Tag Archives: mood

Mood disorders and alcohol don’t mix!

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

When you have a mood disorder, the use of alcohol may be the same as abuse!

Where mood disorders are concerned use may very well be the same as abuse!  Alcohol impairs functioning and it affects thinking, behavior and relationships.  Substances also affect thinking and behavior.  Don’t do anything that would make you relapse to active symptoms.  It is known fact that alcohol and substance abuse make the symptoms of a mood disorder worse and vice versa.  Alcohol is a depressant; one drink at a family gathering may affect one’s mood for days.

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

  • Drugs and alcohol make mood disorders worse and can lead to drug/alcohol dependence.
  • Conflict often related to alcohol use and mood disorders.
  • Two drinks, beer or wine only; never back-to-back days, no more than twice per week with doctor approval.
  • If the doctor approves of one or two drinks, monitor your mood in the days that follow. If your mood is off, you need to consider abstinence from alcohol.

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 and your questions about this material with your doctor and therapist.

How can family help a loved one with depression?

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

How can family help a loved one with depression?

The role of the family in treatment is simply to monitor and report. The family should observe the patient’s behavior and report anything that may be important to the stable functioning and health of the patient. The patient should not be interfered with directly unless, of course, s/he is a danger to themselves or others. The family’s role in treatment is a collaborative effort in communication. The family should think of themselves as team members. We are all on the same team! Keeping secrets from the doctor or therapist interferes with treatment and may ultimately have serious consequences. Families should call their doctor, therapist immediately or 911 if the patient has any of the following behaviors or symptoms, especially if they are new, worse, or worry you. Report when the patient is:

  1. Not taking their medication as prescribed.
  2. Abusing alcohol, substances or medications not prescribed by a doctor.
  3. Severely depressed, irritable, threatens violence or has thoughts of suicide or dying.
  4. Exhibits behavior which may result in injury or harm to the individual, family or community.
  5. Experiencing of any relapse warning signs, especially no sleep.
  6. Experiencing panic attacks, uncontrolled anxiety or restlessness.
  7. Acting on dangerous impulses.
  8. Exhibits unusual behavior that is out-of-character for this individual.

Family should:

  1. Avoid placing blame or guilt.
  2. Avoid enabling. You are not responsible for the patient’s wellness. S/he is!
  3. Make regular opportunities to get away from each other. Have outside interests, hobbies and social activities.
  4. Get regular exercise (doctor permitting). Join a health club or walk at least 40 minutes on regularly scheduled days each week. In the winter if needed, use a treadmill or stationary bicycle.
  5. Learn all you can about mood disorders but do not try to be a therapist.

In most cases I have treated over the years, I have seen the client get annoyed with friends and family when they say, “You seem crabby, did you take your medication today”? The typical response is “just because I’m angry or upset doesn’t mean I’ve skipped my meds”. The way I see it, if you have a history of noncompliance, you don’t have the right to be angry when asked! Take the medication as prescribed so your family doesn’t worry about compliance or need to be intrusive in your life. They should be relatively assured that you are compliant with medication and treatment. Regardless, it is the responsibility of the family to ask because the consequences of not taking it as prescribed can lead to injury and possibly suicide.

    • Monitor and report on medication compliance.
    • Monitor and report on the use of alcohol and drugs.
    • Avoid over involvement unless the person poses a danger to himself or others.
    • Avoid trying to help motivate compliance with treatment.

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://takenotelessons.com   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.

Common questions about depression.

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

Mood, Depression and Relationship Disorders, Common Questions 

The following is a list of commonly asked questions and answers. I believe this will give the reader an overview of mood disorders and common marital and premarital issues associated with mood disorders. Please review them carefully; I also recommend that these questions be reviewed periodically.

1. What is a mood disorder?
A Mood disorder is a generic term for people experiencing mild to severe depressive disorders, bipolar disorders, situational depression, grief, panic and anxiety disorders, phobias, personality disorders and other disorders which may include alcohol or drug abuse or dependence. (Brown, Wang and Safran, 2005)
Clinical depression and bipolar disorders have become more commonly accepted by society generally and thanks, in part, to high profile actors and professional athletes who have disclosed their disorders to the public. Clinical depression and bipolar disorders are biological/genetic problems that you most likely inherited and are considered no different than the diagnosis of other medical conditions such as diabetes or epilepsy. These require education, medication, and ongoing treatment.

It is also important to note that not all mood disorders are lifelong or require medication.

For the purposes of definition here, I use two very different definitions to describe severe mood disorders. The first reflects denial of a problem and the second reflects acceptance of what is. Which one will you choose? The first definition is as follows:

Various forms clinical depression and bipolar disorders are lifelong disabilities, episodic in nature that may cause chronic dysfunction, asocial behavior, and failed relationships.
Here is a breakdown of this definition:

• Lifelong means there is no cure to date, though new medications, if taken as prescribed, have made many people relatively symptom free.

• Episodic means that sometimes the symptoms are worse than at other times for no apparent reason though stressful life events can also have an impact on active symptoms.

