Preface
At the time of this writing, with the COVID-19 pandemic in the U.S. nearly tamed and subsiding, many of us are only beginning to re-emerge from a self-imposed solitude and reward ourselves for the sacrifices we’ve made since early 2020.
Over half a million people in the U.S. have lost their lives to COVID-19 as of the spring of 2021, and there really aren’t many clear indicators of what comes next public health-wise. Vaccine distribution is still gaining momentum, and the public health and safety measures put in place to stem the pandemic are relaxing in every state.
For a country on hold, the wait to return to normal life is finally over, and there is a true reason to hope for a better, healthier America. It really looks like the worst is behind us and that we’ve beaten the coronavirus once and for all.
But there is another crisis approaching on the horizon, and our heroic healthcare workers can’t test for it with a simple, yet uncomfortably deep, nasal swab.
During the pandemic, another silent dual-scourge began to spread like a wildfire – depression and anxiety – and we’re only beginning to quantify the scale and magnitude of this impending national mental health crisis.
COVID-19’s mortality rate may be decreasing steadily, but its secondary effects on mental health are only starting to emerge.
According to research published by the International Journal of Clinical and Health Psychology, the prevalence of Major Depressive Disorder in the general population is now as much as seven times higher than before the pandemic began.
We’ll delve into more specifics later in this guide, yet the general takeaway is clear: a significant number of people from all walks of life are suffering from a variety of mental illnesses post-COVID-19.
In the near future, mental health awareness in the U.S. will literally be critical to saving lives, so that’s one of the reasons why we’re publishing this guide at such a pivotal moment in history.
Millions of people in our country need help, genuine professional help, to cope with mental anguish whether or not the stress is directly due to the pandemic.
Our commitment at Tikvah Lake Recovery is to offer solace and hope to those who’ve suffered silently and alone for so long – and finally reach out to us for help.
Truly, we’d like to thank everyone involved in making this project a reality and express our sincere gratitude because explaining depression to someone suffering from it is never an easy task, especially when substance abuse and addiction co-exist in a dual-diagnosis.
Sometimes, it’s not about the science, the therapy, and the medications. More often than not, what helps recover from depression – what saves lives from suicide – is a simple invitation to seek professional help.
“Depression is like a woman in black. If she turns up, don’t shoo her away. Invite her in, offer her a seat, treat her like a guest, and listen to what she wants to say.” – Carl Jung
Chapter 1 – Fundamentals of Major Depressive Disorder
When you’re suffering from feelings of worthlessness and hopelessness, overcoming depression can seem like an impossible struggle, but you can reclaim control of your life step by step. All it takes is believing that you do, in fact, possess the willpower and determination to finally break the cruel cycle of despair and numbness that is Major Depressive Disorder.
Still, the question remains: doesn’t everyone experience depression from time to time? Isn’t it an ordinary part of life we all go through at some point?
Yes, depression often accompanies life’s most tragic events like the death of a spouse or child, yet there’s a key difference we need you to keep in mind.
Depression caused by grief, bereavement, and sudden loss doesn’t necessarily qualify as Major Depressive Disorder, so the remainder of this guide will refer to the clinical form of the condition as Depression in the proper sense. When speaking of the transient malaise anyone can endure, we’ll instead use the term depression in the lower case.
How common is Depression in the U.S.?
Depression doesn’t care if you’re a millionaire CEO or an average Joe working a 9-5 job; it pays no attention to whether you’re single or in a 30-year marriage, and it certainly doesn’t matter if you’re a man or a woman.
This mood disorder alone affects as many as 7.6 percent of all Americans over 12-years old, and it does not discriminate between walks of life. Anyone can fall prey to Depression’s emotional ravages – anyone!
If you’re an ordinary human being with a core of emotions, needs, desires, and dreams, you can develop Depression at some point in your life. Statistics show that about 15 percent of adults experience Depression at some point in their lives.
That’s a significant fact that you may have never read before, and it does pose an interesting question: does everyone who experiences a bout of Depression actually seek help?
How many people actually seek help for Depression?
The answer is that the numbers suggest most adults don’t seek professional help for Depression, which is why it’s so vital to spread awareness. A new study by Mental Health America revealed that 57 percent of adults suffering from a mental illness do not receive treatment.
Instead, they choose to cope with it in their own way, on their own terms. Unfortunately, those terms could be abusing alcohol and drugs to self-medicate, which only feeds the cycle of addiction and hopelessness further.
Maybe you believe that you’re doing well hiding your sullen, downtrodden mood, or that you’re “toughing it out” beautifully?
But those closest to you will see it; they always do.
Friends and loved ones can easily see that the person they know, love, and support isn’t behaving like himself lately and hasn’t been the same for quite some time.
Undoubtedly, it’s all too natural to want to help but has no clue where to start, so at Tikvah Lake Recovery, we strive to give our patients and their loved ones accurate, actionable information about substance abuse and common aggravating factors like a mental illness dual-diagnosis.
Depression is a perfect example of a topic we go over at our addiction recovery center, so we’ll begin by outlining how professional psychiatrists actually diagnose Depression, the criteria they use to determine whether or not a mental illness is actually present.
How do psychiatrists diagnose Depression in adults?
Without straying too far off course, we’d first like to emphasize that Depression’s clinical presentation looks different depending on your age, gender, and the general severity of the disorder itself.
So, the following criteria, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), are needed to receive an official Depression diagnosis from a psychiatrist.
Understanding the DSM-V’s Criteria for Depression
We absolutely don’t want to overwhelm you with scientific technicalities and abstract medical concepts that don’t make sense to the general public. When you walk into our recovery center, you’re here to reclaim your livelihood, not take a college-level course on addiction and abnormal psychology.
