Evolution Could Explain Why Psychotherapy May Work for Depression – Scientific American

Source: Evolution Could Explain Why Psychotherapy May Work for Depression – Scientific American

Persistent rumination may be an attribute that lets us think our way out of despair—a process enhanced through talk therapy

Evolution Could Explain Why Psychotherapy May Work for Depression
Credit: Malte Mueller Getty Images

A consensus has emerged in recent years that psychotherapies—in particular, cognitive behavioral therapy (CBT)—rate comparably to medications such as Prozac and Lexapro as treatments for depression. Either option, or the two together, may at times alleviate the mood disorder. In looking more closely at both treatments, CBT—which delves into dysfunctional thinking patterns—may have a benefit that could make it the better choice for a patient.

The reason may be rooted in our deep evolutionary past. Scholars suggest humans may become depressed to help us focus attention on a problem that might cause someone to fall out of step with family, friends, clan or the larger society—an outcast status that, especially in Paleolithic times, would have meant an all-but-certain tragic fate. Depression, by this account, came about as a mood state to make us think long and hard about behaviors that may have caused us to become despondent because some issue in our lives is socially problematic.

A recent article in American Psychologist, the flagship publication of the American Psychological Association, weighs what the possible evolutionary origins of depression might mean for arguments about the merits of psychotherapy versus antidepressants. In the article, Steven D. Hollon, a professor of psychology at Vanderbilt University, explores the implications of helping a patient come to grips with the underlying causes of a depression—which is the goal of CBT, and is also in line with an evolutionary explanation. The anodyne effects of an antidepressant, by contrast, may divert a patient from engaging in the reflective process for which depression evolved—a reason perhaps that psychotherapy appears to produce a more enduring effect than antidepressants.  Scientific American spoke with Hollon about his ideas on the topic.

[An edited transcript of the interview follows].

You described in your recent article the idea that humans evolved a propensity toward depression as a means to restore emotional and psychological equilibrium. That allows people to stay well integrated within their social milieus. So, can you explain how depression may be a product of evolution that can actually protect us?

In the late 2000s, I read a paper by the evolutionary biologist Paul Andrews. It was masterful, very thoughtful—and I totally disagreed with it. The main premise was that depression was an evolved adaptation that serves to make people ruminate.

Why did you disagree?

For clinicians, we think of rumination as a terrible thing that at best is a symptom of depression and at worst leads to something that deepens the depression. We’ve always thought of it as a kind of exhaust out the tailpipe that is not really helpful.

But the work of Andrews and his colleague J. Andrew (Andy) Thomson recounted that in our evolutionary past, what got you depressed was some kind of major problem—probably a social problem—that might get you excluded from the tribe. And what you had to do is sit down and think about things.

Most of us can think of anxiety as being a useful function, because anxiety takes us away from danger. It’s quick, it’s rapid, the reaction that occurs after stepping on a snake that might be poisonous when you’re out in the woods. But most folks don’t think of depression as having any function. It’s just something unpleasant. The trick is to figure out what the purpose of depression is—and when Andrews and Thomson looked at what goes on when you get depressed, they found that a lot of energy went to the brain.

And the reason for that is to help us to think more carefully about the things that are going wrong, and first to understand what’s the cause. That answers the question: How come I’m feeling so bad? And the second thing is: How can I do a good job of figuring out a solution to a problem?

So, you don’t have to move rapidly in depression; the bad thing has already happened. You don’t have to get out of the way of a poisonous snake or a leopard. But you do have to solve some kind of complex social problem, and rumination is what gets you there. So as opposed to being an unpleasant byproduct of being depressed, rumination is actually the reason why depression evolved. And it helps you solve complex social problems.

You seem to now be giving some credence to the ideas of Andrews and Thomson. How does this line of thinking actually play out in people’s lives? At what point does depression and the social problems that need to be ruminated upon begin?

These complex social problems often gear up in adolescence when young people start to ask: Am I going to have a boyfriend and girlfriend? How do I get a boy or girl to like me? Am I going to do okay in school? Are my parents happy with me? Am I going to get to go to college? Will I be able to find a job?

How does your expertise in psychotherapy—and specifically cognitive behavioral therapy—jibe with the evolutionary theory of depression?

Cognitive therapy in this context becomes a bit of a natural. It teaches people how to ruminate more effectively. Cognitive theory holds that people got depressed because they hold inaccurate beliefs about themselves. This can be combined with the additional notion that people can get stuck. For example, if something bad happens, you start thinking that you’re a failure, you’re a loser. For most people, depression motivates them to think more deliberately about the causes of their problems and the solutions they can apply. In most instances in our ancestral past this worked well enough; most depressions remit spontaneously even in the absence of treatment. Cognitive therapy, at the least, hurries the process along and, at the most, helps unstick that subset of individuals who get stuck making negative ascriptions about themselves, typically about personal competence or lovability.

The solution is to essentially teach them the scientific method so they get unstuck. We ask a patient to ask themselves: what do you think is the cause of the problem? What other explanations could there be? What’s the evidence supporting one or the other? And especially we encourage patients who get stuck to pit what are called their stable trait theories—“I am incompetent” or “I am unlovable”— against a more behavioral explanation: “I chose the wrong strategies.”

One area that you’ve worked on is whether CBT has a more enduring effect than drugs, and you’re interested in how that might provide evidence for the evolutionary basis for depression.

Basically, we have good clinical evidence that cognitive therapy is at least as effective as medications in the short run, and more enduring in the long run. CBT may get people thinking carefully about their problems in a way that facilitates coming to a resolution, whereas medications may just anesthetize the stress that underlies a depression.

Are you going to test that idea in some way?

I’ve got colleagues in Vietnam, where they’re quite interested in a study we want to do in which we compare folks treated to recovery with CBT versus folks treated to recovery with medication—and compare those against a control that uses Chinese herbal medicine, which is widely believed there to be effective. And if it’s really the case that antidepressant medications suppress symptoms in a way that worsens the underlying course of depression, then those patients should be more likely to have recurrences when we take them off the medications than when we take them off the Chinese herbal medicine. If it’s really true that CBT truly has an enduring effect that protects against depression, then patients treated to recovery should be less likely to recur following treatment termination than patients who recover on Chinese herbal medicine. In essence, the Chinese herbal medicine serves as an ideal nonspecific control because it provides neither the coping skills taught in cognitive therapy nor the pharmacologically active serotonin-related ingredient provided by antidepressant medications. We have a trial that we want to do that should answer the question, but it hasn’t yet been done.

Doesn’t some evidence exist along these lines already, though?

There are over half a dozen studies that indicate that patients treated to remission with cognitive therapy are less likely to relapse following treatment termination than patients treated to remission with antidepressant medications—and a pair of studies that suggest that this enduring effect may extend to the prevention of recurrence. What we do not know is where all this fits within the proposed evolutionary context: whether cognitive therapy has an enduring effect, or antidepressant medications may be detrimental in terms of prolonging the life of the underlying episode—as evolutionary theory suggests. What is needed is a nonspecific control that neither has enduring effects or the anesthetizing effects caused by the medication. Whether cognitive therapy truly has an enduring effect, or antidepressant medications have a detrimental effect, remains to be determined. The comparison of each to a nonspecific control like Chinese herbal medicine should allow us to determine in absolute terms which is which.

You’ve talked about the difficulties in trying to measure whether there really are enduring effects in this type of trial.

It also is possible that the enduring effects observed for cognitive therapy (relative to antidepressant medications) have to do with changes that occur during the course of a clinical trial. Although we randomize patients to cognitive therapy versus antidepressant medications at the outset of the trial, we typically lose about 15 percent of the sample because of attrition, and another 25 percent as a nonresponse to either intervention. That means that only about 60 percent of the sample initially randomized makes it into the comparison of subsequent rates of relapse. If different kinds of patients remit to cognitive therapy than to antidepressant medications, that could bias any subsequent comparisons.

Do you think that these insights about CBT could have an impact for severe depression?

I don’t know, and wouldn’t necessarily assume that they would. For psychotic depression, you’d go to electroconvulsive therapy first. I’m not sure that the analytical rumination hypothesis will apply to psychotic depressions, or that it needs to. For every evolved adaptation there are instances in which the mechanism evolved breaks down and the condition can be considered to be an actual disease or disorder.


We’ve Got Depression All Wrong. It’s Trying to Save Us. | Psychology Today Canada

I really like this vision of depression.


Source: We’ve Got Depression All Wrong. It’s Trying to Save Us. | Psychology Today Canada

New theories recognize depression as part of a biological survival strategy.

Posted Dec 22, 2020

For generations, we have seen depression as an illness, an unnecessary deviation from normal functioning. It’s an idea that makes sense because depression causes suffering and even death. But what if we’ve got it all wrong? What if depression is not an aberration at all, but an important part of our biological defense system?

Depression is a courageous biological strategy to help us survive.
Source: ActionVance/Unsplash

More and more researchers across specialties are questioning our current definitions of depression. Biological anthropologists have argued that depression is an adaptive response to adversity and not a mental disorder. In October, the British Psychological Society published a new report on depression, stating that “depression is best thought of as an experience, or set of experiences, rather than as a disease.” And neuroscientists are focusing on the role of the autonomic nervous system (ANS) in depression. According to the Polyvagal Theory of the ANS, depression is part of a biological defense strategy meant to help us survive.

The common wisdom is that depression starts in the mind with distorted thinking. That leads to “psychosomatic” symptoms like headaches, stomachaches, or fatigue. Now, models like the Polyvagal Theory suggest that we’ve got it backward. It’s the body that detects danger and initiates a defense strategy meant to help us survive. That biological strategy is called immobilization, and it manifests in the mind and the body with a set of symptoms we call depression.

When we think of depression as irrational and unnecessary suffering, we stigmatize people and rob them of hope. But when we begin to understand that depression, at least initially, happens for a good reason we lift the shame. People with depression are courageous survivors, not damaged invalids.

Laura believes that depression saved her life. Most of the time her father only hurt her with words, but it was when she stood up to him that Laura’s dad got dangerous. That’s when he’d get that vicious look in his eyes. More than once his violence had put Laura’s life at risk.

Laura’s father was so perceptive, that he could tell when she felt rebellious on the inside even when she was hiding it. And he punished her for those feelings.

It was the depression that helped Laura survive. Depression kept her head down, kept her from resisting, helped her accept the unacceptable. Depression numbed her rebellious feelings. Laura grew up at a time where there was no one to tell, nowhere for her to get help outside her home. Her only strategy was to survive in place. And she did.

Looking back, Laura does not regret her childhood depression. She values it. Going through her own healing process and working with her therapist helped her see how depression served her.

Laura’s story is stark. It’s ugly. And it helps us understand that even though depression may happen for a good reason, that does not make it a good thing. Laura suffered deeply and describes the pain of her hopelessness vividly. Her depression was a bad experience that started as the last resort of a good biological system.

Depression Starts with Immobilization

According to the Polyvagal Theory, discovered and articulated by neuroscientist Stephen Porges, our daily experience is based on a hierarchy of states in the autonomic nervous system. When the ANS feels safe, we experience a sense of well-being and social connection. That’s when we feel like ourselves.

