Tag: depression

National Depression Screening Day

I’m a bit late on this, but October 5 was National Depression Screening Day.  The day itself, first created in 1990, is an effort to encourage people to determine if they are depressed and seek treatment for their illness.

Common depression screening tools

There are multiple depression screening tools available.  These tools, often available in online questionnaires, allow users to determine if may be suffering from depression.  Ideally, an appropriate screener will then link to resources which will enable a person to get help.

From what I have seen, the Patient Health Questionnaire (PHQ-9) is the most common tool to determine depression.  It’s brief – just nine questions – and allows for the user to easily determine if they are potentially suffering from depression.

There are, of course, many more depression screening tools, including:

  • Hamilton Depression Rating Scale (HDRS)
  • Beck Depression Inventory (BDI)
  • Patient Health Questionnaire (PHQ)
  • Major Depression Inventory (MDI)
  • Center for Epidemiologic Studies Depression Scale (CES-D)
  • Zung Self-Rating Depression Scale (SDS)
  • Geriatric Depression Scale (GDS)
  • Cornell Scale for Depression in Dementia (CSDD)

Does depression screening work?

There is evidence which shows that depression screening can make untreated individuals aware of their problems and encourage them to seek treatment.  Depression screening also appears to be relatively accurate, and its systemic use can make doctors more aware of depression with their patients.

The biggest benefit of depression screening

Depression screening is a useful, if flawed tool, which allows for an individual to determine if they are depressed.  That being said, depression screening increases awareness of depression.  It allows someone to determine if they may be suffering from depression, and seek help.  It also treats depression just like any other physical aliment – this, in turn, has the power of reducing stigma.

How to explain mental illness to your kids

Like the vast majority of parents, my children are the light of my lives.  My son, Auron, is six; my daughter, Ayla is four, turning five in November.  I won’t sit here and wax on and on about how much I love them – I don’t have that kind of time, and you probably don’t have that level of interest.  But, for the sake of this blog entry, please understand that they are one of my main reasons for living, my biggest source of joy and a constant fountain of entertainment, surprise and hilariousness.

So, I suspect many parents can sympathize: Having children when you have depression can add innumerable guilt and sadness to an already debilitating disorder.

When I think about depression in relation to my kids, I think of it from two angles.  First is how it will likely one day affect them.  There is no question that mental illness has a strong genetic component.  Also, as much as it pains me to admit it and as hard as I try to make it otherwise, I suspect that both of my kids will learn some of my behavior and internalize it. Even more unfortunate is that a major source of childhood trauma is having a parent with a mental health disorder, and an expanding body of research has shown that these Adverse Childhood Experiences, or ACEs, can have significant and detrimental effects on the life of a child.

One of the symptoms of depression is guilt, and lemme tell you, this entry is not helping.

Second is how my disorder affects their lives.  As much as I hate to admit it, depression and anxiety have affected my parenting skills.  There’s no doubt that there have been times where it has affected my mood, made me snappier or less willing to do things.  Kids can tell when you are worried or down.  They are like little sponges.  They just know when things are off, and they are far, far more intuitive than most people realize.

So, all of this leads me to the critical question of today’s blog entry: How do you talk to your kids about depression?

Obviously, the answer to this question depends on the age of your child.  The first time it ever came up for me was when my son was about four and happened to walk into the bathroom when I was taking my medication:

“Dad, what are you doing?”

“Taking my pills, buddy.”

“Oh.”  Pause.  “Are you sick?”

Me, internally: Crap.  

Followed by: “Well, Auron, you know how people sometimes get really sad?  Or really scared?”

“Yeah.”

“Well, Daddy sometimes gets really scared or sad for no reason.  These pills help make sure I don’t get too scared or too sad, and they make it easier for me to have a good day.”

“Oh.  I’m gonna go watch Bubble Guppies.”