So, as we explain what Depression actually entails, we’ll do our best to speak in easy-to-understand, down-to-earth language.
To receive a Depression diagnosis, you must experience symptoms every day for at least two weeks straight. It’s the persistence of the low, sullen mood state that a doctor will try to determine during your initial psychiatric evaluation.
But you must clearly show either a diminished interest in pleasurable activities or a sad, depressed mood state that is more or less constant throughout the day.
Again, powerful feelings of depression brought on by grief or a sudden loss don’t automatically count as Depression!
Not only that, but you must also exhibit at least five of the following symptoms over a two-week period:
- Disturbances in appetite and changes in body weight
- Insomnia or other sleep disturbances
- Psychomotor agitation or impairment
- Loss of energy and fatigue
- Feelings of hopelessness and worthlessness
- Impaired ability to think, concentrate, or make decisions
- Recurrent suicidal thoughts or recurrent ideas of suicide with or without a specific plan or an actual attempt
We understand that’s a lot to digest, so here’s a walkthrough of what each symptom might look like if you’re currently in the throes of Depression.
Diminished interest in pleasurable activities or a sad, depressed mood state that is more or less constant throughout the day
As we touched upon above, it’s the persistence of the mood state that defines Depression as a mental illness. You could have moments throughout the day when you’re in a relatively positive mood, smiling and maybe even laughing with friends and family for a short time.
But when you’re alone with your thoughts – things are different, very different, and can quickly take a turn for the worst.
What many people with Depression experience is a remarkable lack of interest in things that they know instinctively should be pleasurable to them.
You may completely abandon your hobbies or your side job and not understand why; you may stop playing in the backyard with your children, and you may also stop watching your favorite movies and Netflix series for no discernible reason.
All you sense is that you’re experiencing a malaise of strange, numb boredom, but you can’t quench it by doing something fun. At its worst, this primary symptom can cause you to isolate and withdraw yourself from the world completely and believe that you “don’t deserve” to feel pleasure at all.
Disturbances in appetite and changes in body weight
This Depression symptom may not be obvious when it’s mild. Initially, you may find that you’re simply eating smaller portions of food, getting full much faster, or skipping meals altogether every once in a while.
At its worst, Depression can almost completely eliminate the desire to eat anything at all. Thus, the only natural outcome is weight loss when Depression effectively suppresses your natural appetite. You may also experience the odd sensation of knowing that you do, in fact, need to eat but have little motivation to do so.
On the other side of the spectrum, Depression can cause you to significantly over-eat, which many psychologists believe is an attempt to self-medicate yourself with an activity that you know soothes your mood. So, the natural outcome is sudden, and maybe precipitous, weight gain in a matter of weeks.
Furthermore, what makes this particular Depression symptom difficult to understand is that one person can experience both under-eating and overeating at different times, causing body weight to fluctuate noticeably.
Insomnia or other sleep disturbances
Along those lines, you may be experiencing persistent bouts of insomnia or hypersomnia, sleeping far too much. Of all depression symptoms, sleep disturbances require immediate intervention because sleep is so critical to healthy brain function.
What’s interesting about Depression is that it can cause several different types of insomnia. You may have trouble falling asleep in the first place, or you may be able to fall asleep but wake several times a night, sometimes every few hours like clockwork.
If either one of these forms of insomnia persists, the detrimental health effects can compound quickly and begin to impair bodily functions like blood pressure and breathing.
If you can’t remember the last time you had a peaceful, restful night’s sleep, it could be a sign of an underlying condition interfering with one of our body’s most essential functions.
At the other end of the spectrum, you may be sleeping as many as 12-14 hours a day no matter when you fall asleep – and never feel rested or satisfied! It all depends on how the mental illness manifests itself, yet many people suffering from Depression only experience one type of insomnia.
Psychomotor agitation or impairment
This symptom is arguably the most subtle of all when Depression is mild. The word psychomotor is merely a medical term that characterizes the interplay between thinking and voluntary muscle movements.
For example, your psychomotor functioning allows you to run, jump up, and catch a football if you’re capable of such a feat of athleticism.
In a psychological context, psychomotor functioning can sometimes refer to muscle movements of the face, which is why deeply depressed people may display a flat, nearly emotionless facial expression; some people can barely smile at all. Psychomotor agitation in Depression can also look like someone is “antsy” or has developed a new “nervous habit” like tapping their foot repeatedly.
Another way psychomotor agitation can present itself is pacing back and forth around the room, or a general inability to sit still for a period of time. Essentially, your mind can’t settle down, so your body reacts with repetitive behaviors that you may or may not notice.
Some people suffering from the severe form of this symptom claim that they can’t sit still at all, even when they’re trying to go to sleep or eating dinner with the family. They literally toss and turn in bed until they’re exhausted and finally go to sleep.
On the contrary, Depression can also cause psychomotor impairment, which means that ordinary activities like brushing your teeth feel more difficult to accomplish. It’s still possible to perform simple activities like taking a shower or taking out the trash, but you may feel completely drained after only a few minutes.
When psychomotor impairment is most severe, you can have trouble socializing, speaking, and communicating your feelings to your loved ones. You literally speak slower, at a lower volume, and find it difficult to form complete thoughts.
Loss of energy and fatigue
Likewise, loss of energy and fatigue go hand-in-hand with psychomotor disturbances. You may feel physically drained even after you manage to get a full night’s rest. If you do wake up and start the day with a relatively upbeat attitude, your mood can quickly plummet when you realize you don’t have the energy to step out of bed, let alone go to a crowded grocery store for bread, eggs, and milk.
