100 ways to improve your mental health

We’ve reached a milestone today – this is my 100th post! To celebrate, I decided to make a list of 100 things. The most helpful idea that came to mind was ways to improve mental health, so here it is. I have broken the list down into categories so that you can find the ones that are the most relevant for what you are working on. (Another milestone: Happy birthday, A. You’re my favorite.)

  

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Emotionally

1. Honor your emotions for what they are and accept them fully.

2. Do something that makes you happy every day.

3. Remember that feelings are temporary; they will always change.

4. Express your emotions creatively.

5. Ask for help when you feel overwhelmed.

6. Know when to back out of a situation.

7. Stop your thinking and ask yourself what you are actually feeling and why.

8. Use a feelings chart to identify what you are experiencing.

9. Surround yourself with little things that make you happy – flowers, art, scented candles, etc.

10. Find positive and uplifting entertainment.

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Mentally

11. Stay in the present.

12. Deal with stress as it comes up.

13. Eliminate bad habits. 

14. Set realistic goals and work towards them.

15. Stop using negative words to describe yourself.

16. Reward yourself for doing difficult things.

17. Take a break when you need it.

18. Find new ways to do things.

19. Stop and consider other perspectives on what you’re experiencing.

20. Use good common sense.

                                                                                              Physically

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21. Exercise regularly.

22. Take time to relax.

23. Eat three meals a day.

24. Take your medication as prescribed.

25. Stay at a healthy weight. 

26. Get enough sleep.

27. See a doctor when you need to.

28. Choose healthy food.

29. Stay away from harmful substances.

30. Love your body as best you can.

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Socially

31. Rely on your support system.

32. Spend time with other people regularly.

33. Be a helpful friend.

34. Respect the needs of others and expect that they do the same.

35. Engage in volunteer work.

36. Eliminate negative influences in your life.

37. Set and keep healthy boundaries.

38. Make time for yourself.

39. Be clear in your communication.

40. Be considerate.

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Intellectually

41. Be educated about your disorder(s).

42. Learn something new every day.

43. Study things you genuinely find interesting.

44. Study something you know absolutely nothing about.

45. Do mind exercises like sudoku, crossword puzzles and word games.

46. Talk to other people about what they do.

47. Take an evening or community course.

48. Think up funny jokes and witty responses.

49. Take notes when you are learning about something. Refer to them later.

50. Do calculations in your head instead of using your phone.

Spiritually

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51. Practice mindfulness

52. Meditate and/or pray.

53. Eliminate unhealthy beliefs.

54. Rely on a higher power.

55. Learn about the beliefs of others.

56. Journal about your spiritual experiences.

57. Share your spiritual experiences with open-minded loved ones.

58. Forgive.

59. Find or decide on your life’s purpose and live it.

60. Stay true to what you believe.

                                                             Environmentally

                                                             61. Surround yourself with beautiful things.

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62. Hang up motivational posters.

63. Spend time in nature.

64. Keep your home clean.

65. Use sticky notes to post affirmations where you’ll see them frequently.

66. Support any environmental causes you believe in.

67. Use your resources well.

68. Take basic safety precautions.

69. Repair broken things so they don’t continue to frustrate you.

70. Stay organized.

Occupationally

71. Do things you love.

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72. Know your limits when it comes to work.

73. Develop schedules and routines.

74. Simplify your work.

75. Get support from colleagues when necessary.

76. Keep good boundaries between your personal and professional lives.

77. Compliment coworkers on a job well done.

78. If you are unhappy in your job, look for a new one.

79. Multitask less.

80. Take a day off when you need to.

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Self-care

81. Journal regularly. 

82. Go for a walk.

83. Make your favorite meal.

84. Use grounding techniques.

85. Have a list of coping skills.

86. Be patient.

87. Keep a gratitude journal.

88. Go easy on yourself.

89. Respect yourself.

Other

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91. Stand up for yourself.

92. Believe you can get better.

93. Keep a beginner’s mindset.

94. Learn from every experience.

95. Keep some money in savings.

96. Have alternatives for self-destructive behaviors.

97. Be prepared for change.

98. Have a safety plan.

99. Stay progress-oriented.

100. Make a list of personal reasons to recover.

Do you have any tips to add? Please do so in the comments!

15 mental health resolutions for 2015

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Happy New Year! As we all know, this is the time of year when people take stock of their lives and find ways to improve. So in the spirit of goal-setting, here are 15 resolutions to keep you mentally healthy in 2015. I encourage you to adopt at least one of them!

1. I will set and maintain healthy boundaries.

2. I will say no to negativity. 

3. I will make time for myself.

4. I will love and accept my body the way it is.

5. I will continue to learn new things.

6. I will practice mindfulness and self-care.

7. I will ask for help when I need it.

8. I will find healthy ways of dealing with stress.

9. I will not indulge in excess.

10. I will surround myself with supportive people.

11. I will take medications as instructed. 

12. I will physically take care of my body (exercise, nutrition, sleep, etc.).  

13. I will only speak positively about myself, in or out of my head.

14. I will shrug off unhealthy guilt. 

15. I will be proud of myself for each step towards recovery.

What mental health resolutions are you making? Post yours in the comments!

Some thoughts on recovery

Today I’m going to get a little more personal than I normally do. I’ve been thinking about where I’m at in my recovery, where I’m heading and what I’ve learned. From this, I have a few things I’d like to say.

