Unfortunately, if you have OCD then the Depression Center website will not be quite the right program for you. We have been considering building an OCD site for a some time... Meanwhile, the experts agree that CBT is the treatment of choice for OCD. If you OCD of mild to moderate severity then the experts recommend that you try CBT either with or without medication. The more severe your symptoms, then the more likely it is that you will need both CBT and medications. The most effective CBT technique for OCD symptoms is called “Exposure and Response Prevention” or “ERP.” In ERP the focus is on exposure work in which you (E)xpose yourself to the anxiety inducing situation (dirt, germs, uncertainty, things not “looking right”) and (P)revent your normal (R)esponse (washing, cleaning, checking, ordering, arranging). So, if dirt on your hands triggers washing, then in ERP you would be asked to sit with dirty hands and tolerate the feeling of discomfort without washing. Like all good exposure work, this works best if the exposures are doable (don’t make you to anxious), planned in advance, and repeatable, because you want to do experiments that you can repeat over and over again to see of your anxiety/discomfort reduces over time. Remember, it helps if you design experiments so that you can stay in the situation long enough to see if your anxiety goes down. So, you are looking for CBT with a focus on ERP. If you cannot find a practitioner in your area who specializes in providing ERP then I would suggest that you start by working your way through one of the following self-help books. They are all good, and there are other good ones.
This is a great question and the answer is important for a lot of people. Fortunately, the answer is also short. You may very well be onto something. PTSD and depression are separate diagnoses but in my experience working with PTSD at least 50% of people with PTSD also meet diagnostic criteria for depression. Trauma often involves loss, so it is possible that people experience symptoms of PTSD and depression in response to a traumatic loss. However, in my experience often depression is a result or reaction to having PTSD. According to my understanding of the research and based on my clinical experience I would say that most people who are suffering from PTSD and depression need to get their PTSD treated effectively in order for their depression to be effectively treated. It may be a long tough road if you experienced severe childhood abuse and more recent domestic violence but it is a journey well worth starting. Some people need to come to terms with their childhood trauma as well as the more recent trauma (domestic violence) while other people may only need treatment for the more recent trauma. It may depend somewhat on whether or not you have ever had a period of time when you were not suffering from symptoms of PTSD. Your doctor may be able to help you seek out effective treatment for your PTSD. If not, you need to find a local provider who can treat you for PTSD.
This is a great question. According to CBT theory one of the major symptoms and causes of depression is negative thinking. When people can’t stop thinking about the past and experience regret and guilt we call it “rumination.” When people can’t stop thinking about the future and catastrophize about the future we call it “worry.” The main way to challenge both kinds of negative thinking is to use thought records. Try working your way through the Depression Program. A large part of the Depression Program was designed to help you challenge negative thinking with thought records. In addition, take a close look at the auxiliary sessions on managing anxiety (Session 10) and worry (Session 11). You will find the techniques described their quite helpful.
I am sorry to hear about your loss. This sounds like a very sad and unfortunately not uncommon situation. Sometimes people do change. The more usual problem is that they do not change very much at all. We just get to know them better and they turn out not to be the person we expected or hoped them to be. Possibly the most useful thing to do in the Depression Program would be to take a close look at the sessions Resolving Disputes (Session 14), Relationships (Session 13), Role Transitions (Session 16), and Grief and Loss (Session 17). These sessions contain a variety of techniques developed as Interpersonal Psychotherapy (IPT) and taking your time and working through these exercises may help you gain a somewhat different perspective and emotional distance from the situation.
