Saturday, February 28, 2009
Fred went blank. He thought and thought, but couldn't remember. Then a smile broke across his face and he asked, "What do you call that red flower with the long stem and thorns?""You mean a rose?""Yes, that's it!" He turned to his wife. . ."Rose, what was the name of that clinic?"
Tuesday, February 24, 2009
True leaders discover keys to the nature of leadership from the example of others, but they never try to become these other leaders. They must use their own gifts and abilities to do what they are individually designed to do.
Monday, February 23, 2009
I think it was her second or third admission (I’m not quite sure) but prior to all her admissions she had attempted taking her life. On all these occasion she felt very lonely and assumed that the only way out was to end the misery once and for all. She had been in the ward for weeks now and was feeling much better but she feared that once she got back into the system she would soon have issues that will bring her back to the same spot of wanting to take her life, for her, this was the real problem.
As I engaged her in a discussion she quickly blurted out that she did not feel I, or any other doctor, could understand what she struggled with. I went on to explain to her that I understood because I had struggled with depression myself and then I went further to share how to overcome it (you could read the full account on my article titled when the clouds gather).
There are many useful articles on the net on this topic but I want to briefly talk about a method which I and many others have proven to be very effective. Actually, I had been practicing it before I knew about it; it is called the cognitive approach/therapy. This approach is effective in mild to moderate cases of depression with or without antidepressants however it is said to be more effective with antidepressant but it doesn’t work in severe cases of depression rather in such cases drugs or electroconvulsive therapy is used.
BACKGROUND TO THIS APPROACH
A.T Beck (1976) developed this approach based on the observation of a distorted thinking pattern that was common to people that were depressed; they had negative view about self, the world, and the future. These thoughts were disturbing and people who were depressed seem to have had no control over them, hence, they were called automatic thoughts. They were also noticed to have had beliefs and assumptions that made ordinary situation seem stressful; and illogical reasoning that propagated these beliefs and assumptions despite contrary evidence.
Here are some of the illogical reasoning (called cognitive distortions by Beck) that are seen in people who are depressed
· Overgeneralization…drawing general conclusion on the basis of a single incident; thinking that the bad outcome of one event will be repeated in similar future event, for example, having lost a partner the individual concludes they will never have a lasting relationship. So words like ‘always’, ‘never’, ‘everybody’ fills their minds- I’m always messing things up, I never get things right etc.
· Magnification (Catastrophising)-Minimization…expecting serious consequences of minor problem and inappropriately shrinking the importance of an attribute or event. I’ll like to term it fear and false humility respectively.
· Selective abstraction…focusing on a detail and ignoring more important features of a situation; for example, they constantly compare themselves with little information or on the basis of an isolated event so they either feel superior or inferior.
· Personalization…they see themselves as the cause of an external negative event which in fact they were not primarily responsible for and this usually results in guilt.
· Arbitrary inference… drawing a conclusion when there is no evidence for it and even some against it.
The above illogical thinking captures the common thinking pattern of people who are depressed hence the cognitive approach aims at modifying, or you could say renovating, this thinking pattern thereby reducing the burden of depression.
THE COGNITIVE APPROACH
As much as these thoughts are called automatic thoughts, which suggest that these individuals don’t have control over these thoughts, they can be challenged and with time checked to the barest minimum and sometimes, completely overcome.
Here are some tips to help challenge and restructure this distorted thinking pattern
1. Distraction…this involves focusing attention away from distressing thoughts, a conscious attempt to refocus usually on things in the immediate environment since automatic thoughts come on unconsciously. Sometimes it may involve engaging in a demanding mental activity to take the mind off the depressive thoughts…ever heard, ‘the idle mind is the devil’s workshop’?
2. Neutralizing…the emotional impact and distress caused by these thoughts can be reduced by rehearsing (either muttering or speaking aloud) a reassuring response. I use to muter words like “God has given me a sound mind; I’m a new creature; the joy of the LORD is my strength”.
3. Challenging Beliefs…like already stated above they make illogical conclusions and have abnormal belief system of themselves, the world, and the future. You will most likely need the help of someone here. You will also have to learn to communicate more rather than brood over imagined assumptions. This may entail choosing to believe the best of you and others, in other words, consider the alternative. For me, I replaced my low self esteem for God’s picture of me as revealed in the bible.