But the autonomic nervous system is also constantly scanning our internal and external environment for signs of danger. If our ANS detects a threat or even a simple lack of safety, its next strategy is the fight or flight response which we often feel as anxiety.

Sometimes the threat is so bad or goes on for so long, that the nervous system decides there is no way to fight or to flee. At that point, there is only one option left: immobilization.

The immobilization response is the original biological defense in higher animals. This is the shutdown response we see in reptiles. Also known as the freeze or faint response, immobilization is mediated by the dorsal vagus nerve. It turns down the metabolism to a resting state, which often makes people feel faint or sluggish.

Owlie Harring/Unsplash
The immobilization response dulls pain.
Source: Owlie Harring/Unsplash

Immobilization has an important role. It dulls pain and makes us feel disconnected. Think of a rabbit hanging limply in the fox’s mouth: that rabbit is shutting down so it won’t suffer too badly when the fox eats it. And the immobilization response also has a metabolic effect, slowing the metabolism and switching the body to ketosis. Some doctors speculate that this metabolic state could help healing in severe illness.

In humans, people often describe feeling “out of their bodies” during traumatic events, which has a defensive effect of cushioning the emotional shock. This is important because some things are so terrible, we don’t want people to be fully present when they happen.

So the immobilization response is a key part of the biological defense, but it is ideally designed to be short term. Either the metabolic shut down preserves the organism, i.e. the rabbit gets away, or the organism dies and the fox eats the rabbit.

But if the threat continues indefinitely and there is no way to fight or flee, the immobilization response continues. And since the response also changes brain activity, it impacts how people’s emotions and their ability to solve problems. People feel like they can’t get moving physically or mentally, they feel hopeless and helpless. That’s depression.

Does Depression Have Value?

It’s easy to see why Laura’s childhood circumstances would set off the immobilization response, and even how it might have helped her survive. But why does it happen in people with less obvious adversity? Our culture tends to think of depression in the person who finds work too stressful as a sign of weakness. Self-help articles imply that they just need more mental toughness and they could lean in and solve it. Even some therapists tell them that their depression is a distorted perception of circumstances that aren’t so bad.

But that is not how the body sees it. The defense responses in the autonomic nervous system, whether fight/flight or immobilization are not about the actual nature of the trigger. They are about whether this body decides there is a threat. And that happens at a pre-conscious point. The biological threat response starts before we think about it, and then our higher-level brain makes up a story to explain it. We don’t get to choose this response; it happens before we even know it.

Studying anxiety has revealed that many modern circumstances can set off the fight or flight response. For instance, low rumbling noises from construction equipment sound to the nervous system like the growl of a large predator. Better run. Feeling like they are being evaluated at school removes kids’ sense of safety and triggers fight-or-flight. Better give the teacher attitude or avoid homework. And to most of us, fight-or=flight feels like anxiety.

Eventually, if these modern triggers last long enough, the body decides it can’t get away. Next comes immobilization which the body triggers to defend us. According to Porges, what we call depression is the cluster of emotional and cognitive symptoms that sits on top of a physiological platform in the immobilization response. It’s a strategy meant to help us survive; the body is trying to save us. Depression happens for a fundamentally good reason.

And that changes everything. When people who are depressed learn that they are not damaged, but have a good biological system that is trying to help them survive, they begin to see themselves differently. After all, depression is notorious for the feelings of hopelessness and helplessness. But if depression is an active defense strategy, people may recognize they are not quite so helpless as they thought.

Shifting Out of Immobilization

If depression is the emotional expression of the immobilization response, then the solution is to move out of that state of defense. Porges believes it is not enough to simply remove the threat. Rather, the nervous system has to detect robust signals of safety to bring the social state back online. The best way to do that? Social connection.

One of the symptoms of depression is shame, a sense of having let other people down or being unworthy to be with them. When people are told that depression is an aberration, we are telling them that they are not part of the tribe. They are not right, they don’t belong. That’s when their shame deepens and they avoid social connection. We have cut them off from the path that leads them out of depression.

It is time that we start honoring the courage and strength of depressed people. It is time we start valuing the incredible capacity of our biology to find a way in hard times. And it is time that we stop pretending depressed people are any different than anyone else.

Why self-compassion – not self-esteem – leads to success – BBC Worklife

Source: Why self-compassion – not self-esteem – leads to success – BBC Worklife

(Credit: Alamy)
By David Robson
13th January 2021
Talking about being kind to yourself may sound like something from a nursery classroom. But even cynics should care about self-compassion – especially if they want to be resilient.

Think back to the last time you failed or made an important mistake. Do you still blush with shame, and scold yourself for having been so stupid or selfish? Do you tend to feel alone in that failure, as if you were the only person to have erred? Or do you accept that error is a part of being human, and try to talk to yourself with care and tenderness?

For many people, the most harshly judgemental responses are the most natural. Indeed, we may even take pride in being hard on ourselves as a sign of our ambition and resolution to be our best possible self. But a wealth of research shows that self-criticism often backfires – badly. Besides increasing our unhappiness and stress levels, it can increase procrastination, and makes us even less able to achieve our goals in the future.

Instead of chastising ourselves, we should practice self-compassion: greater forgiveness of our mistakes, and a deliberate effort to take care of ourselves throughout times of disappointment or embarrassment. “Most of us have a good friend in our lives, who is kind of unconditionally supportive,” says Kristin Neff, an associate professor of educational psychology at the University of Texas at Austin, who has pioneered this research. “Self-compassion is learning to be that same warm, supportive friend to yourself.”

If you are a cynic, you may initially baulk at the idea. As the British comedian Ruby Wax wrote in her book on mindfulness: “When I hear of people being kind to themselves, I picture the types who light scented candles in their bathrooms and sink into a tub of Himalayan foetal yak milk.” Yet the scientific evidence suggests it can increase our emotional resilience and improve our health, wellbeing and productivity. Importantly, it also helps us to learn from the mistakes that caused our upset in the first place.
We all make errors, but self-compassion can help us forgive ourselves and take better care during disappointment and embarrassment (Credit: Alamy)

We all make errors, but self-compassion can help us forgive ourselves and take better care during disappointment and embarrassment (Credit: Alamy)

Relying on self-compassion, not self-esteem

Neff’s research was inspired by a personal crisis. In the late 90s, she was going through a painful divorce. “It was very messy, and I felt a lot of shame about some bad decisions I had made.” Looking for a way to cope with the stress, she signed up for meditation classes at a local Buddhist centre. The practice of mindfulness did indeed bring some relief, but it was their teachings about compassion – particularly, the need to direct that kindness toward ourselves – that brought the greatest comfort. “It just made an immediate difference,” she says.

Superficially, self-compassion may sound similar to the concept of ‘self-esteem’, which concerns how much we value ourselves, and whether we see ourselves positively. Questionnaires to measure self-esteem ask participants to rate statements such as, “I feel that I’m a person of worth, at least on an equal plane with others”.

Unfortunately, this often comes with a sense of competition, and it can easily result in a kind of fragile narcissism that crumbles under potential failure. “Self-esteem is contingent on success and people liking you, so it is not very stable – you could have it on a good day but lose it on a bad day,” says Neff. Many people with high self-esteem even resort to aggression and bullying when their confidence is under threat.

A wealth of research shows that self-criticism often backfires – badly

Cultivating self-compassion, Neff realised, might help you avoid those traps, so that you can pick yourself up when you feel hurt, embarrassed or ashamed – without taking down others along the way. So, she decided to design a psychological scale to measure the trait, in which participants had to rate a series of statements on a scale of 1 (almost never) to 5 (almost always), such as:

I try to be loving toward myself when I’m feeling emotional pain
I try to see my failings as part of the human condition
When something painful happens, I try to take a balanced view of the situation


I’m disapproving and judgmental about my own flaws and inadequacies
When I think about my inadequacies it tends to make me feel more separate and cut off from the rest of the world
When I’m feeling down, I tend to obsess and fixate on everything that’s wrong

The more you agree with the first set of statements, and the less you agree with the second set of statements, the higher your self-compassion.

Neff’s first studies examined how self-compassion related to people’s overall mental health and wellbeing. Questioning hundreds of undergraduate students, she found the trait was negatively correlated with reports of depression and anxiety, and positively correlated with general life satisfaction. Importantly, this study also confirmed that self-compassion was distinct from measures of self-esteem. In other words, you could have someone with a general sense of superiority, who nevertheless finds it very difficult to forgive themselves for perceived failures – a far from ideal combination.
Many think of ‘self-compassion’ as lighting candles, meditating or other notions of ‘self-care’, but self-compassion runs deeper – and even cynics should care (Credit: Alamy)

Many think of ‘self-compassion’ as lighting candles, meditating or other notions of ‘self-care’, but self-compassion runs deeper – and even cynics should care (Credit: Alamy)

Blossoming field

Later research confirmed these discoveries in more diverse samples, from high-school students to US veterans at risk of suicide, all of which showed that self-compassion increases psychological resilience. Indeed, self-compassion has now become a blossoming field of research, attracting interest from many other researchers.

Some of the most intriguing results concern people’s physical health, with a recent study showing that people with high self-compassion are less likely to report a range of different ailments – such as back pain, headache, nausea and respiratory problems. One explanation could be a muted stress response, with previous studies revealing that self-compassion reduces the inflammation that normally comes with mental anguish, and which can damage our tissues in the long term. But the health benefits may also be due to behavioural differences, with evidence that people with higher self-compassion take better care of their bodies through diet and exercise.

People who have higher levels of self-compassion are generally more proactive – Sara Dunne

“People who have higher levels of self-compassion are generally more proactive,” says Sara Dunne, a psychologist who studied the link between self-compassion and healthy behaviours at the University of Derby, UK. She compares it to the advice of a well-meaning parent. “They would tell you that you need to go to bed, get up early and then tackle your problems,” she says. Similarly, someone with high self-compassion knows that they can treat themselves kindly – without overly judgemental criticism – while also recognising what is best for them in the long-term.

This is an important point, says Neff, since some early critics of her work had wondered whether self-compassion would simply lead to lazy behaviour and low willpower. In their view, we need self-criticism to motivate us to make importance changes in our lives. As evidence against this idea, she points to research from 2012, which had found that people with high self-compassion show greater motivation to correct their errors. They tended to work harder after failing an important test, for instance, and were more determined to make up for a perceived moral transgression, such as betraying a friend’s trust. Self-compassion, it seems, can create a sense of safety that allows us to confront our weaknesses and make positive changes in our lives, rather than becoming overly self-defensive or wallowing in a sense of hopelessness.
After making mistakes, many jump to highly self-critical responses, but research shows that cutting yourself a little slack can be the key to resilience (Credit: Alamy)

After making mistakes, many jump to highly self-critical responses, but research shows that cutting yourself a little slack can be the key to resilience (Credit: Alamy)

Rapid interventions

If you would like to gain some of these benefits, there is now abundant evidence – from Neff’s research group and many others – that self-compassion can be trained. Popular interventions include “loving-kindness meditation”, which guides you to focus on feelings of forgiveness and warmth to yourself and others.

