TO READ: Writing Saves Lives
Many writers love to claim it: The act of writing not only helped my life, it saved my life. Author and teacher Louise DeSalvo begins her book Writing as a Way of Healing with this claim; poet, author, painter Natalie Goldberg describes "How Poetry Saved My Life," in Top of My Lungs; my students have made this bold statement; I use it in Chapter 1 of my book-in-progress, Illuminating Words: The Power of Writing to Ease Depression to illustrate one of the key aspects of my recovery from severe bipolar disorder.

In this week's edition of Newsweek (Jan. 22, 2007), writer Anna Quindlen's column is titled Write for Your Life. In it, she describes how the disadvantaged teens documented in the new movie Freedom Writers find connection and even pride when a young teacher gives them blank notebooks and says to write anything at all. Now I know that some writers, including Virginia Wolff, have said that a piece of writing is not truly complete until someone else has read it, but I disagree. I've seen it in my students when they report on their journaling; I've felt it myself. Even writing for oneself can be meaningful and healing.

"Writing is a form of personal freedom. It frees us from the mass identity we see in the making all around us. In the end, writers will write not to be outlaw heroes of some underculture, but mainly to save themselves, to survive as individuals," according to novelist Don DeLillo as quoted in Quindlen's article. I think he puts it very well. While writing intended for family, friends or publication is no doubt fulfilling and empowering, there is a place, a crucial place, for personal, private writing as well. And it even saves lives.

TO WRITE: Be Proud of What You See
I attended a retreat this weekend for writing and silent meditation. It was glorious. About 40 other women and I spoke only when we were meeting in groups to discuss spirituality, writing, and the role of "mystery" in our lives. Meals, writing periods and free time were all in silence - no small talk all weekend. In this freeing and reflective state, the sharing we did do in groups was especially meaningful. One comment that struck me was an older woman recalling how her father firmly told her and her siblings when they were children: "Every morning look in the mirror and be proud of what you see."

Play with this...
Try out this father's advice. Look in the mirror and consider what you are proud of in yourself. Then write continuously for 20 minutes on what you discovered. Personal traits, good habits, accomplishments, kindnesses? Even if you're feeling depressed today, try honestly to find areas of pride - at the very least, you are trudging through a lousy period and you're demonstrating bravery and persistence and modeling those traits to others... all things to take pride in. Now can you look in the mirror again tomorrow and be proud of even more?

TO READ: Should I Start Omega-3's?
A bipolar friend of mine was recently stunned to discover that along with my other meds I don't take an omega-3 fatty acid supplement. She claims great results from taking omega-3-containing fish oil pills - several grams of them - every day for her depression. So am I missing the boat here? I know omega-3's were hot news a few years ago, but what's the evidence say now? My psychiatrist and I set out to discover the latest conclusions on their usefulness.

Although omega-3's were previously widely touted (notably, in The Omega-3 Connection, a 2001 book by expert Andrew Stoll), the latest reviews of all the published studies in this field seem to reach the same conclusion: Maybe they're useful; the verdict is still out.

To summarize extremely briefly, people got very excited when population studies found that people in parts of the world where lots of fish is eaten have lower rates of depression than in regions where fish is a smaller part of the diet. The unsaturated omega-3 fatty acids found in high levels in fish oil could logically play a biochemical role in the brain, and some studies have indicated that depressed people have particularly low levels of omega-3's. Sounds promising in theory, but when psychiatrists around the world eagerly began to study the effects of fish oil supplements for their patients, things got complicated.... In 2006, at least three groups of scientists did careful statistical reviews, each of at least 12 published studies (see Am J Psychiatry 2006; 163:6, June 2006; World J Biol Psychiatry 2006; 7(4): 223-230; and American Journal of Clinical Nutrition, December 2006). Every one concluded the same thing: We don't know yet if omega-3's are really effective.

Yes, there are some quite positive studies, but there are others that contradict them, showing no significant correlation at all between omega-3's and depression improvement. And, the studies are not all easily comparable either - some look at major (unipolar) depression, some at bipolar depression, some at other psychiatric conditions; the doses used haven't been standardized; they use different lengths of treatment; and some used omega-3's alone while others used them to augment antidepressant therapy. All of these things require a good deal of further study before we can say with certainty whether and how to use these supplements.