4. Reassess responsibility… some beliefs persist because people who are depressed overestimate the extent of their responsibility for events that have multiple determinants. So try and see the big picture; a lot of factors contribute to a singular event and this will help address the issue of guilt that arises from personalization (distorted thinking listed above).
Like I had earlier said there are other forms of treatment including medications, exercise and diet and they are very important but various researches has proven this approach as also being effective in mild or moderate cases.
It is said that nature does not allow for a vacuum so to overcome these automatic negative thoughts one has to replace them with positive thoughts. These cognitive exercises should be persistently practiced until you gain mastery then you will notice that the tendency to be and stay depressed will be greatly reduced with time. I will like to leave you with this quote from Philippians 4 verses 8 in the bible
“…whatever things are true, whatever things are noble, and whatever things are just, whatever things are pure, whatever things are lovely, whatever things are of good report, if there is any virtue and if there is anything praiseworthy…THINK ON THESE THINGS”.
Thursday, February 19, 2009
I'm so sorry I haven't updated this blog for a while it's been due to factors beyond my control despite several attempts to rectify it but hopefully this will change soon because I'm seriously working on it. So how are you all doing? I pray you are making progress in your endeavors.I have decided to restructure this blog in a bid to make it more exciting. Here's the plan...every month I'll write various articles on a particular topic instead of bombarding you with different issues in a month. I know this is love month because of valentine but I'll be writing on depression; the signs, symptoms and how to overcome it. I will also share my own story on how I overcame it.
Next month I'll be talking about the big question,'WHAT CAUSES MENTAL ILLNESS?',and what to do if your loved one suffers from mental illness.
You will have to stay tuned to find out what happens in subsequent months. By the way it wont be that boring it would also have the humorous pix and articles you like and of course those inspiring quotes. So tighten your seat belts and enjoy the ride. Cheers.
Saturday, February 7, 2009
"What's the problem?" the docotor inquired.
"Well, I'm 35 years old and I still have no luck with the ladies. No matter how hard I try, I just seem to scare them away."
"My friend, this is not a serious problem. You just need to work on your self-esteem. Each morning, I want you to get up and run to the bathroom mirror. Tell yourself that you are a good person, a fun person, and an attractive person. But say it with real conviction. Within a week you'll have women buzzing all around you."
The man seemed content with this advice and walked out of the office a bit excited. Three weeks later he returned with the same downtrodden expression on his face.
"Did my advice not work?" asked the doctor.
"It worked alright. For the past several weeks I've enjoyed some of the best moments in my life with the most fabulous looking women."
"So, what's your problem?"
"I don't have a problem," the man replied. "My wife does."
A merry heart does good, like medicine, but a broken spirit dries the bones
Everyone have moments of feeling low especially when things go wrong but when this feeling becomes intense and out of control arising from no apparent reason or, even when there is a reason, the intensity and the duration seem out of proportion to the cause, then it could be said to be a depressive disorder. This condition is characterized by a sinking of spirits, lack of courage or initiative, and a tendency to gloomy thoughts.
Depressive disorder is common with a prevalence (will occur at some point in a person’s life) of 5-20% with women twice likely to be affected as men. It ranks fourth as a cause of disability worldwide and has been projected that it may rank second by the year 2020. Race distributions appear equal, and socioeconomic variables do not seem to be a factor. The incidence (rate of new cases) is greatest between the ages of 20 and 40years and it decreases after the age of 65years. It is associated with other physical illnesses, suicide, and drug abuse. It has significant social impact on relationships, families and productivity.
AETIOLOGY [THE CAUSE]
What causes depression is yet to be fully understood, however it is likely to be due to the interplay of multiple variables in the life-span of an individual including biological, psychological, social factors. The biopsychosocial model of depression explains that a genetic factor leads to the individual being vulnerable due to his biological and personality/temperamental make up. Early childhood experiences like separation or loss of parents, traumatic or adverse life experiences, social circumstances, physical abuse or illness could also contribute to one’s vulnerability to depression. All these may then contribute to biological alterations in brain functioning hence the individual becomes increasingly sensitive to the effects of life stressors.
The reason for the gender variation is not also certain but it has been suggested that it may be due to various reasons including hormonal difference (due to increased risk of depression in the premenstrual and post-delivery periods), restricting social and occupational roles (being over- or under-occupied), increased tendency to worry and/or the fact that women are more likely to admit to being depressed whereas men may tend to express themselves differently, for example, through alcohol abuse.
