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[msparticularity]

I am posting a link to Dr. Weil's blog today on this subject: http://www.huffingtonpost.com/andrew-weil-md/integrative-mental-health_b_354332.html

I can personally attest to the importance of bringing to bear a range of on this very complex disorder. I have taken pharmaceutical antidepressants at several times in my life because I needed urgent intervention. I have urged my family members and loved ones to get a prescription to help lift them up enough out of the depths that they can begin to make some steps toward recovery. However, as Dr. Weil suggests, these measures are inadequate alone: just finding "the right prescription" was (for me and many others I have known) impossible.

Instead, when I began to draw from the range of remedies he suggests here, I got serious and lasting improvement. I transitioned over to St. John's Wort with my psychiatrist's monitoring and approval. I also spent several years in in-depth therapy to process the anger and grief that lingered from my earlier life. I now take both St. John's Wort and fish oil, since I also suffer from RA. I have had acupuncture, although I personally find massage therapy more effective. And getting out and moving a bit in the fresh air, even if I am not up to vigorous exercise at the moment, really does help.

The result has been that I have had over a decade of stability--something I never dreamed I could achieve. I have bad days; I get "a little down." But it is within the normal range of moods, and I have effective means for ensuring that I don't drown in it any longer.

Okay, I know I sound like a testimonial, but I really liked this blog entry because it clearly summarized and discussed some stuff that I had to stumble around and figure out on my own over 20+ years. I'd love to think it could be easier now!

[bamabound]

Ms.P - thank you so much for this.  I've had chronic low-level depression for decades and Rx didn't help.  I, too, am stable, since reaching 45: Some of it is knowing myself more and accepting my life, some of it is diet and some is hormonal (or rather, being postmenopausal, lack of hormones), I believe.  But I am having trouble reaching my teenager (who got the genes from both sides of the genetic tree), who doesn't want to listen to mom and doesn't like the drug "cure".  Offspring has discovered aerobic exercise and yoga are his/her "miracles" but resists other ideas.  I'll print out this article to share. 

[msparticularity]

Offspring has discovered aerobic exercise and yoga are his/her "miracles" but resists other ideas.  I'll print out this article to share. 

That's a terrific start, seriously. My best suggestion might be to just add some Vitamin D and perhaps fish oil to that, on principles of general health as well as for the depression.

And my experience, like yours, has been that menopause does ratchet down the mood swings. Although my dramatic improvement began even while I was still in the throes of perimenopause and some pretty insane problems with it, so clearly it wasn't just about the hormones for me.

[outlier]

I'm resurrecting this thread because all the different things I'm doing are not working at the moment. I've always been somewhat prone to depression and anxiety, though much more depression than anxiety. For years I managed pretty well with lots of exercise, walks with the dogs, and just making sure to carve out time for myself to read for pleasure, take walks and photographs, and basically to get out in fresh air and sunlight. I tend to just say no to shopping malls, carnival-type events--any place that's going to be crowded and overwhelming (especially overwhelmingly tacky!). I'm absent-minded, so I do things like extra vitamin D or B-vitamins and lately St. John's Wort when I think of it. I have had good therapists at crucial times, but that's not an option at the moment.

My anxiety manifests as insomnia, and very embarrassingly, as tearfulness. Depression manifests as insomnia, and as a focus on all the cruelty that I am helpless to prevent or ameliorate. I volunteered at the local, very dysfunctional animal shelter until this summer, when I just couldn't do it anymore. I'll be starting a new job soon, which means moving back to somewhere I was pretty happy and have a great group of friends, and where my daughter is. However, her father, my nasty ex-husband, is also there, and I'll be living apart from my husband and the dogs for at least a couple of months.

I'm not really sure what I'm asking for. Suggestions, commiseration, something like that. Maybe it's just winter, or anticipation of moving and all the stress involved, or a combination, but it all seems worse lately.

[kedves]

I'm sorry to hear about what you're going through, Outlier.  When will you be starting the job and moving?  Congratulations on the job, by the way!  I hope you will be very, very busy.  That helps, for me.  Is therapy not an option because of being between insurance plans or something like that, and will you be able to re-start at the new job?  What about medication?  I hope you allow yourself to be less embarrassed by tearfulness.  I cry at kindness and have for years since a period of grief apparently changed the way things work inside me, and people really don't seem to mind at all.  I think some people just feel the bittersweetness of life more than others, but it sounds as if this is affecting your quality of life.

