Month: March 2014

A Treatment Menu

MenuAs a fan of enthusiastic consent in the most general terms, I like to see treatment as an option. In my experience, “shoulds” are less helpful to depressed people than most folks think. Treatment for depression, or the blues, anxiety, paranoia, etc. is something we can try if we want, when we want, and how we want.

I consider treatment to be all deliberate activities that you believe help you feel better. There is no one type of treatment that we should all use. I like to think instead of a menu, full of hope, help, and liverwurst.

Unfortunately not all treatments are equally accessible. The good news for us is that some of the most accessible forms are also the most robust and the have the longest-lasting positive effects.

Here’s an incomplete menu of options. Browse, nibble, make a whole meal. I’ll add more links and references as time allows.

  • Support Groups for depression are free and more common than you might think. Many people with good insurance choose support groups over one-on-one therapy because they find that community heals. Many groups have separate sessions for friends and family. There’s such a thing as a bad facilitator, so you may need to shop around.
  • Meditation may be the best treatment for depression that humans have found so far. Guided meditation can be much more approachable for the severely depressed (Youtube has videos as short as one minute). I’ll be posting some reviews of guided meditations soon.
  • One-on-one therapy is often considered to be the Gold Standard of treatment for depression, and it can be immensely helpful for short term relief and long term recovery. There are a million different kinds, but the most important thing may be a good personal fit with the person in that chair every week. If you’re considering therapy but loathing something about it (like having to gush out your life story to someone all at once) I encourage you to say so at your first meeting or even on the phone before you meet. If the therapist’s response doesn’t help to put you at ease, maybe it’s not a great fit. As my grandmother would say, there are plenty of therapist-fish in the sea.
  • Acupuncture. I have seen acupuncture do amazing things, especially for trauma. Many report “feeling themselves again” for hours, days, or weeks. Any amount of time feeling better can be an inspiration, can help us hope. I recommend doing your research on Yelp or other review services before trying a new acupuncturist.
  • “Alternative” or “complimentary” medicine includes St. John’s Wort, Omega Three Fatty Acids, and endless other natural treatments. If you’re interested, I recommend speaking to an Herbalist or Naturopath in your area. People trained in complimentary medicine tend to take a whole body approach, which can be a welcome change and may be much more appropriate for depression than the strict mind-body split you often find from western medicine. (St. John’s Wort may interfere with the efficacy other medications.)
  • Medicine can help. I’ve recently, on my fourth try, started to have some success with a chemical intervention and it’s SUCH a relief. Many people are hesitant, and that’s ok too. Nothing is right for everyone.
  • Exercise is a go-to for lots of people with depression. Whether it’s yoga, jogging, or P90X, it can be a great way to maintain your progress or curb a downward slide.
  • **Edit** Rest. Lordy how could I forget rest? Whether its sleep (within reason), a slow walk, some TV, or doing very little with a good friend, I think rest is crucial to recovery. It gives your mind time to heal.

What did I leave out? What’s worked for you? Click through to the individual post to leave a comment or email me at

This Blog is Full of Liverwurst

As I’ve mentioned in past posts, I hate when people seem to think that they can fix, off the top of their heads(!), problems that have taken me years to even define. It’s rude and almost never helpful, almost always hurtful. I strive in this blog to never give flippant advice, and to never assume that I know how something will affect any given reader.

And toward that end: The Menu Approach.

I'll start with some Exercise and have the You Do You! as an entre please.

I’ll start with some Exercise and have the You Do You! as an entre please.
(Getting fancy with the multimedia, people!)


When I was feeling better, I would use The Menu Approach when there were too many cool things to do. To avoid becoming overwhelmed at picking the right one, I would pretend all my options were on a menu.

I might want to order everything, but if I tried to eat it all I’d have a terrible night. Also, I don’t expect myself to always pick the absolute best thing on a menu. I just pick something and it’s almost always perfectly good. (I know plenty of people who do stress out about menu choices. If you’re one of them – this post might be liverwurst.)

I try now to use The Menu Approach when people give me advice, even if they don’t present the advice as optional. Oh, you think I should wake up earlier because it might help me avoid nightmares? Thanks. I’ll put that on the menu, but I feel NO sense of urgency in trying it out.

