• Change is inevitable, but overcoming depression requires learning how to notice it and how to utilize the opportunities for positive change when they arise
• Symptoms often represent people’s best attempted solutions based on the absence of acceptable and available alternatives, but symptoms can resolve when better alternatives are discovered
• Clients almost always possess the internal and personal resources for positive change but need help developing them in carefully built up and gradual steps
• People’s most important resources often exist outside of our their immediate awareness: effective therapy involves helping people gain access to the resources they don’t know they already have
• People learn best when they encounter new experiences that naturally challenge them to expand their range of skills and put new problem-solving tools in their personal life skills “toolkits”
• The primary job of an effective therapist is to know how to access and utilize the naturally occurring  personal resources within each client and guide him or her on the path toward positive change

Applying our Therapeutic Approach with our Clients:

Sam’s* decision to seek therapy, he said, was primarily because of his physical pain caused by the car accident in which he was involved several years earlier.  He saw the pain as the basis for a slew of problems he now faced.  He was not able to participate in his life the way he did before the accident.  His marriage relationship was strained and he was more irritable and less patient with his children.  The intimacy that he and his wife used to enjoy was just a distant memory.  He had no energy or interest for those activities in which he used to find pleasure.  He had been demoted at work, which put additional financial pressures on him and on the family.  His weight had increased by more than 35 lbs, negatively impacting his self-image and lowering his already  injured self-esteem.  Sleep was erratic and non-refreshing.  Most worrisome to him was the expectation that his future held little chance of offering anything   except “more of the same.”   

Partners in Healing’s Whole-Person Approach to the Treatment of Depression

Treating Sam involved four therapeutic components that highlight the individually tailored approach that Partners in Healing (PIH) uses in the treatment of depression.  Of course, we recognize that other approaches to treatment can and do play an important role in the overall plan of care of patients.  That is why PIH clinicians strive to partner with health care professionals from other disciplines (e.g., physician colleagues) whenever possible.  We seek to provide effective, collaborative and integrative treatment experiences for our clients. 

• Psychotherapies: Treating depression typically requires identifying and learning to change the negatively biased thinking and emotional “habits” of  depression that serve to maintain a person’s limited self-view and reduces their chances of making  positive change.  By helping Sam to change the thought patterns supporting his negative self-fulfilling prophecy, he was able to open the door to positive change in his life. It also opened the door to pain management.
• Natural medicine therapies: Many people believe that treating depression requires altering brain chemistry.  This is one reason people seek prescribed medication in depression treatment.  We agree that at some level, every mood, thought and action involves a chemical aspect.  It is widely recognized that over-reliance on prescribed medication is not the most effective method of treating depression.  Moreover, there are many ways to impact the body’s chemistry without over-relying on prescription medications.  Sam met with our Naturopathic physicians and learned about natural therapies that supported healthier digestive and metabolic functioning of the body.  This nutritional and natural medicine support gave his body the nutrients it needed to support healthy brain functioning. With a brain that was metabolically healthier, he was able to put into practice some of the suggestions and skills he learned in his psychotherapy work.
• Self-regulation therapies: The ability to regulate one’s thoughts, emotions and behaviors is essential to healthy mental and emotional functioning.  Without self-regulation skills, we are at the mercy of our environment, reacting to whatever happens in our lives rather than actively shaping our life paths.  Learning to utilize self-regulation skills (e.g., hypnosis, biofeedback and meditation) was an important part of Sam’s overall depression treatment plan.  It also helped impact the psychological and physiological aspects of his pain disorder.
• Behavioral activation: We live in the world and not in our heads.  Therefore, an essential part of the Partners in Healing approach to depression treatment involves learning to weave the skills learned in therapy into the fabric of one’s life.  That was a critical part of Sam’s treatment process.  All three components of his therapy (i.e., psycho-therapy, self-regulation training and natural medicines) led to changes in how he conducted his life. The fourth element, the behavioral application of his skills, finally helped Sam to make a positive impact on his sleep cycle, his response to pain sensations, and his capacity to interact with his spouse and children in more satisfying ways. 

