TO READ: Joyous Holidays!
To those of you kind readers and writers who celebrate Christmas, I send greetings for a merry one.

To all, I wish a new year filled with ever-better health and new satisfactions.

Writing will be an important part of maintaining my mental health in the new year; I hope it will assist you as well.

Here's to 2008!
Love,
Beth

TO WRITE: Caring, creating, believing, living. . .
I recently came across the following quote from author and Holocaust survivor Elie Wiesel:


"The opposite of love is not hate, it's indifference.
The opposite of art is not ugliness, it's indifference.
The opposite of faith is not heresy, it's indifference.
And the opposite of life is not death, it's indifference."


Play with this. . .
What can I add to this stunning statement? I suggest you use it as your writing prompt in one of three ways: Write in response to the quote; write a letter to the author of the quote; write from one word/phrase/sentence that you choose from the quote.

Personally, I think I'll write on the subject of indifference itself, and where I notice it in my life and particularly in my depression. Writing about this quote in any way should help break down the indifference that may stifle us at times.

TO WRITE: The Rewards of Using Your Brain
An article in today's New York Times describes how people who use their minds frequently in intellectual and social ways have much lower rates of Alzheimer's disease and dementia. The idea is that by challenging our brains we build up "cognitive reserve" -- extra nerve cells and the connections between them. Then as we age and the likelihood of brain pathology increases, these extra neurons can compensate, leaving us more able to recall names and dates and think well in general. (Remember, those of us with mood disorders already have some structural changes going on in our brains, so this might be extra important for us.)

There are many activities believed to be useful in building cognitive reserve. Doing crosswords and Sudoku puzzles, learning a new language, working with computers, attending plays and concerts, working and traveling have all been identified as activities of older people who have clear thinking. Even knitting can be helpful, it's thought -- as long as you continue to challenge yourself with new techniques and patterns rather than repeating the same old things all the time. You need to introduce new mental challenges in order to reap the benefits.

Play with this. . .
What is the most rewarding thing you do with your brain? If you're taking a class or going to the museum with friends or playing challenging board games, terrific. If you're not, well. . . maybe you should increase the amount of writing you do each week?

For now, describe in writing the most rewarding things you've done with your brain in the past, and what you're doing now. Then consider any activities you might want to explore, including what writing projects you might want to work on. Is now the time to write the first scenes of that screenplay you've been mulling over? What about pulling out that notebook of poems and adding to it? As they say, this is another case of "use it or lose it."

TO WRITE: Your Memory
The New York Times ran a story this morning about chimpanzees who have better short-term memories than humans. Wow. We arrogant humans like to think we're better than all the rest in the thinking department. But when chimps and humans played a computer game in which numbers in randomly placed squares were flashed at them, and they were asked to indicate the squares in numeric sequence, the chimps bested us when the numbers were flashed very quickly. Their short-term memories were stronger.

Memory is being studied a lot lately, perhaps because so many baby-boomers are reaching an age when they begin noticing problems finding words and names. But we with mood disorders know a lot about memory problems already. If the depression doesn't cause difficulties in recall, it seems to be the medicines we take or, in some cases, the ECT we've had.

Play with this. . .
Describe your own memory function. Do you have any problems? Have they changed since you were younger, or perhaps since you've been ill or had certain treatments? Do you have any stories or examples? And how is the memory of those you know -- has this affected your relationship with aging parents, for example? Try to write continuously for 20 minutes; if you feel you've "finished" before that time is up, go ahead and descibe one of your own very vivid memories.

TO WRITE: An Old Friend. . .
During a Thanksgiving trip to my state of origin, Wisconsin, last week, my husband and I had lunch with one of my dearest old friends. Julie and I have known each other since we were in the sixth grade. We walked to school together, since we lived only a block apart, played in the high school band and orchestra together, roomed together for a year in college, and traveled together to Europe. Although we're half a continent away from each other now, we still manage to keep in touch with email, birthday cards, and a visit every now and then.

The three of us talked incessantly and laughed loudly during our entire couple of hours together, as though we'd been apart a few days, rather than a year and a half. And it occurred to me that perhaps the reason this relationship has stood the test of time is not so much the history we have in common, but the way we interact. Each of us questions the other intensely, and we are all good listeners. We genuinely care what goes on in the life and the mind of each other. We spent time brainstorming ways for Julie's new business idea to get off the ground, but my husband got to tell of his latest work adventures too; I got to discuss my writing and we all lamented the slowness of our pending adoption.

While some old friendships have, of course, faded over the years, I feel blessed to have several of these rewarding relationships that have matured over time. They bring joy and a sense of solidity to my life -- these friends are people I have chosen to have relationships with, and our shared history provides comfort and a sense of place.

Play with this. . .
Write continuously for 20 minutes about an old friend -- whether or not you are still in contact. Was it your first-grade jump-roping partner? Your high school best buddy or prom date?

Describe your relationship as it was then, and what you gained from it. If you still know the person, how has the relationship changed and how has it remained the same? If you no longer have contact, consider whether he or she is someone you'd like to look up and talk with.

I'M BACK!

Dear readers and writers,

I thank you all for your patience as this blog has been on hiatus for several weeks. My happy news is that the manuscript for my book, Writing through the Darkness: Easing Your Depression with Paper and Pen, is done! It took quite a few long days and long nights near the end to finish it, but now it's out of my hands, except for reviewing a copy edit. It will be published in June by Ten Speed Press.

The other really wonderful news is that I did not become sick, in mind or body, during these stressful weeks. I don't know why, but I do believe that the personal writing I did during breaks from the book writing was a big help in managing my depression. Hopefully your writing is sustaining you as well, and some new writing ideas from me will help stimulate us all.

I'm grateful for you all. Happy Thanksgiving!

Beth

And, in the meantime, some news...

NEW WEBSITE TO CHECK OUT: www.mcmanweb.com is the site of John McManamy, a writer who focuses on bipolar research. I get his twice-monthly online newsletter, where he describes cutting-edge science in a way understandable by all. You can subscribe for free on his site, as well as checking into several other interesting features. I recommend it, whether you're living with bipolar or depression.

NEW WRITING OPPORTUNITY: www.bphope.com is the site for the magazine bp (that's "bipolar"). I subscribe to the paper version of the magazine, and recommend it, as long as you're willing to look past some ads for psych meds. On the site, you will also find several opportunities to write and have your words published in various ways. A regular feature asks you to offer your opinion on a current topic. Move quickly: if you write in now about what you are thankful for, you may make it into their 11/21 online Thanksgiving edition. While you're at the site, you can also sign up for their Hope & Harmony Headlines email list. AND...

DEPRESSION MAGAZINE TO DEBUT SOON: According to bphope.com, a new magazine for coping with depression and anxiety, esperanza, is coming soon. You can sign up for the premiere edition there too.

