Tag Archives: depression

Anxiety Panic Grief Depression, Bipolar Mood Disorders, Glossary of terms

How to recover from depression?

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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.

Anxiety Panic Grief Depression, Bipolar Mood Disorders, Glossary of terms

Psychiatric Treatment – Help the Doctor Help You

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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.

Anxiety Panic Grief Depression, Bipolar Mood Disorders, Coping skills

How to Cope with a mood disorder without Medication?

77 Comments

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.

Bipolar Mood Disorders

Learn how to manage your anxiety and depression!

48 Comments

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

Manage your anxiety and depression.

It is good to have fun. Have fun! People with mood disorders often become engrossed in the past, their disorder and relationship problems. They tend to ruminate about negative thoughts running over and over. Recreation and exercise (especially walking) are good for depression and anxiety and are a great distraction when one is experiencing symptoms. Any physical activity is likely to be therapeutic. 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.

Lack of motivation is often a direct result of a mood 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 a mood disorder but especially lack of motivation.

  • 40 minutes of cardio exercise, 4 times per week (doctor permitting).
  • Have at least three social activities per month.
  • Get a hobby.
  • Take your medication as prescribed.
  • Abstain/limit drug and alcohol use.
  • Be consistent.

Medication compliance is a huge part of symptom management.  If you are having an issue with your meds, contact your doctor or go to the ER.  If you can’t limit your alcohol use to 2 drinks twice per week then you shouldn’t have any.  Seek professional 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 James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

Home


http://family-institute.org
http://takenotelessons.com     Effective online, 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.

Anxiety Panic Grief Depression, Bipolar Mood Disorders, Glossary of terms, Severe mental illness

What are the symptoms of Severe Mental illness?

14 Comments

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.

Anxiety Panic Grief Depression, Bipolar Mood Disorders, Severe mental illness

How to cope with a mood disorder!

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

Structure is needed when you have a mood disorders.

This form helps create structure around ones weekly activities and goals. People with mood disorders need structure to help manage their symptoms. You can also track your marital/relationship goals if you choose. This tool helps track progress toward any goal by adding structure to your week. Make multiple copies. Modify as needed; feel free to add or delete goals. Rate your mood 1 through 10. Ten is best.  Place copy on your refrigerator or someplace where you can check it daily. Mark the goals each day so that you can see the week in review.  Note your alcohol/drug use and your mood rating in the 3 days after use.  If your mood dips; connect the dots. Being consistent in your goals makes a huge difference in managing your mood. Try it!

Week of _________________

Mon     Tues     Wed     Thurs     Fri      Sat      Sun

Meds compliance

Cardio/walking

Social activity

Hobbies

Chores

Date night

Civility and respect

Sleep # of hours

 Drug, alcohol use

 Time out called

 Time out respected

Mood 1 – 10 best

Family meetings

Psychiatric apt.

This chart helps track progress toward goals and a structured week. Make multiple copies. Feel free to add or delete goals. Place it on your refrigerator or someplace where you can check it daily. You may find it useful; try it.

Note: Always consult with your doctor before starting any exercise program.

Zoom!
Now I can work via Zoom with anyone, anywhere in the country and it is currently 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.

Bipolar Mood Disorders, Coping skills, Glossary of terms, Substance Dependence

What are the Leading Causes of Relapse to Symptoms of Depression?

28 Comments

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

The Leading Causes of Relapse to Symptoms.

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.

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 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://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.

Anxiety Panic Grief Depression, Bipolar Mood Disorders, Substance Dependence

How to be well when you have a mood disorder?

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

How to be well when you have a mood disorder?
Coping with a mood disorders is no easy task!  It takes professional support, medication when necessary, psycho-education 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. You need a psychiatrist to manage your medication, if necessary and a therapist to provide ongoing support.

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 consuming two cups per day, 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 under any circumstance?
Alcohol may affect your mood for days, even weeks. 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 is 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
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 plus years 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. These are inexpensive and fun and a great way to meet your socialization goals!
● Don’t do it for a grade
● Do it because you are interested in it
● Do it to help manage (structure) your symptoms and your free time
● Do it to be more social

6) Make time to nurture your relationship.

Line up sitters so you can have time alone with your spouse or significant other. 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. 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 is currently covered by BCBS Insurance. Check with your carrier. Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
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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.

Bipolar Mood Disorders

How to manage Bipolar Disorder and Denial?

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


Denial is the biggest obstacle to management and recovery of Bipolar Mood Disorder.

People with bipolar disorders, in particular, seem to have the most issues with denial and are, therefore, the most difficult people to treat from a therapist stand point. Through self-deception, rationalization, justification, and excuse making, a person can deny that they have a problem when everyone around them sees that the problem is obvious. This seems to be most common with Bipolar Disorders.

Denial usual takes place around several key issues. They are: acceptance of the disorder, the use of medication in helping manage the disorder and the detrimental role of alcohol and substance use or abuse in achieving wellness.

