Right now life is uncertain. Many big life things are up in the air, making me dizzy and anxious.

Interestingly, none of what may or may not transpire over the next week is necessarily bad. I’m in the hunt for a couple of cool jobs that would see me living in one of two cosmopolitan cities (on opposite sides of the globe). Sounds great, so why so anxious?

Well, I just don’t like living without a strong narrative. It’s a bit like a ‘choose your own adventure‘ book… but with less intrigue and crocodiles.

As I’ve written about previously, I am a graduate of the micro-managing school of depression. So letting go of anxiety attached to uncertainty is a challenge.

According to Mark Tyrell, anxiety is directly linked to uncertainty.  The more important the issue or event that lies in the balance, the greater the anxiety.

Of course, the great irony of fretting over something, is the misguided belief that it’s getting us anywhere. We tell ourselves that it is useful because:

• Maybe I’ll find a solution.
• I don’t want to overlook anything.
• If I keep thinking a little longer, maybe I’ll figure it out.
• I don’t want to be surprised.
• I want to be responsible .(from ‘The Worry Cure‘ by Robert L. Leahy, Ph.D.)

One strategy I’ve read is to draw a circle. Outside the circle you write the things you cant control. Inside the circle, the things you can. My initial response was: “Art therapy! Excellent idea! And then I’ll get my chakras balanced by the local soothsayer on my way home.” But in truth, this mapping task showed me that I could be prepared for the eventualities  - the job interview I have to attend, the presentation I have to give and the possibility of moving overseas… A channeling of anxiety into controlling the elements that were in my reach.

It’s not a bad starting point, but I think I can do better.

Your thoughts appreciated (as always),

Betty

As well as allowing you to see trends in your own happiness, Mappiness paints an amazing picture of Britain, showing happiness rising on public holidays and that Brits aren’t morning people. Huh. Who would have thought waking up in a dark, icy climate was unpalatable?

The Guardian also reported that “intimacy, making love” was by far the happiest activity.

When I heard about Mappiness, my ears pricked up. As one of those ‘controlling’, anal depressives, having a store of information abou when and where I felt happiest sounded almost pornographic. Lists! Data! Self-reflection!

Several times a day my phone pings and I tell it where I am (indoors, outdoors, in a vehicle), what I’m doing (usually drinking coffee and surfing the net), who I’m with and how I’m feeling on a sliding scale.

I’ve always subscribed to the theory that knowing more about my illness is better for me. Not wallowing, mind, just straight up info. After using the app for two weeks, I can now see trends emerging – I always thought I was a morning person. Nope. I’m definitely more into 2pm and 10pm. And for someone who is unemployed I seem to enjoy working a great deal.

Of course, the data cant be taken to seriously. It suggests trends but can’t control for variables (the fight you had with your friend, missing the train, too many cups of coffee).

But if nothing else, stopping for 30 seconds, several ties a day to ask ‘how am I going?’ has been good for me – and might be good for you too.

Mappiness is available outside of the UK, but can only track your personal data (without contributing it to the LSE study). Unfortunately, the app is currently only available on iPhone. 

One way he suggests we can do this is by creating small rituals in our lives around the things that bring us happiness. By incorporating small changes into our daily lives and repeating it at specific times we create a habit. And habits are, hopefully, hard to break.

I love this idea. Truth told, I can take or leave the rest of the book, but I’ve always liked ritual and routine. And better yet, I’m told that after around 30 days these small changes seem like a natural and inevitable part of life.

Most people living in secular Western society don’t do ritual very well. I don’t do church or prayer, but I have a couple of rituals that I enjoy; listening to the news in bed before I fall asleep and long weekend breakfasts.

So what do you enjoy? What brings you happiness? What clears your head? What would you like to do more of?

Go for one or two small things, rather than wholesale changes. And then decide on a regular time to do it – every day, once a week, Tuesdays and Thursdays – whatever. Then keep doing it.

My rituals will be reading for half an hour before bed, and (trying) to wake up earlier. Wish me luck.

Betty

P.S. Check out the rituals of famous writers.

P.P.S. Read Alain de Botton on sustaining your soul with structure

When I started crying this morning my lovely partner said to me “don’t fall in a hole” – his euphemism for “please, please, don’t sink into depression”.  And I snapped back, “I’m sad, not depressed!”.

