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Four years ago, a good friend of mine put her 10-year-old son on Prozac (fluoxetine). He had always suffered from anxiety and anger outbursts, but at age 9, his behavior turned violent, and his ruminations were keeping him up at night. My friend and her husband went to a variety of child psychologists, but the cognitive behavioral therapy wasn’t enough. Finally, they got a referral to a psychiatrist, who diagnosed the boy with attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), and generalized anxiety disorder (GAD). The doctor prescribed both Ritalin (methylphenidate) and Prozac.

The boy’s behavior was much better initially, but the drugs presented other problems: His weight dropped, and he stopped growing. Once a kid who was born with a healthy appetite and would try any food, such as chicken curry at age 1, his parents now couldn’t get him to eat anything. He went from being in the back row of his basketball photos, where the tall kids line up, to the front line, where the short kids kneel. And after six months, his old behavior returned.

The parents weaned him off the Ritalin, and the boy’s appetite returned. They tried to get him to eliminate gluten and sugar as much as possible, and have him load up on protein. They began giving him fish oil supplements, a multivitamin, and a probiotic. The dietary changes had a substantial impact on his behavior.

A few months later, they decided to try to taper him off the Prozac. He did fine initially, and the parents thought they were home free. But two months after he was off the Prozac, their son’s worrisome behavior returned — and it was worse than ever. My friend thought that they should take him back to the psychiatrist, but her husband disagreed. He had researched the half-life of Prozac and other withdrawal stories, and told her that many people go through a delayed withdrawal two to three months after taking the last pill. Unfortunately, he said, they would have to tolerate the bad behavior for a few months until the synapses in his brain made the adjustments.

The husband was right. The boy had two-and-a-half rough months, but he pulled through. Today he is eating, growing, and thriving — managing his anxiety some days better than others.

I remembered her story because I recently tapered off of one of my antidepressants. A month off, I was doing fine when all of a sudden I was hit with some acute anxiety. I wondered, “could it be a delayed withdrawal symptom?” I brought this up to my fellow depression warriors on Group Beyond Blue and ProjectBeyondBlue.com, and received confirmation: When you have tapered off an antidepressant, it is incredibly difficult to know whether you are relapsing into a depression, or if you are merely experiencing withdrawal symptoms that will go away in a few weeks or months.

My friend Margarita Tartakovsy interviewed Ross Baldessarini, MD, professor of psychiatry and neuroscience at Harvard Medical School, and director of the psychopharmacology program at McLean Hospital, for an article on Psych Centraldistinguishing withdrawal symptoms from depression. Dr. Baldessarini believes that when the depression re-emerges quickly, it’s easier to identify as withdrawal. If it happens weeks to months after discontinuation, then he thinks there is much more risk of its being a relapse.

But after weighing in with several of the members on both forums, I’m not so sure I agree with Baldessarini.

For example, one woman went off her antidepressant in March, and got really depressed and anxious in July. Her doctor said this is to be expected and is not unusual at all — that it’s a natural part of the brain’s readjusting process. According to her doctor, it takes a few months for the brain to realize something is missing, and to start the readjusting. The whole process can last six months to a year.

That makes a lot of sense to me. There are so many organic changes going on in the gray matter of your brain when you stop taking an antidepressant. For people like me who have a significant response to a teaspoon of sugar or three bites of pumpkin pie, think about the mayhem that’s going on inside the limbic system of my brain as it tries to reorganize all the synapses after it’s no longer getting a hefty dose of a powerful psychotropic drug. Although I don’t believe most classifications of antidepressants to be addictive — unlike benzodiazepines — I do believe your brain becomes dependent on them, so that it needs to relearn how to ride the bike again without training wheels when you go off them. Lots of skinned knees…

Of course, the withdrawal process is different for everyone. Much has to do with how long a person has been taking the medication, and at what dose. Obviously, someone who was taking 60 milligrams (mg) of Prozac for 20 years might need to wean much more slowly and endure many more withdrawal symptoms (and for much longer) than a person who was taking 10 mgs for a few months.

For some, the withdrawal symptoms are very distinct from the symptoms that they were experiencing before. They might resemble that of the flu: headaches, dizziness, nausea, or fatigue. In fact, Baldessarini discusses the “SSRI Discontinuation Syndrome” in his interview with Margarita that occurs in 20 percent of people who withdraw from antidepressants. A person may become agitated and angry more than depressed (if he or she was depressed before), or sad and lethargic more than anxious (if he or she was primarily anxious before). If a person is suddenly having crying spells after going off a medication that treated her anxiety and insomnia, chances are she is experiencing withdrawal symptoms rather than a relapse of her condition.

