Depression-Proofing Your Home

This is a chopped version of an article I just uploaded on mcmanweb. It's amazing I've never written on this before. Better late than never ...

Let’s start with the proposition that people with mood disorders are extremely sensitive to their environments. You may be stuck where you are, but your entire well-being is riding on making the best of what you’ve got.

Atmosphere

Essential adjectives are vital: Cheery, bright, relaxing, calm. Your home is a key player in setting the right mood. If what comes to mind, instead, is, say, depressing, you are on the wrong adjective.

There is a direct connection between light and mood. If vast quantities of natural sunlight aren’t streaming into your place, then you need to buy stock in a lamp company and make yourself rich by purchasing their entire inventory. You may also want to consider a light box, normally used to treat seasonal affective disorder.

Meanwhile, fresh air (charged with negative ions) is linked to good health, both physical and mental. Cracking open a window is the obvious solution, but if you are you living in a sealed enclosure and inhaling central heating or air conditioning (charged with positive ions), you may need to consider investing in an ionizer.

You also need to be extremely mindful of breathing in anything toxic, from mold proliferating behind the wallboard to chemicals in the carpet to germs the central air-conditioning spits out.

The Bedroom

The basics: A comfortable bed that supports your back, good lighting (for bedtime winding down and for waking up), and as close as possible to absolute quiet.

The quiet aspect deserves special consideration. Many of us have hair-trigger stress responses that can be set off by loud noises. A lot of us also have great difficulty tuning out background noise (such as air-conditioning). These should not be regarded as inconveniences we have to get used to.

Family members: You will be doing both yourself and your entire family a favor by bending over backwards to accommodate the needs of your affected son or daughter (or other family member). If he or she sleeps peacefully, you all sleep peacefully. And daytime will be much easier on all of you, as well. Whatever it takes.

Your Own Special Room

Having your own hideaway is essential, whether in catching your breath or catching up. This is your special piece of the world. It needs to reflect you in all your quirky glory, from the First Folio Shakespeare in the bookcase to the neon Budweiser sign in the window.

However you choose to set up the room, it is giving You permission to be You, whether smoking cigars or meditating, building model airplanes or running a business.

The Kitchen

You are what you eat, but living with a mood disorder means you are often going to be too depressed to want to cook. Therefore, it’s vital to be well-stocked on healthy pre-prepared slap-together stuff. Bags of mixed greens, stir-fry, you get the picture.

The Bathroom

Think of all the stuff that goes on in this room besides the usual - uh - stuff. From looking in the mirror to all the rest of it, you are on display. The other you is evaluating, assessing, taking stock. Don’t like what you see? It’s going to be a rough day.

Likewise, there you are, in your inner sanctum, alone with your thoughts. Is the atmosphere conducive to a meditative experience, a breather, a pleasant time-out? Or is your decompression chamber a depression chamber?

Of all the rooms in the house, the bathroom is the one room where you need to walk out of it feeling much better than you went in. If this isn’t happening, you need to closely evaluate the situation - and treat it as a high priority.

Home Maintenance

Things can easily run away from us, even when we are not depressed. I know for a fact that if I go to bed with two dirty plates in the sink, I will wake up to a family of dirty little saucers. As for clothes on the floor, it’s like tumbleweed piling up against a fence. My theory on rubber bands is they morph into power cables for electronic devices that don’t exist. All my cables, incidentally, defy the law of entropy by self-organizing into gordian knots.

By now, you recognize that the front line in the battle against depression is played out literally on the home front, in our own homes. Make yourself at home and live well ...      

Atypical Depression - Entirely Too Atypical?

I just finished uploading four new articles on depression on my mcmanweb site. The articles replace and greatly expand upon two earlier pieces that introduced depression. In addition, I also wrote a new article to replace my old one on atypical depression.

In the second of my introductory pieces, I propose a “vegetative-agitated” depression distinction that would better serve patients than the highly confusing “typical-atypical” distinction. The following extracts from my two articles make my case ...