Again, we have to stress that this symptom needs to represent a remarkable shift from your normal functioning. For instance, your friends and family will notice immediately if you used to be cheerful and energetic but no longer care to show the same enthusiasm.
At its worst, the loss of energy and fatigue can make someone feel like they can hardly move. Along with psychomotor disturbances, you may not be able to move a limb or pick up your head to speak without significant effort, and even if you do manage it, you can feel like all of your energy is gone afterwards.
Feelings of hopelessness and worthlessness
Moving along the list of Depression symptoms in DSM-V, we’ll briefly mention feelings of hopelessness and worthlessness because these two emotions define the illness. You usually cannot receive a Depression diagnosis without experiencing these emotions.
When we speak of depression, we’re usually describing periods when we’re in a deeply saddened emotional state. But in clinical Depression, there’s an additional sense of being worthless as a human being, having nothing to offer the world, friends, or loved ones.
It’s the combination of these two symptoms that’s the hallmark of Depression because it’s the most common way that people describe their mood: hopeless and worthless.
Impaired ability to think, concentrate, or make decisions
Along with the loss of energy and psychomotor disturbances, an impaired ability to think, concentrate, or make decisions is another Depression symptom specified in DSM-V.
The technical term to describe these mental functions is cognition, the process of thinking and perception. Without a doubt, impaired cognition is a tricky symptom to notice if you’re only beginning to get help, but essentially, impaired thinking and cognition can lead to broadly impaired perceptions, especially when it comes to your mood state.
For instance, let’s say that you stop by the grocery store after work to finally buy the bread, eggs, and milk you’ve been putting off for days. Oddly, as you go through the grocery store aisles, you can’t seem to focus on anything, and it feels like a chore just to find what you came for.
But when you get to the cash register, you realize you forgot your wallet!
It’s absolutely an honest mistake; ordinarily, you wouldn’t get upset. But when experiencing Depression, you might feel like everyone else in line is judging you and getting angry. You also might feel a sudden rush of embarrassment and humiliation when the manager comes by to suspend your transaction while you return with your debit card.
The catch is that both the cashier and the manager were smiling and kept a positive attitude the whole time, but in your perceptions – in your depressed state of mind – you felt like a horrible, worthless person in the moment.
At its worst, Depression can impair how you think to the point where you misinterpret anything you experience as bad or ruined in some way, and that it’s your fault.
You may speak with a friend on the phone and have a great conversation, but when you hang up the phone you immediately think something like, “I know Sara was only being nice to me and didn’t really want to talk” – and feel ashamed.
Recurrent suicidal thoughts or recurrent ideas of suicide with or without a specific plan or attempt
Lastly, recurrent suicidal thoughts and ideas are the most painful symptom of all. Committing suicide is a dangerously seductive thought that may seem like a good idea, but in reality, it’s a horrific tragedy no matter what.
Nothing permanently traumatizes family, friends, and loved ones like burying a depressed person after they’ve taken their own life, so at Tikvah Lake Recovery, we take suicidal thoughts very seriously and always intervene. Essentially, we don’t wait for suicidal thoughts to develop into a suicide plan and an actual attempt.
In its mild form, suicidal thoughts can be very subtle like wishing you wouldn’t wake up after going to bed. You may also have a vague urge to “go away” or “disappear” and release your loved ones from the burden that you think you’re imposing.
The misperception of being a burden is key here because you’re not a worthless burden to those who love you; you’re not!
Along those lines, another way suicidal ideation presents is the persistent, unshakable thought that everyone else around you would be much happier without you around.
It may be something like wishing you’d get into a head-on car crash and die; it can also be something like thinking how great it would be for a tree to fall on you suddenly. The general idea is that you wish you were no longer alive to experience the pain and emotional suffering you’re enduring every moment of every day.
When the disorder gets worse, your thoughts may begin to take a more sinister form, and you start to form specific plans to commit suicide.
Initially, it can be something odd like the idea of driving off a certain bridge to make it look like you didn’t purposely end your life. With suicidal thoughts, there’s absolutely an element of shame when a plan starts to form.
You may also start making micro-attempts to hurt yourself like taking too many over-the-counter sleeping pills but not enough to kill you outright. Regardless, the idea in your mind is that dying could be painful, so you want to “test the waters” before actually attempting to end your own life.
Similarly, you may start to write suicide notes that “explain to the world” why you did it. It’s a fascinating phenomenon that’s another classic symptom of Depression, so when we see that our patients have actually composed suicide notes, we take action right away; we’ll never wait to step in when a life hangs in the balance.
Ultimately, if left unchecked, suicidal thoughts and plans can suddenly become a suicide attempt because the difference between a thought and an action isn’t very far.
Think of how fast it is to decide what you want to eat for lunch. You search your thoughts for what food appeals to your appetite, and you either prepare the meal yourself, decide to go to a restaurant, or wait.
In reality, the transition from a thought to an action only took a matter of seconds.
Likewise, the same process applies to suicidal thoughts and actions. When you think of hurting yourself or ending your own life, an action isn’t very far away, especially when you’ve already formed a plan.
On top of it all, you may also be experiencing unexpected waves of worry and nervousness that are beginning to get more noticeable – and always seem to accompany your most depressed, suicidal moments.
Besides, dealing with a bout of depression is already hard enough for any one to endure without the specter of anxiety looming and compounding your suffering, so the next chapter discusses the basics of anxiety and how it ties into Depression.
But before we continue, we’d like to say congratulations for making it this far! There’s a lot to digest when it comes to understanding the fundamentals of Depression, especially when you’re suffering from it.
Don’t give up! Keep your head high, and give yourself a pat on the back!
You’ve come this far, and you can go even further by reading the next chapter when you’re ready.