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

• Asocial Behavior is that behavior which is irrational, inappropriate showing poor judgment and a lack of insight into one’s own behavior. This can include poor self-care and appearance. It may also include behavior that is harmful to one’s self or others.

• Failed Relationships include social dysfunction, isolation, withdrawal, marital and family conflict and divorce.

The second definition is as follows:

Clinical depression or bipolar disorder are lifelong disabilities, episodic in nature that the individual can learn to manage with medication, education and a skilled therapist. Other mood disorders may require a skilled therapist for ongoing support but may or may not require medication.

In some instances, denial will create failed marriages and conflictual relationships. These two definitions are separated only by education, psychiatric treatment and ongoing therapeutic support. The key here is management of a disability. You manage it or it will manage you! How do you want to live your life?

2. Why shouldn’t you drink alcohol if you are not an alcoholic?
Where mood disorders are concerned, use may very well be the same as abuse! Alcohol impairs functioning and it affects thinking, behavior, and relationships. Alcohol and substances such as marijuana and cocaine also affect thinking and behavior. Don’t do anything that would make you relapse to active symptoms. It is known fact that alcohol and substance abuse make the symptoms of a mood disorder worse and vice versa. Alcohol is a depressant; one drink at a family gathering may affect one’s mood for days.

Alcohol also “washes out” and therefore may negate the usefulness of the medication. Remember, it takes four to six weeks to get the medication to a therapeutic level. When you drink heavily you affect that level. In addition, one should never use alcohol or substances when taking prescription medication. This can be fatal. It is understood that if you are an alcoholic you can’t have any alcohol. If you are not an alcoholic, you still need to check with your Doctor for approval of one or two drinks on very special occasions. In the days after, monitor yourself to see if it has affected your mood. If it does, use is the same as abuse!

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

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

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

6. What are the symptoms of a mood disorder?
Clinical depression and bipolar disorders are biological disorders that can usually be traced through family history whether it was formally diagnosed or undiagnosed. Check the symptoms under A and B with a check mark. If you have four or more related symptoms, discuss these symptoms with your psychiatrist or therapist.

A. Symptoms of depression, anxiety, panic, grief, loss and situational depression
__ Lack of pleasure, loss of interest and energy.
__ Lack of goal directed behavior.
__ 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, worry, sadness, low mood, tearful.
__ Paranoia or false beliefs, 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.

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

The above symptoms of depression and bipolar mood disorders are widely accepted. Since these disorders have a biological basis; a psychiatrist manages the medication while the therapist provides treatment and support. The therapist support often includes psycho-education, symptom reduction and management, increased coping skills and management of other day to day stressors such as job loss, school failure and relationship issues. The psychiatrist, therapist, family, friends and of course, the patient must work together as a team to construct an effective approach to these disorders. The most important aspect of this is good communication.

There are two types of bipolar disorders. They are Bipolar I and Bipolar II. Bipolar I is considered the more severe of the two disorders and has more extreme episodes of mania or depression. It may also have psychotic features such as delusions and paranoia. This generally includes being out of touch with reality. Bipolar II is characterized by milder swings of mania and depression and may have less serious effect on daily routine, relationships, or employment. Both bipolar I and bipolar II need ongoing treatment and medication to manage the symptoms well.

7. What are the symptoms of addiction?

Many of the symptoms of addiction and mood disorder are the same. Seventy to 90% of people with dependency issues also have a mood disorder. A person has to be drug free for one year in order to see if the mood issues are still present. The term dry drunk refers to a person who is drug and alcohol free but the mood issues remain. Common symptoms include:
Depression
Panic
Anxiety
Irritability
Thought disorders, delusions, psychosis
Mania
Restlessness
Confusion
Drowsiness, Insomnia
Slurred Speech
Memory Loss
Tremor
Diarrhea, Constipation
Cold sweats
Dilated pupils, tearing
Itching, hives
Skin flushing

8. How do these disorders interact with one another?
Mood disorders and alcohol and substance abuse do not interact well. In fact, each makes the other worse, especially when one is using and/or not taking medication as prescribed. One must manage both disorders simultaneously and treatment must be a collaborative effort with the level and the array of services necessary to maintain stability, sobriety, and consistency.

9. Can a mood disorder be compared to a physical illness?
It is helpful to think of someone you know who is diabetic and what it means to be a diabetic. Mood disorders may not be as visible as sitting in a wheelchair, but you do have a disability. Mood Disorders, addiction and diabetes are comparable in many ways. Each is a lifelong, biological problem that requires daily attention, education, and support.

Medication, when taken as prescribed, stabilize each condition but knowledge and training play a very important role in healthy functioning. The comparisons demonstrate that mental illness, like other physical handicaps, can become manageable handicaps; not the global disability it is for some. It is a result of genetics, an imbalance in the chemistry of the brain. No one is at fault and no one is to blame. Mental illness is a lifelong disability, episodic in nature that one can learn to manage, with hope and with dignity.