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We all know life isn’t fair. Mental illness is one of those unfair things. Whether it’s caused by nature, nurture or something else, mental illness infringes on our lives in a way that is disruptive and even paralyzing. The things we want to experience and accomplish can seem so far out of reach. Hope can be elusive, but it’s important to believe it’s there.

There are times when I’ve spent months in bed. Other times, I only spent long mornings in bed. Now, I can get up just fine most days. What changed? A million little things. I have had a lot of therapy. I got on the right medications. I have done work on trauma I’ve experienced. I regulated my sleep cycle. I make sure to eat enough. I actively seek out things that keep my interest. I slowed down with school. I cut out negative influences in my life. I’ve worked to better my
relationships. I even got cats. 

So is recovery easy? By no means. All that had to happen simply for me to get out of bed before lunch. If that much and more was required to make that one change, how long is it going to take to do other things? 

The truth is, my whole life. Mental illness can and does go into remission, but you still have to work to stay as healthy as you can. I could say that things are “good enough,” but I think that would be selling myself short. To be honest, I’m not happy with myself unless I am working to heal and become a better person. 

And that is one thing I think mental illness can do: It can make you more motivated to grow and become strong. Recovery teaches you the skills to be healthier, which can be applied beyond reaching a baseline “okay.” As much as not having mental illness would have changed my life for the better in many ways, it would also rob me of some of my strengths. I wouldn’t be as resilient. I wouldn’t place such a high value on good relationships. I wouldn’t know how to handle a crisis. I wouldn’t be as grateful. I wouldn’t be able to run this blog and try to make treatment easier for someone else. 

I wish I knew a better way to express how much each and every good choice you make is significant progress. I don’t know that I’d listen to myself a few years ago. But it ended up adding up. It took a long time, but my life is on track to be what I want it to be. Not all my aspirations will come true, but I’ve made new ones that are realistic to me and my condition. 

I’ve been reflecting about why I run this blog at all. I really, really want my readers to believe that recovery is possible. Not only is it possible, but it’s something you can do. There will come a day when you’ll say, “It was worth it to keep trying.” It might even happen when you least expect it. You are meant to live a good and happy life. You have a right to achieve that. If you do ten things wrong today, the one thing you did right still matters. Those “one thing”s add up eventually.

Have you made progress? Do you have hope you will? Give us your thoughts in the comments.

Diagnosis spotlight: depersonalization/derealization disorder

We all experience dissociation in some way or another. It can be as simple as highway hypnosis, where you suddenly realize you’ve driven for miles without noticing, and as complicated as dissociative identity disorder, formerly known as multiple personality disorder. Somewhere in-between, there is depersonalization/derealization disorder.

First of all, what are depersonalization and derealization?

Depersonalization refers to a distortion in self-awareness. You are, in a sense, unfamiliar with yourself. One typically experiences detachment from the body or the sense that it is unreal. It can even mean watching yourself from outside your body. The self just doesn’t feel real and things might seem like a part of a dream. It can also be watching yourself go about your day and making decisions, but not really feeling in control. Time might also be distorted and there can be physical and/or emotional numbing. 

Derealization is when everything else doesn’t feel real. Your surroundings might feel foggy, distorted, unreal or, again, like a dream. People, places and things that may be familiar seem strange or surreal. It’s hard to fully perceive the world around yourself and it might seem like you are watching everything through a filter of sorts. It can be like living in a bubble. What is around you is very separate from you and it can be hard to fully engage in life. 

Depersonalization/derealization disorder means having episodes of one or both of these. It can be accompanied with a feeling that you’re “going crazy.” There might also be vague physical symptoms, like tingling or lightheadedness. It is often associated with anxiety and/or depression. 

Approximately one-half of adults have had an episode of depersonalization or derealization. It happens. But when it is recurring or even constant, it can become pathological. Onset is almost always before age 25, so it’s something that can be experienced from a very young age. Childhood trauma is considered one of the causes of depersonalization and derealization, but it can happen without it. Symptoms can also be caused by physical conditions or substance use, so those need to be ruled out. Episodes are often preceded by high levels of stress, anxiety, depression, traumatic events (or reminders of them) and/or drug use.

Both therapy and medication are used to treat depersonalization/derealization disorder. In particular, cognitive behavioral therapy allows people to reinterpret the symptoms and psychodynamic therapy can look at unresolved and suppressed internal conflicts. Medication-wise, nothing has been approved specifically for the treatment of this disorder, but anxiety medication and anti-depressants have shown some success. There is also research supporting the use of lamotrigine, an anti-convulsant typically used to treat epilepsy. Using grounding techniques can also be very helpful.

Having the experiences of depersonalization and derealization can be very frightening. But it is a recognized mental health condition and a notable amount of people experience it. If you feel like the symptoms described apply to you, please talk to a doctor or therapist. It is possible to gain control over it enough to where it is not interfering with your life, if it doesn’t go away altogether. 

Have you experienced depersonalization or derealization? What was it like for you? Share your experience in the comments.

Have hope – it will change

  

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Mental illness has a way of trapping you into thinking that you are stuck in it forever. A depressed person doesn’t lay in bed for three weeks and say, “Two more and I’m good.” Someone doesn’t think, “I’ll have five more panic attacks and then I’m done.” It’s pervasive. And even if you can logically convince yourself that it isn’t going to last forever, it’s hard to believe it enough to get the accompanying feeling of relief. It’s like a kid the week before Christmas. It drags on forever. 

