The Coming Depression Onslaught

If this study is to be believed, we’re in trouble.

A study from Boston University conducted a major survey on adults and depression, using previous scores as a baseline measurement. The study used the PHQ-9 questionnaire, which is a nine-question screening method that can be used to determine if someone may be suffering from depression. A 2017-2018 study found that 8.5% of adults were suffering from depression. 

The results were horrifying: 27.8% of Americans are now clinically depressed, according to the results of the study. That is more than a tripling of depression rates. It is massive, it is significant, and it cannot be treated by the current state of our mental health system. 

The study, of course, attributed much of this rise to COVID-19 and the economic stressors placed on society by this disease. The study also found that people with less than $5,000 in savings 50% were more likely to be depressed, further showing the connection between economics, a social safety net, and mental health.

I have a couple of broader thoughts – first, on the general situation, and second, what this study shows us.

First, I think it’s important to keep in mind that this is catastrophically bad but not as bad as it appears! Yes, I said that. First, the good news. This will abate as the pandemic abates and economic damage mitigates. That will happen. It will take time, but I don’t think this represents a fundamental shift in our moods or economic status for the majority of people who took this study.

The bad news? Let’s say this only permanently affects 5% of America. Uhh…that’s tens of millions of people. That is fundamentally, catastrophically terrible. We could be staring down the barrel of millions of people who will never recover without assistance that we cannot hope to provide. Before this crisis, we were looking at a major shortage of mental health workers. There is no way our system has the capacity to deal with all of the people who will need help. 

About two months ago, I attended a hearing on mental illness and the COVID-19 pandemic. One of the things I asked some of our panelists was whether or not there had been an increase in suicides. The answer: Not yet. Emphasis on yet. They were worried that, as the economic toll continues, you’d have a lot of people who would be more likely to die by suicide. This study furthers my concern there.

What can we do? Well, if you believe that economics and mental health are connected – and I do – that means we need to support people in their times of need and provide generous economic supports to get them through this crisis. That means working to prevent evictions and foreclosures. To extend unemployment assistance. To throw money at small businesses in order to keep them open.

This is a catastrophe in the making, but it doesn’t have to be this way. A strong government can stop the economic damage and can abate this crisis, and I don’t think it’s too late. But that’s what we need to get us through the physical, economic, and mental health disaster that we are currently experiencing. 

Do mental health apps work?

One of the things I have seen a lot of lately is apps that claim to be able to help you improve your mental health and get treatment. There are a bunch out there – this includes apps like What’s Up, Mood Kit and MY3, among many, many others.

Here’s the important question: Do they work?

I bring this up because there’s been a bit of controversy with one app, BetterHelp. The App says that it will hook users up with licensed therapists. The controversy, however, emerged with many YouTubers who had engaged in sponsored ads with BetterHelp.

As long as the sponsorship is transparent, I don’t personally see an issue, but problems emerged with BetterHelp itself. First, it’s terms of services explicitly couldn’t guarantee placement with a qualified, licensed professional:

We do not control the quality of the Counselor Services and we do not determine whether any Counselor is qualified to provide any specific service as well as whether a Counselor is categorized correctly or matched correctly to you. The Counselor Services are not a complete substitute for a face-to-face examination and/or session by a licensed qualified professional.

Umm…..that’s a major, major problem. That’s beyond not acceptable. Any app that claims it will provide mental health professionals to users has a moral obligation (and I hope a legal one!) to ensure that the counselors themselves actually are licensed professionals, or at least disclose in a VERY publicly way when they are not.

This entire incident got me wondering about these apps. How good are they? Do they work? Are they substitutes for seeing a counselor in a face to face setting?

First, the obvious: Answers to the questions I posed above will vary widely. It all depends, of course, on the quality of service offered.