These between times are hard.  I'm not depressed now but have been in the past, and the unsettled feeling of what-could-happen compounded can make depression even more disorienting.  My suggestion would be to walk on the sunny side of the street for your own well-being.  You can do good without making it bad for yourself.  What you already do, exercise and dog companionship and outdoors, are keys for me.  I wish I had something more useful to say.

Wishing you good days and warm and peaceful nights -

[alleyoxenfree]

I'm resurrecting this thread because all the different things I'm doing are not working at the moment. I've always been somewhat prone to depression and anxiety, though much more depression than anxiety. For years I managed pretty well with lots of exercise, walks with the dogs, and just making sure to carve out time for myself to read for pleasure, take walks and photographs, and basically to get out in fresh air and sunlight. I tend to just say no to shopping malls, carnival-type events--any place that's going to be crowded and overwhelming (especially overwhelmingly tacky!). I'm absent-minded, so I do things like extra vitamin D or B-vitamins and lately St. John's Wort when I think of it. I have had good therapists at crucial times, but that's not an option at the moment.

My anxiety manifests as insomnia, and very embarrassingly, as tearfulness. Depression manifests as insomnia, and as a focus on all the cruelty that I am helpless to prevent or ameliorate. I volunteered at the local, very dysfunctional animal shelter until this summer, when I just couldn't do it anymore. I'll be starting a new job soon, which means moving back to somewhere I was pretty happy and have a great group of friends, and where my daughter is. However, her father, my nasty ex-husband, is also there, and I'll be living apart from my husband and the dogs for at least a couple of months.

I'm not really sure what I'm asking for. Suggestions, commiseration, something like that. Maybe it's just winter, or anticipation of moving and all the stress involved, or a combination, but it all seems worse lately.

Hi outlier, here's a warm cup of tea and a dose of commiseration.  The shortening of the days is always hard for me, so I feel better when the holidays are done and despite the calendar, it seems like spring is around the corner.  If I'm not reading too much through the lines, the move to the good new job is still an anxious one because of Mr. DopeEx and you may be dreading running into him or more contact with him as a component of your blues.  Is there any way you can just fast-forward that in circumstances that you control? 

I don't know what terms you are on or how big an ass he is, but could you contact him and say you'd like the 3 of you to go get a Jamba Juice and discuss the new arrangements now that you will live there?  He may say no, but you will get the satisfaction of showing that you're not afraid of his opinion or running into him.  This worked for me with my ex-in-laws, whom I scheduled a visit with because I was moving to their area.  I wanted to show that enough water had gone under the bridge and that I hope their lives were going well; we had a civil and congenial conversation, although I'm sure it was the buzz of the family grapevine after I left and none of us kept in touch as we said we would.  However, it did make me no longer fear running into them in a less controlled situation, like out in public with a date!

[msparticularity]

Outlier, there's been some interesting research about the interactions between depression/anxiety and insomnia. While insomnia has traditionally been considered a result of depression, some newer work is pointing toward the role of insomnia in causing and/or deepening depression. Also, of course, anxiety and stress will lead to both!

Do you still have regular health coverage? And if so, can you see if your doctor is willing to prescribe a mild sleeping med to get you through the next month or two? Sleep is just really, really important to physical and mental health, and given everything that you are having to juggle right now, I'm thinking you need some. :)

[outlier]

Thanks so much for sympathy and suggestions. I do have health insurance, therapy's just not an option at the moment because I don't have time to find someone good here and accomplish anything with her or him. I'll have to give all these ideas and suggestions some thought, because my initial reaction is "yes, but..." and I know that means I'm being resistant. Time to go work out on the exercise bike. For now, my insomnia cure is to turn on NPR (well, it's the BBC in the middle of the night here) just at the edge of audible so I have to try to hear it. That helps me focus on something other than whatever I'm stressing about at the moment, so I can fall asleep. It actually works pretty well, but I've needed this approach for too long now. MsP, I'll look up that research, but if you have any links or citations handy, could you post them? I don't have access to libraries and databases at the moment, but I will soon.

Thank you, Kedves, Alleyoxenfree, and MsParticularity.