The point is, though, that it isn’t forever. Like I said, it’s hard to believe. Really hard. But it’s true. There is an end to it. Even if you are suffering from a lifelong condition, the way it manifests will change. There will be variation. The pain you are feeling won’t feel the same way for the rest of your days. 

There is always change. If you aren’t changing, the world around you is. You might not be capable of changing yourself at the moment. That’s okay. Some days/weeks/months/years/decades are like that. But others aren’t. An acquaintance might transform into a good friend. A family member might have a burst of inspiration that results in him being more helpful. Your therapist can learn something new about your diagnosis and apply it to your treatment. You have to believe in change.

Change happens on larger scales, too. Psychologists do studies to find out which treatments are more effective and why. Scientists invent new medications. People learn to become more sensitive to mental health issues. You never know when the next breakthrough is around the corner.

That is why you have to believe that change is possible. It’s happening around you all the time. But it is possible for change to happen to you as well. It might take a really long time, but it does happen. I tried several different medications of a certain class before we found one that worked. Did it suck until we found it? Yeah. Did some of them make me worse? Yes. But when we did find it, it made my life easier. I was in therapy for seven years before I decided to take a chance on a new treatment approach and it transformed my life. I’ve had bad relationships. If I had given up on people, I would not have a boyfriend that makes me better every single day.

You never know how long it will take to change and that’s scary. It really is. I spent over a decade almost constantly fighting with a certain terrible feeling before it subsided. If you’d told me at the start that that’s how long it would take, I might have given up before even trying to get better. That amount of time is overwhelming. But it is a lot shorter than the rest of my life.

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I’ve asked myself if it was worth it. How long can you endure misery before the chance of getting better is no longer worth it? There were times when I would have said not another day. Sometimes, I would have said that ridiculously many days in a row. But part of me didn’t let go. And eventually, things did turn around. 

It seems easy to say that, well, in retrospect it might be worth it. When you’re not in the midst of it, you can say it was possible to overcome. But my life is still affected by mental illness every single day. There are things I want to do that I can’t. Sometimes, I still get set off and have to spend a few days under the covers. But I have also found many things that are worth it. I have found relationships I could not have been healthy enough to manage before. I have come across new interests and started new hobbies that I would not have had the energy or concentration to learn about before. Even running this blog gives my life some sense of meaning. 

No one was more annoyed with the whole, “It gets better,” attitude than me. I felt like an exception. But the fact is that despite feeling hopeless, I still kept trying to get better. That effort pays off eventually. It will be small victories at first. It might be forgetting you’re suicidal for an hour or going a single day without drinking. But every bit of progress is still progress and it’s moving you forward. It might take you a thousand steps to get to somewhere when it takes someone else only 10, but you can still get there. 

With time, those steps do add up. Every day that you do your best matters. Everything is constantly in motion and you are becoming a new person minute by minute. Making the choice to recover helps you become a happier and healthier person. So love yourself for trying. That is one thing I always hold on to: I never stop trying. Knowing that alone has a powerful impact.

What gives you hope? Share stories in the comments.

9 things you need to believe in order to heal

Healing from mental illness is one of the most difficult things you will ever do. It’s a scary process and you never know if you’re going to relapse. But a lot of it is about attitude and belief. Here are some of the things you need to believe if you want to recover from mental illness.

1. It is possible to heal.

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There is very little point in trying to recover if you do not believe it is possible. Not believing it sets up a major barrier that makes progress in treatment minimal at best. Belief in the method of healing is essential to recovery. Take the placebo effect. If a pill that does nothing can make some people better because they believe it is something else, then believing in your actual treatment is going to be fruitful.

2. It is okay for it to take time.

At the start of therapy, people usually want to know how long it is going to take. Some people even expect everything to be solved in a single session. The truth is, it’s going to take however long it’s going to take. The average is 8-12 sessions, but that number is, in a lot of ways, completely meaningless. Whatever you need is how long it’s going to take and that’s okay.

3. It is normal to take a step back.

Recovery isn’t a straightforward trajectory towards wellness. There are ups and downs. You will get worse before you get better. And even when you do get better, you’ll still have bad days/weeks/months. The thing with setbacks is that they actually make you stronger than you were before. You may feel like you overcome it to end up in the same place, but you’ll have grown even more.

4. You are worthy of love no matter where you’re at.

Measuring our self-worth is often done by looking at our output. How well do we do in school? How much money do we make? What kind of significant other have we won over? Mental illness can affect one’s ability to produce, but it doesn’t affect self-worth. You’re just dealing with a different set of characteristics. Now your courage in facing your disorder, determination to get better and willingness to comply with treatment set you apart.

5. Others will support you if you let them.

There are others who will want to help you. And if they’re not already in your life, you will be able to find them. I spent so many years trying to recover without letting others really be there for me. I thought I had to do it myself. You don’t. Once I started letting other people in, I’ve made tremendous progress. I don’t have a big social network, but even one person supporting you makes a difference.

6. Your treatment team can help you.

Research has shown that believing in the ability of your therapist to help you improves therapy outcomes. That’s why sending someone to therapy who doesn’t believe in it or who isn’t ready is pretty useless. If you don’t entirely trust your specific therapist, look for someone else. It is critical that you have faith in those who are helping you. (Here’s a list of questions to ask potential therapists.)

7. Things are always changing.

Don’t give up on yourself because you believe you’ve exhausted every option. The world is in constant flux and your circumstances are changing all the time. There are always new treatments, new research, new therapists, new medications, new friendships, new hobbies, new everything. The belief in change is also helpful when you’re having a setback because you know it won’t last forever.

