Thursday, March 30, 2006

Depression: Ten Ways to Fight It Off, Part 1

Update 2016: This article was featured in my book
"Saying NO to Suicide"

Part 1 | Part 2

(cc) Douglas CooteySome people have asked me how I manage depression without medication. Please keep in mind that medication is not the answer for everybody. Some people either can't afford medications or are hypersensitive to them, which is the case with me. I can't take any medication without worrying about side effects. So today let's get down and dirty. This will be a little lengthy, but I'll list ten steps I might take on any particular day to shake off the black beastie. My challenge today is to make you smile about depression. I may have just conceded defeat with that last sentence, but I'll make the attempt anyway. Since anybody can make up a list and put it on the web, let's make this real. I'll take an actual bout of depression and chart how I dealt with it.

It is 5:30pm and I hear the lilting voice of my wife as she comes home. Instead of happiness I have an instantaneous sense of panic. I had forgotten to pay the power bill, something she had asked me to do. In fact, I hadn't remembered it at all until I heard her voice. Instead, I had been struggling all day to resuscitate my poor PDA which my four year old had taken out of commission.That was enough to get me depressed. I don't call my PDA "my brain" for kicks. It is vital to my daily productivity. However, with my wife's arrival I compounded my frustration and funk with a healthy dose of failure.

My wife nimbly phoned the payment in and saved the day but I was feeling a hundred pounds of stupid on my head. That's when I began to realize I had slipped into depression. It is one thing to feel disappointment with oneself, and another to be let down by events around you, but it's quite another to want to crawl into a hole and disappear. Here's where we begin:

1) It is easier to stave off depression before it happens than after it lays over you like a heavy wool blanket.

I missed this step this time around. I let myself become stressed over the PDA, but depression isn't always something that can be avoided. Sometimes, our mind just decides to move in that direction and take us along for the ride. Still, it is important to recognize your warning signs so you can reverse direction when you can. If depression is merely a chemical imbalance then theoretically one should be able to change that balance back to something more healthy. Meds attempt to do this, but attitude can help us do this as well. Barring some of your own, I suppose you could always drink a can of Moxie instead.

2) You need to know when you are depressed.

I know. I know. Advice like this sounds lame on the surface.

"People Need Air to Breathe! Details at 11."

Step two is simple advice, but crucial to stopping depression dead in its tracks. In my experience many people who suffer from depression often don't fully realize they are Depressed. They are too busy feeling miserable and overwhelmed to futz about with labels and self-diagnosis. Once I recognize that I am Depressed, however, I help myself realize that these feelings are alien and chemically induced. They are not Me. Realizing that, I can summon the strength to give them an eviction notice.

3) Ask yourself, "Do I have a reason to be depressed?"

If the answer is "No", then it's time to take back your life. Being sad for no reason is no fun and should be avoided like summer camps with Al Qaida. If the answer is "Yes", then you need to determine if what you are feeling is appropriate to the situation. If you've lost a loved one, for instance, there is a good reason to feel sad. If you are overwhelmed because you missed your favorite TV program, the depression might be taking things slightly out of proportion.

4) Develop the desire to not be depressed.

So you have a seven sheet long list of reasons why you are depressed and you think they're all really good ones. You may not realize it, but your perspective is a bit skewed.

If you suffer from depression you know how hard it is to shake it off. Heck, it can be hard enough breathing, nevermind summoning strength to get perky. But you need to set your mind to not let depression get the best of you. The process is called mind over mood by some, learned optimism by others. I was able to develop this skill on my own, mostly because I was an ornery cuss tired of being depressed all the time, but some people enjoy the help of a Cognitive Behavior Therapist or Psychologist to help them develop it.

These first four steps help you change from being a victim to being in control. I spent the better part of a decade learning how to do it on my own, but there are many resources available now for people with depression. There is no reason to go it alone. In the next column I'll cover the remainder of this list with six ways to distract yourself from being depressed. In the meantime, work on your self-analysis. It's a lot less expensive than visiting a psychiatrist and asking him or her how you are feeling that day.