[spork]

I'm resurrecting this thread because all the different things I'm doing are not working at the moment. I've always been somewhat prone to depression and anxiety, though much more depression than anxiety. For years I managed pretty well with lots of exercise, walks with the dogs, and just making sure to carve out time for myself to read for pleasure, take walks and photographs, and basically to get out in fresh air and sunlight. I tend to just say no to shopping malls, carnival-type events--any place that's going to be crowded and overwhelming (especially overwhelmingly tacky!). I'm absent-minded, so I do things like extra vitamin D or B-vitamins and lately St. John's Wort when I think of it. I have had good therapists at crucial times, but that's not an option at the moment.

My anxiety manifests as insomnia, and very embarrassingly, as tearfulness. Depression manifests as insomnia, and as a focus on all the cruelty that I am helpless to prevent or ameliorate. I volunteered at the local, very dysfunctional animal shelter until this summer, when I just couldn't do it anymore. I'll be starting a new job soon, which means moving back to somewhere I was pretty happy and have a great group of friends, and where my daughter is. However, her father, my nasty ex-husband, is also there, and I'll be living apart from my husband and the dogs for at least a couple of months.

I'm not really sure what I'm asking for. Suggestions, commiseration, something like that. Maybe it's just winter, or anticipation of moving and all the stress involved, or a combination, but it all seems worse lately.

Have you recently gotten checked for vitamin D deficiency and anemia?  Both can cause fatigue and the latter is associated with sleep problems (not sure about the former).  As for the move, it sounds like the positives outweigh the negatives.

[kedves]

For now, my insomnia cure is to turn on NPR (well, it's the BBC in the middle of the night here) just at the edge of audible so I have to try to hear it. That helps me focus on something other than whatever I'm stressing about at the moment, so I can fall asleep. It actually works pretty well, but I've needed this approach for too long now.

I don't know if this is what you mean, but it sounds as if you are thinking about some things in terms of "what I should be able to get along without."  I hope that's not the case, because if it works and doesn't hurt you, use it forever.  There is no "too long now."  I love my sound-conditioner machine and its kshhhhhhhhhhhhhh every night and I have a mini one for travel.  I agree with MsP 100%, there are few things more valuable than sleep.  Even if you don't have time for starting therapy now, if you have insurance, it sounds as if it could be worthwhile to see a doctor and get some help with that, but nothing.  (Edited:  I didn't know that about anemia, another thing to consider.)

Do you have favorite books from childhood?  I find it very comforting to re-read those when I'm in an upset time.  Actually, I will admit to liking new fiction in children's and young-adult genres, too.  They seem to be where stories of perseverance are written.  That is probably a very individual thing, but I hope you will give yourself more of what you like.

[frogfactory]

Just to mention: St John's Wort isn't worth crap unless you're 'mild to moderate' (in which case the evidence is unclear), and has so many drug interactions it generally does more harm than good.

[msparticularity]

Just to mention: St John's Wort isn't worth crap unless you're 'mild to moderate' (in which case the evidence is unclear), and has so many drug interactions it generally does more harm than good.

Repeated European studies have found it at least as effective as pharmaceuticals for mild to moderate depression, and substantially less likely to interact with other meds. the German government in particular has been a leader in this. The FDA issued an interactions warning in 2000 alerting physicians to possible interactions with meds that interact with MAOIs because it is not clear whether the St. Johns Wort might be similar. However, this was based upon physicians' reports to the FDA of possible interaction events involving prescription drugs, not any actual research. NIH studies indicate both that St. John's Wort is effective for mild to moderate depression, and that it may affect the effectiveness of a few drugs:
    *  Antidepressant medicines
    * Birth control pills
    * Cyclosporine, a medicine that helps prevent the body from rejecting transplanted organs
    * Digoxin, a medicine used to strengthen heart muscle contractions
    * Indinavir and other medicines used to control HIV infection
    * Irinotecan and other anticancer medicines
    * Warfarin and related medicines used to thin the blood (known as anticoagulants)

Common foods and beverages, including such innocuous substances as cheddar cheese, do the same.

[mdwlark]

I was really interested in msparticularity's original post and your situation, outlier.  I know how distressing bad ex-spouses can be, but congratulations on your positive career move.

I don't usually discuss this, because I know people will disapprove and don't care if they do. I go to a Chinese doctor for acupuncture and traditional Chinese medicine for both mental and physical health.  I also consult with an American herbalist/nutritionist.  I read about the research and chemistry on everything I use.  I think of it as complementary rather than alternative medicine.  My Chinese doctor grinds most of his herbal formulas from fresh herbs in his back room.  I have had a lot of counseling too, which is sort of a complementary treatment.   

