Tag Archives: anxiety

Have Anxiety? Learn a simple relaxation technique!

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

Learn how to relax!

Most people experience tension; knowing how to relieve that tension can help prevent or reduce anxiety, headaches, back pain, high blood pressure, and a number of other stress related symptoms.

Listed below are some simple techniques for reducing anxiety that gets in the way of your happiness.

Position: Find a comfortable chair, preferably a reclliner or chair with an ottoman and a headrest where you will not be disturbed for at least 10 minutes. Loosen any tight clothing you may be wearing. Assume a comfortable position; let your hands rest comfortable at your sides. Open your mouth slightly, let your lower jaw hang loose, drop your shoulders, let your chest collapse and your stomach stick out. Breathe slowly and smoothly. Close your eyes; do not fall asleep; do not cross your arms or legs.

Breathing: Inhale through your nose, exhale through your mouth. Become aware of your breathing. Allow your exhale to be slow and easy. As you breathe out, say the word “ one” to yourself. Repeat this for several minutes, thinking “one” on each exhale. Imagine that each slow exhale the tension is leaving your body. When you finish, sit quietly for a few minutes at first with your eyes closed before you get up.

Imagery: When you close your eyes, clear your mind. Go off on a mental trip to a pleasant peaceful place where you feel relaxed, safe, and free of worries or concerns. Stay there several minutes and savor the experience. You can imagine this trip to you restful retreat whenever you feel tense or anxious. It is your private tranquilizer.

Here are some ways to install relaxation practice in your daily routine:

1) Make your daily relaxation practice a ritual; select two regular times each day for about ten minutes at a time and stick to your plan.
2) For instant relaxation remind yourself by sticking a colored dot on your watch so each time you see it you will be reminded to relax.

Note: Using any relaxation technique takes practice; the more you practice the better you will get at this natural form of tension reduction. It is a safe, effective, drugless way to relax. Try it!

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 LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638 for more information.

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.

What are the symptoms of a mood disorder?

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

What is a mood disorder?

A Mood disorder is a generic term for people experiencing mild to severe depressive disorders, situational depression often associated with grief and loss, bipolar disorders, panic and anxiety disorders, phobias, personality disorders and other disorders which may include alcohol or drug abuse or dependence. Check the symptoms list below. If you have four or more related symptoms, discuss these symptoms with your doctor, psychiatrist and therapist.

Common symptoms of a mood disorder

__    Lack of pleasure, loss of interest and energy.
__    Lack of goal directed behavior.
__    Feeling down and depressed
__    Lack of motivation, lethargy.
__    Inability to structure time, poor concentration.
__    Anger, hostility, irritability, resentment.
__    Strained relationships, marital issues, divorce, loss of friends.
__    Withdrawal, isolation, would rather be alone.
__    Difficulty in coping with the past or stuck in the past.
__    Sleeping too much or too little.
__    Anxiety, panic, worry, sadness, tearful.
__    Negative thinking, rumination.
__    Feeling guilty, stressed or hopeless.
__    Poor self-care including hygiene and diet.
__    Aches, pains, dizziness, headaches, or stomach aches.
__    Unintentional weight loss, gain.
__    Crisis prone, police involvement.
__    Low sex drive.
__    Thoughts of suicide, homicide.

    • These disorders require 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?

Zoom!

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

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

http://manageyourmood.net
http://family-institute.org
http://takenotelessons.com   Effective face to face SAT ACT GRE preparation

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.

Find the right medication for depression through genetic testing!

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

Medication with supportive psychotherapy is most effective treatment of clinical depression. Most people go to a psychiatrist for their disorder and get on medication and in a two or three month process they feel significantly better.  As a therapist with over 35 years of experience, I have also seen some that struggle to find the right medication at the right dose for their disorder. I have seen this process take as long as 18 months.  This leads to frustration and possibly discontinuing treatment. Now psychiatry can take some of the guesswork out of the medication process. Genetic testing through GeneSight 866-757-9204 can help you and your doctor find the right medication for your body chemistry.  Call GeneSight for more information.

Note: I have no relationship with GeneSight; I just hate to see the struggle to find the right medication at the right dose.

