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Falling up the stairs

I recently had a client who had struggled with chronic depression for many months and was even hospitalized for it. She once described her depression like a “quicksand”. 

Once depression got a hold of her it began to suck her in. The harder she tried to get out of her depression the more hopelessly stuck she felt. She eventually learned that the trick to dealing with her depression, just like getting out of quicksand was not to struggle but also to not give up.

Instead, she learned to make slow movements toward the solid ground and when available you accept an extended hand to help pull you out. After all, “depression like quicksand” is a real thing and not something you can ignore away.  It is also not a sign of mental weakness and no one should ever feel they have to tough their depression out on their own.

For a long time, the solid ground seemed unreachable for my client because she couldn’t see how to get to it and was too ashamed to ask for help. It was her aunt who also had a history of depression who told her, her secret.  She said dealing with depression was like “falling up the stairs.” She noted that we have all done this before. We start to go up a set of stairs when suddenly we catch our foot and fall forward. Each step up had been progressing before we tripped but even when we trip and fall we always land a few steps further “up the stairs.”   

She also noted that despite all of us tripping up the stairs numerous times in our life we never give up, turn around and go back down the stairs?  Instead, we stand back up and continue climbing the stairs. Maybe a little slower, maybe a little more consciously but always upward and every time we make it to the top.

My client took her aunt’s words to heart and began tackling her depression one day at a time, one struggle at a time.  She began to ask for help from her psychiatrist, her clinician, and her aunt.  She began to get out of bed even when she didn’t feel like it, moved when she felt like standing still. When she felt like isolating she made herself be around others and found that doing something for someone else helped her feel better. It was not easy and sometimes it felt impossible, but every time things got really bad she reminded herself that was just her falling up the stairs. 

Larry Blackwell LCSW, AADC

Could a broken heart be the reason for depression?

Could a broken heart be the reason for depression? At one point or another in our lives, many of us find ourselves in a painful situation of having a broken heart. The first time we go through this experience is usually the worst, and it is one of the hardest experiences for a human being to endure.

In the same way that physical injuries can cause damage to our bodies, emotional injuries can do the same. Negative emotions can affect our energy, sleep, ability to eat,  immune system, and central nervous system. Stored up negative emotions can create a cumulative affects on body, mind, and spirit. Thus, it is vital to detoxify ourselves from negative emotions as they come up, rather than letting them pile on and create a mountain of unprocessed feelings to address later.

A broken heart can not only cause present pain, but it can also trigger old childhood abandonment trauma and losses from the past. This can create a highly intensified feeling which can become overwhelming. Stored up negative emotions can create a cumulative affect on body, mind, and spirit. Some of us carry stored emotional trauma that we are not fully aware of. When we have a broken heart, we can experience the pain that we have carried for years,  in addition to the new layer on top. This is why the pain feels so unbearable.

Grief is one of the most difficult emotions to process. It involves various stages, and you can move back-and-forth between the stages, which include:

  • denial,
  • anger,
  • bargaining,
  • depression, and
  • acceptance.

If you have been prone to depression in your life, grief must be handled very carefully so that it does not submerge you.

Seek help from a qualified therapist and stay close to your personal support system. Take the time to process the relationship and work through the emotions. Emotions have a beginning, middle, and an end. Allow them and accept them. You will get to the other side of a broken heart. It is normal to experience the painful feelings of loss, grief, and depression when you have a broken heart. While you do have to go through the feelings to get to the healing, you will not stay in the pain forever. It will pass. And one and one day you may realize that the loss you experienced was necessary in order to take you on your life’s journey to grow and to experience something better.

Practice disciplined self-care, use your support system, redevelop lost interests and hobbies, listen to music, reach out to people daily to connect, and seek new activities and friendships. While the depression from the grief a broken heart can take some time to recover from, it will not last forever. You will come out of this on the other side stronger, more whole wiser, and able to love again.