Chapter 2 – Anxiety and Mental Health
Of all the symptoms you may experience when suffering from Depression, anxiety is arguably the most challenging to deal with in a therapeutic environment. The reasons are many, but they mostly boil down to the fact that the sensation of anxiety itself doesn’t qualify as a mental disorder, according to DSM-V criteria.
Everyone is capable of experiencing fear and the heart-pounding anxiety that comes along with it. It’s a natural response that human beings evolved over time to avoid potentially life-threatening situations.
Ancient man learned long ago that it’s not wise to hunt for game at night when visibility is nonexistent. In this case, anxiety protected our ancestors from taking unnecessary risks and became an evolutionary advantage.
When examined in an evolutionary context, anxiety is the mechanism that keeps us safe from impending or perceived dangers. Although when it turns into a maladaptive, inappropriate reaction, that’s when ordinary sensations of worry and fear transform into a mental health issue.
Certainly, there are several anxiety-spectrum disorders that the DSM-V describes in detail, such as:
- Separation anxiety disorder
- Selective mutism
- Specific phobia
- Social phobia
- Panic disorder
- Agoraphobia
- Generalized anxiety disorder
But note that there is no diagnosis of just anxiety alone; you need to meet very specific criteria to receive a diagnosis for an anxiety disorder, and the requirements are strict in the DSM-V.
Defining anxiety is such a common point of contention for those new to our recovery center that we believe it deserves its own chapter apart from Depression before we talk about how they interact.
How common is an anxiety disorder?
At the time of this writing, approximately 40 million Americans suffer from some form of an anxiety disorder. That’s the total number of diagnosable cases, not how many people experience anxiety because feeling anxious by itself doesn’t automatically qualify as a disorder.
Anxiety only becomes a mental illness when the symptoms become so severe and persistent that it begins to affect your quality of life.
Honestly, treating an anxiety disorder effectively depends on the specific type of anxiety since some medications and therapies work better than others, especially when an anxiety disorder co-exists with Depression and substance abuse.
The difference between normal anxiety and inappropriate anxiety
We’ll use a hypothetical situation to describe the difference between normal anxiety and inappropriate anxiety. Many of our patients find it very useful when we give real world examples, so we try hard to keep them as down-to-earth as possible.
Besides, if your children run into the street and a car is speeding, your immediate reaction is going to be absolute terror that they might get seriously injured, or killed.
So, let’s say that nothing happens; your children are scared and crying uncontrollably, but it’s a narrow miss because the speeding driver saw them just in time and slammed on the brakes.
Logically speaking, it was only a close call, yet will you still feel comfortable allowing your children to play near the street?
The natural answer is probably, no. In all likelihood, you’ll begin to feel apprehensive and anxious when you remember how close they came to getting run over, and how much they were upset by it.
Without a doubt, this kind of anxiety is normal and justifiable because its purpose is to protect your children from a clear and present danger: reckless drivers flying down your street at 60 miles per hour like they’re practicing for the Indy 500.
That said, what happens if you’re overwhelmed by fear and worry every time your children are anywhere near a busy street? At what point does the instinctual desire to protect them and keep them safe turn into a maladaptive reaction?
It’s a difficult question to answer, and that’s what makes treating any anxiety disorder incredibly challenging.
A healthy way to cope with your very justified parental anxiety would be to contact local authorities and demand that something be done about it because this incident isn’t isolated.
In the end, your street now includes a series of tall speed bumps and clearly marked speed limit signs, thus significantly reducing the likelihood of speeding.
But will you still feel comfortable letting your children play near the street?
In this anecdotal scenario, an unhealthy way to cope with anxiety would be to never allow your children to play outside again, take away all of their outdoor toys, and keep them from driving until they’re 18-years-old “to be on the safe side.”
It’s the magnitude of the over-reaction to anxiety that qualifies as a mental illness, not the sensation of anxiety itself.
How do psychiatrists diagnose an anxiety disorder in adults?
To further illustrate the difference between good anxiety and bad anxiety, we’ll take a brief look at Generalized Anxiety Disorder (GAD) in the DSM-V.
We could outline every single form of anxiety in the DSM-V, but we want to keep this guide as easy to digest as possible because the bottom-line goal is a lasting recovery from depression and anxiety.
Understanding the DSM-V’s criteria for an anxiety disorder
In the DSM-V, GAD requires that you experience an excessive amount of worry and fear about a wide range of events, including going to work or speaking with people. Duration-wise, these powerful feelings must last for at least six months, but if the worry is clearly at an over-the-top intensity, clinicians can wave the six-month requirement.
Similarly, you need to feel like the apprehension and worry you’re experiencing is hard to manage, if at all. GAD truly is a generalized disorder as there’s not always an apparent reason for the worry; it’s just there with no discernible outward triggering event or thought.
In addition, this generalized worry must include three of the following symptoms:
- Feeling restless and on edge
- Fatigue
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbances
Here’s a short look at how each GAD symptom might manifest itself if you really do have a diagnosable condition.
Feeling restless and on edge
If you’re feeling anxious, and your best friend claps his hands next to your ear, you’ll likely jump back and get startled. That’s the ordinary response to a sudden stimulus like a loud noise, but when you have GAD, that same tasteless prank can literally make you fall out of your chair, or punch your friend in the nose to protect yourself.
“Fight or flight” is the cliché that describes how we react to anxiety. Essentially, what it means is that you’re stuck in a constant state of excitement, constantly restless and on edge for no particular reason.
You can become so accustomed to the feeling that you no longer notice it until you sense a rush of unexpected fear.
