Category Archives: Anxiety Panic Grief Depression

What are the causes of relapse to symptoms of depression

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

What causes relapse?  

The causes of relapse to active symptoms of mood disorder have been well documented over the years. It’s no surprise that these reflect the relapse warning signs listed below.
They are:
• Medication non-compliance (Not taking the medication as prescribed).
• Alcohol and substance use and abuse.
• Little or no sleep.
• Lack of social support, isolation.

Non-compliance with medication and alcohol or substance use or abuse are by far the leading causes of relapse to symptoms. These are self-explanatory. However, little or no sleep and lack of social support also need to be addressed.

Alcohol and/or substance abuse will cause relapse to active symptoms of depression, panic and anxiety. If you are not an alcoholic, I recommend no more than 2 drinks twice per week but never in back to back days. If you mood dips in the days following you should consider abstinence.

Sleep is an important issue for most with mood disorders. People with Bipolar disorders usually report that they don’t need much sleep. They have a tendency to play with their sleep/wake cycle. They like the euphoric hypomanic feeling that lack of sleep creates. It is very much like the moth and the flame. There is an attraction to the high that one gets when they are sleep deprived. Unfortunately, you can take anyone in the world and keep them awake for two, three or four days, they will become actively psychotic. For people with a mood disorder, sleep is a mental health issue.

Social support is also very much a part of maintaining good mental health. Even if one is compliant with medication and not using or abusing alcohol and drugs, social isolation can create considerable stress and ultimately cause a relapse to symptoms. It is imperative that people with mental disorders, have an avenue to combat their tendency to isolate and withdraw from people. I encourage my clients to maintain regular social contact. This contact creates reality testing. We don’t think of socialization as reality testing but it is. For example: You have an argument with your spouse; you call a friend and say here is what happened. What do you think? You get feedback on your situation and behavior. That is reality testing. Lack of social support may result in an inability to test the accuracy of what one is feeling or experiencing. This is obviously a very important component of maintaining good mental health.

Zoom!   Now I can work via Zoom with anyone, anywhere in the country and it may be covered by BCBS Insurance. Check with your BCBS representative for more information.   Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.  I am currently doing Zoom only.

http://manageyourmood.net
http://family-institute.org
http://takenotelessons.com   Effective on line, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype and much more.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Issues to discuss before Marriage. What you will learn in premarital counseling?

By: James E. DelGenio MS, LCPC
Senior Staff Therapist
The Family Institute at Northwestern University

Premarital Counseling is a really good idea! 

Premarital counseling can help ensure that you and your partner have a strong, healthy relationship. This will give you a better chance for a stable and satisfying marriage. Premarital counseling can also help you identify weaknesses that may become larger problems during marriage. Good marriages don’t happen by accident. Many issues can be resolved prior to marriage with the help of a therapist. Common issues addressed may include work, finances, lifestyle, spending habits, credit card balances, student loans, savings, retirement planning, roles and responsibilities, children, parenting, in-laws, and leisure and fun. Marriage requires an understanding of yourself, your future spouse, and the tools and skills you need to make it work.

Does your significant other have a Mood Disorder?
Some moodiness is a part of everyone’s life; sometimes we feel happy, other times we are sad; some days we have lots of energy, while at other times we may be fatigued and unmotivated. When mood changes interfere with your ability to function, work or go to school, when they harm your relationships significantly, when they cause you to miss sleep, abuse drugs, or behave in ways you later regret, or when they lead to risky behaviors, thoughts of suicide, or losing touch with reality, your mood requires professional attention.

If this sounds like you’re intended. All is not lost. The key factor in this decision is Denial. If your partner tends to deny issues now, do you really think it is going to get better later?
I find that most premarital couples are well aware of their intended’s mood and alcohol/substance issues. My main questions are as follows:
Is he/she:
• Willing to seek help?
• In need of psycho-education and symptom management?
• Willing to take medication, if prescribed?
• Willing to honestly address alcohol and substance abuse issues?
• Willing to see a therapist for relationship issues and support?
It’s not going to get better if your intended is in denial. Get out while you still can!

Civility and Respect
Work on resolving conflicts in a civil and respectful way. Lack of civility and respect will eventually be the undoing of any relationship. It is possible to argue, resolve conflicts, and agree to disagree in a respectful manner. In order to do this, all couples need rules of engagement for conflict. It is important that couples express how they feel, but this needs to be done in a very caring and respectful manner. This definitely means there should be civility and respect when conflict occurs. That means no hitting (of course), no yelling, no swearing, no screaming or name calling or sarcasm. I encourage you to look at yourself and your relationship with your intended. Are you holding onto resentments? If so, you will need a therapist to help resolve this and teach you how to fight with civility and respect.

Zoom!

Now I can work via Zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

How to cope with depression, panic and anxiety?

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

How to distract yourself from your depression and anxiety?

Socialization, Exercise, Hobbies, and Chores!

