Q & A Mood disorders with substance abuse

Mood Disorders and relationships disorders 2
with Alcohol and substance abuse
Questions and Answers

1. What is a mood disorder?
2. Why shouldn’t you drink alcohol if you are not an alcoholic?
3. Why are depression and alcoholism often found in the same individual?
4. What is dual diagnosis?
5. What is addiction?
6. What are the symptoms of a mood disorder?
7. What are the symptoms of addiction?
8. How do these disorders interact with one another?
9. Can a mood disorder be compared to a physical illness?
10. How does a mood disorder affect thinking and behavior?
11. What should you report to your Psychiatrist?
12. Will you have to be in treatment the rest of your life?
13. Why is medication compliance so important?
14. How do you cope with the past?
15. Why are recreation, exercise and socialization so important?
16. What if you don’t feel motivated to do the things suggested here?
17. What are relapse warning signs aka positive symptoms?
18. What are the negative symptoms of depression and mood disorders?
19. What are the causes of relapse and regression to symptoms?
20. When should you call your doctor, 911 or go to the hospital?
21. What do you do if you can’t sleep?
22. What is the role of the family in treatment?
23. What can family members do to minimize the risk of relapse?
24. How can family members learn to cope?
25. Who is responsible for your happiness?
26. What are the goals of treatment?
27. Why is psychiatric medication useful in controlling symptoms of depression?
28. What if you are inconsistent in taking your medication?
29. What are the possible side effects of psychiatric medication?
30. What are the benefits and purpose of psychiatric medication?
31. What does one do if there is a medical emergency?
32. Where does one go with questions about psychiatric medications?
33. Should the client or family adjust medication dosage if symptoms reappear?
34. How does one learn to make healthy choices?
35. How to be well.

1. What is a mood disorder?
Mood disorders are defined as people experiencing mild to severe depressive
disorders, bipolar disorders, anxiety disorders, phobias, personality disorders and
other disorders including alcohol or drug abuse or dependence. (Brown, Wang and
Safran, 2005)
Depression and other mood disorders have become more commonly accepted by society generally and thanks, in part, to high profile actors and professional athletes who have disclosed their disorders to the public. Clinical depression and mood disorders are biological/genetic problems that you most likely inherited and are considered no different than the diagnosis of other medical conditions such as diabetes or epilepsy. All require education, medication and ongoing treatment. These disorders are usually manifested in the teens and as late as mid 30’s.
I use two very different definitions to describe these disorders. The first reflects denial of a problem and the second reflects acceptance of what is. Which one will you choose?

The first definition is as follows:

A Mood Disorder is a lifelong disability, episodic in nature that may cause chronic dysfunction, asocial behavior and failed relationships. A breakdown of this definition is as follows:
Lifelong means there is no cure to date, though new medications, if taken as prescribed, have made people symptom free.
Episodic means that sometimes the symptoms are worse than at other times for no apparent reason though stressful life events can also have an impact on symptoms.
Chronic dysfunction includes inability to manage day-to-day events, unemployment and often failed relationships.
Asocial Behavior is that behavior which is irrational, inappropriate showing poor judgment and a lack of insight into one’s own behavior. This can include poor self care and appearance. It may also include behavior that is harmful to self or others. Failed relationships include: social dysfunction, isolation, withdrawal, marital conflict and divorce.

The second definition is as follows:

A Mood Disorder is a lifelong disability, episodic in nature that the individual can learn to manage with medication, if necessary, education and coping skills.

In some severe instances, denial of these disorders can create frequent psychiatric hospitalization which can result in a revolving door syndrome in which a person spends their life going in and out of hospitals.

The two definitions are separated only by education, psychiatric treatment and ongoing therapeutic support. The key here is management of a disability. You manage it or it will manage you! How do you want to live your life?
2. Why shouldn’t you drink alcohol if you are not an alcoholic?
Where mood disorders are concerned use is the same as abuse! It impairs functioning and it affects thinking, behavior and relationships. Alcohol and substances such as marijuana and cocaine also affect thinking and behavior. Don’t do anything that would make you relapse to active symptoms. It is known fact that alcohol and substance abuse make the symptoms of a mood disorder worse and vice versa. Alcohol is a depressant; one drink at a family gathering may affect one’s mood for days.

