want to drink more. And drinking more can lead to more severe depression.

It’s not cool to lecture others or say "here’s what you need to do." Therapists and AA folks call that cross-talk. You’re supposed to say “I can relate to that because….”

So here’s how I’ll start. I can relate to the intractable problem of alcohol and depression. I drank enough beer in college to float a barge. I drank enough beer after college to drown a dragon. Only the alcohol never killed the dragon. It only made him angrier.

I kept on drinking, and drank even more when the first real tests of my life came. The loss of a loved one. The stress of owning a business. The stress of parenthood and trying to be a good husband, good career guy and good father at the same time.

The worse it got, the more I drank. The more pain I suffered, the more I tried to dull it with alcohol. I was quite clearly self-medicating, only this medicine has horrendous side effects. Hangovers. Even more anxiety. The inability to concentrate. The obsession over when the next drink can be consumed.

I once quit cold turkey once with no professional help but lapsed back into the same old patterns nearly a year later. Then my depression got worse than ever, and the abuse of alcohol became as bad as it had been in college.

Even though this is an anonymous blog, allow me a little room for rationalization here. I was never a Bloody Mary in the morning or bottle in the desk guy. But I was a prolific binge drinker. After Katy Perry-like Friday nights, I’d be hung over until Wednesday. And then I’d start again on Thursday with heavy drinking.

And it never, ever made me feel better. Only worse. My first therapist equated it to pouring gasoline on a fire. It’s simple, really. Alcohol is a depressant. Depressed people, umm, I should say people like me that I can relate to, probably don’t need more depressants.

If you want to read a great blog about depression and alcohol, which is the chicken and which is the egg, check this one out. If you want to read some scholarly articles about alcohol and depression, click on this link.

Praise God, alcohol abuse is not a problem for me right now. Not today at least. We’ll see about tomorrow.

September 27, 2011

The signs of major depression were there

The signs were there. This is what my journal said one day last spring, about four months before I slipped into a painful, debilitating depression.

Not doing well today/this week. Dejected. Tired. Trouble getting to sleep. Frustrated. Stressed.  Racing thoughts won’t stop. I want to quit my job and get my  life back. Reality is I can’t or won’t.

Anxiety is high. Not getting everything done at work. My focus is inconsistent. Am I ADD too? When I start spiraling down, I can’t seem to stop it.

That’s what I wrote on March 30, 2011. When I saw my therapist that day, her advice was simple: Get through this crisis!

I was going through a stressful episode at work. Like a lot of anxious people, my therapist astutely observed, I attract the anxiety of others around me like a magnet. If they are anxious, I pull in their anxiety.

My therapist also told me to gently bring my mind back to the reality that my job is no different than others. Everybody has stress. It may feel like it, but it's not literally a dragon that I must slay or face a terrible death. It’s a job!

So what went wrong? Why did it all come crashing down four months later?

I am still trying to figure that out with the help of new medicine, more therapy and some self-reflection.

I’m reading a book about co-dependency, which is a broader term than I had previously thought. It’s called “Codependent No More” by Melodie Beatty. Codependency is about more than being an enabler. It’s about learning self-care and, sigh, self-love. That’s not easy for men.

When I entered a partial hospitalization program last summer, I learned some techniques through group therapy. We studied the Crisis Survival Strategies  by Marsha Linehan at the University if Washington. An expert on borderline personality disorder (which I don’t have unless you count when it’s questionable whether  I have apersonality when I’m really depressed), Marsha also writes about how to distract ourselves when we feel threatened by a mental health crisis.

Her handy way to remember the steps is “a wise man ACCEPTS.” The acronym goes like this:

Activities:  Exercise. Do a hobby. Clean. Attend an event. Call or visit a friend. (You get the idea).

Contributing: Volunteer. Do something nice for somebody you love.  Or just say something thoughtful to somebody you work with.

Comparison: Compare yourself to others, especially those who are worse off. (It will remind you that it could be worse and you are probably quite fortunate).

Emotions. Watch a movie or listen to music that will change your emotions for the better. (Don’t watch "Mommy Dearest" if you are depressed. Maybe go with "Old School" or even something lame like "The Sound of Music").