In one recent trial, Tobias Krieger and colleagues at the University of Bern in Switzerland designed an online course to teach this exercise alongside more theoretical lessons about the causes of self-criticism and its consequences. After seven sessions, they found significant increases in the participants’ self-compassion scores, along with reduced stress, anxiety and depressive feelings. “We measured a lot of outcomes,” says Krieger, “and they all went in the expected direction.”

There are also written interventions, such as composing a letter from the perspective of a loving friend, that can provide a significant boost, says Neff. For most people, the habit of self-criticism does not seem to be so deeply ingrained that it is beyond repair. (Neff’s website includes more detailed guidelines on the ways to put this and the loving-kindness meditation into practice.)

Neff says that she has seen an increased interest in these techniques during the pandemic. For many of us, the struggles of isolation, remote working and caring for the people we love have provided the perfect breeding ground for self-criticism and doubt. While we cannot eliminate those stresses, we can at least change the ways we view ourselves, giving us the resilience to face the challenges head on.

More than ever, we need to stop seeing self-compassion and self-care as a sign of weakness, says Neff. “The research is really overwhelming at this point, showing that when life gets tough, you want to be self-compassionate. It’s going to make you stronger.”

David Robson is the is author of The Intelligence Trap: Revolutionise Your Thinking and Make Wiser Decisions (Hodder & Stoughton/WW Norton). He is @d_a_robson on Twitter.

BounceBack Ontario – Canadian Mental Health Association, Ontario

Source: BounceBack Ontario – Canadian Mental Health Association, Ontario

Mood and Anxiety | The Royal

Source: Mood and Anxiety | The Royal

The Royal’s Mood and Anxiety Program cares for people with complex and persistent mood and anxiety disorders. This may include:

  • depression (depressive disorders),
  • bipolar disorder and related disorders,
  • anxiety disorders,
  • obsessive-compulsive disorder (OCD) and related disorders,
  • or trauma-and stressor-related disorders.

We treat patients whose mood and anxiety disorders require highly specialized services. We also support community-based mental health care providers through consultation.

The Mood and Anxiety Program specializes in treating patients who do not respond to conventional treatment. This means that the patients we typically see have recurrent or chronic symptoms and have tried multiple treatment options that haven’t worked for them.

Our services

Short-term follow up

Most people who are seen in our program are here for short-term follow up. This usually means specialized mental health professionals at The Royal help clarify a person’s diagnosis and/or provide treatment recommendations. Some people proceed to receive allied health services in the Mood and Anxiety Program, but for most, ongoing care will be provided by their health care providers (i.e. family doctors) outside of The Royal.

Inpatient and outpatient units

For those who need the most specialized care, we provide more intensive treatment options, including outpatient and inpatient services. Our inpatient service is for patients who require intensive and prolonged care.

The outpatient unit works with patients to develop individualized care plans to help them better manage their difficulties, prevent relapse, and ensure they receive proper ongoing care after discharge.

Our philosophy is to approach care as a respectful partnership between the patient and staff, looking at a wide view of the patient’s situation. This translates into treatment that takes in to account your personal story, ideas and feedback.

Our team of professionals has specialized knowledge and expertise in both the medical and psychological aspects of mood and anxiety disorders, as well as social and vocational rehabilitation. Our program also works with family physicians and community mental health agencies as required to make sure that patients receive the best ongoing care.

Our outpatient services may also support patients referred by other hospitals or directly by community psychiatrists or family physicians. The clinic would work as a complement to the patient’s other mental health care provider to help prevent relapse and recurrence.


Referrals to this program need to be completed by a physician or nurse practitioner.

If you are interested in a referral for yourself or a loved one, please contact your physician or nurse practitioner.

If you are a physician or nurse practitioner looking to refer a patient, please visit our referral page to learn more about our inclusion criteria and to access our central intake forms. If you require assistance submitting your referral, please call +1 (613) 722-6521 ext. 6211.

Note to referring physicians and nurse practitioners: Referrals to The Royal’s Mood and Anxiety Program can be submitted electronically directly from your EMR if you have been set up with Ocean eReferral. Ocean eReferral is a regional program that offers an integrated solution at no cost for all primary care providers in Champlain with compatible EMRs (Telus PSS, QHR Accuro, and certain versions of OSCAR). Once set up, referrals can be initiated directly from the patient’s chart in your EMR, launching the appropriate electronic referral form and automatically populating it with much of the appropriate information for the patient and referring clinician. For more information about eReferral, please email: Champlain_eReferral_Team@lhins.on.ca

When Depression Is a Symptom of Buried Anger | Psychology Today

This is a great technique for depresssion through releasing the energy of anger to free the vital self!



Source: When Depression Is a Symptom of Buried Anger | Psychology Today

Trauma was always a word I associated with a catastrophic event: a car accident, a war experience, child abuse, or being a victim of crime. So, it was an “aha” moment to learn that symptoms of trauma, like depression, could be caused by repeated instances of emotional disregard. Childhood emotional neglect comes in many forms and is more common than one would hope.

Below are a few examples of emotional disregard:

  • Rachel, 8 years old, was scared to go to school. Her father repeatedly told her there was nothing to be afraid of and that she shouldn’t be a “scaredy cat.” Dad didn’t ask what she feared or spend any time trying to understand Rachel’s fear from her point of view.
  • Johnny told his mother he hated his little brother and was sorry he was born. The next moment, a hard slap across the face stunned him. Johnny was told never to speak in such a hateful way again.
  • Barb, age 12, kicked the winning goal in soccer. She got in the car riding high with emotions like excitement, joy, and pride in herself for playing a great game. Her mother, instead of matching her enthusiasm with a big proud smile, immediately pointed out the “ugly” red juice stain on her shirt. She was devastated.

When our emotions are invalidated, we experience a crushing insult. And, it evokes anger and even rage, depending on how young we were when the emotional neglect began plus how often it occurred.

David, a former client of mine, grew up with parents who bristled at emotional displays. As a child, when David cried, he was told he had nothing to be sad about or to “chin up!” When David was scared, he was told to stop being such a baby. When he was excited, he was told to cool it. When he was angry at his parents, they got insulted and left him alone. They never asked What’s the matter? How do you feel? or, Are you ok?

David, now 30, showed up in therapy with depression. Blaming himself for his anguish, he described a privileged upbringing with parents who provided well for him. Attending private schools and being given a generous allowance, he was truly grateful to his parents for their gifts.

We soon discovered that part of what led to his depression was the conflict between positive and negative feelings for his parents. He found it hard to validate his emotions. Guilt, an inhibitory emotion on the Change Triangle, left his anger, a core emotion, buried and festering. Most people don’t realize that we can be grateful to our parents for giving us life, financial security, and for making sacrifices, and, at the exact same time, feel angry at them for not meeting our emotional needs. This understanding helps us embrace our complex and conflicting emotional worlds.

As David grew from a teenager to a young adult, his depression got worse. This makes sense because his anger was still suppressed. To squash anger down, the mind enlists inhibitory emotions like anxiety, guilt, and shame, which are effective at keeping anger out of conscious awareness. But they also feel awful and undermine confidence and well-being. Furthermore, the cost of chronically suppressing anger is depression. The energy needed for vital living and outside engagement gets diverted to keeping rage pushed down so that we don’t lose control or lash out.

Healing Depression by Releasing Rage

One effective way to ease and even heal depression is by releasing the enormous burden of our visceral rage. How is this done?

Anger portrayals, a technique common in accelerated experiential dynamic psychotherapy (AEDP), are extremely therapeutic. In a nutshell, anger portrayals guide a person in identifying anger in their body. Anger typically is felt as heat, energy, and tension. Then, by noticing and staying with the physical sensations inherent in the core emotion of anger, impulses and images emerge, like a movie. Allowing the movie to unfold in real time, the person gives themself permission to envision exactly what the anger wants to do to those who hurt them. In this way, anger comes up and out, and symptoms of depression remit.

Sometimes guilty feelings make it hard to validate and fully experience anger. In the beginning, when David first started to connect with his inner rage, another guilty part of him would leap up and stop the anger from coming up: “But they did so much for me. I’m so grateful for all the good things they did.”

There’s so much emphasis on gratitude these days that it is important to know that we can hold opposite and conflicting truths at the same time. “David,” I said during one session, “let’s fully validate the gratitude and love you have for your parents, and, for just right now, can we ask for the gratitude, love, and any other feelings you have to step back while we tend to the anger inside?”

Rage portrayals work because, as research shows, when it comes to processing emotions, the brain doesn’t really know the difference between fantasy and reality. Imagining what our rage wants to do and then carrying that out in fantasy allows the energy of the rage to come up and out. No longer are forces required to hold down that anger, so energy becomes available again for vital living. The best part about anger portrayals is that no one gets hurt because it’s all happening in imagination.

Depression is the beginning of a story, not the end. It is a symptom that tells us that something deep inside needs tending, be it anger, fear, sadness, or more. And when we tend to ourselves and our deepest truths, we recover stronger and wiser. We no longer need to fear our emotions but can use them along with our logic and reason to meet life’s challenges in the direction of our deepest wants and needs.

Patient details have been changed to protect confidentiality.

The Epidemic of Covert Male Depression | Psychology Today Canada

Source: The Epidemic of Covert Male Depression | Psychology Today Canada

Show me a mad guy, and I’ll show you a sad guy…

For the most part, men have two speeds — neutral and pissed. Experience demonstrates that the state of rage that plagues the majority of the male population is driven less by genuine anger and more by what might be characterize as covert depression manifesting as anger.

Covert depression doesn’t look like the depression with which we are generally familiar, especially to the people around a man who is in the throes of this particular emotional upheaval. Instead, what the people around us tend to witness is subtle irritation, road rage, explosive arguments, passive-aggression, slovenliness, self-sabotage supported by a failure to follow through and/or a faint sense of insecurity that leads to all kinds of shortcomings in performance — at work, at home, within society at large or even in the bedroom.

“Why anger”, you ask? I like to call anger the First Feeling because it goes straight to the root of the aggression that drives our instinct for survival. Because men are not great at filtering and expressing emotions or feelings, we typically express, or more properly act out, our experience of emotion as anger. The whole male dynamic of emotional experience–feeling, reaction and anger–occurs at a very primal and instinctual level. Men are, in some ways, hardwired for rage – it keeps us sharp. Problem …there are no more saber-toothed tigers with which to contend; the mechanism is obsolete.

For men, the key to deflecting this circumstance is recognizing and acknowledging our emotions. We do this by dissecting rage. Here’s an example: when you get cut off on the highway, you become angry. The reason that you become angry is because someone, in your mind (read: feelings), has compromised your safety, or crossed your boundaries. On the other hand, when your boss chews you out you become angry because you may feel his accusations are unfounded, or you feel disrespected or unappreciated, or you’re anxious about losing your job.