Alcohol also washes out and therefore may negate the usefulness of the medication. Remember, it takes four to six weeks to get the medication to a therapeutic level. When you drink heavily you affect that level. It may even precipitate a ospitalization. In addition, one should never use alcohol or substances when taking prescription medication. This can be fatal. It goes without saying that if you are an alcoholic you can’t have any alcohol. If you are not an alcoholic, check with your Dr. for approval of one or two drinks on very special occasions. In the days after, monitor yourself to see if it has affected your mood. If it does, use is the same as abuse!

3. Why are mood disorders and alcoholism often found in the same individual?

The answers here are not completely understood. Some doctors have told me that the sites in the brain that are affected by mood disorders are the same sites affected by addiction. Regardless of the chemistry, just casual use of alcohol by a person with a mood disorder may eventually result in abuse or dependence. If you have a mood disorder, you shouldn’t have any! The consequences are just not worth it.

4. What is Dual diagnosis?
Dual Diagnosis means that two or more independent disorders exist in the same individual. Specifically, for our purposes, when I speak of dual diagnosis, I am referring to mood disorder and alcohol dependence. Each exists independently of one another and yet each makes the other worse. Both are biological and psychosocial disorders with similar symptoms. They are lifelong disorders, which cause the person to be prone to relapse. Both require integrated treatment that includes psychiatric treatment, medication, psychotherapy, education, symptom management and additional supportive treatment such as Alcoholics Anonymous or Narcotics Anonymous.

5. What is addiction?
An Addictive Disorder is the preoccupation with acquiring alcohol and/or drugs,
compulsive use of alcohol and drugs despite adverse consequences and a pattern of relapse to alcohol and drug use despite the reoccurrence of adverse consequences (Miller, 1991).

6. What are the symptoms of Depression/Mood Disorder?
Depression and bipolar disorders is a biological disorder that can usually be traced through family history whether it was formally diagnosed or undiagnosed. Check the symptoms under A and B with a check mark. If you have five or more related symptoms, discuss these symptoms with your Psychiatrist or Therapist.

A. Symptoms of Depression
1. Lack of pleasure, loss of interest and energy.
2. Lack of goal directed behavior.
3. Lack motivation, lethargy.
4. Inability to structure time, poor concentration.
5. Anger, hostility, irritability.
6. Strained relationships, marital issues, divorce, loss of friends.
7. Withdrawal, isolation, would rather be alone.
8. Difficulty in getting along with people.
9. Sleeping to much or too little.
10. Anxiety, worry, sadness, low mood.
11. False beliefs, negative thinking, rumination.
12. Feeling guilty, stressed or hopeless.
13. Poor self care including hygiene and diet.
14. Aches, pains, dizziness, headaches, or stomach aches.
15. Unintentional weight loss, gain.
16. Crisis prone, police involvement.
17. Low sex drive.
18. Thoughts of suicide, homicide.

B. What are the symptoms of a Bipolar Disorder?
Bipolar Disorder formerly known as manic depressive disorder is a mood disorder in which people may have mixed episodes of mania and depression..
These symptoms may also include some of the above and in addition;
1. Rapid mood fluctuations.
2. Feeling high, euphoric or having inflated self-esteem.
3. Irritability, hostility, aggressive or risky behavior.
4. Pressured, fast speech, more talkative than usual.
5. Racing thoughts, skidding from subject to subject.
6. Delusions of grandeur, grandiose beliefs or behavior.
7. Poor judgment, lack of insight, false beliefs.
8. Poor self control.
9. Little or no need for sleep.
10. Increased activity, sexual drive and impulsivity including spending.
11. Easily distracted, poor concentration.
12. Alcohol and substance abuse.
13. Bizarre dress and appearance.
14. Thoughts of suicide, homicide.

The above symptoms of depression and bipolar mood disorders are widely accepted. Since these disorders have a biological basis; a psychiatrist manages the medication while the therapist provides treatment and support. The therapist support often includes psycho-education, symptom reduction and management, increased coping skills and management of other day to day stressors such as job loss, school failure and relationship issues. The psychiatrist, therapist, family, friends and of course, the patient must work together as a team to construct an effective approach to these disorders. The most important aspect of this is good communication.
There are two types of bipolar disorders. They are Bipolar I and Bipolar II. Bipolar I is considered the more severe of the two disorders and has more extreme episodes of mania or depression. It may also have psychotic features.
Bipolar II is characterized by milder swings of mania and depression and may have less serious effect on daily routines, relationships and employment issues associated. Both forms need treatment and medication to manage the symptoms well.

