Bipolar Support Groups.com blog

Mood-stabilizing medications like lithium help normalize brain activity in people with bipolar disorder.

In 1990, Congress designated the first full week of every October to be NationalMental Health Awareness Week. This year that week is October 7-13, 2007 and October 11th is both National Depression Screening Day, sponsored by Screening for Mental Health, Inc., and Bipolar Disorder Awareness Day. Bipolar Disorder Awareness Day is organized by the National Alliance on Mental Illness (NAMI), a non-profit group which is the nation’s largest grassroots mental health organization dedicated to improving the lives of persons living with serious mental illness and their families.

Bipolar disorder is also called manic depression or manic-depressive illness, but its treatment is different from that of depression (see below). It is a chronic brain disorder that causes extreme shifts in mood, energy and ability to function. It is characterized by episodes of mania (being overly ‘high’) and depression (being irritable, sad or hopeless) that can last from days to months. Symptoms often begin in adolescence or early adulthood and can result in poor school performance, poor job performance, damaged relationships, substance abuse, criminal or other irrational behavior and even suicide. Oftentimes depression dominates the clinical picture and mania may go unrecognized, especially if it is mild (called hypomania) or occurs only rarely. However, the recognition of mania is critical to the proper diagnosis of bipolar disorder, which might otherwise be diagnosed as depression (also called unipolar depression).

The treatment of bipolar disorder is different from the treatment of depression. Everyone knows that depression is treated with anti-depressants. But bipolar disorder, even though it has depression as a component, needs to be treated with mood stabilizers first and foremost. Anti-depressants play a much lesser role, if any, in the treatment of bipolar disorder, and they can actually make the illness worse (especially if used alone without mood stabilizers). You can see why proper diagnosis is so important.

In recognition of Bipolar Awareness Day, HealthTalk has created a Special Feature page with a wide variety of useful information, including treatment information, on this illness.

Bipolar Awareness Day was created by NAMI and Abbott Laboratories to, according to the NAMI Web site “increase awareness of bipolar disorder, promote early detection and accurate diagnosis, reduce stigma, and minimize the devastating impact on the 2.3 million Americans presently affected by the disorder.” The government’s National Institute of Mental Health states that about 5.7 million American adults have bipolar disorder in any given year. Other estimates put the number of people with bipolar disorder at 10 million.

Once a year or so, I’m tempted to shave my head like I’m going through chemo to make my depression visible to others. I’m thinking if I pulled a Sinead O’Connor, people would take the illness seriously.

I saw a commercial the other day for some leukemia association and I was jealous.

I know that’s not the response the advertising team was looking for. But as someone who is now responsible for fundraising for a foundation for treatment-resistant depression and chronic mood disorders, I thought about how much easier my job would be if the people for whom I’m raising the money actually looked sick.

I have no problem getting dough for Catholic Relief Service’s Operation Rice Bowlthat feeds poor kids in Africa. The paper carton which you load with dollars and cents has the photo of a beautiful African child with the message: “$1 a day for 40 days of Lent means one month of food for a family, two years of seed for a farmer, and three months of clean water for four families.” For other relief projects, you see the folks with bony arms and legs, extended stomachs, and white, crooked teeth that contrast their dark skin. Who wouldn’t fork over cash to them?

However, asking for dough for depression is a whole other story. I may as well be asking to save the mosquitoes.

At some level, I believe stigma exists in each and every one of us. We think the person who can’t get upright in the morning is too lazy, stupid, or addicted. Their condition is their fault. If it’s your sister who can’t keep a job because of her mood disorder, she isn’t trying hard enough, and she won’t do yoga. If it’s your neighbor who has been depressed her whole life, she wants to be depressed on some level: She is unwilling to move beyond her baggage and do the hard work of recovery. Depression is a white- and blue-collar disease that is invisible to the public, and therefore it’s not real. Everyone who suffers from it has contracted it by their lack of discipline and good sense, their negativity and stubbornness.

I have always been very open about my struggles with depression and anxiety to most people. But there are some social groups to whom I have not divulgedeverything and probably won’t because whenever I mention my mood dips, they look at me as though I am a leper in need of Jesus’ healing. I went back and forth about whether I should include certain people in my fundraising email because my “ask” was connected to my personal story.

I wrote,  “In the 10 years I’ve spent writing and researching mental health issues, I have received thousands of emails and letters from readers who have already tried medication and alternative therapies, but still feel hopeless. They wake up each day wanting to die. For six years I lived that way. Only in the last four months have I woken up without those thoughts, and my passion for creating a dynamic, supportive community has been an important component in my healing.”

I went on to say that if everyone gave five dollars, I would have met my financial goal.

I had high expectations for a women’s group I’m involved in because together we have raised a lot of money for prostate cancer, autism, and other good causes. Even though disclosing my struggle in the way I did made me feel incredibly vulnerable, I thought it was worth it because the group cares about good causes.

No one responded or donated. Not even a, “Thanks for the email … I’ll look at it when I have a minute.”

The truth is that depression isn’t a “good cause,” not to most of the world anyway.  If people are sick through their own fault (as most of us think on some level), why should we have to pull out our wallets to save these pathetic people? That’s theirproblem, not our problem. It’s somewhat like the rationale we use to feel okay about walking past a begger: He wouldn’t have to beg if he simply got a job, and any money I give him will feed his addiction.