While this is true in this instance (I was upset about an event), how do we differentiate between being sad and depressed? And can a prolonged sadness become a depression?

People are in disagreement “both within and outside the field of psychiatry, regarding the boundaries of normal sadness and clinical depression”, according to Dr. Ronald Pies, Clinical Professor of Psychiatry at Tufts University School of Medicine, Boston.

It seems to me, that in a backlash against increasing instances of depression, it has become trendy to denounce the loss of normal emotion and blame the psychiatric world for self-interested diagnoses. “Buck up!”, say the skeptics. “Life’s not so bad. In my day, we didn’t have depression.”

I resent these nostalgic, uninformed and dismissive takes on my condition, but I’m willing to concede that sad and depressed do not belong in the same box.

The Black Dog Institute offer a self-test to see if you are indeed depressed. I took it earlier. Failed with flying colors. But I’m not convinced this means I’m in a depressed state rather than sad.

Commonly, depression refers to severely low mood over a prolonged period of time (more than two weeks) that affects your ability to function normally.

Signs (once again, courtesy of The Black Dog Institute) include:

• Lowered self-esteem (or self-worth)
• Change in sleep patterns, that is, insomnia or broken sleep
• Changes in appetite or weight
• Less ability to control emotions such as pessimism, anger, guilt, irritability and anxiety
• Varying emotions throughout the day, for example, feeling worse in the morning and better as the day progresses
• Reduced capacity to experience pleasure: you can’t enjoy what’s happening now, nor look forward to anything with pleasure. Hobbies and interests drop off.
• Reduced pain tolerance: you are less able to tolerate aches and pains and may have a host of new ailments
• Changed sex drive: absent or reduced
• Poor concentration and memory: some people are so impaired that they think that they are going demented
• Reduced motivation: it doesn’t seem worth the effort to do anything, things seem meaningless
• Lowered energy levels

What’s important here, is that while mood variations make up part of this list, suffering only a couple of them doesn’t constitute ‘real’ depression. Being sad about an event, suffering a trauma or feeling low for no particular reason is awful, but your recovery time is likely to be a lot speedier.

So, to my second question. Is sadness a trigger for depressive bouts? In my experience, yes. Being upset or stressed about something at work can easily transpire into feelings of worthlessness, sleeplessness, anxiety etc. Low and behold, a few days later, having moved on from the original issue, I’m in bed leaving streams of mascara on my nice, white pillows.

This little article from Dr Pies concurs  - sadness can trigger depression. Everyone has their own triggers and points of sensitivity. How we deal with these, and whether we sink or swim will depend on the props and strategies we have in place. Naturally, I’m thinking about mine today.

Do you tend to have triggers for depression? Do you feel sadness and depression can be seperated? I’d enjoy your thoughts.

Betty

1. Giving something up was easier than trying to do something. Depression, unsurprisingly, is a terrible motivator.
2. Trying something for a week is easy. Then if you didn’t enjoy it, give it up. 
3. People won’t like it when you say ‘I’m not eating sugar’. Too bad chumps.
4. You will feel crappy for a few days. Push through. Or post your cranky thoughts here.
5. Sugar is in everything. I mean this in two ways. Naturally (as part of carbohydrates) and added to almost any product you pick up off the shelf.
6. It’s not possible to have no sugar. Instead, I’ve been aiming for less that 20 grams of sugar a day (36g for men), as recommended by the American Heart Association. It’s about 5 teaspoons of granulated sugar. If you’re going fully sugar-free, you’ll get sugar from grains and starches, and in small amounts from veggies. Check your intake by reading food labels (sugar is listed underneath carbohydrates).
7. Wine is sugar-free! I’m willing to give up sugar, but…
8. Sugar is seriously bad for you. Apart from improving moods, going sugar-free lowers your risk of countless diseases.
9. Sugar-free deserts are good. I’ve been making chocolate mousse with stevia (a natural, sugar-free sweetener) and cocoa powder. It’s really good. 
10.  Be informed. The more you know about sugar, the less you’ll want it.

3pm: Feeling agitated and ferociously hungry. Would normally have had my post-lunch sweeties by now. Having an artificially sweetened hot chocolate, and wondering if imbibing a carcinogenic is a good substitute. Hard times, hard measures.