So, what am I going to do? Well, no negative side effects have come up in my reading or talking with friends; my internist says I could start taking some anyway for general heart health; and I really, really don't want to have another serious depression coming my way.... So, yes, I think I'll give a moderate dose (a few grams a day) a try for a month or two. If I don't feel any problem with it, great; if I actually think I feel better or can prolong my remission, fabulous! Meanwhile, I'll keep an eye on the literature in this field and be open to altering my plan. Stay tuned.

TO WRITE: Picturing yourself
We carry visions of everyone we know; we can't help but recall the sparkling eyes of a lover, the tall frame and warm embrace of a friend, the boss's scowl even when you are on time for that big meeting. We hold pictures of their non-physical characteristics as well. Jill is such a talented mathematician, Matthew is arrogant, Lauren has a heart of gold.

So how do you envision yourself? This is a much trickier question. How do you really perceive your own size, shape, color? Your talents, skills and weaknesses? Your faith, maturity and sense of justice? The list goes on and on, of course, and for those of us living with depression or another mental illness, our self-image can be even more complex, and sometimes harder to access too. The illness's effects change who we are, and the illness can alter the way we view everything, including ourselves.

Play with this...
Imagine you are creating a character for a novel you're writing, and that character is based on you. How will you describe her/him for brand new readers? Write continuously for 20 minutes and describe this person - yourself - as objectively as possible. Consider as many aspects of yourself as possible, including the role depression plays in your self-image.

When you reread your piece later, look at whether there are things you'd like to adjust, whether by modifying something about yourself, or by simply deciding to look at something in a new light. The opinion of a trusted friend or therapist might be valuable if you're interested in making changes in your self-image.
Beth

TO READ: Genes May Predict Antidepressants' Effects
If you're reading this blog, chances are you've been there: Your doctor is prescribing an antidepressant for your unipolar or bipolar depression, then mentions the caveat - a big caveat - that this may take up to eight weeks to be effective, if it even is effective for you. When you're miserable, eight weeks is a very long time.

Once again, however, genetics may soon come to our rescue. I've written previously on the burgeoning use of genetics in other aspects of depression diagnosis and treatment (see 10/9/06 and 11/13/06), but now researchers are approaching the very practical issue of predicting "Which med will work for me?"

National Institute of Mental Health scientists screened the genes of nearly 2,000 people being treated with Celexa. They found variations in two genes associated with the treatment. One turned out to be linked to serotonin, one to glutamate, both of which are brain chemicals (neurotransmitters) involved in depression. It's only a start, but ultimately researchers hope to have a panel of genetic markers that can be used to predict which patients are at high risk of failure or side effects if the proposed medicine is used. Hopefully before long we'll see the end of the sometimes endless trial-and-error method of finding the right antidepressants for each suffering person.

For more info: WebMD.com for WebMD Medical News, 12/6/2006.

TO WRITE: Behind me and before me...
Welcome to 2007! After a short winter recess, WriteOutOfDepression is back, and I am looking ahead to the new year with a lot of excitement and a little trepidation too. Now that that busiest of seasons for many of us is over, where are you turning your attentions? In order to take stock and prioritize my ideas for the coming year (or at least the coming week or so), I have been making lists. For me, lists are a good way to trigger my sometimes sleepy winter brain, and they provide me with lots of options and ideas for further writing, something that always helps ground me in a new place or time.

Play with this...
Take a few minutes to quickly list 10 things that you remember about 2006. They might be personal, local or global. Choose one to write on continuously for 15 minutes, focusing on what that remembrance means to you yourself.

Then take about five minutes to list 10 things you imagine for 2007 - things you expect to occur or things you hope for. Look over your list and try to identify at least one small action you'd like to take to affect a desired item - or to hinder something you hope won't come to pass. (I, for example, would like to keep writing consistently on my book manuscript so that it's in good shape when I get a publishing offer; I also want to be more active in contacting my representatives about ending the war in Iraq.) Write continuously for 15 minutes on what doable action(s) would make you feel empowered in 2007.

May you find peace, good health and creative fulfillment in 2007,
Beth