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

11. What should you report to your Psychiatrist?
The Doctor needs your honest input to best help you. If any of the following are problematic, report them to the doctor. Write things down. (See Doctor reporting form in the appendix)
Report on:
1. Medication compliance.
2. Changes in your symptoms including:
a. Sleep patterns
b. Low mood or manic behavior
c. Concentration, poor short-term memory
d. Disturbing thoughts, nightmares
e. Negative thoughts, rumination
3. Drug and alcohol use.
4. Medication side effects or allergic reactions.
5. Social activity or isolation.
6. Self-care.
7. Physical activities, hobbies, chores.
8. Poor money management.
9. Unusual behavior.
10. Thoughts of self-harm or threats to others.

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

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

14. How do you cope with the past?
Many people with mood disorders have difficulty coping with the past. Sometimes they appear to be living in the past, unable to get over some stressful life event. This needs to be explored with a doctor and therapist. This is a clear sign of depression and medication will most likely be necessary. When one dwells on the past, they often have difficulty coping with the present. I like the adage, yesterday is done; worry about today and tomorrow will take care of itself.

15. Why are recreation, exercise, and socialization so important?
It is good to have fun. Have fun! People with mood disorders often become engrossed in the past, their illness, and problems. Recreation and exercise (especially walking) are good for depression and anxiety and are a great distraction when one is experiencing symptoms. 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.

16. What if you don’t feel motivated to do the things suggested here?
Lack of motivation is often a direct result of a mood disorder. It is a symptom. 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. This will help to avoid, “I don’t feel like it today; I’ll do it tomorrow.” Unfortunately, tomorrow never comes. 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.

17. What are relapse warning signs aka positive symptoms?
Relapse warning signs are also known as positive symptoms. They are positive because they are present, active and uncontrolled by medication. These symptoms are typically a result of medication noncompliance or alcohol and drug use. Without intervention, these symptoms can have serious impact on thinking, judgment and behavior and may also include: psychiatric hospitalization, danger of self-injury and harm to significant others or the community.
Relapse Warning Signs reflect symptoms that include:
1. Thoughts about hurting oneself or others.
2. Changes in one’s sleep/wake cycle, especially little or no sleep.
3. Inability to concentrate, rapid speech, skidding from subject to subject.
4. Rapid mood fluctuations, mania, or depression, especially negative rumination i.e. negative thoughts that repeat over and over again.
5. Hallucinations or delusions.

18. What are the negative symptoms of a mood disorder?
Negative symptoms are traits most often missing in the individual. They are characterized by the absence of:
1. Motivation or goal directed behavior.
2. Pleasure.
3. Insight.
4. Good judgment.
5. Self-care, hygiene.
6. Emotional expression.

These symptoms are only partially controlled by medications. They are often what are left when positive active symptoms are controlled. It is for this reason that a person with a mood disorder still needs guided experiential psychotherapy.

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

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

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

22. What is the role of the family in treatment?
The role of the family in treatment is simply to monitor and report. The family should observe the patient’s behavior and report anything that may be important to the stable functioning and health of the patient. The patient should not be interfered with directly unless, of course, s/he is a danger to themselves or others. The family’s role in treatment is a collaborative effort in communication. The family should think of themselves as team members. We are all on the same team! Keeping secrets from the doctor or therapist interferes with treatment and may ultimately have serious consequences. Families should call their doctor, therapist immediately or 911 if the patient has any of the following behaviors or symptoms, especially if they are new, worse, or worry you. Call when the patient is:
1. Not taking their medication as prescribed.
2. Abusing alcohol, substances or uses medications not prescribed by a doctor.
3. Severely depressed, irritable, threatens violence or expresses thoughts of suicide or dying.
4. Exhibits behavior which may result in injury or harm to the individual, family, or community.
5. Experience of any relapse warning signs, especially no sleep.
6. Experience of panic attacks, uncontrolled anxiety, or restlessness.
7. Acting on dangerous impulses.
8. Exhibits unusual behavior that is out-of-character for this individual.

In most cases I have treated over the years, I have seen the client get annoyed with friends and family when they say, “You seem crabby, did you take your medication today?” The typical response is “just because I’m angry or upset doesn’t mean I’ve skipped my meds.” The way I see it, if you have a history of noncompliance, you don’t have the right to be angry when asked! Take the medication as prescribed so your family doesn’t worry about compliance or need to be intrusive in your life. They should be relatively assured that you are compliant with medication and treatment. Regardless, it is the responsibility of the family to ask because the consequences of not taking it as prescribed can lead to regression to symptoms, self-injury, or harm to others.

23. What can family members do to minimize the risk of relapse?
The following are frequent causes of family conflict and should be discussed with the doctor and therapist.
1. Monitor and report on medication compliance.
2. Monitor and report on the use of alcohol and drugs.
3. Avoid critical comments. Use “I feel” statements.
4. Avoid over involvement, enabling, unless the person poses a danger to himself or others.
5. Avoid excessive pressure to achieve.
6. Avoid trying to help motivate compliance.

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

25. Who is responsible for your happiness?
Who owns the problem? Don’t blame others for your disorder or problems. We have to play the hand that had been dealt us via genetics. That does not necessarily mean that relationship conflicts are not real or are just imagined but they can be exacerbated by the disorder and may need to be addressed in couples counseling or family therapy. Remember, a mood disorder is a biological problem like diabetes. If you don’t manage it, it will manage you.