Socialization is an important coping skill. It is good to have fun. Have fun! People with mood disorders often become engrossed in the past, their illness, and problems. They tend to isolate and withdraw. That is just not healthy and is a common symptom of depression. You should have at least 3-4 social events each month.

Exercise (especially walking) is good for depression and anxiety and is a great distraction when one is experiencing symptoms. Research suggests that a brisk walk for 4o minutes (with your doctor’s approval) will lift your mood and reduce anxiety. Don’t wait to feel motivated. Lack of motivation is often a direct result of a mood disorder. If you wait to feel motivated, it may never happen. Walk or do cardio work at least 4 times per week. Pick your days and let the day of the week make the decision for you. This will help to avoid, “I don’t feel like it today; I’ll do it tomorrow.” Unfortunately, tomorrow never comes. Any physical activity is likely to be helpful.

Hobbies can also be an important coping skill. A hobby can serve as a distraction when you are feeling low or anxious. Go to a hobby shop and pick something. I have had a lot of people choose paint by number sets. It’s the perfect hobby. You can pick up a paint brush and distract yourself and put it down and walk away when you need to. I had one man become a very good artist after starting with just a paint by number set. So, go to the hobby shop and pick something!

Chores can also be a great distraction. Many people with depression are overwhelmed by the thought of cleaning their entire living space. Again, use the pick a day method and choose one or two chores per day. Do your chores and exercise on the days you have picked to do them. Try to have at least one social activity per week. Plan to have fun. Adding structure to your life addresses many common symptoms of a mood disorder but especially lack of motivation.

Zoom! Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://jamesdelgenio.com
http://family-institute.org
http://psychologytoday.com

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Why do people resist taking medication for depression?

By: James E. DelGenio MS, LCPC
Senior Staff Therapist
The Family Institute at Northwestern University

Resistance to medication?

Psychiatric medication is useful in controlling symptoms of mood disorders. Mood disorders are considered bio-psycho-social disorders. They affect thinking and behavior and often create relationship issues. In most cases, medication and medication management are essential in the management of the biology or the chemistry of the disorder. I consider this to be the foundation of treatment. It is difficult, if not impossible, to treat a severe mood disorder without medication. You can’t build a solid house without a good foundation. Medication, when necessary, provides that solid foundation.

Therapy addresses the psycho-social treatment issues including identification and management of symptoms, daily living skills, coping skills, and the relationship issues and conflict which often accompany these disorders.

Refusal to take medication is a common issue. I do on occasion have clients who refuse medication. In the past, I have said, “I will work with you to see if the use of coping skills will have an impact an impact on your symptoms. If the use of coping skills does not work, I will revisit the medication issue.” If it does that’s great. If not, I will try to deal with the denial and the refusal of medication.

For instance, what if I told you that you are a diabetic and will have to be on insulin injections the rest of your life?  Of course, you wouldn’t like it, but chances are, you would take the insulin injections in order to live! Why is medication for a mood disorder any different?

Let me remind you that alcohol is a drug and if you are drinking, you are self-medicating with a depressant. This may lead to alcoholism or substance abuse and addiction. Wouldn’t it be wiser, safer, and more productive to let a doctor prescribe the correct medication to help you get on the path to recovery?

Medication and Support

Many people remain on medication their entire lives. Some people with mild depression or situational depression are able to use medication intermittently (6 to 18 months) for periods of stress that caused their depression to re-emerge. Others don’t want those periods of regression in their life, so they chose to just stay on the meds. I encourage clients to consult with their doctor for recommendations.

Therapeutic support may also be intermittent or as needed after a time. Depending on the severity of the disorder and how well a person learns to manage, many of my client’s check-in at least three or four times per year, once they are stable and consistent in management. This is especially common for couples whose disorders affect their relationship.

Unfortunately, some people with severe clinical depression or bipolar disorders  may go in and out of the hospital their entire lives if they remain in denial. This is usually a result of non-compliance with treatment and medication, combined with alcohol and/or substance abuse. Mood disorders and addiction can be global disabilities or manageable handicaps. Which one will you choose?

The number one cause of regression, recurrence of symptoms and possibly hospitalization is not taking medication as prescribed. This is not like having a headache. When you have an ordinary headache, you take two aspirin and twenty minutes later your headache is gone. In order for antidepressants or mood stabilizers to work effectively, the medication must maintain a certain level in the body. When that level is not maintained, debilitating symptoms reappear. These medications take four to six weeks to reach their peak level of effectiveness. When you miss doses of medication, drink or use drugs, you negatively affect that level.

Medication Side Effects and Allergic Reactions

All medications have side effects. Even aspirin can cause ringing in the ears if you take too much. The pharmacy must list all side effects, but that does not mean you will experience any or all of them. Most of the common psychiatric medications for depression and mood disorders have very few, if any, side effects after the first week or so. First, ask your doctor about allergic reactions and possible side effects and what to do in the event of a serious reaction. Severe allergic reactions typically include but are not limited to rash, hives, and swelling (of the tongue). Always read the medication information given to you by the pharmacist. He or she is also a good source of information on medications.