7pm: Cooking dinner. Yes, delicious, starchy pasta. I’ve discovered my lazy-girl pasta sauce has sugar in it. Dang. Not feeling virtuous enough to make something else so I’m telling myself it will be a small amount. Besides – you wouldn’t want me going cold turkey right?

10pm: Yogurt, more artificial sweetners. You can taste they’re not good for you – funny aftertaste.

12.30am Cranky, sleepless, hungry.

Day Two

11am: Got stuck at the supermarket behind a ditherer… Stared down the chocolate bars. They were real scared.

2pm: Skip the macaroon with my afternoon coffee. Don’t feel too deprived.

4:30pm: Weak, headachey, cranky. Apparently normal.

8pm: *Several* glasses of wine. I’m fallible.

4:30am: Wide awake, sightly hungover. Apparently, once alcohol is metabolised your blood sugar drops, and as a result you wake up. Seeing as sugar highs and lows are not the aim of the game, I might have to avoid this stunt while I’m testing the sugar theory.

In other fun news, here’s a page detailing 113 ways sugar will ruin your life, steal your boyfriend and publicly humiliate you.

Day Three

Over this sugar free thing now. Combined with forgetting my medication I was a tired, cranky puppy today. And sweaty… ewwww. Everything has sugar in it! Have you looked at the ingredients lists on food packs recently?!

Read a blog from a fellow sugar-free traveller for tips. She recommended prayer. I prayed for better advice.

3pm: Want cake. Need cake. Major lethargy.

4pm: Break through! A new friend told me she and her partner gave up sugar 18 months ago and have seen major changes in their moods and health. Hearing a bit of real-life testimony has inspired me. And I’m assured the low energy and crabbiness will lift soon. Hallelujah!

Day Four

12:30pm: Feeling good. Not so tired. Not so narky. Mildly anxious about eating out tonight – so much sugar hidden everywhere. I’m becoming paranoid.

1:30am: Dinner was fine. Lovely even. But massive sweet cravings chased me afterwards. Solution: muchos popcorn.

Day Five

A few cravings, but managed to curbs with some sugar free dessert recipes.

Day Six

11am: Awoke to discover my detox written all over my face… in acne. Funnily a swollen, red face isn’t helping me feel better about this project.

10pm: Staving off sugar cravings with spoons of coconut oil as recommended by Sarah Wilson. Wonder if that’s where the acne is coming from?

Day Seven

Made it!! And you know what? Not so hard.

In fact, I’m going to keep at it for a while longer. I cant say how it’s improved my mood as yet, but my energy levels have definitely been improved in the last few days. And that is reason enough.

So the science goes, too much sugar means your body can’t regulate the glucose levels in your blood. As a result you can expect symptoms like

‘ fatigue, irritability, dizziness, insomnia, excessive sweating (especially at night), poor concentration and forgetfulness, excessive thirst, depression and crying spells, digestive disturbances and blurred vision.’ (Food for the Brain) 

Oooohh, sounds fun! And all too familiar.

Kathleen DesMaison’s book, The Sugar Addict’s Total Recovery Program, recommends a seven-step program, slowly phasing out refined foods before eliminating sugar at step six. I’m not that patient.

I’m also not ready to class myself as an addict. Thankfully, going on DesMaison’s criteria of addiction , I only meet one: I get my cranky pants on when I don’t get a sweet treat after lunch… and dinner.

Purists would also say that defined broadly, sugar includes starchy foods like pasta, cereal, white bread etc. Apparently wine is out too. Ha.

I’m passing on purism and the AA style program, but I’m going to try a week without refined/added sugar.

If I don’t go on a hysterical killing spree before breaking down over a pack of chocolate biscuits, I’ll report back.

The Depression Cure, devised by Steve Ilardi is a back-to-basics manual based on 20 years of psychiatric work and in particular, the Therapeutic Lifestyle Change program (TLC… Cute or gross? I can’t decide) that he runs at the University of Kansas.

Treatment ‘in the community’, Dr Ilardi found, was helping less than 25% of people get better, while anti-depressants were working for less than 50% of people. While these are convenient statistics for Dr Ilardi as he advocates his treatment program, this speaks to what I know of depressed people and myself – treatment is haphazard and imperfect.

By comparison says Dr Ilardi (modestly), ‘every single patient who put in the full [TLC] program got better’. The University website does not concur but still suggests a 70% success rate.