Dr. Anita Gadhia-Smith

COVID Brain Fog

I was working with a client online recently (since COVID I have been strictly doing teletherapy) and she told me that she has been feeling forgetful like she is in a fog. She has been working from home since March and while business has not slowed down for her she can’t seem to keep track of things like she used to.  As I’m talking to her I can see she is in her dark and somewhat dreary basement.  She noted that this is her at the home office as it gives her privacy from the kids and her husband.

As we explored her forgetfulness, a pattern began to emerge.  She is still attending lots of online meetings every day but she often loses track of time or finds that some of the smaller tasks that normally fell between regular meetings were being overlooked by her. She noted that when she was in the office, the physical space helped her connect her day.  She might have gone to one conference room for an early morning meeting and after that meeting checked in with an employee whose office was near that conference room. 

When she went to another conference room for a late morning meeting she had a routine to get things done near that conference room including grabbing a coffee. She also noticed that getting up and moving from one physical space to another helped her change gears from one meeting or activity to another. This allowed her a few moments to wrap her mind around the new meeting or task she was about to start. As she sat in her dimly lit, dreary basement and wondered why she was so forgetful I asked her how she now changed from one activity to another. 

She noted that the only thing telling her it was time to change was the clock.  There was no walking with colleagues to or from a meeting and no stopping by the coffee machine. Her view never changed all day long so her afternoon routine was virtually no different from her morning routine which was work on her computer until there was an online meeting and once the meeting ended, work on the computer until the next meeting.   

A few days later I was sitting in my office in an online meeting at my day job (I supervise an adolescent psychiatric unit).  I suddenly realized I had completely lost track of the meeting conversation. I thought about my client and I realized that this has been happening to me more than it used to ever happen when I was attending meetings in person. After reflecting on both my clients and my own experiences I came up with a hypothesis. 

First off, when we are not physically present in a meeting we tend to multitask more. Most of us would never check our e-mails while sitting around a conference table but if we can’t physically be seen we might be tempted to try to use the meeting time more “effectively” by multitasking.  The second part of my hypotheses is that our brains crave stimulation and without enough stimulation, our brains get bored and tend to wander.  So what is the answer? 

Well, my suggestions to my client and myself are threefold. First, stop trying to multitask if you find yourself mentally drifting. Secondly, make sure your workspace is bright and stimulating and thirdly, schedule routine breaks in your day when you will get a new cup of coffee, go check the mail, take the dog for a short walk, etc. You may feel that you don’t have the time for these short breaks that both get your blood flowing and provide you with a brief change of scenery, but if you are experiencing COVID Brain Fog, you can’t afford to not take these breaks.

Larry Blackwell, LCSW, AADC

Drinking during COVID-19

When governors across the U.S. were shutting down states due to COVID -19 they labeled liquor stores as essential businesses.  Many of us laughed at this and said jokingly, “Oh yah, liquor stores are essential lol.”  The reality is that liquor stores were not designated as essential just because people like to drink.

They were designated essential because many people drink so much that if they stopped suddenly it would be dangerous. Most of us consider alcohol as a pretty safe substance after all it wouldn’t be legal if it wasn’t, right?

The reality however is very different. Alcohol can actually be more dangerous to detox from than heroin is.  Someone who is detoxing from heroin feels like they have a really bad case of the flu but as long as they stay hydrated they will usually be ok (should still detox under medical supervision). 

Someone detoxing from alcohol however risks experiencing Delirium Tremens (DT’s). Someone experiencing DT’s may experience shaking, confusion, high blood pressure, fever, and hallucinations to name a few symptoms. They can also experience cardiac issues. The bottom line, alcohol is actually the most dangerous substance to detox from.

Now most of us are not going to become severe alcoholics from this pandemic but reports indicate that there has been a significant increase in alcohol use during the pandemic. 

After all, we’ve been isolated at home either by ourselves or with small groups for a long time. Things can get pretty boring and a few drinks can definitely make it less boring. While there is no initial harm in having a drink or two, ask yourself if the frequency of your drinking has increased? 