Pushing Away: Push the situation away by leaving it for a while. Take a break from your worries. (Maybe pull up He now puts up bits every day that are “fantastic,” as Jerry might say).

Thoughts: Count to 10, watch TV (not the news), read, or do anything that will change your thought pattern (Remember our thoughts determine our feelings. Simple but profound truth).

Sensations: This one sounds nutty if you’ve never been in therapy. One proven technique if it’s a really bad day is to clutch a piece of ice. Or squeeze a ball. Or have sex (that one really is on the list, honey).

Maybe one reason I crashed this summer is I didn’t know these techniques. They don’t always work, but knowledge is power, and effort, any effort, to change our negative thinking is better than stewing in a pot of self-pity.

Source: From Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan.

September 25, 2011

The best part of waking up? I’m still not sure

I’m not a morning person. Never have been. Probably never will be.

I never knew there is a scientific reason that my anxiety seems to be worse in the morning until I did a little research into morning anxiety.

I found this great blog on morning anxiety at The Reality of Anxiety, one of the best blogs out there on mental health. The post is several years old but quite good.

Our bodies naturally produce a stress hormone called cortisol, which was a good thing back when people threw spears at each other and needed a boost of adrenaline to stay alive. It still has its place, such as when my American Express bill arrives in the mail.

Too much morning anxiety, though, only compounds matters. Cortisol levels are already at their highest in the mornings, and when we can’t manage our stress, our adrenal glands keep pumping more of it into our bodies. Morning anxiety creates more anxiety. It can be a vicious cycle.

Here’s what my mornings feel like. I wake up slowly but then quickly begin to worry about my day. That just creates more anxiety. On a good day, I’m okay by 9 or 10 a.m., or my third cup of coffee, whichever comes first. On a bad day, it’s noon or so before I feel “good.”

The inevitable “fight or flight” struggle I have goes something like this. A lot of mornings I don’t want to get out of bed, much less deal with work. Then I start to feel better and realize I can’t flee to Mexico because of my mortgage and the fact that all of my children will eventually need braces. Reality is a great motivator.

By lunch, when I can either work out or at least eat—boosting my blood sugar level at about the same time my cortisol levels are probably evening out—I’m good. Sometimes, I’m even great by 2 p.m. Miracles never cease.

It’s ironic that depression is so often associated with darkness. I actually do better at night, until I start to worry about the next morning.

So what to do? Exercise in the mornings? Not me. I hate exercising until I at least can figure out what day it is.

Pound coffee? Too much makes my heart race and my hands shake.

The simple things help me most. Four square breathing (four deep breaths, holding for four seconds before exhaling for four seconds) and a little devotional time seem to help. At least when I feel like it.

Folgers may have written the best jingle of all times about the best part of waking up. Only I’m still trying to figure out what that is.

September 23, 2011

Think you are depressed? Man up!

Smart people who study mental illness say twice as many women suffer from depression than do men.

I find that hard to believe.

Since I began sharing my struggles with depression with close friends, I’m amazed at the number of men who tell me they are probably depressed.

Is the science wrong? Probably not.

Yet could it be that research shows twice as many women experience depression because men are less likely to admit they need help? Probably so.

I’d be interested to see what effect the Great Recession has had on the number of men who suffer from depression. Suicide rates reached an all-time high in 1932, according a Bloomberg article that references an American Journal of Public Health study.

You don’t have to be a history buff to know that was the height of the Great Depression. (That’s a really sad pun). They may have been the most difficult time in American history for men—at least in terms of mental health.

An article published in the Atlanta-Journal Constitution this week said the suicide rate for middle-aged people (ages 45-64) is the highest it has been since 1998.

The only place I’ve ever met men who tried to commit suicide was in a dual diagnosis program for people who suffer from mental illness and/or addiction. The men I know in my personal life that are struggling with what could be diagnosed as depression aren’t suicidal, but they don’t exactly have a sunny outlook, either.

Several male friends of mine have come to me for advice. They’ve asked me if they could be depressed.