The most comprehensive answer I could find was in this paper, published in March 2018. The answer varies, of course, but in sections, it seems to be yes:

  • Depression: ” A meta-analysis of 18 randomized controlled trials (RCTs) covering 22 mobile apps revealed that using apps to alleviate symptoms and self-manage depression significantly reduced patients’ depressive symptoms compared to control conditions (g=0.38, P<0.001).” However, the apps work best when depression is mild to moderate, not severe.
  • Anxiety: “A meta-analysis of nine RCTs that evaluated the effects of smartphone-delivered interventions on symptoms of subclinical and diagnosed anxiety disorders revealed that users experienced reductions in total anxiety after using anxiety treatment apps (g=0.33, P<0.001). Additionally, anxiety-focused mobile apps delivered the greatest reductions in anxiety symptoms when paired with face-to-face or internet-based therapies. In fact, replacing outpatient patient-therapist sessions with a mobile app resulted in no significant loss of treatment efficacy.”
  • Schizophrenia: “Self-reported patient experience survey results revealed high adherence, positive user experience, and broad-ranging clinical benefits.”

Wow. So, yes, theoretically, these can work!

I have two additional thoughts. First, hey, if it works, it works. The mental health practitioner shortage is, in my opinion, the greatest crisis affecting mental health, and if apps can help close that gap at an affordable rate, it’s worth using.

Second. however, is this: It has to be a real app, with high quality and scientifically based therapies and design. In the digital day and age, it can be all too easy to design a subpar treatment program that can scam users out of money and provide no clinical benefit. I hope, in the long run, that the federal government will step in and better regulate these apps in order to protect users from negative experiences that can damage their mental health and sap their limited resources.

Do you have any experiences with mental health apps that you want to share? Please let us know in the comments below!

TMS Update: Is this what feeling better feels like?

So, it’s been about six weeks since I started Transcranial Magnetic Stimulation. As I type this, I’ve had about 26 sessions, with another ten or so to go.

How am I feeling? Is it working? Better. And yes. It is working. And I feel reasonably convinced at this point that it’s not just the placebo effect.

Let me discuss the second part of that question first, because I think it’s almost the most important. Why do I think it’s not a placebo effect? Because life is NOT perfect. I think – I don’t know, but I think – that if this was a mere placebo effect, I’d be sitting here, flying through the sky. Life would feel perfect. There would be birds and sunshine and candy everywhere and all that crap. Then, eventually, the effect would wear away, and I’d crash hard.

Simply put, that isn’t true. Everything doesn’t feel perfect. I’ve still gotten depressed about things, upset. Most of the time, it’s been normal life events. On a couple of days I’ve still woken up really down, but that feeling fades easier than it did before treatment. Simply put, things aren’t magical.

So then, let me tackle the question in the title: Is this what feeling better feels like? Maybe? I can’t answer that question definitively yet, because I don’t know . Look, I’ve been on anti-depressants and in treatment, as needed, since I was 18. I’m 35. Half my life. So I’m not quite sure what “normal” is.

Here’s what I do know. Since I started TMS and began to feel it’s positive impacts:

  • I’ve been enjoying things more. A lot more. A couple of examples:
    • As I’ve long since established I am a big computer game nerd. I play these games more, and I just like them more. I’ve had more fun playing them.
    • I was with my wife and my kids at a local food fair. I’m sitting there, eating this big ole Taco Salad. My son is leaning on me, eating Mac & Cheese. He’s snuggling in. I’ve got my little boy, good food, happy environment, great music. I felt good. I felt lucky. My phone was firmly in my pocket. I felt like I was in the moment. That didn’t happen before.
  • I wake up in the morning without this impending sense of dread. Without feeling like there’s a ceiling over my head, pressing down. It just feels like the world has less pressure. I still feel stressed, still feel overwhelmed. But the world doesn’t feel like it is filled with nearly as much darkness.
  • I’ve been less snappy. Less grouchy.
  • I’ve had an easier time concentrating and getting things done. My motivation is higher.
  • You know that myth about the depressed writer? Bull. Depression does help give you insight and experience for writing, but if it’s too severe, you ain’t writing. And I’ve had a much, much easier time writing lately.

Arguably the most important observation since this started has been from my wife. She was skeptical when TMS first started. She told me last week that she didn’t think it would work, and part of her almost wishes she didn’t know I was doing it so she wouldn’t risk being fooled by a placebo effect as well.

Why? Because she noticed the difference too. She told me the other day, unprompted, that she sees it’s working. She sees that I am happier. And my wife is smarter than me! So if she is noticing this, it makes me more convinced that this thing really is working.

Are things perfect? Hell no. They never will be.

But they are unquestionably better.

