TO WRITE: Who are You on Meds?
This morning's New York Times features an essay asking: If you've grown up on antidepressants, or even been on them a long time as an adult, do you still have a sense of who you are?

I know my mood is dramatically better, my thoughts less self-critical and morbid and out-of-touch, on my medication. But after more than 20 years on the stuff, who am I? There are things I notice: It 's very hard for me to feel really excited happiness (perhaps due to my mood stabilizer?) and I physically am unable to cry except in the most extreme situations (Have all those antidepressants pumped me up that much?). But I wonder if there's more.

According to the article, by Richard A. Friedman, M.D., we know very little about the long-term effects of these medicines. The studies generally focus on people's reactions for only 4-12 weeks. The longest maintenance study so far has been on Effexor, and lasted two years. (It was better than a placebo at preventing relapses.)

Play with this. . .
Writing continuously for 20 minutes, compare what you notice about yourself on and off medicines. Consider your moods, your thoughts, your feelings, your bodily symptoms, and how long you've taken these drugs. Do your meds affect you ability to work or study, or your relationships? And do they affect your "sense of who you are"?

Hopefully, you'll conclude that you're heading in the direction that is healthiest for you. If not, talk with your mental health care provider.

TO READ: Genetic Testing for Bipolar
How would you feel if your psychiatrist could simply run a blood test to diagnose bipolar disorder? Recent research describes early studies that do just that. According to a National Alliance on Mental Illness (NAMI) press release, University of Southern California scientists have identified 10 specific genes involved in mood state. Using blood tests to determine whether each gene is active, and correlating this information with 29 bipolar patients' mood states, they found that eventually they could actually predict moods.

So what do you think? Is this what we've been seeking all along -- a definitive diagnosis that might mean more accurate and faster-working treatments? Or do you worry about that information falling into the wrong hands? And would this genetic information lead to more stigmatization (ie -- you're definitely "mentally ill") or less (ie -- it's clearly a biological issue, not a character weakness)?

According to NAMI, MSNBC.com did a poll of 10,000 readers and found that 83% thought a blood test would be a good idea since it could help patients get appropriate treatment. I suspect a poll of 10,000 people with mood disorders would yield much more mixed results.

TO WRITE: A Turn for the Better
I'll keep things short and simple and sweet today. . . I'm nervously listening for the phone to ring with a call from the adoption agency saying they've got our first photos of our daughter-to-be! At that point my husband and I will dash to San Francisco to get them. Today (hopefully, hopefully) will be one of the best days of our lives!

Which brings me to today's topic -- an optimistic one that my Stanford group wrote on this week. They wrote very briefly, but their responses were so powerful that I assigned them to write more on this as homework.

Play with this. . .
Here's the prompt: Life took a turn for the better when. . .

Quick! Write down the first thing that comes into your head. Write on it for just three minutes.

Then, write continuously and powerfully for 20 more minutes on this life-changing thing or person or event. And enjoy! (I think my life might just "take a turn for the better" today -- and you can bet I'll write on it!)
--Beth

TO READ: Blogging to Beat Depression?
Millions of us blog these days. Among other things, blogging offers an opportunity to create a diary that includes emotions, as well as events, to share with others. But is blogging, like some other forms of writing, able to help ease depression?

Australian researcher James Baker of the Swinburne University of Technology says yes -- but for a surprising reason.

Baker has found that, in fact, people who begin blogs tend to be "more distressed emotionally" than others. As he told an ABC Online interviewer last month, new bloggers show "high levels of stress, anxiety, depression. They are also more likely to vent emotionally and self blame a bit as far as coping."

However, when Baker surveyed about 130 people, 60 of whom then started a blog, he discovered that two months later the bloggers had changed. They were "a bit happier overall . . . a little bit less distressed," he reported, "but the big difference was that people who actually started a blog felt more socially integrated." This feeling of connection comes from the fact that bloggers are making personal material public, receiving comments, and developing a sense of an online community.

He suggests that, ironically, perhaps people's private postings can help them become more connected to the outside world and, along with that, less depressed.