Saturday, March 25, 2006

New FDA Warnings and a Testimonial

While I'm finishing up the illustrations for my double sized column for this week I wanted to pass along some warnings from the FDA. If you've followed my blog for a while you know that I stand against medications as a first line of attack for treating neurological problems. I see them as rife with side-effects and a poor substitute for coping strategies. This attitude doesn't make me popular. I'd wager that a more popular pro-meds stance would help me retain higher readership around here. Some could argue that my lack of a medical or psychological degree makes me ill-qualified for passing out advice of any kind concerning meds, and I would agree with them to a certain extent. If you really do read my column you know that I don't carelessly tell people to stop taking their meds. I simply encourage them to be careful.

What I can offer with absolute certainty is my life as a worse case scenario. My experience with meds has always been filled with almost every bizarre side-effect they could fit on the prescription printout. I have permanent neurological damage because I was trying to treat AD/HD and depression with desoxyn and zoloft. I now have Chronic Motor Tic Disorder as a permanent friend and let me tell you something - AD/HD and Depression were easier to handle. Nothing can stop me from flailing about uncontrollably or barking out non-sensical gibberish during dinner except a really long nap and sometimes that doesn't work either since I'm an insomniac. I am officially disabled because of side-effects. Doctors have offered me MORE meds to offset the tics, but they have their own side-effects. No thank you.

I have a great doctor now who helps me choose the safest meds possible when needing prescriptions for illnesses. I only wish the turkeys who were trying to help me 14 years ago had been as conscientious. The whole point of this diatribe is that I want you to understand WHY I am hostile towards meds. I cut a lot of jokes around here, but side-effects are no laughing matter. Besides, meds have their limitations. I saw a slogan on another website that summed my attitude perfectly: Pills Don't Teach Skills

Understanding that I have certain apprehensions about meds, also understand that I know everybody doesn't have issues with side-effects like I do and that some people need these meds to survive. It is not my intention to make you folks feel inferior to me. I don't believe you are ignorant dupes, but I would be doing you a disservice if I never spoke a word of caution. If only I had known how damaging side-effects could be. I took my medications for a few weeks despite what they were doing to me because I trusted my doctors and because the meds regulated all the things they were supposed to regulate. I hadn't had such a productive period in a long time. But it came to an end in a way that will last decades.

So take a gander at these new reports of aggression, hallucinations, and heart risk in children on common meds for treating AD/HD. If psychotropic meds work for you, just promise me that you'll educate yourself about the potential side-effects so you can be on the lookout for them. At first sign discontinue meds immediately and contact your physician or therapist. Why play Russian Roulette with your brain?

New Warnings Urged for ADHD Drugs (WebMD)
Panel Advises Disclosure of Drugs' Psychotic Effects (NY Times)
FDA Calls for Improved Warnings for ADD Drugs (LA Times)

Saturday, March 18, 2006

AD/HD: Dealing with Distractibility

(cc) Douglas CooteyThis week was going to be a departure from my usual Adult ADHD topics. I was going to cover my session Monday with my Cognitive
Behavior Therapist. Some people had expressed interest in what that was all about. Too bad I forgot to go.

Let's see. I had the reminder phone call from the secretary. I had my PDA set to beep at me. There were no scheduling conflicts. Kids were picked up on time. So what happened? Well, I got caught up helping my kids and didn't have my PDA by my side1. Out of earshot, out of mind.

But my humiliation makes great grist for a column on easy distractibility, the mainstay of the AD/HD mind. Coincidentally, the very next criteria Hallowell and Ratey list for Adult ADHD
is this very topic.

As evidence that at least one of them has Adult ADHD, Hallowell and Ratey list the most commonly known attributes of ADHD as number eight, somewhere after pathological boredom and bad breath.