Has the amount of your drinking increased?  If you answered yes to either or both of these questions ask yourself if you are beginning to look forward to a drink? Ask yourself what that drink will do for you and more specifically how will it change the way you feel?  You see the reason we use substances is very simple. They change our feelings and they do it quickly.

So what changed feelings do you experience when you drink? There is nothing wrong with wanting to be less bored, less anxious, happier, etc., the risk however is that if we begin to recognize alcohol as a quick path to these desired feelings there is a pull to turn to alcohol more quickly and more often. 

So what’s the harm? Besides the physical damage excessive alcohol use dues to your body, there are other negative psychological consequences. For example, the more you use alcohol (or other substances) to change your mood the less likely you will be able to change your mood without them. In addition, as your body develops a tolerance to alcohol you need to drink more to get the desired effect.

Eventually, however, your drinking just to feel normal. No one plans on becoming addicted to alcohol or another substance but it happens insidiously, little by little until one day you realize you’re no longer in control of your life, instead, the alcohol or substance is in control. The best solution is to avoid substance use completely, but if you aren’t going to do that at least pay attention so you can realize early on if your substance use is changing. 

Larry Blackwell, LCSW, AADC

Join Fight Depression private Facebook group

Recently we started a private group on Facebook for people to connect with the others and get some support from the community. At the same time, we do not allow the information about group members and their words to be spread outside the group. We value your privacy and trust.

To join the group you need to be approved. By doing this we are eliminating the number of random people and keep the community safe from those who’re not really interested in getting or giving help and support.

In this group we are going to discuss your experience and what are you going through. You can get support from the others who had also suffered from depression and found some keys to overcome it. Here you can share your opinions and ask others about theirs.

You’re never alone! Join the group!

Our physical health is crucial but so is our mental health

As the world starts to open up this early summer we are quickly reminded that the pandemic is far from over.  Many southern U.S. states and California are seeing a sharp rise in COVID-19 cases. 

After months of dealing with this pandemic, everyone was silently hoping that COVID-19 would quietly be swept away by the summer winds and life would return to normal. Almost all of us can probably note areas we ourselves were becoming more relaxed about. 

Did we always wear a mask at a drive-through?  Did we use hand sanitizers quite as frequently as we did a few months ago?  The reality is that we are social creatures and isolation is really difficult for us. This lead lots of people who take COVID-19 very seriously to consciously decided that it was time to take more risks by going out for the sake of their mental health. 

The bottom line, we have to find a balance. 

Our physical health is crucial but so is our mental health. This pandemic is beginning to make even the most optimistic of us believe that it is going to be here in our world for a while.  We’d love to hear how you’re managing our changing world and maybe where you’re struggling. Remember, we’re all in this together.

Larry Blackwell

Substance abuse prevention program for teens

The truth is that the pandemic is increasing substance abuse by adults and teens. I could easily modify this to help adults be aware of their own substance use during these difficult times and to also give them pointers about talking to their teens about potential substance abuse.