It sounds like you have a lot of stress at the moment. I am not sure why you are feeling “numb,” “empty,” and “hollow.” But the “not feeling” feeling that you are describing is common both in more severe cases of depression and as a reaction to extreme stress, such as finding out that your mother is diagnosed with lung cancer. It is also at least possible that if you have changed your medications and/or the dose of your medications recently that the change in feeling that you are describing could be a side effect. Since we know that you have been dealing with depression for seven years let’s talk about that first. Depression – If you have been depressed for seven years, and if your depression is at least partly the result of being in an abusive relationship, and if the situation in your relationship hasn’t changed or has gotten worse, then you may be getting more depressed. Being in an abusive relationship grinds people down over time. It could be that you are losing your “fight” and you are becoming more “defeated,” hopeless and helpless. The more hopeless and helpless you feel, the more likely you are to be severely depressed. In fact, the combination hopelessness, helplessness, and “not feeling” are markers for more severe depression. What people tend to say when they are moderately depressed is that they cry or are upset all of the time or that they cry easily or that they will cry for no reason at all. However, when people are more severely depressed they tend to say that they have stopped feeling or that they feel “numb” or “empty” or “hollow". They also say things like “I wish I could cry but I can’t.” If you think that you are getting more depressed or that your depression is worsening, you should speak to your doctor about your symptoms and discuss your options. Stress and Trauma – When people experience stressful and traumatic events, whether it is a chronic stressful event such as being in an abusive relationship, or a more specific singular stress, such as learning about the diagnosis of cancer in a loved one, they often struggle to cope. One of the ways people cope with stressors, maybe especially the chronic kind is that they become “numb” in order to protect themselves from the reality of it. It could be that because you are faced with both a chronic ongoing stressor (abusive relationship) and a more recent specific event (your mother’s diagnosis of cancer) that a big part of how you are coping with the “double dose" of “stress load” is to “shut down”. Numbing allows people to protect themselves insofar as they protect themselves from experiencing the full distress associated with the situation and becoming overwhelmed. So, in short, numbing may be part of how you are currently coping with two very stressful situations. The problem is that if you are experiencing symptoms of “numbing” it may mean that you are really struggling to cope and feeling overwhelmed. If that is true, you should discuss the situation with your doctor and discuss how you might cope differently. If you can’t change how you are coping with your husband, perhaps you could get some help to cope with your mothers’ diagnosis.
It may be possible to be depressed without having negative thoughts but it would be very unusual. According to CBT theory, negative thoughts are very much a key feature of depression. Other symptoms of depression include feeling persistently sad, down or irritated, loss of interest and motivation, lack of energy, change in appetite, significant change in weight, changes in sleep pattern, difficulties with attention memory and concentration, and feelings of hopelessness, helplessness and guilt. However, it is difficult to imagine feeling persistently sad, irritated, unmotivated, and/or tired (for example) without having some negative thoughts about it because as people we cannot help but make meaning of our experience. People who are depressed can sometimes have difficulty identifying their negative thoughts but if they use thought records for a week or two they can usually find some. However, if you cannot identify any negative thoughts then you could rely more on the “B” part of CBT that would include activity scheduling, behavioral activation homework, and behavioral experiments. Behavioral Therapy (BT) for depression works, so even if you cannot identify any negative thoughts you can use the rest of the tools in the Depression Program. As always, we strongly recommend that if you are suffering from the symptoms of depression that you consult with your family doctor to rule out any other possible physical (organic) problems that may be causing your symptoms.
It sounds like you are having difficulties that would benefit from seeking counseling from an expert in relationships and depression. Such a person could help you to examine your thoughts and feelings about the situation and the pros and cons of continuing to behave and react in the same way or a different way. You could try to use the tools in the depression program to examine your thoughts and feelings about the situation and experiment with behaving in different ways. You may find the sessions on managing relationships especially helpful.
The Goldberg Test or the Goldberg Depression Questionnaire is an 18-question self-report measure of the severity of depression developed by the psychiatrist Ivan Goldberg. You complete the Goldberg Test in the first session of the program (on the welcome page in Session 1). The purpose of the test is to help raise your awareness of the symptoms of depression as well as give us an idea of the severity of your depression (higher score = more depressed). Having some measure of how depressed you are when you start the program helps us to better understand who uses the program and make the program better. In the near future we will be asking users to complete a self-report measure of depression symptoms every week so that they can track their improvement as they work through the program.