The most common and less serious side effects are typically sleepiness, nausea, diarrhea, blurred vision, insomnia, dizziness, or headache. These usually go away in the first week or two. If any side effect becomes severe or you simply have concerns, contact your doctor or go to the ER. Know the possible side effects and allergic reactions of your medications. You should always know the name of your medication, frequency, and the dosage in milligrams. Carry a card in your wallet that will tell emergency personnel exactly what you are taking. If you have questions or concerns, direct your questions to your doctor or pharmacist. Dial 911 or go to the emergency room for serious allergic reactions and side effects. Ultimately, the more you know, the safer you will be.

Mental Illness is a disease very much like diabetes. It takes insulin to manage diabetes; it takes psychiatric medication to manage severe depression and other mood disorders. Some say you just have to be tough. “You just have to pull yourself up by your bootstraps and try harder.” This is false and it won’t work. The only way to successfully manage a mood disorder is with education, medication, structure, ongoing treatment and support.

Always contact the doctor when faced with positive (active) symptoms. Do not self-medicate. A doctor never operates on himself or his own family. Don’t play doctor! Remember, the leading causes of relapse are medication non-compliance and drug and alcohol use. The doctor can’t possibly medicate you properly if he does not know honestly what the patient is or is not taking including alcohol or substances!

Rule of thumb: Never lie or withhold information from your doctor or therapist.

It is extremely important to learn to make healthy choices. Sometimes people do not recognize that the choices they make may not be healthy. Once stable and consistent, some people simply need to check-in with their therapist a few times per year. Others need ongoing supportive therapy every two to four weeks to remain stable. The frequency will depend on the individual and how well one manages their disorder. Together with your doctor, therapist, and ancillary supports, if necessary for dual diagnosis, you can learn to manage your symptoms and cope with the day-to-day stress of depression, mood disorder, or dual diagnosis. This is the reason that ongoing support from your doctor and therapist is essential for management.

You should call your doctor, 911 or go to the hospital if you are experiencing medication side effects or an allergic reaction. If you have thoughts of hurting yourself or someone else call your doctor and therapist immediately. If you are actively considering hurting yourself, call 911, go to the emergency room, or call the National Suicide Prevention Helpline, 1-800-SUICIDE (1-800-784-2433).

The Leading Causes of Relapse

The causes of relapse to active symptoms of a mental disorder have been well documented over the years. It’s no surprise that these reflect the relapse warning signs listed below.

They are:

  • Medication non-compliance (Not taking the medication as prescribed).
  • Alcohol and substance use and abuse.
  • Little or no sleep.
  • Lack of social support.

Non-compliance with medication and alcohol or substance abuse are by far the leading causes of relapse to symptoms. These are self-explanatory. However, little or no sleep and lack of social support may also need to be addressed.

Sleep is an important issue for most with mood disorders. People with Bipolar disorders usually report that they don’t need much sleep. They have a tendency to play with their sleep/wake cycle. They like the euphoric hypomanic feeling that lack of sleep creates. It is very much like the moth and the flame. There is an attraction to the high that one gets when they are sleep deprived. Unfortunately, you can take anyone in the world and keep them awake for two, three or four days, they will become actively psychotic or out of touch with reality. For people with a mood disorder, sleep is a mental health issue.

Social support is also very much a part of maintaining good mental health. Even if one is compliant with medication and not using or abusing alcohol and drugs, social isolation can create considerable stress and ultimately cause a relapse to symptoms. It is imperative that people with mental disorders, have an avenue to combat their tendency to isolate and withdraw from people. I encourage my clients to maintain regular social contact. This contact creates reality testing. We don’t think of socialization as reality testing, but it is. For example: You have an argument with your spouse; you call a friend and say, here is what happened. What do you think? You get feedback on your situation and behavior. That is reality testing. Lack of social support may result in an inability to test the accuracy of what one is feeling or experiencing. This is obviously a very important component of maintaining good mental health.

Relapse Warning Signs

Be aware of relapse warning signs and symptoms. When one is taking medication as prescribed by the doctor, symptoms are largely under control and the client is stable. The reappearance of certain symptoms is an indication that the medication may need to be adjusted, reevaluated or changed. These symptoms may also be an indication that the medication is no longer being taken as prescribed or alcohol and substance use is interfering with the effectiveness of the medication.

Relapse warning symptoms include:

  • Thoughts about hurting oneself or others.
  • Changes in one’s sleep/wake cycle, especially little or no sleep.
  • Inability to concentrate, rapid speech, skidding from subject to subject.
  • Rapid mood fluctuations, mania, or depression
  • Poor judgment, risky behavior, or lack of insight into one’s own behavior.