Since I’m obviously not a doctor, I tell them to talk to one. But I also urge them not to stop with their primary care doc if they don’t get the help they need. With all due respect to doctors, internists don’t seem to understand mental illness very well. It’s not enough to get on a drug. Therapy is often needed, too.

If your doctor isn’t helping, ask for a referral to a psychologist or psychiatrist, or look one up on your own online. That’s what I did.

It’s normal to get the blues. But if you feel hopeless, exhausted, persistently sad and have lost interest in things that once gave you pleasure, it might be worth your time to check out this FACT SHEET on men and depression. It comes from the National Alliance on Mental Illness.

So guys, if you think you are depressed, man up! You are not alone.

September 22, 2011

Broken hearts and fragile minds

I’ve read tons of blogs about depression. The Splintered Mind is one of the best.

His latest post, “On Heartache and Depression,” is a must-read for those of us who suffer from depression, especially those who are also coping with loss.

So what’s the difference between sadness and depression? And how do we know when we are just sad or when we’re depressed and might need help?  I’ve been asked that before. Here’s what A Splintered Mind writes about his recent divorce, about the difference between sadness and depression.

Sadness is a response to tragic or disheartening events; Depression is an overwhelming feeling of hopelessness and misery that pulls my heart to the grave. Sadness invites comfort from others; Depression compels me to drive others away.

Brilliant, Splintered Mind. Part of healing, he says, is allowing ourselves to be sad when sad things happen. For me, it’s the death of my father.

Dad, the greatest man I’ve ever known, died two years ago. It took two years for me to slip into the deepest depression I’ve ever experienced. A dark, terrible place I never want to visit again.

Did I go there because I didn’t let myself go where my feelings tried to lead me after Dad’s death? (Note to self: Ask therapist about this next week). And was my depression worse than it would’ve been had I properly grieved two long summers ago?

Splintered Mind further opines about the difference between depression and sadness.

When my thoughts are tainted with hopelessness and dreams of death, I know they are induced by Depression and I fight them off. When I pine for the marriage lost and wish things had turned out differently, or even burst into tears, I know it's a response to the tragedy I'm living through. I allow it to happen.

When sadness threatened to overwhelm for the first two years after my first big loss in life, I didn’t let it happen. I shut down emotionally. I seldom talked about Dad and almost never let myself cry.

Maybe it’s not just sappy therapy speak to say we should let ourselves feel feelings. Smart people who’ve spent a lifetime studying it say our thoughts determine how we feel. So when we think sad things, maybe we should allow ourselves to feel what we’re thinking, to let the tears flow.

Looking back, my recent descent into that dark place was the worst time of my life. Yet while there is still a hole in my heart, those tears were like a salve in my wounded soul. It’s getting better.

So thank you, Splintered Mind. Thank you for reminding me it’s okay to be sad. It might even save my fragile mental health.

September 21, 2011

Anxiety & Depression: Which is the chicken, which is the egg?

Before I was old enough to know what stomach acid was, I knew what it felt like.

I was in the fourth grade, best I can remember. The teacher told me the principal wanted to see me...on Monday morning.

That weekend was pure hell. I worried myself sick. What the heck did I do to get in trouble? Would I get paddled? What would my parents do to me when they were called in? Should I confess to a crime I didn't commit?

Those crazy thoughts swirled in my mind and made my stomach churn...all weekend. I barley slept, worrying like hell about what was to come. I didn't know then that the stomach-churning anxiety that tortured me all weekend all came from my thoughts...irrational thoughts.

Then Monday morning came. The principal called me ask if I would do the honor of raising the American flag at school every day for the rest of the year. I nearly wet my pants with joy.

Some 30 years later, I repeat that ritual weekly, if not on a daily basis. I worry like hell about something that has or hasn't happened and probably will never happen...and then I get depressed. It's a slippery slope of misery that makes me wonder. What comes first? The chicken or the egg? The anxiety or the depression?

