Neurotransmitters, Depression and Anxiety

Definition of a Neurotransmitter

Neurotransmitters are types of hormones in the brain that transmit information from one neuron to another. They are made by amino acids. Neurotransmitters control major body functions including movement, emotional response, and the physical ability to experience pleasure and pain. The most familiar neurotransmitters which are thought to play a role in mood regulation are serotonin, norepinephrine, dopamine, acetylcholine, and GABA.

Neurotransmitter Effects on Mental Health:
· Modulate mood and thought processes
· Control ability to focus, concentrate, and remember things
· Control the appetite center of the brain
· Regulate sleep

Types of Neurotransmitters

Neurotransmitters can be broadly classified into two categories; excitatory and inhibitory. Some neurotransmitters can serve both functions.

Excitatory neurotransmitters are the nervous system's "on switches", increasing the likelihood that an excitatory signal is sent. They act like a car’s accelerator, revving up the engine. Excitatory transmitters regulate many of the body’s most basic functions including: thought processes, the body’s fight or flight response, motor movement and higher thinking. Physiologically, the excitatory transmitters act as the body's natural stimulants, generally serving to promote alertness, energy, and activity. Without a functioning inhibitory system to put on the brakes, things can get out of control.

Inhibitory neurotransmitters are the nervous system's "off switches", decreasing the likelihood that an excitatory signal is sent. Excitation in the brain must be balanced with inhibition. Too much excitation can lead to restlessness, irritability, insomnia, and even seizures. Inhibitory transmitters regulate the activity of the excitatory neurotransmitters, much like the brakes on a car. The inhibitory system slows things down. Physiologically, the inhibitory transmitters act as the body's natural tranquilizers, generally serving to induce sleep, promote calmness, and decrease aggression.

Excitatory neurotransmitters
· Dopamine
· Histamine
· Norepinephrine
· Epinephrine
· Glutamate
· Acetylcholine

Inhibitory neurotransmitters
· GABA
· Dopamine
· Serotonin
· Acetylcholine
· Taurine

Neurotransmitter Overview

Acetylchlorine helps with memory and learning.
Dopamine is primarily responsible for sex drive, mood, alertness, and movement.
Norepinephrine and epinephrine influence alertness, arousal, and mood.
Serotonin is involved in mood, appetite control, emotional balance, and impulse control.
GABA helps with relaxation and sedation.

Acetylcholine

Acetylcholine release can be excitatory or inhibitory depending on the type of tissue and the nature of the receptor with which it interacts. Acetylcholine plays numerous roles in the nervous system. Its primary action is to stimulate the skeletal muscular system. It is the neurotransmitter used to cause voluntary muscle contraction or relaxation in the muscles.

In the brain, acetylcholine is involved in learning and memory. Acetylcholine is a small molecule transmitter that is also found in the hippocampus and prefrontal cortex. The hippocampus is responsible for memory and memory retrieval. Alzheimer’s disease is associated with a lack of acetylcholine in certain regions of the brain.

Dopamine

Dopamine can act as both an excitatory or inhibitory neurotransmitter and functions as the brain’s “feel good” neurotransmitter. It is part of the brain’s reward system and creates feelings of satisfaction or pleasure when we do things we enjoy, such as eating or having sex. Drugs like cocaine, nicotine, opiates, heroin, and alcohol increase the levels of dopamine. Eating foods that taste good and having sex also stimulate an increase in dopamine levels. For this reason, many surmise that a deficient level of dopamine in the brain may be behind peoples’ tendencies to use drugs, drink alcohol, smoke cigarettes, be promiscuous, gamble or overeat.

Dopamine’s functions are diverse, affecting memory, motor control, and pleasure. It allows us to be alert and motivated and to feel satisfied. Dopamine is associated with positive stress states such as being in love, exercising, listening to music, and sex. Once produced, dopamine can, in turn, convert into the brain chemicals norepinephrine and epinephrine.