At that age, I think that was a pretty good way to describe it: Simply, and by relating it to something they already understood.  As my kids have gotten older, I’ve expanded that conversation to talking about it to a stigma perspective.  Whenever we are trying to illustrate something that we think is silly (All boys are better than girls at sports by default, for example), we scream “THAT’S NONSENSE!”  I’ve used that frame to describe how some people don’t think it’s okay to get sad, or get scared, and to try to tell the kids that anyone who is sad or scared should see a Doctor, just like if they had a broken arm.  Do they understand it?  I think so.  I hope so, anyway!

As they get older, it is my hope that the way I have dealt with my mental illness – openly and honestly – will help them recognize the symptoms of it within themselves.  I never want my kids to think that whatever circumstances they may be born with are completely out of their control – I want them to know that they do have the ability to deal with whatever challenges they may face.

I cannot control the mental illness that I have anymore than I can control the weather.  But, just like dealing with a rainy day, I can bring an umbrella.  I can take care of myself by ensuring that I see my therapist when necessary, that I take my daily medication, that I recognize my mistakes and try to learn from them, and by practicing good coping skills.  In that way, I hope I can teach my kids a very critical lesson: You cannot always control the hand that you are dealt, but you can control how to react to it.

As always, I welcome your comments.  How have you dealt with your own mental illness when it comes to your kids?  What have you said – and what have you left unsaid?  Let us know below!

4 Video Games that portray mental illness

As I’ve discussed before, I’m a video game nerd.  Hardcore.  And, as someone who is a bit obsessed with eradicating stigma that is related to mental illness, I remain fascinated by public portrayal of depression, anxiety and addiction.

Video games, I believe, are art.  I define art as the ability to make a profound emotional impact on a person.  As such, the portrayal of mental illness in video games – and indeed, humanity – continue to fascinate me, and make me think.  The good news is this: Video games can often describe the human condition in a more thoughtful and complete than many movies and television shows.  That line of thinking inspired this blog entry: How does video games portray mental illness?  How accurate is that portrayal?

Oh, and spoilers below.

Life is Strange: Before the Storm

LifeIsStrange

This one is the prequel to Life is Strange, one of my favorite games, made by Square Enix.  It is a walking simulator  in which you follow Chloe, the main character, as she battles her way through high school and falls in love with Rachel, the previously unseen character who plays a pivotal role in Life is Strange.  

I firmly believe that Chloe is suffering through some major depression symptoms.  Her father has died a few years before and her mother is dating a man who she openly despises and fights with; both of these experiences can lead to depression.  She drinks and does drugs often enough to have a regular dealer to whom she owes money. Her best friend is gone, and not communicating with her at all.  She comes across as angsty, but it’s more than that.  Her quotes, thoughts and actions are often self-destructive and reflect a young woman in pain.

To me, this is more than just a teen being a teen.  She’s miserable, she fights with her mom and her mom’s boyfriend, her family has financial issues, and she is clearly discovering her sexuality.  These are all symptoms that lead my to believe that Chloe is suffering from depression.

What makes the game more relatable is the game’s treatment of Chloe.  In the start of episode one, she is petulant and miserable – not the greatest portrayal.  However, as the game evolves, she becomes a more sympathetic character, and a multi-layered one at that.  You see her hopes, dreams and ability to connect with others.  And, by hearing her thoughts, you can hear all of the truly heartbreaking things she is thinking and saying to herself, about herself.

You intrinsically want Chloe to be better, to have healthier thought patterns and make better decisions.  And, in that sense, I hope that the game can give people a better idea of what it is like to live a life under duress, as Chloe clearly does.

A Night In The Woods

NightInTheWoods

Disclosure: I’m only part way through this one

A Night In The Woods is a platformer. You play as Mae, who has just dropped out of college and returned home.  I’m not very far along this one, but where I’ve gotten to, strange things are happening in her hometown after she reunites with her friends.

The college drop-out part is interesting.  Again, I’m not far in, but thus far, Mae has refused to talk about what happened to her in college, aside from saying that college “didn’t work out” or some variation of that phrase.  She reconnects with old friends, who all have their own battles:

Mae, the protagonist, experiences depression and anxiety, which sometimes create dissociative states during which she becomes completely disconnected from reality. It is implied, though never directly stated, that Gregg has bipolar disorder. His poor impulse control gets him into bad situations, and at times these factors impact his feelings of self worth. Bea and Angus both struggle with the consequences of abusive pasts and their relationships with their families.

