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Mental Health and Grief

Grief and Mental Health – When the Two Merge

Grief is something that we all experience at one time, or another.  The stages of grief – sometimes explained as 3, 5 or 7 different stages – are pretty well known and include shock, denial, anger, sadness, acceptance in some order.  Most people will struggle but eventually come to some resolution with no prediction as to how long that will take.

Resolution of deep sorrow can be made much more difficult when a pre-existing mental illness is imposed.  A severe loss can trigger a relapse of virtually any mental illness, even when the illness was well treated, and the patient was stable.  Patients may relapse into severe depression, bipolar episodes, panic attacks or a return of obsessive compulsive behavior.  If the patient was not well stabilized, the whole apple-cart can be upset.

Depressed and Suicidal GirlEven the most mentally healthy person can become unstable if unable to resolve the feelings caused by painGrief has been known to result in clinical depression, lasting for a long period which can lead to extreme difficulties and even death in the case of suicide.  The problem comes in a case where one becomes “stuck” at a certain point – usually during the agitation period.

There is a saying;   “depression is anger turned inward.”  The existence of anger over an extended period can cause depression.

Anger allows us to have a heightened response to a threatening situation.  Anger fuels energy, giving us a false sense of power, but over time, the brain and the body run out of that same energy.  This can result in fatigue, emotional lability, and symptoms of depression.  In some cases, depression caused by grief may be resolved with grief counseling.

In other cases, however, depression may have become severe enough that medication may be warranted.  Clinical depression is characterized by:

•    Fatigue and decreased energy
•    Cloudy thinking
•    Feelings of guilt, worthlessness or helplessness
•    Insomnia or excessive sleeping
•    Irritability
•    Loss of interest in pleasurable activities
•    Body pain or digestive problems
•    Persistent sad or empty feelings
•    Thoughts of suicide

How different is this from grief – not much.  The only difference would be in how long it lasts.  Depression carries a high risk of suicide and if symptoms last longer than what would be considered “normal” – for any reason – you should seek treatmentMental Health ChaosDepression that is severe enough to interfere with normal activities for longer than four to six weeks should be treated – even if life circumstances explained it.  Counseling may work – or you may need medication for a short period.

If you have some known mental disorder, stay in contact with your mental health professional.  Most – and I did not say “all”, but most mental health patients find it difficult to self-assess, some find it difficult to be openly honest.  The only way to ensure that an episode of grief is resolved without severe consequences of going “off track” is to allow someone else to help assess your mental state.

Whether you are or are not a mental health patient, know that grief can cause mental illness and can worsen an existing illness – even if only for a short time.  It is not something to be dismissed or ignored as the risks are high.

Melissa Lind

Depression is Anger Turned Inward

Depression – When to Seek Help

Some level of depression is perfectly normal and does not require treatment

Sad and Depressed GirlWe all feel a little down or a little “blue” from time to time. We all have life events that will make us feel very sad as well, such as the loss of a loved one, the breakup of a relationship, financial difficulties, etc.

In most cases, however, these down periods are temporary. At what point, however, should you seek help for your depression? While people feel depression in different ways, and to different extents, there are specific warning signs that one should look for when determining whether or not they actually need treatment or not.

First, if your depression has lasted for more than a period of two weeks, you most likely need to seek treatment. Make an appointment with your medical doctor for a checkup, and discuss your feelings with him. He will most likely perform a physical exam to determine if there is a physical cause for those feelings, and he will also ask about your life events and current stressors.

Other than seeking help if the sadness lasts for more than two weeks, another sign that help is needed — immediately — is if you are having suicidal thoughts, or if you have already attempted suicide.
Do not wait to seek treatment. Contact your doctor, or call a suicide hotline for immediate help!

Feeling HopelessEven if depression is temporary, all of the other symptoms of depression are normal — except for the two discussed above. You may have a change in sleeping and eating patterns, you may feel like everything is hopeless. You may have the fatigue and the aches and the pains.

But again, if those symptoms do not go away within two weeks, or you feel suicidal, treatment is needed.

In many cases, a medical doctor can treat you for the depression, depending on the cause and the severity of your mental state. The important thing is to seek the help and to be as honest with your doctor as possible — whether your doctor is a therapist or not, he (or she) must still keep all conversations with you in confidence.