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://takenotelessons.com   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.

Questions about Mood & Relationship Disorders?

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

Mood and Relationship Disorders.

Questions and Answers

1. What is a mood disorder?
2. What are the symptoms of a mood disorder?
3. Can a mood disorder be compared to a physical illness?
4. What should you report to your psychiatrist?
5. Will you have to go in and out of hospitals the rest of your life?
6. Why can’t you drink alcohol if you are not an alcoholic?
7. Why is mood disorder and addiction often found in the same individual?
8. Why is medication compliance so important?
9. How do you cope with the past?
10. Why are recreation, exercise and socialization so important?
11. What if you don’t feel motivated to do the things suggested here?
12. What are relapse warning signs?
13. What are the causes of relapse, regression and re-hospitalization?
14. When should you go to the hospital?
15. What do you do if you can’t sleep?
16. What is the role of the family in treatment?
17. What can family members do to minimize the risk of relapse?
18. How can family members learn to cope?
19. Who is responsible for your happiness?
20. What are the goals of treatment?
21. Why is psychiatric medication useful in controlling symptoms of mood disorders?
22. What if you are inconsistent in taking your medication?
23. What are the possible side effects of psychiatric medication?
24. What are the benefits and purpose of psychiatric medication?
25. What does one do if there is a medical emergency?
26. How does one learn to make healthy choices?
27. How to be well.

1. What is a mood disorder?

Mood disorders are considered a mental illness. They are biological/genetic problems that you inherited and are considered no different than the diagnosis of diabetes. These disorders are usually manifested in the teens or early twenties. I use two very different definitions of mental illness.
The first definition is as follows:
It is a lifelong disability, episodic in nature that causes chronic dysfunction, asocial behavior and hospital dependency. 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 symptoms very manageable.

Episodic means that sometimes the symptoms are worse than at other times.

Chronic dysfunction includes inability to manage day-to-day events, unemployment and often failed relationships.

Asocial Behavior is that behavior which is bizarre and inappropriate. This includes poor self-care. It may also include behavior that is harmful to oneself or others.

Hospital Dependency means that in some severe instances, frequent psychiatric hospitalization may result in a revolving door syndrome in which a person spends their life going in and out of hospitals.

The second definition is as follows:
Mental illness is a lifelong disability, episodic in nature that the individual can learn to manage with hope and with dignity.

The two definitions are separated only by education, psychiatric treatment and 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? (See how to be well)

2. What are the symptoms of mood disorders?
A. Symptoms of Depression grief, loss panic and anxiety.
a. Lack of pleasure, loss of interest and energy
b. Lack of goal directed behavior
c. Inability to structure time, poor concentration,
d. Anger
e. Sleeping too much or too little
f. Overwhelmed with worry, sadness, low mood
g. Feeling guilty, stressed or hopeless
h. Poor self-care including hygiene
i. Aches, pains, dizziness, headaches, or stomach aches
j. Strained relationships, marital issues, loss of friends
k. Would rather be alone
l. Withdrawal, isolation, lack of close personal ties
m. Difficulty in getting along with people, irritable
n. Crisis prone, police involvement
o. Low sex drive
p. Thoughts of suicide, homicide

B. What are the symptoms of Bipolar Mood Disorder?
(These symptoms may also include some of the above)
a. Rapid mood fluctuations
b. Feeling high, euphoric or having elated mood
c. Irritability, hostility
d. Pressured, fast speech
e. Racing thoughts, skidding from subject to subject
f. Grandiose beliefs or behavior
g. Poor judgment
h. Poor self-control
i. Increased activity
j. Easily distracted, poor concentration
k. Increased sexual interest and drive
l. Thoughts of suicide, homicide

The above symptoms of 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, 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 communication.

3. 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 John had a heart attack. Fortunately, there was no damage to his heart. What was discovered, however, was that John’s blood sugar was very high. He was diabetic. When John 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 a 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.

Mental illness 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 a manageable handicap; not the global disability it is for some. It is a result of an imbalance in the chemistry of the brain. It is no one’s 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.