I was disappointed, yes.

Hurt, yes.

But not surprised.

When you get the constant feedback that I do running a depression community, you see the real picture of stigma today. When people sign up for my community, they are SCARED TO DEATH someone is going to find out that they are on it, that they have depression. Most of them make up pseudonyms or use their initials. “I’m sorry,” they explain to me, “it’s just that I need a job, and I think I would get fired if my boss ever found out I suffered from depression.”

I get it. They are right. They might, indeed, get fired. But what does that say about the current state of awareness of this illness. THAT’S WHAT IT IS, AFTER ALL. AN ILLNESS!!!!!!!!!!!! It’s the only damn illness I know of that has people so ashamed to name. A top executive lawyer confided in me the other day about her very successful daughter who had just been hospitalized for depression. PLEASE NEVER TELL ANYONE!!!!!!!! PLEASE. PROMISE ME!!! My God, it was like she was telling me her offspring robbed a bank on her way to a Playboy photo shoot.

When I was hospitalized for my depression, my mom told relatives and friends I was there for internal bleeding. Now this is a very compassionate person who doesn’t blame me in any way for my illness. But I guess she just couldn’t stomach all the judgment she would get from family members. Kind of like my letter. “Hello??? Anyone out there??? Did no one just get my email where I said that after six years of wanting to be dead I’m waking with new thoughts and would therefore like to help a few folks get better?”

I did get some profound responses and incredibly generous donations. I want to make that clear.

However, the next time I send one out, I’m thinking of including a photo of me and a few people I know with shaved heads. Or maybe I’ll just use Catholic Relief Service’s photo. That might make people think depression is legit, which, of course, it is.

Consider these statistics:

• Nearly 50 percent of asthma patients have symptoms of depression.
• At least 40 percent of people with Parkinson’s disease experience depression, and anxiety is often reported.
• 45 percent to 65 percent of people who have had a heart attack live with depression.
• The lifetime risk for depression in people with multiple sclerosis (MS) is 40 percent to 60 percent.
• Nearly 30 percent of stroke patients develop depression.

A 2009 study published in Archives of Gerontology and Geriatrics confirms that “when pain is severe, impairs function, and/or is refractory to treatment, it is associated with more depressive symptoms and worse depression outcomes. Similarly, depression in patients with pain is associated with more complaints and greater functional impairment.” The study goes on to explain that there is growing evidence that “depression and pain share genetic factors, biological pathways, and neurotransmitters. Thus, the most promising area of future research is elucidating the neurobiological alterations in pain pathways that intersect with those involved in depression.”

This is important to know since, according to research published by the Robert Wood Johnson Foundation, the number of people with chronic illnesses will increase 37 percent, or 46 million people, between 2000 and 2030. That means those of us who are predisposed to depressive episodes to begin with would be wise to familiarize ourselves with those illnesses that are most often associated with depression and can exacerbate our symptoms. The following 10 are a good start.

1. Parkinson’s Disease

The National Parkinson Foundation’s Parkinson’s Outcomes Project, the largest clinical study of Parkinson’s disease ever conducted, shows that depression is the most important factor influencing the health status of people with Parkinson’s. According to the study: “A clear finding from our study is that, taken together, mood, depression, and anxiety, have the greatest effect on quality of life, even more than the motor impairments commonly associated with the disease. Further, our analysis found that QII [quality improvement initiative] participants who receive care from clinics with the most active approach to psychological counseling report the lowest rates of depression.”

2. Heart Disease

Depression is three times more common in people after a heart attack than in the general public, with 15 to 20 percent of heart attack victims qualifying for a diagnosis of major depression disorder and many others experiencing depression symptoms. “Depression after a heart attack is bad not only because of the accompanying emotional distress and suffering,” says Redford B. Williams, MD, professor of psychiatry at Duke University Medical Center in Durham, North Carolina, “it also increases one’s risk of having another heart attack or dying over the ensuing months and years.” People with heart disease who are depressed tend to have more cardiac symptoms than those who are not depressed. Depression and anxiety affect heart rhythms, increase blood pressure, elevate insulin and cholesterol levels, and raise levels of stress hormones.

3. Stroke

Nearly 30 percent of stroke patients develop depression, either in the early or in the late stages after a stroke, according to a study published in the medical journalNeuropsychiatric Disease and Treatment. It is so common that the Diagnostic and Statistical Manual (DSM)-5 categorizes “post-stroke depression” as a mood disorder (due to a general medical condition, i.e., stroke). Stroke causes physical damage to the brain, affecting brain cells that monitor mood and mental function. It’s also a frightening experience that can cause trauma. Although depression may affect functional recovery and quality of life after stroke, it is often ignored. In fact, only a minority of patients are diagnosed and even fewer are treated in the common clinical practice.

4. Dementia

Up to 40 percent of people with Alzheimer’s disease may also experience severe depression according to the Alzheimer’s Association. In fact, a new study published in the journal Neurology found that for people who develop Alzheimer’s disease, depression and other “noncognitive” changes can happen before any of the hallmark symptoms like memory and thinking problems associated with the disease. Another report in the British Journal of Psychiatry found that depressed older adults (over the age of 50) were more than twice as likely to develop vascular dementia and 65 percent more likely to develop Alzheimer’s disease than people who weren’t depressed. It can be difficult to distinguish depression in persons with dementia because the symptoms are similar: a lack of interest in hobbies and activities, difficulty communicating, weight loss, and difficulty sleeping.