26. What are the goals of treatment?
The goals of treatment of mood disorders are typically as follows:
1. Be evaluated by a professional to identify if a disorder is present.
2. Have a psychiatrist identify the need for medication, if any
3. Learn about the disorder and to recognize active of symptoms of the disorder.
4. Learn symptom management.
5. Learn coping skills, especially distraction through structure. Structure is created by having regularly schedule of activities, hobbies, and social support.
a. Encourage regular socialization.
b. Encourage regular cardiovascular exercise at least 4 times per week. (Take a brisk walk at least 40 minutes.)
c. Encourage hobbies and attention to daily chores.
6. Be consistent in the use of coping skills.
7. Learn to identify regressive symptoms, i.e., relapse warning signs and triggers.
8. Learn how to make healthy choices.
9. Learn how to be well.

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

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

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

Note: Always consult with your Doctor before starting any exercise regimen.

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

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

27. What medications do you take?
You should always know the name of the medication, the amount of medication and the frequency of the dosage. For example: “I take 20mg of Escitalopram (Lexapro) in the morning”. This will help ensure that medications given by other physicians will not be contraindicated. In addition, you should always ask your pharmacist about possible drug interactions. Don’t forget to mention any supplements you may be taking. A list of medications and dosages should also be carried on one’s person in the event of an emergency.

28. Why is psychiatric medication useful in controlling symptoms of depression?
Mood disorders are considered bio-psycho-social disorders. They affect thinking and behavior and frequently create relationship issues. Medication and medication management are typically essential in the management of the biology or the chemistry of the disorder. I consider this to be the foundation of treatment. It is difficult if not impossible to treat clinical depression without medication. You can’t build a house without a good foundation. Medication provides that solid foundation. To say it another way, medication does 50% while your management of the disorder does the other half.

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

I do on occasion have clients who refuse medication. In the past, I have either chosen to discontinue treatment or say, “we will have ten sessions and see if we can make an impact on your symptoms.” If it does, that’s great. If it does not, I will try to deal with the denial. In my experience, I have found that men have more difficulty with the notion of taking medication then do women. What if I told you that, “You are a diabetic and must be on insulin injections the rest of your life?” Of course, most people wouldn’t like it, but chances are they would do it. Why is this any different? I will also not hesitate to point out that alcohol is a drug and you are self-medicating with a depressant. This may lead to alcoholism or substance abuse and addiction. At some point, I may give up and discontinue treatment. That doesn’t happen very often because I can be very convincing, but it does happen.

29. What if you are inconsistent in taking your medication?
The key word here is consistency. The medication is extremely important to maintaining mental health. It is the foundation of treatment. If you are not consistent taking the medication, you will have difficulty functioning effectively on a day to day basis. This is not a headache. You take two aspirin and twenty minutes later your headache is gone. These medications don’t work that way. Remember, it takes four to six weeks to maximize the therapeutic effect of the medication. You must build up to a therapeutic level. When you miss medication, you affect that level. You may need to ask for assistance from family or friends. If you miss more than five pills a year, I consider you to be noncompliant with your medication. Always take the medication as prescribed. If you have concerns, side effects or allergic reactions contact your doctor or go to the ER or call 911.

30. What are the possible side effects of psychiatric medication?
Know that all medications have side effects. Even aspirin can cause ringing in the ears if you take too much. The pharmacy must list all side effects but that does not mean you will experience them. Most of the common psychiatric medications for depression and mood disorder have very few if any side effects after the first few weeks. First, ask your doctor about allergic reactions and possible side effects and what to do in the event of a serious reaction. Always read the medication information given to you by the pharmacist. S/he is also a good source for questions about medications.

The most common side effects are typically: nausea, diarrhea, blurred vision, sleepiness, insomnia, dizziness, or headache. These usually go away in the first few weeks. If these or 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 which will tell emergency personnel exactly what you are taking. If you have questions or concerns, direct your questions to your doctor or pharmacist. Dial 911 or go to the Emergency Room for serious allergic reactions and side effects. Ultimately, the more you know the safer you will be. (See Doctor reporting form in the appendix)

31. What are the benefits and purpose of psychiatric medication?
Mental Illness is a disease very much like diabetes. It takes insulin to manage diabetes; it takes psychiatric medication to manage depression and other mood disorders. Some say you just must be tough. “You just have to pull yourself up by your bootstraps and try harder.” This is false. In my opinion, the only way to successfully manage a mood disorder is with education, medication if necessary and ongoing treatment and support.

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

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

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

34. How does one learn to make healthy choices?
Sometimes people do not recognize the choices they make may not be healthy. This falls under the symptoms of lack of insight, poor judgment. Once stable and consistent, some clients simply need to check-in with me a few times per year. Others need ongoing supportive therapy every two to four weeks to remain consistent. The frequency will depend on the individual and how well one manages their disorder. Together with your doctor, 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 a mood disorder. This is the reason that ongoing support from your doctor and therapist is essential for management.