These symptoms are reflected by poor daily functioning, lack of motivation, loss of interest and conflict. These are considered to be active symptoms and usually are caused by non-compliance with medication and use of alcohol or drugs. In many instances, the medication may need to be changed or the dosage adjusted by the doctor. This may also reflect the need for family members to monitor medication compliance and alcohol/drug usage. Relapse warning signs should be reported to the doctor and therapist immediately. Don’t wait!

Zoom

Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://takenotelessons.com   Highly effective online, one on one, SAT, ACT, GRE, standardized test preparation, via face time or Skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material with your doctor and therapist.

How to recover from depression?

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

How to be well when you have depression!
Coping with a mood disorder is no easy task! It takes professional support, medication, in some cases, psychoeducation and experience to manage the debilitating symptoms. With the necessary supports and monitoring, persons with mood disorders can learn to have long-term stability and consistency.
I have also found that it takes an average of about one year to reach those goals. In addition, many people will need some level of support on and off for their entire lives. The bottom line is you can’t do it alone. Initially, you need a psychiatrist to manage your medication, if necessary. Once you are on the right medication at the right dose you can get your prescription from your family doctor. The therapist will provide guidance for symptom management and relationship issues.

Ten Steps to Wellness
1. Take the medication as prescribed by your doctor.
• “I don’t miss often; maybe once per week.”
The number one cause of relapse to symptoms is medication non-compliance. This is definitely a tough one. In order for psychiatric medication to be effective, it must be taken daily as prescribed. I consider compliance to be missing no more than 5 pills per year! Many people don’t like to take medication, especially if it means daily for life. Let’s take one step at a time and see what it’s like to function to your capacity for a year or two before you make decisions about the rest of your life.
But remember, clinical depression is a lifelong illness and it’s all about a chemical imbalance. It is a biological problem first and foremost. It’s like being a diabetic: you must take the medication as prescribed in order to be well.
2. No caffeine, substance abuse, or alcohol.
• “It’s not the caffeine. I like coffee. It doesn’t affect me. I’ve always drank coffee.”
Whether it’s coffee, power drink, soda or tea, caffeine can interfere with sleep and create anxiety. It is the most obvious reason for poor sleep. With your doctor’s supervision to avoid anxiety and headaches, gradually reduce your daily caffeine use. Eventually, when you are caffeine free, I believe, you will feel and sleep better.
I would certainly recommend gradually reducing caffeine use before asking the doctor for a sleep aid. Caffeine may interfere with your sleep/wake cycle. As far as your mental health, I recommend keeping caffeine to a minimum and before noon.
I also don’t recommend working the night shift i.e., midnight to 8 AM. It is difficult for your body to adjust. For a person with a mood disorder, this is not recommended. The back and forth between day and night shifts and the social isolation are risky to one’s mental health. It also wreaks night havoc with the sleep/wake cycle. Lack of sleep for a client with a bipolar disorder may bring about rapid mood fluctuations and jeopardize stability. Tell your doctor or your therapist if you are not sleeping. Wouldn’t it be better to reduce the caffeine rather than take a habit-forming sleeping pill?
• “What? I can’t have a glass of wine with dinner? I don’t do it often. It’s just one glass. It’s not like I’m an alcoholic.”
The second leading cause of relapse to symptoms is alcohol and substance use. Some doctors and even therapists say that it is alright to have one or two drinks if you have no alcohol abuse or dependence issues. I still question this because alcohol and pot are depressants. Why would you take a depressant when you are depressed or taking an antidepressant under any circumstance?
Alcohol may affect your mood for days. At least track your mood on the calendar after you have been drinking to see if it has made your symptoms worse. As far as alcohol and substance use, it is as simple as it is hard. If it interferes with your life, your daily functioning or your relationships, don’t do it!
There is a definitely a negative correlation between the use of alcohol or drugs and a mood disorder. The increased chance of dependence and risk of relapse to the symptoms of your mood disorder are just not worth it. Connect the dots! The bottom line is that for many people USE IS THE SAME AS ABUSE!
I recommend you discuss this with your doctor. If you already know you have a problem, get into Rehab. It’s never too late to turn your life around. Get professional help and go to your Alcohol or Narcotics Anonymous meetings as often as it is necessary to maintain sobriety. Even if you are not dependent, alcohol or pot may not be a healthy choice for you. Don’t deny the obvious. So remember, the healthy use of alcohol for one person, may not be a healthy for you. Make healthy choices!
3. Take care of your physical health.
Be sure to have annual dental and physical exams. Some medications require regular blood testing. Some physical ailments can cause depression. See your doctor regularly.
4. Exercise (cardio)
