Mental Health

Mental illness is a deformation of chemistry not a deformation of character. I recently saw this somewhere and thought if everyone could just realize that the world would be a better place! But that's just part of it. Depression, one of the more common mental illnesses is a devastating disease that literally effects millions in one way or another. Everyone at one point in their lives feels sadness or sorrow due to a situation that is either caused or occurred in their lives. But the illness depression causes you to feel sadness and sorrow for no reason at all. All aspects of your life can be in outstanding order but your brain chemistry won't allow you to enjoy it. Along with the sadness often comes loneliness, self-loathing, sleepiness, sleeplessness, loss of appetite and many other symptoms varying by individual.

For some this disease becomes so bad that they can't see a way out. The disease makes them think that it will never get better and that there is no hope. This is simply not true. Yet while your in the middle of a deep depression it's all most impossible to see the silver lining in the cloud never mind the cloud at all. All you see or imagine is blackness. Anyone dealing with this illness needs the support of the medical community, family and friends. The important message here is that there is hope and that it can and will get better with the help of a support system that you choose. Medicine for many will be a first line of defense. The medicines of today can literally make the difference between the glass being half empty or half full. But medicine is not the whole story either. Therapy is important as well. Being honest with yourself and making the necessary changes in your life so that you are happy is essential to your overall wellness. It's a process that takes time but is well worth the journey!

Table of Contents

The Role of Sugar in ADHD Oppositional Defiant Disorder	Is Dysthymic Disorder a Second-Rate Depression?
Eating for Energy: Tips for Managing Your Mood with Food	10 Benefits of Having Attention Deficit Disorder (ADD)
SINGLE MOTHERS AT GREATER RISK FOR DEPRESSION	DO YOU LOVE SOMEONE WHO SUFFERS FROM DEPRESSION?
What makes You Feel Good/What Makes You Feel Bad,	"Ten Ways to Beat the Heat,"
Alzheimer's Early Warning Signs Often Overlooked, Misunderstood	Does Social Anxiety Hold You Back?
Light up your life: Seasonal Affective Disorder	"Childhood Depression: Do You Know the Symptoms?"
Using Your Journal To Heal Emotional Wounds	Depression Series: Why Don't I Respond to Medications? (Part 1)
Healing is like an Onion	Depression Series (Part 2): My Antidepressant Doesn't Work. What Can My Psychiatrist Do?
Sixteen Things We Say When We’re Being Flooded	Depression Series (Part 3): What to Do with Those Antidepressant Side Effects?
HOW TO TELL SADNESS FROM DEPRESSION	Major Depression and Manic-Depression - Any difference?

The Role of Sugar in ADHD

by Anthony Kane, MD

Introduction

How sugar influences ADHD is one of those controversial
areas in medicine. There are two sides to the debate. On
one side, there is the official medical establishment that
claims numerous scientific studies show that children do not
react to sugar and that sugar does not play a role in ADHD.
On the other side, there are all the mothers who have
personally witnessed that when they give their children
sugar, within a few minutes, their children are bouncing off
the walls. So, the question is with whom does the truth lie.

Evidence for the Medical Establishment

In 1985, Dr. Mark Wolraich published the most influential
study demonstrating that sugar plays no role in ADHD.
Wolraich's team examined 16 hyperactive children for three
days. The researchers manipulated the sugar content of
their diet, but found no effects on behavior or learning.
The same group later published a review article and
concluded "the few studies that have found effects have been
as likely to find sugar improving behavior as making it
worse."

In 1994, Dr. Richard Milich examined thirty-one children
whose mothers felt they were sugar sensitive. He gave all
thirty-one children a sugar-free drink. However, he told
half of the mothers that their child's drink contained sugar.
The mothers who thought that their child had received the
sugar drink all rated their child as being more hyperactive.
These mothers also were more critical of their children and
hovered over them more. Milich concluded that the parental
expectations about the affects of sugar are the cause of the
perception that sugar makes children more hyperactive.
These expectations also influence the way the parents
interact with their children.

There are a few more articles about sugar, but they are
mostly a rehashing of earlier studies. The general consensus
of the scientific literature is that sugar does not lead to
hyperactivity. Unfortunately, some of us have children who
have not read these studies.

Analysis

Wolraich's study was quite thorough. Thirty-seven different
measurements of behavior and learning were taken. They
intensively studied 16 boys in a hospital setting for three
days. So what could be the flaw of this study? I just said
it. "16 boys," "hospital setting," "three
days."
Sixteen boys is a very small sample size. If even 10% of
the ADHD population is sugar sensitive, and the number is
very likely much less, a sample of 16 boys may not contain
a single child who was sugar sensitive.

A "hospital setting" is not a normal environment. Just
because a child can maintain himself in a controlled
environment like a hospital, doesn't mean that he would
function the same way at school or at home.
"Three days" is a very short time. If the effects of sugar
were additive, say over the course of a week, then the study
would miss this. This is still a very good study, but it is
premature to conclude from it that sugar plays no role in
ADHD.

Dr. Milich concluded that it was the mother's expectations
that affected how they viewed the effects of sugar on her
child. Even if true, the results of this study are still
insignificant. We have known for a long time that
expectations influence perception. This is basis of the
placebo effect. All that this study proved was that parents,
who expect their children to behave hyperactively, perceive
their children behaving hyperactively. We knew that before
the study.

As for Wolraich's review article, although it is a very good
article it has the basic flaw inherent in all survey studies.
The author must choose which studies to include and which to
exclude in his review. To put it another way, review articles
are highly susceptible to bias on the part of the authors.
Therefore, although Wolraich's review article is very good
and seems to be very thorough it is not the final word, like
many believe it to be.

Evidence Implicating the Role of Sugar in ADHD

Now for the Side of Motherhood

Wender and Solanto tried to link an increase in aggressive
behavior in ADHD children to sugar ingestion. They compared
17 ADHD children with 9 age-matched normal children to assess
the affects of sugar ingestion. They gave sugar or placebo
challenges as part of a high carbohydrate breakfast. They
did not find a relationship between sugar and aggression.
Although the children with attention deficit disorder with
hyperactivity were significantly more aggressive than the
control subjects, eating sugar did not elicit this behavior.

However, they did find something else. Inattention, as
measured by a continuous performance task, increased only
in the ADHD group following sugar ingestion. The ADHD
children showed no change following placebo, and the control
group showed no change at all. So, according to this study,
sugar ingestion as part of a high carbohydrate meal will
exacerbate inattentiveness in some ADHD children.

Langseth and Dowd found that 74% of 261 hyperactive children
in their study had abnormal sugar metabolism. These
children displayed reactive hypoglycemia after eating
refined sugar. What happened metabolically was that the
large ingestion of sugar caused a surge of insulin to be
released by the pancreas. This caused, in reaction, a
significant decrease in blood sugar levels accompanied by a
surge in the epinephrine levels.

Girardi found that sugar ingestion triggered other metabolic
abnormalities in ADHD children. His team at Yale gave a
standardized oral glucose challenge to 17 children with ADHD
and 11 control children and compared the results.
Baseline and oral glucose-stimulated plasma glucose and
insulin levels were similar in both groups, including the
glucose level bottoming out at 3-5 hours after oral glucose
ingestion. This drop in glucose stimulated a rise in plasma
epinephrine and norepinephrine in both groups. However, the
rise in the ADHD children was nearly 50% lower than in the
control children.

Both groups showed deterioration on the continuous
performance test in association with the late fall in
glucose and rise in epinephrine. However, the drop in test
scores in ADHD children was significantly greater. ADHD
children also had quicker reaction times than normal
children, corresponding with impulsivity. This study
suggests that children with ADHD have a general impairment
of hormone regulation. It appears that sugar may accentuate
this defect.

Sugar and Nutrition

There is another effect of eating refined sugar. You have
probably heard that table sugar is called "empty calories."
This is a true, but not complete picture. Table sugar is a
nutrient vacuum. It provides no nutritional benefit other
than calories, but it requires a lot of other nutrients to
process it. It depletes the child's nutritional base. That
means that if a child's ADHD is caused or exacerbated by the
lack of certain nutrients, having a high sugar meal may
drain these nutrients and push him into a nutrient deficiency
state. And this would not necessarily happen during a
three-day test in the hospital, as in Wolraich's study,
where the children were receiving adequate nutrition.

We have studies that show children who don't eat breakfast
don't perform as well in school. We also have studies showing
that children who eat sugar with a high carbohydrate meal do
poorly on tasks requiring concentration. There are also
claims that some children display increased aggressive behavior.

Conclusion

What do we make of all this? Most researchers say that sugar
doesn't make children hyperactive. Yet, everyone has seen
children go crazy on sugar. How do we resolve this
contradiction? What do we conclude from all this?

There is no concrete evidence that sugar causes ADHD.
However, the evidence against this notion is also not very
strong. We know that ADHD children frequently have abnormal
sugar metabolism. We know that eating sugar does affect
learning and behavior negatively, particularly after a low
protein carbohydrate meal. This occurs even in normal
children. We know that the metabolism of sugar drains the
body's reserve of other vital nutrients. What should we
conclude?

Basically, it is very likely that the medical researchers are
correct in saying that sugar ingestion does not cause ADHD.
All that means is that if you give a normal child too much
sugar, he will not develop ADHD. However, it is clear that
refined sugar does exacerbate some of the ADHD symptoms such
as inattentiveness and possibly aggression in many children.
There are mixed results as to whether or not it affects
normal children in a similar but less pronounced way.

My Recommendations

So, after examining all the evidence, I would recommend
that you should try to give your children protein-containing
meals for breakfast and lunch during the school year. You
should try to keep all your children and yourself away from
refined sugar.

Does this mean that I am saying sugar makes children
hyperactive? Not exactly. I feel that the medical research
is not conclusive either way.