So what can you do with your writing?
"KL" left a comment yesterday saying that s/he has written a book/journal on her/his bipolar experience, and asking what to do with it. Here are some thoughts....

1) Have you shared any of it with others close to you? This is a very personal decision, of course, but you may want to think about how it would feel to allow others to read or listen to some of your words. In some cases, this can help a loved one, friend, doctor or therapist to better understand your experiences and concerns, and can even help you connect with those people. If you're feeling uncertain about this, think about starting by just sharing a page or two of your writing. Also, it may feel safest to begin by sharing with your mental health care professional, then discussing how it would be to share with others.

2) If you're thinking about sharing your work with a wider audience by publishing it in some form, you'll probably have the most luck by starting with small portions of your book, and by looking at specialized mental health publications or websites. The Awakenings Project (link at the right side of this page) accepts submissions of writing by mental health care consumers such as us for publication in their literary journal Awakenings. I've published some poetry there, and they put out a lovely magazine/journal. See the site or contact them about when the next issue will be published.

Keep your eye on the NAMI and DBSA websites and publications too (links at right). They sometimes offer contests for writing about mental illness. (Darn! NAMI's ended today.) (I think DBSA is still accepting art and film on depression and bipolar in a related contest.) Also, these two organizations often accept consumer's writing about their illness experience for their state or local newsletters, so get on the list for those or call and ask if they'll take submissions. I published an article in the California NAMI newsletter several months ago.

If you check around mental health websites, I think you'll find some places to share your words too, whether by publishing articles or by more informal journal postings. This can be a nice way to communicate with others coping with mood disorders. NOTE: If you find any good sites like this, please let me know! I'll be researching this soon for my upcoming book, Writing through the Darkness: Easing Your Depression with Paper and Pen, due out in spring next year. (OK, I had to get in a plug!)

Finally, you can start looking at publishing articles drawn from your journal in general-audience publications. Again, your best bet is to start with smaller ones, and work your way up.

KL and others, let me know what you do with your writing. It can be so valuable in helping both you and others you might decide to share it with.

Best regards,
Beth

TO WRITE: Is That Really Reasonable?
I believe I'm a reasonable person most of the time. OK, reasonably reasonable. But what is "reason"? A student offered this writing topic the other day, and I was intrigued, especially about reason's role in our mental health.

Is reason just what you used to solve geometry problems in high school? I don't think so. I believe reason -- thinking things through -- comes into play at every moment of our lives. And I believe it affects our depression too. The thoughts we use to interpret the world we live in, and the decisions we make on how to act all require reason as well as emotion.

Using reason to battle depression: Cognitive behavioral therapy (CBT) is known to relieve depression by helping a person to identify her immediate thoughts about something, to evaluate them, and to change them if they are unrealistic. When I learned about it, for example, I saw that I tend to do "either-or thinking" -- that is, I see things in black and white sometimes. Once I knew this, I could begin to change it, to use reason to replace distorted thinking patterns with more realistic, healthier ones. In my case, I could tell myself, "This event isn't all good or all bad; it has elements of both, so I don't need to be so extremely upset about it." Working this out could leave me feeling less disturbed or depressed.

Play with this. . .
Do you rely on reason or emotion more when you interpret a difficult event you're involved with? How about when you think about your own role in that event? Write continuously for 20 minutes, describing how you logically reasoned your way through, or reacted with a gut feeling, when something occurred that seemed depressing.

Then reflect: Were you satisfied with the balance of reason and emotion you used to react? Is that balance typical for you? Do you want to adjust it at all? Note: If you want to further explore this issue, there are some great workbooks on CBT available at bookstores, or you could ask your health care professional about a referral to a CBT-trained therapist.

TO WRITE: A Gift You've Given
I've never handed my mom $5 million, or given my husband the keys to a Ferrari, much as all three of us might like that. Still, I have given lots of Christmas and birthday presents over the years. And I hope I have given more than that too. What comes to mind when you ponder gifts you've given to someone?

Was there something chosen with great thought? Something handmade? Something old and sentimental? A personal letter or card with kind words?

When I look at gifts from a larger perspective, I hope I've helped a few people to learn things in my various teaching positions. If you're a teacher of any kind, you've certainly got this covered. I think I've helped a few younger people, such as nephews, to see more of the world and discover their own ideas and thoughts. If you're a parent, you've surely given enormously of this gift.

Play with this. . . .
Write continuously for 20 minutes on a gift you've given someone. Tell the story of what happened and how it felt during and after the giving. Also consider what it meant to the recipient, how it was received, and what it meant to you.

After you write, identify how you feel. Pleased? Proud? Unsure? Disappointed? Angry? How does this make you feel about giving in the future? Perhaps there are unsaid complements you'll want to write and send. Perhaps you'll find you have been hurt and you want to stop giving to this person. You may want to write for another 10 minutes or so on these feelings and plans.

TO WRITE: An "Aha!" Moment

We've all had them, though for me they don't come quite as often as I'd like: moments of sudden clarity, insight, or understanding.

For me, these flashes often occur either during a dream, or just as I'm awakening from some important-feeling dream. I suppose that mysterious sub-conscious mind is working overtime to get the message up to the surface where I can identify it. But I've also had "aha" moments when studying complicated calculus formulas or biochemical cycles. Somehow, sometimes, that period of long, arduous concentration pays off when it all clicks.

For those of us battling mood disorders, it's always important to be open to new insights about what troubles us and what we can do about it. For example, it took me a long time to figure out why I frequently belittled myself about a particular past event -- then it dawned on me one day that perhaps another person bore some responsibility there too. This was a moment of great relief for me, as well as a time of bewilderment: Why didn't I think of that before?

Play with this. . .
Write continuously for 20 minutes on a time you felt a moment of clarity or insight. What was it about? Did something special trigger it? How did it feel?

Then consider: What does this incident tell you about yourself or the particular ways your unique mind thinks and feels? Was the flash you described useful for you? Are there any ways you could replicate the situation in order to invite more such insights? (Personally, I think I will return to my old habit of recording my dreams in the mornings!)

TO WRITE: What do you believe in?
You probably believe in loads of things. . . that we need parity for mental health insurance; that our friends should understand that we have an illness, not a weakness; that fudge brownie ice cream is the best; maybe that there are monsters under the bed.

Here's your chance to convince me, or the reader of your choice, of those deep-seated feelings and ideas. Consider your spiritual beliefs, your political positions, your feelings about depression, your relationships, your activities, your basic wants and likes. Are there any old childhood beliefs that come to mind? Any places where you differ greatly from those around you?

To play with. . .
You can start by writing a list of 100 things you believe in (yes, that's 100), as suggested by Kathleen Adams in her book Journal to the Self. Or, if ideas are already flooding your mind, feel free to simply start writing about these beliefs. Don't get too cerebral - some of the statements that come up might be startling or feel contradictory, and this is fine. Just let yourself write passionately. Write continuously for 20 minutes and convince me of how you feel on these topics.