After reading dozens of articles on typical withdrawal times, and corresponding with dozens of folks, it seems as though three months is the average recommended time (and this begins once you start having symptoms, which could be two months after you’ve weaned off your drug) to wait to see if the symptoms clear up.

Jim Kelly, a member of my forum and a mental health advocate and speaker living in Westchester, Illinois, never agrees to a medication change without a transition plan.

“Changing medications, either starting or ending, cannot be fully assessed until two or three months in; that’s for me,” Kelly says. “And I always request some transitional medication in a small dose to ease side effects.”

Kelly has learned to be patient with the ugly process.

‪”I’m undergoing a change right now, and two weeks in I feel terrible,” he explains. “It feels like withdrawal from the old, rather than anything to do with the new…yet. I wish the two or three months would go faster, but it is what it is.”

Ultimately, I think you know yourself better than anyone and can tease apart the difference between withdrawal or relapse more easily than you think you can. After comparing my symptoms this week to the symptoms of depression I’ve had for so much of my life (for this reason, it’s important to keep a mood journal!), and assessing other things going on in my life (different diet, changes in schedule, etc.), I could recognize it was my brain just readjusting to a different chemistry, and that I’m on the right track.

Much like my friend’s son.

When we discuss the advantages of regular exercise, it’s usually the benefits to physical well-being that take centre stage, and for obvious reasons.

Most are aware that physical exertion can aid cardiovascular health and protect against a plethora of hypertensive conditions. These reasons, alongside wanting to lose weight and improve the way we look, are among the chief motivations for embarking on an exercise program.

But perhaps lesser known and lesser discussed are the benefits regular exertion can have on mental wellbeing, which are numerous. In fact, courses of regular exercise are becoming a more utilized tool in the treatment of mental health issues, for a variety of reasons.

As we’ll discuss, regular exercise needn’t constitute arduous back-to-back shifts in the gym. Just 30 minutes a day can have a range of benefits on mental health.

Mood improvement

Firstly, physical exertion is thought to stimulate the release and activity of endorphins. This process, referred to as the ‘endorphin hypothesis’ and explained by Anderson and Shivakumar as the ‘binding of [endogenous opioids] to their receptor sites in the brain’, has been explored in several analyses.

Besides their analgesic effect on physical pain, the increased activity of endorphins during exercise is also credited for improving the mood of the person practicing it. For instance, one study examining patients living with clinical depressionfound a convincing link between 30 minutes of aerobic exercise performed on a daily basis and “substantial” mood improvement.

Stress reduction

In addition to the stimulation of endorphins, exercise is also known to have a direct effect on the presence of cortisol and adrenaline in the body. These are natural stress hormones, often referred to as the “fight or flight” chemicals which can be triggered by a range of stimuli, including danger or emotional trauma. In persons with chronic stress or anxiety, levels of these hormones may be continually raised.

Intense physical exertion is thought to acutely increase cortisol levels, which is perhaps unsurprising due to the strain the body is being put under.

However, performing 30 minutes of low intensity exercise has been linked by one study with reduced cortisol levels.

Furthermore, regular exercise has been associated with a decreased overall presence of cortisol levels in the long term, as the body will become more used to physical exertion and not need to produce as much. So for those who make a habit of exercise, their resting levels of these stress hormones may significantly decrease.

Raised self-esteem

Another mental benefit of frequent physical activity is that it improves body image, and consequently this aids self-esteem.

One analysis undertaken by researchers at the University of Florida found that exercise at all levels had a positive effect on the way people felt about their bodies; and their results suggested that this wasn’t limited just to those who undertake exercise on a regular basis.

However, most will know from experience that one-off episodes of physical activity aren’t enough to sustain these feelings over the long term, and a person’s positive self-image may wear off after a prolonged period of inactivity.

Frequent exercise on the other hand contributes towards higher energy levels and better overall physical health; and the better we feel, the more comfortable we are about the way we look.

Increased social interaction

One particular advantage of participating in a team sport is that it raises our level of social contact with others.

Recently, I headed an investigation into the calorie-burning value of participating in 28 different olympic activities for 30 minutes each, which celebrated in particular the role team sports can play in helping someone to maintain a regular fitness regime.

The social interaction hypothesis is a term sometimes to describe the link between physical activity in a communal setting and improved mental health. By facilitating the development of social relationships through team and communal fitness activities, exercise can help to reduce feelings of isolation and provide a supportive environment.

Regular social contact is of course more beneficial, but team sports don’t have to account for every session of someone’s entire workout routine. Participating in just one communal activity per week can contribute towards better mental health.

