Ira Stamm on Depression – It’s always been about self-care

Depression self-care was important ten years ago, too.

Recently I was doing advocacy work with the Kansas Mental Health Coalition. At some point I realized that mental health providers were not my core audience and my time would be better spent focusing on building a business to provide market based mental health solutions.  But during my interaction with that group, I connected with Dr. Ira Stamm, a psychologist with a whole career working in mental health who liked our approach and offered this guest blog showing a glimpse into the cutting edge of depression self-care about ten years ago at a Kansas organization which used to be a nationwide leader in mental health.

Ira Stamm posts here about what depression self-care looked like ten years ago

Ira Stamm posts here about what depression self-care looked like ten years ago

He sent us this archived document for posting to share information about depression self-care then and now. Keep in mind that this post is a historical document and does not necessarily completely our point of view and current language. For instance, calling Depression an illness tends to obscure the idea of a temporary problem that Dr. Stamm outlined over ten years ago:

Depression self-care works regardless of the cause:

The causes of depression continue to be studied and debated.

1) Life events and stressors such as the loss of a family member or job, or the termination of a marriage can trigger an episode of depression.

2) Depression appears to alter the biochemistry of the brain resulting in the depletion of chemicals necessary for emotional well-being.

[Notice the sequence here, life events that causes chemical changes that corresponds with our blog showing that life events also cause psychosis.]

3) Since depression is often found in more than one member of the extended family, there is the question of whether depression or a tendency towards depression is inherited genetically. [This question has still not been answered.]

4) Some medical conditions such as low thyroid contribute to depression. Patients who undergo certain surgeries such as open heart by-pass surgery are at greater risk for developing a major depression.

Resolving Psychological Conflict Can be good Depression Self-Care:

There are numerous areas of psychological conflict that contribute to depression, too numerous to list here. As an example, one client experienced dramatic relief from severe depression after sharing with the therapist information he had never shared with anyone. Many individuals experience acute, though transient depression, during some major life stressor such as job loss, divorce, or physical illness. Even seemingly positive life events can trigger unexpected depressions.

I have met with several mothers who developed minor depressive reactions as their adolescent children graduated from high school. These mothers were extremely connected to their children, and were saddened by the anticipated separation and loss as these children moved on with their lives. Sometimes, just a few sessions with a therapist who understands the nature of life cycle changes and transitions, can help a parent understand why they are feeling so sad.

Depression Self-Care by development a strong sense of self:

Andrew Holland wins $150 for avoiding a for depression self-care by having his hobby, Dungeons and Dragons.

Andrew Holland wins $150 for avoiding a for depression self-care by having his hobby, Dungeons and Dragons.

Each of us develops early in life internalized images of ourselves and important caretakers. Early experience with a good, loving mother and father, creates in us a sense that we are good and worthwhile, and a sense of emotional wholeness and well being. It creates, too, a view of others close to us as trustworthy and reliable. This is an ideal script which nurtures and sustains the individual’s self-esteem throughout the life cycle.

In the real world, few of us grow up under such ideal circumstances. A troubled or unstable parent may create in the child tendencies towards self-doubt and sadness. Depending on other life circumstances, the good or negative experiences of the early years are reinforced as we continue to grow.  The good internal images of “self’ and “others” from the early years form an emotional reservoir. When confronted with stress, trauma, or tragedy later in life, some of us have a deep enough reservoir of positive “self’ and “other” images to sustain us through difficult times without becoming depressed. Others of us, whose early years were troubled or flawed, have less of a reserve to draw upon as we encounter life’s complexities. Such individuals are more prone to become depressed under stress.

 The Psychotherapy of Depression

The psychological treatment of depression that follows from this understanding of human development is as follows. The patient visits with the therapist and talks about the conflict creating the depression. Sometimes, the actual source of the depression is unknown to the patient, and the therapist and patient collaborate to understand the unconscious source of the depression. Understanding, and the release and working though of pent-up emotions are two of the curative factors in treating depression with psychotherapy. A third curative factor is the patient’s relationship to the therapist. The patient-therapist relationship re-activates and reinforces earlier positive experiences with important caretakers. This serves to uplift the patient’s mood and positively motivate him or her.

Patients who had unloving, abusive, or traumatic experiences early in life may experience recurrent depressive episodes throughout the life cycle and present more of a challenge for the therapy. These patients benefit from more frequent psychotherapy sessions. For many depressed patients, psychotherapy often has a short “half-life.” The patient sees the therapist on Monday and for the rest of Monday, Tuesday, and Wednesday feels better and encouraged. But by Thursday, the positive effects of the Monday session begin to “wash out” of the patient’s psychological system, leaving him or her feeling emotionally depleted and discouraged. Seeing the therapist again on Thursday reactivates and revitalizes the patient’s inner sense of “good self’ and “good other,” uplifting their mood.