You will have to judge for yourself the affect of sugar
on your own child. However, even if refined sugar does not
exacerbate your child's ADHD symptoms, I have yet to see
one study that shows that refined sugar does anything positive.

Anthony Kane, MD
ADD ADHD Advances
http://addadhdadvances.com
================================================================
Anthony Kane, MD is a physician, an international lecturer, and
director of special education. He is the author of a book,
numerous articles, and a number of online programs dealing with
ADHD treatment ( http://addadhdadvances.com/childyoulove.html ),
parenting issues ( http://addadhdadvances.com/betterbehavior.html ),
ODD, and education.
You may visit his website at http://addadhdadvances.com .
To sign up for the free ADD ADHD Advances online journal send
an email to: subscribe@addadhdadvances.com?subject=subscribeart

Is Dysthymic Disorder a Second-Rate Depression?

By

Michael G. Rayel, MD

Dysthymic Disorder, used to be called Dysthymia, is a
low-grade and yet chronic depression characterized by
feelings of sadness or depression associated with lack of
interest to do things and some physical symptoms such as
lack of energy, sleep, and concentration.

Psychological symptoms such as feelings of hopelessness,
helplessness, and worthlessness can also occur. In addition,
some patients harbor thoughts of death and feelings of
emptiness.

This is a type of clinical depression that is supposed to be
"milder" than Major Depressive Disorder (MDD - used to be
called Major Depression) because the symptoms don't
necessarily happen everyday. Unlike patients who suffer from
MDD, Dysthymic patients are not bed-bound, still able to
work, and does not appear to be sick. But most of these
individuals complain that they haven't felt "normal" or
"happy" for a long time.

Moreover, Dysthymic Disorder is manifested by lack of drive
and motivation. Hence, relatives and friends tend to
misinterpret their mood and behavior. Some patients endure
the stigma of being considered "lazy" or not "motivated
enough" to do worthwhile goals.

As time passes by, patients with this disorder have
difficulty functioning. But because they still appear
normal, the illness is not recognized and patients don't get
treated early. A lot of times, they are not referred to a
psychiatrist.

So is Dysthymic Disorder a second-rate psychiatric disorder?
Based on my experience, patients experience considerable
emotional turmoil. In fact, some dysthymic patients
eventually develop a more serious depression called Major
Depressive Disorder. When "double depression" (dysthymic
disorder and major depression occurring together) happens,
patients are so depressed that they become a threat to
themselves and become functionally impaired. At this time,
psychiatric hospitalization becomes necessary.

So Dysthymic Disorder is a serious health problem that
should be recognized and treated promptly. It is an illness
that somehow hides its existence from everyone including
clinicians and patients themselves.

What is the treatment? Dysthymic disorder can be treated by
antidepressants and psychotherapy. Most patients respond to
treatment although some still suffer despite adequate
treatment. Also, there are some individuals who only respond
minimally. As such, this illness can be more challenging to
treat than others.

About the Author:

Copyright © 2004. Dr. Michael G. Rayel - author (First Aid
to Mental Illness-Finalist, Reader's Preference Choice Award
2002) psychiatrist, and inventor of Oikos Game: A Personal
Development and Emotional Skills Game. For more information,
please visit www.oikosgame.com.

10 Benefits of Having Attention Deficit Disorder (ADD)
By ADD Management Coach Jennifer Koretsky
© 2004 Jennifer Koretsky

There is a common misconception in the world that having
Attention Deficit Disorder (ADD) is a bad thing. While the
ADD-wired brain certainly presents some challenges, it also
offers some incredible benefits. The following is a list of
characteristics that I consistently see in my clients,
friends, and colleagues with ADD.

1. Compassion
People with ADD have a tremendous power to connect with
other people. But it goes a step further than that. We
also have an advanced ability to empathize with others, and
to see many different perspectives.

2. Creativity
I've never met an ADDer who wasn't creative! Writers,
painters, musicians, film makers, designers, sculptors,
comedians - the list goes on! Artistic talents are
abundant. Composers Mozart and Beethoven are believed to
have had ADD.

3. Drive
When an ADDer is bored with a task, completing it can seem
like torture. But give an ADDer an interesting project to
work on and watch out! When we want to succeed, and we have
the necessary tools to do so, there is no stopping us!

4. Problem Solving Ability
ADDers thrive on solving problems and puzzles. Give us an
interesting problem to solve and we won't be able to drop it
until we've found the solution! Important historical
inventors such as Thomas Edison and Thomas Jefferson are
believed to have had ADD.

5. Hyper-Focus
The ability to hyper-focus is something that ADDers can use
to our advantage. When kept under control and directed
towards productive tasks, like accomplishing goals and
living dreams, it can be an incredible asset that allows us
to get the job done, and done well!

6. Sense of Humor/Comedic Flair
Most ADDers love to laugh, and many also have a knack for
making others laugh! Famous comedians such as Whoopi
Goldberg and Robin Williams are rumored to have ADD.

7. Resiliency
There's no denying that even though there are many great
qualities that come along with ADD, there are also
challenges. But ADDers have an incredible ability to bounce
back from those challenges, and others' criticism of those
challenges that we've endured.

8. Intuition
ADDers have a sharp sense of intuition. This may be due to
highly tuned levels of perception, or great insight into the
human mind, or something else that we have yet to
understand. Whatever the reason, it's a very useful gift!

9. Idea Generating
ADDers are wonderful idea generators. We don't usually like
to be bothered with details, but we can come up with ideas
at lightning speed! We're a true asset in brainstorming
meetings!

10. That "Special Something"
Many ADDers feel that they have a unique way of looking at
the world, a perspective that others just don't understand.
That is, until the ADDer meets other people with ADD! You
might say that we're on our own wavelength!

About the Author:
Jennifer Koretsky is an ADD Management Coach who helps
adults learn how to manage their ADD and move forward in
life. She offers individual and group coaching, workshops,
and skill-building programs. Subscribe to Jennifer's free
email newsletter, The ADD Management Guide, by visiting
http://www.ADDmanagement.com/e-newsletter.htm

Oppositional Defiant Disorder
by Anthony Kane, MD

Introduction

Oppositional defiant disorder (ODD) is a psychiatric behavior
disorder that is characterized by aggressiveness and a tendency
to purposefully bother and irritate others. These behaviors
cause significant difficulties with family and friends and at
school or work.

Oppositional defiant disorder is sometimes a precursor of conduct
disorder. Much of the literature tends to lump these two
conditions together. However, they seem to be distinct entities
and, although conduct disorder does have a genetic component, ODD
does not.

Description

Oppositional defiant children show a consistent pattern of
refusing to follow commands or requests by adults. These
children repeatedly lose their temper, argue with adults, and
refuse to comply with rules and directions. They are easily
annoyed and blame others for their mistakes. Children with ODD
show a pattern of stubbornness and frequently test limits, even
in early childhood.

These children can be manipulative and often induce discord in
those around them. Commonly they can incite parents and other
family members to fight with one and other rather than focus on
the child, who is the source of the problem.

Behavioral Symptoms

Common behaviors seen in oppositional defiant disorder include:

Losing one's temper
Arguing with adults
Actively defying requests
Refusing to follow rules
Deliberately annoying other people
Blaming others for one's own mistakes or misbehavior
Being touchy, easily annoyed
Being easily angered, resentful, spiteful, or vindictive.
Speaking harshly, or unkind when upset
Seeking revenge
Having frequent temper tantrums

Many parents report that their ODD children were rigid and
demanding from an early age.

Normal children, especially around the ages or 2 or 3 or during
the teenage years display most of these behaviors from time to
time. When children are tired, hungry, or upset, they may be
defiant. However, children with oppositional defiant disorder
display these behaviors more frequently and to the extent that
they and interfere with learning, school adjustment, and,
sometimes, with the child's social relationships.

Diagnosis

The diagnosis of ODD is not always straight forward and needs
to be made by a psychiatrist or some other qualified mental
health professional after a comprehensive evaluation. The child
must be evaluated for other disorders as well since ODD usually
does not come alone. If the child has ADHD, mood disorders, or
anxiety disorders, these other problems must be addressed before
you can begin to work with the ODD.

If you feel your child may have ODD, there is a quick screening
test. Go to:

http://addadhdadvances.com/ODDtest.html

Causes

What is the cause of ODD? The real answer is that nobody knows.
However, since as scientist we hate to admit this, we have
currently two theories.

The developmental theory proposes that ODD is really a result
of incomplete child development. For some reason, these
children never complete the developmental tasks that normal
children learn to master during the toddler years.

The learning theory suggests that ODD comes as a response to
negative interactions. The techniques used by parents and
authority figures on these children bring about the oppositional
defiant behavior.

ODD is the most common psychiatric diagnosis in children and it
usually persists into adulthood. One would think a lot of
research would be done on this condition. That is not the case.
While there are hundreds of research studies on ADHD and
childhood mood disorders, there is very little research on ODD.

Co-morbidity

ODD is frequently goes along with other disorders. 50-65% of
ODD children also have ADHD. 35% of these children develop some
form of affective disorder. 20% have some form of mood disorder,
such as depression or anxiety. 15% develop some form of
personality disorder. These children frequently have learning
disorders and academic difficulties.

If your child has ODD it is important to know there are other
co-existing problems. These other problems usually must be
addressed before you can begin to help your child with ODD.

Prognosis

So what happens to these children? There are four possible
paths.

1. Some will grow out of it. Half of the preschoolers that
are labeled ODD are normal by the age of 8. However, in older
ODD children, 75% will still fulfill the diagnostic criteria later
in life.

2. The ODD may turn into something else. 5-10 % of
preschoolers with ODD have their diagnosis changed from ODD to
ADHD. In some children, the defiant behavior gets worse and
these children eventually are diagnosed with Conduct Disorder.
This progression usually happens fairly early. If a child has
ODD for 3-4 years and he hasn't developed Conduct Disorder, then
he won't ever develop it.