When should one seek help in cases of depression?

Mental Disorder and Hope

The Whacko is BACK!

By Bruce Anderson (The Freak in the Corner)

Bipolar Whacko Says HelloHey there, you.  How ya been?  You’re looking a little rough, but you know what?  You’re still here.  And that’s a start.  And it could be the start of something wonderful.  You may not believe it now, but have I lied to you yet?  Well… not intentionally.

There was that first bit about Bipolar Disorder which turned out to not be true in my case.  I had been misdiagnosed.  If you have Borderline Personality Disorder, (BPD), chances are your doctor went through about half a dozen diagnoses before he finally arrived at the one you’re stuck with now.  It’s very easy to misdiagnose.  What isn’t easy is living with it.  But guess what?  YOU CAN.  And in most cases, with treatment and a conscious effort to change negative patterns, YOU DO get better.

Just like me!

Oh, come now.  Don’t go all crazy congratulating me.  Crazy is MY job, remember?
But seriously, if you work hard, listen to your doctor and your support network of friends, you too can be awesome again.

Boy, I tell ya… it was darkest before the dawn, though.  Remember how “Justine” had left me and I was still hopelessly in love, but at least I had the Hollywood deal working?  Well… in a fit of pique, I told the director exactly what I thought of the changes he was making to my script.  He didn’t like my choice of words much.  So the deal is a bust.  My movie may never be made, but I’m cool with that.  The movie he wanted to make wasn’t the movie I wanted to make.  And I’m OK with that.  And since I renewed the WGA registration, no one can take and make my movie without me.

But man, that sucked.  And I fell apart.  And drove Justine crazy some more.  And I continued to drive her crazy for several more months.  She had sworn to stop talking to me, remember?  But I’m sure you also remember I can be very manipulative.  I’m VERY good at it, but it’s nothing I’m proud of.

Anyway, rock bottom happened.  I got a beautiful luxury apartment on the fifth floor and all I saw from the window for a long time was the parking lot and how inviting the jump was.  But I didn’t jump.  I got back to work.

Mental WhackoAnd even though I was still all messed up over Justine, I put on a happy face and went to work, because the kids needed me.  And that started to feel good.  And then it started to feel GREAT.  And I still wanted to tell Justine all about it, and that would set me back, but then I’d move forward again. And at the end of the school year, not only was I happy, but the happiness spread.  I was everyone’s favorite teacher.

And though I “lost” my kids, many of them have come back to see me… and tell me again that I’m STILL their favorite teacher.  And that, my friends, is a wonderful feeling.

But alas, the worst has come to pass.  I must now move from my beautiful apartment, which is located in a center of art and culture and is honestly the only place I’ve ever felt was truly home.  And this scares me.

I just gotta keep telling myself it’s for the best.

Because it is.  My girlfriend bought a farm and we’re moving in.

And no… it’s not Justine.  She never took me back, and I’m very glad of that.

Remember how I once said that I have a tendency to romanticize my romantic partners? Well, after a good long time, I took off the rose-colored glasses and began to see things as they really were.  I’m not going to go into details about it.  That would just be rude.  But I finally realized that not only was she not “The One,” she really wasn’t even that good to me.  Is she a bad person?  No.  Does she know how to treat a boyfriend?  Also, a resounding NO.

But I found someone who does.  And she’s got her issues, too.  And we occasionally fight, but we are like-minded enough to get along on most issues, and on the things we don’t see eye to eye one, we respect each other’s opinions, because we respect EACH OTHER.  And this time, it actually goes both ways.

BPD-Whacko Horse FarmerIs it scary to be jumping into a relationship again? Yes, but I’m not exactly jumping.  We’ve been seeing each other for about a year now.  We’ve taken the time to get to know each other.  And importantly, we’ve both been honest about our issues.  Yes.  I told her I have a personality disorder.  And she’s OK with that, but doesn’t put up with my bullshit, which is something that makes me love her even more.

And we COMPROMISE.  She’s moving to my town, because I have a job that makes me happy like no other before it and she doesn’t want me to give it up.  But I gotta give up the city life, and I don’t want to.  But I will.  Because she’s a farm girl, and I’ve learned to appreciate “farmy” stuff.  Horses are cool.  Like REALLY cool, and I would’ve never known that if I hadn’t stepped outside of my comfort zone.