35. How to be well. Ten Steps to wellness.
Coping with depression or mood disorders is no easy task! It takes professional support, medication, psycho-education and experience to manage the debilitating symptoms. With the necessary supports and monitoring, persons with mood disorders can learn to:
1. Take your medication as prescribed. (Problems: contact your doctor or go to the ER)
2. Control symptoms with exercise, chores, and hobbies.
3. Remain stable by making healthy choices
4. Have a network of friends and supports
5. Maintain employment.

I have also found that it takes an average of 6 months to one year to reach these goals. In some cases, it may even take longer due to sensitivity to medication or allergic reactions. In still others it may be the first try at medication fails to control the symptoms and the doctor must switch to a different medication. Obviously, this will cause a delay in controlling symptoms. A company called Gene Sight can do genetic testing when a person has difficulty finding the right medication at the right dose. They can tell you and your doctor which medications would work best for you.

In addition, many people will need some level of support on and off for their entire lives. The essential point is you can’t do it alone! You need a psychiatrist to manage your medication and a therapist to provide ongoing support. If things don’t go well after a time I would not hesitate to get a second opinion. (See Chapter 15 for more detail on how to be well)

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 a tough one. 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 use/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 all right 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, 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 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 essential point 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
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 want to do 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!
• 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 to structure 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. 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, paint by number, 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 ruminating 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 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 and your questions about this material with your doctor and therapist.

How to be well when you have a mood disorder?

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 disorder is no easy task!  It takes professional support, education and experience to manage the debilitating symptoms.  In my practice, I have found that if I can provide a structured program which includes education and training to:

  1. Remain stable
  2. Learn coping skills
  3. Learn to overcome social dysfunction
  4. Have a network of friends and supports
  5. Thrive in a job or school

I have also found that it takes an average of about 1 year to reach those goals, while some people may never reach all five.  In addition, most people will always need some level of support their entire lives.  The bottom line is you can’t do it alone!  You need a doctor and therapist who can collaborate regarding treatment.  I have listed below the 10 elements necessary to cope with a mood disorder. See Disclaimer at the end of this article.

1)  Take the medication as prescribed by your doctor.

Not all my clients require medication but when coping skills and symptom management don’t make a significant impact on symptoms, it’s time to consider medication. This is a tough one.  No one likes to have to take medication, possibly every day for the rest of your life. Moderate to severe mood disorders will require medication for symptom management. It’s all about body chemistry, therefore, it’s no one’s fault.  It is a biological problem first and foremost.  It’s like being a diabetic; you must take the medication as prescribed in order to be well.

2)  No caffeine, substance abuse or alcohol.

People with depression and mood disorders often have problems with sleep.  I do not recommend using caffeine.  It interferes with the sleep/wake cycle.  I also don’t recommend working the night shift i.e., midnight to 8 AM.  It is too hard to get adjusted to a night shift and it also wreaks havoc with the sleep/wake cycle.  Tell your doctor or your therapist if you are not sleeping.

As far as alcohol and substance use, it is as simple as it is hard.  Don’t do it!  Mental illness alters reality.  Alcohol and substance abuse alter reality.  There are negative relationships among alcohol and drug use, addiction, mood disorder and relapse.  The bottom-line is USE CAN BE 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.

 Note: Some Doctors and even therapists say that it is OK to have 1 or 2 drinks once in a while on special occasions even if you are not an alcoholic.  I question this because alcohol is a depressant.  Why would you take a depressant when you are taking an anti-depressant?  I call this the Elvis (Presley) syndrome.  Reportedly, Elvis took uppers to counter act the downers, to counter act the uppers.  It eventually killed him.  If you do drink, I strongly recommend that it be infrequent and on special occasions only.  This should be one or two drinks at most, and I encourage you to monitor your mood in the following few days.  Look for increased depression, disturbing thoughts or anger and irritability.  This will tell you if you can have one or two or none.

3) Take care of your physical health.

Be sure to have annual dental and physical exams.  Some medications require regular blood testing. Some physical ailments can cause depression.  See your doctor regularly.

 4) Be social, outside of the family.

Depression tends to make people isolated and withdrawn.  People need contact with other people to remain grounded in reality.  Even family cannot take the place of social contact in its benefit concerning reality testing.  People with mood disorders cannot always trust what they feel, see or hear.  They need to “check it out” with other people.

We all use our friends to test reality; you just don’t think of it in that way.  For example, you call up your friend and say, “Do you know what happened today?  I had an argument …  She said… I said …” Who do you think was right?”  It’s over simplified but you get the idea.  People need other people for many reasons.  For people with a mood disorder, reality testing or “checking it out” is just one of them.  I recommend at least two social activities per month with people other than family.

5)  Be active.

People with mood disorders tend to be sedentary.  They need to walk and get exercise as much or more than any of us.  I recommend taking a brisk walk, weather permitting, at least 4 times per week for 40 minutes.  Pick your days and stick to them as much as you can.  It is widely accepted today that walking (cardio work) reduces anxiety and improves your mood so get out there and walk.