Sounds a lot like the findings I report in Writing through the Darkness: sharing what you've written is often an important part of the healing process. So, whether you're currently journaling, writing poetry, or, hopefully, doing the exercises suggested in this blog, consider sharing them, either online or person-to-person.

TO WRITE: A Farewell
I'm reading Natalie Goldberg's new book on memoir writing, Old Friend from Far Away. (If you've been reading long, you know I'm a big fan.) As in many of her books, she offers lots of writing topics and ideas, and this one's from her today, with my paraphrasing.

Write a goodbye letter to someone. It could be after a divorce, when a friend moves across the globe or a relative dies. Tell them every last thing you have to say -- this is your last opportunity. You may have complaints, praises, specific awful incidents or glowing memories to share. Get it all out. As Natalie almost always adds: "Ten minutes. Go."

Then (and this is Beth again), consider how you feel. Stirred up, relieved, sad, glad, depressed, lighter? Are there other people, leaving or not, that you'd like to write to? Letters, of all different kinds, can be a powerful way of releasing pent up emotions and ideas. Let yourself go when you write them -- you can decide later whether to rip them up, burn them or send them.

TO READ: No Shame around Depression

I've always felt that the way to combat the stigma around depression and other mental health conditions is to talk about them. These are illnesses, not character flaws. So I was delighted to read this week that, although she unfortunately suffered depression in her 20s, Harry Potter author J.K. Rowling makes no apologies for it.


"The funny thing is, I have never been remotely ashamed of having been depressed. Never. What's to be ashamed of? I went through a really rough time and I am quite proud that I got out of that," the Seattle Post-Intelligencer quotes her as telling a British college magazine. Now that's the attitude we need see and hear more of.


Rowling, 41, said that after separating from her first husband and finding herself a single mom and struggling new writer, she experienced depression and suicidal thoughts. She reported that she sought treatment because of her daughter.

So take heart. As more and more of us are coming out with our mental health conditions, the world does gradually make progress at learning they are simply a no-fault part of life. As so many peers have said to me, no one would tell us to "pull yourself together" if we had heart disease or a kidney stone; why should a brain disorder be treated differently? Thanks for your example, Ms. Rowling.

TO WRITE: Your Sleep Life
Sleep is a crucial, and often disturbed, part of life for those of us coping with depression. Whether problems are due to medications or the condition itself is not always clear. And the symptoms we experience can vary from slightly disturbing to exasperating to just plain weird.

I'm blessed in some ways, I suppose, because I rarely have insomnia. No, my sleep life leans quite the opposite way, leaving me wanting -- sometimes absolutely needing -- to sleep two to four to even six hours more than what most people consider a good night's sleep.

I've had many bizarre and unsettling sleep experiences when depressed, or even months after my mood has recovered. On one first-generation antidepressant, for example, I regularly sat up and opened my eyes during the night to watch amazing and often funny scenes play out in front of me. When I enthusiastically urged my husband to look at these hallucinations, he would have to talk to me or shake me a bit to wake me from my strange state.

Play with this. . .
Write continuously for 20 minutes about your sleep life. Do you have lots of wonderful dreams? An occasional frightening one? Do you need extra medicines to help you get a few hours of rest, or do you feel nearly narcoleptic when you're depressed? Do you find you have unusual thoughts just as you fall asleep or wake up? How does your sleep, or lack thereof, effect your mood? And how do you feel about all this -- angry, frustrated, bemused, relieved? Don't think too much, just let it rip and see where this topic takes you.

TO READ: "Against Happiness" ??
I was amazed to read that a new book, Against Happiness: In Praise of Melancholy, by Eric G. Wilson, actually lauds the experience of sadness or "melancholia" to the extent that it asserts that antidepressants should be used only for severe depressions, not for mild to moderate cases. He's got to be kidding, right?

Against Happiness, clearly titled as a comeback to Peter Kramer's book Against Depression, was reviewed in last Sunday's New York Times by National Public Radio star Garrison Keillor. According to Keillor, Wilson argues that America is so focused on happiness that melancholia -- which he believes is the the source of much great art, poetry and music -- is disappearing.