8. You are not an exception.

I spent a lot of years thinking that there was something so terribly wrong with me that I wasn’t going to get better. I put forth all my best effort with minimal results. I just thought that I was someone who couldn’t get better and that the most we could do is not make things worse. It took six and a half years of therapy to find a crucial component that turned things around. But we found it. You will find it, too, eventually.

9. It will be worth it.

Mental illness changes the way you view the future. It can be very hard to see yourself living the life you want. The truth is, things might not work out the way you’d like. I’ve worked on my undergraduate degree for eight years and still don’t know if or when I’ll get it. But I’m learning to appreciate any progress. I don’t have a lot of relationships in my life, but the ones I do have really matter. There are a few things I enjoy doing that I didn’t know about before. You have to believe that you’ll find something worthwhile, even if it isn’t exactly what you planned.

What beliefs have helped you in your recovery? Add your thoughts in the comments.

Mental health myths: causes of depression

I occasionally post about mental health myths. I try to debunk incorrect beliefs about mental illness. This time I am talking about the causes of depression.

Myth: Depression is caused by sad or upsetting events.

Fact: Depression can strike at any time.

Some people believe that depression is caused by something unfortunate happening. This might be a death, a breakup, illness, loss of employment or other difficult life events. While these situations can certainly trigger a depressive episode, they are not the sole cause of depression.

No one knows exactly how mental illness works, and that includes depression. It is generally believed to be a mix of several different factors. Some of the possible contributors are listed below.

• Genetics. You might have inherited more from your parents than your looks or your mannerisms. Having family members with depression increases your risk of developing it. It’s not a straightforward genetic trait, so it’s unpredictable to know who will get it. But if your parents, siblings, grandparents or other blood relatives have struggled with depression, keep an eye out for symptoms in yourself.

• Brain chemistry. The brain chemistry of depressed individuals is different than that those without it. This brings up the whole chicken or the egg argument about whether it’s the chemistry that causes depression or the depression that changes the chemistry. Either way, it is a factor that might contribute to developing a depressive
                                                                                                                               disorder.

• Hormones. Hormonal imbalances are another potential cause of depression. This might be due to thyroid problems, pregnancy, menopause or other changes in ones hormones. Your doctor can look for other symptoms of a hormonal condition and order tests to confirm any suspicions. There are treatments for hormonal imbalances that will by extension alleviate the depression.

• Substance abuse. Depression often goes hand in hand with substance abuse. One estimate is that 30% of people struggling with substance abuse also experience clinical depression. This might partially be because alcohol and drugs can be used to self-medicate, but the effects of these substances on the body can increase chances of depression as well. 

• Taking medication. Some drugs increase the risk of depression. It can be a side effect. If you are feeling depressed and have recently started taking or changed your dose of a medication, talk to your doctor. There might be other medications that treat the same things and won’t cause you to experience depression.

• Stressful events. We’ve already established that negative events can contribute to depression, but positive ones can as well. If it is causing significant stress, it can cause depression. Some events might include getting married, buying a new home, graduating or starting a new job. 

• Social problems. How you interact – or don’t interact – with others can influence depression. If you feel socially isolated or are struggling with interpersonal difficulties, you might become more depressed. Rejection from a social group can be especially triggering.

It is apparent that a variety of factors contribute to depression. It can be affected by genetics, biology, behaviors, events, relationships and more. It can be complicated to pin down what, exactly, is causing a depressive episode, so it is important to be open with your doctor and your therapist. They can help figure out the causes of your depression and recommend appropriate treatment specific to your causes.

To read all the mental health myth segments, click here.

What has triggered depressive episodes for you? Share your stories in the comments.

Living with physical and mental illness

Health is a complex concept. A holistic view of health allows for multiple aspects to be examined, including physical, mental, social and spiritual health. These different facets interconnect and feed into each other, creating an intricate person as a whole. 

   

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Physical and mental health are highly related. According to the Canadian Mental Health Association, people with a mental illness are at a higher risk for a chronic physical illness. It works the other way, too: If you have a chronic physical condition, your mental health is at risk. Some disorders concern both the body and the mind, including hypochondria, eating disorders and insomnia. 

A combination of mental and physical symptoms can be more debilitating than either on its own. It creates a double struggle. If you are having mental health issues, it might be difficult to attend to physical symptoms. Physical conditions can also increase psychological symptoms such as depression and anxiety.

If you are in this situation, it is possible that you have an extended medical treatment team. You might, for instance, have a primary care physician, a psychiatrist and a specialist for your physical condition. In order to receive the best possible treatment, it becomes extremely important to be open and honest with all of them. If one doctor puts you on a medication that is contraindicated with one you are on from another, you can have very bad reactions. Your primary care physician, especially, should get documentation from everyone you visit. It can be hard to talk about mental illness with someone who doesn’t specialize in it, but do it anyway. She can always consult with colleagues if she is stumped. 

Self-care can help mediate the barrage of symptoms. Taking time to let go of everything else and do something that feels good for you is important. Try to think of things that make you feel better mentally and physically. Listening to and focusing on music can be cathartic emotionally while distracting you from your pain. Exercise is very effective in improving depression and can be part of healing some physical illnesses as well (talk to your doctor about what is safe if you have a physical condition). Getting a massage gives you a nice, relaxing break while relieving muscle tension.