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

6)  Plan to have fun.

When you were a child, it didn’t take much to have fun. You simply go outside and find some other kids and the party is on so to speak.  As 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 mood disorders tend to become consumed with their symptoms.  Planning is a very important part of meeting your social goals.

7)  Work on a hobby daily.

A hobby is a wonderful way to cope and help structure your day.  When no one else is around or when you are experiencing negative thoughts, feeling low or just plain bored a hobby fills the bill.  The key word here is coping.  People often complain about too much free time and yet they will say, “I don’t have a hobby,” but they will sit for hours ruminating about their symptoms.  That is just not healthy.  So, don’t tell me why you can’t work on a hobby.  Tell me what hobby you are going to choose and get to work.  Hobbies should be worked on at least 1/2 hour any time you are having difficulty coping with your symptoms. I have seen some do paint by number as an easy way to distract themselves. The nice thing is you can pick it up and put it down and walk away.

8) Do your chores on assigned days.

Chores are a great way to distract yourself from your symptoms. 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. Make a cleaning schedule and stick to it. 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. Tape it on your refrigerator or someplace where you will see it every day, and then, stick to your cleaning schedule.  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.

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 vacuum – do it.    It is a coping skill, and it also gives you the added benefit of a healthy environment in which to live.

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.

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 a psychiatric hospital.  I could take just about anyone in the world; if I kept them awake long enough, they would lose touch with reality.  Lack of sleep usually indicates that the person is not taking their medication as prescribed.  Remember Goal # 1.  Take the medication as prescribed by your doctor.  If you’re still not sleeping, notify your doctor.  It only takes a few sleepless nights to lose touch with reality and relapse to 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, poor sleep and alcohol use 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 days, even weeks.  Don’t deny the obvious.  This is just not a healthy choice.  So, remember, what is healthy for one person, may not be a healthy for you.  Make healthy choices!

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.

Q & A Mood disorders with substance abuse

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

Mood Disorders and relationships disorders.
Questions and Answers

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

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

The first definition is as follows:

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

The second definition is as follows:

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

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

The two definitions are separated only by education, psychiatric treatment and ongoing therapeutic support. The key here is management of a disability. You manage it or it will manage you! How do you want to live your life?

2. Why shouldn’t you drink alcohol if you are not an alcoholic?
Where mood disorders are concerned use is the same as abuse! It impairs functioning and it affects thinking, behavior and relationships. Alcohol and substances such as marijuana and cocaine also affect thinking and behavior. Don’t do anything that would make you relapse to active symptoms. It is known fact that alcohol and substance abuse make the symptoms of a mood disorder worse and vice versa. Alcohol is a depressant; one drink at a family gathering may affect one’s mood for days.

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

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

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

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

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

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

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

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

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

7. What are the symptoms of addiction?

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

8. How do these disorders interact with one another?

Depression/mood disorder and alcohol and substance abuse do not interact well. In fact, each makes the other worse, especially when one is using and/or not taking medication as prescribed. One must manage both disorders simultaneously and treatment must be a collaborative effort with the level and the array of services necessary to maintain stability, sobriety and consistency.

9. Can a mood disorder be compared to a physical illness?
It is helpful to think of someone you know who is diabetic and what it means to be a diabetic. Some years ago, a friend of mine named Mark had a heart attack. Fortunately, there was little or no damage to his heart. What was discovered, however, was that Mark’s blood sugar was elevated. He was diabetic. When Mark moved out of intensive care, they began to teach him how to cope with his newly discovered disability. They taught him how to measure his blood sugar and give himself insulin injections. They taught him what he could eat and what he could not
eat. They even taught him what to do if he had a reaction to food or his medication. When he was discharged from the hospital, they had a nurse visit him at home several times a week for several weeks just to make sure that what he had learned in the hospital, he continued at home.

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

10. How does a mood disorder affect thinking and behavior?

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

11. What should you report to your psychiatrist?

The Doctor is part of the team. S/he needs your honest input to best help you. If any of the following are problematic, report them to the doctor. Write things down. See Stability, Symptoms, Medication, and Education Review)

Report on:

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

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

13. Why is medication compliance so important?
The number one cause of regression and reoccurrence of symptoms is not taking medication as prescribed. This is not like having a headache. When you have an ordinary headache, you take two aspirin and twenty minutes later your headache is gone. In order for antidepressant medications to work effectively, one must maintain a certain level in the body. When that level in not maintained, debilitating symptoms reappear. These medications take four to six weeks to reach their peak level effectiveness. When you miss doses of medication you negatively affect that level.