5. Hypertension

High blood pressure can impact depression; however, it is more likely that depression affects high blood pressure. Stress hormone levels are raised during depressive episodes, which, in turn, elevates blood pressure. Acute stress and severe depression will elevate blood pressure to the point where damage to blood vessels is caused.

6. Diabetes

I was shocked to find out how many people in my depression communities, Project Beyond Blue and Group Beyond Blue, have diabetes. In a 2010 study published in the Archives of Internal Medicine, it was determined that the diabetes-depression relation is, in fact, “bidirectional,” meaning that just as people with diabetes have a higher risk for developing depression than those without the condition, people who have depression are more likely to develop diabetes, at least type 2 diabetes. “We can say that the two conditions are linked to each other and are both the causes and the consequences of each other,” says the study’s senior author, Frank Hu, MD, PhD, professor of nutrition and epidemiology at Harvard School of Public Health.

7. Cancer

The prevalence of mood disorders among persons with cancer can vary depending on the type of cancer and its clinical stage. In an older 1983 study published in theJournal of the American Medical Association, 47 percent of the patients were diagnosed with a kind of psychiatric disorder — most of them adjustment disorders. However, a more recent study published in the journal Cancer shows that 53.7 of people with terminal cancer were diagnosed with a psychiatric disorder: delirium, dementia, adjustment disorders, major depression, or generalized anxiety disorder.

8. Multiple Sclerosis

Depression is the most frequent psychiatric diagnosis in people with MS, according to a study published in the Journal of Rehabilitation Research & Development. The lifetime risk for depression in people with MS ranges from 40 to 60 percent. Depression could be a result of the disease process, since MS damages the myelin and nerve fibers deep within the brain — areas involved in emotional expression and control. Depression may also be associated with changes that occur in the immune and neuroendocrine systems. According to the study, “the etiology of depression is multifactorial and likely associated with psychosocial stress, focal demyelinating lesions, and immune dysfunction.”

9. Asthma

I was surprised to learn that nearly 50 percent of people with asthma may experience clinically significant depressive symptoms. The stress involved in having this particular illness and the disruptive symptoms seem to be what contribute most to psychiatric diagnoses. For example, those who experience dyspnea and nighttime awakening are at increased risk for major depression according to a study published in the Medical Journal of Australia. Asthma has also been associated with anxiety in a study of children and adolescents. In general, the depression and anxiety is worse among persons whose asthma is difficult to control: 87.5 percent of people with frequent asthma attacks experienced mood disruptions, compared to 25 percent of people with less frequent attacks, according to other research.

10. Arthritis

A study from the Centers for Disease Control and Prevention published in the journal Arthritis Care & Research indicates that one third of Americans aged 45 years and older with arthritis have either anxiety or depression. Interestingly enough, anxiety was almost twice as common as depression. Most people who had depression (85 percent) also had anxiety. But only half (50 percent) of the people who had anxiety also had depression. The study suggests that everyone with arthritis may be at risk for mood disruptions, and that screening all adults with arthritis for anxiety and depression is more important than ever, especially since the results found that only 50 percent of those with anxiety and depression sought help in the past year.

A team of researchers funded by the National Institutes of Health (NIH) recently discovered why the drug ketamine may act as a rapid antidepressant.

Ketamine is best known as an illicit, psychedelic club drug. Often referred to as “Special K” or a “horse tranquilizer” by the media, it has been around since the 1960s and is a staple anesthetic in emergency rooms and burn centers. In the last 10 years, studies have shown that it can reverse — sometimes within hours or even minutes — the kind of severe, suicidal depression that traditional antidepressants can’t treat.

Researchers writing in the August 2010 issue of Archives of General Psychiatry reported that people in a small study who had treatment-resistant bipolar disorder experienced relief from depression symptoms in as little as 40 minutes after getting an intravenous dose of ketamine. Eighteen of these people had previously been unsuccessfully treated with at least one antidepressant medication and a mood stabilizer; the average number of medications they had tried unsuccessfully was seven. Within 40 minutes, 9 of 16 (56 percent) of the participants receiving ketamine had at least a 50 percent reduction in symptoms, and 2 of 16 (13 percent) had full remission and became symptom-free. The response lasted an average of about a week.

In a small 2006 NIMH study, one of the first to look at ketamine for depression, 18 treatment-resistant, depressed (unipolar) patients were randomly selected to receive either a single intravenous dose of ketamine or a placebo. Depression symptoms improved within one day in 71 percent of those who were given ketamine, and 29 percent of the patients became nearly symptom-free in a day. Thirty-five percent of patients who received ketamine still showed benefits seven days later.

In the most recent study, reported online in the journal Nature in May 2016, researchers discovered that a chemical byproduct, or metabolite, is created as the body breaks down ketamine. The metabolite reversed depression-like behaviors in mice without triggering any of the anesthetic, dissociative, or addictive side effects associated with ketamine.

“This discovery fundamentally changes our understanding of how this rapid antidepressant mechanism works, and holds promise for development of more robust and safer treatments,” said Carlos Zarate, MD, of the National Institute of Mental Health (NIMH), and a study coauthor and pioneer of research using ketamine to treat depression. “By using a team approach, researchers were able to reverse-engineer ketamine’s workings from the clinic to the lab to pinpoint what makes it so unique.”