DISCLAIMER: First, again, I’m not a doctor or medical professional – I’m a damn politician and writer. I’m certainly doing my best to write an accurate description, but if you have any questions or concerns, please contact a medical professional. Second, this probably goes without saying, but I’m going through this treatment like any other normal person and paying with my insurance. I am not receiving any compensation or consideration whatsoever for sharing my experiences. However – and again, this is just me writing – I’ve had my TMS from the TMS Center of the Lehigh Valley. I am grateful for their skills, professionalism and willingness to work with my rather insane schedule. I highly, highly recommend them if you are local to the area.

TMS Update

Well, as I type this I am 10 sessions into the 30 session Transcranial Magnetic Stimulation sessions. 1/3 of the way there. Woohoo!

How’s it going so far? Well…maybe better? Honestly, yeah, starting at the beginning of the 2nd week, it did start to feel like I was feeling a bit better, but let me define what I mean. Birds did not start singing. The sky is not the bluest it has ever been. Depression is still there. Life is not perfect.

But, to some extent, I have to say, it does feel like things have gotten a bit better. My life hasn’t dramatically improved, but there does seem to be a bit less…pressure. Like, the ceiling of depression which pressured down on me seems a bit lighter. That’s the best way I think I can put it.

To be clear, this may be placebo. The readings that the Doctor gave me showed that depression probably wouldn’t start to improve until week four. When I mentioned this to him, he said some people did feel better in week two, but for many it was longer, and it is certainly possible that this is just placebo. So I guess we will see!

Some other notes:

  • For me, there are no side effects. Even the slight headaches that during the treatment have become more tolerable. I haven’t taken a Tylenol before a treatment since it started, and my head has not hurt a soon as the treatment has ended.
  • You really do build a resistance to the minor pain caused by the treatment. Of the ten times I’ve had it, I’ve fallen asleep three of them, which is kind of funny.
  • I went through the math in my head the other day. As I said in the last entry on this subject, the magnet taps your head for four seconds, then rests for twelve. During the four seconds in which you get tapped with the magnet, it makes contact 40 times. A session is twenty minutes, so you get tapped 3,200 times a session. Multiply that by the 30 sessions, and congratulations, you’re getting smacked by a magnet 96,000 time over six weeks!

Only 64,000 taps to go!

The futility of gratitude – and why it’s so important

I had an interesting realization in therapy the other day, and it led to this blog entry. Stay with me for a second.

My therapist and I were talking about trying to change my mindset from both a depression and anxiety perspective. I think a great deal of anxiety comes from a fear of “not being able to handle” any given situation – be that going to school, work, travel, whatever. I’m not quite sure what “not being able to handle” means, save for turning into a blubbering ball of sad and fear, but whatever. Now, by and large, that’s a silly fear. There’s no such thing – not really – as “not being able to handle” something. Sure, there are some life events and experiences that go better than others, but short of dying, you get through life.

This sort of fear in stressful situations can manifest itself in many ways. One of them is that it causes a shift in mindset. You no longer engage in new experiences to enjoy them or learn from them – instead, you do so in order to say “I survived” them. This mindset can be damning for so many reasons. You start an experience not looking to enjoy it, but to get through it. This kind of bunker-mentality can absolutely destroy your ability to get any joy. To try new things. To adventure or gain new experience. Indeed, it makes you afraid, and it makes you far less willing to be adventurous. You live in a constant state of looking over your shoulder, wondering when the anxiety attack will hit. Wondering when you will get cripplingly sad. Wondering what goes wrong next.

This way of thinking, of living – survival versus gratitude – can be absolutely crippling. And it leads me to the point of today’s entry: I don’t want to just survive. I want to thrive. I want to learn and to live. Don’t you?

How do you do that? Hahaha, yeah come on, you know I don’t have an answer. I only have a piece of one. That’s this: Try to change the way you approach new situations. Approach them from a perspective of gratitude and gaining new experience. Instead of entering an anxiety-provoking situation from the perspective of, “Oh, God, how am I gonna get through this?” ask yourself, “Okay, what can I learn from this?” or better yet, “How can I be grateful for this experience?”

Now, I titled this entry, “The futility of gratitude” because I am not an idiot. When you are depressed or anxious and someone tells you to “Be grateful,” you probably want to punch that person in the face. Grateful? For the crippling fear and sadness? That’s madness.

But, that’s exactly why it’s so important.