In both situations detailed above you experience anger, but the motivation for that anger is different in each situation. Learning to look at the experience of anger and recognize the underlying feelings and emotions, then expressing those emotions and feelings in a productive manner, diffuses the anger.

As this diffusion begins to happen, the covert depression that ultimately drives our general sense of anger and annoyance starts to take shape as a lack of fulfillment, or disappointment over broken dreams, or anxiety about being able to provide for our family, or performance at work or being a good husband or partner.

It’s not really necessary to understand the why or the how of our human condition or our social circumstances. It’s more important, once we’ve recognized what that circumstance is, to ask the question, “What next?”. I was in an airport a few months ago and saw an advertisement for what I believe was an investment firm. It was a picture of Tiger Woods standing in the rough and tall grass up to his knees. Hand drawn into the picture was a vertical arrow with a break in the line; the small piece at the bottom had a label that said, “10% what you did” — at the top, the label said, “90% what you do”.

In the case of covert depression, emotional success does not rely on the why and how, but more upon what we do next. Tiger Woods lifting the ball out of the rough and onto the green is a metaphor for men lifting ourselves out of our covert depression by both finding and feeling our feelings.

Deconstructing our state of rage leads us to a place where we can drill down into that underlying covert depression that is driven by the subtle sense of “less than” that is visited upon us. This leads to a deconstruction of the depression, and that provides a context for working through the issues that are driving the depression in the first place.

© 2008 Michael J. Formica, All Rights Reserved

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10 Signs of Walking Depression


This is Part 1 in a series on depression in creatives.

Part 2: 10 Ways to Walk Away from Depression
Part 3: When Medication Isn’t Enough: Rethinking Depression with Eric Maisel

Note: I wrote this article to raise awareness of low-grade depression, which many people don’t recognize in themselves. I am an author and creativity coach, so I wrote it particularly for writers and artists, but these signs could apply to anyone ~ I believe we are all creative in one way or another.

There are many causes of depression; in my work I focus on people’s needs to create art and to make meaning, and on how to deal with the depression that arises when those needs go unmet for whatever reason.

Let’s play a little word association.

When I say someone is DEPRESSED, what comes to mind?

You might think of someone who:

  • Looks or acts sad most of the time
  • Cries often
  • Can’t feel any emotions (positive or negative)
  • Can’t get out of bed or leave the house
  • Can’t work
  • Can’t take care of themselves or others
  • Thinks or talks about suicide

That’s what severe depression can look like, and it’s a terrible and potentially deadly illness. Most people would notice those signs, realize something was wrong, and hopefully get some help.

But depression has many different faces and manifestations.

I was one of the walking depressed. Some of my clients are too.

We have many of the symptoms of clinical depression, but we are still functioning.

On the surface, people might not know anything is wrong. We keep working, keep going to school, keep looking after our families.

But we’re doing it all while profoundly unhappy. Depression is negatively impacting our lives and relationships and impairing our abilities.

Our depression may not be completely disabling, but it’s real.

10 Signs of Walking Depression

“I once read that succumbing to depression doesn’t mean you are weak, but that you have been trying to be strong for too long, which is maybe a form of denial. So much of life happens somewhere in between being okay and complete breakdown—that’s where many of us live, and doing so requires strength.” ~ novelist Matthew Quick

Walking depression can be hard to recognize because it doesn’t fit the more common picture of severe depression. But it can be just as dangerous to our well-being when left unacknowledged.

This list isn’t meant to be exhaustive or to diagnose anyone. But these are some of the signs I’ve observed in myself and those I’ve coached:

Nothing is fun. You root around for something to look forward to and come up empty.

You can’t find flow. Working on your creative projects feels like a grind, but you keep plodding away. There is research that shows that neuroticism (the tendency toward negative moods) is associated with lower rates of flow.

Your energy is low. Maybe you’re not getting enough rest because you’re too anxious to sleep, or you’re trying to cram too many tasks into a day, or you’re punishing yourself by staying up. Whatever the reason, you are effin’ tired.

You feel worse in the morning and better at night. I remember explaining this to a friend, who found it mystifying. In the morning I felt the crushing weight of all the things I had to do that day. In the evening I was temporarily free from expectations and could enjoy a moment’s respite.

You have simmering resentment toward others. Sure, you’re still doing what everybody asks of you, but you stew in anger the whole time. You are jealous of and bitter toward people who look happier than you feel.

Your self-talk gets caustic. You say nasty things in an effort to shock yourself into action. You use shame as a motivator.

You feel distanced from people around you. It’s hard to have genuine, intimate conversations because you have to keep up this front that you are alright.

You deprive yourself of creative work time (the artist as sadomasochist). This helps you exert some control and stirs up feelings of suffering that are perversely pleasurable. Also, taking on new projects that prevent you from writing or making art lets you prove to yourself that you’re still strong and capable.

Jen Lee has coined the term Dutiful Creatives to describe those who are inclined to take care of their responsibilities before anything else.

“If life were a meal, you’d consider your creativity as the dessert, and always strive to eat your vegetables first. Pacing and knowing how to say No are your strengths, but your creativity is more essential to your well-being than you realize.” from Jen Lee’s Quiz: What Kind of Creative Are You

You notice a significant mood change when you have caffeine or alcohol. A cup of coffee might make you feel a lot more revved-up and optimistic. A glass of wine might make you feel really mellow and even ~ gasp! ~ happy. (That’s how I finally realized that I was depressed.)

You feel like you’re wasting your life. Some people have a high sensitivity to the inherent meaning in what we do. Creativity coach Eric Maisel calls this our “existential intelligence.” If our daily activities don’t carry enough significance ~ if they don’t feel like a worthwhile use of our talents and passions ~ then soon we are asking ourselves, “What’s the point? Why should I keep going?”

(Eric Maisel has published a book called Rethinking Depression, which I talk to him about in this post, When Medication Isn’t Enough.)

Why is it hard to admit that you have walking depression?

You may recognize many of these signs in your life but still be slow to admit that you are depressed. Why is that?

Because it feels presumptuous to put yourself in that category when you’re still getting by. You feel like it would be insulting to those who are much worse off than you. You may feel like you have no real reason to be depressed.

Because your pride and your identity take a hit. You have to admit vulnerability and allow that you are not the all-conquering superhero you thought you were.

Because you realize that you and your life need to change, which feels like more work piled on your plate.

Because you are admitting your own responsibility for your unhappiness and that can trigger self-judgment.

Because you might uncover grief or anger at those around you for not seeing and taking better care of you.

What to do, what to do?

I’ve posted another entry about how creatives heal from walking depression, and here are the highlights:

  • Rest.
  • Make use of medication and other physical treatments.
  • Do therapy.
  • Practice gratitude.
  • Make connections.
  • Reduce your responsibilities.
  • Spend time creating.
  • Change your thoughts.
  • Develop a meaning practice.
  • Change your life.

These steps are simple to say, not easy to do, so make sure you get as much support as you can.

Important: If you are in dire straits, please contact your doctor or visit the International Suicide Prevention Wiki to find a hotline near you.

11 Things Only Someone On Antidepressants Understands | Prevention

It’s time to stop treating antidepressants differently than medication for physical ailments.

Source: 11 Things Only Someone On Antidepressants Understands | Prevention

  November 30, 2015

facts about antidepressants
Linda Braucht/Getty
There’s a spin class I like here in New York City, and the instructor happens to have diabetes. Periodically in the middle of class—sometimes barely even slowing her pedaling feet—she’ll check her blood sugar with a quick prick of her fingertip. Occasionally she’ll explain herself before or after class. Other times, no explanation necessary. I’m sure others like me who have worked out with her more than a few times hardly notice anymore.
Therapists and doctors and writers like to draw an analogy between the constant vigilance required of people with diabetes and that of people with depression. A person might need to be on insulin for the rest of her life, and there’s no shame in that. Depression, too, the thinking goes, can require lifelong treatment—why should our perception of that medication be any different?

Still, I can’t imagine this spin instructor popping off the cap of a bottle of Zoloft in front of 30 sweaty strangers.

It’s not a perfect analogy: We now know that depression is perhaps infinitely more complicated than the comparatively well understood fix for type 1 diabetes of replacing missing insulin. But it still makes the point so clear it nearly punches you in the stomach: We wouldn’t judge someone for treating a physical illness with medication, so why do we judge someone for doing the same for a mental illness? Diagnosing depression can be just as challenging as treating it. (Do you experience any of these nine surprising depression symptoms?)

I’m confident we’re (slowly) moving away from this stigma, but we’re not quite there yet. Whether it’s because a person on antidepressants doesn’t necessarily “look” sick or because we simply don’t understand the benefits antidepressants have to offer, it’s obvious we need more honest discussion of these meds and whom they work for and how. Considering the most recent data available suggests 11% of Americans over the age of 12 take an antidepressant—and that was in 2008!—we owe them a little more compassion and understanding.

In an attempt to help make things clearer and help us all be even just a little more accepting, here are a few things only people taking antidepressants truly understand.

Antidepressants are not a cure.
Depression is thought to be a noxious combination of genetic, environmental, and psychological factors that leads to profound feelings of sadness, hopelessness, pessimism, irritability, and fatigue, among many other possible symptoms. Antidepressants, the medications most commonly used to treat depression, affect a number of brain chemicals called neurotransmitters, which are thought to be involved in regulating our mood. While meds can make a drastic, sometimes lifesaving improvement in how a person is feeling, antidepressants don’t always mean the end of bad days—or even meh days, for that matter.

Freelance writer Lynn Shattuck, 41, likens antidepressants to her contacts. “I’m super-nearsighted; I need contact lenses to see,” she says. “Antidepressants aren’t a happy pill; they just clear the fog for me. They help clear my vision and enable me to be able to see a little more.”

She’s been on and off meds to help manage depression and anxiety for 2 decades. “My antidepressants are just one tool in my toolbox,” she says. “I don’t think any one thing for someone with depression is necessarily the answer.”

For Rob O’Hare, 34, an actor, comedian, and web producer who also happens to be my dear friend, antidepressants haven’t made negative thoughts vanish, but they’ve helped speed them along. “Without medication, I might feel devastated,” he says, “but with medication, I won’t feel awful, and then the feelings will pass—and that’s actually a drastic improvement!” He was first diagnosed with depression in 2003, and while he recognizes that he still harbors negative thinking patterns, “they have a chance to get better now with medication.”

You don’t have to be on them forever (but you might be).

 It can be tempting to take antidepressants for a month or two, feel like you’ve improved leaps and bounds, and figure you no longer need meds, says psychiatrist Michelle Tricamo, MD, an assistant professor of psychiatry at Weill Cornell Medical College in New York. “That’s not something we want to see,” she cautions. “Just like you want someone to finish the whole course of antibiotics to prevent relapse, we don’t want anyone to prematurely discontinue antidepressants, either.”

Typically, Tricamo says, your doc will want you to be relatively symptom-free for about a year before you talk about stopping the meds, she says, to make sure the changes in how you’re feeing are going to stick. What’s even more important than how long you’ve been on antidepressants is that you don’t try to go off them alone. A doctor can help you expertly taper your dose to wean you off with as few withdrawal effects as possible (we’ll get to more on withdrawal later).