In response to the Nature report, Sara Solovitch of The Washington Post wrote that “experts are calling [ketamine] the most significant advance in mental health in more than half a century.” She reported that many academic medical centers, including Yale University, the University of California in San Diego, the Mayo Clinic, and the Cleveland Clinic, have all begun offering ketamine treatments off-label for severe depression.

It all sounds too good to be true, right?

The Drawbacks of Ketamine

The predominant drawback of ketamine is the lack of data.

There haven’t been enough clinical trials on the drug to assure its safety, and there’s a lack of information on the long-term effects of its use.

Ketamine’s effects are also short-lived. To be used as an effective antidepressant, it would need to be administered regularly, which leads to concerns about addiction, tolerance, and, again, long-term effects. The data that we do have on long-term use comes from people who have taken ketamine recreationally, as well as those who have used it to treat chronic pain. One 2014 study published in the British Journal of Clinical Pharmacology included among possible side effects psychedelic symptoms (hallucinations and panic attacks), nausea, cardiovascular stimulation, memory defects, and bladder and renal complications.

Still, the drug holds promise for uncovering new ways of treating depression and offers hope for the most severe and complicated mood disorders that baffle psychiatrists today.

“Unraveling the mechanism mediating ketamine’s antidepressant activity is an important step in the process of drug development,” said Richard J. Hodes, MD, director of the National Institute on Aging, about the most recent NIH study. “New approaches are critical for the treatment of depression, especially for older adults and for patients who do not respond to current medications.”

I overheard my husband describing my health to someone on the phone the other day.

“She’s definitely better,” he said.

“She’s trying a lot of new things. It’s hard to say what’s helping the most.”

“Well, she’ll always have it. I mean, it will never go away completely. But she’s able to manage her symptoms as of late. She’s able to get out of bed in the morning and go to work.”

Wow, I thought to myself, he gets it.

He truly gets it.

In some ways, he accepted the enduring nature of my illness long before I did.

I’m an easy sell — dangerously gullible — so when I hear commercials for new drugs promise an end to death thoughts, fatigue, apathy, and anxiety, I believe them, much like I believed in Santa Claus until my mean cousin made fun of me because I was way past the age to have not figured out it was Uncle Steve who was donning a white beard and ho ho ho-ing between his martinis.

When I decided to go the holistic route, I’d read profile after profile in diet and health books about people who were on four kinds of medication to treat theirbipolar disorder, but once they eliminated gluten and dairy from their diet (and added fish oil supplements, a probiotic, Vitamin B-12), they could ditch the meds and enjoy a happily-ever-after life.

Then there was reality, which fails to produce sexy sound bites.

It’s hard to finally swallow the fact that treatment-resistant depression, bipolar disorder, and other severe mood disorders can be lifelong companions because the bulk of health literature focuses on easy cures. Our media won’t promote any message that is complicated or messy, anything short of the quick fix. As Toni Bernhard, author of “How To Be Sick” says, “Our culture tends to treat chronic illness as some kind of personal failure on the part of the afflicted — the bias is often implicit or unconscious, but it is nonetheless palpable.”

I’m just as guilty as the person who hasn’t been fighting symptoms her whole life.

Yesterday I ran into a friend and her husband at church, and the husband told me that his daughter was bipolar and has attempted suicide three times.

“Does she have a good doctor?” I asked.

“Oh yeah,” my friend said, “she’s at the University of Virginia.”

Why did I ask about her doctor?

Because it’s easier for me to hear that a person who tried to take her life three times doesn’t have the right care. If she has a top notch medical team and is still suicidal? That means her illness — which is my illness — is that much harder to treat. It’s serious stuff.

I felt lucky to be having a day without symptoms.

I’m even luckier to have had a string of 13 symptom-free days, as documented in my mood journal.

The difficult truth for many of us with chronic mood conditions is that, while we can experience glorious remissions, we’re never cured. Much like the cancer patient, we need to rearrange our entire lives so that the most important thing we do each day is to stay in remission (if we aren’t depressed) or to aim for remission (if we are depressed). We are always on call for the surprise visits from our illness and can never relax to the point of forgetting we are sick.

I have learned from members of Group Beyond Blue, the online depression support group I moderate, that this kind of vigilance doesn’t have to absorb the spills of joy from your life. If you know that everything is transient — the depressive episodes and the remissions — you are better able to welcome each. As Buddhist teacher and author Pema Chödrön explains, the healing happens in the movement between emotional states or in the natural cycle of our moods. She writes:

We think that the point is to pass the test or overcome the problem, but the truth is that things don’t really get solved. They come together and they fall apart. Then they come together again and fall apart again. It’s just like that. The healing comes from letting there be room for all of this to happen: room for grief, for relief, for misery, for joy.

I posted that quote on my Facebook page awhile back, and a woman disagreed with it. She was bipolar and said that her medication combination has provided her a newfound stability.

I congratulated her.

Part of me envied her.

I do better with lines than with circles.

But my recovery is still very much a work in progress.

Just ask my husband.

