October 2018 - Dr. Dawn, The Suicide Prevention Pharmacist

Birthday

As I write this entry, I have just celebrated another birthday. This year is not particularly special, but people are always so nice about recognizing that it is a special day in my life. Perhaps the fact that it is not particularly special is a good thing, and I want to share why I am thinking that way.

When someone is facing a major illness, a birthday can be a very big deal. Here, birthdays mean survival. They mean hope and faith and love and life. If I remember correctly, the American Cancer Society had a big ad campaign on TV about donations and support leading to more birthdays for cancer sufferers. The intent here is wonderful, and everyone should have as many birthdays as possible despite what conditions they may have. Of course, sadly, we know that many people do die from cancer, and that birthdays are cut short. We also know that cancer is an important health issue to address.

But, I wonder – what about a “more birthdays” campaign for mental illness? We know a lot about mental illness here: it tends to strike a lot of people when they are young, and people with mental illness tend to die earlier than others. And, as I know, death can be an unfortunate outcome of depression or other mental disorders. In many ways, mental illness is a lot like cancer, but I have yet to see a “more birthdays” campaign for mental illness. Perhaps we should work on making that happen.

But, back to my birthday. I feel incredibly fortunate because my birthday is not a big deal – I am not trying to fight cancer or mental illness or any other serious disease. My birthday is just like any other day, and I wish that all birthdays could be like mine.

The Mind Body Connection

When it comes to the mind and the body, I think a lot of us think about them as two separate things. It’s possible to partially blame it on some long standing historical perspectives. As a result, we believe that one does not influence the other. However, many people have started to talk about how the mind can affect the body, and those ideas seem to be gaining more acceptance and are receiving more attention. But, what about the body affecting the mind? Is that even possible? What does that look like?

In my general quest for knowledge I have heard about interesting research that the body can indeed affect the mind. One example involves using Botox. Botox has been used cosmetically for many years as a way to smooth lines and wrinkles on the face. However, it has been found that people who have had Botox for frown lines have also shown improvements in mood. There is an argument that a person may feel better because they think they look better, but there seems to be more to it. Another example comes from exercise, where it has been shown that it can improve mood as well.

So, Botox and exercise for depression? Of course, these are only a few examples from a larger world of possibilities, but there is growing evidence that the body can and does affect the mind. Using this idea as a framework, my hope is that this will give us even more possible treatment options for depression. So, if possible, why not consider Botox? Why not consider exercise? Overall, I like the idea that the mind and body work together and should not be treated separately. Once we think about everything as being connected, I believe we can find even more ways to treat the whole individual.

Mistakes

Today’s theme for me has shaped up to be about mistakes. I thought I had caught a big one at work, but after investigating I found out that all was well, which I am glad is the case. Then, it seems like I have heard other talks or songs about mistakes today, and it has me thinking about them in general. In my mind, to make mistakes is to be human. It is just a part of life. However, I wonder how our perception of mistakes might lead to things like depression.

Is it possible that someone thinks they have made a large number of small mistakes or one big mistake and then that has led to depression? It seems entirely possible to me. In general, I think we all have a great capacity to internalize a lot of mistakes, even though there was likely many other factors that played a part. I think a lot of us put a lot of pressure on ourselves to be good all of the time, and when we do stumble, we take it very personally. So, my call here is to really take a harder look at our mistakes and see if we can lessen the severity of how we internalize them.

Now, as a disclaimer, there are some mistakes (intentional murder, intentional violent crimes) that are pretty awful, and I am not including those in this post. However, for the rest, a key point is that mistakes are likely the result of a behavior. So, the mistake is from something you did, not an extension of who you are as a person. If this is true, then internalizing the mistake is not great. You dislike the behavior, not you as a person. My hope is that you start to look at mistakes in this way and separate them from who you are. You may need to make amends or apologize for some mistakes, but overall, I hope people can understand that how we feel about our mistakes can lead us down a path to depression. But, there are healthier ways to cope with our mistakes.

Social Determinants of Health

Lately, I have heard a lot about “social determinants of health”, but I have vaguely glanced over the idea. Today, I want to explore this more in-depth and give you an overview.

Although you can find a discussion about this topic in lots of places, the information I am presenting here comes from the website healthypeople.gov and the Healthy People 2020 program. They define social determinants of health as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Some examples of social determinants include access to educational opportunities, access to job opportunities, quality of education, transportation options, public safety, social support, exposure to crime, access to mass media, and culture. Healthy People 2020’s approach to social determinants of health is focusing on five key areas: economic stability, education, social and community context, health and health care, and neighborhood and built environment.

I am happy to see that many organizations, including the U.S. government, is really starting to address these factors, because I think they absolutely have a role in our overall health. We need to start looking at not only the entire person, but the larger context in which the person lives their life. I am looking forward to what we find out and how we can address the problems that are identified (problems that I suspect a lot of us already have an idea about). Specifically, when looking at this and depression, I think we might find even more potential factors that lead to depression.

How about you? Have you heard about social determinants of health before? Do you think these are important to our health? I hope you agree that this is another great way to look at a bigger picture of our health.