Then reread your writing. What do you find - any surprises in your list? Any surprises in how passionately your felt? And are there any ways you might use this information to make small or large changes in your life? Perhaps this exercise will help trigger a discussion with someone close to you, or help you make a life decision.

TO WRITE: Being Alone

Personally, I need alone time--sometimes a lot of it. It keeps my mood more stable, my stress level lower, I can be more creative, and a few more items typically get checked off my to-do list when I have it. And I'm usually happy alone.

Of course, I'm something of an introvert, and I understand from extroverted friends that their alone time isn't always necessary or even welcome. Unlike mine, their inner fires are stoked by being with people, whether one-on-one or at the big parties I sometimes dread.

All of us must also deal sometimes with loneliness, a related state.

Play with this...
Write continuously for 20 minutes on being alone. Do you embrace it or merely tolerate it when it occurs? Do you feel invigorated or lonely? If lonely, is it just for an hour or so, or do you feel it in terms of your larger life issues?

When you've considered these issues, what can you learn about yourself? Are there changes you can make in how you spend your time? Would a few minutes with a cup of coffee before the family wakes up make it a better day? Do you want to work at getting involved with more people and groups? Are there old friends you'd like to make contact with? Large or small, sometimes changes such as these can have a significant effect on our moods.

To Write: Seeing the World Anew

"We must learn to see the world anew." -- Albert Einstein

I'm always intrigued to see what this true genius had to say about daily life as well as about quantum physics, and this quote recently caught my eye. I'm curious about whether his special insight extended to the "real world." In this quote, I think it did, whether he intended it to or not. I have no idea if this line was referring to a Unified Theory or to the experience of everyday awakening to what is around us. Regardless, it seems beautiful, even spiritual, advice.

What would I like to see anew in my world? Small things, like the little gifts on my desk right now -- the heart paperweight from Mom, the silly magnet from brother Mark about me drinking too much coffee. People thought about me and chose these tokens just to fit me. I see that I could appreciate these important people more.

I'd like to see lots of bigger things anew too, of course. I take for granted the tan foothills outside my window, when I could be embracing their presence and hiking their trails much more often. And bigger still, I want to savor and be open to my current good health. Though I don't want to dwell on previous difficult years, I do need to compare and remind myself frequently of the joy and opportunities I have today when I'm able to think and write and laugh. Furthermore, I should look at my life anew, especially when so many others are hungry or at war. I did nothing to deserve being is this place with so many benefits -- the fates landed me here. If I look at these things anew, I feel many things, but gratefulness in particular.

Play with this...
What does this Einstein quote mean to you? Do you think of being open-minded to scientific theories or artistic expression or solving world problems, or do your thoughts tend toward your daily life and the things and people in it? How does your current state of health or illness play into this? Is there any way you could frame this situation to see it anew in a more positive light -- perhaps through what you've learned on your journey? Write continuously for 20 minutes and see what you see anew in your words.

TO WRITE: "Positive Psychology" Interventions for Depression
In the last few years, the new field of "positive psychology" has been sweeping through college classrooms, huge research studies, popular books, and the cover of Time magazine. This innovative approach to the ways we think and feel is aimed at increasing happiness, whereas traditional psychology has decreased unhappiness.

Dr. Martin Seligman of the U. of Pennsylvania is a pioneer in positive psychology. His website --authentichappiness.org -- states that, "Positive psychology interventions... lastingly decrease depression symptoms." Now this is worth pursuing!

In one study, he found that people who rated "severely depressed" on a written test improved in one week to the mild-to-moderate level of symptoms. In fact, 94% of these people decreased in depression! So what did they do?

Play with this...
Each night for one week, write down three things that went well that day and why they went well. That's all.

If you want, take the depression symptoms questionnaire on the authentichappiness.org website before and after, and see what your own mini-experiment finds. (There are many other interesting questionnaires you can take there for free, including those measuring character strengths and routes to happiness.)

At he end of the week, I suggest you write for 10-20 minutes on how you feel now compared to before you began, and what you think of this "Three Blessings" exercise. Is it useful for you? Did you enjoy it, or was it a drag? Do you think you'll continue this practice?

NOTES: Do NOT use this technique to replace your current treatments! Don't throw away your medicines. This study, as I have read it, had not yet been done with controls, and there was NO diagnosis of major depression made -- they only studied "depression symptoms."

TO WRITE: Being outside
Have you noticed? It's summer! (OK, at least here in the U.S. -- if you're in the midst of winter where you are, just adapt this for your clime.) It's sunny and bright here in Northern California this morning, and I'm thinking it might be fun to walk to the nearly regional park after class today. But the half-written chapter on my desk will probably call me back.

Are you celebrating the weather by spending time at the beach, the lake, the strip of grass outside your door? Are you a forest person, a desert person, a mountain person -- or would you really rather sit in the living room with a book? (That's OK too.)

Personally, while I love the snowy winters I grew up with in Wisconsin -- up to a point -- I get most excited when it's a bit warmer, like this, and I can hike on a forested mountain trail. Watching for wildflowers and animals as I climb beside a gurgling stream with tall pines overhead is as wonderful as it gets for me.

Play with this...
Choose some type of outdoor space and write continuously for 20 minutes, beginning with "In a forest, I am. . . " (fill in whatever word is appropriate for the site you have in mind). This might be a spot you love or hate or are afraid in, one you're near everyday, or one you dream of visiting.

Then consider: How does it feel to write about this location? What can you do to feel well emotionally based on this writing? Does it confirm that you're a contented indoor type who despises mosquitoes, or does it trigger ideas about where to stroll this afternoon or camp this weekend?

TO WRITE: Responsibility
"Responsibility"means many things -- I know, I admit I looked at the thesaurus after a student recommended this topic. My first thought had been about "taking" responsibility, being the conscientious one who steps forward and is accountable when a task needs to be done. But we also use the word when we lay blame ("Kids, who is responsible for this mess?"), or assign trustworthiness ("Beth would never make a mess; she's very responsible").

What does responsibility mean to you? For me, in the larger sense, it indicates a sense of rightness, of standing up for what I believe in, even in the face of intense opposition. It is an inner compass that reminds me of what truly matters to me -- like ending the war; like trying to live more sustainably; like treating people fairly.

Play with this. . .
Write continuously for 20 minutes on the topic of "responsibility" and what it means to you -- whether it's finding a baby sitter you're comfortable with, or protesting for civil rights, or taking proper care of your mental health.

After you write, consider what your thoughts and feelings on this topic indicate about you. Do you feel overly responsible for things? Do you tend to shirk duties? Are there ways you would like to manifest more responsibility for certain areas in your life? All of these issues play into my self-image, and thus my mental health, I'm sure. Are there ways you could adjust "responsibility" in your life and improve your mood in the process?