3. The child may continue to have ODD without any thing
else. This is unusual. By the time preschoolers with ODD are
8 years old, only 5% have ODD and nothing else.

4. The child develops other disorders in addition to ODD.
This is very common.

Treatment

Most of these children have some other disorder along with their
ODD. Treating this other disorder is the key to proper ODD
management. This frequently means giving medication. Although
this type of medical intervention does not make the children
"normal", it can make a big difference. It often allows other
non-medical interventions to work much better.

For example, if a child has both ODD and ADHD, then giving the
child Ritalin may have a significant effect on his ODD, also.
This positive effect does not seem to be related to the severity
of the ADHD. That means even if the child has mild ADHD and
could do without Ritalin, if he is treated medically, you might
see an improvement in his ODD.

Once the other problems are under control, the best treatment
for ODD is parent training. In a study published in 1998,
eighty-two research studies were evaluated were examined for
efficacy. Approaches focusing on parent training were the most
affective techniques.

The main point is that some parent-training program is essential
in addressing ODD. This is not going to work for everyone, but
it is the best treatment that we have available for ODD.

Advice to Parents

That is with regard to your child. If your child has ODD you
need to take care of yourself, also. No child needs a martyr as
a parent.

Here are some of the things you can do:

· Maintain interests other than your child with ODD.
You have to be a person.

· Try to work with and obtain support from the other
adults (teachers, coaches, and spouse) dealing with your child.

· Take time to work on your relationship with your spouse.
Raising these children is very difficult and can put a strain
on the best of marriages.

· Manage your own stress with exercise and relaxation.

· Take frequent vacations. This is a must.

Conclusion

It is tough to live with children who have ODD. What is worse
is that there does not seem to be any cure. However, if you
make sure that your child has his other problems addressed and
you improve your parenting skills by enrolling in a parent
training program, you can do a great deal to improve your
child's condition and your own.

Good luck-

Anthony Kane, MD

ADD ADHD Advances

http://addadhdadvances.com

================================================================
Anthony Kane, MD is a physician, an international lecturer, and
director of special education. He is the author of a book,
numerous articles, and a number of online programs dealing with
ADHD treatment (http://addadhdadvances.com/childyoulove.html),
parenting issues (http://addadhdadvances.com/betterbehavior.html),
ODD, and education.
You may visit his website at http://addadhdadvances.com.
To sign up for the free ADD ADHD Advances online journal send
an email to: subscribe@addadhdadvances.com?subject=subscribeart

Eating for Energy: Tips for Managing Your Mood with Food
by Susie Michelle Cortright
author, More Energy for Moms

Here's a meal-by-meal guide to eating for energy and managing your mood with food.

Breakfast

Eating a good breakfast boosts your concentration and revs your energy, particularly in the morning when you may need it most. Without breakfast, you're more likely to make that second pot of coffee by mid-morning.

Instead, keep your blood sugar on an even keel with complex carbohydrates. Avoid refined carbohydrates, such as white bread and white sugar. These have a high glycemic index, which can cause spikes and dips in your blood sugar levels.

The right complex carbohydrates provide your brain and muscles with the steady flow of the energy they need. Grains are great sources of B vitamins, which aid in the metabolic production of energy. The best carb choices for breakfast are natural whole-grain breads and cereals.

For the best breakfast, add a low-fat protein, such as yogurt, cottage cheese, or skim milk, and watch your fat intake as well as your meat consumption (meat takes more energy to digest).

Mid-morning snack

Turns out, snacking may not be such a bad idea. Eating every few hours helps your body use nutrients more efficiently. It stimulates your metabolism, keeps your blood sugar levels steady, reduces stress on your digestive system, and decreases hunger, which means you'll be less likely to overeat when mealtime finally rolls around.

If you're craving carbs, which many of us do at this time of day, choose whole-grain bread, cereal, or fruit.

Fruits and vegetables deliver a low-fat, high-fiber alternative to the vending machine choices. Raw carrots
and sugar snap peas, for example, provide a crisp, satisfying crunch and won't zap your energy.
Challenge yourself to eat at least five servings of fruits and vegetables each day.

For maximum energy throughout the day, avoid foods that are laden with simple sugars, such as cookies, pastries, candy bars, and sodas, which can bring on erratic blood sugar levels.

Instead, try some lean protein (low-fat yogurt, cottage cheese or lean meat) to help tide you over until lunch.

Lunch

At midday, go light. Because a hefty helping of carbohydrates can increase the amount of serotonin in the brain and cause that sleepy feeling, focus on low-fat protein.

Protein can actually raise energy levels by increasing brain chemicals called catecholamine. Eat a lunch of low-fat
cheese, fish, lean meat, poultry, or tofu.

Mid-afternoon snack

Choose something that will keep you satisfied until dinner. A little bit of fat is fine. It gives those carbohydrates and proteins some staying power. My favorite? All-natural peanut butter and a few crackers.

Before your work-out

Carbohydrates are fastest to digest and pack quick energy. Add protein for staying power, but stay away from fats. They can make you cramp.

Dinner

The agenda for the evening can dictate what you'll eat for dinner. Need to stay on overdrive for back-to-school
night? Choose low-fat proteins. If you're in relax mode, indulge a little.

Whatever's on the menu, remember the Pie Test. Envision your plate as a pie. Seventy-five percent of the pie
should be filled with fruits, vegetables, and grains and 25 percent with other foods, such as diary
products and meat.

Before bed

Before turning in, a carbohydrate-rich snack can supply serotonin to help you fall asleep. But go easy. Too much food can reduce the quality of your sleep.

Eating for energy is one of the most effective, powerful, and fast-acting mood-boosters. Try it today and see!

Copyright 2004 Susie Cortright

This article is excerpted from More Energy for Moms, by Susie Cortright, http://www.momscape.com/energy Susie is the author of several books for women and founder of the award-winning Momscape.com, a website designed to help busy women find balance. Visit http://www.momscape.com today and get Susie's free course-by-email "6 Days to Less Stress."

Major Depression and Manic-Depression - Any difference?

By

Michael G. Rayel, MD

Countless number of patients and their family members have asked me about manic-depression and major depression. "Is there any difference?" "Are they one and the same?" "Is the treatment the same?" And so on. Each time I encounter a chorus of questions like these, I am enthused to provide
answers.

You know why? Because the difference between these two disorders is enormous. The difference does not lie on clinical presentation alone. The treatment of these two disorders is significantly distinct.

Let me begin by describing major depression (officially called major depressive disorder). Major depression is a primary psychiatric disorder characterized by the presence of either a depressed mood or lack of interest to do usual activities occurring on a daily basis for at least two weeks. Just like other disorders, this illness has associated features such as impairment in energy, appetite, sleep, concentration, and desire to have sex.

In addition, patients afflicted with this disorder also suffer from feelings of hopelessness and worthlessness. Tearfulness or crying episodes and irritability are not uncommon. If left untreated, patients get worse. They become socially withdrawn and can't go to work. Moreover, about 15%
of depressed patients become suicidal and occasionally, homicidal. Other patients develop psychosis-hearing voices (hallucinations) or having false beliefs (delusions) that people are out to get them.

What about manic-depression or bipolar disorder?

Manic-depression is a type of primary psychiatric disorder characterized by the presence of major depression (as described above) and episodes of mania that last for at least a week. When mania is present, patients show signs opposite of clinical depression. During the episode, patients show significant euphoria or extreme irritability. In addition, patients become talkative and loud.

Moreover, this type of patients doesn't need a lot of sleep. At night, they are very busy making phone calls, cleaning the house, and starting new projects. Despite apparent lack of sleep, they are still very energetic in the morning - ready to establish new business endeavors. Because they
believe that they have special powers, they involve in unreasonable business deals and unrealistic personal projects.

They also become hypersexual - wanting to have sex several times a day. One-night stands can happen resulting in marital conflict. Like depressed patients, manic patients develop delusions (false beliefs). I know a manic patient who thinks that he is the "Chosen One." Another patient claims that the President of USA and the Prime Minister of Canada ask for her advice.

So the big difference between the two is the presence of mania. This manic episode has treatment implications. In fact the treatment of these disorders is completely different. While major depression needs antidepressant, manic-depression requires a mood stabilizer such as lithium
and valproic acid. Recently, new antipsychotics, for example risperidone, olanzapine, and quetiapine, have been shown to be effective for acute mania.

In general, giving an antidepressant to manic-depressed patients can make their condition worse because this medication can precipitate a switch to manic episode. Although there are some exceptions to the rule (extreme depression, lack of response to mood stabilizers, among others), it is preferable to avoid antidepressants among bipolar patients.

When considering the use of antidepressant in a depressed bipolar patient, clinicians should combine the medication with a mood stabilizer and should use an antidepressant (e.g. bupropion) that has a low tendency to cause a switch to mania.

About the Author:

Copyright©2004. All rights reserved. Dr. Michael G. Rayel - author (First Aid to Mental Illness-Finalist, Reader's Preference Choice Award 2002), speaker, workshop leader, and psychiatrist. Dr. Rayel pioneers the CARE Approach as first aid for mental health. To receive free newsletter, visit www.drrayel.com. His books are available at major online
bookstores.

Alzheimer's Early Warning Signs Often Overlooked, Misunderstood
by Jim Erskine

A new report released as part of National Alzheimer's Awareness Month contends that most family members miss early signs of Alzheimer's Disease in a loved one -- simply because they don't know
what they should be looking for.

Early warning signs, or "markers" of Alzheimer's can be subtle, appearing months or even years before memory loss and other clinical symptoms are apparent. However, these are often misunderstood or
unrecognized by family and friends. Signs include:

1) Depression: Over 50% of all Alzheimer's patients exhibit symptoms of clinical depression, up to two years before memory loss is apparent.

2) Loss of the sense of smell: The affected person's ability to discern odors may decrease dramatically, though they are usually unaware of it. Their sense of taste usually remains intact.