When clinical depression is the disorder; it is biological. It is genetic in origin. One can usually trace it in family history. It may be a grandparent, parent, uncle or cousin, even if it was never formally diagnosed, the history is typically there. No matter how much one tries to pull themselves up by their bootstraps and try harder, they will not make a significant impact on managing their symptoms. Even a skilled CBT therapist, employing cognitive behavioral techniques will not make a significant difference in the management of the disorder.

This means that medication is indicated. Some women, generally more men will initially refuse medication. I often hear, “I won’t take medication.” I describe my view and experience in general terms. If that is not enough to convince them, I will agree to cognitive behavioral therapy for period of time. If there is still no impact on symptom management through clearly defined goals, I revisit the medication issue to encourage reconsideration. Ultimately, it’s your life; you can be a victim of your disorder or you can choose to manage it. It doesn’t happen often but I have discontinued treatment and offered some referrals to other therapists who are willing to treat the disorder without the help of medication. Personally, I just can’t do it at least not for very long.

This is also true around the use of alcohol and recreational drugs such a marijuana. Remember, alcohol is a depressant. When you are already depressed why make it worse. Initially it helps but then it slams you in the days that follow. That is why it is known as self-medicating.

Some clients, again mostly men will refuse to consider stopping the use of marijuana. Yet the reason they have initiated treatment is panic and anxiety. Duh! Though not addictive per se, marijuana is habit forming psychologically. Prolonged daily use may cause anxiety and panic for those with a mood disorder. Take medication or stop using. I encourage both.

Though denial can be an issue for both men and women, I have found that men especially do not want to admit that they have a problem. They are generally more resistant to seeking help, taking medication or facing dependence.

In my practice, I recognize that this is a trust issue. If I feel that this will be an issue, I will put the referral for a medication evaluation off for a time while building a therapeutic relationship. I also address this resistance as most therapists do by comparing mood disorders with other physical disabilities such as diabetes or epilepsy. All are physical issues with a genetic origin which affects thinking and behavior. If your doctor told you, “I’m sorry to inform you that you are diabetic like your father was”, you would not like it but would likely be willing to take insulin injections.

The same thought process regarding antidepressants or mood stabilizing medication should apply with a diagnosis of mood disorder. There really is very little difference! Until you can accept your issues and play the hand you were dealt by genetics, environment and personality traits, you will be unlikely to manage your life well.

This will affect your marriage, relationships, employment and your ability to cope with day to day life. There is no soft way to peddle this. A psychiatric evaluation will determine if medication is appropriate. Medication does the first 50% and is considered the foundation. Once on the right medication at the right dose, symptom management with a skilled therapist will likely be more successful. Once this is addressed, we are more likely to resolve relationship issues through individual, family or couples counseling.

Case Scenario
Case Scenario: Denial or Acceptance – Beth
Beth is a twenty something year old female who enjoys partying with friends. Her friends can drink, smoke pot and stay out until 4am without major negative impact on their life. Beth cannot. Her partying has made her medication ineffective.

She initially presented with severe anger issues. She reported that she would lose control, even become violent. She was already on an antidepressant but it wasn’t helping. The symptoms of clinical depression including her lack of motivation, poor sleep, poor concentration and tendency to withdraw and isolate have come to a head. She reported that her anger was out of control. In addition, she had no motivation and had difficulty getting out of bed. She was experiencing panic and anxiety and had thoughts of suicide.

Beth can’t do what her friends did almost every weekend. I encourage someone like this to track their alcohol and pot use in the days after to see if this can help her connect the dots. It’s tough when your friends can do it but you can’t. I always remind my clients that they do have a disability that they need to manage. This makes them different, not bad, just different. However, if she makes the connection then it becomes a choice. A choice to be a victim of her disorder or a choice to be well. You’re only to blame if you ignore it. Then you need to be held accountable.

Payment and Insurance:
Blue Cross and Blue Shield PPO insurance welcome. Cash, check, Visa, Master Card or American Express accepted.

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://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.

Bipolar Mood Disorders, Glossary of terms

What are essential elements of managing depression?

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

Essential elements in managing your mood!
While a severe mood disorder and/or addiction may not be curable, their results need not be chronic dysfunction. You need not be a helpless victim of a debilitating illness. The frustrating pattern of wellness followed by relapse can be disrupted with proper psychiatric support, therapy and an array of supportive services which ultimately teaches the person about their disability and how to choose to be well.
The fundamental operating principle is that each person has the capacity and responsibility to maintain a state of recovery. Gladstone, DelGenio, Taussig, et al. (1984) have identified interrelated elements which will reduce relapse and bring the person to a higher level of functioning.
These components are:

Structure addresses the importance of your daily routine the management of symptoms including medication management and compliance and the use of free time, physical activity, exercise, social activity and hobbies. Planning your day/week is key to management.

Psychoeducation refers to the guided experiential learning that takes place in individual, couple or family therapy.