For more information on how Partners in Healing can help you with mood related conditions, please contact us at  763-546-5797.

By David Alter, PhD

*”Sam” represents a composite of several clients written so as to protect the privacy and confidentiality of the individual people the character “Sam” represents.

I often hear weight gain among the list of troubles of patients who are depressed.  Sometimes it’s just a few pounds, sometimes it is more.  Often, it is too many.  It makes sense that depression could lead to weight gain; being depressed makes it more difficult to get out of bed and be active.  Being depressed can make it harder to pay attention to what you are eating.  People who are depressed often turn to food to make them feel good or for more energy.  On top of this, gaining weight can lead to poor body image and self-esteem, which can leave people feeling more depressed.  

Research shows: Depressed people tend to gain more weight than those who aren’t depressed. Over 5,000 young people were followed for 20 years. Everyone-whether depressed or not – put on at least a few pounds.  BUT those who were depressed gained the most weight (particularly around the waistline). The study also showed that being overweight, does not necessarily lead to depression.*   

Weight gain and depression are complicated and can be influenced by a number of factors: 

Sleep Disturbances: Depression often causes a disruption of sleep and insufficient sleep can lead to depressive symptoms.  When tired, people turn to food for energy or can take in calories from late-night snacking. Insufficient sleep causes the excretion of ghrelin and leptin, which disrupt the sensations of hunger and feeling full so people might tend to eat more, and feel less full.  Not getting enough sleep also can cause increased fat storage. 

Stress: Stress moves us forward and helps cope with life's demands, but it also affects our mood and emotions.  When under stress our bodies store fuel, slow down metabolism and excrete cortisol and other hormones which are more likely to cause     obesity in the abdominal region.  Elevated cortisol levels also   increase appetite to help the body refuel after stressful times, so people with depression may eat more food – particularly high carbohydrate foods.  

Antidepressants: Unfortunately, weight gain is a side-effect of some anti-depressants; 25% of those on antidepressants gain weight.  Some people report they gain weight on anti-depressants because they start to eat and enjoy food more.  If a medication is effective but causes weight gain, the pressing need to getting depression under control may take precedence. There are antidepressants that are less likely to affect weight.  A conversation with your health care provider is recommended before you make any medication changes and to determine the best course of care.  Carbohydrate control can be a key component in weight control for those using psychotropic (i.e., mood altering) medications.   

Getting help:  

Losing weight is hard, and depression can make everything feel harder. Fighting depression while trying to lose weight can seem insurmountable.  Starting and making change is especially hard when depressed and therapy can be helpful with this.  If you are overweight, depressed or both, you can get help now.  Getting exercise is a prescription for depression and can allow you to sleep better.  A 20-minute walk not only helps to reduce levels of the “stress hormone” and lift the spirits, it burns extra calories. Bodywork, guided imagery, naturopathic work and hypnosis can all be helpful too.

In my practice at Partners in Healing, I incorporate psychological, behavioral and experiential tools and therapies into my work to address the complex interplay between depression and weight management challenges. 

By Alana Riss Fine, PhD

It can be difficult to tell the difference between sadness and depression in children and adolescents because they share many common features. For example, a loss of interest in usual activities, sleep problems, body aches and pains, and problems in school or with peers are some of the more typical problems seen in children and adolescents who are either sad or depressed. However, feeling sad is a normal reaction to a loss or an unexpected stressor, such as the death of a grandparent or an impending transition (e.g., moving or changing schools).

For children who are sad, behavioral symptoms are usually time-limited because children typically have the internal resources to manage their feelings and to move beyond their sadness. On the contrary, for children and adolescents who are depressed, these symptoms may last two or more weeks. In other words, they don’t just ‘get over it’.  It is difficult for them to see the light at the end of the tunnel. This is also true for children and teens who live with chronic or life threatening illnesses, or those who have experienced significant trauma in their lives.