So, your faithful whacko is going to learn to do “farmy” things.  I can already put up fence posts.  Next thing you know, she’ll have me milking the chickens and stuff.

And you thought I had gone all serious on you.

Well, I am a bit more serious now.  Or more to the point, I don’t feel the NEED to be funny.  The funniest people are often the saddest.  Because they can’t feel joy themselves, they spread it in others, if only just to see it so they remember it exists.

Poor Robin Williams is proof of that.  May he rest in peace!

If only he had known that you DON’T have to die to get it.  You just have to make a few changes, face your demons, take your doctor’s advice seriously, maintain your support network, stay busy, and maybe milk a few chickens.

You’re gonna make it, amigos.  I am.  And if this freak can manage it, so can you.

Until next we meet… KEEP FIGHTING!

Bruce

Zoloft for a Treatment of Depression

Is it safe to use Zoloft for a treatment of depression?

Zoloft is a common antidepressant that doctors prescribe for the treatment of depression and depression symptoms. Zoloft is a very gentle antidepressant but has a powerful effect as well.

Depression and ZoloftZoloft can start working in as little as a week, although it could take up to three weeks to feel the symptoms of depression easing. Zoloft is safe to take for an extended period; however, one should never stop taking Zoloft “cold turkey.”

It isn’t addictive, in the truest sense of the word, but Zoloft is an SSRI, which means that it is forcing a change in the brain chemistry. Because of this, your doctor will most likely “wean” your body off of Zoloft slowly by reducing the dosages, and allowing your brain to do more of the work without help from the medication.

Zoloft is not just prescribed for the treatment of depression. Research has also found that it is a suitable medication for the treatment of panic disorders, post-traumatic stress disorder, obsessive-compulsive disorder, and social anxiety disorder.

There are side effects associated with the use of Zoloft. These include impotence and/or changes in sex drive and libido, upset stomach, drowsiness, anxiety, irritability, urination problems, appetite changes, headaches, constipation or diarrhea, blurred vision, nightmares, insomnia, hair loss, dry mouth, sweating, muscle spasms, slowed speech, irregular heartbeat, and tremors.

Symtoms of DepressionBefore taking Zoloft, your doctor needs to know if you have a history of mania, suicidal thoughts, high blood pressure, kidney disease, liver disease, heart disease, seizures, enlarged prostate, urination problems, thyroid problems, or glaucoma.

Despite the potential side effects, most people don’t have any trouble with Zoloft, and it is one of the most-prescribed drugs for the treatment of depression. It is also considered one of the safest drugs for depression treatment. If you suffer from depression, you should definitely discuss Zoloft with your physician.

Zoloft for depression treatment despite potential side effects

Cutting – An Actual Mental Disorder

Non-Suicidal Self-Injury

A lot of people are shocked and horrified at the thought of self-mutilation and for many years “cutting” was categorized only as a symptom of Borderline Personality DisorderBPD, as you may know, has symptoms of unstable personal relationships, impulsivity, and extreme mood changes (different from Bipolar disorder as they can change on a dime and swing wildly).

The new issue of the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition or DSM-5, includes it as a separate diagnosis of Non-Suicidal Self-Injury (NSSI).  Research has suggested that NSSI can occur independently of BPD but is also often a co-existing or co-morbid illness, occurring alongside BPD, Bipolar Disorder, one of the many anxiety disorders or with other disorders such as anorexia or bulimia.

Cutting DisorderI am the mother of pre-adolescent children – who are beginning to believe they know all about people who act “weird” or do “weird” things (their words, not mine).  My daughter has recently talked about the “EMO” kids – which as a dumb mom, I had to figure out was a social group of kids who were “emotionally dark.”  She includes in her description of an “EMO” as “you know, like kids who are cutters.”  It is stereotypical to think that they all wear black clothing and heavy eyeliner – as some may – but many do not.

Some people who have the disorder would never be suspected of such – but then we are also sometimes surprised when someone who seems to have everything commits suicide, only to find that under the polished exterior was extreme anguish.  Often, cutting will be dismissed as a “stage” and it may be a “stage” – but often it is not.  Many patients – have arms or hips full of patterned scars – proving that it is often a condition all to itself.