In general, depressed people with psychotic symptoms are usually moderately to severely depressed. When people are moderately to severely depressed, with or without psychotic symptoms, they usually have difficulties with attention, concentration and memory. In addition, the side effects of some of the medications used to treat psychotic symptoms can leave people feeling somewhat slowed or “dull.” In general, the best place for people to start in this situation is to seek reasonable accommodation in the workplace, to increase the chances of recovering more fully and successfully staying at work in a safe and sustainable way. Accommodation for depression typically includes flexible hours, reduced workload, assignment to specific tasks and projects, and regular meetings to discuss progress in the accommodation plan. Accommodations for depression and other common mental health problems are very inexpensive for employers and very effective in helping people recover. An excellent resource for help in making these kinds of decisions and having these kinds of conversations can be found in the ”Working Through It” video series on the Great West Life Centre for Mental Health in the Workplace. http://www.gwlcentreformentalhealth.com/display.asp?l1=2&l2=17&l3=173&d=173 In addition, people can use CBT techniques to challenge how they are thinking and feeling about the situation. If someone is trying to work when they are moderately to severely depressed, they often need to work hard to learn to give themselves a break, even if others cannot or will not. Finally, there are specific CBT techniques for treating psychotic symptoms which people may find helpful if they can access a psychologist who does this work. For example see: http://psychcentral.com/news/2010/06/07/cbt-for-psychosis-reduces-depressive-symptoms/14357.html http://www.slideshare.net/citinfo/cognitive-behavior-therapy-cbt-for-psychosis-4456085 http://www.routledge.com/books/details/9780415549479
"Can a person be labeled/diagnosed as being bipolar when they have only experienced mania/hypomania from antidepressants? Or does a person have to have had a manic/hypomania event without being medication induced? Is there such a thing as atypical bipolar disorder?
In some people, response to antidepressant treatment alone (especially the older class of antidepressants), often for depressive symptoms, may not only help to relieve the depressive symptoms but also may trigger manic like symptoms which for most people tend to go away when taken off the antidepressant (or a mood stabilizer is added). Generally speaking the rule is that if a manic or hypomanic episode is caused by a substance such as a toxin, prescription drug, or drug of abuse, then the diagnosis is “Substance-Induced Mood Disorder.” The exception to that is if the manic or hypomanic episode cannot be explained by the use of a substance. If someone has not had a clear history of significant highs (i.e, manic or hypomanic symptoms) in the past, then the risk is low that they have a true bipolar disorder.
The answer to the second question is “yes” insofar as the depressive episodes associated with Bipolar Disorder may include “atypical” symptoms of depression. “Atypical” symptoms of depression include mood reactivity, weight gain, excessive need for sleep, “leaden paralysis” or feeling like you can’t move or like you are moving through cement all the time, sensitivity to rejection. More often when people are diagnosed with Bipolar I Disorder they are Diagnosed according to their most recent episode as hypomanic, manic, depressed, or mixed. If things are really unclear they can be diagnosed as “Most Recent Episode Unspecified.” When people are diagnosed with Bipolar II Disorder it is because their pattern of symptoms is recurrent episodes of major depression with hypomanic episodes. In both cases if depressive episodes include “atypical features” then that could be specified. The diagnosis of “Bipolar Disorder Not Otherwise Specified” which is used to describe symptoms when there is a very rapid alternation in depressive and manic moods but the symptoms don’t quite meet diagnositc criteria for either depression or mania or other symptoms that don’t quite “fit” in other diagnostic categories.