7. What are the symptoms of addiction?

Depression, anxiety and panic
Psychosis – hallucination, delusions, thought disorder
Irritability, mood changes, racing Thoughts
Memory Loss, confusion,
Drowsiness, slurred speech
Euphoria
Constipation, itching, hives
Restlessness, Insomnia, tremor
Diarrhea, cold sweats
Dilated pupils, tearing, nausea, vomiting

8. How do these disorders interact with one another?

Depression/mood disorder and alcohol and substance abuse do not interact well. In fact, each makes the other worse, especially when one is using and/or not taking medication as prescribed. One must manage both disorders simultaneously and treatment must be a collaborative effort with the level and the array of services necessary to maintain stability, sobriety and consistency.
9. Can a mood disorder be compared to a physical illness?
It is helpful to think of someone you know who is diabetic and what it means to be a
diabetic. Some years ago, a friend of mine named Mark had a heart attack.
Fortunately, there was little or no damage to his heart. What was discovered,
however, was that Mark’s blood sugar was elevated. He was diabetic. When Mark
moved out of intensive care, they began to teach him how to cope with his newly
discovered disability. They taught him how to measure his blood sugar and give
himself insulin injections. They taught him what he could eat and what he could not
eat. They even taught him what to do if he had a reaction to food or his medication.
When he was discharged from the hospital, they had a nurse visit him at home
several times a week for several weeks just to make sure that what he had learned
in the hospital, he continued at home.

Mood Disorders, addiction and diabetes are comparable in many ways. Each
is a lifelong, biological problem that requires daily attention, education and support.
Medication, when taken as prescribed, stabilize each condition but knowledge and
training play a very important role in healthy functioning. The comparisons
demonstrate that mental illness, like other physical handicaps, can become
manageable handicaps; not the global disability it is for some. It is a result of
genetics, an imbalance in the chemistry of the brain. No one is at fault and no one
is to blame. Mental illness is a lifelong disability, episodic in nature that one
can learn to manage, with hope and with dignity.
10. How does a mood disorder affect thinking and behavior?

The symptoms of mood disorder and addiction are very similar. In fact, the
treatment is also similar. Once medically detoxified, a person with mood disorder
may be prescribed the some of same medications as in the treatment of substance
abuse. It often takes a year or more of sobriety to determine if the person is
suffering the effects of addiction or mood disorder or both as in dual diagnosis. You
may have heard of the term dry drunk. This refers to someone who is alcohol free
but has not addressed the accompanying mood disorder. This includes irritability,
hostility and relationship issues.

11. What should you report to your Psychiatrist?

The Doctor is part of the 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. See Stability, Symptoms, Medication, and Education Review)

Report on:

1. Medication education needed and compliance.
2. Changes in your symptoms including:
A. Sleep patterns
B. Mood
C. Concentration, poor short term memory
D. Disturbing thoughts
3. Drug and alcohol use.
4. Medication side effects or allergic reactions.
5. Social activity or isolation.
6. Poor self care.
7. Physical activities, hobbies, chores.
8. Poor money management.
9. Unusual behavior.
10. Thoughts of self harm or threats to others.

12. Will you have to be in treatment the rest of your life?
I would like to say no but many remain on medication their entire life. Therapeutic support may or may not be necessary after a time, depending on how well one learns to manage their disability. I have clients who see me a few times per year just to check in and reinforce their self management. Some people with severe mood disorders may go in and out of the hospital their entire life if they remain in denial. This is usually a result of non-compliance with treatment and medication combined with alcohol and/or substance abuse. I try to point out that though you are not sitting in a wheel chair; it is not as visually obvious a disability but if you have a mood disorder you do have a disability. Mood disorders and addiction can be a global disabilities or manageable handicaps. Which one will you choose? Medication and ongoing supportive treatment may be essential for maintaining healthy functioning.

13. Why is medication compliance so important?
The number one cause of regression and reoccurrence 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 antidepressant medications to work effectively, one must maintain a certain level in the body. When that level in not maintained, debilitating symptoms reappear. These medications take four to six weeks to reach their peak level effectiveness. When you miss doses of medication you negatively affect that level.

14. How do you cope with the past?
Many people with mood disorders have difficulty coping with the past. Sometimes they appear to be living in the past, unable to get over some stressful life event. This needs to be explored with your doctor and therapist. Once this is done, I suggest one simply moves on. When one dwells on the past, they often have difficulty coping with the present. Yesterday is done; worry about today and tomorrow will take care of itself.