TO WRITE: Wishes and Dreams
Are you a shopaholic? A collector? Do you dream of a different home, more money, a new job?
Even if you don't consider yourself very materialistic, I think all humans have wishes about things they'd like. A way to end the war? Enough food for everyone? Peace of mind?

I know my list includes items big and small. I had my eye on a new laptop for quite a while before buying it, but going to the mall depresses me (really). And it's very hard for me to watch TV news without aching for ways to mend all our problems. There are many days when just an extra hour of time to work or to read for pleasure would be fantastic.

Play with this:
Write continuously for 20 minutes starting with the phrase: If only I had...
You can come back to this phrase in your writing as many times as you like.

What sorts of items did you come up with? Are any of them readily attainable? Are any worth planning and working toward? Do any of them give you insight into your mental health? You may even want to write another 10 minutes on the answers to these questions.

TO WRITE: If I Weren't Doing This...
Do you work? Even if your depression has interrupted your work life, you may identify with a certain occupation you once held. Whether you're a corporate VP right now or a mechanic on sick leave, a retired salesperson or a former astronaut -- or even if you've never been paid to work --you've had jobs. Weren't you a student in high school? Have you been a homemaker, a gardener, a cook? Have you ever mowed the lawn or helped a child or walked a dog?

Now that you've thought about what you've done in the past, consider what things you'd love to do in the future. Imagine you could do anything, starting tomorrow -- whether or not you think you have the experience or education for it. What occupation do you dream of?

My friends may be surprised to learn that I've always secretly yearned to be a long-haul truck driver. I suppose the solitude to think as I watch the miles of America roll by somehow calls to me. It's certainly unlike anything I've done professionally before!

Play with this...
Write continuously for 20 minutes on: An alternate occupation I'd love to try....

Let the sky be the limit (or don't, and go for that astronaut job). How about a sculptor or a real estate mogul? An Olympic swimmer or -- oh, the irony! -- a psychiatrist? Describe how it would feel to be working, where you would go each morning, what you dream of doing on the job.

After you re-read your writing, consider how your mood might be affected by this new position. Are there healthy aspects of this type of work that you could implement now? Is this dream job something you might want to actually pursue -- and what steps would you need to take? Does your writing shed any light on how you've felt about work you've done in the past or are doing now? Is there any other job you'd also love to investigate? Write that one out too!

TO WRITE: Darkness and Light
In English, we use the words "dark" and "light" to describe a myriad of things, including paint on the walls, lamps, our thoughts, and our moods. But have you ever considered the concept more broadly?

For visual artists, the degree of light in a work is often a key aspect of the piece as a whole. Should the landscape painting feature a sunrise or be under ominous cloud bank? What do the shades of color in an abstract work indicate? What mood is implied by the shadows of a portrait?

In one of my favorite writing books, Wild Mind, author Natalie Goldberg discusses with a friend how everything can have these attributes, including watermelon (light, they conclude), friendship (very dark and scary), Minnesota (real dark), and death (light and dark). "As we talked more, dark transformed," she writes. "Dark became good and bad. It became energetic, fertile, less scary, more desirable."

Play with this...
Write continuously for 20 minutes, starting simply with the topic of "darkness and light," and see where it takes you. Really let your mind go, beyond the traditional categories we tend to use. What do the concepts mean to you, how do you apply them, and how could you think about them differently? And is friendship or watermelon dark or light for you?

Then read what you've written. What ideas or words are the most exciting to you? Start with one of those and write 20 more minutes, going deeper into your mind. Afterward, consider carefully how this kind of writing feels to you. Were you surprised where you writing went? Did it begin to flow automatically, without effort? And -- how did this feel to you emotionally? Whatever you find, keep what you've learned in mind when you write in the future.

TO WRITE: The Wisdom of Youth
What did you know when you were a kid? A lot, you probably thought at the time, if you were like me. But what do you now think as you look back on your childhood days? Our experiences were limited, but perhaps our wisdom was right on. And what does our state of knowing back then say about our mood now?

Play with this. . .
Write continuously for 20 minutes on: In fifth grade, I thought....
Did you have strong beliefs about how the world worked when you were ten or so? (I was seriously questioning both the existence of God and the need for school.) As you left elementary school and headed for junior high, did you have misconceptions that in retrospect are funny or surprising? (Did you know where babies come from?) What views did you hold about yourself and your family? What were your plans for the future? (Any firemen or veterinarian wannabes out there?)

Looking back at your writing, consider how your mood was then -- already showing signs of depression, or still innocently happy? If depressed, try writing some more on this period of your life, but consciously change the circumstances you describe so that you are pleased with the result. If you were in good spirits as a kid, are there any lessons there for you now, such as specific activities that brought you joy, and that might again?

TO WRITE: Caffeine and Alcohol
Whether or not you take medicines for your depression or other mental disorder, there are legal substances that may play a big role in your life and health. We know that alcohol abuse can devastate the lives of entire families. But even if your intake is moderate, do alcohol or caffeine affect the way you live?

Students in my writing classes usually have quick and definitive responses and stories about this issue -- usually because they respond differently to these common substances than they did before they became depressed or began taking meds. For some of us, many cups of coffee are needed to get through the day; for others, a sip of tea in the morning will mean a sleepless night. And, while some patients -- and their physicians -- feel they should completely avoid alcohol's potential mood-changing properties, others enjoy an occasional drink without a problem.

Play with this...
Write continuously for 20 minutes about your feelings about caffeine and/or alcohol. Do you use either? Why or why not? Have they affected your life adversely? Has your attitude toward them changed with your depression? And would you like to change your intake patterns for either?

TO WRITE: What's to Become of Us?
I've got to give credit to an unknown student for this one too, a fascinating question to write on: Where do you think we're going in our evolution?

If you're a biologist, like me, your thoughts may go immediately to Darwin and genetics and survival of the fittest. If you're a sci-fi buff, you might be thinking in more high-tech terms. If you're a mystic, perhaps your ideas about death and beyond come in to play on this one. And if you're a global warming expert...?

Play with this...
Without thinking too much beforehand, write continuously for 20 minutes on where you think the human race is going evolutionarily. You can create a serious and thoughtful freewrite, or let your imagination go and write a fictional account of the future.

Afterward, consider what mood you were in when you wrote this piece. We're probably all likely to sound more pessimistic when depressed. But does consciously trying to write more optimistically help to improve your mood? There is evidence that the different ways we tell stories can affect our thinking and even behavior, so it doesn't seem outrageous as a hypothesis. If your writing sounded "down," try a rewrite and see what you think.