The only way to break anxiety and depression is to change the way you think. The way you process thoughts and emotions. And the only way to do that is to shift your mindset. So, just try this. Try, every now and then, asking yourself this question: “How am I learning from this new and difficult situation?” or “What can whatever I am experiencing right now teach me so I don’t encounter these problems in the future?” Fear is only crippling is it denies you the chance to grow, to learn. And there’s no such thing as an experience you can’t handle.

So, try to ask yourself that. Try to ask yourself what you can be grateful for. What you can learn. Shift your mind, and maybe you can shift your emotions too.

Redemption – my book – is now available

Today’s the day. A really, really big day, for me. Today, my book, Redemptionis available for order.

First, the logistics: If you pre-ordered it on your Kindle, it should be there! If you want to order it for Kindle or order a print copy on Amazon, go right to the website. To order it in other formats, or to order a printed copy directly from me (which I will sign and ship!), visit my website. Also, if you use Goodreads, you can check out the book’s page here.

Again, here’s what the book is about:

Twenty young people wake aboard the spaceship Redemption with no memory how they got there.

Asher Maddox went to sleep a college dropout with clinical depression and anxiety. He wakes one hundred sixty years in the future to assume the role as captain aboard a spaceship he knows nothing about, with a crew as in the dark as he is.

Yanked from their everyday lives, the crew learns that Earth has been ravaged by the Spades virus – a deadly disease planted by aliens. They are tasked with obtaining the vaccine that will save humanity, while forced to hide from an unidentified, but highly advanced enemy.

Half a galaxy away from Earth, the crew sets out to complete the quest against impossible odds. As the enemy draws closer, they learn to run the ship despite their own flaws and rivalries. But they have another enemy . . . time. And it’s running out.

Okay. Now for the personal stuff.

This book was written during one of the ugliest, most depressed periods of my adult life. I was in a bad funk, my wife was having a hard time at work, and we were both just struggling. I had started seeing my therapist again, I had increased my medication, but I was still in a really bad way. And I made a decision that I needed to do more, and remembered how writing had saved me when I was a teenager. I’d already written a non-fiction book – Tweets and Consequences – and while I’d enjoyed that process, I wanted to do more. I wanted to write something that was truly meaningful to me on a personal level.

Twenty years ago – probably more – I had this idea as a young teenage writer about kids winding up on a spaceship with no idea why. While I was thinking about writing, I remembered this kernel of a plot. I wanted to write about mental illness as well, since that cause has become such a part of my life.

And thus, Redemption.

As for why this is so important to me. Please understand that this isn’t just a book. It’s difficult to explain how meaningful writing this was on a personal level. The best way I can put it is this: When you write, if it is about an issue that you really care about, you’re not just creating words. You’re putting a piece of your heart out for the world to see. This book is a huge piece of who I am and my personal mission of helping people who suffer from mental illness find hope and recovery. I hope this book can do for others what it did for me – help pull me from the darkness. I hope it can help people realize that they can live good lives, even with depression, anxiety and mental illness. And I hope it’s a good read.

Anyway, world, meet Redemption. I hope you enjoy it!

Depression and meditation

Ugh, just writing this article makes me a little depressed. Why? Well, cause I can’t stick with this. No matter how hard I try, I absolutely, positively cannot stick with meditation – and that’s despite the evidence I’m about to write about below.

The studies are clear and I have written about the subject before: Meditation helps with depression. According to one study published in The Lancet, meditation may be as useful as anti-depressants at keeping depression at bay (side note: Damnit! I really need to look at this again!). This study noted the benefit of mindfulness meditation, which is a specific type of meditation.

What is mindfulness meditation? Mindful.org describes it simply: “Take a good seat, pay attention to the breath, and when your attention wanders, return. By following these simple steps, you can get to know yourself up close and personal.”

Want to know more? I found a few interesting resources on the subject. First, there’s this, from Headpsace, a meditation app I’ve used before. The article details the struggles of a very depressed man who tries meditation in a desperate attempt to get some relief and how meditation changes the way he thinks. The Washington Post ran a similar story earlier in the year, in which the author discusses how the Headspace app (this isn’t a sponsored post, I swear) helped them relearn their thinking.

Want more info on the research behind meditation? Check out this article on Mindfulness-Based Cognitive Therapy, which is a specific type of meditation designed to help those with depression.