I use The Menu Approach to rob the advice of its sting. The “wise adviser” may not realize that mornings are the hardest part of the day for many depressed people, and that making your morning longer might be a special kind of torture.

So instead of getting mad at them for thinking they know what’s good for me when they do NOT understand what’s going on with me, I put it on The Menu. And sometimes I just let it sit there. Like liverwurst.

P.S. This blog is full of liverwurst! Please treat it as such

The Benefits of Treading Water

I’ve written a little before about depression metaphors. Once I hear one that feels right, I tend to stick to a metaphor as if it were true. They’re not true, and I think it’s really important to shop around.

The cliff metaphor seemed appropriate when I was first diagnosed. It captures that idea that you can face a lot of difficulty and still be ok, you can still be on top of the mountain, plodding along. And then something terrible happens in your life or in your brain and suddenly it feels like you’ve fallen. You can no longer even struggle, or you can but it won’t do any good. You’re over the cliff and it feels impossible to help yourself.

Nowadays my favorite metaphor for what I’m dealing with is treading water. It’s constant, it’s difficult, it’s exhausting. Continuing to tread doesn’t feel like it’s making me stronger. It’s just wearing me down.

In those rare moments when I realize that I’m more comfortable than usual, I imagine that the floor has risen, that I’m standing for a bit. I can rest.

The metaphor helps me to recognize those moments and to try to stay in them, to take note of them and try to make them happen again. If I were at the bottom of a cliff I’d be telling myself, Yeah, you might be a little better now, but you are still categorically at the bottom of a fucking cliff!

For me, treading water is less all-or-nothing, and it encourages me to rest whenever I find that I can.

What metaphors do you love or hate? Click the title of this post to comment below, or email me at Thanks!

Can I Just Say? #3

Like other people, especially clinically depressed people, I tend to isolate myself when I’m feeling down, which of course makes things worse. But what I really hate is when my depression manages to isolate me while I’m out with friends.

Like when people talk about their dreams (“I dreamed I gave birth to my boyfriend!”), I don’t feel like I can chime in (“I dreamed I drowned in my own blood, vomit, and teeth! Crazy, right?!”).

You might as well tell people that you killed a guy with a trident.

I Changed Your Diapers So…

This post is a modification of an email I sent to younger family members a few weeks after I was diagnosed. Unlike most posts, it’s full of advice. I took the liberty because we face similar family histories of depression and because I changed their diapers so I get to boss them around.

The first good thought I had after the shock of diagnosis was that I would write this email.

This email is meant to help you guys deal with depression (which is way more common than we think) or avoid it completely (which is totally possible).

I’m currently suffering my fourth or fifth major episode. I’m not the smartest person on this email chain but I’m no dope either. It’s shocking to me how bad I had to get before I started to think something was wrong, that I had to be totally incapacitated, unable to work or look for work, before I realized that I needed help.

This email is to encourage you to be nice to yourself. There are a lot of things you can do to protect yourself – like we should wear sunscreen because skin cancer in our family is even more common than red hair.

First and foremost, I want you each to believe that your happiness is important. Prioritize it. Cultivate habits that you enjoy. Practice your hobbies. Don’t let them fade with age.

Wherever you go in life, keep in touch with friends and family. Build or join communities within every new city. 

If you find yourself reaching for the bottle to handle stress, to get to sleep, or to relax at the end of most days, talk to someone. Alcohol is a depressant.

I strongly recommend a regular meditation practice. Ten minutes a day of focusing on Love, or your breath, or a positive image is an incredibly powerful tool. It makes us kinder, happier, and more resilient to life’s challenges.

This email is to encourage you to seek help. Getting treatment during or after your first or second episode drastically improves your chances of recovering fully, and never having to put up with this shit again. Asking for help (and then asking again) is not a weakness, it’s fucking rad.

Whatever you’re worried about, whether it’s grades or work or drinking too much or personal relationships or anything – don’t beat yourself up about it. Try to treat yourself like you would a younger sibling. Ask what’s wrong and strive to have the courage to face it.

Don’t expect to be able to fix your problems by yourself.

Let’s be the first generation that isn’t ashamed of this stuff. The first one to be proactive and not hide from each other when we’re feeling our worst.

And always remember: your family, we don’t love you because of what you do. We just love you.