NOTE TO FAITHFUL READERS:
You may notice that there's no "TO READ" article posted this week.... The TO READ feature will probably appear rather sporadically through the next several months as I focus on writing my book, The Power of Writing: Easing Your Depression with Paper and Pen, to be published in spring 2008 by Ten Speed Press. I'll continue to post a TO WRITE writing exercise each week. And I'll likely come across depression-related topics on occasion that I just can't wait to share. Thanks for your understanding. Keep in touch! --Beth

TO WRITE: Gender and Social Stigma

A student recently suggested "patriarchy" as a writing topic. That's a heavy issue for me to get my mind around, so I tried to think of very specific ways I have been affected by this social scheme. While the differences between the treatment of men and women is enforced in truly frightening ways in some countries today, and while there are evidently still a few matriarchal cultures in existence, here in the US I feel I live in a patriarchal culture that tries to portray itself as egalitarian.

So how has that affected me? I brainstormed. I do think that in one job I was treated differently than a man would have been in terms of mentoring. Also, I took my husband's last name when I married -- though I use my maiden name as my often-included middle name to try to keep it present. I know I've been looked at oddly when alone in some public establishments, where a man, I suspect, wouldn't have been noticed. I'm sure there are lots more, big and small....

Play with this...

If you need to brainstorm at all, take 3-5 minutes to make a quick list of times you feel you were discriminated against because of your gender. Then write continuously for 20 minutes on one of them, describing what happened as a story with beginning, middle and end.

How did it feel to identify and write about this issue? Did you describe a trauma or a mere annoyance? Did writing about it change your mood at all? If the story felt upsetting, try rewriting it with a different (fictional) ending that you prefer. This can often feel empowering.

TO READ: Extend Your Life by Treating Your Depression?
It's long been known that if you follow a group of people -- half depressed and half not -- for several years, more of the depressed ones tend to die during that period. But now there's good news: A recent study shows that if you treat the depressed people, they live longer.

In the study, researchers took half of the depressed group, all over 60 years old, and treated them with either medication or psychotherapy. The other half went untreated. They found that the treated people were only half as likely to die during the study as they untreated group. (This was after controlling for age, sex, smoking habits, level of education and current physical illnesses.)

Although the scientists don't know why yet, the decrease in deaths came nearly all in the group of patients who also had cancer.

Here's yet another reason to treat your depression, either with meds or psychotherapy -- in addition to feeling less depressed, you may just live longer too.

For more info: Joseph J. Gallo, The Annals of Internal Medicine, May 15, 2007.

TO WRITE: Leaving on a Jet Plane... or Car or Bike or Boat
You're thrilled or you're dreading it ... you're dashing about or you're dragging your feet. No matter where you're headed out-of-town, no matter how you're getting there, going on a trip can be stressful and emotional. And if you're depressed already, it can feel overwhelming.

If I'm healthy when I'm about to fly or drive anywhere, I'm so excited that I underestimate the time required to prepare and pack. I forget until the last moment to take care of crucial phone calls or take out the trash. I'm often doing laundry at midnight before an early departure, because I must have some favorite outfit clean and ready-to-go. And then there are the decisions about what to pack, and how large a bag I'm really going to need for a weekend in the mountains or a three-week trip to Europe.

My husband, meanwhile, tosses some clothes in the nearest duffel bag and has time to read a magazine before we leave. (Sigh.)

Play with this...
Write continuously for 20 minutes on a voyage you've taken and your emotional and physical preparations. How did you feel -- whether you were off to trek in Nepal or take a day trip to the beach? And how did you get ready? Did one affect the other? If it was a less-than-great experience, can you plan something differently for next time? (I'm instituting a rule for myself that says I aim to depart 30 minutes before I actually need to. Just a mental game, but, with some luck my brain will buy into it.)

TO READ: My First Book is Being Published!
Like this blog? You're going to love this book.

I'm delighted to announce that I have just signed a contract with Ten Speed Press to publish a book I'm writing on the power of writing to ease depression.

The book (we're still fine-tuning the title) will be based on my experiences, the experiences of my creative writing students with mood disorders, and the scientific evidence of writing's many healing properties. It will describe some of the types of writing you can use to lift your mood, including freewriting, journaling, poetry, memoir, and even fiction -- and how you can write on your own or begin a writing group for people with depression. Lots of exercises -- to jump start your own writing -- and examples of students' writing -- for inspiration -- will be included.

Whether you're dealing with major depression or a difficult life transition, this book is designed to help you with techniques that can help heal your thoughts, emotions, and spirit.

If you'd like to be on my mailing list for early information and updates, please leave a comment.

The book will be available in May or June, 2008 -- just a year from now. My next few months will be spent writing like crazy! Hurray!

Stay tuned....
-- Beth

TO WRITE: Those Really Big Questions in Life
In the writing group I lead at Stanford, I sometimes pass around a paper on which people can suggest topic ideas. Members' topics, like those I bring in myself, range from the very specific -- washing dishes, a childhood toy -- to the huge and abstract -- the meaning of life, for example.

Recently I noticed a large proportion of the group's ideas were of the "really big" variety. These issues sometimes require a few minutes of writing before you truly get your mind around them, but they tend to be very rewarding.

Play with this...
Write continuously for 20 minutes on one or both of these questions: Who do you think you are? What is reality, anyway?

Though you may need to start with broad concepts, try to bring your writing back to the personal level too, by using specific examples and using details gleaned from your senses.

Wait a day or so, then reread your piece. Have you learned anything about your own beliefs? Have your beliefs been strengthened? Drawn into question? Does this affect your perception of your depression at all?

TO READ: Groups Offer Comfort and Even Joy in the Mental Health Community
I have a lot of mentally ill friends. Maybe you do too. Twenty-one years ago, when I was diagnosed with major depression (which later became categorized as bipolar disorder) I personally knew only one person who I even suspected of having a mental illness. Now people with depression, bipolar disorder and other conditions are everywhere in my life!

I find that as we go through this life-altering experience, we tend to bond to one another for information and support. You may have noticed it in your life too. When you suddenly get a diagnosis, or a prescription, everything changes, and you need someone to turn to -- someone who's been there. That's why I believe the services provided by the National Alliance on Mental Illness (NAMI) and the Depression and the Bipolar Support Alliance (DBSA) (see links at right) are so vitally important. And I know that sense of connection and shared experiences is one of the reasons people seek out my writing class for people with mood disorders at Stanford.

Being immersed in the mental health culture may involve reading about depression or other conditions, recognizing that you have mentally ill friends or relatives, seeking education and camaraderie in support groups or therapy groups and, in a surprisingly high number of cases, holding paid or volunteer positions in mental health advocacy. (In addition to my writing group, I speak as a volunteer on mental health issues for two organizations.) And there is a great deal of comfort, release and joy in these communities.

This weekend I took part in the NAMIWalks for the Mind of America in San Francisco's Golden Gate Park. The positive vibes and goodwill were everywhere -- from the fact that there were 90-odd teams participating, to the cheers and thanks of volunteers as we finished our 5k walk, to the open-minded chats going on at the booths offering information, books, and items made by people with mental illness. I felt proud to be a part of helping make these illnesses more visible in our still-stigmatizing society.