As a child and adolescent therapist, part of my job is help parents and their children to distinguish between sadness and depression. One critical distinction between the two is the presence of suicidal thoughts and plans. It is also important to determine how long the child has been experiencing these emotional and behavioral symptoms. This is why I place an emphasis on partnering with parents because they often provide useful information. Their observations are critical to understanding a child’s or adolescent’s mood and how the  family functions. After all, children live in families!

Three Effective Treatment Strategies

In my practice, I integrate three effective strategies that help children and adolescents to cope with their depression.

1. Self-hypnosis—a tool used to help children create a shift in their thinking and to manage negative moods
2. Biofeedback—can show children how their bodies react to negative thoughts.
3. Creative Expressive Therapies—depending on the child’s interests, I like to integrate drawing, play, and expressive writing into the therapeutic process

The Treatment Benefits

Helping children and adolescents learn new ways of coping has many positive and lasting effects:

• less family conflict
• increased school attendance
• better academic performance
• more positive social interactions
• alleviation of aches and pains
• improved coping strategies

If you are having a difficult time determining if your child is sad or depressed, make an appointment to partner with me to help your child address their concerns.  Call me at 763-546-5797.

By Harriet Kohen, MSW, LICSW

It is not surprising that many women and some men suffer from depression and anxiety when faced with fertility challenges.  The ups and downs of infertility and its treatment drain the spirit right out of people.   I hear daily the intensity of the experience, “This is personal.  I feel invisible in the world.  This is physical.  I hate my body.  I am demoralized and afraid.  This is expensive.  I have no control and I feel out of control.  This has taken over my life.  I’m so worried about my relationship.” 

Some women have mood consequences from using birth  control pills and ovarian stimulation medication, on top of the fear of not having a child.  For many of the people I see, the following “formula” captures their experience: 

Uncertain Outcome of Procedures + Uncertain Length of Time + Internal/External Pressure + Medications + Fear = DEPRESSION and ANXIETY. 

It is important to distinguish between depression and grief when dealing with fertility challenges.  Grief hurts but it does not lead the thinking process toward self-hatred and negative thinking.  Depression is a heaviness all its own. 

Help is Available at Partners in Healing

Our integrated fertility team at Partner in Healing can help.  We provide:

1. Specialized counseling for individuals and couples who are suffering from fertility challenges, that includes hypnosis, cognitive behavioral therapy, and EMDR (Eye Movement Desensitization and Reprocessing); 
2. Acupuncture and Chinese medicine;
3. Naturopathic medicine and nutritional counseling; and
4. Medical massage aimed at reclaiming your body from the rigors of treatment.  We collaborate with national and local leaders specializing in fertility treatment. Let us help you regain your sense of wholeness and rebuild hope as you build your family. 
   

By Deborah Simmons, PhD, LMFT

We now know that key areas of the brain show significant changes when people are in states of depression.  The affected brain areas regulate working memory, decision-making, information processing, mood regulation and energy management (i.e., metabolism) in the body. We also know that those brain circuits and brain chemicals are highly sensitive to social interactions. For example, research shows that the same areas of the brain that are active when someone is experiencing intense physical pain are active when a person has been rejected or cut off from a major social relationship.  In other words, our social experiences change the structure of the brain.  In turn, those structural and chemical changes in the brain enable new perceptions, new thoughts and new behaviors to emerge.  At PIH, we offer a variety of mind-body therapies (e.g., psychological therapies,  alternative therapies, and nutrition-based  therapies) through which your brain-behavior  connections can be changed to help put you back in charge of your life.  We also collaborate with medical professionals outside of PIH who are part of your care team. Our primary goal is to help you make positive change “with your brain in mind.”

What is Depression?

