Depression is sometimes perceived as a character flaw, being overly emotional, or just having a bad day. It's not. It's a real condition with treatment options, and real consequences when untreated. 

• Isolation
• Decline in physical health 
• Missed work and lack of job security
• Impaired relationships
• Substance use and addiction
• Suicide

All can be consequences of untreated depression.  Studies show that counseling can be as effective as medication in some cases, and is highly effective in combination with medication. So talk to your doctor and visit a therapist if you have 5 or more of these symptoms:

• Sadness lasting all day almost every day for 2 weeks or more
• Loss of interest lasting all day almost every day for 2 weeks or more
• Appetite changes
• Sleep changes
• Intense guilt
• Difficulty concentrating
• Chronic fatigue
• Feeling physically sped up or slowed down
• Suicidal thoughts and hopelessness

I regularly encourage clients to develop a "self-care" plan as a way to manage the challenges and difficulties that life regularly presents to each of us. Self-care can be anything that provides a sense of ease and comfort, and varies depending on each individual. Sometimes we identify things like exercise, meditation, joining social groups, reading, watching movies, aromatherapy, hiking.

​Because my personal and professional experience tells me that yoga is an effective tool for self-care, I often encourage clients to try it and sometimes I teach them yoga during our sessions. Likewise, I often hear clients say that they find a sense of peace in the outdoors, I encourage them to go to natural places as regularly as possible, as much as our urban environment here in Dallas allows. 

​This past week, I came across two articles about these very things. 

This article in Medical News Today outlines three new research findings that support the use of yoga as a supplement to treatment for depression. They each followed patients who scored high on depressive symptoms prior to starting a yoga program (Bikram in one study and Hatha in the other two studies) and found significant symptom reduction at the end of the program. In one of the studies, symptom reduction lasted for at least four months after the end of the program.

​These study results are no surprise for those who have personal experience with the mental benefits of a regular yoga practice. We are learning more and more that empirical research findings support it as well.

The Japanese call it taking a "nature bath", referring to the practice of fully immersing oneself in the sights, sounds, smells and textures of natural places. What a wonderful way to describe the common feeling of peace that many of us experience when hiking, camping, swimming, and discovering beauty in nature.

​This article in Time magazine outlines how connecting to "green space" can improve mood and wellbeing for many of us. It highlights that the quality of greenspace is more important than quantity. For instance, cleanliness, accessibility, and the ease of connecting to others are more important factors than the size of the greenspace. So for those of us that live in urban environments, local parks, walking trails, and tree lined neighborhoods are resources to our mental health.

So... if you're finding your mental health challenged today, if you're feeling down or anxious or stressed or angry... break out that yoga mat and do some downward facing dogs and sun salutations. Take a walk to your local park and circle it a few times. Take some deep breaths of the soft breeze. Watch the birds, and listen to them. Feel your heart beating as you move and know that you are giving yourself a wonderful gift!

.Psychosis involves one or both of the following:

• Hallucinations. Hallucinations occur when you hear, see, or otherwise sense something that is not actually present. Auditory hallucinations occur when something is repeatedly heard that others do not hear, most commonly voices. Voices can be loud or quiet, aggressive or gentle, sudden or predictable.  Visual hallucinations involve seeing something that others do not see. These experiences may include seeing shadows, people, animals, or other figures. Less frequently, other types of hallucinations occur. These include tactile (feeling something on the skin or inside the body that isn't there), gustatory (tasting something foreign or inexplicable), or olfactory (smelling something with no known cause). 
• Delusions. Delusions are fixed, false beliefs to which you hold strongly and which interfere with your normal cognitive functioning. Examples could be believing that you are being followed, or that your phone is tapped. These are examples of persecutory delusions. They can be accompanied by hallucations, such as seeing someone following you or hearing someone tampering with your phone. Other types of delusions also exist. Delusions of grandeur involve believing you are special and different from others, have been chosen to perform special tasks, or are being given special sorts of information. Delusions of guilt or sin involve beliefs that you are unforgivable and/or should be punished.  Erotomanic delusions involve beliefs about others being in love with you. Delusions of reference involve placing unusual significance on specific objects, people, or events in your environment. 