3) Hearing loss: Signs include turning up the TV too loud, avoiding use of the phone, and withdrawal from conversations.

4) Visual / Spatial Impairment: The person affected may have difficulty recalling visual details about objects and locations, or problems following maps and directions.

5) Unusual fingerprint patterns: Up to 75% of people who develop Alzheimer's have an abnormal number of ulnar loop patterns on their fingertips. These are similar to patterns found on Down's Syndrome
patients, suggesting that some people may have a genetic predisposition to Alzheimer's.

The complete report, "How to Tell if Your Loved One May Be Getting Alzheimer's" may be viewed online at http://www.alzhelp.com.

With over 4 million older Americans suffering from Alzheimer's Disease, National Alzheimer's Awareness Month is observed each November to help friends and family become better informed about this disease. Recognizing early indicators of potential Alzheimer's related problems is vital, because the sooner an individual is diagnosed and treatment is started, the better their chances for a longer, healthier life.

"What makes You Feel Good/What Makes You Feel Bad,"
by Susan Dunn, MA Clinical Psychology, The EQ Coach

Emotional Intelligence is all about self-awareness, understanding how emotions work within you and others. Our feelings are regulated by neurotransmitters such as serotonin, norepinephrine, and dopamine. Here are some things to know about serotonin, called the "feel good" neurotransmitter.

Research indicates that low levels of serotonin in the brain can lead to the underlying inability to handle powerful feelings which can results in impulsive acts, aggressive behaviors, poor judgment, and self-destructive tendencies. According to the Society for Neuroscience, in experiments, monkeys with less serotonin are the ones who take daring jumps from the trees and injure themselves. Rats low in
serotonin do risky things in experiments, and also accept small immediate rewards instead of waiting for a bigger prize.

Restoring levels of serotonin in the body relieves symptoms of depression and anxiety. According to Carolyn Meltzer, MD, serotonin receptors decrease significantly with age, up to 55%, so as you age, keep this in mind.

How do we get more serotonin or use what we have better? According to Dr. Allan Lieberman, MC, FAAEM, vitamin B6 and magnesium can elevate it. Some natural sources are bananas, pumpkin seeds, peanuts, tomatoes, plums, avocadoes, pineapple, eggplant and walnuts.

Antidepressants work with the serotonin you produce; they don't make more of it. Your body produces serotonin through L-tryptophan. L-tryptophan is present in pork, duck and turkey. According to Harvard psychiatrist Joseph Glenmullen, author of "Prozac Backlash," it can also be enhanced by talk therapy and by aerobic exercise such as jogging or dance.

Touch also increases serotonin during massage and decreases pain levels, improves sleep patterns, decreases fatigue, anxiety, depression and cortisol levels in fibromyalgia patients, according to the International Journal of Neurology.

Another important source of serotonin can be increased light. Norman E. Rosenthal, M.D., National Institute of Mental Health, feels that the intensity of the light is what counts, not the spectrum. However full-spectrum light used in the poultry industry causes chickens to live twice as long, be calmer and less aggressive, and produce eggs 25% lower in cholesterol. Apparently, even human cholesterol
levels drop when people are exposed to sunlight.

Non-full-spectrum lighting, which is often used in work places, has been shown to create hormones ACTH and cortisol in levels considered stressful.

Being around water can help some people feel better. Research has shown that a cruise can be beneficial to your wellness.

There are more tips about feeling better in "Depression:The Need to Go Within," by Susan Dunn.

In sum, part of emotional self-awareness means becoming aware of what physical factors innate to you enhance your mood - the foods you eat, the chemicals you put into your body, the exercise you get or don't get, and your surroundings.

© Susan Dunn, MA Clinical Psychology, The EQ Coach,
http://www.susandunn.cc , is the author of "Depression" -http://www.webstrategies.cc/ebooklibrary.html . She also offers Emotional Intelligence assessments, tests, coaching, distance learning, and seminars for your workplace.
Mailto:sdunn@susandunn.cc for FREE eZine. Call 210-496-0678 for immediate service.

"Childhood Depression: Do You Know the Symptoms?"
by Susan Dunn, MA Clinical Psychology, The EQ Coach

Why are the nursery colors pastel, wrote Edna St. Vincent Millay, the poetess. Better they should be red and yellow
because that's the intense emotional world children live in. When an adverse event happens in their life, they may not
understand it cognitively, and may not show it in a way that you can tell, but children feel the loss of friends, pets,
loved ones, the stress of moves and having a new sibling, the pain of divorce, and other life events.

"Prayer to Persephone"
by Edna St. Vincent Millay

Be to her, Persephone,
All the things I might not be;
Take her head upon your knee.
She that was so proud and wild,
Flippant, arrogant and free,
She that had no need of me,
Is a little lonely child
Lost in Hell-Persephone,
Take her head upon your knee;
Say to her, "My dear, my dear,
It is not so dreadful here".

[You'll recall from your mythology that Persephone was the goddess of the Underworld, wife of Pluto (or Hades).]

Children do get lonely, sad and angry, but they don't always show it the way an adult would. As you can see in the poem, this child was "wild," "arrogant," and "flippant." These are active states; none of that curling up in bed, sighing
and sleeping all the time. But this is true for some adults as well. Keep learning about depression-it's increasing,
and it isn't what you think it is.

Emotional disorders are widespread, and affect all age groups, children included, depression included. Contrary
to the Disney view of childhood, it isn't all carefree and happy.

HOW TO KNOW IF YOUR CHILD IS DEPRESSED?

According to psychologists Sam Goldstein, Ph.D., and Barbara Ingersoll, Ph.D., in their article, "Lonely, Sad and Angry: How to Know if Your Child is Depressed and What to Do," typical symptoms in depressed children include sadness or irritability, low self-esteem, and loss of interest in previously pleasurable activities."

They describe depression as a "whole-body illness." i.e., it doesn't just involve changes in mood, but affects sleep,
appetite, general health and performance. One sign may be complaining of vague physical symptoms like a stomachache, that's hard to pin down, or not having their usual energy (enthusiasm).

Depression also affects children's ability to think and concentrate (just as in adults), so school performance often
decreases, grades go down, and irritability can cause behavior problems. Or they become withdrawn and start
dropping friendships and the isolation makes the depression worse.

Another clue you'll have is that the child becomes difficult to be around, affecting family life. They may cry a lot, or
whine, or be argumentative and irritable, whereas formerly they were easy-going and pleasant.

Depression affects how the child thinks, feels, looks, and behaves. That's what "whole-body" means.

Facial expression can be glum, or mask-like, or sullen and provocative. (I think of the face of the little boy on the
original "War" album.)

At no time-either childhood or teen years-are moodiness, poor self-esteem and school failure to be considered
"normal." Be attentive and notice changes such as these, and dare to seek treatment.

DEPRESSION IN CHILDREN IS RISING

The statistics on childhood depression are alarming. According to Ingersoll and Goldstein, "during a year's time,
8-9% of children between the ages of 10 and 13 suffer from an episode of depression. As startling as these figures
are, it is likely that they reflect only the tip of the iceberg, since the incidence of depression in young people
appears to be on the rise in our society."

According to studies, the authors say, people under 40 are three times more likely to suffer from a depressive illness
than those over 40. Within the under 40 group, the lower the age, the higher the risk of a depressive illness.

Keep in mind, as you read these statistics, that it is therefore also not "normal" for a senior to be depressed.
When you suspect depression-in yourself or in a loved one-seek diagnosis.

THE CAUSES OF DEPRESSION

As I cover in my book, "Depression: The Need to Go Within," brain science contains to make a compelling case that
depression is a combination of problems with neurotransmitters (chemical messengers in the brain), genetic vulnerability, and stressful life events.

How does this work? A child may be born genetically predisposed to depression, but suffer no adverse events, and
it never shows up. Or a child can be relatively non-depressive, but suffer some traumatic event -one major or several smaller in succession-and manifest the symptoms. It also follows that those at most risk are those with
genetic disposition (as shown in family history) who then suffer stressful or negative events.

Adverse events would include divorce of parents, death of parent or sibling, many moves without sufficient support,
extreme poverty, family violence, malnutrition, hospitalization, and others.

DARE TO DO SOMETHING

We can no longer ignore the presence of depression, so there isn't the same stigma to being diagnosed. As the parent,
the one who cares, know your child's personality, and watch for variations. If an adverse event occurs, know how to
support your child through it, and be watching for change.

If you notice symptoms, start by checking you're your child's pediatrician. They can start the process and refer
you where needed for proper diagnosis and treatment.

EMOTIONAL INTELLIGENCE BUILDS RESILIENCE

Also learn what you can about Emotional Intelligence to increase your own Resilience (against adversity) and
therefore your child's. Developing your Emotional Intelligence is always beneficial-to both you and your
child.

© Susan Dunn, MA Clinical Psychology, The EQ Coach,
http://www.susandunn.cc . Individual and business coaching, EQ coach training, the EQ e-Book Library (
http://www.webstrategies.cc/ebooklibrary.html ). Susan is the author of "Developing Your Child's Emotional
Intelligence," and "Depression: The Need to Go Within." Mailto:sdunn@susandunn.cc for FREE eZine.

Does Social Anxiety Hold You Back?

In the "Anxiety Disorders" section of the manual entitled "Diagnostic Criteria from DSM IV," which is used for the diagnosis of mental health conditions, there are 12 anxiety diagnoses covered.

The fifth, and what may appear to be a soft diagnosis, is Social Phobia (Social Anxiety Disorder). In contrast to "Posttraumatic Stress Disorder," "Obsessive-Compulsive Disorder" and "Panic Disorder" this diagnosis may seem to be lighter than the rest.

Please don't be fooled by names or the sound of names or even the fact that many of the others have achieved more press time. Social phobia is a very real threat to the quality of life for many individuals.