“Depression” is often described in terms of colors. In its milder form, depression involves a temporary period of feeling “blue.” In its more severe form, it has been associated with blackness, a dark state of mind and body that  people describe as falling into an abyss from which it feels there will be no escape.  Depression’s darkness was recognized 2000 years ago when “melancholy” was used to describe it, a word referring to an excess of a black substance in the body believed to be responsible for the gloominess of depression. No matter the particular form of depression you experience, Partners in Healing (PIH) is here to help you discover an approach or combination of treatment approaches that can help you move through the darkness of depression and back into a brighter light with a more positive outlook on your  future. 

Depression Treatment at PIH

This issue provides a number of perspectives on depression and offers ideas about steps you can take to get back in charge of your life.  At Partners in Healing of Minneapolis, we believe that depression arises from a combination of factors (i.e., genetic, biochemical, psychological, social and nutritional factors), which is why it remains so important to approach each person’s personal struggle with it in an individualized way.  Just as there is no single common cause of depression, there is no single common solution to its effective treatment.  However, at PIH we take the time to generate a plan of care that is specific to your particular needs.

Brought to you by Deborah Simmons, PhD, LMFT

Today's article in TIME Healthland on miscarriage and depression validates the experience of many of my clients.  Women, and often men, feel so misunderstood about miscarriage and how waves of pain can come, long after a healthy baby is born.   Please don't try to fix it, or ask if someone is over a miscarriage.  They are not over it, just living through a struggle that hangs around for a long time.  Please don't promise that they will have another a baby.  We cannot make such promises.  Compassion and just listening go a long way.  

Images.com/Corbis

By Bonnie Rochman Tuesday, March 15, 2011

When a woman miscarries, it's typically far more hurtful than helpful to say something like, “At least you have other children.” Now, new research backs that up and goes a step further, finding that even women who go on to welcome a child after a miscarriage or stillbirth report prolonged depression and anxiety surrounding their loss.

“We kind of assumed in the academic world that if you have a healthy baby, everything would be fine,” says Emma Robertson Blackmore, the lead researcher and an assistant professor of psychiatry at the University of Rochester Medical Center.

Each year, about 1 million U.S. women endure a miscarriage or stillbirth. Up to 80% of those women get pregnant again, but researchers found that nearly 13% of women who had a miscarriage or stillbirth before delivering a healthy baby still had symptoms of depression 33 months after the birth. Of those with two previous losses, almost 19% of new mothers had symptoms of depression within that same time span, according to the study published online this month in the British Journal of Psychiatry. The researchers tracked 13,133 pregnant women in the United Kingdom who were participating in the Avon Longitudinal Study of Parents and Children. They were screened for depression and anxiety throughout their pregnancy and after giving birth. Most reported no miscarriages, but 21% said they had experienced at least one.

The findings are significant for clinical care. Typically, women are flagged for potential postpartum mental problems based on a previous history of depression or a lack of social support. “But we never thought of flagging women who've lost a pregnancy,” says Robertson Blackmore.  It's expected that women who've suffered a loss might be more anxious in subsequent pregnancies, especially up until the point at which they lost the pregnancy. “Say you had a miscarriage at 15 weeks,” says Robertson Blackmore. “You can imagine until you get to that point, you think, Oh, my God, is everything going to be okay?
“After that point, we really expected symptoms of depression to decrease,” she says, “but they didn't.”

In fact, multiple losses only compounded feelings of despair. Women who lost two or more pregnancies experienced depression more frequently than those who'd lost one; of those who'd lost four pregnancies, 22% reported experiencing depression three years later.  Some of the depression may stem from the inept way in which others can react to miscarriage. People say well-intentioned but insensitive things, or they worry about saying the wrong thing, so they say nothing at all.

“With advancing medical knowledge, everyone assumes pregnancy is going to go well,” says Robertson Blackmore. “When that doesn't happen, it strikes fear in a lot of people. It's so common, but people don't know what to say.”

(Brought to you by Deborah Simmons, PhD, LMFT)

While depression is challenging, there are any number of ways to treat it.  One of my clients recently shared this poem with me when she was in the grip of severe depression.  Her creativity became a touchstone and helped to lift her out of years of depression.  She asked that I share this poem with you.  Please feel free to share it with others.  She is thriving, by the way.  You can, too. 