If you’re interested in more information on how meditation may help people with anxiety and depression, look at this pretty fascinating article from Harvard, which details specifically how depression can physically change your brain.

I will say this: As I’ve bitterly noted repeatedly, there have been many instances where I have actually meditated with some regularity, only to stop after some period of time. But, during those times, I did notice some changes about the way I was thinking. Specifically, I found myself focusing less often on anger, frustration and bitterness. I found myself better able to let things go, and it felt great. Sadly, inevitably, a busy life caught up with me, and I let the practice fall away.

Time to try again!

As always, I conclude with a question: What has been your experience with meditation? Have you practiced it – or do you practice it – on a regular basis? Notice any changes that you want to share with us? Please tell us your story in the comments below!

Finding light in the darkness

I’m going to write about two things that personally motivated me to deal with my own demons in a very public way. The short-term inspiration for this is me rereading the acknowledgements section of Redemption. The longer-term inspiration for this is a public tragedy and a low period in my life.

Okay, first, here’s a small section of the acknowledgements in Redemption:

To Robin Williams. Yours was a life well lived, and I hope to be part of a positive story of those influenced by how it ended.

Let me go backwards. Robin Williams completed suicide on August 11, 2014. He had long suffered from a slew of mental health challenges, including depression and substance abuse. However, Williams was suffering from “diffuse Lewy body dementia,” which ultimately contributed heavily to his suicide.

William’s suicide ultimately inspired me to go public with my story. That started when some idiot on Facebook decided to spout off shortly after Williams’ death by saying something along the lines of, “So sad Robin Williams committed suicide. He just needed to pray to Jesus more!”

No, you schmuck, that’s not how it works, and that ignorant comment got me so damn fired up that I wrote an op-ed in my local paper, detailing my own struggles with depression, anxiety and suicidal ideation. That, in turn, set my career in motion in a very different way, making me become much louder about mental health issues. I’ve spoken at events detailing my own struggles, cofounded a mental health caucus, appeared in PSAs and introduced legislation designed to help those who are suffering from mental health challenges. I know that the work I’ve done in this realm has helped people – and I know I have a lot more to do to help more.

It also inspired this speech, the most difficult one I have ever made:

Fast forward about seven or eight months, and I’m struggling, in the midst of one of the most depressed periods of my life. I’m struggling at work, my wife is struggling at work, and life just generally sucks at the moment. I go back to see my therapist. I increase my medication. And then I realize something else: I desperately need an outlet. Something to help get me through everything I am suffering from. I decide to start writing again – I wrote fiction as a kid and had published the non-fiction book I wrote, Tweets and Consequences.

And I remember this goofy plot idea I had as a kid, twenty years ago, about kids getting trapped on a spaceship. And I realize something: That’s not a bad plot. But what if I could make it more? What if I could fold in a mental health message as well?

And thus, Redemption is born.

For what it’s worth: I have a character named Robin in Redemption. In all fairness though, that’s also my daughter’s middle name, so let’s call that character’s naming a 50% tribute to Williams and 50% tribute to my daughter.

The death of Robin Williams helped me and countless others find their voice and seek help. I know that this may be cold comfort to those he loved and those who loved him. But I sincerely hope that they can take some solace in knowing that Williams’ life and death helped so many, including me. His was a life well lived – and, as I said above, I hope to be a small part of that story.

You can always find light in the darkness. Pain makes us great, and with time and therapy, you can turn the most agonizing periods of your own life into something incredible.

As long as you breathe, there is hope. The trick is just finding it sometimes.

Why “Redemption”

As I said in an entry the other day, I have a book coming out on June 5. It’s called Redemptionand it’s about depression, anxiety and saving the world. From the blurb:

Twenty young people wake aboard the spaceship Redemption with no memory how they got there.

Asher Maddox went to sleep a college dropout with clinical depression and anxiety. He wakes one hundred sixty years in the future to assume the role as captain aboard a spaceship he knows nothing about, with a crew as in the dark as he is.

Yanked from their everyday lives, the crew learns that Earth has been ravaged by the Spades virus – a deadly disease planted by aliens. They are tasked with obtaining the vaccine that will save humanity, while forced to hide from an unidentified, but highly advanced enemy.