The key concepts 

  1. Parents and teens need to know why teens are at such high risk for substance abuse including nicotine.  This is extremely important.  The reality is that because teens’ brains are not fully developed yet, they physically lack the ability to accurately judge the consequences of their behavior (think of some crazy things you did as a teen that you would never do now). This goes for every teen to a greater or lesser extent, even the class valedictorian. In other words I.Q. Has nothing to do with this. 
  2. Teens are more motivated by both emotional and physical rewards (rewards equal excitement) than either adults or younger kids.  This means that teens are basically wired to engage in highly risky behavior such as vaping, drug use, and risky driving, etc. This same motivation for rewards can be used by parents to minimize risky teen behavior. 
  3. Families need to know the protective and the risk factors that help shape if a teen will develop a substance abuse problem whether it be nicotine, alcohol, weed, opioid, etc… Parents need to know the fact that healthy parental involvement is the number one protective factor for teens when it comes not only to preventing tobacco use but preventing other high-risk behavior as well.  Parents need to be educated on how to capitalize on their unique role as the number one protective factor.
  4. Teens need to understand how activities such as vaping can quickly reduce stress and anxiety. As teens experience the benefits of their substance use they increase the risk of using more dangerous substances. Teens don’t realize the dangers of self-medication, they only know it works.  
  5. Parents need to be aware of their own substance use and what message they are sending their teens. I’m not saying they have to abstain (unless they want to) but they should use legal substances responsibly.  If parents smoke or even if they engage in excessive drinking it sends the message to teens that tobacco use is no big deal. 
  6. Most parents don’t know how to talk to their teens about difficult topics like substance use.  I’d like to help parents and teens learn some collaborative problem-solving techniques to help both teens and parents to communicate with each other so both can feel heard.  
  7. Most teens and their parents don’t think that they will end up with serious substance abuse issues. After all, a thing like opioid use is a big leap from vaping or even smoking weed. While most teens will not end up with a substance abuse problem they and their parents need to understand that even things like cigarettes and vaping are not harmless. Nicotine affects the growth of the teen brain and primes it for further substance abuse. We also know that the younger a person starts using things like cigarettes and e-cigarettes the higher the risk they have for developing a serious substance abuse problem.
  8. Teens/young adults can be taught  motivational intervention techniques to shape their beliefs and attitudes about substance use. This is extremely important. These motivational intervention techniques can actually create a level of “inoculation” for teens against high-risk substance use. The motivational techniques don’t tell teens what to think about substance use, instead, they help the teens ultimately make up their own minds about drug use. This happens at a deeper level and can actually circumvent the underdeveloped executive processing. A great example of this is back at the height of the AIDS epidemic. Despite teens being much more impulsive than adults, teens actually practiced safe sex at a higher rate than adults. Once they got it solidly in their heads that AIDS would kill them, they were able to begin to plan ahead to protect themselves. 
  9. Families need to know the benefits of contracting with teens around substance abuse. Now a simple contract on its own is not worth the paper it’s written on. Instead, the contracts I am talking about are more like living treatment plans. For example, parents and teens would discuss what the teen is willing to commit to
    For example if a teen vapes they may not be willing to commit to stop and parents need to respect that but parents can add in incentives if their teen cuts back. Since we know that rewards work better than punishments parents can reward their teens for all abstinence. I realize that it can at times be hard to know if your teen has been abusing substances but by providing parents with the tools to talk to their teens about substances as well as educating them on warning signs they can have a pretty good idea. 
    Another part of the contract covers things like If your teen gets drunk. While there should always be consequences for teens getting drunk the consequences should be less severe if the teen were to call the parent for a ride than if the parent finds out on their own. Consequences would also be spelled out so if a teen calls mom or dad for a ride they shouldn’t have to worry about a lecture at the time of pick up. Instead, the consequences are preset so the parent can focus on acknowledging the thing their teen did right which was to call them for a ride.

Larry Blackwell

Teletherapy during COVID-19

I was meeting with a new client yesterday over teletherapy. Teletherapy has become one of my new norms since COVID, but I must say I am not only getting used to it, I’m enjoying it. 

If a client cancels, I have the luxury of going downstairs to visit with my family until my next session. This is just one of the little silver linings that have come out of COVID-19, but that is not what I wanted to write about. What I wanted to write about is how this very professional, successful woman acknowledged that COVID has been tough on her and her family. 

She realizes that she and her husband have been fortunate to have been able to work from home during the past 5 months, and despite some benefits, I mentioned above, she also noted that her world has become very small as she and her family spend 80% of their time at home. 

This has led to some understandable stressors in the house but also to her questioning if she is satisfied with her job anymore. COVID-19, it appears, has caused her to re-evaluate what is important to her. 

While we were talking I thought about this website and how it’s purpose is not to just help people struggling with depression but to help people like this woman who is not depressed but who would benefit from sharing what she is going through. 

My guess is that you all have stories to tell about how COVID has impacted your life, many for the worst but some for the better.  Don’t worry if your story is good enough to share, your story is your story.  The goal is to simply provide a place for people to give and get support and encouragement.