Psychosis is not a mental health diagnosis, but rather a set of symptoms that accompany a diagnosis. Schizophrenia, schizophreniform disorder, and brief psychotic disorder are three diagnoses distinguished only by the duration of time symptoms have been present. They each include either hallucinations or delusions, may include disorganized speech and/or behavior, and may include what's called "negative symptoms" which manifest as lack of emotional or behavioral expression. Negative symptoms include decreased interest in activities, decreased speech, decreased social interaction, or decreased ability to experience pleasure.  Schizoaffective disorder involves the symptoms of schizophrenia listed above, with an accompanying mood disruption like depression or mania.  Delusional disorder involves delusional thinking without the symptoms listed above that indicate schizophrenia-related disorder. Depression and bipolar disorder in their most severe forms can include psychosis as well. 

Psychosis can be induced by substance use, and usually pass once intoxication passes. Most notably, methamphetamine, hallucinogens (particularly synthetics like K-2), and stimulants like cocaine can induce symptoms that look like psychosis. Acute alcohol withdrawal can also produce psychotic-like symptoms, and should be treated immediately.  

Some medical conditions may also induce psychosis. The most notable conditions in which this may occur are endocrine and metabolic disorders, autoimmune disorders like lupus, and temporal lobe epilepsy. 

Stay tuned for another post on treatments available for disorders that include psychosis. In the meantime, here is a helpful page from the National Institute of Mental Health on schizophrenia.

In order from most restrictive to least:

1.      Medically Managed Inpatient

• Supervised detoxification and stabilization under the care of 24/7 medical staff
  
• Provides safety when detoxing from substances like alcohol, benzodiazepines, opioids
• Helpful when clients have complicated medical conditions and co-occurring substance abuse and mental health conditions

2.       Inpatient or Residential (IP)

• May or may not include 24/7 medical care
• Involves a stay at the facility or hospital while receiving treatment.
• Can last from overnight, a few days, weeks, or in rare cases a month or more.
• Usually receive medical care, individual counseling, group counseling, family counseling, recreation, all meals
  

3.       Partial Hospitalization (PHP)

• Involves spending most all of the day at the facility or hospital, but evenings and nights are spent at home
• Usually receive medical care, individual counseling, group counseling, family counseling, some meals
• Removes you from your everyday environment without the added cost and time of spending nights
• Must have a stable and healthy home environment
  

4.       Intensive Outpatient (IOP)

• Involves 3-6 hours per day at the facility or hospital
• Involves group, family, and individual counseling, might share a meal
• Appropriate for those who need a high level of care to support a change in everyday living but need to maintain their work or school schedule
• Must have a stable and healthy home environment
  

5.       Outpatient (this is what Flourish provides)

• Weekly counseling sessions for family, individual, or group
• May or may not involve collaboration with physicians for medication management
• Focus may be on abstaining from substance use or problematic behaviors, and preventing relapse 
• Focus may be on “harm reduction”, or decreasing the amount or frequency of substance used
  

6.       Prevention and Early Intervention

• Information is provided to the general public about mental health and substance abuse
• May be used with  individuals experiencing life stress that may lead to substance abuse or mental health diagnosis

Health care professionals can help you make the best decision for what level of care is most appropriate. The first step is reaching out and letting us know what you're going through. We are here to help.

So this discontent that accompanies the holidays is another example of paradox in life...that along with joy comes pain, along with celebration comes sadness, and along with community comes isolation. Do you allow yourself to experience the not so joyful part of the holidays or do you avoid it? Do you accept your dissatisfaction or do you attempt to force yourself and others to be jolly? Is there a way to accept the imperfections of our families, friends, jobs, finances, and moods this holiday season so that we can then have a different... and better... experience? 

Here are three ways to process and accept the not-so-jolly feelings this time of year.

1. Name the negative feelings. Sad, Mad, Guilty, Ashamed, Rushed, Frantic, Afraid. Those are just a few of the many emotions we feel any time of year. But these "bad" feelings seem particularly closeted around the holidays, because really, who wants to be around an sad person at Christmas, or a mad person at Thanksgiving? But there's an important distinction between bringing others down and simply owning your emotions. By naming the feeling, recognizing when it's present, writing about it, painting a picture about it, talking to someone about it in an effort to move past it, you are coping in a healthy way. Complaining, whining, brooding, sulking, exploding, getting drunk or high...these are not healthy ways to express negative emotions because they impair relationships. These methods of expression send your loved ones running for the hills at the prospect of spending extra time with you this time of year. Take time to understand this distinction, then process the negative stuff in a way that will free you from it rather than creating more of it. 