4. What should you report to your psychiatrist?
The Doctor is part of the team. S/he needs your input to best help him to help you. If any of the following are problematic, report them to the doctor. Write things down.
1. Report on medication compliance
2. Changes in your Symptoms
A. Sleep patterns
B. Voices
C. Mood
D. Physical changes
3. Drug and alcohol use
4. Medication side effects
5. Social activity
6. Self-care
7. Physical activities, Hobbies, Chores
8. Money management
9. Unusual behavior
10. Threats to self or others

5. Will you have to go in and out of hospitals the rest of your life?
Typically, in severe cases, some people go in and out of the hospital their entire life. This is usually a case of non-compliance with medication or alcohol or substance abuse. Mood disorders can be a global disability or a very manageable handicap. Which one will you choose? Education, medication and ongoing supportive treatment are essential for maintaining healthy functioning.

6. Why can’t you drink alcohol if you are not an alcoholic?
It is well documented that alcohol and substance abuse make the symptoms of a mood disorder worse. Where mood disorders are concerned, use is the same as abuse! Alcohol is a depressant. Even casual use may affect your mood for days after you drink. I suggest you monitor your moods for the next several days after drinking. Alcohol also affects the usefulness of the medication. Antidepressants take weeks to build up to a therapeutic level. When you drink you affect those levels.  In addition, one should never use substances when taking prescription medication. This can be fatal.

7. Why is mental illness and addiction often found in the same individual?
The answers here are not completely understood. Some say that the sites in the brain that are affected by mental illness 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 alcohol dependence. If you have a mood disorder, you can’t have any! The consequences are just not worth it.

8. Why is medication compliance so important?
The number one cause of regression and re-hospitalization is not taking medication as prescribed. In order for medications to work effectively, one must maintain a certain level in the body. When that level in not maintained, debilitating symptoms reappear.

9. How do you cope with the past?
Many people with mood disorders have difficulty coping with the past. Once this is explored with your doctor and therapist, 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.

10. Why are recreation, exercise and socialization so important?
It is good to have fun. Have fun! People with mood disorders often become engrossed in their illness and problems. Recreation and exercise (especially walking) are good for depression and a great distraction when one is experiencing symptoms. Distraction from symptoms is an important coping skill. (Internet, video games, TV or reading don’t help with distraction.)

11. 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. Do your chores and exercise on the days you have picked to do them. Plan to have fun. Have at least one social activity per week. (See how to be well.)

12. What are relapse warning signs?
Relapse Warning Signs reflect symptoms that include the following:
1. Thoughts about hurting oneself or others
2. Too much or not enough sleep, especially no sleep
3. Inability to concentrate, rapid speech, skidding
4. Rapid mood fluctuations, mania or depression
5. Poor judgment, risky behavior
These symptoms are typically a result of alcohol use, substance use or medication noncompliance.

13. What are the most common causes of regression, relapse and re-hospitalization?
1. Medication noncompliance
2. Alcohol and/or substance use
3. Social isolation
4. Family conflict

14. When should you go to the hospital?
When you are in danger of hurting yourself or someone else or when there is a medical emergency such as a medication reaction.

15. What do you do if you can’t sleep?
Stop drinking caffeinated beverages. Don’t nap during the day. Report it to your doctor.

16. 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 report on the following:
1) When the person does not take their medication as prescribed.
2) The use of alcohol, other substances or medications not prescribed by a doctor.
3) Behavior which may result in injury or harm to the individual, family or community.
4) The presence of any relapse warning signs, especially no sleep.
5) Social and leisure activities.
6) Unusual behavior

17. 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.
4. Avoid over involvement.
5. Avoid excessive pressure to achieve.
6. Avoid trying to help motivate.
These are frequent causes of family conflict and should be discussed with the doctor and therapist.

18. How can family members learn to cope?
1) Mental illness is no one’s fault. It is a biological problem. Avoid placing blame or guilt.
2) Provide opportunities to get away from each other. Check with your local AMI support group about meetings and their ongoing social activities.
3) Pursue other activities. Join the local YMCA or health club and get some exercise and social support.
4) Have outside interests and hobbies.
5) Walk at least 40 minutes on regularly scheduled days each week. In the winter, use a treadmill or walk the stairs. (Be careful; hold the handrail.)
6) Learn all you can about mood disorders but do not try to be a therapist.