As has been noted by Kotaku, the game’s creator’s have both discussed their own battles with mental illness:

The game’s creators have spoken candidly in the past about their own mental health struggles. Scott Benson, who animated and illustrated the game, has type two bipolar disorder. Programmer Alec Holowka runs the Everybody’s Fucked Up podcast, which aims to break through stigma around mental illnesses by interviewing people who have experienced them. (Bethany Hockenberry, the writer of the game, was unable to meet with Kotaku for an interview.)

This game is different than the standard platformer in a few ways, but chief among them is that it allows users to make dialogue choices that affect the game.  This puts you in the driver seat and gives you the perspective of Mae, thus ensuring that you get a first-hand look at what it is like to live a life with depression.

As I said, I’m only a little way into this one, but I’m very curious to learn more.

Please Knock On My Door

Disclosure: I haven’t played this one.

PleaseKnock

This is the portion of the blog entry where the games start getting a touch more obvious.  In Please Knock On My Door:

Please Knock on My Door is a simple game about a person living with depression. The protagonist, a blocky, inky-black character, lives a fairly standard life: Wake up, go to work, come home, repeat. The days are punctuated with mundane tasks like making a sandwich or showering, but each one carries extra weight as it drains — or bolsters — the main character’s mental fortitude.

The game’s art style is simple and stripped down, forcing players to experience the emotions of the game, not be overwhelmed by its graphics, and the focus on simple decisions and how draining they can be gives players the experience of depression, and the added knowledge that each decision made can weigh on a normal human being.  In that sense, it seems to concentrate on giving players the sense of just what a burden living with depression can be.

Depression Quest

Depression Quest

Disclosure: I haven’t played this one either.

Gee, I wonder what this game is about?  From the website:

Depression Quest is an interactive fiction game where you play as someone living with depression. You are given a series of everyday life events and have to attempt to manage your illness, relationships, job, and possible treatment. This game aims to show other sufferers of depression that they are not alone in their feelings, and to illustrate to people who may not understand the illness the depths of what it can do to people.

The game was designed by Zoe Quinn, who faced a slew of death threats for her efforts.  Charming.

As for the game itself: You live the life of someone with depression, making what are relatively mundane decisions about living life.  That being said, in the game, happier decisions are often grayed out, forcing the player to experience life as through someone with depression.  The game is told through a series of text decisions.  In that sense, again, it tries to get the user to experience depression from a first-person perspective.

—

These are just four, and there are certainly many more.  Any other games you’d like to share?  Let us know in the comments below!

Social media is (mostly) terrible for your mental health

Before I was a State Representative, my full time job was to work for the Greater Lehigh Valley Chamber of Commerce.  Among other things, I ran the Chamber’s social media, while also teaching small business owners how to make more money by using Facebook, Twitter & LinkedIn.  I used to do presentations on a pretty regular basis, and I’d always joke that, when I first started using Facebook in college, I never thought that I’d be teaching people how to use it to make more money!

Yeah, about that: I also never thought it would make people more depressed, but here we are.

First, a disclaimer: I’m still social media obsessed.  Facebook & Twitter are my two vices, with a side of LinkedIn & Instagram.  That being said, there is ample evidence to show that social media is bad for your mental health.

Here’s what the research shows.

First, social media forces others to make unrealistic comparisons of themselves with others.  I always come back to my first days in college, being stuck in my dorm room, crying, and telling my Dad that I was the only one who felt this miserable.  His response stuck with me: Of course that’s what I thought!  I was literally the only one in my room!  Countless others were in their room, bawling their eyes out, and all I saw were people enjoying themselves.

Likewise, people only upload happy, smiling pictures and their successes to Facebook and Instagram.  News feeds can give you a distorted picture of reality and lead to the impression that everyone is much, much happier than you.  That’s because people only show their successes – not their failures.  But this comparison is terrible for your mental health.

