Depression: What’s the hook?

When we teach the Powerful Tools for Caregivers class, one of the assignments for caregivers is to make an action plan to do something they enjoy each week.  Sometimes when we care for others, particularly in long-term caregiving situations, we can “lose ourselves” in the process.  The focus is so much about the other person that slowly parts of us erode away.  One of my colleagues tells about a caregiver who had “lost herself” for so long that she could not even remember anything that she enjoyed.  My colleague prompted the participant, “Did you ever do any crafts?  Sewing, knitting, crochet?”  As it turned out, the woman used to enjoy crocheting.  The instructor asked her to use crocheting as her action plan for enjoyment.  The woman balked.  She didn’t think she could do that.  In a stroke of inspiration, the teacher said, “Do you think you can either find or buy a crochet hook sometime this week?”  Sometimes, you just have to start somewhere.  

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As it turned out the caregiver found her crochet hook, and with it she found some skeins of yarn.  Eventually she found a few minutes to start crocheting.  Before she knew it, she was taking a bag of crocheting supplies with her to her husband’s medical appointments.  She still enjoyed crocheting!  When she found the crochet hook, she started to find a little part of herself that she had lost along the way.  

Sometimes depression can be a slow losing of yourself or a lack of joy and enjoyment. I have been reading about depression and one author suggested finding four things you can enjoy each day.  I think of the woman and the crochet hook.  When you are truly depressed, finding one thing may seem daunting.  A booklet from the National Institute of Health, explains that depression affects different people in different ways.  Depression is a real illness that is treatable.  And, if you have depression, you are not alone.  According to a Center for Disease Control site, during 2009–2012, 7.6% of Americans aged 12 and over had depression (moderate or severe depressive symptoms in the past 2 weeks). Depression was more prevalent among females and persons aged 40–59.

Loss of interest or pleasure in hobbies and activities is just one of the signs of depression.  A persistent sad or empty feeling, along with feelings of guilt, worthlessness and helplessness can be signs of depression.  Decreased energy and difficulty concentrating or sleeping are also symptoms and are worthy to note, particularly when these symptoms stretch out over several weeks.  Depression not only affects mood, but also cognitive abilities and can manifest in physical symptoms.  

There are many components that play a factor in depression, as well as multiple types of depression.  Depression can be different throughout the lifespan.  While there is much to study and learn about depression, one of the most important things to know is that depression is treatable.  The treatments may be as varied as the individuals who have depression.  I met a person once who even used an app on his phone to assist his mental health.  More commonly, though, treatment for depression includes medication or one of several types of therapies, or a combination of medication and mental health counseling therapies.

If you feel you have been dealing with depression, be sure to consult with a medical or mental health professional to see what therapies and/or medications might be recommended for you.  As well, there are some other things you can try.  Being active and exercising can provide a huge mental boost.  Spending time with others can be an uplifting activity.  Doing something good for someone else can go a long way to make you feel better.  Of course, doing something you enjoy or used to enjoy is particularly important.  

If you are feeling depressed, you need to find your “crochet hook,” whatever that positive thing might be in your life.  Like a string of yarn, you may feel unraveled or knotted up, but seek help until you find the pattern that works for you and your depression.  

The links below may be the hook you need for help:


Depression and College Students
Bipolar Disorder in Children and Teens
Bipolar Disorder
Depression
Depression in Women

Resources from MSU Extension:


Depression: What You Should Know
Fifty Stress-Busting Ideas for Your Well-Being
Handling Challenging Times
It's Your Choice: Decision Making and Goal Setting
Managing Anger for Better Health and Relationships
Understanding and Managing Stress
Understanding Grief and Loss After Death

Get Through the Crisis and LIve

I suppose if you live long enough, you gather some of those moments that are both vivid and vague – some mixture of surreal and so real.  As I think about one such moment in my life, I could describe exactly where I was, I could sketch the room down to the furniture placement and direction I was facing.  I know the date and the day of week.  What I cannot describe is the time of day, the weather or who called me with certainty.  Even the conversation is vague, but the reason for the call is vivid.  Too vivid.  My co-worker’s son, who was a 13-year-old 4-H member, had killed himself.  He was a delightful young man.  I was new to the job, so I had only worked with him for six months, but in that time, I was with him often through summer 4-H activities and after school programs.  He was an upbeat, energetic kid with an engaging and infectious smile.  I believe he acted impulsively that day, not truly realizing the permanence of his action.  

The day for him was a bit unusual.  He had gotten into some small trouble at school.  His mother had been called in and both were visiting with the school administrator when the alarm sounded for a fire drill, which meant he walked outside with his mom and the principal in front of the whole student body. He was given the choice between in-school or out-of-school suspension.  He opted for out-of-school.  His mom took him home, lined him out with some chores and went back to work.  When his dad came home, not much later… his son was gone.