19. Who is responsible for your happiness?
Who owns the problem? Don’t blame others for your illness or problems. Remember, a mood disorder is a biological problem like diabetes. If you don’t manage it, it will manage you. See how to be well.

20. What are the goals of treatment?
When dealing with a lifelong illness, it is important to understand the goals of treatment. Goals generally fall into six overlapping areas, they are as follows:
1 Medical
2 Social
3 Daily Living
4 Coping
5 Prevocational, vocational
6 Personal
As you will see, some goals can be placed under more than one area. A goal may remain as long as is necessary to ensure consistent compliance. Write down your goals and put them on the refrigerator. Some examples of Goals are as follows.
Medical
1 Take medication as prescribed
2 Report the presence of symptoms
3 Maintain abstinence from alcohol
4 Avoid caffeinated beverages
5 Maintain a healthy diet
6 Get medical and dental check-up annually
7 Keep psychiatrist appointments
8 Have blood work checked as directed by your doctor
9 Report less than 4 hours of sleep to your doctor
10 Report medication side effects to your doctor or ER

Social skills
1 Have at least one social activity per week
2 Try to avoid sleeping/ napping during the day
3 Call a friend
4 Make plans for the weekend

Daily Living Skills
1 Wash hair twice a week
2 Shower (daily)
4 Do your own laundry on Saturday (pick the same day each week)
5 Wear clean clothes

Coping Skills
1 Read goals daily, put a copy on the refrigerator at home
2 Be on time for work and appointments
3 See your doctor, especially when experiencing symptoms
4 Take a brisk walk 40 min every day (get Dr approval to exercise)
5 See your therapist regularly for support
6 Check in with family regularly
7 Work on a hobby 1/2 hour every day or when you are experiencing symptoms

Prevocational, Vocational
1 Bath daily
2 Dress appropriately
3 Look for a job on Monday (pick days)
4 Practice writing job applications
5 Attend school on assigned days
6 Do chores on assigned days
7 Do volunteer work on assigned days
8 Concentrate on chores at home (do a good job)
10 Be on time for appointments
11 Go to work

Personal
1 Make healthy choices.
2 Spend quality time with your family.
3 Improve self-esteem.

21. Why is psychiatric medication useful in controlling symptoms of Mood Disorders?
Mood disorders are considered bio-psycho-social disorders. It is a biological issue that affects thinking and behavior and often times creates 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 severe mood disorders without medication.
Therapy addresses the psychosocial treatment including identification and management of symptoms, daily living skills, coping skills and the relationship issues often accompanying these disorders.

22. What if you are inconsistent in taking your medication?
The key word here is consistent. The medication is extremely important to maintaining your mental health. If you are not consistent in taking the medication, you will have difficulty functioning effectively on a day-to-day basis. You may need to ask for assistance from family or friends. Always take the medication as prescribed.

23. What are the possible side effects of psychiatric medication?
Always read the medication information given to you by the pharmacist. If you have questions or concerns, direct your questions to the pharmacist and your doctor. Go to the ER for serious side effects.

24. What are the benefits and purpose of psychiatric medication?
A Mood disorders is disease very much like diabetes. It takes insulin to manage diabetes; it takes psychiatric medication to manage mood disorders. Some say you just have to be tuff. You just have to pull yourself up by your bootstraps
so to speak and try harder. This is false. In my opinion, the only way to successfully manage a mood disorder is with medication and treatment.

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

26. How does one learn to make healthy choices?
Sometimes people do not recognize the choices they make may not be healthy. Others simply need ongoing supportive therapy. Together with your doctor and therapist, you can learn to manage your symptoms and cope with the day to day stress of a mood disorder. This is the reason that ongoing support of a doctor and therapist is essential for management.

27. How to be well.
Coping with 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 mental illness can learn to:
1. Control Symptoms
2. Remain stable
3. Have a network of friends and supports and
4. Maintain employment
I have also found that it takes an average of about one year to reach those goals but some people never reach all. In addition, most people will need some level of support 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.