Fatigue
Also, when your mental state won’t ever settle down, the natural result is physical fatigue, which may seem counter-intuitive. It’s a mistake to think that our energy level is purely a physiological phenomenon; there’s a mental aspect to it too. If you have GAD, you may literally worry yourself to bed from time to time as your mind goes blank or doesn’t seem to stop on its own without significant effort.
Difficulty concentrating or mind going blank
Along those lines, difficulty concentrating or a mind going blank are two more symptoms. Similar to fatigue and energy level, GAD can put the mind and body into an inappropriate state of alert.
If you’re experiencing this symptom, you won’t be able to turn off your worry and fear; it’ll be an ever-present undercurrent in your everyday life.
Sometimes, your loved ones may even start to say that you’re simply a “worry wort” and think nothing more of it because feelings of fear are normal, especially for you.
The problem is that when you’re stimulated and can’t turn it off you’ll find it difficult, if not nearly impossible, to refocus attention elsewhere. Even if you can manage it, changing your train of thought will likely take an incredible amount of effort – and lead to more anxiety!
Irritability
The irritability requirement is another counter-intuitive symptom, but it relates to the fact that your mind is in a constant flight-or-fight state. You’re always ready to react when danger is near, so it’s easy to become irritable. Anyone can experience this symptom, yet the general rule of thumb is that irritability and anxiety occur predominantly in men.
Muscle tension
Muscle tension is another result of being in an excited, sometimes agitated, state of mind all the time. If you have chronic neck and shoulder tension that won’t go away, GAD could be the underlying cause, but muscle tension can affect other parts of the body too.
Some people experience tension in their jaw muscles, which may cause constant teeth grinding to alleviate the feeling; others experience muscle tension throughout their back.
Sleep disturbance
Finally, we come to the last symptom: sleep disturbances. Is it any wonder that you can’t sleep if your mind is in a constant state of worry? When you’re in the throes of an anxiety disorder like GAD, the smallest bumps in the middle of the night can make you jump out of bed ready to “fight.”
But the trick about treating anxiety is that when it becomes a full-fledged disorder like GAD you’ve basically already normalized your response to it. Changing your thought patterns and behaviors will rely on recognizing that you’re mind isn’t ever at rest; it’s a whirlwind of inevitable calamities lurking around every corner.
Understanding these symptoms is vital to understanding how anxiety relates to depression as well as other mental illnesses. Without a clear comprehension of what constitutes normal anxiety and what doesn’t, you’ll likely have a far more difficult time treating any mental illness that also manifests anxiety.
So, before you continue reading, we want you to take a moment to soak in everything you’ve read up to this point. We’ve thrown a lot of information at you, so give yourself credit!
Coping with depression, anxiety, and substance abuse requires that you empower yourself with the right knowledge and self-confidence.
If you’re feeling overwhelmed, take a step back and see how far you’ve gone!
Certainly, there’s more to learn in the following chapter about treatments, yet here’s what you can do right now to manage your symptoms and seek counseling.
Chapter 3 – Managing Symptoms and Seeking Counseling
So far, we’ve gone over the essentials of what it takes to receive a Depression diagnosis and an anxiety disorder diagnosis. Unfortunately, both can be present at the same time, making coping with the mental anguish twice as hard – unless you start managing your symptoms today and seek professional counseling.
What’s most striking about people suffering from Depression and anxiety is that many outright refuse to accept that they need help in the first place.
There’s always an undercurrent of denial that says, “other people may get depressed but not me! I’m only going through a hard time, and it’ll pass.”
But does it pass, or does it return periodically? And if this frame of mind is working for you, why do you keep feeling horrible time after time?
Tragically, the answer a depressed person might give could be, “because I don’t deserve to be happy, and everything is my fault.”
If this person sounds like you – or someone you love – take a moment, put this guide down, and contemplate whether or not you’re actually open to accepting help.
Ask yourself, “am I too afraid to ask for help?” Initially, it’s a major hurdle that many of our patients find difficult to overcome.
Breaking through denial to begin managing symptoms
The concept of denial has almost become a cliché in pop culture. According to the portrayals we see in film and television, you can deny that anything is a problem if it causes you stress.
But in a real psychological context, denial is far more complicated and difficult to break through even when it’s painfully apparent that a problem exists, such when you narrowly survive a drug overdose.
Before you began reading this guide, it may have never occurred to you that not dealing with a situation is, indeed, a way to deal with it!
Denial involves rejecting anything that gives you a sense of vulnerability (anxiety) or takes away your sense of control. You’ll do everything in your power not to accept that something is wrong, very wrong, and you’ll try to downplay the severity.
Sometimes, denial can cause you to justify your actions no matter how absurd it sounds to those around you.
Breaking through denial requires professional help to make lasting change. It’s feasible to do it on your own, but will the results be temporary or permanent?
One common reaction we see when people begin to come out of denial is anger, misdirected anger, specifically.
You could get angry with your loved ones for “forcing you” to seek help; you could get angry at your psychiatrist and therapist; and you could get angry at getting angry.
At first, you’ll resist coming to terms with denial because no one likes to admit that they’re coping mechanisms are insufficient, and many will defend their opinions and beliefs with an incredible ferocity and conviction.
Still, experiencing denial isn’t a character flaw; it isn’t rudeness or a penchant for lying; and it isn’t a mental illness. Denial is a common thought process that we all experience from time to time.
Although it’s relatively normal, denial crosses the line when it prevents you from seeking professional help and makes the treatment you do agree to receive less effective because you never truly buy-in from the start.
If there’s one way you can empower yourself to recover from a mental illness and substance abuse, it’s breaking through denial and accepting that you do, in fact, need help and that you don’t have all of the answers.