15. Why are recreation, exercise and socialization so important?
It is good to have fun. Have fun! People with mood disorders often become engrossed in the past, their illness and problems. Recreation and exercise (especially walking) are good for depression and anxiety and are a great distraction when one is experiencing symptoms. Distraction from symptoms is an important coping skill. Internet, video games, TV or reading generally do not qualify as distraction or most individuals.

16. What if you don’t feel motivated to do the things suggested here?
Lack of motivation is a direct result of the disorder. If you wait to feel motivated, it may never happen. Walk 40 minutes per day at least 3-4 days per week with your doctor’s permission. Pick your days and let the day of the week make the decision for you. 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 mood disorder but especially lack of motivation. (See how to be well.)

17. What are relapse warning signs or positive symptoms?
Relapse warning signs are also known as positive symptoms. They are positive because they are present, active and uncontrolled by medication. These symptoms are typically a result of medication noncompliance or alcohol use. Without intervention these symptoms can have serious impact on thinking, judgment, and behavior and may also include: psychiatric hospitalization, self injury and harm to others or the community.

Relapse Warning Signs reflect symptoms that include:
1. Thoughts about hurting oneself or others.
2. Changes in one’s sleep/wake cycle, especially little or no sleep.
3. Inability to concentrate, rapid speech, skidding from subject to subject.
4. Rapid mood fluctuations, mania or depression.
5. Poor judgment and risky behavior.

18. What are the negative symptoms of depression & mood disorder?
They are the symptoms that are most often missing in the individual. They are characterized by the absence of:
1. Lack of motivation or goal directed behavior.
2. Lack of pleasure.
3. Lack of Insight.
4. Poor judgment.
5. Poor self care.
6. Poor hygiene, self care.
7. Lack of emotional expression.

These symptoms are only partially controlled by medications. They are often what are left when positive symptoms are controlled. It is for this reason that persons with a mood disorder still need education, psychotherapy and supportive therapy.

19. What are the most common causes of relapse and regression to symptoms?
1. Medication noncompliance
2. Alcohol and/or substance use or abuse
3. Little or no sleep
4. Social isolation
5. Family conflict

20. When should you call your doctor, 911 or go to the hospital?
Call your doctor or pharmacist if you are experiencing medication side effects or an allergic reaction. When you are thinking of hurting yourself or someone else call your doctor and therapist. 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).

21. What do you do if you can’t sleep?
Little or no sleep is a relapse warning sign. Depression, mood disorders and dual diagnosis cause sleep/wake problems. First stop drinking caffeinated beverages or foods containing caffeine. Don’t nap during the day. Take your medication as prescribed. Maintain abstinence from alcohol and substance abuse. Always discuss your sleep issues with your doctor. Insomnia can be a precipitating event for relapse to active symptoms and possibly self harm or harm to others. In this event, call 911 and/or your doctor.

22. What is the role of the family in treatment?
The role of the family in treatment is simply to monitor and report. The family should
observe the patient’s behavior and report anything that may be important to the stable functioning and health of the patient. The patient should not be interfered with directly unless, of course, s/he is a danger to themselves or others. The family’s role in treatment is a collaborative effort in communication. The family should think of themselves as team members. We are all on the same team! Keeping secrets from the doctor or therapist interferes with treatment and may ultimately have serious consequences. Families should call a health care professional or the police immediately if you or a family member has any of the following symptoms, especially if they are new, worse, or worry you:

1. When the person does not take their medication as prescribed.
2. The abuse of alcohol, substance abuse or medications not prescribed by a
doctor.
3. Depressed mood, irritability, thoughts of suicide or dying
4. Behavior which may result in injury or harm to the individual, family or
community.
5. The presence of any relapse warning signs, especially no sleep.
6. Panic attacks, uncontrolled anxiety or restlessness.
7. Feeling very angry, agitated, or violent behavior.
8. Acting on dangerous impulses.
9. Unusual behavior that is out-of-character for this individual.
In most cases I have treated over the years, I have seen the client get annoyed with friends and family when they say, “You seem crabby, did you take your medication today”? The typical response is “just because I’m angry or upset doesn’t mean I’ve skipped my meds”. The way I see it, if you have a history of noncompliance, you don’t have the right to be angry when asked! Take the medication as prescribed so your family doesn’t worry about compliance or need to be intrusive in your life. They should be relatively assured that you are compliant with medication. Regardless, it is the responsibility of the family to ask because the consequences of not taking it as prescribed can lead to injury and possibly suicide.