I've not yet read the book, and I'm not sure I will, for frankly I find this argument depressing. I've written about creativity and the writing-depression connection in my book, Writing through the Darkness: Easing Your Depression with Paper and Pen (to be released in June, 2008). Indeed there are correlations between bipolar disorder and artistic creativity, and much lesser correlations between depression and creativity. Who knows, maybe a lot of art and literature has in fact been born of low moods? So maybe, one can argue, melancholia (which Wilson sees as "turbulent," while depression itself is "passive"), has a certain benefit for society as a whole. (By the way, I know I've certainly had both passive and turbulent clinical depressions, so I don't buy this distinction.) But if it causes suffering that could be abated, I say get rid of depression.

If mild and moderate depressions are not treated, they can become severe depressions. And if a person wants her or his melancholia treated, and a qualified professional believes it appropriate, by all means it should be treated. (If a person is merely transiently sad, an antidepressant isn't going to do the trick anyway.) If a person doesn't want such treatment, and some artists don't, at least at times, I respect that. But to argue, as Wilson does, as cited by Keillor, "The greatest tragedy is to live without tragedy," is to romanticize depression. A romantic aura around what are biological brain disorders stigmatizes these conditions, and stigma contributes to many people's reticence to seek treatment.

Even if melancholia/depression does lead to some creativity, I can't believe it has cornered the market on human innovation. If human suffering can be alleviated, it would be very sad not to do it.


See: Eric G. Wilson, Against Happiness: In Praise of Melancholy (Sarah Chrichton Books/Farrar, Straus and Giroux); Garrison Keillor, Woe Be Gone, New York Times, March 16, 2008.

TO WRITE: Organizing Your Life
As I write this, I am surrounded by piles of papers covering my desk. Some are messy, some relatively neat; some are short, others tall; some were born today, at least one is a year old, I'm embarrassed to say. I've been meaning to straighten up, sort, file and toss -- really.

While I'm sure I'm not alone with my paperwork problem, we all have much larger things to organize too. Like our life in general. How are your priorities? (What are your priorities?) Are you using your time, money, talents and energies the way you'd like? Are there activities you're dreaming about but not getting to?

Personally, I'm trying right now to find more time for myself in my schedule. I'm leading my writing group, attending another, taking yoga classes, doing marketing work for my upcoming book, starting to prepare for the arrival of our adopted baby in a few weeks, trying to write, etcetera, etcetera -- and I'm spending way too much time on other volunteer work, especially the omnipresent meetings it involves. So, I'm getting out of a few things. I've felt reluctant, even ashamed, to say "No" to several things lately but, have discovered that it's actually empowering! I can decide how to spend my time and, frankly, the world won't fall apart without me being involved in every decision.

Play with this. . .
Write continuously for 20 minutes about something you'd like to organize in your life, whether it's one bathroom drawer or your entire calendar. How would it feel to just begin your organizational task? How could you break it down into manageable components? (I was intrigued to find recently that more than one person in my writing group proposed this topic on an anonymous suggestion sheet. I suppose we do tend to feel disorganized and out of control when we're depressed.)

Then consider how you would feel after organizing something. For me, a clean desk is like a new start on life. Maybe you too would feel empowered, free, or pleased to accomplish something tangible. If you're depressed right now, start small -- just delete three bulk emails you're not going to bother reading anyway, or toss out some junk mail that's accumulated on the kitchen counter. Voila!

TO READ: Antidepressants Don't Help Most Patients?
Could we have been misled by the "non-publishing" of studies that show poor results for common antidepressants? New research combining both the "good" and "bad" results of many studies on antidepressants' effectiveness suggests so. The new data says the medicines are no more beneficial to most patients than a placebo pill, and only help certain severely depressed people.


Irving Kirsch of the University of Hull, in the United Kingdom, along with colleagues from the US and Canada, studied Prozac, Effexor, Serzone and Paxil. They used a statistical "meta-analysis" to combined the data from all the trials submitted to the US Food and Drug Administration. Data from some of these studies had never been published, and some included what might be considered disappointing results.