High levels

However, too much of a good thing can be bad for you. An increased level of dopamine in the frontal lobe of the brain contributes to the incoherent and disrupted thought processes that are characteristic of schizophrenia. Excessive levels of dopamine cause our thinking to become excited, energized, then suspicious and paranoid as we are hyperstimulated by our environment. With low levels of dopamine we lose the ability to focus. When dopamine levels are too high our focus becomes narrowed and intense. High dopamine levels have been observed in patients with poor gastrointestinal function, autism, mood swings, aggression, psychosis, anxiety, hyperactivity, and children with attention disorders.

Low levels

Too little dopamine in the motor areas of the brain are responsible for Parkinson's disease, which involves uncontrollable muscle tremors. A decline in dopamine levels in the thinking areas of the brain is linked to cognitive problems (learning and memory deficits), poor concentration, difficulty initiating or completing tasks, impaired ability to “lock onto” tasks, activities, or conversations, lack of energy, lack of motivation, inability to “feel alive”, addictions, cravings, compulsions, a loss of satisfaction in activities which previously pleased you, and slowed motor movements.

Epinephrine

Epinephrine, also known as adrenaline, is an excitatory neurotransmitter. It is derived from norepinephrine and is secreted along with norepinephrine in response to fear or anger. This reaction, referred to as the “fight or flight” response, prepares the body for strenuous activity. Epinephrine regulates attentiveness, arousal, cognition, sexual arousal, and mental focus. It is also responsible for regulating the metabolism. Epinephrine is used medicinally as a stimulant in cardiac arrest, as a vasoconstrictor in shock, as a bronchodilator and antispasmodic in bronchial asthma, and anaphylaxis.

High levels
Epinephrine levels which are too high can result in restlessness, anxiety, sleep problems, acute stress, and ADHD. Excess amounts of epinephrine can also raise the blood pressure, increase the heart rate, cause irritability and insomnia.

Low levels
Low levels of epinephrine can also contribute to weight gain, fatigue, lack of focus, decreased sexual arousal, and poor concentration.

Stress tends to deplete our store of adrenalin (epinephrine), while exercise tends to increase it.

GABA

GABA is the abbreviation for Gamma-aminobutyric acid. GABA is the major inhibitory neurotransmitter in the central nervous system and plays a major role in regulating anxiety and reducing stress. GABA has a calming effect on the brain and helps the brain filter out “background noise”. It improves mental focus while calming the nerves. GABA acts like a brake to the excitatory neurotransmitters which can cause anxiety if the system is overstimulated. It regulates norepinephrine, adrenaline, dopamine, and serotonin and is a significant mood modulator. The primary function of GABA is to prevent overstimulation.

High levels
Excessive GABA levels result in excessive relaxation and sedation, to the point that normal reactions are impaired.

Low levels
Insufficient GABA results in the brain being overstimulated. People with too little GABA tend to suffer from anxiety disorders and may have a predisposition to alcoholism. Low levels of GABA are associated with bipolar disorder, mania, poor impulse control, epilepsy, and seizure disorders. Since proper GABA functioning is required to induce relaxation, analgesia, and sleep, dysfunction of the GABA system is implicated in the pathophysiology of several neuropsychiatric disorders, including anxiety and depression. In 1990, a study linked lowered levels of GABA to a predisposition to alcoholism. When men of alcoholic fathers with low GABA drank a glass of vodka their GABA levels rose to the equivalent of the control group.

Glutamate

Glutamate is a major excitatory neurotransmitter that is associated with learning and memory. It is also thought to be associated with Alzheimer’s disease. Glutamate has been implicated in epileptic seizures and is a key molecule in cellular metabolism. It is also one of the major food components that provides flavor. Glutamate is found in all protein-containing foods such as cheese, milk, mushrooms, meat, fish, and many vegetables. Monosodium glutamate is a sodium salt of glutamate.

High levels

Excessive levels of glutamate are toxic to neurons and have been implicated in the development of neurological disorders such as amyotrophic lateral sclerosis and Huntington's chorea, peripheral neuropathies, chronic pain, schizophrenia, stroke, and Parkinson's disease.

Low levels

Insufficient levels of glutamate may play a role in impaired memory and learning.

Histamine

Histamine is most commonly known for its role in allergic reactions but it is also involved in neurotransmission and can affect your emotions and behavior as well. Histamine helps control the sleep-wake cycle and promotes the release of epinephrine and norepinephrine.