Second, social media can make people depressed. Studies have shown that social networking makes people feel more depressed and have negative effects on self-esteem.  According to this 2017 study, more time on social media is correlated with higher levels of anxiety.  Perhaps most fascinating is this 2016 study:

Users who took a week-long break from the social media site were found to be more satisfied with life and rated their own well-being as higher.

Third, social networking doesn’t necessarily make anyone more social or feel more connected.  According to a study which appeared in the American Journal of Preventative Medicine, higher social media use led to increased perceived social isolation:

Young adults with high SMU [social media utilization] seem to feel more socially isolated than their counterparts with lower SMU. Future research should focus on determining directionality and elucidating reasons for these associations.

Oh, and all of this says nothing about cyber bullying, a major problem for today’s youth.

Not for nothing, but the worst network for your mental health?  According to this Time article, Instagram:

While the photo-based platform got points for self-expression and self-identity, it was also associated with high levels of anxiety, depression, bullying and FOMO, or the “fear of missing out.”

The evidence also makes it clear that this affect can be magnified in kids and teenagers, who are still developing their sense of selves and frequently have the greatest issues with self-confidence.

All of this being said, I don’t want to make it sound like social networking is all bad for your mental health.  As the same Time article I cited above notes, there are many positives:

There were certainly some benefits associated with social networking. All of the sites received positive scores for self-identity, self-expression, community building and emotional support, for example. YouTube also got high marks for bringing awareness of other people’s health experiences, for providing access to trustworthy health information and for decreasing respondents’ levels of depression, anxiety, and loneliness.

Social networking is a tool: It can be used for good or for bad.  The problem, here, is becoming more apparent: Social media is stunting our social relationships, mental growth and ability to truly connect with each others.  While more research needs to be done, and more time is needed, it truly appears that these communication tools are having the reverse effect that they sought: They are making us more isolated and separated.  Considering their rapid and continued raise, this is a disturbing possibility.

Your smartphone may be making you depressed

I remember catching this story ages ago: A study found that the more time you spend on your iPhone, the more likely you are to be depressed.

Then, yesterday, a friend was kind enough to send me this article about how the University of Berkeley was offering students “counseling” in response to a conservative speaker coming onto campus.  I totally agreed with the article’s premise: That it is absurd to offer counseling for an optional speaker who some students may disagree with, and that such an offer does real harm to the mental health world be further stigmatizing and cheapening the need to get help.  However, there was a passage in the article which really caught my eye:

Researchers have, however, identified reasons to be concerned about the psychological health of teenagers and young adults. In her new book, “iGen,” social psychologist Jean Twenge argues that we may be on the brink of a major mental-health crisis among the generation born between 1995 and 2012, a crisis she links to smartphones and social media.

This made me wonder: Just how true is this statement?  As always, standard disclaimer: I’m not a scientist, just an observer with a real interest in mental health.  That being said, it certainly appears that the answer may be yes.

First, there’s this powerful Atlantic piece, written by Jean Twenge, which makes the case that iPhones are, without a doubt, leading to a “mental health crisis.”  It also argues that smartphones are causing problems at rates previously unheard of in past generational changes:

Psychologically, however, they are more vulnerable than Millennials were: Rates of teen depression and suicide have skyrocketed since 2011. It’s not an exaggeration to describe iGen as being on the brink of the worst mental-health crisis in decades. Much of this deterioration can be traced to their phones.

The articles conclusions are stark and tie directly to smartphones.  It makes the case that teens are going out less, spending less time with friends, showing less independence, dating less, having less sex and driving less than cohorts from previous generations.

So what are they doing with all that time? They are on their phone, in their room, alone and often distressed.

The case here is clear: Screen time makes teens less happy, and more likely to screen for depression.  Seriously, there’s a ton in this article, so if this is an area of interest to you, I highly suggest you read it.  It made me want to set my phone on fire.

Anyway….