For a time the world was black and white, right or wrong, true or false…
Then along came humanity, with each diverse individual truth and story.
Coloring false with layers of truth.
Deepening the hues of right and wrong.
Clinging to black and white stories was more and more challenging and  difficult in a polychromatic world.
Beauty—Humanity—Truth
are never monochromatic.

Poetry, photography, scrapbooking, painting, use what you have and find the creative spark that lives within you.  And contact us at 763-546-5797 or info-@pih-mpls.com if you or someone you know is needs help with depression.  We can help. 

(Brought to you by Dr. Deborah Simmons)
We have been teaching a lot lately about the Six Dimensions of Holistic Treatment for Depression (Relational, Biological, Energetic, Physical, Cognitive, and Spiritual).  I thought you might be interested in this article from the January/February 2011 issue of AARP:  The Magazine, entitled “Do Yoga, Be Happy”.    Dr. Chris Streeter’s conclusion?  Yoga has an effect on brain chemistry similar to that of antidepressants.  It beats walking, too.

DO YOGA, BE HAPPY
As a mood booster, yoga beats walking
By Holly St. Lifer

Feeling blue?  Try a downward-facing-dog pose.  A new study from Boston University School of Medicine found that yoga boosted mood more effectively than walking.  Doing an hour of yoga three times a week for 12 weeks increased GABA levels by 13 percent, as measured in the study’s healthy participants right after a session.  GABA, a neurotransmitter in the brain, is lower in people who are depressed; levels rise with the use of meds.  The walkers showed no significant increase in GABA levels.  “This is the first study to find a behavioral intervention—yoga, in this case—that has an effect on brain chemistry similar to that of antidepressants,” says study author Chris Streeter, MD.  

      Authored by Dr. Deborah Simmons

I was very troubled by this article on middle-aged suicide in today's New York Times.  If you or someone you know is suffering, please ask for help.  At Partners in Healing of Minneapolis we provide mind and body support for individuals, couples, and families suffering from depression and bipolar disorder, as well as those who are grieving.  There is hope.  Let us bring sunshine back into your life.  Call us today at 763-546-5797. 

Rise in Suicides of Middle-Aged Is Continuing

By PATRICIA COHEN  (Published in the New York Times, June 4, 2010)

For the second year in a row, middle-aged adults have registered the highest suicide rate in the country, according to the federal Centers for Disease Control and Prevention. Historically, the eldest segment of the population, those 80 and older, have had the highest rates of suicide in the United States. Starting in 2006, however, the suicide rate among men and women between the ages of 45 and 54 was the highest of any age group. 

The most recent figures released, from 2007, reveal that the 45-to-54 age group had a suicide rate of 17.6 per every 100,000 people. The second highest was the 75-to-84 age range, with a rate of 16.4, followed by those between 35 and 44, with a 16.3. 

The rate for 45- to 54-year-olds in 2006 was 17.2 per 100,000 people, and in 2005 it was 16.3. “It’s such a startling rise,” said Dr. Paula Clayton, the medical director of the American Foundation for Suicide Prevention. 

Researchers are puzzled by the increase, but Dr. Clayton said the rise in suicide among Americans born in the 1950s and 1960s was probably a result of a combination of factors, including easier access to guns and prescription drugs and what may be a higher incidence of depression among baby boomers. 

“Ninety percent of people who kill themselves have a mental disorder at the time of their death,” which can be aggravated by drug and alcohol abuse, Dr. Clayton said. Problems related to health, jobs, relationships and finances have also been shown to be important risk factors for suicide, the C.D.C. reported. 

Men are more than three times as likely to commit suicide as women, and they tend to use guns. American Indians, Alaska Natives and non-Hispanic whites are also at greater risk. Veterans are also vulnerable.

About 50,000 people die each year from violence-related injuries; suicides account for more than half that number.