High levels
High histamine levels have been linked to obsessive compulsive tendencies, depression, and headaches.

Low levels
Low histamine levels can contribute to paranoia, low libido, fatigue, and medication sensitivities.
MonoaminesThis is a class of neurotransmitters which includes serotonin, norepinephrine, GABA, glutamate, and dopamine. The monoamine hypothesis holds that mood disorders are caused by depletion in the levels of one or more of these neurotransmitters.

Norepinephrine

Norepinephrine is an excitatory neurotransmitter that is important for attention and focus. Norepinephrine is synthesized from dopamine and is strongly associated with bringing our nervous systems into the “fight or flight” state. Norepinephrine triggers the release of hormones from the limbic section of the brain that signal other stress hormones to act in a crisis. It can raise blood pressure and increase heart rate. It can elevate the metabolic rate, body temperature and stimulate the smooth bronchial muscles to assist breathing. It is also important for forming memories.

High levels
Elevated norepinephrine activity seems to be a contributor to anxiety. Also, brain norepinephrine turnover is increased in conditions of stress. Increased levels of norepinephrine will lead to alertness and mood elevation and increased sexual interest. However, high amounts raise blood pressure, increase heart rate, and cause anxiety, fear, panic, stress, hyperactivity, an overwhelming sense of dread, irritability, and insomnia.

Low levels
Low levels of norepinephrine are linked to lack of energy, focus, and motivation. Insufficient norepinephrine levels also contribute to depression, loss of alertness, and poor memory.

PEA

PEA is an excitatory neurotransmitter made from phenylalanine. It is important in focus and concentration.

High levels
Elevated PEA levels are observed in individuals experiencing "mind racing", sleep problems, anxiety, and schizophrenia.

Low levels
Low PEA is associated with difficulty paying attention or thinking clearly, and in depression

Serotonin

Serotonin is an inhibitory neurotransmitter involved in the regulation of mood, anxiety, libido, compulsivity, headaches, aggression, body temperature, eating disorders, social anxiety, phobias, sleep, appetite, memory and learning, cardiovascular function, muscle contraction, and endocrine regulation. Other brain neurotransmitters, such as dopamine and norepinephrine, also influence mood and arousal. However, serotonin generally has different effects.
Serotonin plays a major role in sleep and mood regulation. Proper amounts of circulating serotonin promote relaxation. Stress reduces our serotonin levels as our body uses up serotonin in an attempt to calm itself.

Low levels
Low levels of serotonin can result in depressed mood, anxiety, panic attacks, low energy, migraines, sleeping problems, obsessions or compulsions, feeling tense and irritable, craving sweets or loss of appetite, impaired memory and concentration, angry or aggressive behavior, slowed muscle movement, slowed speech, altered sleep patterns, and having a reduced interest in sex.

High levels
Excess amounts of serotonin cause sedation, a decrease in sexual drive, a sense of well-being, bliss, and of being one with the universe. However, if serotonin levels become too high they can result in Serotonin Syndrome, which can be fatal.

Serotonin Syndrome

Extremely high levels of serotonin can be toxic and possibly fatal, causing a condition known as “Serotonin Syndrome”. It is very difficult to reach these high levels by overdosing on a single antidepressant, but combining different agents known to increase levels of Serotonin, such as an SSRI and an MAOI, can result in this condition. Taking recreational Ecstasy can also have this effect, but rarely leads to toxicity. Serotonin Syndrome produces violent trembling, profuse sweating, insomnia, nausea, teeth chattering, chilling, shivering, aggressiveness, over-confidence, agitation, and malignant hyperthermia. Emergency medical treatment is required, utilizing medications that neutralize or block the action of serotonin.

Factors affecting serotonin production

Your hormones and Estrogen levels can affect serotonin levels and this may explain why some women have pre-menstrual and menopausal mood problems. Moreover, daily stress can greatly reduce your serotonin supplies.

While exercise and exposure to light may increase or stimulate serotonin levels, antidepressants can aid the brain to replenish its own supply. The most recent SSRI antidepressants, (selective serotonin reuptake inhibitors) are current drugs of choice to increase serotonin circulation.