8. Easy distractibility, trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation, often coupled with an ability to hyperfocus at times.
The hallmark symptom of ADD. The "tuning out" is quite involuntary. It happens when the person isn't looking, so to speak, and the next thing you know, he or she isn't there. The often extraordinary ability to hyperfocus is also usually present, emphasizing the fact that this is a syndrome not of attention deficit but of attention inconsistency.

It's a wonder any of my paper route customers ever got a paper when I was in High School. There were so many distractions pulling at my attention. Forest paths, dirt roads, ponds, juvenile delinquency, etc. Then there was always the busy stage within my mind filled with ideas and daydreams. With all the distractions going through my head I'm lucky I didn't ride my bike into a tree. Some may say that all young men have this problem (distractibility, not riding into trees), and young girls, too. And they may be right, but most kids grow out of it. The ability to focus is seen as a sign of maturity as children learn to be productive. In comparison, kids with ADHD are seen as immature, and their adult counterparts are seen as cartoon characters. The only adults with AD/HD who are respected are those that are dead or have internet startup companies2.

Because society doesn't tolerate failure, there are an awful lot of angry and bitter adults with AD/HD out there. Some of them leave me comments. They take umbrage with my light-hearted approach to disability. They dismiss me as "cute" or claim I don't fully understand the issues at stake. Perhaps they feel if I trivialize AD/HD I trivialize them. Well, I've tried the sober approach. All it did for me was make me uptight, grumpy, and no fun to be around. Now look at me! Shamelessly absentminded and invited to parties every weekend - any day now. Just think how popular I'd be if I actually made my meetings.

Of course, making light of screw ups doesn't mean I make excuses for myself, but I won't beat myself up either. Nothing breeds distractions like a good blue funk brought on by brow beating. I just wish more people in positions of authority realized this. Although it is true that discipline and willpower are the attributes that help people focus and accomplish great things, telling somebody with ADHD to "stop dilly-dallying", "hurry up and get it done", or "stop fidgeting around and pay attention" doesn't build character the way they think it does. It is more like telling somebody who is colorblind to separate the eggshell white cards from the antique white ones then getting mad when they can't.

Distraction sure isn't colorblind. We all experience it, but being distracted to the point of irritating others takes the kind of talent only AD/HD people have. Years ago my wife wouldn't allow me to cook because I'd constantly melt pans on the stove when cooking ramen. I'd get distracted drawing and forget all about them. Of course, I'm an expert at cooking ramen now. Even spaghetti. I may branch out into manicotti one of these days. But this is because we analyzed how I worked and figured a way to help me stay on track. If my wife had just yelled at me for ruining her pans I'd still be melting them today. Recognize our limitations, teach us to work around them, and you'll soon have less to get frustrated about.

Well, within reason. We can no more NOT be distracted than you can NOT be frustrated when we make you late, or forget to put gas in the car, or tune out when you're trying to talk to us. But our heart is in the right place. If yours is too we could meet in the middle somewhere and get along just fine. Focus, like patience, takes effort and practice.

As for my recent cock up, I've called and rescheduled. I even left an apology. If he chooses to charge me, then he charges me. I really can't help that; I did miss the appointment. I have a feeling, though, he's used to that sort of thing. He has AD/HD himself.

Coping Strategies:

1) Keep that PDA by your side!
2) Would you work at a paint store picking swatches of color for customers if you were colorblind? No, neither would I. Then why do we work at jobs that expose our AD/HD weaknesses while ignoring our strengths? Perhaps it's because we want to do the job but don't give enough study to whether we can do the job. Adults with AD/HD who have figured this out are happier at their jobs and more successful all around because they work within their strengths. They have found jobs where their AD/HD is either not exposed, or is even an asset.

Tuesday, March 07, 2006

ADHD: Bored of Boredom - Five Ways to Bear It. One Way to Beat It.

(cc) Douglas CooteyLast week's column didn't strike a chord in as many people as others I've written. I can only think that is a good thing. There is hope for the survival of the species. We can't all live like maniacs at the far edge, dangling off cliffs, betting the house on a football game, juggling machetes, etc...but would you be surprised to learn that all that high stimulation activity is a subset of something you probably CAN relate to?