According to the Sequenced Treatment Alternatives to Relieve Depression (STAR*D)study, an unbiased investigation funded by the National Institute of Mental Health, at standard doses of the most commonly used class of antidepressants (SSRIs), only 30 percent of people with severe depression achieve remission with the first medication prescribed. Switching to a new drug — and it often takes twelve weeks to achieve an adequate response to medication — is effective about 25 percent of the time. So after 24 weeks (close to 6 months), only 55 percent of people with severe depression will experience a remission of symptoms.

That isn’t exactly good news to me.

What about the other 45 percent?

Every day on Project Beyond Blue, my depression community, I hear from someone who has unsuccessfully tried 20, 30, or 40 different medication combinations and is hanging on to life by a very thin thread. I know that desperation myself, which is why, in the last two years, I have spent a lot of time and money exploring different alternative therapies.

Here are 10 non-drug therapies for depression that have provided some relief to members in my community or to friends I know battling this beast. Even if you don’t have treatment-resistant depression, they are good to know about and can be used in addition to taking medication to build extra resiliency. Remember that I am just a highly-opinionated (but well-researched) writer, not a doctor, so consult with your physician before changing the course of your treatment.

1. Transcranial Magnetic Stimulation

I can’t count on my fingers the number of people I know who have been saved bytranscranial magnetic stimulation (TMS). Former advertising executive Martha Rhodes certainly was. In her riveting memoir, 3000 Pulses Later, she shares her journey back to health with this new technology. TMS involves a non-invasive procedure that stimulates nerve cells in the brain with short magnetic pulses. A large electromagnetic coil is placed against the scalp which generates focused pulses that pass through the skull and stimulate the cerebral cortex of the brain, a region that regulates mood. The procedure was approved by the FDA in 2008.

I first heard about TMS two years ago. I investigated it for myself, but my insurance didn’t cover it, and all 30 sessions can run about $15K. However, due to efforts made by Neuronetic, Inc., a leader in TMS technology, insurance coverage for patients has increased from 100 million to over 200 million people, in both government and commercial insurance plans. A recent study in the Journal of Clinical Psychiatrydemonstrated the long-term effectiveness and durability of NeuroStar TMS Therapy in adult patients for over a period of one year. Just this morning the company announced that it has $34.4 million (including an investment from GE Ventures) to spend in order “to broaden treatment accessibility for existing patient populations in need of a non-drug therapy option.”

2. Dialectical Behavioral Therapy

Dialectical behavioral therapy (DBT) has become another popular topic in my depression community. A kind of cognitive-behavioral therapy developed in the late 1980s by psychologist Marsha Linehan, it once was reserved to treat borderline personality disorder. Today it is used to address all kinds of mood disorders. “As someone who has suffered from depression and anxiety, I use many techniques that I learned from my DBT support group in my daily life,” one woman in Project Beyond Blue told me today. “The behavioral exercises and visualizations I learned in the group help to calm me and have been extremely effective, especially when I’m feeling an anxiety attack or overwhelming sadness coming on. Breathing techniques, distracting and interrupting myself from negative thoughts, and total acceptance of my strong emotions without judgment give me a sense of control and self-love when I’m feeling most out of control and unlovable.”

3. Yoga

Many studies have confirmed that yoga helps relieve depression. For example, in a 1993 study, 50 female university students with severe depression practiced Shavasana yoga for 30 minutes daily for 30 days. There was a significant reduction in their depression score mid- and post-treatment. Teagan Fea has been teaching yoga and facilitating retreats for 15 years in New Zealand, Australia, Peru, and Mexico. She has designed a comprehensive online meditation and yoga program to help free people from depression, especially those who have tried medications. “When yoga is applied therapeutically,” she explained to me, “the practice can be specifically designed to reduce the symptoms of depression. Moving and holding postures while focusing on the breath discharges stored and depressed energy, allowing it to move through the body and be released. The visualization, breathing, and meditation components of the practice assist in rewiring the brain and strengthening new thinking patterns. Yoga is a powerful tool that can assist with deep transformation.”

4. Mindfulness-Based Cognitive Therapy

As I mentioned in my piece on mindfulness the other day, a new study from the University of Oxford found that mindful-based cognitive therapy (MBCT) is just as effective as antidepressants for preventing a relapse of depression. Studies indicate that both MBCT and mindfulness-based stress reduction (MBSR) programs “have broad-spectrum antidepressant and antianxiety effects and decreases general psychological distress.” I took the 8-week course last year. As a result, I am more aware of my stress reactions and am proactive about reducing my stress before I break down. I can identify the thinking patterns that lead to depression, like the inner critic and jumping to the future. Especially beneficial is locating tension in a certain region of my body, and trying to relax it.

5. Hanna Somatic Education

“You translate everything, whether physical, mental, or spiritual, into muscular tension,” said F.M. Alexander. Our muscles have memory. They tell our story. We respond to life events with physical tension. With repetition and trauma, this reflexive physical tension can continue into chronic muscular tension. Hanna Somatic Education, developed by Thomas Hanna, is a system of neuromascular education (mind/body training) that gently addresses chronic pain, restores freedom of movement, and relieves stress. Somatics works specifically with sensory-motor amnesia — teaching the brain how to relearn muscle motions. Ryan Moschell, a long-time Annapolis massage therapist, is now a somatic educator. Instead of manipulating muscles for his clients as he did as a therapist, he now teaches clientshow to do the work themselves, how to move specific muscles to relieve pain and tension. “Learning HSE from a certified Hanna Somatic Educator empowers you to have more control over your own body and lifelong neuromuscular wellness,” he explained to me.