23. What can family members do to minimize the risk of relapse?

1. Monitor and report on medication compliance.
2. Monitor and report on the use of alcohol and drugs.
3. Avoid critical comments. Use “I feel” statements.
4. Avoid over involvement unless there is alcohol and substance abuse,
medication noncompliance.
5. Avoid excessive pressure to achieve.
6. Avoid trying to help motivate compliance.
These are frequent causes of family conflict and should be discussed with the doctor and therapist.
24. How can family members learn to cope?

Mental illness is no one’s fault. It is a bio-psycho-social problem.
1. Avoid placing blame or guilt.
2. Don’t enable! You are not responsible for the patient’s wellness. S/he is!
3. Make regular opportunities to get away from each other. Have outside interests, hobbies and social activities.
4. Get regular exercise. Join a health club or walk at least 40 minutes on
regularly scheduled days each week. In the winter, use a treadmill or
stationary bicycle.
5. Learn all you can about mood disorders but do not try to be a therapist.
25. Who is responsible for your happiness?

Who owns the problem? Don’t blame others for your disorder or problems.
Remember, a mood disorder is a biological problem like diabetes. If you don’t manage it, it will manage you.
26. What are the goals of treatment?
The goals of treatment of mood disorders are typically as follows:
1. Be evaluated by a professional to identify if a disorder is present.
2. Have a psychiatrist identify the need for medication, if any
3. Take medication as prescribed.
4. Learn about the disorder and to recognize active of symptoms of the
disorder.
5. Learn symptom management.
6. Learn coping skills, especially distraction through structure. Structure
is created by having regularly schedule of activities, hobbies and social
support.
A. Encourage regular socialization.
B. Encourage regular exercise at least 4 times per week
Take a brisk walk at least 40 minutes.
C. Encourage hobbies and attention to daily chores.
7. Be consistent in the use of coping skills.
8. Learn to identify regressive symptoms, i.e., relapse warning signs and
triggers.
9. Learn how to make healthy choices.
10. Learn how to be well.

Generally goals fall into five overlapping areas:
See which ones may apply to you in addition to the ones described above:
1 Medical
2 Social skills and support
3 Coping skills
4. Daily living skills
5. Personal

1. Medical
1 Take medication as prescribed.
2 Report the presence of symptoms, suicidal or homicidal thoughts.
3 Maintain abstinence from alcohol and substance abuse.
4 Avoid caffeinated beverages, especially if sleep is poor.
5 Maintain a healthy diet and daily living skills.
6 Get medical and dental check-up annually.
7 Maintain psychiatric and therapeutic contact.
8 Have lab testing as directed by your doctor.
9 Report your sleep/wake cycle to your doctor.
10 Report medication side effects and allergic reactions to your doctor or ER.

2. Social skills and support
1 Have at least one social activity per week
2 Try to avoid napping during the day
3 Join a club, call a friend, take a class
4 Make plans for the weekend

3. Coping Skills
1 Read goals daily, put a copy on the refrigerator at home
2 Take a brisk walk 40 min at least 4 times per week.
Note: Always consult with your Doctor before starting any exercise regimen.
3 See your doctor, especially when you are experiencing symptoms
4 See your therapist regularly for support.
5 Check in with family and friends regularly and express your feeling
appropriately. Try to avoid conflict.
6 Work on a hobby a half an hour every day or when you are experiencing
symptoms as a distraction.

4. Daily Living Skills
1 Bathe daily
2 Dress appropriately
3 Do chores on assigned days
4 Do volunteer work on assigned days
5 Go to work, be on time
6 Manage your finances

5. Personal
1 Always maintain civility and respect
2 Make healthy choices.
3 Spend quality time with your family and friends.
4 Improve your self-esteem with your therapist.

27. What medications do you take?
You should always know the name of the medication, the amount of medication and the frequency of the dosage. For example: “I take 20 mg of Lexapro in the morning”. This will help to ensure that medications given by other physicians will not be contraindicated. In addition, you should always ask your pharmacist about possible drug interactions. A list of medications and dosages should also be carried on one’s person in the event of an emergency.
28. Why is psychiatric medication 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 typically 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 mood disorder without medication. You can’t build a 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 it addresses the relationship issues which often accompanying these disorders.