The TLC theory is that by combining six lifestyle elements that address six different triggers, hey presto, wellness will be yours:

• High Omega-3 diet or supplements
• Engaging activity,
• Physical exercise,
• Sunlight exposure,
• Social connection, and
• Enhanced sleep.

In short, live well. But also live in a way that is contrary to our fast-paced yet sedentary lifestyles – which is the hard bit.

According to Dr Ilardi, depression is a lifestyle disease brought on by modern living, for which he points to the ever-cheerful Amish as proof. For me, this is too broad a generalisation. Firstly, anecdotal evidence suggests otherwise. I come from a long line of depressives on both sides of the family tree. This does not necessarily mean my own condition is genetic or hereditary (read more) but more likely a mixture of nature and nurture. Additionally, calling depression a lifestyle disease ignores depression brought on by trauma, hormonal imbalance (such as post-natal or menopausal depression) and the grey areas between depression and other mental health conditions.

I also don’t fully subscribe to the notion of engaging activity. Dr Ilardi introduces the concept of rumination – dwelling on your misery. He suggests that doing something – anything – else is essential. I don’t agree.  It’s important to have purposeful, stimulating activities, but life is short and cross-stich is boring. Further, having one’s mind constantly occupied goes against the underlying philosophy of the book – that modern life goes too fast. By all means, break the cycle of bad thoughts when they creep in, but this can’t be the only strategy. Stopping for a breath and slowing the mind has a lot to be said for it.

Despite my criticisms, I share some of Dr Ilardi’s ideas on treatment, working on the factors within ones control (isn’t that what this blog is about?) and creating the best environment for your medical and psychological treatments to work in.

It’s not for me to spoil Dr Ilardi’s secret formula, but the elements are all here and you can read more for yourself here. Much of what is laid out is common sense – eat better, exercise more, sleep more, seek fulfilling relationships and activities. While these things are often easier said than done when depressed, the harsh irony stands: self-care is infinitely more important for people who suffer or are prone to depression.

The jury, however, has been out on just how beneficial sunshine (or more specifically the vitamin D we derive from it) really is for mood enhancement. A new study from UT Southwestern Medical has delivered the most conclusive evidence yet.

The study of 12,594 people, took four years and those with a history of depression were analysed separately. While increased vitamin D was found to correlate with decreased instances of current depression (for those with and without pre-existing depression), lower vitamin D levels were more likely to be associated with depression ‘in persons with a history of depression’, and may therefore be linked to longer term mood sinks.

So the silver lining? People with depression gain more benefit from soaking up rays. Consider this permission to book a holiday on a sunny beach post-haste!

For those of us flung far from the equator sunshine doesn’t turn up nearly often enough. Desk jockeys and people with dark skin are also unlikely to absorb enough Vitamin D. So apart from making a mad dash to grab it when you can (and it doesn’t take much), there are a couple of other options.

Vitamin D supplements are available from a chemist (some countries require a prescription), and it’s also available in small amounts in eggs, fortified dairy (milk and yogurt), fish and fish oil – which, if my grandmother is to be believed, will cure all that ails you. If a large tablespoon of cod liver oil isn’t your scene, there are also fish oil tablets.

Fake sunshine, via the solarium is often touted as an alternative, but for what it’s worth, I wouldn’t get in a sun bed if Ewan McGregor invited me into it.  The concentrated UV rays are too much of a skin cancer risk, and frankly, I don’t want the wrinkles. (Shallow? Yes).

For everything you ever wanted to know about Vitamin D, but were too afraid to ask click here. And then go outside… you’re looking a little pale.

I’ve been living with clinical depression since 2002, and ten years on I’m more convinced than ever that we don’t really know what that means.

The medical profession knows far more than they used to – brain science is constantly evolving, good medication is more readily available and psychology has branched into new fields. But finding the right fit for each individual is largely trial and error. And while medicine might help, it’s no silver bullet.

While it’s still a big mystery, there’s a bit more room to talk about mental health nowadays.

This blog will look at the supplementary lifestyle options. No new-age nonsense, no funny business, no cults. Just little changes that I hope will make a difference. I’ll be the guinea pig and report back to you. I’m also going to try and have a look at some emerging research – if you’ve heard of something interesting, let me know!

Betty