After that weaning period, some people might carry on drug-free. Antidepressants can function like that ever-illusive perfect face wash that clears up your acne after a few weeks and you’re set, O’Hare imagines. “But for someone like me, depression is chronic,” he says. “I just have to manage it.”

If you do stay on them forever, it’s not because you’re addicted.
Shattuck says she was constantly establishing timelines in her head for when she’d be able to ditch antidepressants. It took years for her to come to terms with the fact that she might take them for the rest of her life. “I believe this is part of my genetic makeup and something I need,” she says.

Her attitude is key in understanding long-term antidepressant use: People who benefit from the meds are taking them because they still provide those benefits. There’s no high, and there are no cravings, Tricamo says. Antidepressants can cause withdrawal, which is probably where this misconception came from, she says, but it in no way means you can’t stop using them.

It’s not always an easy decision to start taking them to begin with.

There are critics out there who say antidepressants (and heck, countless other meds) are simply overprescribed. But the process of beginning antidepressants doesn’t start with some haphazardly written prescription. Docs frequently recommend therapy first, Tricamo says, which can result in significant improvements for many people with mild to moderate depression.

When she’s considering who might benefit from meds, Tricamo evaluates how much depression interferes with a person’s daily life. “If adults are unable to get to their jobs or leave their homes or can’t support themselves, these might be times to use a medication,” she says.

Some people still have hangups about starting meds, even if therapy hasn’t helped. “The biggest internal battle was the idea that I should be able to feel better by myself,” Shattuck says. “If I just did enough therapy or herbs or whatever, I could treat myself naturally.” Such defeating self-talk, she says, is a nonstarter because “depression is, in and of itself, a distorted way of thinking,” she says. “It makes it really, really challenging to get yourself out of that on your own.” We wouldn’t suggest that a person with a broken leg should simply pull herself up by her bootstraps.

Tricamo emphasizes the importance of working through these concerns and making the decision to try antidepressants a collaborative one. “They’re the ones taking the medication, after all,” she says of her patients. “You can’t force them, and since you’re not there to give it to them every day, you might not even know if they’re taking it.” Thoroughly explaining the risks and benefits can help a person understand why meds are important and how they might help. “If you don’t get them to buy in to treatment, treatment is going to fail,” she says.

Side effects can be harmless or hellish.

Anyone who has seen one of those horribly cliché staring-out-a-window-while-it’s-raining TV commercials for antidepressants knows that the accompanying long list of potential side effects is equally horrible. Many of them, like weight gain, insomnia, nausea, low libido, delayed or vanished orgasm, and diarrhea, to name just a few, sound entirely unpleasant.

Certain meds come to have a reputation for one side effect or another, but there’s no real way of knowing what you might feel when you start one or how long the side effects will last. Nausea, headaches, or a jittery feeling usually vanish within the first couple of weeks, Tricamo says, but weight gain or a dampened sex drive might be harder to cope with. “Unfortunately, it’s something we can’t really predict.” Side effects aren’t based on the dose of the med or really anything else measurable or adjustable, she says, although they are likely to be worsened by drugs or alcohol. While the unpredictability is certainly frustrating, it shouldn’t be prohibitive. “We can switch antidepressants, and we usually do find one that isn’t so harmful in these ways,” she says.

“It’s kind of a guessing game,” O’Hare says. He ended up in the emergency room after what was likely an allergic reaction to Lexapro when he first tried it in 2003. He’s since tried a handful of others with varying rates of success: Cymbalta and Wellbutrin both made his depressive symptoms worse, he says. Effexor made him feel something he can only explain as “medicated.” He gained weight on Remeron, but describes the experience as feeling like his body was no longer his own. He’s currently feeling some improvements on Prozac and is about to visit his psychiatrist for the first time in a month.

He’s stayed away from any antidepressants thought to mess with libido. He guesses everyone has their own threshold for tolerating different side effects. Some weight gain might not bother one person while it’s a deal-breaker for others, for example. “If a drug was going to diminish my libido, then I just wasn’t going to deal with that,” he says. “Among the drugs I haven’t taken are some I haven’t taken for that reason.”

But you’re not about to become a zombie.
The idea that antidepressants totally change your personality is understandable, Tricamo says, since they are tinkering with your brain. The persistent “I won’t feel anything” fear, however, is unwarranted. “Antidepressants are designed to help you return to your former demeanor,” she says, not transform you into some always-up or totally-out-of-it new you.

MORE: American Women Run On Prozac

“There’s some need to preserve a sense of your own identity or some kind of self-integrity or a version of yourself that being medicated might alter,” O’Hare says of this hesitance some people have to taking antidepressants. Of course, if you do feel like meds are “flattening” you, talk to your doctor, who can likely suggest another option.

There’s usually some trial and error involved before you find the right one.
When Shattuck first started medication, she went on Paxil and had horrible nightmares. Zoloft gave her heart palpitations and sent her anxiety through the roof. But just because one antidepressant makes you, say, sweat profusely, doesn’t mean they all will; it’s worth giving a few a try if nothing feels quite right at first, Tricamo says.

Even if you try one and feel nothing—no uncomfortable or dangerous side effects, but no real improvement either—don’t give up. With dozens on the market, odds are the first one isn’t the right one, O’Hare says, and frankly, it could take years to find one that helps. He was so frustrated by his experience with one drug in 2014 that he decided he wouldn’t try anything for a while. “I didn’t want to go through that hunt,” he says.

The process of starting a new antidepressant over and over again isn’t ideal, but it’s worth it to him. “It’s hard, but when you have major depression, after a while it’s just not worth being unmedicated or untreated anymore,” he says. “It’s so worth it to not feel the way you do when you’re suffering through major depression.”

Stopping or switching can be a Process with a capital P.
If only it were as simple as filling a new prescription. To avoid those aforementioned withdrawal symptoms—which can include anxiety, irritability, dizziness, headaches, muscle aches, and chills—doctors carefully and methodically wean patients off antidepressants when it’s time to stop or change meds. Shattuck says the last time took about a month to gradually taper her dose with her doctor. She felt flu-like fatigue, was more tearful than usual, and had what’s come to be called “brain zaps,” a feeling likened to an electrical current momentarily pulsing through the brain. Some people notice the effects of tapering almost immediately, Tricamo says. Some lucky others have no problems whatsoever.

Yes, yoga, meditation, and getting more sleep can help. That doesn’t mean antidepressants don’t.

Tricamo has a patient whose mother continually tells her she should quit the meds and take up yoga and meditation instead. There’s (probably) nothing wrong with any of the lifestyle tips offered up by your neighbor, your uncle, or that blogger you follow on Pinterest—but that doesn’t mean antidepressants are out. “Maybe she should be doing yoga and meditation, but that doesn’t mean she shouldn’t also be taking Zoloft and going to therapy every week,” Tricamo says. In fact, all these tools might work better together, if antidepressants are the “contact lenses” that clear the fog so you can actually get yourself to the yoga class.

MORE: 7 Reasons You’re Tired All The Time

Even if people mean well, this “just try yoga instead!” mentality is rooted in stigma, Tricamo says, against both psychiatric illness and its medical treatments. As long as there’s reason to believe there is a biological basis for mental illness, however, there’s reason to believe there is a biological treatment to go along with it. “If you have asthma and you can’t breathe, are you going to try to just meditate through it?” she asks.

O’Hare does his best to tolerate this kind of advice because he knows his friends mean well. “I’m not about to criticize my friends for whatever bits of helpfulness they’ve thrown my way,” he says. “I’m grateful for any and all of it, even when it is repetitive or bullshit.”

You can maybe even safely take them while pregnant.

Starting or growing a family can be a tricky decision for anyone, but women who use antidepressants have an extra layer of complication to decode. Questions about how antidepressants might affect a developing fetus have long been up for debate, and the most recent news is the meds don’t seem to have lasting cognitive or behavioral effects on children born to moms who use them.

Know what does leave a lasting impact on the lil guys? Moms who are depressed. “My midwives kept saying it’s not just the safety of my unborn baby that we had to consider but my safety and mental health,” Shattuck says. She stayed on antidepressants during both her pregnancies, a decision she calls “the most difficult part of my journey” with depression. Her son, now 6, and her daughter, almost 4, are both healthy. “They didn’t go through any of the scary things you find if you Google ‘antidepressants during pregnancy,’ ” she says with a chuckle. She was wracked with guilt, though, a feeling she doesn’t imagine she would have had if she had needed meds for, says, diabetes at the time. “A lot of people have to take medication during pregnancy for physical ailments,” she says. “I don’t know if I would be as hard on myself as I was about antidepressants.”

Sure, there’s a lot we don’t entirely understand about how they work. But they work.
You’ve likely heard the relatively straightforward theory that depression is caused by an imbalance of the neurotransmitter serotonin in the brain. If that were the case, drugs called selective serotonin reuptake inhibitors (SSRIs), which work by keeping more serotonin available in the brain, would obviously be an easy solution.

Unfortunately, it’s pretty clear today that depression is a much more complicated story than that: Serotonin’s not the only neurotransmitter involved, for starters, and we still don’t entirely know how antidepressants actually work. We know depressed people’s brains look different on imaging tests, but “we don’t necessarily have all the answers from science yet,” Tricamo says.

Whether we prescribe the meds, take them, or know someone who does, we’d probably all be more comfortable if we did have more answers. Antidepressant-bashing critiques range from there are too many people on them who don’t need them to they don’t work at all and patients only benefit from a placebo effect. “There are significant questions we should be asking about who needs antidepressants, why doctors prescribe them, and how the insurance industry approaches mental illness,” Maura Kelly wrote in the Atlantic in 2012. “But that, of course, doesn’t mean that antidepressants are dummy pills that have no real effect; and it’s crucial that depressives—many of whom are suspicious of medication—realize that.”

Shattuck is just glad they’re even an option. “Until really recent history, people didn’t have access to medication that could help them if they had depression,” she says. “I’ve come a long way from thinking, ‘Why can’t I do this on my own?’ to a place where I’m thankful I live in a time where it’s not quite as stigmatized and there’s access to help.”

Netflix series about teen girl’s fictional suicide raises alarm | The Seattle Times

In the month since the popular Netflix show “13 Reasons Why” was released, a rising chorus of mental-health experts, and worried parents, contend that too many of the show’s messages on suicide are inaccurate and potentially dangerous.

As a mom who lost her son to suicide in 2013, a Houston nurse became concerned when she heard about the popular Netflix show “13 Reasons Why.” By then her 15-year-old daughter had already binge-watched it.

In the series, the character Hannah Baker kills herself in despair, leaving audiotapes for the people she holds responsible, among them, her rapist, fickle friends and bullies. The tapes are part justification for her suicide and part vengeful accusation of her peers.

But in the month since the show’s release, a rising chorus of mental-health experts contend that too many of the show’s messages on suicide are inaccurate and potentially dangerous. Superintendents and school counselors around the country have issued warnings to parents that “13 Reasons Why” glorifies suicide and could lead to an increase in copycat behavior and self-harm among vulnerable students.