My former therapist (she moved to the West Coast) taught me some techniques to deal with the runaway thoughts of negativity and despair. She taught me to take a deep breath, close my eyes and envision a stop sign in intimate detail...the exact color of red, the lettering of the word STOP. It works sometimes, sometimes it doesn't.

My current therapist, who is brilliant at helping me with these cognitive therapy techniques, has encouraged more of the same and taught me to reign in those maddening episodes of anxiety, to gently put the brakes on the runaway train that is my brain—without skidding off the highway. Sometimes it works, sometimes it doesn't.

That's because changing our behavior, our thoughts that control our feelings, isn't easy.

Do you suffer from anxiety? If so, ask for help. For me, the combination of talk therapy, drugs (Abilify, Cymbalta and generic Valium as needed) has helped immensely from that dark, deep pit I felt helplessly trapped in not so long ago.

I am no doctor and no expert. I only know that asking for helping, taking deep breaths and thinking about stop signs is a good start. Maybe if I can keep sharpening those skills, the depressions that come won't be quite so dark, quite so deep and quite so long.

September 18, 2011

If you don’t feel sexy, go for a walk

The doctor told me to do two things to cure my depression. 1.Get up and get moving and 2. Tell my wife we need to have more sex.

That was the advice given to me by an internist a couple years ago, when I was mired in the muck of depression.

I came away thinking two things. If you suffer from depression, you need to see a specialist. And second, that doctor has not been married for very long.

Those of us who deal with depression know how hard it is to get off the couch some days, much less run off to Zumba class. They know that depressed people don’t exactly feel sexy. And our significant others sure as hell don’t feel attracted to us when we can barely muster a smile.

I’m learning that doctor isn’t all wrong, though. I remember when walking to the mailbox felt like a victory after a “sick” day in the bed. When I don’t feel like running, a hobby I enjoy when I’m not bluesing, a brisk walk down the street and back relieves the pain of depression, at least for a little while. HERE'S WHY

If I can force myself to go for a run and suffer through the first mile, the payoff can be huge. Exercising seems to do even more for anxiety, providing somewhere for those random running thoughts to escape.

As for sex, well, it’s pretty good for depression, too. Or so I hear.

September 14, 2011

To Hell and Back

We were standing atop a mountain, at one of the prettiest places in Georgia, when I grabbed my big brother's arm and fell to my knees.

"I can't do it," I cried out, sobbing.

My children and their cousins were close by, but I couldn't help it. I wept uncontrollably. This was it. The worst moment of my life.

But why?

I have a beautiful wife. Three beautiful children. A great job. So what the hell is wrong with me? Why so much darkness and pain—real, physical, gut-wrenching pain?

I didn't care "why" that day. I only knew that it was time to surrender. Time to declare that depression had defeated me that day. Time to admit that the anxiety, the racing, jumbled thoughts that made my life a nightmare were much too much to bear alone.

We sent my children away that day, one week after the doctor instructed me to turn over my meds to my wife for fear that I might hurt myself.

It would get better. It had to. How could it get any worse?

I leaned on the arms of my family, my wife, brother and mother, and gave up. Right then and there I gave up and told them I couldn't do it alone. I was sick of being sick, so sick of it that I didn't care what the strangers looking on thought. Didn't really even care that my children saw me in such a pathetic, miserable state. I had to get help. For them. For me.

Three days later, I entered a partial hospitalization program in Birmingham, Alabama. New drugs coursing through my blood and pumping chemicals into my brain, I found my bottom. I learned that my thoughts control my feelings.

I learned that my family history wasn't my fault. I felt like Beniah of Biblical times... I had slipped into a snowy pit with a lion for the fight of my life. This time, I would not stop until the lion is dead.

I had lost 30 pounds without really trying. Left one career and started another. Nearly lost my wife, or so I thought.

This time, with God's help, will be different. I will stand up and fight, even when I don't feel like getting out of bed.

Thousands of dollars and numerous therapy sessions later, I am still standing, still fighting. I won't give up.

I am a writer by trade, but writing this blog is the hardest thing I have ever done.

My hope and prayer is this little blog will help someone else. Southern men like me can't admit when we are weak, when we can't do it alone. It's time for that to change.