What is Social Anxiety Disorder? Glad you asked. Following is a list of life areas impacted by social anxiety --

1. Meeting new people
2. Answering the door
3. Interacting with merchant clerks at banks, grocery stores etc.
3. Setting appointments with doctor's offices etc.
4. Attending church
5. Buying or returning items at retail outlets
6. Sick days where your anxiety has made you sick
7. Driving (fear other drivers looking at or thinking of you)
8. Paying at the gas station
9. Eating in front of other people
10. Signing your name in front of others
11. Attending or hosting social events
12. Dating
13. Talking in a small or large group
14. Expressing your opinion
15. Performance situations, such as playing on an athletic team, singing in a choir etc.
16. May or may not have panic attacks
17. Fear of what others are thinking of you
18. Fear of being embarrassed or humiliated

Next is a general physical symptom list of the physical signs of social anxiety --

1. Blushing
2. Sweating
3. Dizziness
4. Heart palpitations
5. Muscle tension
6. Dry mouth
7. Shaking
8. Nausea
9. Diarrhea
10. Headache

These are a few of the symptoms of social anxiety as experienced in life areas and physically. Many folks have social anxiety but do not realize that this is what they struggle with. Oftentimes thinking about or engaging in any of the activities listed above will induce anxiety.

The real danger with this disorder is that it can subtly grow into a monster. Left unattended, social anxiety can reshape the life that you should be living into one that is centered around avoidance of anxiety. Some of you are aware that you have anxiety and fight with it constantly. Many others are not aware of anxiety as the culprit, even though it's impacting all these life areas. That's powerful!

Ongoing social anxiety can result in developing a pattern of avoidance, whereby you begin putting off many of life's activities. Too often, you have only the best of excuses, but if you suffer from social anxiety, it's really anxiety driving
your life's bus.

There are many keys in the overcoming of anxiety. At the top is bolstering your self-confidence. Ironically enough, the more withdrawn you become while feeing anxious and avoiding activities, the stronger the social anxiety becomes.

A FEW KEY AREAS TO TARGET IN OVERCOMING SOCIAL ANXIETY:

1. Participate in activities which increase esteem and a sense of personal safety

2. Establish an area of expertise or mastery and allowing those abilities to be present in anxiety situations

3. Learn relaxation strategies that become serenity-hygiene habits

4. Challenge irrational thought patterns that support the anxiety

5. Keep an anxiety scale journal to chart goals and progress

6. Seek a caring individual to hold you accountable to your goals

7. Know that peace and anxiety cannot exist at the same time. Any ritual which brings peace into your life is a
great tool to use to eliminate anxiety

8. Practice knowing that you are loved and have a right to live a joy-filled life!

This is your life! If you find yourself angry over being anxious, that's GOOD -- but only if you direct your anger at
anxiety and allow it to become an energizer in your efforts to reclaim your life.

~~ @@ ~~
Dave Turo-Shields, ACSW, LCSW is an author, university faculty member, success coach and veteran psychotherapist whose passion is guiding others to their own success in life. For weekly doses of the webs HOTTEST success tips, sign up for Dave's powerful "Feeling Great!" ezine at http://www.Overcoming-Depression.com
~~ @@ ~~

LIGHT UP YOUR LIFE: SEASONAL AFFECTIVE DISORDER

Ah yes, the you can just now begin to feel the cold bite in the air during the mornings and evenings. Soon the leaves will turn all sorts of brilliant colors. The autumn season is on it's way. I love the fall. It's my favorite season of the year.

Unfortunately, for many who suffer from a disorder called Seasonal Affective Disorder (SAD), the dread of the upcoming change in seasons is growing.

I am writing this late summer article for those of you who struggle with seasonal depression, or have wondered if you might. I am writing now, before the onset of the fall season, because I want for you to be proactive before this problem gains a foothold in your life.

The research is unclear about the average percentage of the population that suffers from seasonal affective disorder. There has been substantial studies of those with depression, bipolar disorder and atypical depression, which show that 60% or more with these particular diagnoses have additional elevations in depression symptoms during the fall and winter seasons.

We've all heard the term "biological clock." We are now somewhat sure of exactly where this resides in the brain. One responsibility of our biological clock is to measure the amount of light that comes through our retinas. Then our nervous system communicates this information to the Pineal Gland. The Pineal Gland is responsible for producing Melatonin. The more light that comes through, the less Melatonin that is produced. In the fall and winter, when daylight hours are much fewer, the Pineal Gland produces much more Melatonin.

Ironically, Melatonin is a hormone known to have many positive benefits for us. It is prescribed for insomnia, helps with jet lag, improves immune function and is an antioxidant. The bad news for those of you who suffer from SAD is that it seems Melatonin is the culprit.

The symptoms for Seasonal Affective Disorder include, but are not limited to the following list:

1. Excessive eating
2. Weight gain
3. Depression
4. Excessive sleeping
5. Decreased physical activity; much more sedentary
6. Increased levels of fatigue
7. Unclear or sluggish ability to think
8. Feeling slowed down physically and mentally
9. Previous history of elevated depression in fall/winter
10. Strong cravings for sweets and starchy foods

Now, if some of this sounds familiar to you, and you're sure you do not struggle with seasonal depression it's because we all slow down some in the winter. We're biologically built to go into a sort of natural hibernation mode. The difference is when the symptoms listed above significantly impair several of your important life areas, such as family, social and work productivity in such a way that you are much less functional.

Take a proactive stance now. We're all familiar with "Prevention is the best medicine!" Have a fall and winter plan. Please, do it now while you are better able to put together a thoughtful plan of action. Here are some
starters:

1. Plan at least three social activities each month
2. Expose yourself to as much bright light as possible
3. Stay or become physically active through exercise
4. Have good support systems in place
5. Buy an indoor light box which gives 10,000 Lux natural
   full spectrum lighting
6. Start a natural or prescribed antidepressant four weeks
   prior to the beginning of mid-fall and terminate use four
   weeks following the end of winter. Talk to your family
   doctor about this.

For those of you who already have a depression diagnosis of one kind or another, and you know you dip deeper into depression in the fall and winter, this proactive approach is absolutely vital for you. And, I have some additional ideas for you.

1. Adjust the dosages of your antidepressants at the beginning and end of the fall/winter seasons
2. Add 3 new stress management skills to your skill base
3. Exercise!
4. You should own and use a light box, even in the summer months.
5. Monitor depression using a simple daily mood chart scale of 1-10, with 10 being severe depression. Commit to a
   "planned ahead" action you will definitely take (like seeing your family doctor) if your rating is over 6, three or more days in one week.
6. Make a list of past symptoms - a trigger list if you will. And share it with one other person.

A light box should be used very specifically, and there are a few concerns about using light boxes for seasonal affective disorder.

Light boxes work similar to the description above. If more light goes through the retinas, on to the biological clock, and through the nervous system to the Pineal Gland, the production of Melatonin will slow. The result will be elevated mood.

If you have any type of eye problems involving the retina you must consult your eye specialist first, before using a light box. These types of eye problems include macular degeneration, retinitis, pigmentosa and diabetic retinopathy.

The minimum amount of time to use a light box for a positive effect is 30-60 minutes. Generally the first positive response reported from sufferers of seasonal affective disorder is increased energy levels.

If you oversleep and struggle with getting up in the morning the best time to use your light box is in the morning. And, I know you don't want to hear this, but the best way to use the light box is to get up 30 minutes early and use it immediately for 30 minutes.

If you tend to nod off early in the evening, only take wake up too early in the morning and cannot get back to sleep the best time to use the light box would be in the evening.

Be careful if your diagnosis is Bipolar Disorder. You can still use a light box, and probably should, but there is some risk that you could go into a hypomanic or manic phase. The best time for Bipolar folks to use the light box is in the mid-afternoon. It is also strongly suggested that you stay
on, or use a mood stabilizer medication in combination with the light box.

Seasonal affective disorder is a very real and debilitating disorder. I suspect it will show up in a future edition of the diagnostic guide for the psychotherapy profession. You can make a remarkable difference in the quality of your fall and winter seasons by taking action now. Please help yourself out, you deserve to feel good year 'round!

To your best autumn and winter season ever!

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Dave Turo-Shields, ACSW, LCSW is an author, university faculty member, success coach and veteran psychotherapist whose passion is guiding others to their own success in life. For weekly doses of the webs HOTTEST success tips, sign up for Dave's powerful "Feeling Great!" ezine at http://www.Overcoming-Depression.com
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Depression Series: Why Don't I Respond to Medications? (Part 1)

Maria has been feeling depressed for at least two and a half years. About three years ago, her husband of 20 years left her for another woman. Devastated, she became despondent and tearful almost daily.

Eventually, her depression got worse associated with inability to function. Her appetite, energy, concentration, and sleep became impaired. She also felt hopeless and suicidal. Her psychiatrist put her on a starting dose of antidepressant. She responded initially but after a few days, she felt just like before taking the medication.

For the past two years, Maria has tried four types of antidepressants. She has taken the usual adult doses of these drugs. Although she somewhat improves, she has virtually remained the same - depressed and disabled.

Maria seems to be taking the medications regularly. But why is she not responding to her antidepressants?

Maria is just one of the many depressed individuals who don't feel "normal" despite treatment. Depression is a treatable
disease but how come some people don't do well on medications?

There are many reasons why depressed patients like Maria don't improve on antidepressants.

First, is the diagnosis correct?

Depression can be caused by many clinical entities. Sometimes, knowing the right diagnosis is a challenge. Medical disorders, medications such as beta-blockers and benzodiazepines (e.g. clonazepam), and various psychiatric disorders can cause depression and they all require different treatment. If your doctor fails to identify and treat the true cause of your depression, you will remain depressed despite the use of antidepressant.

Second, are there co-morbid disorders?