Vegetative or Agitated?

In other words, are you feeling sort of like you have a bad cold but without the runny nose, fever, and diarrhea? No energy? Can't get started? No motivation? Can barely string two thoughts together? Just want to curl up into a ball and not wake up? Your clinical condition is dead but breathing. You get the picture.

Or does your depression feel more like you're in neutral, but with the motor running out of control? "If only, if only," a piece of your over-ruminating prefrontal cortex may be chanting. "I can't take it!" the primitive reacting limbic region of the brain may be screaming. You want to grab the world by the throat and shake it. Folded into all of this may be anxiety. You get the picture.

Two very different mental states, obviously. But way too many doctors (my guess is most) refer to both conditions as "depression" and send patients out the door with the exact same prescription.

Figuring out depression is very binary, really. Emotion, mental activity, physical activity, and tell-tale behavior - too much or too little, high or low, up or down, under or over. Gradually a picture begins to emerge, a very complex one full of anomalies, a testament to your uniqueness and to the fact that no two depressions are alike. Nevertheless, the picture is likely to resolve one of two ways.

Which side of the universe you find yourself on suggests different (though overlapping) treatment and recovery strategies: energizing agents and lifestyle practices for vegetative depressions, calming agents and lifestyle practices for agitated depressions.

Typical or Atypical?

According to the DSM-IV, as opposed to major depression, the patient with atypical features experiences mood reactivity, with improved mood when something good happens. This would broadly translate to an individual momentarily taking leave of his or her Stygian gloom to laugh at a friend slipping on a banana peel.

Likewise, there would be an element of enthusiasm to news of winning the Powerball lottery.

In addition, the DSM-IV mandates at least two of the following: Increase in appetite or weight gain (as opposed to the reduced appetite or weight loss of "typical" depression); excessive sleeping (as opposed to insomnia); leaden paralysis; and sensitivity to rejection.

Sensitivity to rejection could be interpreted as the flip side to mood reactivity. Here, there is a visible response to bad news rather than good. Either way - mood reactivity or sensitivity to rejection - beneath despair that borders on catatonic, we see signs of life, of a "dead but breathing" individual capable of animation.

But is this only confusing the picture?

A 2001 study by Posternak and Zimmerman cast doubt on the only feature of atypical depression that is mandatory under the DSM - that of mood reactivity. In their study, the authors evaluated the five symptoms of atypical depression across five different groups of patients (including women, different age groups, and according to severity and length of time of symptoms), and discovered mood reactivity only featured among the women patients, suggesting this particular criteria should be dropped.

In practice, psychiatry is retrofitting a set of diagnostic anomalies over the notorious DSM symptom check-list. Thus, before we can even determine if an individual has atypical depression, a clinician must first find evidence of "major depressive disorder." (Check-list depression, in other words.)

Then, in making a diagnosis of "major depressive disorder with atypical features" the clinician, in effect, is asked to contradict parts of that same check-list.

A 2010 abstract to a review article (the full article is in Japanese) tells us that we are probably looking at four views of atypical depression. To give you an indication of the complexity of the discussion, following is a representative segment of one sentence of the abstract:

...reflects the theory that mood nonreactivity is the essential symptom of "endogenomorphic depression", which was proposed by Klein as typical depression.

The original Japanese would have been no less confusing, a point which the author seems to happily acknowledge. Indeed, the abstract resolves into brutal clarity in its summary dismissal of the diagnosis:

Consequently, the concept of atypical depression has become overextended and gradually lost its construct validity.

In the current discussion over what constitutes atypical, psychiatry has lost sight of the fact of how the term came about in the first place - as a hypothesis for why certain patients with unipolar depression responded to MAOIs rather than tricyclics.

Let the conversation build on that important piece.

***

My new depression articles:

What Is It? 
Figuring Out Depression 
Placing Depression in Context
Depression Plus
Atypical Depression