Don’t be afraid to ask for help. It can reduce stress, which negatively impacts both physical and mental health. If you can’t do heavy lifting, call your brother. If you are struggling in school because of a condition, talk to your school’s accessibility services. If a work task becomes difficult, ask a colleague to help or talk to your boss about possibly changing your responsibilities. If you can’t get out of bed, ask a friend to drop off dinner and maybe have a chat. If you would be willing to do it for someone else, there is probably someone willing to do it for you, too.

Having limitations due to illness can be discouraging. It might mean giving up your favorite hobby. It could exclude you from having certain careers. It means you may have to be more dependent on your loved ones. But there are still ways you can contribute. Just find the things you can do, no matter how small. It adds up and you never know how much something will matter to someone else. We are all interdependent and your contributions, while maybe not as obvious or notable as those of others, are part of what makes your relationships work. 

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As someone living with multiple physical and mental health conditions, I have found that attitude is essential in this situation. When I give in to feeling discouraged, I become more dysfunctional. I lay in bed all day thinking negatively about how I am laying in bed, then I keep doing that. When I focus on how I made my brother happy by spending time with him, had all of my studying pay off at the end of the semester or wrote four blog posts in one day (it happened once), it’s a lot easier to be healthier. When I concentrate on enjoying the things I am doing, it gives me more motivation to keep doing those and other things. 

It’s a special kind of burden to struggle with illnesses of both the mind and the body. Don’t do it alone. Let those around you help you, whether it’s your medical team or your neighbor. When everyone does what they can, things tend to fall into place eventually.

Do you struggle with both physical and mental health? Tell us what you find helpful in the comments.

Diagnosis spotlight: trichotillomania

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We all have nervous habits, like biting nails or chewing on pencils. But when taken to an extreme, such repetitive actions can become a serious problem. One case is trichotillomania, a condition of repeated compulsive hair pulling that results in hair loss. While much more than a nervous habit, it can have similar feelings of instinctive impulsivity and a soothing power. It is also difficult to stop, so much that professional help is often needed.

Hair pulling can occur at numerous different sites on the body. Some of the most common ones include the scalp, eyebrows and eyelashes. With the latter two, they may become removed completely. Trichotillomania of the scalp can lead to visible hair thinning and baldness. To be diagnosed with it, efforts to stop must have failed and there must be significant distress and/or impairment in at least one major area of life. This might include avoiding social situations due to embarrassment or shame. It can be exasperated by stress.

Trichotillomania is more common than you may think. According to the DSM (psychiatric diagnostic manual), it affects 1-2% of the adolescent and adult population in any given year. Women are ten times more likely than men to have trichotillomania. In children, the ratio is more even. 

There can also be accompanying behaviors to trichotillomania. Rituals may be established in how the hair pulling is done. This might include looking for certain types of hairs, trying to pull out hair in a specific way (like leaving the root intact), studying the hair, playing with it and chewing the hair. It is not required diagnostically, but other body-focused symptoms (nail biting, lip chewing, skin picking, etc.) can be present. Trichotillomania also often co-occurs other mental illnesses, notably major depressive disorder. These should be assessed for and addressed as part of treatment.

Seeking help for trichotillomania is important. In addition to the psychosocial consequences of this disorder, there are multiple medical concerns that accompany it. It can lead to permanent damage to hair growth and quality. Less commonly, it can cause skin conditions, carpal tunnel syndrome and musculoskeletal pain. If the hair is eaten, it can cause dental damage and very painful digestive problems.

  

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Treating trichotillomania primarily involves psychotherapy. Cognitive, behavior and acceptance and commitment therapy have been found to be particularly effective. Habit reversal training might be a big part of treatment, teaching you how to redirect and lessen your behaviors. There is no FDA approved drug treatment for trichotillomania, but some drugs might help alleviate symptoms. These include SSRI antidepressants, clomipramine (a tricyclic antidepressant), olazopine (an atypical antipsychotic) and naltrexone (used to treat substance dependence).

Relapse is very common with trichotillomania. One thing to remember is that a slip up does not mean you are actually relapsing. You can engage in your behaviors without returning to them fully. Let those times simply be single instances instead of an excuse to return to full-blown pathology. Stick to any treatment plans you have developed and don’t be afraid to reenter treatment. Trichotillomania is not a character flaw. It’s a mental disorder that very well might be partially due to abnormalities in brain chemicals. That’s not your fault.

It might be difficult to seek help for trichotillomania, seeing as those who have it often find it embarrassing. Remember that it’s a real condition and that you have as much of a right to treatment as someone with bipolar disorder or diabetes. Any competent therapist will not judge you or berate you. They are there to offer support and help you learn how to manage the condition. With treatment, trichotillomania can and does get better. 

Have you experienced trichotillomania or another compulsive, body-focused problem? Share your thoughts and experiences in the comments.

Are antidepressants safe for youth?

Antidepressants are used both as first line and adjunct treatment for depression. The most commonly used type is selective serotonin reuptake inhibitors, or SSRIs. A simplified explanation of how SSRIs work can be found here. These drugs are also used to treat other mental health conditions, mostly anxiety disorders. It does takes several weeks for the positive effects of the medication to manifest, at least with depression.

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All medications come with certain risks and side-effects. SSRIs, however, can be extra hard on children, teens and young adults. The FDA has issued a black box warning on all SSRIs, which is its strongest warning. It states that taking these medications can cause an increase in suicidality in those up to age 25. 