Cutting Disorder - Mental IllnessSelf-mutilation most often starts in the early teen years when adolescent emotions are at their height – but often extends well into adulthood.  The majority of “cutters” are female – but not all.  There is often a co-existing mental illness and may have a family history component – but also often occurs following events of abuse – including sexual, physical or emotional abuse.  Sudden life changes such as unemployment or divorce – and isolation may trigger an occurrence.

People who “cut” often express a desire to “feel” as if they cannot truly attach to their own emotions.  Others will say they “cut” to kill the pain – this is because the act of producing pain also causes the body to release endorphins (the body’s natural painkiller) that makes them feel better.  Unfortunately, even though the action may induce temporary euphoria – it is often followed by guilt and a return of the negative feelings.

NSSI is defined as:

• 5 or more days of intentional self-inflicted damage to the surface of the body without suicidal intent – in the past year.
Patients must be intending to:
o Seek relief from negative feelings or thoughts and/or
o Resolve interpersonal problems and/or
o Induce a positive emotional state
• The behavior must be associated with 1 of:
o Interpersonal problems
o Negative thoughts or feelings
o Premeditation
o Ruminating on injury (obsession)

NSSI includes not only “cutting” but also burning, hitting or punching, head banging, biting, non-aesthetic piercing or carving of skin (tattoos and body piercing don’t apply), pulling out hair or other “topical” mutilation.  If a patient has expressed suicidal thoughts or shows suicidal tendencies – it is not classified as NSSI as the intent of a person with NSSI is not to commit suicide.
NSSI should be first viewed as a serious medical condition that truly requires treatment.  It may be resolved by treating an existing co-morbid psychiatric condition – but likely it will also require psychotherapy to resolve some of the underlying issues.

Definition of Self-injury/cutting (Mayo Clinic)

Cutting and Self-Harm: Warning Signs and Treatment (WebMD)

If you see signs of NSSI or “cutting” in a child, teen, or adult that you know – encourage them to seek help.

Melissa Lind (WriterMelle)

An Actual Mental Disorder – Cutting

Bipolar Disorder – Euphoria vs. Dysphoria or Mixed Episode

Most symptoms of Manic Episodes appear to be positive

Manic-depression or Bipolar disorder is usually perceived on of two ways – a person who alternates between depression and euphoria – or a person who alternates between depression and craziness.

Often a person who is told that they are bipolar will identify one of those two states – and will object based on the fact that they have never been “euphoric“, and they have never been actually psychotic or “crazy”.

Bipolar disorder or Manic-Depression is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) – “the Bible” of psychiatric disorders – as “…clinical course that is characterized by the occurrence of one or more Manic Episodes…”

7 “points” retrieved from: DSM IV Criteria for Manic Episode – Food and Drug Administration

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week. With three or more of:

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g., feels rested after only three hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas, or subjective experience that thoughts are racing
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. Increase in goal-directed activity (either socially, at work or school or sexually) or psychomotor agitation
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

There is another specifier – “The symptoms do not meet criteria for a Mixed Episode” which is left out in a lot of thought processes.

Bipolar - EuphoricOne problem that is often encountered when diagnosing Bipolar disorder – or when trying to convince someone who has Bipolar disorder that they do, indeed have the illness – is that most of the “symptoms” of a Manic Episode appear to be “positive” or “happy.”  If you examine the wording – it looks on the surface and is often described as periods of “Euphoria” or extreme happiness.

In truth, many people with Bipolar disorder don’t have periods of “euphoria,” they don’t have what is perceived as “inflated self-esteem or grandiosity“, and they don’t seek out “excessive involvement in pleasurable activities.”  They may have “dysphoria,” they may believe that they have to do everything themselves, they may experience psychomotor agitation…they may be in a really active bad mood.

This is a state of “dysphoria.”  It is also called a “mixed state” where the Manic Episode and the Depressive Episode occur at the same time.  Features may include the racing thoughts, irritability, lack of sleep, psychomotor agitation of a Manic Episode but also include anhedonia or lack of enjoyment, inappropriate guilt, or suicidal thoughts which are symptoms of depression.

Unfortunately, this disconnects in presentation, and lack of awareness of mixed states (in both the patient and some professionals) often gives the bipolar patient an “easy out” in acceptance of the diagnosis.

Melissa Lind

Mixed Episode or Manic Episode with Mixed Features is given too little attention!