I do on occasion have clients who refuse medication. In the past, I have either chosen to discontinue treatment or say “we will have five sessions and see if it makes an impact on your symptoms.” If it does, that’s great. If it does not, I will try to deal with the denial. In my experience, I have found that men have more difficulty with the notion of taking medication then do women. 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 it. Why is this any different? I will also not hesitate to point out that alcohol is a drug and you are self medicating. This may lead to alcoholism or substance abuse and addiction. At some point, I may give up and discontinue treatment. That doesn’t happen very often because I can be very convincing but it does happen.
29. What if you are inconsistent in taking your medication?

The key word here is consistency. The medication is extremely important to
maintaining mental health. It is the foundation of treatment. If you are not consistent taking the medication, you will have difficulty functioning effectively on a day to day basis. This is not a headache. You take two aspirin and twenty minutes later your headache is gone. These medications don’t work that way. Remember, it takes four to six weeks to maximize the therapeutic effect of the medication. You have to build up to a therapeutic level. When
you miss medication, you affect that level. You may need to ask for assistance from family or friends. If you miss more than five pills a year, I consider you to be noncompliant. Always take the medication as prescribed. If you have concerns, contact your doctor.

30. What are the possible side effects of psychiatric medication?
Know that 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 them. Most of the common psychiatric medications for depression and mood disorder 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. Always read the medication information given to you by the pharmacist. S/he is also a good source for questions about 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 few weeks. 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. Care a card in your wallet which 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.

31. What are the benefits and purpose of psychiatric medication?
Mental Illness is a disease very much like diabetes. It takes insulin to manage
diabetes; it takes psychiatric medication to manage depression and 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. In my opinion, the only way to successfully manage a mood disorder is with education, medication, ongoing treatment and support.

32. What does one do if there is a medical emergency?
Call 911 immediately!

33. Should the client or family adjust the medication if symptoms reappear?
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 cause of relapse is 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.

34. How does one learn to make healthy choices?
Sometimes people do not recognize the choices they make may not be healthy.
Once stable and consistent, some clients simply need to check-in with me a few times per year. Others need ongoing supportive therapy every two to four weeks to remain consistent. The frequency will depend on the individual and how well one manages their disorder. Together with your doctor and 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.

35. How to be well.
Coping with depression or mood disorders is no easy task! It takes professional support, medication, psycho-education and experience to manage the debilitating symptoms. With the necessary supports and monitoring, persons with mood disorders can learn to:
1. Take your medication as prescribed.
2. Control symptoms.
3. Remain stable.
4. Have a network of friends and supports and
5. Maintain employment.
I have also found that it takes an average of about one year to reach those goals. In addition, most people will need some level of support on and off for their entire lives. The bottom line is you can’t do it alone! You need a psychiatrist to manage your medication and a therapist to provide ongoing support. The following is a brief summary of the 10 steps of How to be Well:

How to be Well

1) Take the medication as prescribed by your doctor.
This is definitely a tough one. Many people don’t like to take medication, especially, everyday for the rest of your life but remember, clinical depression is a lifelong disease and it’s all about body chemistry. 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.
People with depression and mood disorders often have problems with sleep. I do not recommend using caffeine. It interferes with the sleep/wake cycle. I also don’t recommend working the night shift i.e., midnight to 8 AM. It is too hard to get adjusted to a night shift and it also wreaks havoc with the sleep/wake cycle. Tell your doctor or your therapist if you are not sleeping.

As far as alcohol and substance use, it is as simple as it is hard. Don’t use it! Alcohol is a depressant. You are already depressed. There is a negative correlation between casual use of alcohol, drug use and mood disorder. The increased chance of dependence and risk of relapse to symptoms are just not worth it. The bottom-line is USE IS THE SAME AS ABUSE! Don’t use, ever! If you already have a problem, get professional help and go to your Alcoholics Anonymous or Narcotics Anonymous meetings as often as it is necessary to maintain sobriety.

Note: Some Doctors and even therapists say that it is OK to have one or two drinks if you have no alcohol abuse or dependence issues. I still question this because alcohol is a depressant. Why would you take a depressant when you are taking an anti-depressant under any circumstance?

If you chose to disregard my position, I strongly recommend that alcohol use be infrequent and on special occasions. The use of alcohol should be limited to one or two drinks at most. I suggest that you to monitor your mood in the days that follow. Look for increased depression, disturbing thoughts, anger or irritability. This will tell you if you can have one or two or none.