The scientists found that patients with moderate depression responded almost equally well to the drugs versus a placebo. In addition, "Drug–placebo differences . . . are relatively small even for severely depressed patients." The severely depressed people seemed to respond to medicine somewhat better, but this was attributable to the fact that they responded worse to the placebo.

For additional info: see PLos Medicine (a peer-reviewed journal of the Public Library of Science) for February 26, 2008.

TO WRITE: Just Wastin' Time
Here in the U.S. many people feel that there's something "wrong" about just sitting and letting the mind wander for a while sometimes. There are things to do! This idea is so prevalent that many believe they shouldn't even do one thing at a time, but must multi-task. Now that I'm feeling considerably less depressed lately, I find myself succumbing to this thinking at times too. But honestly, if I stop to think, I feel that occasional time spent reflecting on the day and composing my thoughts or "spacing out" is a wonderful activity.

If you're depressed, chances are good that even accomplishing the simplest activities may seem overwhelming -- whether it's making it to the office on time or just getting your teeth brushed. When I've been in such states, I tend to chastise myself for not getting off the sofa and acting; I ruminate about what others are getting done. But from a now-healthy perspective, I see I should sometimes let myself relax and doze freely or flip through a magazine without guilt. I'm not arguing that we shouldn't fight like tigers to get well, but that now and then, guilt-free "wasting" time is healthy.

Play with this. . .
Write continuously for 20 minutes starting with "When I waste time. . ." You may want to consider what you do, when you do it, and for how long. How do you feel about it at the time or afterward? Would you like to adjust the amount or frequency of your "wasting" time, or perhaps your attitude toward it? (Maybe you want to go for a walk or stare at the wall for a half hour before you write this. . . .)

TO READ: Today's the Day
I'm very excited to announce to my readers that today my book, Writing through the Darkness: Easing Your Depression with Paper and Pen, went to press!

Copies will be in bookstores in June. If you find this blog interesting or useful, I think you'll find this book valuable. It's a writing guide that provides a menu of approaches -- freewriting, memoir, poetry and storytelling -- to help cope with the pain and confusion and stigma that surround depression. I also describe my own journey through bipolar depressions, and the exciting research that's been done on the writing-depression connection. Many of the wonderful members of my creative writing group for people with mood disorders that meets at Stanford University have contributed encouraging comments and samples of their work. I hope you'll check it out in June.

-- Beth

TO WRITE: Freedom
I'm reading The End of America by Naomi Wolf, and it's scaring the heck out of me. Wolf's studies indicate that there are ten changes that occur in countries just before they move from a democracy to a fascist state, and that the U.S. is going through all ten right now. Sound alarmist? I thought it would too, but her evidence and her arguments seem very strong so far.

Especially after having lived for several months in the Soviet Union when I was a teen, I value my American freedoms tremendously. For example, we're allowed to say and write what we want, basically. But there are lots of other types of freedom I value too. How about the freedom of spending my life outside of the walls of a mental institution, except under extreme circumstances, when I want to be there anyway? (Granted, we have short forced hospitalizations for those deemed to be putting themselves or others at risk -- what's known as a "5150" here in California.) How about the freedom to decide on how I'll treat my depression? How about the freedom to pursue what I want to do with my time and resources?

Play with this. . .
Write continuously for 20 minutes starting with: "The freedoms I have. . ." You might describe your freedom to wear the clothes or hairstyle you want, the freedom to read what you want, or the freedom to explore the entire Internet, if you are in a country that allows those things. Or you might explain your feelings about a freedom you feel you lack.

Then consider how your freedoms affect your psychological life. Does thinking about them make your life feel a little less confined? How do your thoughts of freedom affect the emotions and thoughts you allow yourself to feel and share?

TO WRITE: Gimme a Hand
When we're depressed and it's hard to function, it's natural to wish for some help from our doctors, family and friends. That's one reason support groups for mood disorders are growing in popularity, and presumably one reason they've been proven to improve the course of members' depression.