Other articles have confirmed the link between smartphones, depression and anxiety.  What is most interesting to me is the nature of this relationship.  Anyone who has ever taken Psych 101 knows that correlation does not equal causation, meaning that just because two things are connected does not mean that one (smartphone use) causes the other (depression or anxiety).  That may be the case, but it may be that depression and/or anxiety actually cause an uptick in smartphone use; personally, I can vouch for this – when I get anxious, I frequently turn to my phone as a crutch or escape from reality.  It also may be a third item, like lack of self-confidence, simultaneously causes both depression and an uptick in smartphone use.

That being said, the Atlantic article I discussed above makes the case that the relationship is linked, and that smartphone use is causing depression.  That conclusion, however, is not uniform, per this meta-analysis:

…the studies examined were correlational, meaning that it is not clear if smartphone use causes symptoms of mental illnesses or if symptoms of mental illness cause greater smartphone use.

As I said above, I’m not a doctor or a scientist, but I do know that smartphones can have a deleterious effect on mental health and social development.  I suspect this is an area that will be the subject of increasing research as time goes on, and I certainly hope that is the case.

Now, go outside!

What you should know if you love someone with depression or anxiety

In the course of my +15 year battle with mental illness, I’ve experienced many emotions that aren’t directly related to the actual depression/anxiety.

One of the most prominent of those is a tremendous feeling of guilt.

I’ll be honest: Loving someone with depression, anxiety or any mental illness sucks.  It just does, and I’ve experienced it from both ends.  You feel so helpless, you don’t know what to do, what to say, you always feel like you are walking on eggshells…it just plain sucks.  And I’ve always felt so bad for my wife and for my kids, who have seen me at some of my worst moments.

I’ve been lucky: I think most of the relationships I’ve had over the course of my life have been healthy ones, and that’s to say nothing of my wonderful wife.  In an effort to figure out how to better help me with my mental illness, she once came with me to my therapist in order to get a better grasp on how to pull me out of an anxiety attack.  This is one of the kindest things I think she ever did for me.

Mental illness is a difficult thing to describe.  It’s hard to convey the hopelessness of depression, the sheer terror of an anxiety attack, the slavery of addiction.  It’s even harder to explain it if you are actively in the throws of it.  When I’ve been at my worst, there have been so many things I’ve wanted to say to the people who love me or care for me, but haven’t been able to find the words.  So here are a few.

First: Don’t think you can make us better.  Suffering from depression has sometimes felt like flinging out a lifeline to someone, anyone, searching for hope before drowning…but it’s still okay.  We don’t expect you to heal us…at least we shouldn’t.  That’s not your job, and even if someone you love does expect that, that’s not fair.  No one should expect you to cure them, to save them.  Love and support is all you can give, and that’s all anyone can reasonably expect of you.

Second: You don’t have to understand.  You don’t have to know everything that we are going through, largely because we may not be able to communicate it at that particular moment.  That can be one of the most difficult things, knowing that someone you love is in pain and not quite being sure why.  As difficult as it can be, let that part go.  Just focus on trying to get someone through that difficult moment.

Third: Your primary job needs to be to get someone through a crisis.  From there, turn to the professionals.  I can’t emphasize this enough.  You may feel incredible guilt and pain at not being able to heal the person you love.  Say it with me, over and over again: It is not your job to fix what is broken.  Support is the only thing anyone can reasonably expect.

Fourth: We’re not always going to be up for talking about it.  But that doesn’t mean we don’t want you there.  Sometimes, sitting there, holding our hand is the best and only thing you can do.

Fifth: Mental illness is not an excuse – ever – for poor treatment.  Understand this.  Mental illness is never an excuse for bad behavior – it may be the reason, but not an excuse.  If someone is making a legitimate effort to find their way out of the darkness, they deserve your love and support.  If they refuse to seek help, it becomes an entirely different matter.

Sixth: Everything you have to offer may not be enough.  Despite your best efforts, despite herculean levels of love, support, care and affection, it may not be enough.  You have to understand that the mental state of the person you love may continue to decline, and that isn’t your fault.  You cannot hold yourself responsible for the declining mental state of someone you love and someone who is ill.