One of the worst parts about depression — and there are certainly many — is that it robs you of hope. Hope that you’ll actually feel better. Hope that the darkness will lift. Hope that the emptiness will fill up and you’ll feel motivated and excited. Hope that it won’t be like this forever. Hope that you’ll get through it.

“I’ve been struggling with depression for almost 35 years,” said Douglas Cootey, who pens the award-winning blog A Splintered Mind. “In that time, I have often felt hopeless, usually during times of suicidal ideation…Depression has a way of warping our outlook so that we only notice the bleakest parts of the world.”

The darkness stops feeling like a lens that distorts your reality, and starts to become your reality, said John A. Lundin, Psy.D, a psychologist who specializes in treating depression andanxiety in adults, teens and children in San Francisco and Oakland, Calif.

“Depression often robs you of the memory of joy or happiness, so it becomes difficult to draw on happy memories to give one hope for the future,” Lundin said. Depression even makes hope seem foolish, like an illusion, he said.

Many people with depression aren’t able to articulate that they feel hopeless. Because doing so requires putting “words to an experience that just feels as real and encompassing as the air they breathe.” Saying you feel hopeless, Lundin said, can actually be a positive step. “[I]t holds the implication that hope is something that is possible.”

“Depression can be overwhelming,” said Cootey, also author of Saying No to Suicide: Coping Strategies for People Dealing with Suicidism and for the Loved Ones Who Support Them. “All those negative emotions are suffocating. This makes it difficult to believe that things will get better.”

Most of Rebecca Rabe’s clients say they’ve lost hope because they feel alone. They feel like no one understands what they’re going through. They feel like they can’t talk to anyone.

Loss of hope also might represent a loss of belief that you matter or that you can be loved, Lundin said. (This is something he works on with clients, helping them understand why they don’t feel adequate or lovable.)

What can you do when hope feels unfamiliar or impossible? What can you do when you’re in the middle of the storm?

Cootey stressed the importance of using a wide variety of coping strategies. “When I use my coping strategies to overcome depression, the next day isn’t a prison of more of the same. It’s a brand new day free of the sadness.”

Colleen King, LMFT, a psychotherapist who specializes in mood disorders and also has bipolar disorder, stressed the importance of having a treatment team and support system. This might include a therapist, doctor and several friends and family. Ask them to help you remember the times when you’ve felt better, she said. Ask them to “encourage you to be in the moment when you do experience temporary joy, even if it’s for a few minutes.”

Both King and Lundin suggested participating in activities that feel nourishing to your soul, activities that you love to do when you’re not depressed. Do them even if you don’t feel like it, King said. “You will most likely alter your mood at least a little bit, and [the activity] may be a welcome distraction from depression.” Plus, it helps to “arouse glimmers of hope that you can feel whole and healthy, again.”

It often feels like depression will last forever, King said. Which is why she also suggested placing prompts at home and work to remind yourself “that you are having a depressive episode and that it’s not a permanent state of being.”

Don’t underestimate the power of small steps. Rabe, LMFT, who specializes in treating children, teens and young adults with depression, anxiety and trauma, shared this example: She worked with a woman who was struggling with depression and complained about “not being able to do anything.”

They worked on tracking small but significant accomplishments and setting small goals. “For example, she would strive to check 10 things off her list. Sometimes just getting to therapy got her these 10 checks.” After all, getting to therapy is anything but trivial. It involves getting up, showering, getting dressed, driving to the office, making the appointment on time, talking in session and driving home, among other tasks. Her client also started reaching out to supportive loved ones (instead of isolating herself); taking walks; and writing in her journal—all of which has helped to diminish her depression and create a more positive outlook.

“I’ve been through the worst my mind can throw at me. I’ve felt the pain of suicidal depression,” Cootey said. “I’ve wished and even planned for my own death, yet I learned an important truth: Depression lies to us.” This is another reason it’s helpful to surround yourself with support: These individuals can help you see through the lies, he said.

“You do have worth. You will overcome this. You won’t be sad forever.”

There is always hope for someone struggling with depression, Rabe said. “People are resilient human beings, and they can do so much more than they think they’re capable of.”

Also, remember that “how hopeless you feel does not correlate to whether you can feel better,” Lundin said. Depression is an illness that extinguishes hope. It’s the nature of the disorder.

Thankfully, therapy and medication can help. So can participating in support groups. “Some depression requires a short treatment to work, and other takes a long time. But I have never met a patient who didn’t see significant progress if they stuck with it.”

If your therapist or doctor doesn’t seem to be helping, seek out new providers, King said. “Having a trusting and caring treatment team greatly assists with creating confidence and hope for the future.”