I recently attended a training for 4-H Extension where one portion addressed youth in crisis.  As a former, and still certified, school counselor and teacher, I have had experience working with youth at crisis points.  One of my Extension colleagues was also formerly a school counselor and she made a salient point during discussion – all of us are counselors.  If a youth chooses to connect with you, you have been chosen by them for a reason.  My colleague encouraged us to be aware and to recognize the fact that we can all have enormous influence.  I think what she was trying to say is keep your eyes, ears and your heart open.  

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Montana has a high rate of suicide and has been among the top five states for nearly 40 years.  We tend to focus on youth suicides, perhaps because it seems like such a tremendous waste of potential life.  Maybe youth suicide bothers us because we realize that some of the things we once thought were huge challenges in our youth, only seemed so huge because we lacked experience in dealing with them.  The more challenges we face and conquer, the more we feel empowered to keep doing so.  I think, in the case of my young friend, he had never had anything that even slightly tarnished his otherwise stellar reputation before that day and he didn’t know how to handle it.  While to the adults in his life, his trouble may have seemed trivial and insignificant (or at least out of proportion with the cost of his life), to him, in that moment, it was monumental.  Certainly, no matter what age, some of what people are dealing with seems insurmountable, torturously difficult and painful.

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During the training, the instructor talked about how misunderstood suicide can be.  He spoke of the people who have attempted suicide at the Golden Gate Bridge in San Francisco.  Of the “jumpers” who have attempted suicide at the bridge, very few have survived.  However, and this is particularly important, of those who attempted and lived, when asked what their first thought was they went over the edge, the overwhelming majority said, “I wish I hadn’t done that.”  In fact, one jumper said, “I instantly realized that everything in my life that I’d thought was unfixable was totally fixable—except for having just jumped.”

A mid-century study followed up with 515 people who were prevented from attempting suicide at the bridge during a 30+ year time span revealed that indeed more than three decades later, 94 percent were still alive or had died of natural causes.   This study reveals that suicidal behavior is often acute and crisis-oriented.  It is quite likely temporary, if the person can make it through the high-risk period, which may be just a few months.  I have often heard it said that suicide is a permanent solution for a temporary problem.  

Which brings me back to my colleague’s comment that we are all counselors.  I’m not suggesting that we absorb responsibility for anyone else’s decisions.  For instance, the day that 4-H member completed suicide, I don’t know that I could have done anything to change the outcome, as I was entirely unaware of the events of that day, until it was too late.  Nor could any of the adults surrounding him have predicted the suicide based on previous interactions with him.  I do think, however, that if anything at all might have interrupted him, the impulse would have passed and he would have made it through what he perceived as a critical crisis.  You never know when you might be able to be that needed interruption.  

If you are in crisis and want help, call the Montana Suicide Prevention Lifeline, 24/7, at 1-800-273-TALK
(1-800-273-8255).  Reach out to someone.  There are people in your life and in your community who have their hearts open and want you to live.  

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The following resources were curated by Montana Department of Health and Human Development and can also be found on their website.

2014 US Suicide Data

2015 Montana Youth Risk Behavior Survey - Suicide Report

A Manager’s Guide to Suicide Postvention in the Workplace

A Prioritized Research Agenda for Suicide Prevention

Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment (SAMHSA)

After an Attempt

• A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
• A Guide for Taking Care of Yourself After Your Treatment in the Emergency Department
• A Guide for Medical Providers in the Emergency Department Taking Care of Suicide Attempt Survivors

After a Suicide Toolkit for Schools

Altitude and Suicide

Assessment of Suicide Risk using C-SSRS (please watch training video before using scales)

Bullying and Suicide Prevention- SAMHSA Webinar

Depression Management Tool Kit

Emergency Departments:  Caring for Adult Patients with Suicide Risk

Handbook for Recovery After a Suicide Attempt

Jail Suicide Study - 20 Years Later

Let's Talk Montana

• Let's Talk Billings
• Let's Talk Miles City

Means Reduction and Suicide

Media Guidelines for the Reporting of Suicide

Montana Strategic Suicide Prevention Plan-2013

Preventing Suicide: A Toolkit for High Schools

Preventing Suicide by American Indians

Primary Care Guidelines in Assessing Suicide Risk in Veterans

SAMHSA Suicide Prevention Toolkit for Senior Living Communities

Skills and Support for Coping with Suicidal Thoughts

Social Programs that Work - Good Behavior Game

SOS Flyer

State Suicide Plan

Suicide & Bullying

Suicide in Montana Handout

Suicide Mortality Review Team

• 2014 SMRT Final Report 
• Montana Code Annotated 53-21-1107 -  Montana suicide review team
• Suicide Mortality Review Team