Seventh: Don’t be afraid to reach out for help.  You alone may not be enough to get someone through a crisis, but if someone else is there, don’t hesitate to reach out.  When I’ve had some of my worst moments, my wife connected with my family and friends – if the option is available to you, do the same.

Eigth: Odds are, we’re really, really sorry.  Like I said earlier, I can’t tell you how badly I’ve felt for the lack of control I’ve endured for my own emotions, how that has effected my life and my behavior.  Trust me, it sucks every day to know that my own mental illness may lead to my kids having their own challenges one day.  That being said, if you love someone with mental illness and they’ve experienced these feelings of guilt, I’d encourage you to ask the person you love the same thing my wife has asked me: “So, what are you going to do about it?”  I may not be able to help the way I feel, the disorder I suffer from, but I can control my decision to seek treatment as necessary.  Tell the person you love to get help.  Tell them you love them.  Tell them to use those feelings of guilt as a motivator to be better, for themselves, and for you.

There’s more, but this is just my perspective, my thoughts.  I’d love to hear yours.  Please comment below, from either perspective – that of someone who is mentally ill, or someone who loves someone who is.  What do you wish you knew, or want to communicate?

Study: Depression can be treated with…anti-inflammation drugs…??

A friend was kind enough to send me this article, and this one is too strange sounding not to share: According to a new study, depression is “a physical illness caused by a faulty immune system” that can be treated with anti-inflammatory drugs.

From an article on the study:

Current treatment is largely centred around restoring mood-boosting chemicals in the brain, such as serotonin, but experts now think an overactive immune system triggers inflammation throughout the entire body, sparking feelings of hopelessness, unhappiness and fatigue.

It may be a symptom of the immune system failing to switch off after a trauma or illness, and is a similar to the low mood people often experience when they are fighting a virus, like flu.

“In relation to mood, beyond reasonable doubt, there is a very robust association between inflammation and depressive symptoms.  We give people a vaccination and they will become depressed. Vaccine clinics could always predict it, but they could never explain it.

According to the article, more tests will begin next year to see if anti-inflammatory drugs can help alleviate depression.

Obviously, this piqued my curiosity, so I did a little bit more digging.  First, this area of study isn’t new – there are studies dating back at least six years that would support the notion that inflammation and depression are linked.  From that article:

Previous studies have linked depression with higher level of inflammatory markers compared to people who are not depressed. When people are given proinflammatory cytokines, people experience more symptoms of depression and anxiety. Chronically higher levels of inflammation due to medical illnesses are also associated with higherrates of depression. Even brain imaging of people with depression show that their brain scans have increased neuroinflammation.

The article went on to recommend that everyone take anti-inflammatory steps (which are good for you regardless), including better diet, stress reduction, exercise, mind-body exercises and breathing exercises.

This is new to me, and fascinating.  That being said, it makes me nervous.  I’ve always operated under the assumption that depression – and mental illness in general – are not caused by – or treatable with – a single bullet.  They are a combination of things: Genetics, stress levels, thinking patterns, etc., that make someone mentally ill.  As such, the notion that one thing – inflammation – could be the cause of depression – well, it gives me pause.

It would be so, so wonderful to be wrong!

Two points about this research, and understand, please, that they are coming from a layman, not a doctor!:

First, more tests are required, so don’t run out and buy an anti-inflammatory today.  More information, specifics and treatment options are still needed.  For now, keep going to therapy and taking your medication, darn it!

Second, let’s say, for a moment, that future studies confirm a connection between inflammation and depression.  That does not (necessarily) mean that you should stop taking your medication or going to therapy.  Remember, all body-mind reactions are a two way street.  Yes, your body can affect your mind, of course, but the way you think can affect your body.  When you are scared, your heart rate accelerates, your breathing speeds up and you get sweaty.  Don’t think that being depressed, having negative emotions or damaging thought processes can’t potentially cause the inflammation that causes depression.  I’ve always believed – at least for me – that a combination of medication and therapy are the best way to deal with depression.  If you believe that too, don’t think that therapy will no longer be necessary just because you take some pills that can make the swelling go down.