Ten elements necessary to cope with mood disorders.

1) Take the medication as prescribed by your doctor.
This is definitely a tough one. No one likes to have to take medication, especially, every day for the rest of your life but remember. Mental illness 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, drugs or alcohol, ever.
People with mental illness 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 messes up 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 do it! Mental illness alters reality. Alcohol and substance use alter reality. There is a relationship between alcoholism, drug abuse, addiction, mental illness and relapse. 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 AA or NA meetings as often as it is necessary to maintain sobriety.

3) Take care of your physical health.
Be sure to have annual dental and physical exams.

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 mental illness 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 one social activity per week 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 3-4 times per week. Pick your days and stick to them as much as you can. It is widely accepted today that walking 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 are a child, it doesn’t take much to have fun. You simply go outside and find some other kids and the party is on so to speak. As an adult, 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 mental illness 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 when no one else is around or when you are hearing voices or depressed or just plain bored. 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 1/2 hour every evening or 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 cleaning schedule. This is not about how you feel. If you felt good, you wouldn’t need this stuff. 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 the psychiatric hospital. I could take just about anyone in the world; if I kept them awake long enough, they would loose 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 back to severe symptoms.

10) Make healthy choices!
This is my generic one. This one may very well be different from person to person. What is a healthy choice for one person may not be healthy for another. For example, if you have a mood disorder, sleep and alcohol are mental health issues.

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 discontinuing caffeine before asking the doctor for a sleeping pill. Avoid caffeine for one month and see if you don’t 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 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!

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
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.

Copyright 2012 all rights reserved

Weekly Review of Consistency for management of Depression!

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

How to build structure for consistency in management of mood disorders!

This form helps you monitor your progress towards goals each week. Consistency is key when you have a mood disorder. People with mood disorders need planning and structure to help manage their symptoms. You can also track your marital/relationship goals if you choose. This tool helps track progress toward goals by adding structure to your week. Make multiple copies. Modify as needed; feel free to add or delete goals. Rate mood 1 through 10. Ten is best – 1 worst. 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 alcohol/drug use and your mood rating in the 3 days after use. Being consistent in your goals makes a huge difference in managing your mood. Try it!

Week of _________________

Goal:                                      Mon       Tues        Wed        Thurs        Fri        Sat       Sun
Medication compliance
Cardio/walking
Social activity
Hobbies
Chores
Date night
Civility and respect
Sleep # of hours
Drug, alcohol use
AA/NA meetings
Time out called
Time out respected
Mood
Family meetings
Psychiatric appt

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.  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
http://takenotelessons.com    Highly effective online, one on one, SAT, ACT, GRE, 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.

Why do people resist taking medication for depression?

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

Resistance to medication?

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

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

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

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

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

Medication and Support

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

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

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

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

Medication Side Effects and Allergic Reactions

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

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

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

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

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

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

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

The Leading Causes of Relapse

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

They are:

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

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

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

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

Relapse Warning Signs

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

Relapse warning symptoms include:

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

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

Zoom

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

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

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

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

Psychiatric Treatment – Help the Doctor Help You

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

How to prepare for your psychiatry appointment?

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

Report any changes in your symptoms to your doctor including:

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

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

3. Poor concentration, poor short-term memory

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

5. Drug and alcohol use/abuse

6. Medication side effects or allergic reactions

7. Social activity or isolation

8. Poor self-care

9. Physical activities, hobbies, chores

10. Poor money management

11. Unusual behavior

Psychiatric Medication

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

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

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

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

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

Medication and Support

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

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

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

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

Medication Side Effects and Allergic Reactions

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

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

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

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

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

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

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

The Leading Causes of Relapse

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

They are:

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

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

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

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

Relapse Warning Signs

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

Relapse warning symptoms include:

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

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

Zoom!

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

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

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

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

How to Cope with a mood disorder without Medication?

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

How to cope with a mood disorder.

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

Recreation and exercise

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

Social activity

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

Hobbies

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

Chores

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

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

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

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

When to consider medication?

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

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

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

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http://family-institute.org

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

What are essential elements of managing depression?

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.