6. Binaural Beats

When Anneli Rufus, author of Unworthy (possibly my favorite self-help book), interviewed a scientist who studied the brain activity of Buddhist monks, she mentioned that “brain-entrainment music” employing binaural beats can create different effects on mood (depending on the kind of low-frequency tones). The technology has actually been around for well over a century, but it has taken us a while to apply it to mainstream medicine. A few recent studies show that the use of binaural beats, or audio therapy, can significantly reduce anxiety, at least during cataract surgery, and can even help symptoms of ADHD in children and adolescents.

Rufus was skeptical, but thought she’d try it out. “As the sounds pulsed through my head,” she explained to me, “I almost immediately felt changes: easier breathing, inner warmth and brightness, a profoundly soft smiley mellowing-out is the only way that I — a complete non-scientist, non-expert, ordinary and occasionally anxious and depressed rube — can describe it.” The feelings didn’t last all day, but for her, “listening to binaural beats provides quick, merciful, wonderful, short-term relief.”

7. Eye Movement Desensitization and Reprocessing Therapy

Two years ago I called up my friend Priscilla Warner in tears. Disillusioned with psychiatry, I was done trying new medications. However, I wasn’t benefitting from any alternative remedies either: not diet changes, not meditation, not acupuncture or yoga. I had gone down the list and nothing was working. Priscilla told me to try eye movement desensitization and reprocessing (EMDR). Of all of the things she tried to get rid of her anxiety (she chronicles this is her bestselling memoir, Learning to Breathe), it was the EMDR that she feels made the most difference.

Eye movement desensitization and reprocessing is a psychological therapy originally designed by Francine Shapiro that uses eye movements and other procedures to process traumatic memories. With studies supporting its use as an effective intervention for post-traumatic stress disorder (PTSD), EMDR is now recommendedfor PTSD by the Department of Veterans Affairs and other organizations. For persons whose depression is triggered or aggravated by any kind of trauma, it seems to be a wonderful tool. For example, Grace, a woman in my depression community, explained to me, “EMDR helped to take the intensity out some of my trauma memories and flashbacks. It processes trauma memories so they are more fully integrated into your life narrative and decreases the likelihood of triggers and flashbacks from trauma.”

8. Biofeedback

Biofeedback is a process that trains you to have better control over your mind and body by using electric sensors that provide feedback. You are able to see on a screen how certain thoughts produce subtle changes in your body, and how relaxing or tensing certain muscles, in turn, impacts your thoughts. With just a little success manipulating your mind and body, you become empowered to use your thoughts to control your body (and vice versa). Biofeedback is used to help a variety of physical and mental health issues, including high blood pressure, chronic pain, irritable bowel syndrome, and Raynaud’s disease, and is especially helpful for people who can’t tolerate medication or for whom medications haven’t worked.

9. Transcendental Meditation

In his book, Transcendence: Healing and Transformation Through Transcendental Meditation, celebrated psychiatrist Norman E. Rosenthal, MD, presents the impressive science behind this specific kind of meditation. A twenty-year researcher at the National Institute of Mental Health, Dr. Rosenthal knows the brains of patients with severe mood disorders. In fact, he conducted one study just on patients withbipolar disorder to see how transcendental meditation (TM) might help them. He writes, “Several patients reported increased calmness, improved focus, and improved ability to stay organized and set priorities — no surprise given TM’s known effects on the prefrontal cortex. TM helped bipolar patients improve their executive function, just as it did for people with anxiety disorders and ADHD.”

10. Tai Chi

Back before I read the studies demonstrating the benefits of tai chi for depression, anxiety, and stress management, I was on to it. For five years before she died, my neighbor did tai chi at the senior center at least twice a week. I witnessed the profound change this ancient Chinese martial art made in her. She twitched less and smiled more. She was increasingly more comfortable in her body. The combination of slow movement, breathing, and meditation seems to especially benefit the elderly, as a study by researchers at UCLA indicates. “When they combined a weekly tai chi exercise class with a standard depression treatment for a group of depressed elderly adults, they found greater improvement in the level of depression — along with improved quality of life, better memory and cognition, and more overall energy — than among a different group in which the standard treatment was paired with a weekly health education class,” reports Mark Wheeler for the university.

Weight gain is one of the main reasons that people diagnosed with depression and other mood disorders stop taking their medication. Some people gain as much as seven percent of their body weight — or more — from psychiatric meds. In a study funded by the National Institute of Mental Health that was published in July 2006 in the Archives of General Psychiatry, researchers reported that nearly one in four cases of obesity is associated with a mood or anxiety disorder. But following a strict treatment plan that involves meds doesn’t have to mean shopping for a larger pants size. There are effective ways to manage your weight on psychiatric meds. Here are some strategies that you might find helpful:

1. Control Food Portions

Skip the diet. Just limit your portions. Restaurants today tend to serve two to three times the amount of a healthy portion. We’ve added 570 calories A DAY to our diets since the late ’70s, and half of those calories can be attributed to large portions, according to research from the University of North Carolina in Chapel hill. In aFitness magazine article, Lisa R. Young, PhD, RD, says, “Even though today’s serving sizes can be more than triple what the USDA recommends, they’ve become our new normal, and anything smaller can seem puny by comparison.”