This is fascinating.  And potentially hugely promising.  I can’t wait to track more information about this, and I really hope that this can provide people with real relief in the future.

Google launches depression screening tool

I caught this over the weekend and found it to be very interesting: Apparently, Google has launched a tool that serves as a brief depression screening.

First, about the screening.  It is the PHQ-9, which is only nine statements.  It asks users to select the level of agreement with nine statements, ranging from “Not at all” to “Nearly every day.”  They include items like, “Little interest or pleasure in doing things” and “Feeling tired or having little energy.” The information can then be shared with the user’s health care provider and used to seek treatment.

This is noteworthy for many reasons.  The screening will pop up in the event that “depression related searches” are made, similar to the way that the number for the National Suicide Prevention Lifeline (1-800-273-8255) pops up for suicide related searches.  Given the prevalence of Google in modern life, this can, hopefully, help make people more aware of mental illness and steer them to treatment options.  This is also particularly important, given the spike in suicide-related Google searches.  That spike, incidentally, is tied to 13 Reasons Why on Netflix, a show I suspect I will be writing about in the future.

Indeed, I’d argue that the most significant reason that the availability of the depression questionnaire is important is because of the major rate of spikes in suicide that we are seeing.  Suicides are rising across the board, but particularly for young girls aged 15-24, who have seen suicide rates increase to 40 year highs.  Obviously, this is the generation that is the most technologically dependent, so increasing their awareness about mental illness and treatment options can be a very, very good and healthy thing.

As good of a thing as this is – and it really, really is a good thing – depression screenings are not without their problems.  There are some studies which report that versions of the PHQ can demonstrate “poor specificity in detecting major depression” or false positives.

That being said, for the sake of argument, let’s assume the absolute worst about the PHQ-9: That it leads to an unacceptably high amount of false positives for depression.  Google’s use of it is still a great:

  • First, false positives is very different than false negatives.  A single accurate, positive test about the PHQ-9 can steer people into treatment and give them the help that they so desperately need.
  • Second, it can help move positive views of mental illness in a positive direction.  Too many people still view mental illness as a weakness or something that can simply be conquered by willpower.  That, of course, isn’t the case anymore than a broken arm can be healed by well-wishes.  Having a source viewed as positively as Google advertise depression screenings can, hopefully, convince people of the importance of seeking treatment for mental health.

As always, I’d love to hear your thoughts.  Let us know in the comments!

An overview & critique: Depression in fiction books

For reasons that I will inevitably wind up discussing more in-depth later, this is a topic that I am very interested in.  After all, there is no doubt about it: So much of our world is informed by our media, including fiction books.  Major pop culture phenomenons – books like Harry Potter and The Hunger Games, for instance – wind up having a major impact on a whole slew of societal attitudes, everything from the names of our children to the hobbies we play.

Of course this extends to serious issues, like mental health.  As I sat, thinking about this entry, I came to the realization that I cannot think of too many books I’ve read that explicitly feature stories about characters who feature mental illness – even when the book is potentially about something other than mental illness.  This is important from a stigma perspective: I think it is vital that readers hear stories about people with mental illness living a successful life, despite their challenges.

Now, please don’t misunderstand: Just because I haven’t read them doesn’t mean they aren’t out there.  A very quick Google search reveals no shortage of books that discuss exactly this topic.  And, indeed, many of these books touch of mental illness in a more tangential way.

Two young adult books that I’ve read immediately come to mind.  One is Fangirl by Rainbow Rowell, which discusses a young woman moving to college and dealing with a slew of pressures, then finding therapy in her writing.  Another, Anthem of a Reluctant Prophet by Joanne Proulx, features a character who clearly is struggling with depression and anxiety, even though it goes unspoken throughout the novel.