If you're coping with depression and you're not familiar with NAMI and DBSA, do yourself a big favor and check them out for education on illnesses and treatments, emotional support for consumers and their families, resource lists, legislative and research updates, and especially to learn where there are support groups near you. You don't need to feel alone as you grapple with difficult thoughts and feelings.

TO WRITE: Oh, Those 'Parental Units'
Whether you feel your parents are the guiding lights in your life or people who cast dark shadows -- or, most likely, something in between -- there's no denying that parental relationships are crucial to shaping who we are. Think back to your growing-up years: How did you experience them, or the other person or people who raised you? Nearly all of us can point to both happy and painful childhood events. And what of your current relationships: Are your parents living? Do you have regular contact, rare contact, no contact? Do conversations mirror those of childhood, or have they evolved in some way?

These reflections can be eye-opening for anyone, but perhaps especially to people coping with depression. If you feel like it, consider the relationship, if any, between your parents and your difficult moods. Some people believe there is a direct cause-and-effect relationship; others find their parents their greatest support. There's no good or bad -- our parents are only one part of our lives and, as adults, we have already moved on considerably to shape ourselves, and we'll continue to change and grow.

WARNING: This can be an intense topic. Remember the "flip-out" rule -- if it feels too scary to go there, just don't go. Write on something else this week.

Play with this...
Choose one parent or guardian. Take 20 minutes of continuous writing to describe your past and present relationship with that person. Try to incorporate at least a couple of specific stories of events. Also consider how you might like to improve your view of that relationship today -- could you recognize your separateness and release some frustration or pain, for example? Can you feel thankful for any part of your interactions? You may want to share what you've written with a safe friend, partner or therapist. Remember: We are always evolving and becoming stronger as adults.

TO READ: Happy Faces Trigger Less in the Brains of Depressed People
When you're depressed, you know it's hard to put on a smile -- and it can even feel difficult to react to smiling people around you. Now brain research shows that depressed people do have real impairments in the ways they process happy faces.

In a recent study, depressed people were slower and less accurate at "processing" -- in this case, detecting the gender of -- happy faces than were healthy people, as shown by functional MRI. But after eight weeks on Prozac, and improvement in symptoms, this ability returned. On another task, responding to increasingly happy faces, the emotion-processing regions of the depressed brains were less active than they were in healthy people's brains. In this case, the difference was not improved by the antidepressant.

Being able to recognize and respond to other people's emotions is a crucial part of interpersonal relationships. These different responses demonstrate that it's not a personal failing to have trouble reacting to a friendly person when you're depressed, but a measurable neurobiological trait of the illness.

For more information: Am J Psychiatry 164:540-542, April 2007.

TO WRITE: Simple everyday routines
One way in which writing can help us see ourselves is by bringing the ordinary details of our life into clear view. For example, when you stop long enough to see a daily ritual broken down into its individual steps, you may appreciate it differently -- its intricacies, its roles, even its beauty. Consider this poem by former U.S. Poet Laureate Ted Kooser, who, incidentally, was a life insurance executive in Nebraska most of his life.

The Necktie
His hands fluttered like birds,
each with a fancy silk ribbon
to weave into their nest,
as he stood at the mirror
dressing for work, waving hello
to himself with both hands.

Play with this...
Write a poem about a simple routine task or ritual you do. As Kooser's poem shows, this action can be something quite small and ordinary. Describe the routine, considering its meaning to you, and various ways you could express its qualities to others. Take at least 10-20 minutes to write and revise your poem. (If you really prefer prose to poetry, use that, but try the poetic form first.) What does this everyday habit reflect about your life?

TO READ: Depression's Devastating Self-Criticism Explained
When serious depression kicks in, one often-heard complaint is, "I do everything wrong." Now researchers have brain-wave evidence about where this perception may come from. Results from one study show that depressed people make no more mistakes than healthy controls -- but that they truly are better at detecting their errors.

Scientists measured two types of brain waves as subjects did a simple signal-detection task, and found that depressed people were just as quick and accurate as the non-depressed. No slowness or concentration problems were noticed. However, both types of brain waves -- one called error-related negativity, which measures brain resources used in early detection of errors, and the other called error positivity, which indicates error detection -- are exaggerated in depressed people.

Those responses indicate that the depressed group used more of their brain resources to detect errors. Researchers suggest that when they make a mistake, depressed people are more likely to notice it than a healthy person would be. While this extra acuity might be a good thing in certain situations, it also may be responsible for the hyper-criticism often felt during the illness. Something to bear in mind when that I-can't-do-anything-right feeling kicks in!

For more info: American Journal of Psychiatry 2007 164:58.

TO WRITE: A Sound from Childhood
Memories, especially those from childhood, can often evoke strong emotions, as well as triggering even more memories. Instead of replaying the same old childhood stories in your mind (we all have some that we rely on to piece together the story of our life), try with this exercise about specific sounds to see what other details or experiences you may not have thought about for a while. "New" material can supply all sorts of creative undertakings. In addition, focusing on specific sensory experiences makes for strong writing.

Play with this...
First, brainstorm a list of five to ten specific sounds you recall from childhood. My list includes the zip when my father cast his fishing line from a canoe on a lake, and the blaring honk of the tornado alarm in elementary school. Next, choose one of these sounds -- preferably one you haven't thought about for a long time -- and write for 20 minutes about your experiences relating to it. Then consider how it felt to write this memory -- was it sad, funny, a relief, an "aha" experience? If a particularly difficult memory came up, give yourself a few more minutes to write an imaginary ending to the story that wraps things up in a way you'd prefer.

TO READ: Why Did I Have To Gain 80 Pounds on Antipsychotics?
Researchers may have solved the mystery of why so many people with bipolar, depression, schizophrenia and other illnesses who take certain antipsychotic medications tend to gain weight -- sometimes lots of it.

While these medications may effectively treat symptoms such as hallucinations and delusions, that's a high price to pay. (I know -- I gained 80 pounds in a few months on one of these meds. Fortunately it's almost all come off now that I'm on a newer one instead.) Many people gain to the point that they become at risk for life-threatening conditions such as heart disease and diabetes.

Scientists knew that the link between brain cells and appetite seems to be an enzyme known as AMPK. Now, in a recent study at Johns Hopkins University, when researchers gave the antipsychotic medication clozapine to mice, their AMPK activity quadrupled. When the scientists chemically suppressed the mice's appetites, the AMPK levels lowered. But what mediates such a connection?

It turns out that histamine -- the substance responsible much allergic misery, as well as a protein which aids communication between cells -- plays a key role in the interaction between AMPK and appetite. By blocking histamine's effects, clozapine no longer led to AMPK spikes.

The results are exciting: This discovery may allow scientists to develop both a new generation of antipsychotic drugs that doesn't cause weight gain, and safe weight-loss drugs.

For more info: Proceedings of the National Academy of Sciences, online edition, February, 2007.