“We are concerned about our children watching this series without adult supervision because it romanticizes and sensationalizes the idea of suicide,” Lisa Brady, superintendent of schools in Dobbs Ferry, New York, wrote in an email to parents.

Its creators have defended the show, saying they aimed to make the drama helpful to struggling kids.

But for the nurse’s family, the show has been devastating. Her daughter, who found her brother’s body, has been working through depression and trauma ever since. With treatment and regular therapy, things got better — until she watched “13 Reasons Why.” Now the show has set off new thoughts of despair and suicide in her daughter, she said.

“If I’d known about the show beforehand I would have monitored her Netflix account a bit more,” said the nurse, whose name is being withheld to protect her daughter’s privacy. “If kids have a history of depression, self-harm or suicidal thoughts, I don’t think they need to watch it.”

On Friday, in a letter to parents, Robert Avossa, superintendent of Palm Beach County schools in Florida, reported that his employees have seen an uptick in self-mutilation and threats of suicide among elementary- and middle-school students since the show began.

The Netflix series, which may be renewed for a second season, is based on the 2007 young adult novel “Thirteen Reasons Why,” by Jay Asher. It includes a graphic scene in which Hannah kills herself with a razor. Its creators say it’s an unglamorous death, and they worked hard to make sure it wasn’t gratuitous.

Netflix has created an accompanying 30-minute documentary “Beyond the Reasons,” which includes the cast, producers and mental-health experts discussing some of the show’s more difficult scenes. In the documentary, Brian Yorkey, the creator of the series, said, “We did want it to be painful to watch because we wanted it to be very clear that there is nothing — in any way — worthwhile about suicide.”

In a statement, Netflix said the writers sought the advice of medical professionals while writing the script, and the show carries a TV-MA rating as well as a warning about graphic content. “Our members tell us that 13 Reasons Why has helped spark important conversations in their families and communities around the world,” the statement said.

Some parents have defended the show. Dawn Zawadzki, a paralegal from Fort Mill, South Carolina, said she watched part of the series with her 16-year-old daughter.

“Everybody is saying ‘it glamorizes suicide,’ but I don’t think it does,” she said. “It’s making us wake up and look at it.”

Not everyone agrees. Just before its March 31 release, a producer sought the support of the JED Foundation, a teen suicide-prevention group. “I think they were looking for us to say, ‘It was a great educational tool,’ ” or that “they handled the issues in a psychologically helpful way,” said Dr. Victor Schwartz, a psychiatrist and the chief medical officer at the JED Foundation.

Ultimately, he could not support what he called “one long revenge story.” The group issued a guide about the show, advising people who choose to watch it to view it with someone else and to take breaks between episodes rather than binge watch.

“It’s complicated, because they got a lot of important issues out on the table,” Schwartz said. But he’s concerned that students could think of suicide as a way to get back at people and worried that showing the specific way Hannah died would spur imitators. “The missteps are high stakes,” he concluded.

The problem, suicide-prevention experts said, is that even an ugly suicide can beget copycats. Research has shown that “someone else’s death by suicide can reinforce a vulnerable person’s motivation to die by suicide,” said Madelyn Gould, a professor of epidemiology and psychiatry at Columbia University.

On Instagram, Paris Jackson, a 19-year-old model who has tried to kill herself in the past, called the series, “extremely triggering.” “Please only watch this show with caution and keep in mind that it may put you in a dark place,” she wrote in a post that got more than 20,000 likes.

The National Association of School Psychologists has advised teenagers who have had suicidal thoughts to avoid the series entirely. They recommend that any teenager should watch with a parent who can make it clear that suicide is not a solution to problems.

The show’s fatalism leaves the impression that suicide can’t be stopped, experts said. In one concerning scene, a character agonizes that he could have done more to help his friend. A school counselor tells him: “If she wanted to end her life, we weren’t going to stop her.”

The statement runs counter to the advice given to teachers and peers about how to help at-risk teens.

“For kids, that action is staying with your friend, not keeping it a secret, and telling a trusted adult,” said Richard Lieberman, who coordinated suicide prevention for Los Angeles Unified School District for 25 years. Another option is to call the National Suicide Prevention line, 1-800-273-8255, or text HOME to 741741.

David Miller, author of “Child and Adolescent Suicidal Behavior: School-Based Prevention, Assessment, and Intervention,” said that children and adolescents often tell their peers about their suicidal behavior rather than adults. He said, “the way adults are portrayed as incompetent or clueless” is a major problem in “13 Reasons Why,” because he thought it would dissuade students from seeking critical assistance.

Although the creators of “13 Reasons Why” aspired to educate, the show itself never mentions a critical point: most children who die by suicide have a mental-health disorder like depression that is treatable.

26 Pieces of Advice That Have Actually Helped People With Mental Illness

With that expert’s list of ways to manage anxiety, the latest trendy mental health app and that “magical cure for depression” your aunt heard about on TV, it seems like everyone’s full of mental health advice these days.

Source: 26 Pieces of Advice That Have Actually Helped People With Mental Illness

 With that expert’s list of ways to manage anxiety, the latest trendy mental health app and that “magical cure for depression” your aunt heard about on TV, it seems like everyone’s full of mental health advice these days.

So, we asked our mental health community to share pieces of advice they’ve actually found helpful. These little nuggets of wisdom aren’t FDA-approved, but when used correctly side effects may include: self-care, acceptance and a little more patience with yourself.

Here’s some advice that’s actually helped people with mental illness:

1. “On a particularly difficult day, I was trying to fight through an anxiety attack and finish all the child-related tasks I needed to complete. My husband kept offering help, and I kept refusing. He pulled me aside in the laundry room as I was frantically folding another load and said, “Just let me help you.” It doesn’t immediately make the anxiety go away, but it’s helped me learn to let go.” — Maria Heldreth

2. “Don’t wait. See a doctor. Don’t be afraid to ask for help. Don’t be embarrassed. Chances are, someone knows exactly what you’re going through.” — Kristin Salber

3. “I have depression and anxiety (as well as other chronic medical conditions), and after the worst week I’ve had in a while, my doctor  said,“Find something you enjoy, and if you can’t find that, find the joy in something.” This really had an impact on me and still reminds me to look for a silver lining.” — Faith Merryn

Related: To the Husband With the Wife Who Has Depression

4. “I have generalized anxiety disorder, and I made friends with someone who’s extremely similar to me. She told me to always be myself and the people who truly care will stick around. It truly did help.” — Julia Ann Lange

5. “Words can hurt to say, but they need to come out. Write all those words down on paper.” — Melissa Cote

6. “A friend recently told me that no matter if I get a job one day or not,your life matters as long as you can make people smile. When I think of it that way, it’s easier to see my life as something of worth.” — Emma Wozny

7. “A great therapist I had told me to focus on ‘harm-reduction, not perfection.’ I felt like I was expected to magically ‘get better,’ and she helped me learn that starting with baby steps was totally OK.” — Jen Decker

8. “Someone said, ‘I’ve been here, I know a way out, I’m here to show you too.’ And, ‘It gets better, it may not leave, but it gets better. And it has.” — Tom Everman

9. “I have anxiety and major depressive disorder. This is going to sound ridiculous, but my best friend once told me, “When you’re sad, watch ‘The Simpsons.’” It actually works when I’m panicking, too. It gets my mind off whatever I’m obsessing about, and I usually end up laughing.” — Dawn Czarnecki Seshadri

10. “It wasn’t long after my diagnosis that I was told pretty bluntly: ‘This illness is has no cure. You’re going to carry this illness for the rest of your life. So you can either wallow in the weight of that, or you can fight for your only life and make it a good story.’” — Lyss Trayers

11. “My depression and anxiety stem from a traumatic childhood. Just hearing ‘it wasn’t your fault‘ from my psychologist was incredibly helpful.” — Kathrine Elise

12. “Don’t always believe what your brain is telling you.” — Kerri Lewis Brock

Related: 36 Things People With Anxiety Want Their Friends to Know

13. “It’s OK to feel sad. You don’t need to pretend.” — Allyson White

14. “The best advice: Treat yourself as if you were a good friend.”— Julie Jeatran

15. “Celebrate every accomplishment, no matter how small,instead of dwelling on all the things we perceive as failures.” — Jennifer Northrup

16. “I have post-traumatic stress disorder and bipolar disorder. When I was in intensive outpatient therapy, the counselor looked at us and said,‘It’s over. That moment is over. It isn’t going to happen again.’For some reason, that resonated with me.” — Nicole Hanes

17. “They told me this: ‘You are not broken; you are a whole person. You are just human. A human who is living, learning and growing. And learning, living and growing comes with bumps in the road. Remember that this is just a bump.‘” — Kallie Kieffer

18. “Your worst days will only be 24 hours.“ — Arielle Smith

19. “You wouldn’t skip a dialysis or chemotherapy appointment. Your therapy appointments are just as important. No excuses.” — Jennifer Davis

20. “‘I think you need to give therapy a try.‘ Thanks to that, I started therapy and I’m now on the path to recovery.”  — Julianne Leow

21. “Your struggles are your accomplishments in disguise.” — Katherine J Palmer

Related: 14 Things I Didn’t Expect to Learn at a Psychiatric Hospital

22. “Remember: Depression lies. Don’t believe it.” — Beth Brogan

23. “Always ask for help. There is never any shame in asking for help.” — Meghan Shultz

24. “Take life 5 minutes at a time.” — Stephanie Lynn

25. “You can’t give everyone else everything you have. You absolutely have to save a little of yourself for yourself.” — Shawn Henfling

26. I am a human being. Not a human doing. I just have to be.” — Michelle Balck

Answers have been edited and shortened.

By Sarah Schuster

More from The Mighty:

What the Starbucks Barista Didn’t Know When She Wrote ‘Smile’ on My Coffee

31 Secrets of People Who Live With Anxiety

I Have OCD. This Is What It’s Like to Be in My Mind for 3 Minutes.

What makes you happy?

recommended by a client today, so I put

it up here for all to find and use.


What makes you happy?

After I Was Diagnosed With Bipolar Disorder, I Decided to Move Forward

After I Was Diagnosed With Bipolar Disorder, I Decided to Move Forward

Posted: Updated: 

When I was 17 years old, I was diagnosed with Bipolar Disorder, something that came as no surprise, as my life prior to my diagnosis was fraught with behavioral challenges. At 21 years old, after years of battling uncontrollable moods, fits of rage, a myriad of body image issues, addiction and frustration with finding adequate medication I found myself in my first psychotic episode. This was no way to live, I knew I was capable of so much more as an articulate young woman with big dreams. At 5 o’clock in the morning on July 7, 2011, after driving through the night with a head full of racing thoughts in a mind that possessed zero ability to cope, I found myself collapsed on the porch of my father’s home manic, enraged and inconsolable. I was surrendering, I could no longer fight the battle my life prior to that summer had felt so unrelenting and inhibiting. After a brief rest early that morning, the first few hours of sleep I had experienced in days, is when made my decision to thrive. For years prior to that hazy morning, I had been urged by loved ones to receive intensive clinical psychological treatment in a formal setting, but I believe part of me was always resisting in denial and arrogance. It was at the end of my rope where I found my desire to change the trajectory of my life. On July 11, 2011, I made the first imprints in the path toward my new way of being in the world. I spent 90 days in intensive psychological care and healing treatment where I acquired invaluable “tools” that allowed me to move forward in the world, the woman I was on my father’s porch that July morning became a shadow of my former self and an unwelcome stranger in my future.