2. Choose one negative experience you've had around this time of year that may still trouble you, and write about it in rich detail. Really delve into the memory of it.... with the following important caveat. 

Have a loved one or a professional within reach if your memory is extremely painful. Don't attempt to go at this alone your memory is traumatic, meaning it involved physical or psychological violence, a natural disaster, accident, combat, sexual abuse, or something equally disturbing. Use this checklist to help you recall traumatic events in your life. If you have experienced trauma, a mental health professional can help you work through it safely.

If you're memory is not traumatic, rather just unpleasant, continue this rich description process. Remember where you were, who was around (if anyone), what the surroundings looked like, particular objects, scents, and sights you recall from the day. Identify what upset you most. Was it specific words that were spoken, tone of voice used, and/or facial expressions that bothered you? Maybe you had a very negative experience and you were alone. What was the hardest part? Do you recall what was going through your mind? If your event involved the actions of others, what reactive thoughts do you recall having as the event was happening? What feelings did you have? It's important to distinguish thoughts and feelings here. Feelings get imprinted onto a memory and your later recollections of it, like at subsequent holiday gatherings or certain times of year. The feelings are the proverbial "baggage" that we carry. Once you've described your memory in detail, choose the least disturbing detail and bring it into your awareness while consciously relaxing for one minute. Set a timer on your phone, and sit in a relaxed state as you keep ask yourself, "is it possible to not pour more negative energy into this memory?"  Then over the course of the next few days or weeks, successively bring the more troubling aspects of the memory, one at a time, into your awareness as you practice relaxation. You are re-training your brain to process the memory in a different way, and eventually it will become less uncomfortable.

If you or someone you know if sad much of the time, is withdrawing from things they used to enjoy, seems hopeless or having thoughts about death, this poem may resonate with you. I wrote it sometime last year during a particularly long stretch of down days. I've struggled with depression on and off throughout my life, and writing about it has always helped. I encourage others experiencing depression to speak to someone you trust, and own that it happens. But don't let it define you. Being sad isn't all you are...you are a bright, blooming, vessel of energy beneath the veil of depression. 

Days Pass
by Kambria Kennedy-Dominguez


Nine days passed, or twenty nine, or ninety nine.

Breath keeps coming, oxygen flows in and out,

I am breathing above great wall of water.

Only to find I’m trapped again beneath

Clear white water turns to stale black confinement

Like quicksand.

A trick of the mind

Makes me believe I am sadness.

From under it I gasp, I must rise-- it is only water!

I command myself without compassion for illness or exhaustion

I must transcend this trick, expose the foolery of a sad mind

I grasp, I swim, I grasp

Upward toward air and daylight

As if there is leverage between finger and water

I slip down, giving way to downward pressure,

Moving fast to swallow me whole.

How scary is this darkness and the sinking--

What fear is provoked in the heart of a child to be swallowed up!

Fear leaves its image upon us, like a permanent tattoo,

Like a searing brand proving ownership.


Please share this with anyone you know. Forward to friends, share on Facebook, tweet and retweet. There are lots of organizations whose mission is to end the stigma around mental health issues. A particularly great page is http://notalone.nami.org. There are some courageous stories here of real people experiencing psychological pain.

I don't really like the term "mental illness" because it implies pathology or disease, and it's not always helpful to label our experience that way. One of the hallmarks of the counseling profession is our uniquely developmental and strengths-based perspective. Counseling grew from the need for career guidance in the early part of the 20th century when wartime in America shifted its workforce needs. The earliest counselors helped people find what they're really good and enjoyed, and encouraged them to follow that career path.  This emphasis on the clients' assets and how they can become productive members of society continues to inform our profession today. 


My own story reflects this. I've experienced depression, discouragement, ill health from lack of self-care, family issues, etc. Because others have helped me find encouragement and recognition of my strengths, I (most days) am lifted above depression to find my vessel of energy to bloom and Flourish...