TO WRITE: A Cold Got You Down? Write About It!
I see low, deep gray clouds and the spattering of raindrops outside my window here in Northern California today. And the weather report says a big part of the country is getting snow on this day before tax day. Have the recent shifts in weather contributed to a spring cold for you, as it has many people I know? (So far, so good for me ... for this month.)

After you wake from your weekend nap and pop some more Benadryl, don't turn on the TV to numb your mind. Instead, consider curling up with a cup of hot tea and a blanket in your favorite chair and writing out just how miserable you are. You might just feel better. Your mind will engage and you may forget your sore throat for a while. And remember that writing has been demonstrated to improve immune functioning. I'm not claiming that writing will cure your cold -- but research does show that writing even 20 minutes a day for four days in a row about a difficult or traumatic experience leads to fewer doctor visits for months later. Now that's something to think about!

Play with this...
Describe how your body feels right now as if you're writing for someone who's never had a cold -- the aches, the fever, the lethargy, the stuffiness. OR describe a time you were sick as a child -- what were your symptoms? Who took care of you? How did the illness resolve? Write continuously for 20 minutes. When you look back at the pages you've filled, you'll see you have accomplished something today after all.

TO READ: Religion Shown to Help Depression for Many of Us
The data is overwhelming: Study after study shows that people who consider themselves religious or spiritual, especially those who attend weekly religious services, tend to be generally healthier and longer-lived than those who don't. And -- this rule of thumb holds true for depression in particular too. Interestingly, it's reported that 95% of Americans believe in God or a Universal Spirit. Along the same lines, a study of psychiatric inpatients found that 80% consider themselves religious or spiritual.

In terms of overall health, for example, one study which tracked more than 5,000 people from right here in Alameda County, CA, found that those who attended religious services at least weekly were 25 % less likely to die during the study than others. A huge 1999 study of 21,000 American adults found that by attending religious services more than once a week, people tended to extend their lifespan by up to seven years in general, and up to 14 years in African-Americans.

In terms of depression, the results are remarkable too. For example, in one study of 177 people (age 55-89) over one year, self-reported religiousity was correlated with less depression, and with recovery from depression in those who were initially depressed. Another study looked at depressed and medically ill men over age 60 for one year and found that, even after accounting for 27 other variables, religiousity was associated with both a greater likelihood of remission and a quicker remission from depression. In one review of 29 studies examining the relationship between depression and religious involvement, 24 found that religiously involved people had less depression and fewer depressive symptoms; five found no association.

Treatment of depressed religious people has been shown to be more effective in terms of post-treatment depression when religious content is added to standard cognitive-behavioral therapy and, in another study, when religious content is added to standard psychotherapy.

And what if you don't consider yourself a "religious" person? Good news: benefits of a spiritual but non-religious practice can still provide benefits that complement your medical treatment. Consider a regular yoga or meditation practice, for example. Also, giving to others through works and services can often provide a strong inner response. In addition, pay attention to your personal support network, and health habits such as drinking and smoking -- all of these have been shown to be improved by religious involvement, but don't rely on believing.

Remember -- spiritual beliefs should not be used to replace your medical care! Instead, appreciate how they can complement and augment one another in your efforts to feel better.

For more info see: www.mayoclinicproceedings.com/inside.asp?AID=1338&UID and www.mcmanweb.com/article-102.htm

TO WRITE: Could a "Laughter Club" Beat Out Prozac?
Is it hard to laugh when you're depressed? Well, consider doing it in a group. That old saw about laughter being the best medicine is being enthusiastically applied in Shanghai. China Daily reported that this month faculty members at Fudan University began inviting students to "laugh away their cares and concerns" by joining the Heartfelt Laughing Club.

Members, inspired by observations that laughter is powerful - and contagious - typically meet in parks early in the morning. They raise their arms high and begin laughing loudly, then silently with mouth closed, then open, in an effort to ease everyday stresses. Sometimes the laughter is combined with yoga and meditation. Chinese psychologists leading the Fudan group discovered that others follow the humor-filled practice too: There are more than 80 laughter clubs in India, and several thousand around the world!

Do you think they could be on to something?

Play with this ...
Even if it's been a while since you've giggled much, recall some times you have. Did you laugh yourself silly at Bugs Bunny as a kid? Or was it that time you and friends played a prank on a teacher? For me, watching Monty Python or Saturday Night Live with my gang of pals in high school comes to mind.

Write the story of a funny - no, hilarious - thing you once laughed at. How did it start, how did you react, did you feel different afterward? Are similar events still amusing to you now, or have your tastes changed? And what might make you laugh today - could you rent a video, play with the dog, rehash a family mishap with your sister? As usual, give yourself 20 minutes to write continuously about the laughter in your life. And leave a comment to let us know what works for you!

TO READ: Approaching a Genetic Understanding of Depression
Scientists continue to chip away - and sometimes blast away - at the mystery of depression. And they're making progress. In a major step forward, a consortium of psychiatric researchers announced last month the identification of a region on chromosome 15 that has "a very good chance" of ultimately explaining why some people develop depression.

You probably know that both genetic and environmental factors are believed to be responsible for depression. A better understanding of specifically which genes (there are thought to be several) in our DNA place us at risk for depression would constitute a major research breakthrough: If scientists can locate the key genes, they can determine how they affect the brain and, as a result, can develop more effective therapies for the illness.

Two studies reported in the February American Journal of Psychiatry were conducted by groups at six universities, led by Stanford professor Douglas Levinson, M.D. First these researchers studied 650 families in which two or more members had experienced multiple bouts of severe depression that began in childhood or early adult life. They scanned the entire genome and found areas of "linkage" between depression and DNA markers in several areas. Then they homed in on the most suspicious region, which lies on chromosome 15.

What they found, after studying more than 88 DNA markers in that area, was what Levinson called "one of the strongest genetic linkage findings for depression so far."

The consortium is now studying more than 2,000 people to identify specific genes in the regions, including on chromosome 15, that look most likely to carry variations that increase depression risk.

TO WRITE: What We See and What We Don't
Many writers claim that observation is what their work is really all about. Author and writing teacher Natalie Goldberg says, "Writing is 90% listening."

But it's not just the writer surreptitiously monitoring the lovers at the next restaurant table for plot ideas and dialog. In fact, every human needs to observe his life and the world around him and try to fit the two together. Observing and reflecting are key, whether it's deciding when it's safe to step off a curb, or determining when to change careers. For people living with depression, observing the situations that make us feel worse or better, and the reactions we have to those stimuli, can be a powerful tool. We can use this technique both in the present and in retrospect.

Play with this...
Write continuously for 20 minutes, starting with the following prompt, and see what you discover.
Looking back, it was obvious...

TO READ: Changing the Structure of Your Brain
Wow, am I reading a great book right now! Train Your Mind, Change Your Brain by the wonderful science writer Sharon Begley, is billed on the cover as, "How a new science reveals our extraordinary potential to transform ourselves," and, "A groundbreaking collaboration between neuroscience and Buddhism."

