Tag: depression

Becoming an emotional “Weeble”

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Are you old enough to remember Weebles?

They were (apparently still are?) egg-shaped figurines with a weighted bottom, sold as toys to little kids who … like to play with egg-shaped figurines, I suppose. I never actually owned a Weeble, but their tagline has been indelibly etched in my brain: Weebles wobble but they don’t fall down.

I think there is a lot of value in being an emotional Weeble, regularly wobbling as you experience the highs and lows at the extremes of the emotional continuum (and everything in between), all the while trusting you will not fall down.

When it comes to experiencing strong emotions, too often the people I meet in therapy fear they will fall down, or worse, feel they have previously repeatedly fallen down and now live in dread of the next time it will happen.

One of the hypothesis to explain the development of panic disorder is to view it as a “fear of fear”:  the noxiousness of a previous experience of panic leaves us hypervigilant and sensitized to any changes in our body that might indicate another one is around the corner. This level of vigilance itself leads to symptoms in the body (since it activates the fight or flight response), which we then notice and attribute catastrophic meaning to. Catastrophizing thoughts create more fear, which exacerbates our physical symptoms, and the cycle continues.

Similarly, some of my clients with a history of depression are understandably highly attuned to their emotional fluctuations and notice subtle changes in their mood state. Developing a level of self-awareness and attunement to the early warning signs of depression is actually an important part of relapse prevention, but it can also be counterproductive when the emphasis gets narrowed to the moment-by-moment ‘how am I feeling’ rather than the broader ‘how am I doing’.

Depression is a pervasive mood state that impacts all aspects of our experience (our thoughts, emotions, and behaviour), while sadness or grieving are feeling states. Feeling sad about a saddening event is not likely to lead to a relapse into depression, but interpreting that sadness as a sign of an impending return to depression – and acting listless, resigned and despairing in response, avoiding work and social interactions, letting nutrition, sleep and exercise lapse – certainly could.

Being an emotional Weeble means being both willing to experience our emotions, and able to see that they are passing feeling states. Just like the Weeble that one might imagine screaming as it teeters to its edge, having a solid and grounded centre helps us pull back upright. And just like the Weeble, we likely won’t stay upright for long before the next wobble sends us teetering.

Should you hire an Antidepressant?

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Although the question of whether we are becoming a more depressed society or are simply getting better at identifying and acknowledging depression is open for debate, what’s clear is that the rate of prescription of antidepressant medications has dramatically increased since their introduction into the market place some 60 years ago. Today, there are over 30 types of antidepressant formulations available, and they have become the most commonly prescribed class of medications, outdistancing the second most commonly prescribed (blood pressure medications) by 5 million prescriptions per year (US figures for 2008).

In my counselling practice it’s not uncommon to hear clients say they were offered a prescription for an antidepressant by their family doctor or walk-in clinic physician, often after only a brief discussion of their symptoms and concerns. So if antidepressants are more available in general, and can or have been made available to you specifically, what do you need to know to determine if they are the right approach for you?

It’s a multi-faceted question, but to help start to answer it, I often ask clients to use the analogy of hiring an antidepressant, the way they would consider hiring an employee. That means working through several steps:

     1. Getting clear on the job you’d like the antidepressant to do. What are the symptoms of depression you’d like it to relieve? For example, “I’d like to sleep better, I’d like to get through the day without crying every 5 minutes, I’d like to have some energy and not feel like everything was a chore” are all good job descriptors for an antidepressant. “I’d like my partner/parents/children to be less annoying” is not.
    

     2. Giving the antidepressant a fair trial at the job. This means taking the medication at the dosage prescribed, and for the duration (typically 6 to 8 weeks) necessary to assess its effectiveness. It also means not mixing antidepressants with other medications or excessive amounts of alcohol, or with other mind or mood altering drugs.
    

     3. At the end of the trial period, evaluating the antidepressant’s performance. That is, assessing how well it did the job you hired it to do, and also determining its cost to you (both the financial cost, and any cost paid out in side effects).

You can – and I would suggest, should – research an antidepressant’s ‘qualifications’ by reading about its track record of effectiveness and its history of results and side effects, but that’s not sufficient information to know whether it works for you. Ultimately, you yourself are the best resource to determine whether something is helping or not, and that’s a power (and responsibility) you don’t want to outsource.

What I learned from Reality TV (this week)

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I’m a little obsessed with watching the Discovery’s Channel’s Naked and Afraid. Truth be told, I find the purported ‘reality’ in a lot of reality TV pretty fascinating (from a purely psychological perspective of course, I’m not wasting precious hours of my life, I’m doing research!)

For the uninitiated, the premise of Naked and Afraid is to take a man and a woman who are self-described “survivalists” in their normal lives and drop them (naked) in some remote and awe-inspiringly dangerous part of the world, where they do their best to survive the elements and each other for 21 days.

For me at least, the show supplies unending grist for the psychological mill, but here are three of the things that have stood out most:

  1. Shoes are truly the unsung heroes of attire, and much more of a necessity (versus a nice-to-have) than I ever appreciated.
  2. The line we draw between food/not-food is arbitrary and highly context-specific. In my day-to-day life, a severed and partially decomposed bird’s head found of the beach would be solidly in the not-food camp. This show makes the case that 18 days without a solid meal would have one reconsidering that.
  3. It takes a lot of work to make and maintain a fire.

For the Naked and Afraid contestants, fire is fundamental to survival, and they accordingly approach it with a high degree of reverence and care. Today fire (and everything that comes with it) is something most of us take for granted, but the many references to fire that show up in our language speak to its primacy in our ancestral legacy. We ‘light a fire under’ things (or people) to get them going, we question whether or not there’s a ‘spark’ when we meet a potential partner, we say ‘the flame’s gone out’ when passion has taken its leave, we hope for an idea to ‘catch fire’ or watch it go ‘up in smoke.’

Many of the clients I work with come to therapy in part because they’re trying to light or re-ignite a fire. Some have found that depression has dampened all their tinder so that even generating a spark seems unlikely, some are trying to keep the winds of self-doubt from extinguishing intention before it has a chance to catch, and others are poking at the dying embers of a love relationship, wondering if they can be coaxed back to life.

What I’ve learned from the Naked and Afraid contestants is that lighting a fire takes focus and patience, and that timing is everything; the same gust of wind that would encourage a going fire snuffs out the kindling’s flame. I’ve also learned that lighting the fire is only half the battle. Once you have your fire lit (or your project started, or your lover back), you need to keep tending and adding fuel to the fire, all the while keeping an eye out for any rainstorms brewing in the distance.