SYMPTOMS [HOW TO RECOGNIZING IT]
Although depression is very common it often goes undiagnosed and undertreated. Here are some features of depression
- Depressed mood present most of the day, nearly every day, with little variation, and often a lack of responsiveness to changes in circumstances. It may be worse in the morning and improves as the day goes on.
- Loss of interest and enjoyment
- Reduced energy and decreased activity
- Reduced concentration, indecisiveness or diminished ability to think
- Reduced self-esteem and confidence
- Ideas of guilt and unworthiness
- Negative/pessimistic thinking
- Ideas of self harm, recurrent thought of death or suicide (not ‘fear of dying’) which may or may not be acted upon.
- Disturbed sleep; either reduced with early morning wakening 2-3hours earlier than usual or increased more than 10hours/day at least 3days a week, for at least 3 months.
- Weight change associated with either decreased or increased appetite.
The above symptoms should have been present for at least 2 weeks and represent a change from the individual’s normal behavior. It should also not have been due to the effect of drug/alcohol misuse, medication, a medical disorder, or a loss of a loved one.
Mild depressive episode: at least 2 of A and at least 2 of B.
Moderate depressive episode: at least 2 of A and at least 3 of B.
Severe depressive episode: all 3 of A and at least 4 of B.
Severity of symptoms and the degree to which these symptoms impair the individuals function also serve as a classification guide.
SOME OTHER SUBTYPES OF DEPRESSIVE DISORDERS
- Atypical Depression: it is of moderate severity characterized by overeating, oversleeping, extreme fatigue and heaviness of the limbs, prominent anxiety, and varying gloomy mood but able to enjoy certain experiences though not to normal level. There is also oversensitivity to perceived or real rejection.
- Seasonal Affective Disorder: there is a clear seasonal pattern to the recurrent depressive episodes, that is, it tends to occur at a particular season of the year. The symptoms are classically depressive symptoms as presented above.
Postnatal Depression: a significant episode of depression associated with childbirth in 10-15%of women within 6months following delivery. Symptoms are similar to usual depressive disorder. The mother may be bothered about the child’s health or her ability to adequately cope with the baby.
BIPOLAR DISORDER: though not necessarily a subtype but a mental disorder with two aspects; a manic and a depressive phase. The features of depression are also similar just that these individuals could be tilted to their manic phase by the antidepressant drug (you could read my article on bipolar affective disorder to know more about manic symptoms).
Depression is responsive to psychotherapy and medications called antidepressants. Milder cases could be treated with brief psychotherapy intervention alone. The more severe cases are treated with combination of medication and psychotherapy this is superior to medication or psychotherapy alone. Among the psychotherapies, cognitive behavioral therapy (which deals with modifying thought patterns) and interpersonal psychotherapy (which deals with resolving personal relationship and life problems) have the most data that support their efficacy however, other psychotherapies like supportive therapy, couple therapy and dynamic therapy are suggested to also be valuable forms of treatment.
Another important and effective form of treatment which is occasionally used especially in severe or treatment unresponsive cases or when the medication is contraindicated is the Electroconvulsive therapy.
COURSE [POINTS TO NOTE]
Untreated cases generally last 6-24months with two thirds achieving spontaneous full recovery.
Majority of patients have a recurrence of symptoms but individual variation makes it impossible to predict the likely period of recurrence.
Episodes of recurrent depression tend to be shorter, 4-16weeks.
Recurrence is greater when there is incomplete recovery (residual symptom of low mood, anxiety, sleep disturbance and so on), previous recurrence, and a strong family history of mood disorder.
Suicide rates for severe depressive episodes is about 13% (which is 20 times more likely than the general population) with a slightly higher rate of 12-19% for those who have had need for admission.
There is good evidence that the use of antidepressant medication impacts significantly on all the above data; it reduces the length of depressive episodes, the presence of residual symptoms and the recurrence of symptoms.
PROGNOSIS [THE OUTCOME]
Due to individual differences these factors do not have 100% predictive ability however good predicting factors of the outcome include sudden onset, ‘endogenous’ depression (that is caused by factors within the individual and independent of outside factors) and early age of onset. Poor predicting factors include a slowly creeping in onset of symptoms, low self confidence, alcohol or other drug abuse, personality disorder (for example borderline personality… you can read up my article on BPD), presence of a physical illness and lack of social support.