Depression and Substance Use Disorders

We all understand that depression does not exist in a vacuum. Sometimes, it may be the only diagnosis a person has, but there is still a lot of factors that come with that diagnosis. Many times, however, there are other things going on. Some people might also have high blood pressure or diabetes. Maybe they have a different physical disability. Today, I want to talk about a particular combination – depression and substance use disorders.

In basic terms, a substance use disorder involves using a drug that has not been prescribed for an intended purpose. Some drugs, like heroin and meth, are illegal across the board. Some others, like opioids or benzodiazepines, are legal but must be prescribed for a specific purpose. Those suffering from depression (and other mental illnesses) also have a strong chance of having a substance use disorder. A lot of times this is not discussed, but it is starting to get more attention. In the past, depression and substance use disorders have been treated in different places, and that has caused a lot of frustration, because treatment for one can help with treatment for the other. Sometimes it is hard to determine what came first. Was the person depressed, and then started to self-medicate with a drug? Or, was the person self-medicating and then got depressed?

Regardless of how it happens, the important thing is to recognize that these things can happen at the same time. As always, it is super important to remember to treat the entire person, not just the most obvious problem. We need to demand that treatment for depression and treatment of a substance use disorder can be done at the same place and at the same time. We need to understand that substance use disorders are common in mental illness. Lastly, we also need to understand that like mental illness, substance use disorders are NOT a sign of bad behavior or choices, but is also a real group of illnesses.

Happy ALL of the Time?

While I can’t speak about the rest of the world, here in the United States it seems like we are obsessed with “being happy”. We want to be happy, and we want those that we care about to be happy too. What exactly does “being happy” mean? I think you can find many different answers for a definition, but part of that definition seems to include the idea that we should be happy all of the time. Today, I want to share that I think being happy all of the time is not realistic, nor is it healthy.

In the recent history of my life, I have been bothered by the idea that I am not happy all of the time. Why shouldn’t I be happy I ask myself – I really do have it all in most respects. But, try as I might, I get sad or angry or mad, and it happens more than once a week. Then, when I haven’t “been happy”, I have felt bad about not being all sunshiny all of the time! And so the downward spiral goes. However, I am starting to recover from this.

It’s time to get real. Being happy all of the time is not ideal. We are all humans, and we all have a wide array of feelings. As long as we are not hurting others or ourselves, it is ok to feel what we feel and roll with it. We all need to lose the pressure to be happy all of the time, because life is simply not built that way. So, give yourself the permission to feel what you need to, and be happy when it makes sense to you.

If you are dealing with depression in any way, no doubt the pressure to “be happy” is way larger than what the rest of us face. But, the same goes for you as well. You will be happy when you can. It can take time to get into recovery and feel some joy again, and that is ok. No one should pressure you to just “be happy and get over it”. Let’s all give ourselves a break, and let’s just feel the variety of emotions that humans were meant to feel.

Fundraising

I try to do as much as I can to help advance mental health for all. One of the ways that I have started to do more of this is through fundraising. Fundraising. To a lot of us, this is not a fun word. It can involve uncomfortable conversations, and many people do not like to ask others for help. I am not necessarily worried about the asking part, I just don’t find it all that enjoyable to do. However, the more I learn, the easier it is becoming to make fundraising a more interesting task.

Although it now seems obvious in hindsight, fundraising is a world all of its own. There are people who study to be professional fundraisers, and there is a whole lot you can learn about the process. In fact, the amount of fundraising resources out there is probably overwhelming. So, if you ever want to take a deeper dive into fundraising, that material is available. But, here are the big things I have learned so far – most fundraising comes from individuals, and fundraising is really about relationships instead of money. The idea is that building relationships will lead to generous support. This is more than just a one-time ask, although you can do that. Asking is an important piece, but the relationship is even more important.

When I think about fundraising as building relationships, I get a lot more excited about it. It still takes a lot of work, but I like the idea of making sure relationships come before the money.

How about you? Do you enjoy fundraising? Have you considered fundraising for mental health causes? Do you like the idea of building relationships before asking for money? Does that make fundraising seem like less of a chore? I encourage you to think about ways you can learn more about fundraising.

Clutter

When you think about where you live, work, or do other activities, do you think about how much clutter or mess is in those spaces? Do you dread seeing a pile of papers on your desk? Do you cringe thinking about a particular room or closet in your house that is just hiding a big pile of stuff? Do you avoid going to places that seem too crowded with things? On the flip side, do you enjoy spaces that feel really open? Do you love seeing drawers, desks, or closets that are organized?

While you may not spend a lot of time thinking about such things, clutter and mess in our environments can have an impact on our moods. I feel like I am a classic example of this, even though I am not always great at organizing and making it better. But, when I am in cluttered spaces it typically will make me more anxious, frustrated, and unpleasant. It feels like the clutter is in control, and sometimes it can even be a safety concern. Usually, I would prefer to be away from the clutter, but that isn’t always possible.

So, if I think about it for people dealing with depression in some way, clutter can add to an already stressful situation, and people may not even be aware of it. But, if you do take the time to consider it, is it possible that doing even a little organizing might help make people feel a little better? I’m not talking about doing huge projects, but going through a drawer here or a pile there. Easier said than done I’m sure, but what is important is to understand how clutter in the environment can affect our moods. Even doing just a little bit of organizing can be a simple way to improve how people are responding to their surroundings.