Taurine

Taurine is an inhibitory neurotransmitter involved in neuromodulatory and neuroprotective actions. Supplementing with taurine can increase GABA function. By helping GABA function, taurine is an important neuromodulator for prevention of anxiety. The relevance of GABA support is to prevent overstimulation due to high levels of excitatory amino acids, such as norepinephrine and epinephrine. Therefore, taurine and GABA constitute an important protective mechanism against excessive excitatory neurotransmitters.

Overcoming Insomnia

Do you stay awake all night and sleep all day? Do you lie around all the time but never get rested? Do you have trouble getting to sleep? Are you able to get to sleep, but wake up frequently throughout the night? Do you believe you are sleeping long enough, but you still wake up tired?

We are continually stressed and running short on time and it would seem logical that after running around all day we would have no trouble getting to sleep at night. But that is not the case. Many of us are finding it increasingly difficult to get to sleep at night. To further complicate matters, we tend to depend upon caffeine, cigarettes and sugar as a substitute for what only a good night's sleep can provide. Sleep patterns, thinking processes and mood are intimately related. Sleep deprivation makes us irritable, unable to think clearly and depressed. Many of us become so desperate to get a good night's sleep that we resort to medications, but are they really necessary? Perhaps the best medicine of all is to start really listening to your body instead of working against it.

How to Establish Good Sleep Patterns:

1. Establish a sleep schedule. Calculate a bedtime that will allow you to get this many hours and wake up at a reasonable hour (for example, when you need to get ready for work). Determine the number of hours you need to feel rested. Don't worry if you don't fit into the "norm" of eight hours. A good guideline to start with is how many hours you sleep when you "sleep in" on the weekends. The first day, wake yourself at the time you would like to be your usual waking time, whether you are rested or not.

2. Exercise. With many of us working in offices all day, we never actually do enough physical labor to tire our bodies so they can get a good sound night’s sleep. A good hard work out will make you tired a few hours later. Admittedly, most people find it easier to fit a workout into their morning schedule and be consistent about it. But if you can manage to workout a few hours before bedtime, it may help “wear you out” and make you tired. Weight lifting and swimming, or a really tough cardio workout can be great for inducing sleepiness afterwards. If you belong to a gym, indulge in a few minutes of sauna time after your workout. This will warm up and relax your muscles and further relax you and prepare you to rest.

3. Establish a bedtime ritual. A couple of hours before bedtime begin to allow you to wind down. A regular evening ritual can help you relax and will signal your body that it's time to rest. (By the way, this works great with small children too.)

4. Avoid naps. Do not take a nap during the day, no matter how tired you get. This only makes it harder to get a good night’s sleep at night. It may also offset your nightly routine and sleep schedule since you won’t get tired until much later.

5. Avoid caffeine. Limit your intake of caffeine. Do not consume any caffeine after mid-afternoon. Its effects can take hours to wear off. You will eventually find that you are getting enough rest and don't need an extra boost in the morning to wake up.

6. Try natural sleep aids.
Melatonin supplements taken near bedtime help the body fall asleep. Melatonin is a naturally occurring hormone associated with the sleep cycle. Your body starts to produce it when the sun goes down to signal the system that it’s time to sleep. As we age we produce less and less melatonin. Melatonin supplements work best if you take them about 30 minutes before you want to go to sleep, then lie down in a dark room to replicate the natural processes. If you continue to move around in a lighted room they will not be as effective. Melatonin can be purchases rather inexpensively over the counter at most pharmacies.

Kava Kava, Valerian or chamomile tea produce calming effects.

A hot bath or a massage is great for warming and relaxing the muscles. This can be particularly helpful for someone who can’t sleep due to stress or anxiety.

7. Avoid sleeping pills. Avoid artificial sleep medications, tranquilizers, or alcohol. Although you may fall asleep, your sleep will not be gentle and natural. You will feel groggy in the morning. Many of these aids produce only light sleep, not the deep, RAM sleep that we need in order for our bodies to repair themselves and to feel rested in the morning. Most tranquilizers and alcohol have a tolerance effect – it takes more and more of the chemical to get the same effect.