But there's another aspect to this concept of people helping people. When we help someone else we tend to feel much better too. Think about it: How did you feel last time you held a door for someone struggling with packages? How do you feel when someone close says, "Thank you," for listening to their problems or assisting them with some task? I know I immediately feel good about myself -- the complete opposite of the way I usually feel when I'm depressed.

Play with this. . .
Write continuously for 20 minutes about a time when you helped someone else. Have you ever given information to someone newly diagnosed with depression, for example? Have you ever given a little money to someone who really needed it? Done any volunteer work?

Then describe how it felt. Maybe it diminished your depression for even just a minute? Is it something you'd like to try to do more of?

TO WRITE: It's a Secret!
Whether you want to admit it or not, you know you've got some. . . . Today I'm thinking of the new hiding place I found for the heart-shaped box of chocolates my husband's not supposed to see until tomorrow. (He recently discovered the behind-the-desk spot I'd used for birthday and Christmas gifts for years.)

Of course, you may have larger issues from the past looming unsaid, or you may have tiny guilty pleasures. You may have secret aspirations too. (Who says writers can't be superheroes or ballerinas on the side?)

Play with this. . .
'Fess up. Remember that this, like any writing, can be hidden, discarded or destroyed as soon as it's finished, so go ahead and let it all out. Write continuously for 20 minutes starting with In my secret life, I. . . .

Then read what you've written and see how you feel. Has a burden been lifted, or perhaps a new idea hatched? Or do you realize that you're really craving a pint of ice cream and an afternoon of soap operas? Let me know what you discover.

TO WRITE: A Fear

We've all got fears, large or small, significant or pretty trivial, relating to things likely or unlikely to occur. For example, while I'm fortunate to have no major phobias, I am not comfortable with snakes. I can touch, or even hold, someone's pet serpent for a moment, but the idea of suddenly coming across a snake when hiking makes me squeamish, even if I know it's unlikely to be a poisonous one. Still, I do hike, so it hasn't got complete control over me.

A much larger, more significant and, sadly, more likely object of fear for me is the possible return of my severe depression. I know how wrenching, debilitating and even life-threatening that can be. I try to guard against making too much of the issue, but the thought of its return, or the feel of just a small symptom, can strike terror in me.

Play with this. . .
Write continuously for 20 minutes about something you are afraid of. It might be a tiny issue or a life-altering one. What is it? How does the thought of it feel emotionally and in your body? Have you ever faced this thing head-on? Would you want to?

Then write for five more minutes, considering: If someone were to help you with this fear, what should she or he do? Maybe reassurance is what you need. Maybe someone to hold your hand on that plane trip. Maybe a therapist or psychiatrist could help you gradually acclimate to a scary situation. For me, an occasional reminder before hiking that most snakes really are much more afraid of me than I am of them is probably what is called for. Oh, and maybe sturdy hiking boots too.

TO WRITE: Dream a Little Dream
We have them multiple times every night, researchers say -- but what do we really know about our dreams? I agree with the standard wisdom about remembering more of those slippery experiences: keep a dream journal by your bedside and record whatever you recall immediately when you wake, even if it's just an image or a feeling. Indeed, when I've practiced this for even a few days, I've found that I begin to remember more and more of my nighttime adventures.

Then, of course, there's the issue of what to do with these often bizarre movies with emotions. Many types of psychotherapies use dreams in various ways, but I think it's really up to you to use these journeys as you see fit. They may amuse, frighten, inspire, explain, or call you to action. But usually -- usually -- I feel better after I've written a dream down and examined it.

Play with this. . .
Write continuously for 20 minutes about a dream you've experienced. It might be from last night or a long time ago; it might feel trivial or life-altering. Describe what happened, including all of the sensory details you were aware of. Then see if any connections or ideas occur to you.

For example, I often find that I dream about my life at the moment in the form of a house -- a simple or complex layout of rooms, a messy or tidy interior, maybe worries I should be spending more time in the office or the kitchen. There's the common dream theme about taking a trip too -- maybe the road suggests your life journey? But you may make completely different connections to these sorts of events and symbols, and that's what is most important for you.