Three quick wins for managing Depression and anxiety symptoms
We hope that you’ll eventually agree to seek professional counseling, yet we completely understand that many people may not have access to a psychiatrist or therapist right away.
When you’re suffering from Depression, you can’t afford to wait another moment to take action because the specter of self-harm and suicide is very real once the disorder progresses.
Of all forms of denial, denial about suicidal ideas and its consequences requires immediate intervention.
But you’re not powerless! You can take the initiative until you find the opportunity to see a professional therapist, so here are three quick wins that we hope comfort you while you seek counseling.
Stop abusing drugs and alcohol
We mention this tip first because if you don’t get clean and stop abusing substances, whether or not they’re addictive, you won’t be able to treat a mental illness correctly.
Until you’re clean and sober, a psychiatric evaluation won’t be reliable because clinicians typically can’t distinguish between your true self and the behaviors you display while under the influence.
It’s likely that many of the symptoms causing you such distress and fear may be directly related to substance abuse. As such, simply stopping the abuse, even if only for a few days or a week, gives you a critical window of opportunity to clear your mind and seek counseling before drugs and alcohol once again pull you back into denial.
Get at least 6+ hours of sleep
Along those lines, drug abuse and mental illness can both trigger insomnia or hypersomnia. Essentially, sleep is when our body heals and rejuvenates itself, and the detrimental health effects of sleep deprivation are devastating.
Ironically, abruptly stopping drug abuse “cold turkey” may trigger insomnia depending on how your body reacts when you start to get sober. For instance, nicotine is notorious for causing insomnia when you’re a long time smoker and try to quit; for some, alcohol does the same.
Still, you can begin to develop healthy sleeping habits by going to bed at the same time every night, or dimming the lights around the house at the same time. It’s also a good idea to resist reading or playing games on your smartphone before going to bed.
We know it’s not an easy ask, but it is a quick win if you can start getting at least six hours of rest as you look for the right counseling.
Eat healthier meals
When you’re in the throes of Depression and anxiety, eating can feel like a chore. You may go a long time without eating and actually become accustomed to it. In this case, start small and eat a simple balanced breakfast that’s rich in fruits and vegetables.
Along those lines, if you’ve been binging on drugs for a few weeks, your body will be craving proper nutrition, and it’s easy to feel somewhat better when you start to take care of your body as well as your mind.
Appetite disturbances are common among depressed people, so the idea is to make managing that particular symptom part of your daily routine. It’s an easy way to pat yourself on the back for eating a healthy diet, even if you only manage to do it for a few days.
Overall, the general idea is to take small easily achievable steps to buy yourself time to find the counseling you need to regain control of your life.
Chapter 4 – Treatment Options
Up to this point, we’ve walked you through the fundamentals of how you may receive a diagnosis for Depression or an anxiety disorder like GAD. Clinicians rely on specific criteria to determine whether or not a mental illness is present or if another medical condition would better explain your symptoms.
That’s why a physical examination and general check-up helps to rule out the possibility that your feelings of worry, sadness, and apprehension aren’t caused by a physical condition.
For example, anemia, kidney disease, and liver disease can cause fatigue, drowsiness, and low energy that may look like depression. The idea is that once you determine that no physical ailment is causing your symptoms the likely culprit is an undiagnosed mental illness like Depression.
But when you first receive a diagnosis from a licensed psychiatrist, the news may come as a shock, or as we discussed previously, you may completely deny it and continue living as you were.
Accept the diagnosis to accept help
The bottom line about treating a mental illness is this: you must accept the reality that you have a mental illness, and that you haven’t been successful managing your life up to this point.
Just like a substance abuser must accept that using drugs is an unmanageable compulsion, so too must you come to terms with living with a mental illness. You can’t deny that you have a mental illness and expect the symptoms it’s causing to subside; usually, people who refuse professional help choose to self-medicate.
While it’s difficult to find statistics on how many people don’t seek treatment for a mental disorder, the general consensus is that a significant proportion of the adult population in the U.S. doesn’t seek help. To be fair, some people don’t have access to mental health care or can’t afford it.
Still, when you finally take charge of your out-of-control life and admit that you have a problem and find counseling, it’s a sign that you’ve already accomplished more than most.
Medications to treat Depression and anxiety
We must stress this fact again: you have to be clean and sober for treatment to work as intended. Medications that treat Depression and anxiety are great examples of why your psychiatrist needs a clean slate to begin your treatment.
When you receive a psychiatric evaluation, it’s vital that you’re honest to your doctor about what you’re feeling and what you’re doing. If you’re experiencing profound waves of anxiety, prescribing an anti-anxiety medication alone may not suffice.
Likewise, you may begin taking an antidepressant and find out later that the medication isn’t working as well as you’d like. Switching between prescriptions over the course of your recovery is common because treating mental illness is an inexact science.
What works for someone else may not work well for you at all!
Today, the field of psychology has a mountain of statistical data to support the effectiveness of antidepressants and anti-anxiety medications.
Overall, your psychiatrist will have a range of options to start a treatment plan, and the medications he or she chooses will depend on the severity of your symptoms.
If you’re suffering from thoughts of suicide, priority number one will be addressing that particular manifesting with an anti-depressant.
Antidepressants
Your doctor will literally have several dozen antidepressants he or she can try. There isn’t only one class of antidepressants available as science has evolved our understanding of Depression and how to treat it best.
Without a doubt, it’s only natural to wonder what these medications do to the brain, and the answer revolves around the concept that Depression is the result of a chemical imbalance between nerve endings in certain sections of the brain.
Specifically, antidepressants target this imbalance and restore proper functioning to alleviate Depression – and anxiety!