8. Get up. If you are unable to get to sleep, get up and do something else until you become tired. Lying in the bed tossing and turning just frustrates you further and reinforces that the bed is for tossing and turning instead of sleeping. If you are troubled by racing thoughts that just won't stop, get up and do something to keep you occupied until the thoughts subside. They'll pass much more quickly this way.

9. Only use the bedroom for sleep. Try to do other activities in another area of the house so your body learns that the bed is for sleeping and nothing else.
Tips:
1. Don't despair if you have to go sleepy for a couple of days to get back on track. For most people, these steps will work if followed faithfully.
2. Keep a regular schedule, even on weekends. If you do, every day will feel as glorious as "sleeping in" on the weekends.
3. If keeping a regular sleep schedule is not working for you, consult an expert for further assistance. Certain sleep disorders, such as sleep apnea, have been associated with depression.

Strategies for Living with Depression

In many ways depression is a lot like diabetes. Though you can administer insulin alone to a diabetic, combining the medication with positive lifestyle changes makes treatment twice as effective. If a diabetic takes their insulin sporadically, continues eating a diet heavy in sugar and gets no exercise, how effective will the insulin be? An improved diet and exercise will not only decrease the reliance on insulin and help stabilize the blood sugar; it will also decrease the debilitating symptoms of the disease and allow the patient to participate more fully in their own recovery.

Likewise, antidepressants may decrease some of the symptoms of depression and may lift a person’s mood a bit. But if they take their antidepressants sporadically, do not eat well, get no exercise, sit in a dark house and do not interact with anyone, they are doing things that not only exacerbate the depression, but make it harder for the medication to do its job.

The tips listed below will help lift your mood with or without medication. However, they must be done consistently and on a daily basis in order to be the most effective.

1. Schedule your day
Depression tends to sap our energy and kill our motivation. We end up sitting around all day and accomplishing nothing. There is also a tendency to isolate and vegetate. When we do this, we feel even worse because we have lost yet another day and accomplished nothing. Develop a schedule that requires that you to: 1) accomplish at least one task, even if it is minor and 2) get out of the house at least one time per day.

2. Schedule something fun or pleasant to do each day
When depressed we are often low on dopamine and serotonin. Doing things which are pleasant or fun increase the levels of dopamine and serotonin and lift our mood. Americans tend to be very task oriented and often view “fun” as frivolous and optional. Also, when we are depressed and the housework is backed up, we haven’t paid the bills this month, and we are behind in our jobs, scheduling something fun seems to be a luxury we can’t afford. Fun also takes energy.

However, a brain is like a bank account. If you don’t put something you can’t make withdrawals. Schedule something that rejuvenates you. Make a deposit in your neurotransmitter account, so that you increase the neurotransmitter levels and can use those increased levels to clean the house, pay the bills, and catch up at work.

3. Develop a support system
People who are depressed tend to isolate and withdraw from people around them. They stop taking phone calls, don’t answer the door, don’t leave the house, and don’t go out to socialize. Develop a support system who will point out to you when you are doing this and prod you to get out of the house. Human interaction and socialization is important to mental health, even if it is just a walk around the block or a cup of coffee with a friend.

4. Consider taking an antidepressant
The items on this list require that you be able to overcome the apathy, the lack of energy, the lack of motivation, and the sadness in order to get up and make yourself do these suggestions. If you are not eating, not getting out of bed and not bathing, this may be too much to ask. If your depression is so severe that you are not functioning at the most basic levels you may need to take an antidepressant to give you enough energy and motivation to develop other coping skills for dealing with the illness.

5. Exercise
Research is showing that for mild to moderate depression 30 minutes of exercise daily can be as effective as an antidepressant. Some type of cardiovascular exercise appears to be the most effective. And it does not need to be long, grueling or strenuous. A simple stroll around the block for 30 minutes has been shown to be effective for lifting the mood. Just get up and move.

6. Expose yourself – to sunlight
People with depression tend to isolate and stay inside, often closing the blinds and curtains and sitting in the dark. Research has shown that daily exposure to sunlight for 15-30 minutes helps lift the mood and alleviate depressive symptoms. Take that daily walk around the block and get your exercise and your sunlight.