Ongoing treatment and support via the level of service necessary to maintain a state of wellness. This is a step-down approach which gradually reduces the frequency of individual therapy from weekly to as needed.
These are further defined below:

Structure
First, you must recognize the need for structure in combating your disorder. Initially, structure means securing an array of supports including an individual/family therapist and a psychiatrist. Add Alcoholics Anonymous (AA), Narcotics Anonymous (NA) or Smart Recovery meetings and professionally led alcohol and addiction groups for dependence or dual diagnosis. Most service providers are willing to collaborate with one another once written permission is obtained from the client. The collaborative support of the treatment team will create a common treatment plan. This will aid all providers to work in the same direction with common goals.
Once the treatment team is in order, the client learns the skills to combat the lack of structure in their daily life. This includes their medication management, i.e., taking the medication at the same time each day which will help ensure compliance. It also includes management of the sleep issues that mood disorders create. This means maintaining consistent sleep/wake habits. It is important to get up and get to bed at the same time each day.
In addition, many people are overwhelmed with common daily tasks such as grocery shopping, chores and laundry. These too can be structured by the day of the week and can become routine. I recommend that you spread out these tasks by picking various days of the week for each task. If it is Tuesday for instance, and that is the day you have picked to clean the kitchen, the day of the week makes the decision for you. This will help to address the lack of motivation which is so common among various mood disorders. The structure provided by this approach will hopefully be the foundation for success, permitting the person to achieve his or her individual capacity for stability and consistency.

Psychoeducation aka Experiential Learning

In the early 1990s, my father-in-law had a heart attack. Fortunately, there was little damage to his heart. What was discovered, however, was that his blood sugar was elevated. He was diabetic. When he moved out of intensive care, they began to teach him how to cope with his newly discovered disability. He learned how to measure his blood sugar and how to give himself insulin injections. He was taught what he could eat and what he could not. He even learned what to do if he had a reaction to a particular food or his medication. When he was discharged from the hospital, a nurse visited 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. Through education and experiential learning, my father-in-law learned how to manage his diabetes. He learned to manage his disorder so well that eventually he was able to take oral medication and discontinue insulin injections.
In psychotherapy, psychoeducation refers to teaching the person how to be well. The therapist will explore relationship issues, provide education about the disorder, symptoms, medication, relapse warning signs, and teach the coping skills necessary to maintain healthy functioning. I say, “This is not as obvious as if you are sitting in a wheelchair, but you do have a disability. You will need to learn how to manage it.”
Clearly, you will need a licensed therapist to assess and identify your disorder. The therapist will guide you through the experience and teach you how to cope with your symptoms. The goal of psycho-education is to help you maintain consistency in the management of your disorder. Without consistency in management of your moods, life will be a rollercoaster and much harder than it needs to be.
You may also be referred to a psychiatrist to confirm your diagnosis and possibly prescribe medication for you. Medication education is very much a part of psychoeducation. Initially, if necessary, the doctor will discuss the reasons for and purpose of the use of medication. In the case of mild or situational depression, a psychiatrist may help you determine if medication may be appropriate for a limited time. Typically, the psychiatrist will give you the option of taking medication and encourage continued psychotherapy for daily management. Additional services and supports may be necessary if alcohol/substance abuse and dependence are related issues.

Ongoing treatment
Ongoing treatment refers to the lifelong nature of many mood disorders. Some call it recovery, but to me that implies cured. I prefer to call it maintenance and stability. It takes about a year, sometimes two to learn all that one needs to know and experience to master the symptoms of a mood disorder. As time goes on and stability is achieved, the focus of treatment becomes about consistency in managing the symptoms. Unfortunately, there are those who say, “I feel good; maybe I don’t need treatment or medication anymore.” As much as I try to warn against this, even predict that this day will come, there are those who have to see for themselves. I guess some people just have to learn the hard way. I hope you hear what I am saying and take the less difficult route.
If you do want to try discontinuing medication, please do it with your doctor’s guidance. Typically, you discontinue these medications the way you began them, i.e. gradually. Though antidepressants and mood stabilizers are not addictive medications, an abrupt discontinuation will create uncomfortable side effects and may even be dangerous. Many people refer to the symptoms of abrupt withdrawal from medication as flu like symptoms.
Major depression disorders and bipolar disorders have become more commonly accepted by society in general thanks in part to high profile actors and professional athletes who have disclosed their disorders to the public. Clinical depression and bipolar 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 epilepsy. Other mood disorders may be just as debilitating if left untreated. Most will require psychoeducation, medication, and ongoing treatment. These disorders are usually manifested in the teens and as late as mid-30s. Real changes come from within. With structure, psychoeducation, and ongoing treatment, you can control your disorder.
The most effective way to achieve stability and consistency is through ongoing therapeutic support. Initially this means weekly visits to the therapist and monthly visits to the psychiatrist. As time goes on and the client gains mastery over his or her disorder, the time between visits is extended. You will know because there will be less to discuss. I have clients who I now see monthly or even quarterly. I have found the best long-term results are achieved with ongoing therapeutic support. Practically, this means that we gradually step down the frequency of therapy after you stabilize and begin to master your disorder. Sessions are gradually reduced from weekly to as needed. This is just to check in and remind people that because they don’t have active symptoms does not mean that they are cured. The goal is stability and consistency.
Recovery means management of an intermittent lifelong disorder with only minor interference in one’s life and relationships.

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.