The acute presentation and course of bipolar disorder as a whole is quite heterogeneous. Therefore, a wide range of symptom clusters and patterns may be diagnosed as not being inconsistent with the diagnosis. What is important is that at least once in their life they have met for a clear manic episode (even without a history of depressive episodes) = Bipolar I, or have had a clear hypomanic episode (for 4 days or longer) with depressive episodes in their history = Bipolar II. Some people can experience a mix of these symptoms together which we would call a "mixed bipolar episode". The further we get away from these two diagnoses, the murkier it becomes, and the greater the likelihood for misdiagnosis. The next tier down in the diagnostic system is Cyclothymia which should be described as recurrent episodes of "subclinical" depression and subclinical "hypomania" (e.g., did not meet full criteria for either a full depressive episode or a full hypomanic/manic episode ever - once they do, then the diagnosis changes to either Bipolar I or II). If we are talking about things like "ultra radian cycling", referring to very rapid changes in mood on a day to day basis, that would be consistent with a diagnosis of Bipolar Disorder Not Otherwise Specified (NOS). However, confidence in this diagnosis requires substantial time to rule out the possibility that it could be an alternate bipolar presentation (e.g., mixed episode), or may be better accounted for by other physical or psychological issues (e.g., thyroid problems, ADHD, etc). Sometimes, these diagnoses require time and further detailed investigation by the family doctor.
This is a great question. Let me start by saying that there may be two questions here. The first question is about what to do about setbacks when you are trying to recover from depression and the second question could be about what to do to prevent setbacks from turning into recurrence or relapse. So, I will try to answer both. 1. Setbacks are inevitable and you cannot avoid them. Recovery from depression is rarely a slow steady improvement. It is more often like a game of snakes and ladders. So, on your way to getting better you are likely to go through some periods of time that are tougher than others, especially if you encounter situations that trigger your negative core beliefs. However, working through setbacks is an important part of recovery from depression. Indeed, many CBT therapists welcome a setback before the end of therapy as an opportunity for the client to learn how to use their CBT techniques to prevent relapse. If you are recovering from depression you expect setbacks and you apply CBT techniques to overcome them. The idea is that you get better and better at applying the techniques and better and better at overcoming setbacks before they become relapses.
Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects, especially in young people. In 2004, the Federal Drug Administration (FDA) looked at published and unpublished data on trials of antidepressants that involved nearly 4,400 children and adolescents. They found that 4 percent of those taking antidepressants thought about or tried suicide (although no suicides occurred), compared to 2 percent of those receiving placebos (sugar pill). In 2005, the FDA decided to adopt a "black box" warning label—the most serious type of warning—on all antidepressant medications. The warning says there is an increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the FDA proposed that makers of all antidepressant medications extend the warning to include young adults up through age 24. The warning also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor. To find the latest information visit the FDA website. Results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders. The study was funded in part by NIMH. Finally, the FDA has warned that combining the newer SSRI or SNRI antidepressants with one of the commonly-used "triptan" medications used to treat migraine headaches could cause a life-threatening illness called "serotonin syndrome." A person with serotonin syndrome may be agitated, have hallucinations (see or hear things that are not real), have a high temperature, or have unusual blood pressure changes. Serotonin syndrome is usually associated with the older antidepressants called MAOIs, but it can happen with the newer antidepressants as well, if they are mixed with the wrong medications.
Some of the most common symptoms of depression are lack of motivation, loss of interest and pleasure, lack of energy, and fatigue. When all you want to do is stay in bed all day, the way to motivate yourself to get out of bed is to believe that by acting "as if" you were motivated to get out of bed, even for a little while, you may feel a little bit less depressed. Remember that when people are depressed they do not feel motivated to do things that would normally interest them or give them pleasure. Normally, when people are not depressed, motivation comes before action. Usually, when we want to do something, such as go to a movie, we first want to go to a movie, and then we go to a movie. However, when you are depressed, action has to come first. Essentially what you have to do is try to act "as if" you are somewhat less depressed than you are and get out of bed and do something that would normally give you a sense of pleasure or accomplishment for a least a little while and then check to see if you feel better or worse or the same. So, you have to go to the movie without really wanting to and then check to see if going to the movie made you feel better or worse. The key is to set some reasonable goals for activity and then check to see whether doing something makes you feel better or worse. Engaging in activities that normally give you a sense of pleasure or accomplishment is medicine for depression. Set small, reasonable, doable goals for the day and keep track of the effects of your actions on your moods.
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This program is for educational purposes and is not to replace the advice of your family physician or other health care provider. © 2000-2012 Evolution Health Systems Inc.