I try to carve out an acceptable portion before I dig in, since it’s difficult to determine how much you’ve consumed otherwise. Sometimes I’ll use a smaller utensil to remind myself to savor the food and take small bites.

2. Eat Slowly and Chew Your Food

You’ve most likely at some point wolfed down a massive meal and felt fantastic until 15 minutes later, at which time you secure a few plastic bags because you’re convinced that you’ll explode on your kitchen floor. It takes an average of 20 minutes for your brain to recognize that your stomach is full — a definite waiting period between the time that the fork delivers its bite to the mouth and the bite’s arrival to the stomach. Getting in sync with this digestive schedule can not only save you from discomfort, but can also trim your waistline. If you take your time to savor the food, you’ll feel more satisfied by eating less.

RELATED: Your 10 Biggest Antidepressant Problems, Solved

This is one of the reasons that French people don’t get fat, according to a study from Cornell University in Ithaca, New York. They can better gauge when they’re full by using internal cues to know when to stop eating, unlike Americans who stuff their faces while watching TV or graze all day long, never sitting down for an official meal. The French may eat baguettes and brie, croissants and butter, and all the other forbidden foods, but they enjoy them at a table with friends or family.

3. Keep a Food Journal

Taking notes keeps you accountable for everything you put in your mouth. It’s all there on paper for you to read as many times as you want. Knowing that you’ll record everything as you’re stuffing your face with a pastry can be the difference between eating one chocolate croissant and four. You’ll also keep your momentum when you’re in a groove because you’ll see your progress as recorded in your journal. Finally, you can pick up on patterns of eating behavior during the month and connect binge eating to various stressors or other events.

4. Get Support

Just as it’s difficult to stop smoking if you live with a smoker, it’s much more challenging to lose pounds when you’re surrounded by junk food addicts. You’ll be less tempted to snack on Twinkies if they’re not in your house. Obviously, you can’t put the people in your household on a diet with you, but there’s a level of support you can ask from them. You might also try an online or local weight loss support group to discuss weight loss challenges and frustrations.

5. Set Realistic Goals

It can be tempting to set a goal of losing five pounds every week — or some other unrealistic goals for weight loss — much like we set New Year’s resolutions that never stick. It’s better to be conservative and realistic. The safest rate of weight lossis between 0.5 to 2 pounds a week. Typically, if you lose weight at a slower, consistent pace, you tend to keep it off.

It’s helpful to break down your goals into incremental steps. For example, you might want to start walking for 10 minutes a day for two weeks, bumping it up by five minutes every week. You could also try to adopt a healthy diet in stages. For example, you might start limiting sweets for a few weeks before you attempt to cut out white bread.

6. Start an Exercise Program

You don’t need to run a marathon to get a good workout. Walking up to 30 minutes, three to four days a week is often enough to get your heart rate up and your pounds off. Choose an activity that’s convenient for you to do on a regular basis, and make it part of your day. It’s best to set a consistent time and stick to it.

7. Tap Into Your Emotions

Often, eating isn’t about hunger. It’s about soothing some emotional wound. Food can be a powerful source of comfort to relieve stress, sadness, anxiety, loneliness, or boredom. But there are more effective ways to soothe uncomfortable feelings, like calling a friend, walking, or engaging in a support group. By recognizing the behavioral and emotional cues, you can better direct your angst.

This is so important.

Anxiety is a little-understood mental disorder, but a common one. Many with anxiety will never seek out any kind of treatment for it and often suffer alone, keeping their thoughts and feelings hidden from those around them.

That’s why we’ve decided to not editorialize the disorder, but bring you the direct thoughts ofpeople who suffer from anxiety. For those of us who tackle anxiety on a daily basis, these thoughts may ring true to you. And for those who know someone struggling with this disorder, you can certainly learn a thing or two about how to treat those you love.

These are 11 people telling you what they’ve always wanted to.

1. “The hardest part of getting help with social anxiety is talking to people.” —Sarah Beewell

2. “I’m still me. I’m not my anxiety.” —Abi Wylie

3. “Everything can change in less than 30 seconds. Too many people in one area, no known exits in a certain situation.” —Ashleigh Young

4. “For real, it’s not you, it’s me. Generalized anxiety feels like drowning all the time.” —Cory Lee Tyler

5. “Don’t give up on me when I isolate myself.” —Jen Jolly

6. “Just having someone you love and trust reminding you to breathe sometimes really helps.” —Tania Lynn Sidiqi

7. “I need you to reach out to me, even when I’m so anxious I’ve stopped leaving the house.” —Hayley Lyvers

8. “I’m sorry for every invite I’ve declined. I’m sorry my anxiety hurts you too.” —Melissa Kapuszcak

9. “Don’t shut me out. My anxiety may stop me from doing certain things but just being asked to join in can sometimes make my day.” —Vikki Rose Donaghy

10. “There’s just so much going on in my mind, sometimes I can’t keep up with what’s going on around me.” —Amanda Jade Briskar

11. “When I can’t do something, no one is more disappointed than me. Please try to understand that.” —Lindsey Hemphill

62 percent of students report marinating in perpetual, toxic anxiety.

Pursuing your degree? Feeling the pressure? It’s that time in the term when the heat is turned up-between deadlines, exams and everything in between. If you are a student of today, you likely have a lot going on in the between.