Sound confusing? Well, I suppose anytime you get the Dalai Lama to write a foreword for a book on nerve cells in the brain, it's unusual, that's true. And neuroscience is typically thought of as a daunting field. Despite those things -- or maybe because of them -- I'm telling everyone I know to read this book! It's absolutely fascinating and it's very accessible.

Here are some of the things I've learned so far, boiled down and boiled down again. When I was a college student, and even when I was a graduate student in biology, it was taken as a given that whatever brain cells you were born with were what you got for good -- no exceptions. This was simply a basic rule of neuroscience. But... Begley describes a whole host of recent experiments that show how that belief is hooey. Instead, the incredible changes our brains can make -- the "neuroplasticity" of the brain -- will amaze you. For instance, in people blind from birth, you might imagine that the enormous visual cortex part of the brain would sit silent, since no visual input can get in through the eyes. No! In fact, instead of lying dormant, the visual cortex actually switches jobs to help the person hear certain tones and rhythms more acutely than sighted people can. In other words, it helps them compensate. Similarly, the brain region believed to only be able to process auditory stimuli can, in deaf people, be recruited to help the visual cortex to gain even more information from peripheral vision than usual, thus helping a deaf person to notice and react to changes in the environment more quickly.

What these kinds of experiments mean is that we can change our brains. By attending to particular things in our environment, we can cause regions of nerve cells in the brain to grow, to shrink, to adjust their function, even to change jobs completely. So, if you take up the violin, even as an older adult, your brain's motor cortex in the region controlling your left (fingering) hand, will grow. It takes attention and practice, but our minds really can change the structure and the electrical and chemical activity in our brains! That's consciousness changing matter.

I'm only half-way through the book, but I'm hooked. So stay tuned for an upcoming discussion of what happens when neuroscientists study the brains of Buddhist monks who have meditated for years, and learn what these discoveries mean for the treatment of OCD and depression.

TO WRITE: How Do You Care for Yourself?
Last time I circulated a notepad asking for writing topic suggestions in our class meeting at Stanford, I got an amazing mix of responses. We've already written using several of them as our jumping-off point -- from "joy" to "patriarchy" to "I'm afraid of" to imagining being "rich beyond dreams."

But one topic that comes up very regularly on such lists is how to manage your moods. And on this page, the topic of "self-care" came up specifically. Everyone who has coped with a mood disorder, even for a short time, has probably gravitated toward some activities that feel self-soothing or calming or activating or encouraging, depending on what you need at that time. When I'm depressed, reading a novel or writing about the situation over a big cup of coffee at Starbucks helps considerably. It doesn't remove the depression, but it reminds me that there are still things I can enjoy - even if only a little bit - and that I have the ability to seek out those things. And, in my case, the jolt of caffeine doesn't hurt either.

Play with this...
What self-care techniques can you recommend to others? Does walking the dog help you bond with her and get some exercise? Does herbal tea help you get a much-needed good night's sleep? And what about writing -- you may not feel up to crafting a poem, but does a good freewrite in your journal ease your burden a bit? Write continuously for 20 minutes on self-care and see what you discover -- then share your findings with a friend who could use them, and perhaps pick up a few tips from her too.

TO READ: Gamma knife surgery - could it help depression someday?
A former writing student recently made me aware of a "knife-less" brain surgery technique which is becoming widely used around the world. Called gamma knife surgery, it destroys tiny bits of brain tissue by focusing beams of cobalt radiation on, for example, a brain tumor. The gamma knife can be used even for deep brain sites and, unlike conventional radiation treatments or surgery, can be focused with one-tenth of a millimeter precision, so healthy tissue is largely unaffected.

Sounds very impressive to me. Now vascular malformations, both cancerous and benign brain tumors, epilepsy and other conditions are being treated with the gamma knife on over 60,000 patients each year, according to one web site.

But what about depression? I surfed and web-surfed some more, but haven't come across any studies on using gamma knife surgery in this realm. Yet. One site discusses using it for obsessive-compulsive disorder and even vaguely suggests using it for depression in the future....

But where in the brain would it be used? As this blog has described several times, more and more evidence is stacking up that says brain structures - not just the flow of neurotransmitters - are changed in depression. Perhaps one of these sites could be treated. Often the confusing point in these cases is that we don't know whether those structural changes cause, or are caused by, depression. The other approach would be to simply focus on brain regions now understood to regulate emotions and mood. But identifying the precise areas to target is still too difficult. Still, it sounds as though researchers are starting to consider the possibilities of gamma knife surgery for psychiatric illnesses. One more potential future treatment to keep an eye on.

For more info: www.sciencedaily.com, www.sd-neurosurgeon.com

TO WRITE: Are You Friendly with Your Little Pink Tablets?
If you take antidepressants - or mood stabilizers, antipsychotics, anti-anxiety drugs, sedatives, stimulants or any other of the panoply of psych meds - how do you feel about them? For many people with depression, that handful of tablets and capsules that it sometimes seems we gobble like candies can be hard to get down. That is, while we know intellectually that these drugs are helping us, or at least could help us, many of us still have mixed emotions about taking them.

Have you ever wondered what exactly those pink or white or turquoise or yellow pills are doing once you swallow them? Scientists still can't fully explain how they operate to change our thoughts and our entire mood. How does that mystery leave you feeling? At different times I've felt dumbfounded, nervous, grateful, embarrassed, angry, resentful and relieved to reach for my regular doses from those amber bottles.

Play with this...
Write continuously for 20 minutes describing your feelings about taking medicines for psychiatric reasons. What emotions did you feel initially? Have they changed at all? How do you feel when you take your prescribed dose today? And would you feel any differently if these were drugs you were taking for some non-psychiatric ailment? Untangling such thoughts and feelings may provide some insight into our attitudes toward our depression and our life situations as well as our treatments.

TO READ: Drug Combo for Resistant Depression
Has your depression - or you - been dubbed "hard to treat"? Been through drug after drug without success? A new study looking at treatment with the combination of antidepressants Effexor (venlafaxine) and Remeron (mirtazapine) looks encouraging.

Irish psychiatrists just reported a study of 32 patients (44% men) who had been through an average of 2.5 drug trials without depression relief. Impressively, after 4 weeks on this combination of meds, 44% had responded; after 8 weeks, 50% responded; and at a 6-month follow-up, 75% of those still taking the meds had significantly responded.

The down-side? No "serious" side-effects were reported, but 19% of patients felt sedated and 19% experienced weight gain. Five of the 32 quit the trial because of these effects. Remember to keep trying if your depressive symptoms haven't been helped by meds yet - just because one drug or combination doesn't work for you doesn't mean others won't!

For more info: Journal of Psychopharmacology, Vol. 21, No. 2, 161-164 (2007).