Month: May 2018

Mental Health First Aid

Most of us have heard about classes for CPR, choking, and first aid for physical wounds and injuries.  These classes provide a lot of helpful information and practice that can help save lives.  However, did you know that there are mental health first aid classes as well?

This idea is fairly new to me, and honestly I can’t believe I hadn’t heard about it before.  There are also probably several different ones out there, but the one I have heard about is called Mental Health First Aid.  You can find out more at their website, which is www.mentalhealthfirstaid.org  Essentially, these are classes that can cover both youth and adult mental health first aid.  The classes teach you how to work with someone who is experiencing a mental health or substance use crisis.  My assumption (since I haven’t taken it) is that they include both information and practice situations.  Much like the CPR and first aid classes, they can provide information that can help save lives.

After hearing about this, it made perfect sense to me.  If we have first aid for physical injuries, why not have first aid for the mental aspect?  As a result, I am working to set up a training that I can attend.  I have no doubt that I will learn skills that would be helpful for anyone to know.  After all, like CPR and first aid, we never really know when we might be called upon to help someone in either a physical or a mental crisis.

How about you – does first aid for mental health seem like a great idea?  Would you be interested in taking one of the classes I mentioned above?  What would you hope to learn in one of these classes?  For any of us touched by depression, I think these classes are worth considering.

Connections

When someone is depressed, that depression is connected to everything about the person.  It can affect what they do, where they go, how they feel, who they interact with, and many other factors.  Although depression does not and should not define a person, it will be tied to the person who is suffering from it.  Anyone else who is around that person will also feel a connection to the depression, but it might be felt in a variety of different ways.  The main point here is that depression has connections, whether someone wants them or not.

But there is good news.  When you really start to think about it, everything is connected.  This could involve a deeper philosophical conversation, but to keep it somewhat simple it is sufficient enough to say we are all connected as humans and what goes on in the world.  So, from that, if depression can be connected, then happy thoughts and actions are also connected.  If someone is depressed, seeing or hearing about a happy event can give that person connections to happier thoughts.

Of course, someone who is depressed may end up feeling even sadder that they could not experience the happiness for themselves or that they simply cannot feel much at all.  That is understandable.  But, the very act of witnessing or being exposed to happy thoughts creates a connection that can be so important.  It may not appear to help much in the moment, but the more happy and meaningful connections that can be made for a depressed person, the more a benefit is possible.

I understand this may all sound pretty vague, but overall the idea is that depressed people should be as connected to as much happiness and meaning as possible.  It may not be the absolute ticket to recovery, but it can help expose the depressed person to a more helpful way of experiencing life.

On the Go Counseling?

Recently, I have noticed that there are several services available where you can see a therapist via your phone or computer at times that may be more convenient for you.  The services vary in how often you can utilize it and how it is paid for, but the overall idea is that you can essentially have “on the go” therapy sessions when you need them.  Is this a good idea?

Honestly, I think it is too early to tell.  Like my earlier post on telehealth, this essentially runs into some of the same concerns.  These services really fall under telehealth anyway, but are even more flexible than some of the more formal ones set up by clinics and provider groups.  For example, my dad still went to a clinic to then look at a screen with his provider on it.  What I am talking about here is logging onto your computer or phone from wherever you might be to instantly have someone to “visit”.

Again, in some ways I think this is pretty amazing, and I have honestly thought about using a service just to talk to someone about shorter term concerns that I have.  That is the beauty of these services – they can be pretty short term.  However, if you have depression these off and on services may not be so great – it may be better to establish a long term relationship with someone you can actually see face to face.  Not to say this is impossible here, but it might be harder to do.  But, there is also the idea that something is better than nothing.  And, if your depression is really challenging and you don’t even want to leave the house or your bed, something like this may be the place to start.

What do you think?  Do these services add value in some way?  Would you consider trying them?  My guess is that this will continue to grow, so hopefully we will see more benefits than issues with these services.