7. Eliminate stressors
When the body is stressed it “burns” more serotonin in an effort to calm itself. Low levels of serotonin can result in depressed mood, anxiety, panic attacks, low energy, migraines, sleeping problems, obsessions or compulsions, feeling tense and irritable, craving sweets or loss of appetite, impaired memory and concentration, angry or aggressive behavior, slowed muscle movement, slowed speech, altered sleep patterns, and having a reduced interest in sex. Eliminating stressors will allow more serotonin to be available to the brain to lift the mood.

8. Get more sleep
Sleep and mental health are vitally connected. Some research now suggests that insomnia not only contributes to depression, but may be a leading cause of it. Our bodies repair and regenerate themselves when we are in the deepest levels of sleep. When we are unable to get sufficient sleep, or deep enough sleep, the neurotransmitters that regulate mood are depleted.

9. Be aware of what you eat
The neurotransmitters which regulate mood are made from amino acids and other elements which are found in the foods we eat. That is why it is important to eat a well-balanced, nutritious diet when fighting depression. Depression often eliminates our appetite, or makes us crave sweets and carbohydrates. Not eating will obviously cause depletions in the nutrients we need to make the neurotransmitters which will make us feel better. Eating sweets and simple carbohydrates will give us a temporary “high” as the glucose they produce floods are bloodstream and skyrockets our blood sugar levels and releases dopamine. But these simple sugars leave our bloodstream just as suddenly as they entered resulting in a “crash”. Not only is this bad for your endocrine system which regulates blood sugar and insulin levels, it’s hard on your mood as well.

Instead, try to eat complex carbohydrates (fruits, vegetables, and whole wheat products) combined with protein (dairy products, eggs, lean meat). The complex carbohydrates will be broken down and released slowly over time, creating a gradual and long-lasting increase in your blood sugar while the protein will provide the amino acids needed to make and neurotransmitters, increasing their levels.

10. Avoid alcohol and drug use
Alcohol and many drugs typically thought of as “downers” (opiates, benzodiazepines, etc.) act as depressants, meaning they not only exacerbate depression, but may be the cause of it. Other drugs typically thought of as “uppers” (cocaine, speed, etc.) are often used by people struggling with depression to temporarily lift their mood. However, these drugs often act by dumping all of the neurotransmitters into the system at one, giving us the “high”, but then leaving our systems totally depleted of neurotransmitters and causing a “crash” that is worse than the depression we began with. It’s best to avoid drug and alcohol use and to develop more healthy ways of lifting our mood.

11. Learn How to Stop Negative Thoughts
Cognitive Behavioral Therapy (CBT) is one of the primary therapeutic techniques used to treat depression. Why? Because it identifies and corrects cognitive distortions (negative thought patterns) which can exacerbate or cause depression. Most, if not all, people who suffer from depression harbor negative thinking patterns. It’s not clear whether these are a result of the depression or precede it. Either way, eliminating them is crucial to being able to elevate your mood on a permanent basis. This is best done with a therapist who can help you identify and change your own specific thought patterns. Keeping a “thought” journal can also be helpful in identifying negative thought patterns.

12. Beat Procrastination
When we are depressed it's easy to say, "I'll worry about that tomorrow." Or “I’ll take care of that when I feel more like doing it.” Yet when tomorrow arrives you will only have piled more work on that day and have made it even harder to face. Also, no one ever “feels like” paying bills or washing dishes. They do these tasks knowing they will feel better once they are done. Learn techniques to break through the urge to procrastinate and you can save yourself from having all the little jobs pile up into big ones.

13. Get a Handle on Your Household Chores

Your environment affects your mood and living in a messy house is depressing. Developing strategies for getting housework done is crucial to helping alleviate depression.

14. Consider Getting a Dog

I say “consider” because own a pet is a big responsibility which could last up to 20 years. Proper veterinary care also has to be considered in your budget. However, many of my clients have benefited greatly from having a dog. Owning a dog requires you to get up and walk it a few times a day, which means you get a walk as well. Funny, we won’t walk ourselves, but we will walk a dog. Owning a dog also allows you to go to the dog park, which is a great method of socializing. You don’t have to dress up and the topic of conversation is – your dog – something dog owners love to talk about.