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) Be social, outside of the family.
Mental illness tends to make people isolated and withdrawn. People need contact with other people to remain grounded in reality. Even family cannot take the place of social contact in its benefit concerning reality testing. People with mood disorders cannot always trust what they feel, see or hear. They need to “check it out” with other people.
We all use our friends to test reality; you just don’t think of it in that way. For example, you call up your friend and say, “Do you know what happened today? I had an argument … She said… I said …” Who do you think was right?” It’s over simplified but you get the idea. People need other people for many reasons. For people with a mood disorder, reality testing or “checking it out” is just one of them. I recommend at least two social activities per month with people other than family.

5) Be active.
People with mood disorders tend to be sedentary. They need to walk and get exercise as much or more than any of us. I recommend taking a brisk walk, weather permitting, at least 4 times per week for forty minutes. Pick your days and stick to them as much as you can. It is widely accepted today that walking reduces anxiety and improves your mood so get out there and walk.
Note: Always consult with your doctor before starting any exercise program.

6) Plan to have fun.
When you were a child, it didn’t take much to have fun. You simply go outside and find some other kids and the party is on, so to speak. As adults, we need to plan to have fun. For example, if you had a boring weekend you might say to your spouse, “This was a lousy weekend. Next week we need to plan to get together with …” Get the idea? People with mood disorders tend to become consumed with their symptoms. Planning is a very important part of meeting your social goals.

7) Work on a hobby daily.
A hobby is a wonderful way to cope and help structure your day. When no one else is around or when you are experiencing negative thoughts, feeling low or just plain bored, a hobby fills the bill. The key word here is coping. People often complain about too much free time and yet they will say, “I don’t have a hobby,” but they will sit for hours ruminating about their symptoms. That is just not healthy. So don’t tell me why you can’t work on a hobby. Tell me what hobby you are going to choose and get to work. Hobbies should be worked on at least a half an hour any time you are having difficulty coping with your symptoms.

8) Do your chores on assigned days.
Household chores are also a way of coping with free time. First, list all your chores and make a schedule for each day of the week. Once written, tape it on your refrigerator or someplace where you will see it every day, and then, stick to your schedule. This is not about how you feel. If you felt good, you wouldn’t need to do this. If it’s Monday and you are scheduled to clean the bathroom – do it. It is a coping skill and it also gives you the added benefit of a healthy environment in which to live.

9) Get at least 5 to 7 hours of sleep per night.
As I stated earlier, sleep is very important to maintaining your mental health. Too much sleep is not healthy. No sleep is a quick ticket to active symptoms or psychiatric hospitalization. I could take anyone in the world; if I kept them awake long enough, they would lose touch with reality. Lack of sleep usually indicates that the person is not taking their medication as prescribed. Remember Goal # 1. Take the medication as prescribed by your doctor. If you’re still not sleeping, notify your doctor. It only takes a few sleepless nights to lose touch with reality and relapse to active symptoms.

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. For example, if you have a mood disorder, poor sleep, alcohol use, medication compliance and exercise are mental health issues. Remember! You manage it or it will manage you.

Issue 1 Sleep
Typical response: “It’s not the caffeine. I like coffee. It doesn’t affect me. I’ve always drank coffee.” Whether it’s coffee, soda or tea, caffeine interferes with sleep. It is the most obvious reason for poor sleep. I would certainly recommend gradually discontinuing caffeine before asking the doctor for a sleep aid. Avoid caffeine for one week and see if you don’t feel and sleep better.

Issue 2 Alcohol
Typical response: “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.”
Alcohol is a depressant. It may affect your mood for days, even weeks. Don’t deny the obvious. This is just not a healthy choice.
So remember, what is healthy for one person, may not be a healthy for you. Make healthy choices!

Issue 3 Medication Compliance:
Typical response: “I don’t miss often; maybe once per week.” This is not headache; for the medication to be effective it must be taken daily as prescribed.

Issue 4 Exercise:
Typical response: “I just don’t feel like doing it; you know I’m tired when I get home.” Walking or cardiovascular work for forty minutes at least four times per week or anytime you fell low or anxious lifts your mood and reduces anxiety. Take responsible for your wellness. Always check with your doctor when starting an exercise program.

For those in the metropolitan Chicago area, I have offices in Millennium Park on Michigan Avenue, and near 22nd St and Wolf Road in Westchester. Call 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 when necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

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