Ideas about “traditional” and “non-traditional” students have flipped, with increasing numbers of students being working professionals, juggling all kinds of demands, who want to earn new and advanced degrees.

But across the board, what unites students of all ages and life circumstances is this: unprecedented stress levels. According to the Anxiety and Depression Society of America, an estimated 62 percent report marinating in perpetual, toxic anxiety.

This isn’t the kind of stress that gives us enough juice to perform and stay on task (known as “eustress”), and not the kind that typically comes along with today’s market conditions and rigorous standards. Over half of students are wrestling with the “what-if-I’m-not-good enough,” nail-biting, running scared and no-room-to-breathe kind. Yikes.

It’s no joke. A recent report from the American Psychological Association notes sharp increases in severe psychological problems being reported amongst students. Stress is a force to be reckoned with. It eats away at us. It erodes our sense of wellbeing.

To say that it can disrupt the learning process is a dramatic understatement. On top of being a major health concern, it is the number one culprit that impedes academic performance and persistence. And this is true for all ages and types of students — from undergraduate to graduate. Stress can make us sick and stop us in our tracks.

Having taught at every grade level in education (yes, from Pre-K through doctoral students), and also working with them in the therapy room, I’ve seen firsthand the perils we can face at each juncture of development. It’s human. When we’re earnestly setting goals and working toward them, fears and doubt creep in. It happens to the best of us, and we don’t necessarily conquer it altogether, either.

I started becoming worried about my students, who are professional adults seeking new and advanced degrees. Like their 18- to 22-year-old counterparts, stress is no stranger, and risk factors for depression and anxiety are sky high.

I recently conducted a qualitative study with them to understand how they were defining stress and what, if anything, helped them to keep calm and carry on.

It didn’t take long to discover some good and bad news.

The good: the students demonstrated there are ways around the mental avalanche, and thatintense anxiety could be redirected and even harnessed in some situations. This study revealed that prevention is critical, and getting help and engaging in proactive, healthy behaviors made a difference, and was key to avoiding extreme distress.

The bad news: Students were marinating in stress, and they weren’t worried just because of academic pressures, but mainly from their work and personal demands. The stress effected their health, relationships and self-confidence. They also said their grades were shaky when they weren’t actively working to combat the ill effects of stress.

After countless interviews and discussions from this study, and over the years, I wanted to share five key lessons to keep in mind if you or someone you love is in the throes of college-related stress:

1. Know that education is a privilege.

It may be hard to remember when you are battling deadlines, but across the globe, educational opportunity is not a given right. Not even close. Only a small percentage of the world population hold undergraduate, let alone advanced degrees.

The fact that you have access to learning is a tremendous resource to cherish. Education can transform you and allow you to become better equipped for change agency, hopefully in ways that open the doors for greater access and less disparities. Keeping this perspective is vital.

2. Don’t scratch that ridiculous perfectionism itch.

When you are highly motivated and conscientious, you want the A, and often at all costs. This makes it hard to receive feedback and leaves you on an endless pursuit to hit it out of the park every time. The more you scratch, the itchier you become.

Your calamine lotion is knowing that you are at a point in your development. The more you learn, the more you realize there is to discover. Do your best, but know that you are apt to learn through mistakes, and sometimes you just have to get on base.

3. Resist the bait of imposter syndrome.

The feeling of “I don’t belong” or “Someone is going to find out I’m not as good as they think” happens in and outside the classroom. Women are at a higher risk for this. So are first generation and minority students.

Adult students finding their way back to the classroom worry they “should’ve” been further along, without realizing that life’s variables and the amazing opportunities of today have flipped the notion of “non-traditional student” upside down, with more of us than ever entering in the classroom at every age and stage of development.

Fight the tendency to default to shame or faulty beliefs. You obviously belong. And most of us don’t wear our fears and anxieties on our sleeve. The higher up we go, the more likely the doubts. We’re all scared. It takes time to gain traction and confidence.

4. Become a time management ninja.

Time management is an integral part of navigating college-related stress. Wasted time leads to disarray. You don’t necessarily have to completely abandon all tendencies towards procrastination, but make every moment count.

The more organized you are, the better. Make lists, keep a schedule, notice where you can become more efficient. Structure and routines matter. They will leave needed time for rest and play, which will also take you that extra mile.

5. Remember you’re not alone.

The pressures of college life, at every level, are multifaceted. Seek community and reach out to your peers, professors and colleagues. All institutions have health and counseling departments specifically devoted to offering confidential support. There are a whole cadre of caring experts on hand. And groups like Active Minds are doing a world of good in reducing stigma and creating access.

Luckily, students are more likely than ever to know this and to reach out. There is power inhaving a safe place to debrief stress and strategize. This is an included aspect of tuition. Many employers also provide access through EAP’s (Employee Assistance Programs). Health insurance covers costs of therapy.

You don’t have to be saturated with stress to need this. Be proactive. Make use of the many resources available to help you enjoy optimal health, keep your anxiety in check, and maximize your opportunities.

Which of these lessons do you need to put into action first? Doing so will not only help you in the classroom and beyond, but also help you establish critical habits for the long haul after you graduate.

Your accomplishments will likely be even sweeter when you are healthy enough to enjoy them. Grades and reaching goals have their place, but your mental health is always more important than anything else.

……