Depression can exist along with other psychiatric disorders such as anxiety disorder, alcohol or drug problems, personality disorder, dementia, and psychosis. Depression will persist if these co-morbid disorders are not treated. For instance, depressive disorder with psychosis cannot be adequately treated just with antidepressant alone. You need an antipsychotic drug added to an antidepressant to treat the illness.

Third, is there an ongoing neurological or medical disorder that precipitates, aggravates, or complicates depression?

Hypothyroidism, hyperthyroidism, vitamin B-12 deficiency, pancreatic cancer, brain tumor, Parkinson's disease, and stroke can all cause depression. If any of these disorders are present, antidepressants are less likely to help. The goal in these situations is to treat the underlying medical condition. A 65 year-old lady came to see me complaining of severe depression. On evaluation, she disclosed that she had been on three types of antidepressants for the past four years with minimal response. I checked her recent laboratory results which showed an abnormal thyroid! No wonder, she was not responding to the medication.

Fourth, are there ongoing psychosocial issues?

Financial problems, family conflict, work-related stress can all precipitate and complicate depression. Despite adequate medication treatment, some individuals will remain depressed especially if such problems are not addressed by the therapist or psychiatrist. Is there any way you can reduce the stressors? Please do so the earliest you can.

The treatment of depression is frequently straightforward. Occasionally however, various factors complicate it. For antidepressant to be effective, a psychiatrist should ensure that the diagnosis is correct, that co-morbid psychiatric disorders and medical problems are treated, and that psychosocial issues are adequately addressed.

Maria's doctor should explore further the real problem and provide the most appropriate intervention.

About the Author:

Copyright © 2003. All rights reserved. Dr. Michael G. Rayel -author (First Aid to Mental Illness-Finalist, Reader's
Preference Choice Award 2002), speaker, workshop leader, and psychiatrist. Dr. Rayel helps individuals recognize the early signs of mental illness and provide early intervention. To receive free newsletter, visit www.drrayel.com. His books are available at major online bookstores.

Depression Series (Part 2): My Antidepressant Doesn't Work. What
Can My Psychiatrist Do?

Maria has been increasingly depressed for the past few years. She has tried at least four newer antidepressants but so far, she doesn't seem to respond. Unable to work, she's now feeling helpless and hopeless. Likewise, her family is discouraged. Frustrated and baffled by Maria's lack of progress, the family doctor refers her to a psychiatrist.

What can the psychiatrist do to help Maria?

The psychiatrist has several options in dealing with a treatment-resistant or refractory depression. First, Maria's psychiatrist can optimize the dose of her antidepressant. Maria has been taking low doses of antidepressants. In spite
of her lack of response, the medication dosage has not been increased. To obtain a clinical response, her psychiatrist
should increase the dose every two to three weeks. The antidepressant can be adjusted up to the maximum allowable
dose if no or only partial response is observed.

Second, her psychiatrist can choose to augment the effect of her antidepressant with another medication such as lithium,
triiodothyronine (T3), or buspirone. Among augmenters, lithium and triiodothyronine have the best support from the
literature. Despite lithium's efficacy, some doctors avoid this drug because it requires regular blood monitoring and
has unfavorable side effect profile such as acne, tremors, and thyroid and renal dysfunction.

Recently, studies have shown atypical neuroleptics such as olanzapine and risperidone to be good augmenters. In my
opinion, further studies are necessary to establish these two drugs as standard augmenter. Indeed, research studies
and clinical experience have found augmentation strategy to be effective.

Third, combination strategy is worthwhile to try. Maria's psychiatrist can add another antidepressant to boost the effect of her current antidepressant. For instance, trazodone can be added to an SSRI (serotonin reuptake inhibitor e.g. citalopram). Literature suggests that combining two drugs with different mechanisms of action and drugs that involve several brain chemicals has resulted in clinical improvement. In this scenario, one antidepressant plus another antidepressant is equal to three, or four or even ten, not two.

Fourth, the psychiatrist can switch from one antidepressant to another. Previous studies have shown that when making a
switch, a drug should be replaced by a drug from a different class e.g. from SSRI to SNRI (serotonin and norepinephrine reuptake inhibitor e.g. venlafaxine), or from TCA (tricyclic agent e.g. nortriptyline) to SSRI. But recent studies show that switching drugs within the same class (e.g. SSRI to another SSRI) is just as effective.

Fifth, Maria's psychiatrist can also treat other ongoing symptoms or drug-related problems that further complicate her depression. If she is anxious and agitated, then her psychiatrist should prescribe antianxiety drug (e.g. lorazepam) or if Maria is psychotic then adding an antipsychotic drug should help. Moreover, medication side effects (such as insomnia, dryness of mouth, constipation, etc.) that negatively affect Maria's compliance to the drug should be addressed promptly.

Lastly, if despite above measures Maria doesn't respond to antidepressants, then electroconvulsive therapy should be
entertained. Of course, this procedure should be done with her consent.

In summary, Maria's psychiatrist can optimize the dose, augment or combine treatment, switch the medication, treat side effects and ongoing symptoms, or use electroconvulsive therapy for treatment-resistant or refractory depression.

About the Author:

Copyright © 2003. All rights reserved. Dr. Michael G. Rayel - author (First Aid to Mental Illness-Finalist, Reader's
Preference Choice Award 2002), speaker, workshop leader, and psychiatrist. Dr. Rayel pioneers the CARE Approach as a first aid for mental health. To receive free newsletter, visit www.drrayel.com. His books are available at major online bookstores.

Depression Series (Part 3): What to Do with Those Antidepressant Side Effects?

Maria's depression was difficult to treat. As you can recall, various medications had been tried to no avail. But
after several months of treatment, Maria has eventually become stable on a combination of two antidepressants.

She's now able to do her usual activities and is motivated to go back to work — something she has struggled to do for a while. Despite her improvement, antidepressant side effects have emerged and are bothersome. Maria begins to consider discontinuing her medications prematurely.

Antidepressant side effects are real and negatively affect patient's compliance. Many patients like Maria consider
stopping the medication even at the risk of relapse because of distressing side effects.

How do you deal with some of the common antidepressant side effects?

Insomnia
Some antidepressants e.g. SSRIs (serotonin-reuptake inhibitor) are highly stimulating that they cause insomnia
when taken in the afternoon or at bedtime. Take this type of medication in the morning. Discuss with your physician the
use of a sedating medication such as trazodone or sedative-hypnotic drug along with the antidepressant. If you
want to take only one pill, talk to your doctor about switching to a sedating antidepressant such as mirtazapine.

Moreover, sleep hygiene should be practiced. Avoid naps and intake of caffeinated drinks such as coffee and soda in the afternoon and evening. Involve in regular exercise and physical activities during the day. Moreover, use the
bedroom only for sleep and sex and not for recreational activities.

Weight gain

Regular exercise is weight gain's antidote. If no medical contraindication, you may consider jogging, walking, or
swimming. To reduce some excess and unwanted fat, keep yourself busy with physical and recreational activities.

How about diet? Diet has always been a part of any weight control regimen. Monitor your carbohydrate intake. Ice
cream, chocolates, and other high-caloric foods should be reduced. If none of the above works, talk to your doctor
about switching pills.

Sexual dysfunction

Sexual dysfunction happens too often but is rarely asked or discussed in the clinic. Some physicians and patients feel
embarrassed about this subject. When you have concerns, be open to your physician. Discuss the possibility of switching medication to an antidepressant (such as bupropion or mirtazapine) that doesn't significantly impair sexual
functioning. Also, talk to your doctor about adding another drug such as bupropion, yohimbine, or even mirtazapine to
counteract the sexual side effect.

How do you know if the sexual dysfunction is from the pill rather than from depression? If the dysfunction persists
despite successful remission of depression, then you should consider other causes such as drug-induced dysfunction or
other medical causes e.g. diabetes.

Dry mouth

Tricyclic antidepressants (TCA e.g. amitriptyline) are notorious for causing dry mouth. Why? These drugs have
distressing anticholinergic side effects. Avoid this type of drugs. If TCA is still considered, talk about the use of
desipramine or nortriptyline. Compared to other TCAs, these two drugs have less anticholinergic effects.

Moreover, try ice chips. Frequent sips of water should also help. To avoid dental cavities, try sugarless candy or
sugar-free gum.

Constipation

Like dry mouth, constipation is usually caused by TCAs. To prevent it from happening, drink enough water and eat high
fiber foods such as vegetables and fruits. Consider stool softeners if the above interventions fail. If possible,
avoid TCAs.

Nausea and vomiting

Patience is the key in dealing with these side effects. Frequently, patients develop tolerance within two weeks.
Take the medication with food. If ineffective, talk to your doctor about possibly reducing the dose of your medication
or trying antacid or bismuth salicylate (Pepto-Bismol)

Memory lapses

If given permission by your doctor, try to reduce the dose. Also, discuss with your physician about switching
antidepressant (especially if dose reduction doesn't alleviate your concern) and avoiding drugs with anticholinergic side effects.

Moreover, don't mix the antidepressant with alcohol. The alcohol-drug interaction can only worsen the memory and
cognitive functioning. While on psychotropic drugs, be careful driving and using mechanized equipment.

Dizziness

While still in bed, sit up for 30 seconds, then stand up for another 30 seconds while holding a rail, a table, or a chair
before walking. Take the medication at bedtime. Some people use support hose with success.

Agitation or anxiety

Some people benefit from a brief use of benzodiazepine such as lorazepam. Breathing exercises and progressive muscle
relaxation should also help.

In general, some side effects such as gastrointestinal upset and insomnia may resolve in a few days. Patience is the key.
However, be on guard. When they occur, address them promptly. I'm not however suggesting that you should be your
own doctor.

Collaborating with your doctor is an effective way to cope with mental illness and medication problems. Treatment
options such as the need to switch or reduce medications should be discussed in an open and accepting manner.