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

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

16. What if you don’t feel motivated to do the things suggested here?
Lack of motivation is a direct result of the disorder. If you wait to feel motivated, it may never happen. Walk 40 minutes per day at least 3-4 days per week with your doctor’s permission. Pick your days and let the day of the week make the decision for you. Do your chores and exercise on the days you have picked to do them. Try to have at least one social activity per week. Plan to have fun. Adding structure to your life addresses many common symptoms of mood disorder but especially lack of motivation. (See how to be well.)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

27. What medications do you take?
You should always know the name of the medication, the amount of medication and the frequency of the dosage. For example: “I take 20 mg of Lexapro in the morning”. This will help to ensure that medications given by other physicians will not be contraindicated. In addition, you should always ask your pharmacist about possible drug interactions. A list of medications and dosages should also be carried on one’s person in the event of an emergency.
28. Why is psychiatric medication useful in controlling symptoms of Mood Disorders?
Mood disorders are considered bio-psycho-social disorders. They affect thinking and behavior and often times create relationship issues. Medication and medication management are typically essential in the management of the biology or the chemistry of the disorder. I consider this to be the foundation of treatment. It is difficult if
not impossible to treat a mood disorder without medication. You can’t build a house without a good foundation. Medication provides that solid foundation.
Therapy addresses the psychosocial treatment issues including: identification and management of symptoms, daily living skills, coping skills and it addresses the relationship issues which often accompanying these disorders.

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

29. What if you are inconsistent in taking your medication?

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

30. What are the possible side effects of psychiatric medication?

Know that all medications have side effects. Even aspirin can cause ringing in the ears if you take too much. The pharmacy must list all side effects but that does not mean you will experience them. Most of the common psychiatric medications for depression and mood disorder have very few if any side effects after the first week or so. First, ask your doctor about allergic reactions and possible side effects and what to do in the event of a serious reaction. Always read the medication information given to you by the pharmacist. S/he is also a good source for questions about medications.

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

31. What are the benefits and purpose of psychiatric medication?

Mental Illness is a disease very much like diabetes. It takes insulin to manage diabetes; it takes psychiatric medication to manage depression and mood disorders. Some say you just have to be tough. “You just have to pull yourself up by your bootstraps and try harder”. This is false. In my opinion, the only way to successfully manage a mood disorder is with education, medication, ongoing treatment and support.

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

33. Should the client or family adjust the medication if symptoms reappear?

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

34. How does one learn to make healthy choices?

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

35. How to be well.

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

How to be Well

1) Take the medication as prescribed by your doctor.
This is definitely a tough one. Many people don’t like to take medication, especially, every day for the rest of your life but remember, clinical depression is a lifelong disease and it’s all about body chemistry. It is a biological problem first and foremost. It’s like being a diabetic; you must take the medication as prescribed in order to be well.

2) No caffeine, substance abuse or alcohol.
People with depression and mood disorders often have problems with sleep. I do not recommend using caffeine. It interferes with the sleep/wake cycle. I also don’t recommend working the night shift i.e., midnight to 8 AM. It is too hard to get adjusted to a night shift and it also wreaks havoc with the sleep/wake cycle. Tell your doctor or your therapist if you are not sleeping.

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

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

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

3) Take care of your physical health.

Be sure to have annual dental and physical exams. Some medications require regular blood testing. Some physical ailments can cause depression. See your doctor regularly.

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

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

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

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

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

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

10) Make healthy choices!
This is my generic one. This one may very well be different from person to person. A healthy choice for one person may not be healthy for you. For example, if you have a mood disorder, poor sleep, alcohol use, medication compliance and exercise are mental health issues. Remember! You manage it or it will manage you.

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

Issue 2 Alcohol
Typical response: “What? I can’t have a glass of wine with dinner? I don’t do it often. It’s just one glass. It’s not like I’m an alcoholic.”
Alcohol is a depressant. It may affect your mood for days, even weeks. Don’t deny the obvious. This is just not a healthy choice.
So remember, what is healthy for one person, may not be a healthy for you. Make healthy choices!

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

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

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   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.

Manage your Mood Disorder!

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

Mood disorders represent people experiencing mild to severe depressive disorders, bipolar disorders, panic, anxiety disorders, phobias, personality disorders and other disorders including alcohol or drug dependence.

Major research over the years has not completely explained one singular definitive cause of mood disorders. Generally, most consider a combination of bio-psycho-social factors including: family genetics, personality traits and stressful life events such as marital stress, financial issues, severe injury, chronic health issues or death of a relative or friend.

Strained relationships double the risk of triggering a mood disorder.

In the treatment of mood disorders, family conflict is present often enough that it be given symptom status.

It is estimated that up to 70% of the people who are currently diagnosed with a mood disorder also have alcohol and/or substance abuse issues. 

Casual use of alcohol or substances complicates treatment of depression/mood disorders and will likely result in a relapse to symptoms, alcohol and substance abuse and possibly hospitalization or suicide.

People with mood disorders who are long term casual alcohol users are very likely to develop alcohol dependence or addiction over the course of their lifetime. 

These two separate and distinct mood disorders (depression and addiction) complicate and exacerbate each other. For example, depressive symptoms can be a trigger for alcohol cravings.

Most patients benefit from combined psychotherapy, medication and an array of support services when dual diagnosis is present. Patients with chronic psychiatric illness are at risk for substance abuse and dependence.  Plans for comprehensive treatment of mental illness must include measures to prevent, detect, and treat substance abuse. Poor medication compliance and poor response to traditional substance abuse treatment have been associated with dual diagnosis. Substance abuse decreases compliance with treatment, compromises the efficacy of medication and thereby increases the risk of symptom exacerbation and relapse.