Still, sometimes some type of psychotropic (psychiatric) medication may be needed to jump start you or to get you through a crisis.  If you haven't had bad experiences with psychiatric medications, you might want to try it. Psychotropic medicines do not work on me and tend to make me worse, which is why I turn to natural solutions and Chinese medicine.  

I take Flax Seed Oil instead of Fish Oil, but Yes to either one!  I take Vitamin D, but I get tested occasionally at my (regular) doctor's office for Vitamin D level. You don't want to be either too high or too low.  Most Americans are much too low.  D-3 is the formula that the body can best use.  I also take a B-Complex supplement.  

If you follow any of what I'm doing listed below, do so at your own risk and do your own research.  Test slowly and carefully. 

I agree with msparticularity about the really close and bidirectional relationship between insomnia and depression.  For both anxiety and insomnia, I have used Passionflower with pretty good results for both.  Usually one capsule would do the trick on rare occasions, two.  Some people use Valerian Root but I found it too nauseating and too strong.  Now I use a Chinese anti-anxiety formula. They also have a formula for sleep, but the anti-anxiety formula works better for me for both.  

The Chinese see depression as a symptom, like a fever, not as a separate disease.  They treat depression by balancing the communication between the liver, spleen, kidneys and digestive system with a series of multi-herbal formulas and acupuncture.  

I use Ginko Biloba sometimes for reversing direction on cyclothymic (bipolar-like) cycling and for the mental fog created by depression.  But my Chinese doctor says it should be taken only temporarily in times of low energy, and not used daily, (as I was doing before I consulted with him).  I cut back gradually on Ginko as the Chinese treatments worked, but I still use it occasionally. 

[msparticularity]

Mdwlark, I have pursued complementary therapies also. I have certainly taken pharmaceuticals when I have needed them, and I have also sought alternative therapies for long-term and chronic conditions. US medicine is very, very good at treating acute conditions, and not nearly as good as others (especially Chinese medicine) with chronic health issues.

Outlier, the work on insomnia and depression is being done by Michael Perlis at the U of Rochester. There's a popular account of his studies here, and in Psychology Today. It seems to be pretty widely known and accepted, too, so that an increasing number of doctors are willing to treat sleep issues and see if that will help with depression.

Also, I'll reiterate what I found, which is that the fish oil was actually the key to lasting change in my mood issues. It's been found to potentiate SSRIs generally, in fact, so I think my experience was not unusual. (And, of course, good therapy!) 

[outlier]

I've been thinking about the various advice, and I read those articles yesterday. Thanks, MsP.

About the St. John's Wort: in my particular situation it seems to be helpful. I'm not on any prescription medication and I rarely take over-the-counter meds either, so there are no interaction problems, and while I don't have a doctor's diagnosis, if there were one it would probably be mild or moderate depression. I think it's mainly change fatigue and irrational worry about the next move not working out, not leading to the stability I'm now craving. While this move will ultimately be a very good thing, this whole decade feels like it's been one move after another, and the one before it was not marked by stability or continuity, either. And my ex- portrays it as a character flaw on my part, one that makes me unfit to be a parent. He communicates that indirectly to my daughter and has communicated it much more openly to lawyers, mediators, a child therapist, and the courts. It helps that all of those parties disagree with him, but it's still wearing. Mdwlrk, I have noticed similarities between our exes from other posts you've made. I can't recall specifics, but I know that the comparison has jumped out at me several times.

As for the complementary medicine, a friend of mine goes to an acupuncturist. I'll be renting a room from her and her family for a few months, so I'll get a chance to hear about it and maybe get a referral. I haven't explored any non-traditional (by western standards) approaches. I would like to learn to meditate, but I haven't put much time or energy into it yet.

Kedves, I'm not thinking of anything as "something I should be able to get along without"--just noting how long the periodic insomnia's been going on, and wanting to get to a point where I'm not experiencing insomnia, though I think my case is probably pretty mild. Oh, and I do re-read favorite books in times of stress. There was a time, when I was finishing up the Ph.D. and preparing to move to ex-husband land for the first time, when I resorted to Calvin and Hobbes as bedtime reading. (I just left ex-land last year after fruitlessly searching for a livable job for 4 years, and now, after a year and a half away, have finally found one.)

Thank you all for discussion and suggestions. It's amazingly helpful to think about this in response to specific questions and suggestions, because it helps me get out of pure feeling and begin to analyze. Thanks.