The seventh symptom in Hallowell and Ratey's Diagnostic Criteria for Attention Deficit Disorder in Adults is:

7. An intolerance of boredom.
A corollary of number 6. Actually, the person with ADD seldom feels bored. This is because the millisecond he senses boredom, he swings into action and finds something new; he changes the channel.

If there is one aspect of AD/HD I wish people who don't have it could fully understand it is the intolerance of boredom. One of the loudest complaints I have heard from people who don't have AD/HD is that everybody gets bored. "Everybody has a hard time focusing when it's noisy or boring," they say. "Everybody has a hard time finishing boring tasks. AD/HD people aren't special. Get over it you mewling, mealy mouthed, misfit!" OK, maybe they're not that bad, but dang, they're close.

Where was I again? Oh, intolerance.

Certainly people who don't have attention deficit disorder cannot relate with this intolerance for boredom. They wonder why we can't do what they do all day long: grin and bear it. After all, isn't that part of growing up? Well, here's the secret even the hallowed Hallowell and Ratey didn't quite express. When they stated that the millisecond we sense boredom we change the channel, they forgot to mention that it isn't actually a choice we make. This is what makes us different. The millisecond we encounter boredom our brain races, leaps, bounds, or flies in a totally new direction. Sometimes it tries to do all of them at once. It pursues any event it can seize upon that sparks interest and staves off boredom.

We want to focus. We need to focus. But our brain is constantly trying to stay entertained. It's as if our brain is coated with boredom repellant teflon. I disagree with Hallowell and Ratey. I am constantly bored, even when surrounded by things that I love to do, but it is worst in public. For me, trying to pay attention when I am bored is physically uncomfortable. My brain feels like it's trying to escape out my ear.

What can we do about it?

There are two aspects to this problem that have two different solutions: 1) Paying attention when you're supposed to and 2) avoiding boredom in a constructive way.

From what I've been told, paying attention has some serious benefits. No, really! Like when you're driving you can avoid accidents. Or when your girl is expressing her heartfelt feelings you don't suddenly ask, "Hey, wanna catch a movie?" I also hear paying attention is great for on the job performance. I think I may try that sometime.

Usually medications are prescribed to aid people with ADHD to deal with this problem. I'll leave that for you to discuss with your therapist, doctor, or aromatherapy practitioner. The medication solution has a few detriments that aren't always obvious: They're expensive. Your body acclimates to the medications resulting in increased dosages or cycling regimens. Medications can have varied and diverse side-effects which are adverse to your health and mental well-being. And lastly, you may simply forget to take them.

Here are five suggestions you can try to keep yourself on track when you feel boredom mugging your attention span.

  1. Get comfortable, or, if boredom is lulling you to sleep, get uncomfortable.
  2. Make sure you've eaten, visited the rest room, adjusted your clothes, etc. Minimizing distractions will help you stay the distance.
  3. Mentally prepare yourself. Even a little positive attitude can empower you. I'll say things to myself like "You can do this!" and "It's just for 30 minutes." Without the pep talk I just suffer.
  4. Take notes. Keeps you physically and mentally engaged. At worst, you could always doodle.
  5. Develop your will power. You have it. Use it. It won't be easy at first because your mind has ideas of its own about curing boredom.

Of course, all this assumes that absolute attention is mandatory. Sometimes, you just don't want to be bored or waste time. I used to find myself staying home because I knew I would be bored and dreaded that happening. I was becoming a hermit. Fortunately for my social life I created my Boredom Emergency Kit.

Over the years I have filled a satchel with every possible activity I could imagine to stave off episodes of crippling boredom. Now there is no last minute hesitation about leaving or even scurrying about finding something to bring along just in case I get bored.I just grab my satchel and go. It is filled with notebooks, sketchbooks, art supplies, and even musical instruments from time to time. I have an iBook to throw in there as well. I never have an excuse to feel bored. Even knowing it is at hand helps me tolerate boring activities. Now I never have to just grin and bear it.

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