15. Laugh
Watch a funny movie, call that friend that always keeps you in stitches, or go to a comedy show. Whatever it is that makes you laugh makes it harder to be depressed.

Conclusion

These are just a few of the methods people use to fight a depressed mood. Depression is an insidious disease that can slowly suck the joy out of your life or drive you end it all together. Overcoming depression requires hard work and discipline. It requires a dedication to making serious changes in your lifestyle in order reduce the symptoms. However, the more time and effort you are willing to invest in fighting it, the better your chances are for wresting your life back out of its clutches.

Housekeeping with Depression

Depression destroys so much of our motivation and energy that if can become difficult to keep up with day-to-day chores, yet a dirty living environment only serves to make us feel more worthless and discouraged. The following tips can help you get a handle on your house work.

1. Keep up as you go
Little things like rinsing and putting your dishes in the dishwasher as soon as you are done or putting things away right after you use them will keep your home clean and clutter free and prevent you from having a huge job to tackle later on.

2. Set small, manageable goals
Break up large projects into small, manageable tasks that can be done fairly simply and in a short amount of time. Each day give yourself a task to accomplish that feels manageable to you, even if it's just cleaning a bathroom or tossing in a load of laundry. Over the course of a week, it all adds up to a cleaner home.

3. Learn to work efficiently
Get organized. Have the cleaning tools you need for a certain area stored in that area so you don’t have to walk across the house or upstairs just to get the mop. That makes the job of mopping that more daunting.

Have the proper tools to do the job. Having a mop you like to use or a duster that works efficiently makes the task that much easier to face. Jobs that are completed more quickly and more easily are more likely to get done when you are tired.

4. Overcome procrastination
When we are depressed it's easy to say, "I'll worry about that tomorrow." Or “I’ll take care of that when I feel more like doing it.” Well when tomorrow arrives you will only have piled more work on that day and made it even harder to face. Also, no one ever “feels like” paying bills or washing dishes. They do these tasks knowing they will feel better once they are done. Learn techniques to break through the urge to procrastinate and you can save yourself from having all the little jobs pile up into a big one. To read more about beating procrastination, please see my article, “Overcoming Procrastination”.

5. Progress, not perfection
Expecting perfection is setting you up for disappointment and stress. Forgive yourself for being human and set reasonable standards that keep you comfortable and sanitary.

6. Delegate when possible
If there are other people living in your home, it may create more work to “train” them to do their part. But in the long run it will pay off and ease the burden on you. Delegate out certain tasks, especially those you tend to put off. You may even trade tasks you hate for those which are not so difficult for you to face.

7. 15 minutes per day
Schedule just 15 minutes per day for housekeeping chores. You would be amazed at what you can accomplish in only 15 minutes. Most of us can face doing anything for only 15 minutes.

8. Clean house with a friend.
Schedule times for a friend to come over and help you clean your house, then schedule a time to go to his or her house and reciprocate. We are less likely to disappoint a friend than we are ourselves, so you will feel obligated to show up clean. You will also get a little socialization, which tends to be lacking when we are depressed. When depressed it’s easy to isolate and withdraw.

9. It's okay to hire a maid service
If it's within your budget, hire a maid service. You'll have a clean home and one less thing to worry about.

Depression as a Reaction to Inappropriate Optimism?

I'm starting to realize this within myself and thought it might be helpful for others. I'm starting to wonder how much of my own depression is a reaction to my mother's adamant optimism. This is a woman who - if you told her you had a brain tumor and only six months to live - would tell you, "Well look on the bright side, you have six months! You could've gotten hit by a truck and have no time at all!" Now this kind of forced optimism might be helpful, but it also completely denies that a tragedy has just struck. And it completely denies the person experiencing the tragedy the right to be afraid, shocked, horrified, sad, mad, or anything else. In defense of mom, I think this is her attempt to make me feel better, but it actually does the opposite and makes me feel unheard.

As an adult and a therapist, I know that changing negative thinking patterns will make me feel better. However, I initially felt an intrinsic, deep-seated resistance to this when I first heard it. In examining this resistance I realized that what I "heard" when people said you had to change the negative thinking patterns was that I had to think like my mom. I thought the antithesis of depressed thinking was a bizarre and surreal, Pollyanna sunshine, perpetually perky, outlook on life which felt false and shallow to me.