Almost three years later not a day goes by where I don’t draw on the lessons learned through my decision to thrive. I am currently finishing my Bachelor’s degree in clinical psychology and work as a peer counselor to youth experiencing their first onset of mental illness in Los Angeles, California. Everything I do comes from a place of gratitude for my demons and experiences that catalyzed my decision to forge the path I am on today. For I would be nothing without them just as I would be nothing without the boundless compassion, patience and support of the loved ones in my life who have championed all of my efforts.

I used to think the notion that people could change was a farce … until I did it myself. I am changing everyday, creating a more authentic self with every opportunity to do so, and within the beautiful chaos of it all — I am thriving.

Arianna has invited her Facebook followers to share their wake-up calls — the moments they knew they had to make changes in their lives in order to truly thrive and not just succeed — as part of a series produced in conjunction with the release of her book Thrive: The Third Metric to Redefining Success and Creating a Life of Well-Being, Wisdom, Wonder and Giving. You can read all the posts in the series here.

100 Ways To Motivate Yourself – YouTube

There is a multitude of free videos on YouTube  that can be helpful to assist in motivation and inspiration.
Here is just one.

100 Ways To Motivate Yourself – (Life Changer!) – YouTube.

100 Ways to Motive Yourself is packed with techniques for breaking down negative barriers and letting go of pessimistic thoughts that prevent you from fulfilling your goals and dreams. Whether you’re self-employed, a middle manager or a Fortune 500 executive, it’s easy to get stuck in a humdrum life and only fantasize about what “could have been”. Motivational speaker Steve Chandler helps you turn that way of thinking into what “will be”. His ideas will help you create an action plan for living out your vision in business or life in general. 100 Ways to Motivate Yourself is filled with proven methods for changing the way you think and developing self-creation. Chandler draws on the feedback he’s received from corporate and public seminar students to ensure that the methods work.

If you would like a free full Mp3 copy of this video, visit Our Website at http://insideabundance.com/ – Click “Free Downloads” and subscribe, and then download FREE OF CHARGE! .

Louise Hay – How To Love Yourself – YouTube

Louise Hay – How To Love Yourself [10 steps to loving yourself] – YouTube.

Published on 30 Jul 2013

Download Full Audiobook: Louise Hay – How To Love Your Self:http://worldbookonline.us/HowToLoveYo…

Would you like to be more at ease with yourself?
Do you sometimes feel that you are your harshest judge?
Would you like to incorporate more positive energy into your life?

If so, then this CD is for you! Louise L. Hay guides you through each of her ten steps to loving yourself. She discusses the concept of criticism, the power of meditation, being willing to change, what you believe you deserve, and much more. These ten steps are perfect for you if you’re looking for more realistic, practical ways to feel good about yourself. Louise closes the lecture with a beautiful and empowering meditation.

About the Author: Louise L.Hay
Louise L. Hay is a metaphysical lecturer and teacher, and the bestselling author of 27 books, including You Can Heal Your Life and Empowering Women. Her works have been translated into 25 different languages in 33 countries throughout the world. Since beginning her career as a Science of Mind minister in 1981, she has assisted thousands of people in discovering and using the full potential of theirown creative powers for personal growth and self-healing. Louise is the owner and founder of Hay House, Inc.

15 Things I Learned from My Nervous Breakdown…

very good list of things to meditate on . . .



15 Things I Learned from My Nervous Breakdown… and How They Can Help You Live Your Best Life – Calgary’s Child Magazine.


15 Things I Learned from My Nervous Breakdown… and How They Can Help You Live Your Best Life

I suffered a nervous breakdown at age 36 – and it turned out to be a breakthrough. Here are 15 important things about life and happiness that I have learned, and that I hope you will take to heart in the coming year.

I want you to do me a favor. Look to the upcoming year and ask yourself – realistically – what lies in store in 2012? If you’re like most people, a huge portion of your life will be spent anxiously plugging away at a job you may or may not enjoy with coworkers you may or may not like. Okay, yes, you work hard to build a better life for your family. But here’s the question: Will you have time to enjoy them? Will you be too exhausted to throw the ball with your son? And how many nights will you get home too late to tuck him in this year?

This pattern of stress and striving has to stop. We already live in uncertain and depressing times, and our lifestyles are driving us not toward new heights, but over the brink. And if you’re not careful, you may suffer the same fate I did.

When I was 36 years old, I was successfully leading my family’s auto parts business, I was well respected in my community, I had a wonderful wife and son… and I also suffered a nervous breakdown. Yes, at that point in my life, I enjoyed what I did and was truly proud of my successes, but I was also pushing myself too hard and prioritizing the wrong things, and eventually, it all caught up with me.

For months leading up to my breakdown, I suffered from a paralyzing depression and anxiety, and found it difficult to complete tasks as simple as deciding whether to order coleslaw or potato salad with my lunch. But I still consider myself to be very fortunate.

As horrific as it was, my breakdown was actually also my breakthrough. It was an in-your-face wake-up call that forced me to realize that I was driving myself too hard, and for the wrong reasons. I finally had to say, “Enough is enough! I am done destroying myself and ruining my life!” Admitting to myself that my former way of life wasn’t working was the beginning of my road to recovery and true happiness.

For the past decade, I have taken a closer look at what really makes people happy and unhappy, and I have seen most of my goals and priorities shift. In the same way, it’s in your best interests to shift your habits and focus in 2012. Call it a New Year’s resolution to simply be happy.

I have come to realize that how happy and fulfilled you are is largely under your control, and that it has less to do with success and accomplishments than you might think. I believe that most people are experiencing many – if not all – of the stressors that led to my breakdown, so please don’t wait until you, too, reach a breaking point to make changes in your life. I’m totally convinced now that true happiness is a possibility for everyone, so I’m asking you to take the lessons I have learned to heart.

If you’re ready to change the way you approach life before you drive yourself over the edge, read on for 15 life lessons that I have learned:

1. You have to choose and prioritize happiness – it doesn’t just happen. If you subscribe to the belief that your happiness is wholly dependent on what happens to you, you’ll always be dissatisfied. The truth is, your fulfillment largely depends on the choices you make: how you see the world, what you allow to influence you, what you focus on, and how you react to circumstances, regardless of whether they’re good or bad. In other words, it’s not what happens to you; it’s how you look at what happens to you.

If you want to make a dent in your stress levels, you have to make choosing happiness a priority every day. With all of the responsibilities on our plates, nothing is likely to happen unless we specifically focus on it. So make happiness one of the two or three priorities you absolutely must accomplish each day. To remind yourself, put a note where you can see it – maybe on the refrigerator or bathroom mirror. And if that sounds selfish, it’s not. If you’re extremely stressed or become depressed because of the way you’re living your life, you’re hurting many more people than just yourself. And what’s more important than teaching your kids to be happy? Always remember that children learn by example. If they see you living a harried, stressed life, that’s the pattern their lives will follow as well…and their children’s after them, and so on.

2. Striving for work/life balance is worth its weight in gold. Times are tough, and some of us are finding it necessary to work long hours to keep our jobs and livelihoods. Others have fallen into the trap of the work-ego addiction: over time, you become hooked on the “high” you feel when you accomplish something, get a promotion, etc., and you begin to spend more and more time at the office. Whatever the reason, if extremely long hours are becoming a habit for you, break it. No matter how good your intentions are, overloading on work will cause your relationships, mindset, and even health to suffer.

Prior to my breakdown, it was normal for me to work seventy- or eighty-hour weeks. In my personal dictionary, “rest” and “relaxation” were synonymous with “irresponsibility” and “slacking.” Boy, was I wrong. Working as much as I did is more than the human body is designed to take continuously. If you drive yourself that hard, you’ll eventually begin to run on fumes before you shut down entirely. Being firm about creating and maintaining a healthy work/life balance is no more selfish than prioritizing happiness – in this case, it’s about simple self-preservation! And if you’re still skeptical, remember this: no one looks back on their lives at age eighty and says, “Gee, I wish I’d spent less time with my family and friends and more time at the office.”

3. We are our own worst critics. If you’re like most people, you probably tend to focus a lot of your mental energy on the things you mess up rather than on the things you do well—even though most of us do a hundred things right for every one thing we do wrong. And although you may not realize it, focusing on that one wrong thing is very dangerous, because our thoughts are incredibly powerful. Until you give yourself permission to break free of the cycle of self-blame and negativity that causes you to be stuck demanding perfection from yourself in every situation, you’ll never have a chance to be a truly relaxed, content, and happy person.

It’s not easy to rewire your habitual thought processes, but you need to build yourself up more and beat yourself up less. I used to expect nothing less than perfection out of myself, which was delusional! We’re all human, which means that we’re going to make mistakes from time to time. That doesn’t mean that we’re in any way unworthy or undeserving of love. In fact, learning to love myself was at the core of my own happiness journey. If you aren’t satisfied with who you are, you’ll always be looking outside yourself for validation…and you’ll never be truly content. And like me, you might also push yourself beyond healthy limits in order to get accolades from other people.

4. It’s never too late to start living in the present. How often do your thoughts “live” in the present? More to the point, how often are they instead fixated on your “disappointing” or “disturbing” past or spent worrying about your future? If you are like most people, your percentage of time not spent in the present is way, way too high, and thus you’re missing out on life itself. If you’re letting what’s already happened eat away at you or fretting about what might come to pass, you’re not enjoying the blessings all around you. You’re exacerbating your anxiety and unhappiness by choosing to dwell on things you can’t change or control.

I used to spend a majority of my time rehashing my past mistakes and worrying about what might happen in the future, neither of which did anything for my peace of mind or self-esteem. In fact, these unhealthy and self-critical thoughts were a major contributor to my breakdown. Now that I’m making a conscious effort to live in the present, I’m actually enjoying all of the great things in my life instead of letting them pass me by unnoticed. Plus, I’m actually a lot more productive now that all of that mental space that used to be occupied with worries has been freed up!

5. Focusing on what you’re good at is best for everyone.
 If you aren’t good at something – especially if it’s work-related – chances are you’ll feel compelled to spend a lot of time and effort getting your skills up to par. It’s natural to want to shore up your weaknesses, but the fact is, this strategy tends to cause you a lot of stress for (most likely) mediocre results. Instead of trying to be good at everything, stay in your strengths as much as possible. When you’re doing what you’re good at, you’ll be happier and higher performing.