I’m coming at this from the perspective of Young Adult novels, which I must confess, I still enjoy (a quick look at my Goodreads page will confirm this!).  But, from the perspective of mental illness, there is an important reason for discussing this genre in particular: 50% of all mental illness starts at age 14, and 75% by age 24.  If this issue can be addressed early enough – particularly during it’s onset – it can make a big difference.

I suppose my point is this: As best I can tell – and, again, admittedly, I could be wrong, please correct me if I am – it seems like mental illness in fiction is addressed in one of two ways:

  1. It is completely undiagnosed, leaving readers guessing or playing armchair psychiatrists, and that’s never a good idea.
  2. It is the centerpiece of the book.

Don’t get me wrong, neither of these things are necessarily bad in and of themselves.  I’m just having this conversation from a stigma perspective.  The first option listed above can be problematic and fail to fully address a characters illness, which can lead to misguided perceptions about the way that mental illness works.  The second option can be good, but it, too, can make people think that mental illness is somehow more debilitating than it truly is.

Also, please understand, I’m not criticizing any author or book.  Many of the ones that deal with mental illness – directly or indirectly – are powerful, and it’s not possible or fair to be critical of an author simply because they don’t address a particular issue in a way I want to see it done.

That being said, from a stigma perspective, that’s what I’d love to see more of.

Any thoughts to add, or books I am missing?  I’d really love to know – if only to read them!  Please let us know in the comments.

Depression is more than feeling sad

One of the things I have certainly struggled with in my personal life – and I think one of the things that many people don’t realize – is what depression truly is.  I saw this image ages ago in my Facebook feed, and I think it sums it up personally:

depression is more than sad

This is so, so accurate (except for the Mario Kart part – I got nothing there) and I say this based on more than just a viral image.  According to the DSM (Diagnosis & Statistical Manual, the official way in which mental illnesses are diagnosed), the following five symptoms are indicative of a Major Depressive Disorder:

  • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad, blue, “down in the dumps,” or empty) or observation made by others (e.g., appears tearful or about to cry). (In children and adolescents, this may present as an irritable or cranky, rather than sad, mood.)
  • Markedly diminished interest or pleasure in all, or almost all, activities every day, such as no interest in hobbies, sports, or other things the person used to enjoy doing.
  • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day.
  • Insomnia (inability to get to sleep or difficulty staying asleep) or hypersomnia (sleeping too much) nearly every day
  • Psychomotor agitation (e.g., restlessness, inability to sit still, pacing, pulling at clothes or clothes) or retardation (e.g., slowed speech, movements, quiet talking) nearly every day
  • Fatigue, tiredness, or loss of energy nearly every day (e.g., even the smallest tasks, like dressing or washing, seem difficult to do and take longer than usual).
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day (e.g., ruminating over minor past failings).
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day (e.g. appears easily distracted, complains of memory difficulties).
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideas without a specific plan, or a suicide attempt or a specific plan for committing suicide

The first item is specifically about depression and feeling sad.  The rest are most definitely not.  And it’s important to note that everyone experiences depression differently, and at different times.  For some, sadness is the overwhelming emotion.  For others, it’s complete anhedonia.  These emotions are felt in different ways, at different times.

I write about this based on my own experiences.  I’ve found that, when I am going through a rough patch, it isn’t often led off by sadness – usually, I start with insomnia and a loss of appetite – I always lose weight when I am depressed.  Things usually go downhill from there.  Not for nothing, but those two symptoms are often the canaries in the coal mine.  I work out a lot so I’m almost always hungry, and if I don’t want to eat, I almost always wonder if something is wrong.  It’s amazing, the way depression sneaks up on you like that…it comes out of nowhere and starts to nibble at your mind, before you are even aware of it….

My point is this: It would be foolish to assume that depression is just depression.  It can be experienced as an entire series of symptoms, many of which have nothing to do with feeling sad, and all of which can easily be confused with something else.  I draw some comfort from this – there is nothing “wrong” with me – well, besides the obvious, haha.

I’m really curious to hear from others.  Have you experienced depression in some other way, including those not listed here?  Let us know in the comments!