People with mood disorders tend to be sedentary. They need to walk and get exercise as much or more than any of us. You don’t have to join a gym; all you need to do is take a brisk walk. You don’t have to run but you do have to hustle a little bit. Studies going back thirty years or more say that cardiovascular exercise lifts one’s mood and reduces anxiety. The more recent studies show that those old studies are true but the walk needs to be at least 40 minutes to get the full benefit toward lifting your mood and reducing anxiety.
Walk at least 4 times per week. I also recommend that you pick your days, otherwise you will say, “I don’t feel like it today; I’ll do it tomorrow.” Tomorrow comes and the same thing happens. If you make a schedule and stick to it (say, Monday, Wednesday, Friday and Sunday), the day of the week makes the decision for you. “Oh darn, today is Monday. I have to walk.” Remember, depression affects one’s motivation; if you wait until you feel like doing it, it may never happen.
Note: Always consult with your doctor before starting any exercise program.
5. Plan to have fun
It’s good to have fun; have fun! When my son was about four years old, I remember distinctly, it was a beautiful summer day. Our front door was open and he stood there and saw children outside playing. He said, “Dad, there are kids out there! Can I go out and play?”
My point is that when you are a child, all it takes is something as simple as finding other kids and the party is on! As an adult, it takes planning, especially if you have a mood disorder. You need to take time to plan to have fun. Join a bowling league, take a pottery class or cooking class, take ballroom dancing, or take a photography class at the local park district. Take an adult education class at your local community college or park district. It’s not about the grade so you can also skip the tests and homework if you want. Check out meetup.com or adventsandadventures.com These may also help provide some structured socialization. These are inexpensive and fun and a great way to meet your socialization goals!
• Do it to be more social.
• Don’t do it for a grade.
• Do it because you are interested in it.
• Do it to help manage your symptoms and your free time.
6. Make time to nurture your relationship.
Line up sitters so you can have time alone with your spouse or significant other. Planning is key! This may feel awkward at first, but keep it up anyway. Gentlemen, don’t let the wife be responsible for all the social and vacation planning. Do your share. Plan a date night. Take turns choosing what you will do. When you go to dinner, discuss your next date night, event, or do vacation planning. Don’t use the date night to discuss difficult issues. This is should be a fun time and a way to nurture your relationship. If you are going to have fun, you are going to have to plan ahead!
7. Be social
A common symptom of a mood disorder is social dysfunction or social isolation. Human beings are by nature social creatures, but unfortunately, a common symptom of mood disorders includes social isolation and/or withdrawal. Call a friend and make a lunch date. Have people over to play cards or watch a sporting event. If you don’t have a large social network, use the park district or local community college to meet people. Taking a class or joining the volleyball league at least gives you an opportunity to be with people and make a friend. While meeting strangers may seem intimidating, think of it this way: if you don’t know them to begin with, then you really have nothing to lose if things don’t work out. On the other hand, you never know when a stranger can turn into your new best friend, business partner, or love interest!
8. Hobbies
Try woodworking, sewing, knitting, crossword puzzles, gardening, toy trains, arts and crafts, or whatever you choose! Go to a hobby shop and look around but pick something and stick to it. Work on your hobby several times per week or when you are feeling low, negative, or worrisome. It is quite possible you will enjoy the activity so much that you will forget about your symptoms for a while. Hobbies are a great way to distract yourself from troubling thoughts when one else is around.
9. Chores
Most any physical activity is a good distraction from your negative thoughts and symptoms. Chores are another way to distract yourself and give you a clean environment. When you have depression, the idea of cleaning the entire house or apartment can be overwhelming. Break your chores down into one or two chores each day. For example:
• Monday is vacuuming
• Tuesday is bathroom cleaning
• Wednesday is washing the floor
• Thursday is cleaning the kitchen
• Friday is changing the sheets and towels day
• Saturday is laundry day
• Sunday is a free day. It is your reward for doing your chores all week long.
Chores are a great way to distract yourself from your symptoms. Most any physical activity will help. Make a schedule and stick to it. Try to come up with your own list of distraction activities. The more things you try, the less likely you will be a victim of your disorder.
10. Make healthy choices
This is my generic one. This one may very well be different from person to person. A healthy choice for one person may not be healthy for you. If you have a mood disorder, poor sleep, too much caffeine, alcohol or drug use, and social isolation are mental health issues. Remember! You manage it or it will manage you!

Zoom!

Now I can work via Zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative.  Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Psychiatric Treatment – Help the Doctor Help You

By: James E. DelGenio MS, LCPC
Senior Staff Therapist
The Family Institute at Northwestern University

How to prepare for your psychiatry appointment?

Help the doctor help you to avoid relapse to active symptoms of depression, anxiety or panic.  The Psychiatrist is an integral part of the treatment team. S/he needs your honest input to best help you. If any of the following are problematic, report them to the doctor. Write things down so you are prepared for your appointment.