The older I get the more I realize that life and being healthy in it is about balance. Adopting the other extreme - unrealistic happiness - is just as bad as being unrealistically unhappy. Neither one of them presents a balanced, complete view of the picture at hand. Yet, maintaining an entirely negative viewpoint is not "real" either.

An example? I was stuck in a nightmare of a traffic jam yesterday on the dreaded I-35. Previously I would have had a conniption fit. I would have stressed about how long it was going to take, how stupid it was to have taken I-35 in the first place, and obsessed on the poor driving habits of the people around me. However, taking the opposite viewpoint - that this was all just lovely and not a problem at all would not work either. That just wasn't real. So I tried the middle ground. Unfortunately, this sucked and was truly exasperating. However, I wouldn't die, having a conniption fit only made me feel worse, I had survived such things before, and by the end of an hour it would all be over and I would be going along my merry way. So I just had to figure out how to pass this miserable one hour. Fortunately, I didn't have anywhere I had to be so I wasn't going to late for anything. If I had to be in a stupid traffic jam, this was a fairly good time for it.

There - a balanced viewpoint. It still felt "real", but I didn't drive myself crazy with it either.

Pessimism vs. Optimism

Martin Seligman, author of "Learned Optimism" makes an interesting comparison between optimism and pessimism below:

Martin Seligman: Well let me take the larger issue that I think underlies the question. Those of you who have read ‘Learned Optimism’ from part of what I’ve said tonight, probably think that I’m an advocate of optimism. I’m not. There’s a cost benefit analysis about optimism, and let me go through the cost benefit analysis with you now. There seem to be three benefits of optimism which I talked about one of them tonight. The first is it’s apt to make your life noticeably less depressed, it fights depression. The second benefit of optimism, second benefit of learning disputation, learning cognitive therapy, learning optimism, is that it increases your achievement, so if you look at grade point average, or performance on the sports field, or how many insurance policies people sell, what you find is that optimistic people do better than they’re predicted to do, and pessimistic people achieve less. And the third benefit of optimism is physical health. There’s good reason to believe that the immune system among optimistic people is perkier than among pessimists. The rate of infectious illness is lower among optimists, the probability of death from second heart attack is markedly lower among optimists. So it gives you three things.

But there’s one thing that pessimists do better than optimists. I tried to brush this under the rug for years, it doesn’t brush under the rug. And it’s that pessimists know the score. Pessimists are more realistic than optimists, they know when there’s danger there. There’s a large number of experiments which show that pessimists are more accurate than optimists about how much control they have, that they are more accurate in their memories about success and failure, that their belief systems are generally more accurate. So three benefits of optimism, one benefit of pessimism. What kind of sense do we make of that?

The entire article can be found here.

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Never Argue with a Delusion

In listening to my mother describe her best friend's struggles with her daughter who has Schizophrenia I am reminded of an important tenet I learned while working in the state hospital: Never Argue with a Delusion.

Delusions are when people believe something which is not true. They can manifest themselves in many, many different varieties. Paranoia can be one, where the client believes that people are watching them, conspiring against them, poisoning their food or medicine, or trying to hurt them. Grandiosity can be another version, where the client believes they have a million dollars in the bank, that they are a messenger sent by their God, or they are a very powerful or influential person. Delusions can also be quite mundane or simple. Clients can be believe that messages are coming to them through the radio or television, or that family members are lying to them about a certain issue.

Whatever flavor of delusion you are working with, you can never beat it, except with medication. Using logic, reason, or trying to show the person the reality of the situation ("look - I'll eat a bite of your lunch to show you that it is not poisoned") will never work. The client will always find away around it ("You haven't put the poison in yet" or "You knew I wouldn't eat it so you didn't poison this meal"). Trying to argue with a delusion accomplishes nothing except to frustrate the family, cause an argument between the family member and the client, and possible result in hurt feelings or even a violent confrontation.

The most important thing is to realize they are not doing this on purpose. They're not just being stubborn or obtuse and they're not doing it to get your goat. To address it, try to accept it if you can and focus on dealing with the issue of getting the medication adjusted to appropriate levels.