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!