Discontinuation Syndrome

A few posts ago I wrote about tapering antidepressants.  Right after I wrote this, there was a very good article in the New York Times on April 7, 2018, about withdrawing from antidepressant medications.  The article is entitled “Many People Taking Antidepressants Discover They Cannot Quit” by Benedict Carey and Robert Gebeloff.  As the title suggests, the article highlights people who have had issues with stopping antidepressants.  In fact, some people have had such trouble with stopping the medications that they have chosen to remain on them instead of dealing with the withdrawal symptoms.  What really struck me was that the term “discontinuation syndrome” was used.  Isn’t that just a fancy way of saying withdrawal?

Regardless of what you call it, there are many people who struggle with stopping antidepressants, even if the drug may not really be giving much of a benefit to the individual.  There is some research being done on tapering protocols, but the article also mentions that many people have taken tapering into their own hands and have tried to make it work for them without any help from a medical professional.  Of course, drug companies don’t necessarily have any strong desire to work on protocols to help people safely stop the medications they are selling.

I think this article is yet another call to think about what works for you as an individual, assuming you are taking antidepressants.  Can you stop an antidepressant without any issues?  Would you prefer to try a taper instead?  Perhaps the taper may take months or even over a year to complete – is that alright with you?  What side effects are you willing to accept and how long are you willing to accept them?  This article is further proof that antidepressants may not necessarily be the wonder drugs many people think they are.

Learning

While I have lived with someone who has had depression, I have not had depression myself.  Because of this, I can only speculate what it feels like to experience depression.  Also, I learn about it from the experiences of those who have went through it or are currently experiencing it.  Add to that that every person is unique and has different experiences.

One thing that I have found interesting is the stories of someone with depression talking about how they learned so much from the depression.  Is it possible that depression can teach you life lessons?  It may seem impossible or difficult when the depression is at its worst, but I believe that depression can give you lessons and gifts along the way.  Now, I am not saying this is a preferred way of learning about life, but I am inspired by the stories of those who have taken their history of depression and turned it into lessons learned and/or looked at some parts of it as a gift.

Again, I can only speak as someone who has seen depression but has not lived it, but from my angle I have learned a lot along the journey too.  Lessons about trust, loyalty, autonomy, dignity, compassion, and gratitude are just a few of many things I have really had to struggle with and grow as a person.  They did not come easy, and again, it would not have been the way I would have chosen to learn those lessons, but they are there and make me who I am today.  Although arguably easier for me to do, I have taken those experiences and tried to make myself and my world a better place in spite of it.

How about you?  Do you see depression as a way to learn?  Do you see that depression could be a gift in some way?  It may seem odd to think about it this way, but perhaps depression can give us some positives too.

Tapering Medications

For a lot of people with depression, medications are a part of any attempted treatment or alleviation of symptoms.  However, I think there are some important considerations when taking medications for depression that may not always come up with other types of medications.  One of those considerations is tapering.  Tapering can go two ways – a dose can be gradually increased or “tapered up”, or it can be gradually decreased or “tapered down”.  Of course, with a gradual decrease the medication may ultimately be stopped.

Why do I think tapering is important for depression medications?  First of all, I think tapering up is good to help watch for both side effects and effectiveness.  If you start at a high dose and have side effects, you might have not had the side effects at a lower dose.  Also, the medication may work at a lower dose just as well as at a higher dose, so taking the least amount needed is better in my opinion.  As many people have heard, the advice is to “start low and go slow”, and I think that is critical for a lot of medications, and definitely for any used for depression.

Tapering down medications is also important.  I think we need to give our bodies time to adjust to changes in the medications we are taking, so again taking it slow is key here.  Tapering down too fast can also cause side effects, and I believe we should do everything we can to minimize those.

So, if you are taking any medication for depression, consider asking your doctor about tapering the medication.  Can you “start low and go slow”?  Can you try tapering down to see if a lower dose is just as effective?  Each person is unique, and tapering can look different for each person, but I encourage you to think about the tapering process when it comes to taking medications.