This warning is issued because 4 percent of children treated with SSRI medication experience suicidal thinking and behavior (including attempts). This is twice the rate of those who took a placebo (sugar pill). So while the odds of having this reaction to an anti-depressant are low, it is important to watch for, especially in the first month or two and around dosage changes. 

It is believed that the benefits of taking an SSRI outweighs the risks. And it is true that it is a fairly rare reaction. But without discouraging antidepressant use, I want to stress how real that suicidality can be. I was 20 the first time I took an SSRI and there was a marked difference in my level of suicidality. I went from thinking about dying to planning on it. As soon as I realized this, I contacted my psychiatrist and he reduced the dosage. I had to be watched for a few days, but it got better.

What I learned from that is to not go through medication changes alone. Let important people in your life know about the change. These include family, significant others, therapists and other healthcare providers. When symptoms become worse, it can be hard to reach out for help. If others are looking out for you, it is much safer to go through medication changes. They can notice if you change and help make sure you talk to your healthcare provider.

Suicidality isn’t the only side effect of medications. Even in adults, SSRIs can make you more depressed before you get better. I’m now 26, but I let my mom, boyfriend and therapist know every time I go through a medication change, even if it’s just changing the dosage of something I’m already on. No matter what you are taking – whether it’s for a physical condition or a mental one – I think it’s good to tell those who will be around you the most. 

So are SSRIs safe for those under 25? For the most part. Just monitor any adjustments very closely. If you are thinking of taking or having your child take antidepressants, mention any concerns you have to your prescribing physician. She can help you make a plan for how to handle any side-effects that might come up.

Have you taken antidepressants while under the age of 25? What was your experience? Let us know in the comments.

Substance abuse and mental health

Mental illness has a potentially devastating companion. Substance abuse and dependence are common in people who are struggling with their mental health. According to the National Alliance on Mental Illness, 29 percent of those who are diagnosed as mentally ill abuse either alcohol or drugs. That's almost one-third. Looking at it the other way around, over one-third of all alcohol abusers and more than one-half of all drug abusers struggle with mental illness.

  

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This creates an entire population of mental health patients with very distinctive needs. Treating a mental illness becomes much more difficult when substance abuse and dependence are involved. If you have a predisposition towards a certain illness, but it has yet to manifest, substances can trigger it. When you are already struggling, substances can make your symptoms worse. On the other hand, mental illness can make you want to self-medicate and thus can cause a substance abuse problem. The two feed into each other.

When you are abusing or dependent on a substance, you cannot engage in treatment for your mental illness in the same way you can when sober. Your mind will simply not work the way it needs to in order for you to heal from your mental health issues. In addition, sometimes these substances can interfere some with medications. This is why it is so important
                                                                                                                  to get help for substance abuse problems. 

There are, of course, rehab and treatment centers specifically for detoxing. For some people, this is the best route to go. But it's worth knowing that there are also treatment facilities that cater specifically to people with the dual diagnosis of mental illness and substance abuse. There are entire programs that are designed to help with the specific needs of this population. When evaluating facilities, ask about these types of programs. Some of them will be listed as psychiatric hospitals, so don't rule those out when you are searching for a treatment center.

More in-depth information on substance abuse and mental illness can be found at the Substance Abuse and Mental Health Services Administration's website. You can also call them at 1-800-662-4357. The primary purposes of this helpline is to refer people to treatment options in their area. The National Institute on Drug Abuse offers a helpful guide for evaluating treatment centers on this page.

Have you or someone you love experienced problems with both mental illness and substance abuse? Share your stories and insights in the comments.

Diagnosis spotlight: posttraumatic stress disorder

Life isn’t always kind. No one is immune to twisting an ankle or feeling heartbreak. The difficult aspects of life are just normal a part of the experience. Trauma, on the other hand, is something damaging that is outside the realm of normal human experiences. It’s not something that is expected and it can be very difficult to cope with. War, sexual assault, major natural disasters and life-threatening accidents are all examples of this.

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Traumatic events can leave anyone shaken for a while, but when symptoms won’t go away, it can become an illness. When the aftereffects of the trauma seriously interfere with major areas of your life for an extended time, it might be post traumatic stress disorder (PTSD). According to the guidelines in DSM-5 (a volume used for mental health diagnosis), this is a psychiatric condition that is the result of “exposure to actual or threatened death, serious injury, or sexual violence.” It can be a result of something that you experienced, witnessed or (in a few cases) heard about. Symptoms have to occur in each of four different areas: reexperiencing, avoidance, cognition/mood alteration and hyperarousal.

Reexperiencing is exactly that: experiencing the trauma over and over again. This can happen in lots of different ways. You might have intrusive memories, nightmares, flashbacks or negative reactions to things that remind you of the event. On the extreme end of the spectrum, you may actually think the trauma is happening right then and there.

Another reaction is to avoid anything that is associated with the event. It could be trying to stay away from external reminders or you might avoid your own thoughts and feelings. If someone was in a serious car accident, he might drive different routes – even when longer – in order to not pass the scene of the accident. An assault victim might go to extreme lengths to distract herself from the memory and associated feelings. It can also include avoiding seemingly benign things, such as teddy bears, frying pans or the rain, if they are somehow reminders of the trauma.

  

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There must also be changes in thoughts and/or feelings as a result of the trauma. It could be being plagued by negative feelings (fear, anger, guilt, etc.) while being unable to experience positive emotions (happiness, calm, love, etc.). Others might be unable to remember an important part of the trauma. Distorted thoughts, such as “it’s my fault that I got mugged” or “nowhere is safe,” can also occur. Feeling detached from others and having a decreased interest in significant activities are also signs.