About the Author:

Copyright © 2003. All rights reserved. Dr. Michael G. Rayel – author (First Aid to Mental Illness–Finalist, Reader's
Preference Choice Award 2002), speaker, workshop leader, and psychiatrist. Through the CARE approach, Dr. Rayel helps individuals recognize the early signs of mental illness and provide early intervention. To receive free newsletter,
visit www.drrayel.com. His books are available at major online bookstores.

“Sixteen Things We Say When We’re Being Flooded,”
by Susan Dunn, MA Psychology, The EQ Coach

"Flooding" means your emotions have overtaken your ability to reason. The reptilian brain, designed to keep us alive, sends strong messages designed to stop us from thinking. If a wild animal was charging toward you, and you stopped to think, "Now what species is that?" you would be dead.

The reptilian brain tells us to quit thinking and act, and in today's world, there are times when that's not in our best interest.

Tears, screams, noises and physicals behaviors being the extreme, here are some of the ways to know you've been flooded.

1. I can't think straight.
2. I'd like to kill her.
3. This isn't like me.
4. I have no idea.
5. I don't know what to say.
6. I have to have that man.
7. Help!
8. What did you just say?
9. I'm a nervous wreck.
10. But that will never happen to me.
11. I can’t possibly do that.
12. This is insane.
13. I can’t help falling in love with you.
14. I’ll do it, but it’s against my better judgment.
15. Why am I doing this?
16. I feel like I've lost my mind.

©Susan Dunn, MA Psychology, The EQ Coach, http://www.susandunn.cc . Get to know your brains
– study emotional intelligence. The EQ Foundation Course, The EQ Learning Lab, and The EQ eBook Library are here to help you. Mailto:sdunn@susandunn.cc for FREE eZine.

Ogres are like onions"~ Shrek, "They smell?"~ Donkey, "No, they have layers. Onions have layers, Ogres have layers. End of story, bye bye, see you later."~ Shrek "You're so wrapped up in layers, onion boy, you're afraid of your own feelings."~ Donkey
~from the movie "Shrek"

Healing Is Like an Onion

By Fran Hafey

Unpeel an onion. As you're unpeeling it, you notice it keeps going and going until you reach the center and even then you can peel until there is nothing left.

That's what we need to do when we heal. We need to begin peeling away the outer layers that aren't needed, throwing them away. As we work to the next level we deal and heal with that part. It's not an easy or short process, and can be different for everyone.

Sometimes the peeling away can make us cry just like that onion. We reach memories and old wounds that open up and can cause us many emotions. What ever they are, they need to come out, be dealt with and understood, no matter what they are.

Getting rid of the "old stuff" has to be a decision we make on our own. No one can walk our journey for us. We may have many teachers and people that love us and can help guide us, but the choice us ultimately ours.

Just as the donkey said above, sometimes we're so wrapped up in the layers we're afraid of our real feelings. How often do we hide from them, instead of facing them head on, dealing with them and then letting go, allowing them to dissipate into the air like the mist that once surrounded us and kept us from seeing and feeling the truth?

Like the Ogre, we know we have the layers, but we avoid them until one day the shifting of energy brings them about and we must face them. We can only run so far and why not decide to reclaim your personal power, pick up your sword of light and cut those layers away.

Peeling away the layers of pain, hurt, misery, un-forgiveness, anger, discomfort and doubt will indeed make more space and time for those things that bring us joy!! As these things come to the surface, we are then able to sort them out, face the questions we have and note our reactions to them. We can then deal with them once for all, allowing ourselves to let in the light of love, peace and healing.

You'll be amazed at how wonderful and free we can feel when we finally reach the layers worth saving and healing. So lets get started today peeling and healing!!

Copyright: Mystickblue (c) September, 2003 All rights reserved.

About the Author

Fran Hafey is a Spiritual Counselor, Writer, Healer and Earth Activist She provides guidance and inspiration via her Website, groups and newsletter through the Internet and other Resources.
To read more of her articles visit the Author's
Website: http://Mystickblue.com or
http://groups.yahoo.com/group/SpiritualPathways/join
She's currently working on publishing her own books about love, inspiration, peace, magic and nature stories for Children of all ages.

Using Your Journal To Heal Emotional Wounds

Are you an adult suffering from the effects of a difficult
childhood? Were you abused or a witness of abuse in your family?

If you have unresolved issues from your past, using a journal can
help you sort out your feelings, and `release' you from your past
tramaus.

Medical research has shown that writing about unresolved, upsetting
Events can actually improve your physical well being - both short
term And long term.

Before you start, it is important to formulate a plan for dealing with difficult feelings that will come up. Remember that the purpose is to heal ourselves, not re-traumatize ourselves.

Here are some tips on how to get started with this difficult, but necessary, task:

1) Start slow. Before you put pencil to paper, close your eyes, do some deep breathing or yoga exercises.
2) Date and time your entries. Record how you're feeling now, then delve into your past.
3) Give yourself permission to write whatever comes up. Be honest with yourself. No one ever has to read what you have written.
4) As you approach your painful subject, you will likely be tempted to stop writing, to push back down those painful feelings. Develop self-soothing behaviors that will calm your anxieties, but not obliterate them. Take a break - Play with the dog; water the plants; go for a walk or shoot a few hoops. When you're calmer, sit
down and start writing again.

By putting your difficult past into writing, little by little, you will start to lighten the load you've carried all these years. You will actually feel lighter. Once you face the truth, you can heal from it, and put it behind you.
Then you can move on to a future that is unhampered by your past.

****************************************************
Maryanne Fitzgerald is the publisher of Moms World
E-zine. To subscribe send email to:
mailto:mfitzgerald41@cogeco.ca?subject=SUB
or visit: http://www.homeincomesolutions.net
****************************************************

"Ten Ways to Beat the Heat,"by Susan Dunn, MA Clinical Psychology, The EQ Coach

It's the dog days of summer (in the northern hemisphere) when the temperature goes us (and has been up for a while) and tempers can flare. Learning to manage anger is an emotional intelligence competency and a process of personal awareness and growth.

1. Understand the physiological process and how it effects you.

It's called affective neuroscience, and you'll find it fascinating. Check it out! Take an EQ course http://www.susandunn.cc/courses.htm ) and get the basics so you understand what's going on
and how it works within you.

2. Learn your hot buttons and what triggers your temper. For each of us it's different.

3. Learn what causes stress in your life and eliminate what you can. Work with your coach to remove obstacles, generate options, reframe problems, meet goals and lessen the frustration in your life.

4. If it's beyond your control, let go and let God.

5. Develop some healthy outlets for your anger such as whacking weeds, hitting a tennis ball, meditating, or practicing yoga..

6. Learn how your diet affects your disposition.

We are what we eat. Caffeine, and high fat/high cholesterol food increase irritability. Remember the 3 white poisons - sugar, flour and cocaine.

7. It can be as simple as getting enough rest and sleep.

Drugs, including over-the-counter medications can also affect your mood and ability to handle your
emotions.

8. Learn to cool down, just as you do after exercising.

Stop, count to 10, take deep breaths, think about something distracting. Sunsets and rivers are often suggested, but for you, it might be thinking back over an exciting ballgame while you sit in that traffic jam. Learn to self-soothe so you can "regain your senses" and think clearly. Take a time-out if need be and come back to the issue
later on.

9. Do things that foster your self-esteem.

When you feel good about yourself, anger is more manageable, and you earn your self-esteem!

10. Get emotional intelligence coaching.

You must get coaching in addition to reading and study, because EQ involves social and emotional
skills that must be practiced with expert guidance.

(c)Susan Dunn, MA Clinical Psychology, The EQ Coach, http://www,susandunn.cc. Coaching for all
your needs, with an emphasis on emotional intelligence applications to all areas of your life. Mailto:sdunn@susandunn.cc for free ezine.

HOW TO TELL SADNESS FROM DEPRESSION

You have and will experience sadness. It might be the loss of a job, pet or a loved one. Yes, even a loved one. The trouble is, particularly here in the United States, we have a quick-fix for everything... why not sadness too?

Our quick-fix for sadness is that it's simply not allowed. Healthy purging of sad feelings is great for you physically and wonderful for your mental health. When you stuff the expression of healthy sadness it may lead to health problems, interpersonal issues and depression.

So, the first lesson is FEEL your sadness over whatever issue is at hand. It doesn't make you weak or less a man or woman to do so. Yes, I have to say "woman" today too, because women have also begun to place the same negative meaning on expressing feelings of sadness; so they hold back too.

There are Five Basic Stages you will go through with a significant change or loss in your life. They are:

1) Shock/Denial
2) Anger
3) Asking "What if..." questions
   or making "If only" statements.
4) Sadness
5) Acceptance

Please keep in mind several points about the five statements made above. First, each one is NORMAL! You may cycle through the steps several times and may not do so in the order listed above.

The only time these steps become a problem is when you become stuck at a particular step. Here's an example.

I met a woman about a year ago. She'd been married over 25 years. She and her husband were planning on traveling after he retired. He died within a year of retirement from cancer. She came to see me three years after his death.

She had become stuck at step 3 above. She questioned, over and over again, whether she had done everything she could for him and all their family during those last days before his death. After about a year of ruminating minute-by-minute, she became quite seriously depressed. Then later, she was referred to me by her physician.

We worked through her questions from step 3. She then went through a normal period of being angry over the loss of her husband and how that had changed her life and retirement plans. She felt appropriately sad about the loss of her best friend.

She's not terribly happy about working, but she's been working full-time now for about six months. She is hoping to begin dating. She's insecure about it. "It's been so long since I've dated!" She quips. But, she is on her way to a new life and her level of acceptance is growing each day.

Other times depression may set in from a traumatic event, or a series of negative life events that overlap and
overwhelm your usual ability to cope. If this is you, you are often bewildered as to why you can't simply shake out of it as you normally would. Or if it was a trauma event, you will often find that simple security issues (e.g.,
walking out into a dark parking lot at night after shopping) will trigger panic and later deep depression.
Sudden trauma threatens your sense of general safety in the world at large.