You may not know that some anti-depressants also work to control anxiety, but it depends on the type of anxiety you have and whether or not you’re abusing certain drugs.
One of the most difficult parts of treating a mental illness is that you won’t “feel” anything at all except for a few common side effects like drowsiness or dry mouth.
Anti-anxiety medications
If your doctor determines that you need an anti-anxiety medication to soothe your symptoms, he or she will most likely proceed with caution since many anti-anxiety drugs themselves have the potential for abuse.
In low, controlled doses, drugs called benzodiazepines work well for the treatment of acute panic attacks, but it’s a habit-forming medication at high doses. Your doctor will weigh the risk of prescribing such a mediation to you only if you meet certain criteria.
If you’re suffering from an opiate addiction, the last thing you need is to substitute one habit for another, so prescribing anti-anxiety medication is a delicate balance that only a professional should perform.
Therapies for Depression and anxiety
Suffering from Depression is awful, and when you’re at your worst, the outlook seems hopeless. The good news we want you to keep in mind is that certain therapies have proven effective against Depression, specifically a treatment called cognitive-behavioral therapy.
It’s a different treatment modality that puts you in much more control over your therapy. Instead of discussing past traumas to analyze them, cognitive-behavioral therapy (CBT) seeks to change the harmful thought patterns that feed into your illness.
Data show that CBT can treat Depression well when you buy-in and take an active role in your recovery, but before we go any further, we’ll explain the general theory behind CBT and its ultimate goal.
Understanding how cognitive-behavioral therapy developed
Compared to “hard” sciences like chemistry and biology, psychology is still a relatively new field of study and medications to treat mental illness are even newer.
You may not know that anti-depressants and anti-anxiety medications didn’t exist before the mid-20th century, yet they’re now first-line treatments when someone is suffering from severe Depression and uncontrollable anxiety.
During that same period, psychoanalysis took a similar leap forward, and we now have a range of therapies that can help you conquer Depression once and for all. Researchers have studied many, but CBT keeps proving that it’s notably effective against mood disorders like Depression or Bipolar Disorder.
Although to see why CBT is helpful, you have to ask yourself the question, “what determines my behavior?”
What determines behavior?
This question is paramount to psychology and has been pondered for centuries. In fact, it’s the entire purpose the field exists, to understand why humans behave as they do.
Initially, the earliest thinkers in psychology like Sigmund Freud postulated that the mechanism that determines behaviors – what we feel, do, want, love, and need – is unconscious.
According to Freudian theories, we have several parts of our psyche that serve distinct functions in our development as we age. Freud’s theory was that a dysfunction in any one of these areas leads to mental disorder. He also emphasized the idea of repressed trauma as the source of some mental illnesses.
Of course, there was no way for Freud to prove his ideas through hard science, so he developed the “talking cure” when he treated women for a condition known as “hysteria” at the time. Freud discovered that when a patient is able to speak and think freely in a safe environment, they can release emotional distress in a healthy setting to restore balance to their psyche.
Even today, many of the ways we think of human behavior still hearkens back to Freudian ideals, but not everyone was sold on Freud’s point-of-view, so over the years, alternative theories of what determines behavior have emerged.
Are human behaviors completely determined unconsciously, or do other mental processes like cognition play a larger role than previously understood?
In the 1960s, a University of Pennsylvania psychiatrist named Dr. Aaron Beck pioneered CBT as a distinct treatment modality, which answered that very question.
Rather than emphasizing the unconscious psyche, Beck conceptualized Depression as a stream of automatic negative, maladaptive thought patterns. Thus, to treat mental distress, one must change those harmless thoughts and replace them.
While it’s difficult to say if one psychological theory is more correct than another, a mountain of statistical evidence since the 1960s strongly suggests that Beck uncovered a new way to treat Depression other than the Freudian modality.
Thoughts, emotion, behaviors, and illness in CBT
According to the CBT perspective, mood disorders like Depression may be the result of a vicious cycle: a feedback loop of negative thinking, feelings, and behaviors that repeats over and over again.
If you accept the fact that mental illness does exist, it follows that a disorder must cause shifts in emotion and thinking too. The underlying trauma doesn’t matter as much as the effect the distress is manifesting in the moment: sadness or thoughts of suicide.
Once you experience negative thoughts and changes in emotion, it also changes the actions you choose, or don’t choose, to take. Then, those actions and behaviors lead to decreased functioning in our lives.
After that, this decreased functioning at school, work, and home starts to cause what therapists call interpersonal or psychosocial problems.
One quick real-world example is when your spouse is suffering from severe Depression, and the course of the illness is indirectly causing strain in the marriage. Another common scenario is when you become so depressed that your job performance also declines.
Then, once those interpersonal issues get worse, Depression symptoms intensify likewise. When you make mistakes at work, and you’re not performing up to standards, it’s only natural to worry about getting fired and feel stress.
But when you’re suffering from Depression, a passing worry about losing a job or losing your marriage can feed into changes in cognition and emotion, which leads to changes in behavior and psychosocial distress – which makes Depression symptoms worse and reinforces the negative thought patterns.
It’s true that there isn’t a blood test or a brain scan that proves this theory definitively. Still, what we do know is that therapies based on this point of view, such as CBT, appear to be very effective.
Depression and anxiety can feel like a whirlwind that never stops, so essentially, CBT allows you to “slow down the tape” of automatic, negative cognition to identify ways to capture, control, and correct inappropriate thoughts.
There are other contemporary treatments in development like transcranial magnetic stimulation and psilocybin “magic mushroom” therapy, but these ideas don’t yet have the scientific foundation that CBT has because CBT has been studied for decades.