For people who don’t respond to therapy and medication, other treatments are available, such as transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT), Lundin said.

With good treatment, effective and varied coping strategies and compassionate support, you can feel better. The heaviness gets lighter.  The world becomes brighter.

So no matter how hopeless you feel right now, please don’t throw away your shot. Hope and relief are not some foolish illusion. They are real. They are possible.

It’s said that people with mental illness face a double-edged sword.

Not only do they have to contend with serious, disruptive symptoms, they still have to deal with rampant stigma. Sadly, mental illness is still largely shrouded in stereotypes and misunderstanding.

Stigma also can lead to discrimination. Yes, even in this enlightened day and age, it doesn’t appear as though prejudice and discrimination against individuals with mental illness are decreasing. (This studyshows in some cases, it might even be increasing.)

We see stigma everywhere. Every time violence is automatically connected to mental illness in an article or news report, we see it.^*

We see it in movies and other forms of media. We see it at work where stereotypes might be perpetuated, where employees are afraid to “come out” with their diagnosis.

We see it with our families or friends, who might say versions of “just snap out of it” or “get over it already” or offer “advice” like sleep more, eat less, look on the bright side and try harder.

There’s also just pure ignorance, especially when it comes to serious mental illness such as bipolar disorder andschizophrenia. As E. Fuller Torrey, M.D., wrote in Surviving Schizophrenia: A Manual for Families, Patients, and Providers,“Schizophrenia is the modern-day equivalent of leprosy, and in the general population the level of ignorance is appalling.”

But what happens when that stigma comes from within — when people with mental illness internalize these negative public perceptions?

An excellent article in Esperanza magazine — whose tagline is “hope to cope with anxiety and depression” — explored the issue of self-stigma. Not surprisingly, internalized stigma can worsen a mental health condition. How?

According to the article, self-stigma makes people less likely to seek treatment. (Other studies have confirmed these findings as well.) From the article:

“For example, a 2009 study from Leipzig University in Germany identified internalized stigma as ‘an important mechanism decreasing the willingness to seek psychiatric help’—and of far more influence than ‘anticipated discrimination.’ Likewise, a U.S. study of college students, published in Medical Care Research and Review in May 2009, found that personal stigma (as opposed to perceived stigma) was ‘significantly’ associated with unwillingness to seek help.”

Even medical students — who suffer from depression at high rates — report concerns about stigma. In a recent studypublished in the Journal of the American Medical Association, 53.3 percent who reported high levels of depressive symptoms worried that disclosing their diagnosis would be risky.

Also, 34.1 percent of first- and second-year students and 22.9 percent of third- and fourth-year students reported that they’d feel less intelligent if they sought help. And these are the individuals who’d presumably be more comfortable than the average person in seeing a professional.

Self-stigma also can lead to isolation, lower self-esteem and a distorted self-image. “People with a mental illness with elevated self-stigma report low self-esteem and low self-image, and as a result they refrain from taking an active role in various areas of life, such as employment, housing and social life,” according to David Roe, professor and chair of the department of community mental health at the University of Haifa. He and other researchers are exploring the efficacy of a new intervention to minimize self-stigma.

So what can you do? The Esperanza article suggested these tips to combat self- and social stigma:

“Explore therapy to help you reframe your life experience, improve your self-image and replace negative self-talk with more positive language.

Use the Internet for peer support. Twitter with others who have depression, trade recovery stories with Facebook friends, or join an online mental health forum (such as those at psychcentral.com or Esperanza’s new peer-to-peer forum at hopetocope.com or hopetocope.ca).

Practice strategic disclosure. Tell your story to a peer or person with a realistic view of depression.

Get involved in outreach. Join advocacy groups. Participate in or help organize a walkathon or mental health fair. Write protest letters to media outlets or companies that spread negative stereotypes.”

Whether you have a mental illness or not, push past the misperceptions, and educate yourself with the facts.

Realize, for instance, that someone with depression isn’t able to just snap out of it. (Trust me, if they could, they would!) Realize, too, that eating disorders are serious illnesses; the person can’t just eat to fix it. (Anorexia nervosa has the highest mortality rate of any mental illness.)

Such is the same with all mental illnesses.

Educating yourself about what mental illness is and what it isn’t can help tremendously. So can spreading the word to others and getting involved in advocacy.

And, importantly, remember that you are not alone! Mental illness is common, and it touches everyone’s lives in one way or another. Consider checking out support groups or online forums to connect with others who are in similar spots.

Have you experienced stigma? Have public perceptions of mental illness affected you or your seeking