If you are wondering if you have Major Depression here are some guidelines to help you to the correct answer. For the best possible solution please seek professional evaluation. I offer professional consultation for individuals through email, making this step easy and convenient.

MAJOR DEPRESSION SYMPTOMS:

1) Depressed mood nearly every day.
2) Diminished interest    in regular activities.
3) Significant weight loss or weight    gain.
4) Sleeping difficulties.                                                                                                                                      5) A feeling of being    "slowed down."                                                                                                             6) Fatigue and energy loss nearly every day.
7) Feeling worthless or excessive and inappropriate guilt.
8) Difficulty in staying on task or making decisions. 9)
   Frequent thoughts of death, including but not limited to
   suicidal thoughts.

Having a few of these symptoms does not necessarily qualify your for the diagnosis of Major Depression. You need to have at least five symptoms consistently over a two-week period of time or longer.

If you decide you have Major Depression please confirm this with a depression screen which you may find on my website at http://www.overcoming-depression.com/depression-symptom.html Additionally, please consult your family doctor and a trained professional who specializes in depressive disorders. A family doctor can assist in ruling out a possible medical condition and a therapist knows how to assist you in digging yourself out of that deep depression rut.

Dave Turo-Shields is an author, university faculty member, success coach and veteran psychotherapist whose passion is guiding others to their own success in life. For weekly doses of the web's HOTTEST success tips, sign up for Dave's powerful "Feeling Great!" ezine at www.Overcomingdepression.com-

DO YOU LOVE SOMEONE WHO SUFFERS FROM DEPRESSION?

Relationships in which one individual is depressed are nine times more likely to divorce. Wow, the normal divorce rate is already over 60% nationally! But, it's not always a spouse who is depressed, sometimes it is a child or an extended family member.

In this article, however, we'll be focusing on depressed partners. Most people agree that marriage should be 50/50. We all know this is an ideal, and, with the ebb-and-flow of
marriage, the percentages slide up and down but should do so in both directions. For instance, one week the wife gives 70% and the husband 30% and another week the husband give 80% and the wife 20%. This is the way "ideal" marriages work.

Unfortunately, this is not the case when chronic depression enters the marriage. Let's say that the husband has chronic depression. The wife may pick up many of the tasks that would customarily fall to the husband. Depending on how long this goes on, an avalanche of negative momentum begins.

The longer this process goes on, the more the wife begins to feel resentful, hence, there is less compassion for the
one struggling with depression. Yet, for the wife, it's like being a single mother while married. I've been told by many spouses that it would be easier to be a single parent than to live with a spouse struggling with depression, because it's like having a special-needs child in addition to all the other responsibilities.

I do not make any of these remarks to assign blame or heighten anyone's sense of being victimized. It's very important to understand that EVERYONE suffers when depression attacks a loved one. Blame only functions to create animosity and distance between two loved ones.

Sometimes the spouse of a depressed partner becomes depressed as a result of living within a "depressed lifestyle" for too long. Depression is said to be contagious and can become a shroud over the spouse or family. It's also vital to consider that depression may not only be genetic, but it can also be taught. You heard me right. For instance, our children's most powerful classroom is the home. Both "Nature and Nurture" contribute to depression.

Depression works its way into your moods, attitudes, behaviors, tone of voice, posture, life outlook, personal hygiene, work ethic, spiritual beliefs and so on. If you live in a "depression atmosphere" you are constantly modeling and teaching how to be depressed. I hope this serves as inspiration for change, not shame. Shame only feeds the power of depression.

The first step in a plan of action is to know that it is actually depression that you're dealing with. I won't go into those details here. You can find those answers at the website listed in my biography below.

Naming and accepting the problem is half the battle, for BOTH spouses. Why? Well, when folks are depressed, there
is no obvious scientific evidence to prove it. And yet people have an instinctive need to what is causing such pain. The depressed person may project their negative feelings onto those closest to them, i.e. a spouse, a boss, the children, the neighbors etc. If you're married to a depressed person, at times you may question your own sanity.

You might blame external sources for your spouse's suffering. Without understanding, you might attack your spouse, assuming they do not care or are lazy. What appears to be marital problems, may, in fact, be depression. But certainly marital problems can develop over time when depression goes untreated.

Another important fact to point out is that men and women experience depression differently and each will respond
differently when their spouse is depressed. This requires two separate articles just to begin to respectively cover
gender issues involved in depression.

Here's what to do. First and foremost, realize that depression is the foe, not your spouse. Developing a "we" instead of an "I" approach to depression treatment is vital. A good recovery motto might be best summed up from the cartoon, Bob the Builder: "Can WE do it? Yes WE can!"

Do everything you can to learn about depression. Seek professional advice. If depression has been present for a
long time, both the relationship and the depression will require attention.

Have individual and marital recovery plans. It's the surest way to give depression the one-two punch that can knock it out of your lives. Write your recovery plans down and spend time reviewing, modifying and noting progress
made.

Once depression is stabilized, create a list of "red flag" symptoms. This serves as your safety net. If these symptoms recur it would indicate that prompt attention is required. Then list solutions you each are willing to act on if you notice symptoms reappearing. Commit to this in writing and each of you sign it.

Create external support systems. Note that I did not say external griping sessions. There's a major difference
between griping and purging. The former only feeds righteous resentment, and deepens the depression problem
overall, and the latter helps clean you out.

Support pillars can be comprised of friends, colleagues, churches, support groups and any place you decide is safe
to disclose to. Do not hide your dirty laundry in the closet, so-to-speak. Depression loves to isolate individuals, marriages and entire families. It's one of the primary ways it grows strong.

Do recovery activities together. Attend therapy or psychiatry sessions together. Participate in online counseling together. Read a depression recovery book together. Exercise together, pray together or keep a mood log together. If your children are at the appropriate age, educate them about chronic depression. There are good children's books on chronic parent illness.

Most importantly, develop the "WE!" It's you and your spouse against this powerful depression foe. Together you
can do this!

Best recovery wishes and always let me know if I can be of any help.

Dave Turo-Shields, ACSW, LCSW is an author, university faculty member, success coach and veteran psychotherapist
whose passion is guiding others to their own success in life. For weekly doses of the webs HOTTEST success tips,
sign up for Dave's powerful "Feeling Great!" ezine at http://www.Overcoming-Depression.com

by Dave Turo-Shields

In a recent study of 2,921 single and married mothers it was discovered that single mothers have a 40% higher
incidence of major depression, with a depressive episode lasting an average of 12 months.

There are two primary areas that catapult single mothers into depression. These are:

1. Increased number of life stresses

2. Decreased amount of social support

These findings correlate strongly with my experience in working with depressed, single mothers. What the research
did not address was the Catch-22 that single mothers are in.

If you are a single parent you already know what I am about to say. If a non-married, childless adult observed all
that a single parent does throughout a day, they would need two days sleep to recover from watching such an exhausting day in the life of a single mom.

A single mother often does the work of three people on any given day. Now, ask that single-mother to take time to
reduce a stressor and increase her social support system and boy are you in for a fight!

There does not appear to be a way out. It's love, duty, hard work and little sleep for single moms.

Is there a better way?

Yes! However, before presenting it to a single mother, you'd better make doubly sure you've done a glorious job of
attempting to understand what her average day is like,

FIRST!

When an individual is heard, and I mean really listened to from the heart, they have a tendency to open up ("Seek
first to understand..."). Then you may have the opportunity to offer suggestions.

Now, let's flip the coin. Single mothers are often not just exhausted, but can also be jaded, indignant, prideful
and stubborn. Life has not turned out the way they dreamed it would. Perhaps there were marital dreams, dreams of the perfect home, dreams of providing the best for their children, dreams of spending more time with their children and dreams of being the perfect family and more. All lost.

In place of those dreams they may have bitter feelings over the marital loss, less than optimal living situations, no
"play" time with their children, visitation issues, child support issues, financial stress and the list could go on
for many more pages, couldn't it?

If you are a stressed-out single mom, please pay special and close attention to what I wrote above (maybe read it
twice)... then read on.

Here are some ways to make your life easier. They are listed in no particular order, except if you are moderately-
to-severally depressed. If that's the case then Major Depression (diagnosed by a professional) demands prompt
attention first and foremost. Please, please take care of you! A few folks are counting on you to ;-)

1. Immediately seek help medically and professionally for depression.
2. Live forgiven towards yourself and others.
3. Compromise with that critical "Inner Judge" that only seems to want to persecute you unfairly.
4. Put down your pride and take ALL the help you can get --    if people offer, accept; if you need help, ask!
5. Implement "quickie" stress relievers such as deep breathing, going to a getaway in the mind, a quick 10
   minute hot shower...
6. Get organized and/or ask for help in doing so. It's    especially important to do so around daily routines such
   as morning rituals, after-school rituals, chores, mealtimes, baths, bedtimes and family fun time.
7. Keep the clutter-bug out of your life. Commit to only    looking at mail once. Recycle household items
   continually -- if you're out of space, it's time to    recycle. Get your kids involved.
8. Create a single parent co-op, where you can switch on and off with transporting kids, doing house or apartment
   projects, babysitting for each other...
9. Are you doing for your children what they can do for themselves? Feed their sense of mastery and
   independence. They often will feel great knowing they have helped their family out in some way.
10. Keep a sense of humor. Many a single mother has told me, "If I didn't laugh I don't know what I'd do."
11. Get your children involved in camps, church, Sunday Bible School, Big Brother/Big Sister Programs, mentoring
    programs. Let others offer what you don't have the time or energy to offer.
12. Seek financial advice. Having direction and a plan sure beats constant worrying!
13. Keep a family calendar. It's nice to allow your kids to be in activities, but don't overdo it -- one per season
    is a good rule.