Report any changes in your symptoms to your doctor including:

1. Changes in sleep patterns, little or no sleep.

2. Changes in Mood often accompanied with negative thoughts, seemly on repeat.

3. Poor concentration, poor short-term memory

4. Disturbing thoughts of self-harm or harm to others

5. Drug and alcohol use/abuse

6. Medication side effects or allergic reactions

7. Social activity or isolation

8. Poor self-care

9. Physical activities, hobbies, chores

10. Poor money management

11. Unusual behavior

Psychiatric Medication

Psychiatric medication is useful in controlling symptoms of mood disorders. Mood disorders are considered bio-psycho-social disorders. They affect thinking and behavior and often times create relationship issues. Medication and medication management are essential in the management of the biology or the chemistry of the disorder. I consider this to be the foundation of treatment. It is difficult, if not impossible, to treat a severe mood disorder without medication. You can’t build a solid house without a good foundation. Medication provides that solid foundation.

Therapy addresses the psychosocial treatment issues including identification and management of symptoms, daily living skills, coping skills, and the relationship issues which often accompany these disorders.

Refusal to take medication is a common issue. I do on occasion have clients who refuse medication. In the past, I have said, “I will work with you to see if we can make an impact on your symptoms.” If we do, that’s great. If not, I will try to deal with the denial and the refusal of medication.

What if I told you that you are a diabetic and will have to be on insulin injections the rest of your life? Of course, most people wouldn’t like it, but chances are, they would take their medication. Why is medication for a mood disorder any different?

Let me remind you that alcohol is a drug and if you are drinking, you are self-medicating with a depressant. This may lead to alcoholism or substance abuse and addiction. Wouldn’t it be wiser, safer, and more productive to let a doctor prescribe the correct medication to help you get on the path to recovery?

Medication and Support

Many people remain on medication their entire lives. Some people with mild depression or situational depression are able to use medication intermittently for periods of stress that cause their depression to re-emerge. Others don’t want those periods of regression in their life, so they chose to just stay on the meds. I encourage clients to consult with their doctor for recommendations.

Therapeutic support may also be intermittent or as needed after a time. Depending on the severity of the disorder and how well a person learns to manage, I recommend that my clients check-in at least three or four times per year. This is especially common for couples whose disorders affect their marriage.

Unfortunately, some people with severe mood disorders may go in and out of the hospital their entire lives if they remain in denial. This is usually a result of non-compliance with treatment and medication, combined with alcohol and/or substance abuse. Mood disorders and addiction can be global disabilities or manageable handicaps. Which one will you choose?

The number one cause of regression and recurrence of symptoms is not taking medication as prescribed. This is not like having a headache. When you have an ordinary headache, you take two aspirin and twenty minutes later your headache is gone. In order for antidepressants or mood stabilizers to work effectively, the drug must maintain a certain level in the body. When that level is not maintained, debilitating symptoms reappear. These medications take four to six weeks to reach their peak level of effectiveness. When you miss doses of medication, drink or use drugs, you negatively affect that level.

Medication Side Effects and Allergic Reactions

All medications have side effects. Even aspirin can cause ringing in the ears if you take too much. The pharmacy must list all side effects, but that does not mean you will experience any or all of them. Most of the common psychiatric medications for depression and mood disorders have very few, if any, side effects after the first week or so. First, ask your doctor about allergic reactions and possible side effects and what to do in the event of a serious reaction. Severe allergic reactions typically include but are not limited to rash, hives, and swelling (of the tongue). Always read the medication information given to you by the pharmacist. He or she is also a good source of information on medications.

The most common and less serious side effects are typically nausea, diarrhea, blurred vision, sleepiness, insomnia, dizziness, or headache. These usually go away in the first week or two. If any side effect becomes severe or you simply have concerns, contact your doctor or go to the ER. Know the possible side effects and allergic reactions of your medications. You should always know the name of your medication, frequency, and the dosage in milligrams. Carry a card in your wallet that will tell emergency personnel exactly what you are taking. If you have questions or concerns, direct your questions to your doctor or pharmacist. Dial 911 or go to the emergency room for serious allergic reactions and side effects. Ultimately, the more you know, the safer you will be.

Mental Illness is a disease very much like diabetes. It takes insulin to manage diabetes; it takes psychiatric medication to manage severe depression and other mood disorders. Some say you just have to be tough. “You just have to pull yourself up by your bootstraps and try harder.” This is false and it won’t work. The only way to successfully manage a mood disorder is with education, medication, structure, ongoing treatment and support.

Always contact the doctor when faced with positive (active) symptoms. Do not self-medicate. A doctor never operates on himself or his own family. Don’t play doctor! Remember, the leading causes of relapse are medication non-compliance and drug and alcohol use. The doctor can’t possibly medicate you properly if he does not know honestly what the patient is or is not taking including alcohol or substance use!

Rule of thumb: Never lie or withhold information from your doctor or therapist.