Half a galaxy away from Earth, the crew sets out to complete the quest against impossible odds. As the enemy draws closer, they learn to run the ship despite their own flaws and rivalries. But they have another enemy . . . time. And it’s running out.

Now, here’s the question I keep getting: Why is it called Redemption?

First is the obvious: It’s the name of the ship. But it’s the name of the ship in the book for a reason.

Okay. So I wrote this thing not just to tell a science fiction story, but to tell a story of mental illness and give those who suffer hope. That’s sort of been my driving force, as an elected official and advocate for the mentally ill. And to be perfectly honest, that permeates just about every facet of the book. Including the name of the ship.

I named it Redemption because I think the idea of guilt – and seeking Redemption – was and is a big part of my depression. Guilt is a common symptom of depression. It’s something I certainly got to know in a very personal way. And I spent most of my life searching for redemption. I desperately wanted to be redeemed from some unknown sin. And I think that’s something that’s relatively common among those who have suffered.

The entire plot is, at it’s core, a redemption story, but not from a sin: From mental illness, from depression and from anxiety. It’s a redemption that I think we all strive for. In my experience, it’s almost not complete obtainable. Personally, I know I will never be completely free from mental illness. It will always be there, running in the background like an iPhone app. Recovery isn’t an end state, it’s a journey. And that’s a lesson I that I have tried to learn all my life, and a journey I try to highlight in Redemption.

As always, I’d love to have your thoughts. Is this an experience you understand? No? Either way, let us know in the comments!

“So, what are you going to do about it?”

One of the most impactful memories of my life occurred somewhere in the late summer of 2012. At the time I was +220 pounds, and I’m about six feet tall, so this was way up on where I should have been. I had just eaten a ton and had the misfortune of standing on the scale, thus depressing myself more than usual.

Anyway, I was in my living room with my wife, sitting on the couch. My wife had completed her own significant weight loss journey a few years prior, dropping fifty pounds, so I knew she would understand my sadness over my weight and where I was.

So, there I sat, complaining to my wife about my weight. She was silent, nodding, as I listed how upset I felt at what I had allowed myself to do to my body. And then, finally, she asked me this question:

“So, what are you going to do about it?”

That was the question that changed my life. I mean, there I was, complaining about how miserable I was, and I hadn’t done a damn thing to make it better. That wasn’t fair and it wasn’t right. How dare I complain when I hadn’t even tried to improve? So, right then and there, I decided to do something.

In terms of weight loss, I got lucky in that my body was more amenable to losing weight than that of many others. I downloaded a calorie tracker from Livestrong and used that, and exercise, to shift my mindset. Staying in my allocated calories became like a game. And, over time, it worked. I dropped thirty pounds and kept them off. I’m in better shape now than I was in my 20s.

Now, that being said, in writing my blog entry earlier this week, I remembered this question and how it applies to mental health as well. That entry dealt mainly with what I wish every “support person” knew about depression and mental illness, and one of the items mentioned was that none of us really want to be depressed, and we’d all love to get better.

Allow me to propose this question then, support people. It’s the question that you may want to ask when the depressed/anxious person that you love is in pain. You may want to ask it in the most non-judgmental, softest way possible. You also may want to ask it in a tough love sort of style, as my wife did to me:

“So, what are you going to do about it?”

Depression sucks. It does. And it’s taken me years and years to realize that it’s not a weakness and not my fault. Indeed, it’s not the fault of anyone who has it. But there is a big difference between not my fault and not my responsibility. All of us who suffer from some sort of mental illness have an obligation to do something about it. That may mean doing little things on our own time, like exercise or meditation. It may mean seeing a therapist or psychiatrist to discuss medication. But above all else, it means managing our disease.

Support people, here’s where you can come in. Ask us this question. If the depressed person you love truly wants to get better, they’ll need an answer. They’ll need to do something about it in order to get better or get through the rough patch they are in. It is a question I have to ask myself from time to time when things get bad. Sometimes the answer may be, “Wait a week and see if I’m this miserable still – if I am, I’m going to see my therapist.” Sometimes the answer may be, “I’m making a call now!” But above all else, there needs to be a real answer.

And, as always, I’d love to hear your thoughts! How do you ask your loved one or yourself this question. What has your experience with this been like? Let us know in the comments below!