Suicide Prevention: A Toolkit for High Schools

Suicide Prevention Toolkit For Rural Primary Care Providers

Suicide Prevention Resources for LGBT Youth

• Leader's Guide for Suicide Prevention amo`
  
  
  
  ng LGBT Youth Workshop
• Packet of Handouts for Suicide Prevention among LGBT Youth Workshop
• Suicide Risk and Prevention for LGBT Youth
• The Trevor Project

Suicide Survivor Handbook

Talking to Children About Suicide

Tools for Primary Care

• Basic scoring guide for Clinicians
• PHQ - Questions
• SAFETY Plan Template
• Safety Planning Guide
• Safe-T Protocol with C-SSRS

Warning Signs of Suicide

Warning Signs Poster

Youth Suicide Prevention Video

Zero Suicide

Hearts: For Loving and Living

In a recent Strong Hearts Healthy Women class, we discussed the connection between stress and heart disease.  We discussed that often we have not been taught productive ways to deal with our emotions or stress.  Coincidentally, my mom and I were recently talking with a friend about her parents and their health.  I never met my maternal grandfather, Fenton Burgess, because he died of a heart attack at age 50.  Mom said one day he told my grandma he wasn’t feeling well and thought he’d go see Dr. Buker at the clinic.  He was sitting in the waiting room when he dropped over and died from a heart attack.  The family knew of three other heart attacks that he had, but his autopsy showed enough scarring in his heart to indicate that he had perhaps had several more prior to the final one.  I know Grandpa Fenton smoked, which is a contributing factor, but while my mom was telling the story, she added a piece I had not heard before about Grandpa.   She said, “He struggled with his temper.” 

Studies have shown that people with a quick temper are at greater risk of suffering a heart attack or dying from heart disease.  Quick anger, or hostility, may increase blood pressure and contribute to the hardening of the arteries or atherosclerosis.  How emotional and physical changes in the body are linked is a fascinating area of research. Physical changes based on emotions, such as anger, can cause damage to the cardiovascular system.

Years ago, when I first moved to Teton County, I had the pleasure of attending a class in Browning, where I listened to an eloquent and wise women talk about disease in our society.  She broke down the word, “dis-ease,” and reminded us that any time your mind was not at ease, the body would find a way to manifest the situation and often it was in the form of disease.  In addition to temper, depression is found to have links to heart disease.  Depression is reported more in women. 

One of the natural ways to manage both anger and depression is through exercise.  Our Strong Hearts class participants thought of many positive mechanisms to cope with negative emotions.  The list included finding a walking partner or exercise companion, or volunteering to reduce social isolation and bring meaning to life.  Pets have long been recommended as a therapy for depression.  Yoga, Tia Chi, meditation and prayer also made the list.  Purposeful stretching and breathing can be beneficial.  There are many breathing exercises available, but one we tried in class was inhaling through the nose for a four-count beat and exhaling through the mouth for a six-count beat. 

We talked about some of the unhealthy responses such as overeating, over-consuming alcohol and smoking. Some newer negative tendencies may include binge consuming media, whether video or social media. Some concerns were raised about constant interruptions our devices and our world provide and how regaining purposeful focus can be so instrumental in reducing stress. In order to reduce stress, we may need to set boundaries as to when and where we respond and how often we take a break from social contact. Perhaps you’ve heard of FOMO, or the Fear Of Missing Out. In a March 2014 post, Forbes author Kristi Hedges put it this way, “You might have FOMO if you constantly check social media and email. This isn’t about logging into Facebook a few times a day; this is feeling antsy if you can’t be connected at all times. We like to blame our work cultures for forcing us to always be available on email, but in my experience, it’s more often a choice the person makes. After all, we train people how to treat us.” I think, in addition to exercise, meditation and breathing, we will need to learn how to disconnect to reduce stress. At the beginning of the year, I took four days to renew and refresh, and probably most importantly, to disconnect. I didn’t leave my house, didn’t answer any phones or emails and minimized my interaction with others. Sometimes, we just need to recharge for our mental and physical health.

This photo of Grandpa Fenton was on
display in our home.  It always made me
wish I had known him.  

As you think about the mind and body connection, you may want more techniques for dealing with the stress in your life.  The MontGuide, “50 Stress Busting Ideas forYour Well-being” may be a good resource for you.  I wish my Grandpa Fenton would have found some better ways to cope with his stress, so I might have been able to meet him. It is best to get a handle on your stress, not just for your heart, but for those you love, some of whom you might not have even met yet.