Hyperarousal refers to having very strong negative reactions to your environment. You can’t feel safe, so you respond as if you are always in danger. An increased startle response or hypervigilance (intense and unwarranted efforts to detect threats) are common reactions. Problems sleeping or concentrating are also potential disruptions. You might also become irritable or angry without being seriously provoked. It can even go as far as engaging in self-destructive behavior. 

Psychotherapy is the most common treatment for PTSD. This can take many forms. Sometimes desensitization to the experience through repeated exposure can reduce symptoms. Other times, processing the event and what it means is called for. Medication might help with individual symptoms, but are not meant to treat the condition as a whole. There are also treatment techniques such as hypnotherapy and what is called EMDR (eye movement desensitization and reprocessing). Talk to your clinician about your treatment options because there might be more than you think. 

PTSD is a normal reaction to an abnormal event. It can seriously interfere with all aspects of living, so it’s very important to seek a professional opinion and subsequent treatment if you are experiencing several of the symptoms described. Recovery might seem unthinkable in the midst of the disorder, but it is possible to overcome extremely difficult parts of your life. It might take a long time, but remember that it can be done and working on it is better than allowing it to take over your life. 

Cut your med costs in half (really)

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Here's a quick tip that can potentially cut the cost of your prescription medications in half! I don't use exclamation points often, so this is cool. I learned this trick from a pharmacist, actually, even though it's not necessarily to their advantage. This saved me when I was on a $100/mo. medication without insurance. 

The next time you visit your health care provider, ask if any of your medications are available in pill (not capsule) form. Then see if there's a pill that's double the dose you need. If there is, ask to have that one prescribed instead and then take half a pill instead. This isn't possible with every med; if you have a time-release prescription, it won't work. Your doctor could say no, but it's definitely worth trying – especially if you don't have adequate insurance. I know that you can do this with a fair amount of medications.  

Outside of that, check if your preferred pharmacy does price matching. In general, at least in my area, Costco has the lowest prices (and you don't have to buy in bulk). You can, of course, switch pharmacies. But there are sometimes reasons to stay with the one you use. Making a few calls around town, though, could be a big saver.

Do you have any other money-saving tips when it comes to meds? Share your tricks in the comments.

Diagnosis spotlight: seasonal affective disorder

Our environment has a strong influence on our mental health. In fact, an entire disorder is dependent on the time of year: seasonal affective disorder (SAD). Often referred to as the "winter blues," this disorder typically follows an increased depression that begins in the fall and increases as the winter moves on. In some cases, however, the disorder starts up in the spring and peaks in the summer.

Symptoms vary between winter and summer SAD. According to the Mayo Clinic, symptoms of fall and winter SAD include depression, hopelessness, anxiety, loss of energy, a heavy or "leaden" feeling in arms or legs, social withdrawal, oversleeping, loss of interest in activities you once enjoyed, appetite changes (especially a craving for carbohydrates), weight gain and difficulty concentrating. Spring and summer SAD, on the other hand, is demonstrated through anxiety, trouble sleeping, irritability, agitation, weight loss, poor appetite and an increased sex drive.

It's easier to dismiss a problem if it goes away on its own. It can take a long time for someone to be motivated to get help and since SAD dissipates after a few months, some people will never seek treatment. The problem is that this is a cyclical disorder that returns year after year, meaning that it isn't actually going away. 

SAD, though dependent on the seasons, is not any less severe than other forms of depression. It should be taken just as seriously as "regular" depression. This means actively seeking treatment is just as important. The most commonly used treatments are light therapy, medications and psychotherapy.

Light therapy (also known as phototherapy) involves sitting in front of a box that emits specific wavelengths of light. This treatment is based on the idea that a lack of sunlight is partially to blame for the illness, a theory that is supported by increased rates of winter SAD in the north. This is the least invasive treatment and a good first step. Make sure you buy a quality box and consult with your doctor. How long you expose yourself to the light and what time of day you do so is important and should be determined by a professional.

SSRI antidepressants are also used to treat SAD, especially in more severe cases. It can take several weeks for the medication to work, so if you know you know have a yearly problem with SAD, you might want to start a regimen before winter (or summer) hits. Make sure to not go off the medication before your doctor recommends it, even if you feel better. 

Psychotherapy can also be effective in treating SAD. While you can't control the coming and going of the sun, you can control other factors that might be influencing the SAD. A therapist can offer suggestions for managing and reducing your symptom. A therapist can also possibly get at other underlying causes of and contributions to the depression, seeing as it is rarely only one thing that is the root of the problem. 

It's unnecessary to suffer from seasonal depression year after year. If you or someone you know struggles at a particular time of year, don't dismiss it. The temporary nature of the disorder does not reduce its seriousness. Schedule an appointment with a doctor or therapist to further explore what your options are in treating SAD.

Do you get more symptomatic at certain times of the year? What has helped you? Share your thoughts in the comments.

My take on meds

Feel free to ignore this post if you don't want an opinion piece. I just feel that since I will be talking about medication, it's probably best that I explain my stance to provide some context. 

There's so much good that has come from modern medicine. This includes a wide assortment of medications that help treat and even prevent certain conditions. These include entire categories dedicated to mental health issues. Due to the fact that we don't know enough to not be experimental, new discoveries are made by chance. For instance, anti-seizure medication can be used in the treatment of personality disorders. It's a frontier we have yet to conquer.