It is extremely important to learn to make healthy choices. Sometimes people do not recognize that the choices they make may not be healthy. Once stable and consistent, some people simply need to check-in with their therapist a few times per year. Others need ongoing supportive therapy every two to four weeks to remain stable. The frequency will depend on the individual and how well one manages their disorder. Together with your doctor, therapist, and ancillary supports, if necessary for dual diagnosis, you can learn to manage your symptoms and cope with the day-to-day stress of depression, mood disorder, or dual diagnosis. This is the reason that ongoing support from your doctor and therapist is essential for management.

You should call your doctor, 911 or go to the hospital if you are experiencing medication side effects or an allergic reaction. If you have thoughts of hurting yourself or someone else call your doctor and therapist immediately. If you are actively considering hurting yourself, call 911, go to the emergency room, or call the National Suicide Prevention Helpline, 1-800-SUICIDE (1-800-784-2433).

The Leading Causes of Relapse

The causes of relapse to active symptoms of a mental disorder have been well documented over the years. It’s no surprise that these reflect the relapse warning signs listed below.

They are:

  • Medication non-compliance (Not taking the medication as prescribed).
  • Alcohol and substance use and abuse.
  • Little or no sleep.
  • Lack of social support.

Non-compliance with medication and alcohol or substance abuse are by far the leading causes of relapse to symptoms. These are self-explanatory. However, little or no sleep and lack of social support may also need to be addressed.

Sleep is an important issue for most with mood disorders. People with Bipolar disorders usually report that they don’t need much sleep. They have a tendency to play with their sleep/wake cycle. They like the euphoric hypomanic feeling that lack of sleep creates. It is very much like the moth and the flame. There is an attraction to the high that one gets when they are sleep deprived. Unfortunately, you can take anyone in the world and keep them awake for two, three or four days, they will become actively psychotic or out of touch with reality. For people with a mood disorder, sleep is a mental health issue.

Social support is also very much a part of maintaining good mental health. Even if one is compliant with medication and not using or abusing alcohol and drugs, social isolation can create considerable stress and ultimately cause a relapse to symptoms. It is imperative that people with mental disorders, have an avenue to combat their tendency to isolate and withdraw from people. I encourage my clients to maintain regular social contact. This contact creates reality testing. We don’t think of socialization as reality testing, but it is. For example: You have an argument with your spouse; you call a friend and say here is what happened. What do you think? You get feedback on your situation and behavior. That is reality testing. Lack of social support may result in an inability to test the accuracy of what one is feeling or experiencing. This is obviously a very important component of maintaining good mental health.

Relapse Warning Signs

Be aware of relapse warning signs and symptoms. When one is taking medication as prescribed by the doctor, symptoms are largely under control and the client is stable. The reappearance of certain symptoms is an indication that the medication may need to be adjusted, reevaluated or changed. These symptoms may also be an indication that the medication is no longer being taken as prescribed or alcohol and substance use is interfering with the effectiveness of the medication.

Relapse warning symptoms include:

  • Thoughts about hurting oneself or others
  • Changes in one’s sleep/wake cycle, especially little or no sleep
  • Inability to concentrate, rapid speech, skidding from subject to subject
  • Rapid mood fluctuations, mania, or depression
  • Poor judgment, risky behavior, or lack of insight into one’s own behavior

These symptoms are reflected by poor daily functioning, lack of motivation, loss of interest and conflict. These are considered to be active symptoms and usually are caused by non-compliance with medication and use of alcohol or drugs. In many instances, the medication may need to be changed or the dosage adjusted by the doctor. This may also reflect the need for family members to monitor medication compliance and alcohol/drug usage. Relapse warning signs should be reported to the doctor and therapist immediately. Don’t wait!

Zoom!

Now I can work via zoom with anyone, anywhere in the country and it will still be covered by BCBS Insurance.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://takenotelessons.com   Highly effective online, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

The Family Institute at Northwestern University

James DelGenio LCPC is a senior staff therapist who offers remote teletherapy and accepts BCBS PPO Insurance.  Teletherapy is HIPPA approved via Zoom.com 

His services include: Individual and family counseling, marital and premarital counseling, and treatment of mood disorders and substance use and dependence.

Offering Teletherapy anywhere in IL via zoom.  HIPPA approved and accepted by BCBS PPO Insurance.

TFI is a unique not-for-profit organization that is leading the way in all facets to strengthen and heal families from all walks of life through clinical service, education and research. No other institution brings together such a concentration of knowledge, expertise and academic credentials to help improve the lives of people in the Chicago area and around the globe.

As a practicing Psychotherapist for over 40 years, I employ a variety of clinical approaches including Cognitive Behavioral Therapy (CBT) in the treatment of couples, families and individuals.

Individual Practice: Assessment and treatment of anxiety, stress, panic, trauma, anger, grief, depression, mood disorders, mental illness and alcohol/substance abuse.

Marriage and Family Practice: Lack of intimacy, infidelity, poor communication, conflict over finances, lack of trust, parenting and behavior issues, premarital and divorce issues.