After you've written about your dream and your impressions about it, write for five more minutes about whether there are any ideas about your waking life that you'd like to take away from this exercise -- maybe even insights about handling your depression or the happenings around it.

TO WRITE: The Poetry of Nature

As I write this I can see that the rounded line of hills that runs up and down San Francisco's East Bay region is changing color. Last week they were the color of straw. Then they looked like wet, dirty straw after several days of rain. And now they are a dusty green as they begin their annual transformation into glorious emerald green. I sometimes miss the Midwestern seasons I grew up with, but I treasure this metamorphosis each winter too.

Writing and poetry about nature is, of course, plentiful in our times and has been in many historical and ancient societies too. The Haiku form of poetry virtually always uses the natural world for its topics, in fact. (It's three lines long -- five syllables, seven syllables, and five syllables, respectively, in case you're trying to remember it right now.)

Play with this. . .

Choose a detail from the natural world -- you may want to go for a walk for inspiration, or even carefully look at a houseplant if you can't get out. Now write a list of at least ten words or phrases that come to mind when you think of this detail. (My list from the hills' color included: straw, emerald, dusty, trickling streams, blades of grass, tall weeds, my sneezing, the horizon, overseeing the bay, climbing rocky trails.)

Now use some items from this list to write a poem about the detail you originally chose. You may want to create a Haiku, or you might do a free verse poem by simply writing some sentences or phrases, and playing with where you "break" or end each line. If any analogies come to mind as you do this, you might include them too. For example, I might compare the hills' colorful transformation to my own recovery, or the seasons' inevitable return to my friend K's constant support.

Poetry can be a powerful means of expression and healing, and some people find it their favorite. Even if you're hesitant at first, give it a try and see what you come up with. Of course it's definitely fair game to alter it, adjust it and play with it later until you're happy with your poem. Just have fun.

TO WRITE: The Term "Mental Illness"

Many of us -- whether we live with depression, bipolar disorder or another psychological condition -- have strong feelings about being labeled "mentally ill." Personally, I'm OK with it at this point, twenty-plus years into my bipolar disorder. But there was a time when that term made me very defensive and conjured up images of complete non-functioning. Fortunately, most of us do function to some degree most of the time, yet this descriptor is often used, particularly by those in the medical fields, I find.

As one trained as a biologist, I think I may actually prefer being "mentally ill" because it indicates that my condition is physiological as well as psychological. That doesn't mean I'm excused from the hard work of striving for recovery, but it helps remind me that it's not all my "fault."

One member of my writing group at Stanford prefers that we discuss our "mental health" rather than our "mental illness," and I think this can be very helpful too, because it is so much more positive -- and because it is more inclusive of those suffering, for example, from a depression that is situational, but not clinical.

Play with this. . .
Have you ever had the term "mentally ill" used to describe you? How have you felt about it? If you bristle at it, do you have another suggestion? And how important do you think this language is in perpetuating or countering stigma?

I'm curious about what you come up with -- leave a comment if you like. And consider whether it might be helpful to discuss with your loved ones or doctor the language used about your health.

TO WRITE: Nurturing Yourself

Another new year! Happiness and health to you in 2008. We (Americans at least) tend to get wrapped up in resolutions for improving our life this time of year. Most of them aren't a lot of fun -- dieting, more time at the gym, etc. But I suggest you consider a resolution to nurture yourself more, whatever that might mean to you. Everyone needs some time to rekindle the inner flame, and when I'm dealing with depression I need it all the more. But I know that when you're under that cloud it can be very hard to see what might ease your pain.



Play with this...

Write continuously for 15 minutes starting with "I am nurtured by..." and describe the things that come to mind. If you get stuck, return to that sentence stem again and again. These can be big things or small things -- I know people who love candles and hot baths; others like a walk in nature; others crave a chat over coffee with a particular friend or mentor; I love a period of time designated for nothing but reading for pleasure; and of course there's writing! If you're really in a low mood, can you promise yourself a one-hour break from thinking negative thoughts about yourself? After you've brainstormed ideas in writing, reread your piece and, in five minutes more writing, determine what step you can take this week toward being kind and nurturing to yourself.