Chapter 5 – The Road to a Lasting Recovery
If you’ve made it this far into this guide, you should congratulate yourself and give yourself credit because there’s a lot of information to digest when it comes to mental health. Eventually, the concepts and information you learned will become second nature as you continue to receive treatment.
At Tikvah Lake Recovery, we want you to enjoy a happy, vibrant life, a lasting recovery that puts your mental anguish behind you.
But one of the questions we hear the most is: what’s the best way to treat Depression and anxiety?
How to most effectively treat mental illness
Statistics show that treating Depression with medication alone or therapy alone are comparable. When you combine them, your chances of recovery increase dramatically, yet you can get even more results when you include intensive one-to-one counseling in your treatment plan.
So, think about treating a mental illness as a three-part strategy: medications to alleviate the symptoms, therapy to change negative thought patterns, and additional support to fill-in the gaps.
The truth of the matter is that not every therapist focuses on CBT. Without a doubt, it’s a common treatment modality nowadays, but there’s no guarantee that the therapist you choose will use CBT techniques.
Still, the general idea is that you must combine a variety of medications, treatments, and therapies to most effectively treat Depression and anxiety.
What you don’t want to do is assume that therapy and medications don’t work after only a few weeks of treatment. There will be times when your medications don’t seem to be doing the trick, and there will also be moments when therapy seems to be getting nowhere.
If you rely on one avenue of treatment, you’ll have a more difficult time when that particular activity isn’t producing results at the time.
The truth is that therapy takes time to pay dividends, and there’s almost never an ah-ha moment when everything gets solved in a single session. It’s a gradual recovery process that requires a team of skilled professionals to get the best results – lasting results, so you can put this period of your life behind you and move on.
No one asks to suffer from Depression, so don’t be so hard on yourself if that’s possible. You deserve to feel happiness again because Depression has robbed you of your self-confidence and self-esteem. There is hope, so never give up, even when you think nothing is working right and never will.
You can overcome it. We know you can!
The road to a lasting recovery is to accept help in the first place, take your medications as prescribed, be an active participant in therapy, and seek support from a team of professionals whenever possible.
In the end, the most effective way to treat Depression is through a holistic, multi-pronged approach that doesn’t rely too much on any one treatment avenue. It’s OK to have variety in a treatment plan.
Honestly, you can overcome any mental illness because millions of people just like you have already done so.
There’s statistical evidence that medications will work if you allow them, and therapy is much more than simply getting helpful advice; you learn life-changing skills with CBT that you wouldn’t have learned otherwise.
The challenge of dual-diagnosis substance abuse
You may not know that you can receive two diagnoses at the same time: substance abuse disorder and clinical Depression.
While we’ve tried to stay on topic about mental health, you may have noticed that we delved into the issue of substance abuse at times throughout the guide.
The age-old question about drug abuse and mental illness is this: which one causes the other? Does drug abuse trigger the development of a mental disorder, or does the mental disorder preclude someone to use drugs?
It’s sort of like the question of which came first, the chicken or the egg?
There is still no clear answer as to which one does come before the other, the substance abuse or the mental disorder. But anecdotal evidence suggests that the mental disorder comes first. Then, substance abuse steps in to wreak havoc.
So, that’s why a psychiatrist will want you clean and sober before agreeing to treat you.
At Tikvah Lake Recovery, we’re a luxury addiction recovery and treatment center that can also treat mental illnesses like Depression and also a variety of anxiety disorders, including GAD.
We offer both types of treatment because that’s what it takes to recover from a dual-diagnosis. Anything less than an all-hands-on deck approach will likely fall short.
When you treat the substance abuse and leave the mental illness untouched, the risk of relapse increases significantly, especially if the drug abuse is related to a mood state like mania.
Likewise, you can’t go to therapy, still abuse drugs, and recover from a mental disorder. It simply doesn’t work that way because your mind needs to be clear and sober. Otherwise, you’re still captive to the substance, and treatment will likely not be effective, if at all.
Why choose Tikvah Lake Recovery?
As you can see, addressing a mental illness and a substance abuse disorder in the same therapeutic setting is ideal. That’s why our luxury addiction treatment facility offers the full range of amenities to make your stay as comfortable as possible.
Interestingly, our center is actually a sprawling 15,000 square-foot mansion resting on the shores of Tikvah Lake in Florida, so we can provide you with the peace and privacy you need to take stock of your life and how to change it.
The privacy of our patients is top of mind from the moment you arrive, and we strive to make your stay with us a pleasurable experience.
We also have an on-site chef that will prepare fresh, nutritious meals in addition to an on-site masseuse and spa. All of the amenities you’re looking for in a five-star hotel are available on the grounds of Tikvah Lake Recovery.
But the commitment and the dedication of our clinical staff shines brightest. We’re a team of professionals and counselors that understand how to treat dual-diagnosis effectively.
When you trust us with your recovery, we respect your privacy and offer a secluded, calm setting that we hope makes your stay with us worthwhile.
Our facility only has six beds, so we’re not like the typical rehabilitation center that only performs group therapy sessions. Here, you’ll receive the one-to-one intensive counseling you need to finally get your life back on track and heal.
For those who need a breath of fresh air and exercise, we’re located near state parks that contain miles of hiking trails and scenic views of the waterfront. For those who value peace and quiet, we have a number of private, quiet places to enjoy.
At Tikvah Lake Recovery, you’ll find the perfect luxury addiction treatment facility with the right staff expertise to finally break the cycle of addiction and mental illness.
In the end, we hope this guide showed you that you can feel hopeful again after seeking professional counseling. We’ve helped many people suffering from addiction just like you, and we’re offering that same assistance to you right now.
Contact us to learn more about what we can do for you, or your loved ones.
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