The National Center for Health Statistics (2006) show about half of marriages will result in divorce.  These statistics also show that stress and arguments over money are major contributors.

Social disability is a primary source of stress; it prevents patient’s developing the supportive relationships that could provide a buffering effect; thus, it is a potent predictor of symptom exacerbation.

Social support plays a critical role and is a necessary component if treatments are to improve the patient’s overall level of functioning, quality of life and compliance with treatment.

Mood disorders rank among the top 10 causes of worldwide disabilities. About 1 in 7 people in the USA have a mental disorder. Depression affects nearly seven percent of the population of American adults. Major depressive disorder is one of the most common mental disorders in the United States. Women are 50% more likely as men to experience depression over their lifetime. Major depressive disorders account for about 20 to 35% of all death by suicide. A major risk factor for suicide is a combination of depression and alcohol or substance abuse. Clients with a mood disorder and/or dual diagnosis (mood disorder and alcohol dependence) can be taught to manage their disorders, much as people learn to manage other physical handicaps such as diabetes or epilepsy.

As one can easily see from the above literature, mood disorders including alcoholism and addiction can have a tremendous impact on our life and relationships.  Given the research it is quite possible and even likely that either you or your spouse will experience a mood disorder at some time in your life time.  Even without these disorders, sometimes life just gets in the way of our relationships.  We can easily lose our connection to our spouse due to stressors such as finances, job stress, children’s activities, parenting issues, in-laws, health issues, and death of a relative or friend. These issues, in turn, can lead to poor communication, conflict, loss of civility and respect, apathy and infidelity which creates resentment and a feeling of distance from our spouse.  Now add the complications of alcohol abuse and addiction and we are guaranteed that issues will negatively impact our relationships, creating conflict and increase the possibility of divorce.

The goal here is to give people the knowledge and skills to overcome these issues when they occur.  Chances are they will occur at some point in our relationship. There is no Cinderella story; no happily ever after.  If we are going to have a healthy, happy relationship for life then we need to recognize that relationships take work and attention.  We can’t allow life to get in the way. My goal is to make couples more aware and hopefully prevent conflict and divorce. I want to give people the tools to deal with life stressors, mood disorders, addiction and the ability to withstand whatever life hands you.

Therefore, in upcoming Blogs I will address coping with mood and relationship disorders, alcohol/drug dependence and the other common issues that tend to get in the way of our relationships and marriage.

As a therapist, I also recognize that in some relationships, couples are past the point of working on their issues themselves without a skilled therapist to intervene. I recommend a Cognitive Behavioral Approach to treatment regardless of who the therapist is.

If you have questions, please don’t hesitate to contact me at 847-733-4300 Ext 638. I can address your relationship, mental health issues and provide support for your alcohol and substance abuse issues, if any.

BCBS 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

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
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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.

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Seasonal Affective Disorder (SAD)

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

What is Seasonal Affective Disorder?

SAD as it is known by many, is a type of depression related to the dark gloom of fall and winter with shorter days and less sunlight. SAD is exacerbated by a decrease in activity level that is generally created in the cold winter months. The symptoms are largely the same but not as severe as for other depressive disorders including poor sleep and fatigue, crying spells, irritability, poor concentration, weight gain and loss of sex drive. In some severe cases, seasonal affective disorder can also be associated with thoughts of suicide.

Though symptoms usually improve in the summer, many people have found relief from the use of full spectrum lighting in their homes. These lights come in a variety of shapes and sizes and can be easily found on the internet. Probably the least expensive of these is the 27-watt full spectrum CFL bulb which can be placed strategically in fixtures and lamps throughout one’s residence. These are effective when used on a daily basis. Sometimes, however, these lights are simply not enough. In these cases, many of my clients have found relief by taking an antidepressant for a period of time and by increasing the level of physical exercise especially cardio work.

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://manageyourmood.net
http://family-institute.org
http://takenotelessons.com   Highly effective SAT, ACT, GRE, standardized test preparation 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.

Why depression and alcohol just don’t go together?

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

Why are mood disorders and alcoholism often found in the same individual?
The answers here are not completely understood. Some doctors have told me that the sites in the brain that are affected by mood disorders are the same sites affected by addiction. Regardless of the chemistry, research has shown that just casual use of alcohol by a person with a mood disorder may eventually result in abuse or dependence. If you have a severe mood disorder, you shouldn’t have any!

At least see how drinking affects your mood in the 3 days that follow alcohol use. Track it; give yourself a mood score from one to 10, ten being the best. Maybe you can limit alcohol use to one or two drinks twice per week and see if that helps. If you see in charting your mood that it does effect you negatively, than you shouldn’t have any. The consequences are just not worth it. If you can’t stick to two twice a week, you may need alcohol treatment.

Zoom! Now I can work via zoom with anyone, anywhere in the country and it may 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://jamesdelgenio.com
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.

Learn how to manage your anxiety and depression!

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.

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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.