Telehealth

Most of the time, when you think about going to a health care provider you think of a face to face visit.  Some of that is important if a physical exam is needed, and there is just something about the close human interaction between a patient and provider.  However, the idea of absolutely having a face to face visit every time has changed.  There are a lot of “virtual” visits going on today, where the interaction takes place over video or some form of telehealth.  Your provider could be hundreds or thousands of miles away but still be able to give you care.

Are there telehealth visits for depression?  Yes, there are.  I remember back in 2011 when my dad was depressed – his psychiatrist worked locally and at an office hundreds of miles away.  Some of his appointments were by telehealth video, and honestly at the time I found it appalling.  Telehealth is not the same as a face to face interaction, and it seemed especially odd in psychiatry, where I feel that people who are depressed and/or mentally ill really need that human connection.  Despite not liking the idea all that much, what I settled on was that telehealth services were better than no services.  Unfortunately, that is the decision my dad had to face, and he chose to try something over nothing.  I’m proud of him for that.

So, have my thoughts on telehealth changed since then?  Yes and no.  In an ideal world, everyone would get that face to face interaction.  However, I do applaud the telehealth movement as a solution to help more people get access to providers.  Telehealth no doubt helps us to reach a wider range of people, and it can be done from almost anywhere.  There is also work being done to make telehealth interactions as realistic as possible, so I am excited to see where that leads.  In all, if the choice is telehealth or nothing, I would likely choose telehealth.

Depression and Spirituality

Lately I have started to take a bigger interest in the intersection between depression and spirituality.  When you are depressed, is spirituality even a consideration for most people?  If so, what is considered?

Based on my personal experience with my dad, his thoughts were always negative.  My family had a Christian background, so a lot of what I know is related to God, Jesus, and the Holy Spirit.  My dad would always discuss how he felt that God was punishing him for something that he had done.  What troubled him was what behaviors were so bad that he deserved that particular form of punishment, namely the depression, negative voices, and suicidal thoughts.  He figured he must have been pretty awful, and that made his illness even worse.  Not only did it make him question his behaviors, but it also made HIM feel like he was a bad person.  It was heartbreaking.

Although I don’t have any numbers to back it up, my sinking suspicion is that the thoughts my dad had are pretty common.  Depressed people feel like they must have done something wrong and are being punished by God or some other spiritual being.  They also must feel like they are inherently bad people.  And, while some of this thinking maybe be a result of the depression itself, I wonder how much of it comes from messages related to our spiritual practices.

Can we change the spiritual messages related to depression?  I think so.  There are already some great ideas and programs out there, and I think we are seeing progress solely based on how you hear more about it in our places of worship.  However, I think it is important to have discussions about how spirituality can play into depression, and how we can use our spirituality to help us get better instead of making it worse.

After the Training

As I mentioned in my last post, I was getting ready to attend a training, and now that training has been completed.  As usual, anytime I learn something new or have multiple “aha” moments I can say it was well worth the time and effort.  Being around others can definitely give you some new ideas to think about too.

What did I learn?  Honestly, a lot of the stuff that we want to share with providers wasn’t very new.  Most of the material I had either heard before, read before, or spoken before.  What really got me thinking was the perspective of the provider.  We had some physicians in the class, and even as a pharmacist I hadn’t really considered a lot of their thoughts and feelings when they are treating patients.  They really have a lot on their plate.  There are many legal and ethical rules they have to abide by, and they are humans too.  They also can be traumatized by what they see and experience.  Overall, everyone needs to be cared for in any medical situation.  Regardless of your role, you have to take care of yourself first before you can take care of anyone else.  As a result of this training, I feel like I have a better understanding of how physicians navigate the health care system they work in.

While some of the lessons were very powerful for me, there were additional benefits.  I got to meet new people and/or spend time with those I had met before.  It was also great to take some days out of the regular routine and think about things that are bigger than my little issues at home.  It was refreshing.  If you ever get the chance to go to a training or class to learn more about depression (whether the main topic or part of a larger discussion), I encourage you to do so.