Potential problems with treating depression with medication:

Bicycling and art at the same time: Critical Mass pauses outside the Nelson Atkins Gallery

Bicycling and art at the same time: Critical Mass pauses outside the Nelson Atkins Gallery

Some patients do not respond to or tolerate the SSRIs or other anti-depressant medications well, and some simply prefer to participate in psychotherapy without taking medication.  Doctors were attracted to the SSRIs when they first became available more than a decade ago because the SSRIs were easy to prescribe and appeared to have few side effects. A decade later [remember now this means two decades later since this is a ten year old document] we appreciate that the SSRIs can indeed be helpful to many patients, but they also have drawbacks. Many patients report sexual side effects either in the form of decreased libido or delayed orgasmic response. Some patients taking SSRIs display a certain degree of apathy about life. One client felt so much better after taking an SSRI that he realized one day that he had not paid his bills in three months.

Another patient, a musician, complained that she no longer had the ‘angst’ that made her an excellent pianist. The reader who would like to know more about the pros and cons of taking these medications should consult the books by Kramer (1993) and Glenmullen (2000).  Kramer is a psychiatrist from Brown University Medical School who wrote a largely positive account about the benefits of Prozac. Glenmullen is a psychiatrist with the Harvard University Health Services whose book about Prozac and the SSRIs serves as a cautionary tale.   [This book is called Prozac Backlash , and shows that very debatable medication effectiveness, serious withdrawal effects than disclosed, and more dangerous side effects than disclosed were already a problem 10 years ago.]

[Here is a fairly recent article by Peter Kramer from the New York Times and a critique of this article.]

A Comprehensive Depression Self-Care Program for Outpatient Treatment

[Yeah! Solutions! More solutions! We always promise to give you solutions if we tell you about a problem.]

  •  Individual psychotherapy – 2-3 sessions a week during the acute phase of the depression (1-4 months); then 1-2 sessions weekly for 6 months -3 years
  • Antidepressant medication (as needed) [be very careful to get all information first so you can can a fully informed decision]
  • Marital therapy and/or Family therapy (as needed)
  • Exercise and/or sustained athletic activity
  • There is ample research that exercise releases chemicals in the brain that elevates mood and wards off depression.
  •  Nutritional plan – Several books have appeared that document the relationship between what we eat and our moods. Two books by Wurtman and Suffes (1996) and DesMaisons (1998) are written for those trying to lose weight. These authors draw a direct connection between mood and levels of serotonin in the brain. Their diet plans are based around ways to increase levels of serotonin in the brain through the foods we eat. A book by Stoll (2001) draws a direct link between depression, bipolar illness, and other disorders and the level of Omega-3 fatty acids in the brain. While none of these authors advocates the treatment of bona fide clinical depression through the use of diet alone, it stands to reason that diets that include foods that enhance the production of serotonin and supply Omega-3 fatty acids may benefit those struggling with depression or who are prone to depression.
  •  Yoga/ meditation/biofeedback – These modalities help people to relax, to become emotionally centered, and better able to respond to stress.
  •  A Full and Productive Day – Keeping busy in a positive and productive way helps to fight depression. Clients may benefit from making up a weekly schedule, being sure to include enough time for rest and relaxation.
  •  Contact with People/Caregivers Each Day –  Regular, ongoing, and sustained contact with others is one of the best things people with depression can do to help themselves.  No one with depression should feel alone. Friends, family members, co-workers, therapists, and others can all empathize with the depressed person because almost everyone has struggled with some degree of depression at some point in their life.
  •  Expressive therapy and hobbies (art, dance, music, crafts, etc.) – These adjunctive therapies allow people to express and work on their emotions in non-verbal ways.
Check out this poem by Floetic Nette about poetry helps her get through challenges:

References:
DesMaison, K (1998) Potatoes not Prozac. New York: Simon & Schuster
Glenmullen, J. (2000) Prozac Backlash. New York: Simon & Schuster
Kramer, P. (1993) Listening to Prozac. New York: Viking Press
Stoll, A.L. (2001) The Omega-3 Connection. New York: Simon & Schuster
Wurtman, J. & Suffes, S. (1996) The Serotonin Solution. New York: Fawcett Columbine

Ira Stamm, Ph.D., ABPP is a psychologist in independent practice in Topeka, Kansas where he treats adults, adolescents, children, couples, and families. Dr. Stamm is Board Certified in Clinical Psychology by the American Board of Professional Psychology and holds licenses to practice psychology in Kansas and Missouri. He is also a Licensed Clinical Marriage and Family Therapist in Kansas.

[Don’t forget this a historical document and is presented here with the author’s permission to compare what we knew about depresion self-care 10 years ago.  This document does not reflect all of Wellness Wordworks’ current use of langauge, diagnoses, and labels, but is included to show how far we have and haven’t come.]

 What do you use for depression self-care? What helps you get through difficulties?

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