As I’ve said, I used to be a total perfectionist. I felt like I was a failure if I didn’t excel in absolutely everything I tried. It probably won’t be a surprise to hear that all I accomplished was making myself miserable when I failed to live up to my impossibly high standards. If that sounds familiar, I’d suggest focusing more time on a hobby or personal interest to start, even if you do it for only twenty minutes every other day. And if you determine that your career doesn’t utilize your strengths, start looking at online job postings or for local classes in your field of interest. It’s never too early—or too late—to start doing the things that make you happy.

6. Exercise is worth its weight in therapy.
 Yes, you’ve heard it (a million times) before, but exercise is one small change that yields really big, life-changing benefits. For starters, it will begin to make you feel more relaxed, stronger, and more capable of handling life’s challenges—also, it will improve your sleep, and it’s a natural anti-depressant that will help your attitude and outlook. In fact, exercise actually opens you up to future change by invigorating your mind and body.

I’m convinced that exercise is the single most important thing you can do to improve your life right now. Looking back, I believe that my breakdown occurred when it did because I had broken my feet and couldn’t work out. Before that point, exercise was essentially acting as a medication that helped to counteract the effects of the stressful lifestyle I was living, and after I recovered, it has continued to boost my energy and outlook. If working out is already a part of your life, great! If it isn’t, commit to walking just twenty minutes every other day to start out. You don’t have to join a gym, sign up for exhausting classes, and completely reorder your life to reap the benefits of this investment!

7. You need to feed your mind healthy ‘food.’ When was the last time you watched the nightly news and turned off the TV feeling positive and uplifted? If anything, hearing the headlines is more likely to be depressing and discouraging. Although many of us don’t want to admit it, the things we hear, read, and experience influence our own attitudes and outlooks, so it’s important to consciously “feed” your mind positive materials.

It may sound hokey, but over the years I’ve become a big proponent of motivational books, audio recordings, and DVDs. Whether we’re at work, talking with friends, or at home watching TV or surfing the web, most of us encounter a lot more bad news and predictions than we do good. No wonder we become negative and cynical! It’s important to seek out positive things that will counteract these influences and dispel unnecessary stress. Learn new, constructive things and expose yourself to fresh ways of thinking so that you don’t get stuck in a self-destructive rut.

8. Surround yourself with positive people. If you stop for a drink at the water cooler and find your colleagues griping about how much work they have to do and how unreasonable your boss is, you probably don’t think much of it. In fact, depending on how your own day is going, you might even join in. And although you may not realize it, your attitude will start to deteriorate. The fact is, if you spend a significant amount of time around other people who are negative, your own outlook will begin to mirror theirs.

It’s much easier for others to drag you down than it is for you to build them up. In terms of your attitude and happiness levels, you will be the average of the five people you spend the most time with, so you need to be around other people who share your commitment to happiness if you want to avoid unnecessary stress. I’m not suggesting that you completely sever relationships that aren’t entirely uplifting, but gradually, you need to gravitate more toward positive people and distance yourself from those who tend to bring you down. This might mean calling a positive friend and asking to meet up for coffee or a beer, or walking away from the water cooler when your coworkers begin to gripe and complain.

9. Invest in your relationships – especially your marriage.
 When we’re driving ourselves to the brink, personal relationships are usually one of the first things to suffer. After all, the more time you spend at work, the less time and energy you have to invest in friends and family. You don’t consciously realize it at first, but this gradual deterioration can leave you feeling unappreciated, angry, alone, and anxious. Remember, though, that loving, supportive relationships will majorly enhance your happiness levels, and that friends and family care about you and accept you in a way that your employer never will.

It’s never a waste of time to reach out to the people who are meaningful to you and tell them how important they are to you, or to try to address any unresolved grievances and apologize for the things you may regret. And there’s one relationship you need to focus on in particular: the one with your spouse or significant other. Put more work into this relationship than you do into anything else: your house, your car, or your job, etc. Celebrate your spouse every day. Tell her (or him!) all the time how beautiful she is and how lucky you are to have her in your life. Trust me: this can make such a great difference in your emotional health, your stress levels, and your overall happiness! I truly believe that I would not be as happy as I am today without the love of my wife, and I also believe that my breakdown would have been much worse without her support.

10. Take control of what you can. If you’re reading this, chances are your life isn’t exactly stress-free. It’s practically impossible to live in the modern world without a million worries ranging from work deadlines to bills to clogged gutters. While you aren’t omnipotent, you probably can influence at least a few of the things that are causing your anxiety. Try to eliminate or minimize situations that are stressors instead of constantly dealing with their effects. Often, it’s the little things that make the biggest difference when it comes to relieving stress.

Start by identifying the two or three things that cause you the most stress on a consistent basis – maybe having a messy house is one. Often, you’ll find that there are concrete things you can do to lessen or even eliminate the pressure. For example, you might have a frank discussion with your spouse and kids regarding chores. Or, you might finally hire a cleaning person to help you once or twice a month if you can now afford it. Also, if you can’t eliminate or change a stressor, such as a job you hate but can’t afford to quit, challenge yourself to handle it differently. Specifically, decide beforehand how you will react in a more enlightened way when certain stressful situations occur – actually visualize yourself handling them with poise instead of becoming outwardly or inwardly worked up. Having a game plan in place before the “beast” rears its ugly head really can reduce your negative reactions to stressors—big time.

11. Being friendly is a good investment.
 In our culture, it’s become a badge of honor to stride around with an air of importance and a stony face. After all, if you’re too busy to say hello, you must be important. Yes, it’s easy to become absorbed by your responsibilities – but you’re not doing yourself any favors by shutting out the rest of the world. Even if you don’t have time to answer all of your emails, you can still smile at people in the hall and say a friendly hello to the cashier in the grocery store. Making positive connections will bring more happiness to you and to others.

Have you noticed that although our society is more and more “connected” by technology, we interact less and less with other people on a meaningful, face-to-face level than ever before? Our plugged-in lifestyles aren’t doing us as many favors as we thought they would. Even when we’re not at work, we’re likely to be glued to our smartphones or laptops, which amps up our stress. Make a conscious effort to unplug and make a friendly connection with another human – even a simple smile or hello is great. The fact is, everyone on Earth is carrying some sort of burden. You can’t make their pain, stress, or grief just magically disappear…but you can be what I call a “lamp-lighter” – someone who makes others feel just a little bit lighter and happier on their journey, even if only for five seconds. When you make friendliness a habit, you’ll attract kindness and smiles in return…and you’ll feel great about yourself for making a positive difference in the world!

12. Helping others is the soul food of life. One of the (many) negative side effects of our busy lives is that we tend to think mostly about ourselves: how much work we have left on that big presentation, how we’re going to find time to take the kids to sports practice and pick up groceries, and much, much more. No matter how busy you are now, consider helping others to be an integral part of the healthy work/life balance that will help you to avoid unhappiness. This will give you perspective, make you feel good, and will prevent you from staying in the negative me-focused cycle that was making you unhappy in the first place.

Since my breakdown, I’ve become very involved in philanthropy. I’ve found that it really is better to give than to receive, and that reaching out a helping hand to someone who isn’t as fortunate as you tends to quash selfish impulses and highlight your own blessings. Giving of yourself doesn’t have to involve money, either – remember that your time, talents, and compassion are just as valuable as cash, if not more so. Consider visiting a disabled veteran at the VA, or simply rolling your neighbor’s trashcan up the driveway! And if you have kids, you’ll be setting a wonderful example for them. I promise you, whether you’re giving time, energy, money, or encouragement, being generous will build up your self-esteem, broaden your perspective, keep you anchored in reality, and connect you to your blessings – all components of a happy life.

13. It’s important to connect with something bigger than yourself. Yes, spirituality (much like politics) is a touchy subject. But believing in something bigger than yourself is essential to developing the kind of perspective you need to be happy. Whether you consider your Higher Power to be God, Yahweh, Allah, Buddha, Krishna, the Universe, or even just Nature or another entity, being willing and able to see and feel His (or Her, if you prefer!) presence in your life will enable you to move away from self-centeredness and focus your energy and concerns on the greater community. It’ll also provide solace and give meaning to unfortunate events and troubling life circumstances.

Personally, I’ve been connected to the Jewish faith for my entire life. But it was only after my breakdown that I really allowed my faith to grow. My personal belief that God exists and cares about me has changed the way I view the world—but you don’t need to espouse my beliefs, or even join an organized religion and attend services regularly. What I do hope you’ll do is make an effort to clarify your thoughts about faith and also make an effort to connect to your Higher Power, whether it’s through prayer, meditation, writing in a journal, doing random acts of kindness, or just spending time in nature. Eventually, I hope you’ll begin to see your Higher Power as a source of inspiration, renewal, strength, guidance, and aid – as I do.

14. A grateful heart is a happy heart. It’s very easy to take things for granted: the information your coworker emailed you, the fact that your car is running, and even the food you’re eating for dinner. The fact is, most of us have gotten into the habit of ignoring all of the good things in our lives. Instead, we focus our mental energy on being upset about what’s wrong and what we don’t have. Yes, cultivating an “attitude of gratitude” might be a clichéd concept, but the humility that comes from knowing you owe so much to so many others will, in turn, spur you to give back more often to those less fortunate than yourself. Plus, studies have actually shown that thankful individuals are 25 percent healthier than their counterparts, too!

To start tapping into the power of gratitude, just say “thanks” to the people who help you out during your day. And beyond that, try to notice all of the blessings in your life. If you live in America, you have access to great education, healthcare, and the freedom to worship and work as you choose. Those are huge things to be thankful for right out of the gate! We take these “basics” and much more for granted, and we often have others—whether it’s an ancestor of ours, a veteran, or a coworker—to thank for them. It’s extremely important to be aware of all of your blessings, and to honor and thank those whom you owe.

15. Asking for help isn’t a sign of weakness. All of the things I have learned from my breakdown will help you to cut your stress levels, and they’ll also aid you in cultivating a more balanced, happier life. But it’s also important to realize that feeling anxious, overwhelmed, or depressed are all very serious, and you shouldn’t expect yourself to easily “fix” these issues on your own.

If you feel that you’re in over your head, or if your best efforts aren’t working, please reach out and ask for help. I might never have recovered after my breakdown without the help of my friends, family, and medical professionals. This is all big stuff. You shouldn’t—in fact, you can’t—make big changes in your life alone. At the very least, you’ll need the support of those who love you.

Ultimately, I’ve learned that the quality of your life is largely up to you. If you’re anything like me – and if you’re honest with yourself – you’ll have to confess that a striving, stressful lifestyle is not making you happy. I’ll admit that many of the changes I’m asking you to make in order to avoid more unhappiness (and perhaps even a breakdown) go against what society says you should do if you want to be successful. But I have found out the hard way that a “successful” yet stressed out and unhappy life is certainly not, in reality, a truly successful life at all.

Todd Patkin is the Author of Finding Happiness: One Man’s Quest to Beat Depression and Anxiety and – Finally – Let the Sunshine In (StepWise Press, 2011, ISBN: 978-0-9658261-9-8, $19.95). The book is available at bookstores nationwide, from major online booksellers, and at www.findinghappinessthebook.com.