The “new normal” and mental health

As we continue to progress through the various stages of COVID-19, life has changed for most people. There is a “new normal.”  Most of us have changed our routines, activities, priorities, and the way we spend our free time. In addition to all the external changes, there are also internal changes at the mental, emotional, and physical levels.

In my psychotherapy practice, I have seen an increase in anxiety, depression, anger, anhedonia, sleep problems, and relationship issues. 

Parents and children have spent months on end together in the home, and parents are stretched to perform all of their own required activities, plus to homeschool their children and monitor their learning. Children have been deprived of the ability to be with one another and to play normally. 

Because of the lockdowns, children have been spending much more time with electronics and have become more attached to their phones, iPads, and computers. This has escalated a phenomenon that was already occurring before COVID-19. Parents are struggling to set limits with their children about how much screen time they can have. Single and separated parents have had the biggest challenge of all, as they have to wear more hats than ever. 

Adult relationships have also been unmasked. Some couples have found that they are happier than ever, as they now can focus on each other without distractions. Others are experiencing the manifestation of problems that were lurking under the surface and that have only become more intense. In some cases, domestic violence has increased. Add to all of this the economic issues, loss of jobs, businesses, and lack of customary socialization, play and fun in our lives, and you have a mental health crisis.

As these five months have now gone by, many people have settled into new patterns. While these new patterns may be different, we can still try to make lemonade out of lemons. Focusing more intently on what we do have, what we can do, and how to connect meaningfully with others can make a positive difference. Radical self-care and having a routine are also very helpful in self-regulation and managing fluctuating emotions. A daily routine contributes highly to a sense of well-being.  Regular exercise has made a positive difference for many, as evidenced by the fact that there is now a waiting list for most home gym equipment.

Keeping yourself mentally and physically healthy during the “new normal “requires attending to psychological, emotional, physical, and spiritual dimensions of ourselves. Try to do one thing every day for each of these dimensions. Even if we are living and working from home most of the time, we can still be creative, manage our time wisely, and engage in constructive activities. This requires us to take full responsibility for our well-being. 

Never before have we been in a position where so much has been both taken away and given to us at the same time.

Let’s all look for the opportunities that we have during this temporary pandemic, and make some important positive changes to take with us into the future. When we are trying to cope with things that are beyond our control, we can always decide not to let ourselves be psychologically controlled by the uncontrollable. Stay active and be creative. This too shall pass. 

Dr. Anita Gadhia-Smith

Understanding different types of depression

Because of Covid-19, many people are currently experiencing symptoms of depression for the first time. This can include low energy or lethargy, feeling overwhelmed, negative thoughts, lack of appetite, overeating,  difficulty sleeping, relationship problems, intrusive thoughts, and existential crisis.

There are different types of depression, and it is important to understand your own situation thoroughly to assess what you are going through.

Some depression is hereditary in families and has a biological origin. This type of depression is difficult to conquer through therapy alone and often requires medication in addition to therapy. If you have tried everything that you can behaviorally, and chronic depression is still not lifting, then it may be time to consider taking medication. Remember that medication is not a cure all by itself, but that it can make it easier to do the work that you need to do behaviorally to change your life.

Situational depressions are somewhat different. They can happen to anyone, for any number of reasons. They are largely dependent on external circumstances rather than internal biology, and can be brought on by relationship break ups, loss of job, financial problems, health problems,  grief, trauma, and national crises.

While some people take medications for a short-term problem, others choose not to take it  and can work through the problem without medication. It is important to remember that prescribed psychotropic medications can also have a withdrawal syndrome, and that the longer you take them, the greater the chance that you may have difficulty getting off. The best way to get off of medication is to taper gradually under the supervision of a psychiatrist.

If you are experiencing a situational depression right now, as many people are during Covid-19  and the very tense climate in our country, know that this too shall pass. Situational depressions are temporary, although they can be recurring. Seek help from a qualified professional, and use therapy, psychiatry, and support groups to help you get through. You will get to the other side with wraparound support.

Dr. Anita Gadhia-Smith