I have a great level of respect for those who dedicate their lives to finding ways to improve and extend our lives. Unfortunately, the pharmaceutical industry as a whole is not run by philanthropists who throw money at it. It's a business. This means that they have to make money. The competition can be healthy in terms of innovation, but it has to be financed. This is how Prozac got renamed Sarafem and prescribed for PMS. Once the original use for a drug has been tapped into, it's time to find ways to keep making money off of the same formula. Do you have to take four pills a day? We just made a different one that does the same thing, but you only have to take it once! You think anti-psychotics are reserved for schizophrenia? No, they're also used for autism, dementia and even insomnia.

Honestly, it's a really complex system and I'm not here to preach about it. But since medication is a significant aspect of the mental health industry, I can't ignore it. In order to offer a respectful climate for discussion of something so attached to opinion, this is the perspective I am coming from:

• Medication has the potential to significantly improve and even save lives in the mental health field.

• Some people need medication. They have exhausted all their options and cannot find anything else that is sufficiently effective.

• It is not our job to judge whether or not someone needs medication. Don't think your sister needs lithium? It's the job of her and her doctor to figure that out. Think your friend needs some anti-anxiety pills? It's not your call.

• Side effects are a factor that should be taken into consideration when prescribing medication.

• When it comes to children, teenagers and young adults, special precautions need to be taken and other approaches should be more carefully considered. While the body and mind are still developing, a cost-benefit analysis is definitely warranted.

• Are we overprescribing? Probably. I refuse to believe all my classmates who take Ritalin or Aderall actually have attention deficit hyperactivity disorder (ADHD), a childhood disorder that doesn't spontaneously emerge in college.

• Never encourage or support someone in going off their medication without proper medical supervision. Not only may it be inappropriate in terms of treatment, but not regulating the tapering off of a substance can cause withdrawal symptoms and other serious – possibly permanent – complications.

• There are alternative approaches that can be taken, and that's okay, too.

• Ultimately, it's about getting better. Whatever works (and is relatively healthy) is great!

I understand completely if you disagree. I don't claim to be an expert. I'm just being honest about where I'm coming from so that any biases I have are pre-announced. 

Psychologist, psychiatrist – what's the difference?

It seems to me that the most mixed up terms in the mental health field are actually two of the most fundamental ones: psychologist and psychiatrist.

There are a variety of types of mental health providers and they all have their purposes. Depending on the issue at hand, it is important to know which practitioner will be of the most help. So whether searching the Internet or checking the yellow pages for someone to help, it's important to know what, exactly, to look for.

There are, of course, other types of practitioners. Therapists, counselors, psychoanalysts, social workers, art therapists – there are a lot. There will be posts about these professionals in the future, but it seems that understanding the difference between psychiatry and psychology is the most pressing.

A psychiatrist is a medical doctor (MD). She will have gone through all of the same medical training as anyone else in medical school, but will have specialized in psychiatric disorders. Although they used to act more like traditional counselors, currently, the primary purpose of psychiatrists is to make diagnoses and prescribe medication. (It should be noted that regular physicians can also, to some degree, prescribe psych meds. This will be discussed in a later post.)

Pros: With a few rare exceptions, psychiatrists are the only mental health practitioners who can prescribe you medication. They also have medical training that might pick up on a physical ailment that is causing mental side effects instead of assuming it is a psychiatric condition. If you have a combination of physical and psychological symptoms, a consultation with a psychiatrist is worthwhile in order to understand the root of your problems.

Cons: Depending on who you're seeing, it is a very real possibility that she will spend ten minutes with you, hand you a prescription for the drug du jour and charge you $200. While a good psychiatrist will at least have an extended first consultation to understand your background and situation, they are usually paid per appointment, not per hour. Do not expect talk therapy.

A psychologist has a doctoral degree (either a Ph.D. or a Psy.D.) in psychology, has passed licensing exams and completed lots of supervised hours. Their training is more or less entirely focused on mental health and other psychological issues. This is the person you see in the movies: the man with diplomas on the wall, sitting in a comfy chair while hysterical clients pour their hearts out. Now, it doesn't always work like that, but it gets to the general idea. It's someone to talk to who has been trained in how to respond to a variety of issues.

Pros: Consulting a psychologist can be a good starting point for receiving treatment. He will be qualified to sort out what, exactly, you are experiencing and will have the academic background to suggest and utilize the optimal treatments. (This could include a referral to a psychiatrist if medication or other health complications should be considered.) Psychologists can also perform certain functions that other counselors cannot, such as administering certain psychological tests. All in all, psychologists are there to listen and to give you a lot more time and attention than a psychiatrist would.

Cons: The most obvious con is that psychologists cannot prescribe medication. (There are a few controversial programs in some states that grant psychologists prescription privileges, but don't count on it.) The field is also more diverse than psychiatry when it comes to treatment options. While a good thing, in practice it means that sometimes it can take a while to find the right practitioner. Additionally, psychologists are generally more expensive than other professionals with similar services, such as licensed counselors and social workers. (These will be discussed in another post.)


All right, there are the basics. Psychiatrists: medical doctors. Psychologists: talk therapists. Often it is a good idea to see both. A combination of antidepressants and counseling has been found to be more effective in treating moderate depression than either on its own.


What has your experience been like with psychologists and psychiatrists? There are so many interesting stories out there.