Specialization: Treatment of couples, depression and its impact on relationships and the family.

Zoom! Now I can work via Zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information. Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://takenotelessons.com   Highly effective on line one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Symptoms of Bipolar Mood Disorders and how to cope.

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

Negative rumination i.e. negative thoughts on repeat often cause conflict in relationships.  Physical distraction of any kind will help some, i.e. cardio work, chores, walking, hobbies. If these don’t help you will need to consider medication.

Overwhelmed with anxiety, panic, depression. This causes lack of motivation and loss of interest.  Need for medication is a must.

Changes in the sleep wake cycle esp. little or no sleep.  Could be heading for a manic episode. Often caused by non-compliance with the medication or alcohol use and abuse.

Isolation and withdrawal from friends and family.  We all need social contacts for good mental health. Look at the pandemic!

Alcohol use or abuse. Either way alcohol and mood disorders do not mix. Alcohol is a depressant and it will increase your anxiety. Don’t drink; you will feel better!

Little or no impulse control; Risky behavior, such as sex, reckless driving.

Uncontrolled spending w/o regard for ability to pay.

Racing thoughts and speech, grandiosity, invincibility.

Verbally abusive to others.  Conflictual relationships. Never permit physical abuse; report it. Get out!  Go to a shelter but get out.

Denial, No need for help or medication! Can’t trust your own thoughts. Need reality testing with friends and family to get past denial.

Hopelessness, thoughts of suicide.

Medication is as necessary as insulin is to a diabetic.  It’s just genetics with faulty chemistry.

How to Cope with a mood disorder without Medication?

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

How to cope with a mood disorder.

It is good to have fun. Have fun! People with mood disorders often become engrossed in the past, consumed with depression and anxiety. They tend to have negative thoughts that just repeat over and over again. Learning to cope takes experiential learning with a CBT therapist.

Recreation and exercise

Recreation and exercise play a key role in management of symptoms. Especially cardio exercise such as walking is good maintenance of depression, anxiety and panic symptoms.  These are a great distraction when one is experiencing symptoms. Any physical activity is likely to be therapeutic.  Join a park district team, like softball or volleyball.  It’s a good social activity too!

Social activity

Regular social activity is important and healthy; get out with people at least 3 times per month. Consider joining the Park district, volunteering, church groups and activities, or working a shelter.  Find something!  Avoid alcohol.

Hobbies

Get a hobby!  Hobbies to consider? Try paint by number. It’s easy but it takes concentration.  Helps deal with negative thoughts and repeat that often accompany depression. You can also walk away easily by simply rinsing out the brush.  Plan 1/2 half hour per day.

Chores

Even chores can also help with distraction. Make a schedule of chores and stick to it.  Monday is vacuuming, Tuesday is laundry, etc. This also helps keep your living environment healthy.

Distraction from symptoms is an important coping skill. The tendency to isolate and withdraw also need to be overcome. The Internet, video games, TV or reading, generally do not qualify as distraction for most individuals.

Planning is key because mood disorders require structure. If you are going to have a good weekend, you will need to plan ahead to meet your exercise and social goals.

Unfortunately, sometimes these are just not enough, therefore medication will need to be considered.

When to consider medication?

I am sorry to have to say this but moderate to severe mood disorders require medication to control the symptoms. It’s all about chemistry. If you are diabetic, you would take insulin; you wouldn’t like it but you would do it.  This is no different.  It is just a chemical imbalance.

When coping skills don’t work, you will need to reconsider seeing a doctor and getting on medication. Even with medication, however, you will still need to practice coping skills.  Medication does 6o% and coping skills do the rest.  In these instances, the medication becomes the foundation and will help the coping skills work effectively.

Call James E. DelGenio MS, LCPC  847- 733-4300 Ext 638.

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Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

What are the symptoms of Severe Mental illness?

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

What are the symptoms of mental illness?

1. Positive Symptoms: (characterized by their presence)
a. Impaired contact with reality.
b. Hallucinations, delusions (often paranoid).
c. Thought disorders.
d. Thoughts of suicide, homicide

2. Negative Symptoms: (characterized by their absence)
a. Lack of pleasure, loss of interest and energy
b. Lack of goal-directed behavior.
c. Blunted affect.
d. Lack of insight.
e. Poverty of speech.
f.  Poor judgment.
g. Poor self care including hygiene.
h. lack of motivation.
i. Inability to structure time, poor concentration,

3. Interpersonal Relations
a. Asocial behavior, bizarre and inappropriate.
b. Withdrawal, isolation.
c. Lack of close personal ties.
d. Difficulty in getting along with people, irritable, angry.

4. Family Conflict
a. Crisis prone, police involvement.
b. Over involvement, overly intrusive family in trying to help.

Zoom!  Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information.  Call 847-733-4300 Ext 638.

http://jamesdelgenio.com
http://family-institute.org
http://psychologytoday.com
http://takenotelessons.com

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.