Happy New Year . . .

Non-Drug Options for Dealing with Depression

                               “When it comes to treating depressive symptoms, there’s no better                     medicine than healthy and loving relationships”

 The following options can be very effective for relieving depression symptoms. Although antidepressant medications are also an option, because they’re so widely marketed only non-drug alternatives are listed and described here.

  1. Psychotherapy – Going to a reputable and licensed mental health professional who offers counseling or psychotherapy for depression can be very helpful. This may include family, couple, or group counseling or therapy.
  2. Vigorous Aerobic Exercise – Consider initiating and maintaining a regular cardiovascular or aerobic exercise schedule. This could involve a referral to a personal trainer and/or local fitness center (e.g., YMCA).
  3. Herbal Remedies – Some individuals benefit from taking herbal supplements. For example, there is evidence that Omega-3 Fatty Acids (Fish oil) can reduce depressive symptoms. It’s good to consult with a health care provider if you’re pursuing this option.
  4. Light Therapy – Some people describe great benefits from light therapy. Information on light therapy boxes is available online and possibly through your physician.
  5. Massage Therapy – Research indicates that massage therapy can relieve depressive symptoms. A referral to a licensed massage therapy professional is advised.
  6. Bibliotherapy – Research indicates that some people benefit from reading and working with self-help books or workbooks. The Feeling Good Handbook (Burns, 1999) and Mind over Mood (Greenberger and Padesky, 1995) are two popular self-help books.
  7. Mild Exercise and Physical/Social Activities – Even if you’re not up to vigorous exercise, you should know that nearly any type of movement has antidepressant effects. These activities could include, but not be limited to yoga, walking, swimming, bowling, hiking, or whatever you can do!
  8. Relationship Enhancement – As suggested by the opening quotation, the most potent medicine available for addressing depressive symptoms is a healthy and loving relationship. You can work on improving relationships in many ways, especially by developing effective communication skills, engaging in mutually enjoyable activities, and making a commitment to behaving in ways that support both your own mental health and that of your partner.
  9. Other Meaningful Activities – Never underestimate the healing power of meaningful activities. Activities could include (a) church or spiritual pursuits; (b) charity work; (c) animal caretaking (adopting a pet); and (d) other activities that might be personally meaningful to you.

 For information about this tip sheet, contact John Sommers-Flanagan, Ph.D. at johnsf44@gmail.com

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26 Years with Rita

Today, on our 26th anniversary, we started with a run in Greenwich, CT, followed by massages in Eastchester, NY (thanks Chelsea!), and then found a fabulous Indian restaurant with a buffet lunch. It seemed only right to top all that off with a trip to the Goodwill, but somehow we ended up at the Goodwill store in the Bronx, which was a little frightening. . . if only for the traffic. I parked with one tire on the sidewalk while we scored a children’s book, a clear glass mug, and a 5 pound sweet potato from a street vendor. This particular day was a metaphor for the 26 years; no formal gifts purchased, but an entertaining and sometimes unpredictable adventure . . . which turns out to be the best gift of all.

My 2011 Letter to Santa

Dear Santa.

You’re probably keenly aware of the fact that if you do a good job at small things, people just keep asking you for more. That being the case, this year I’ve got four major gift requests.

First, please do what you can to eliminate human greed. I think greed has outlived its evolutionary usefulness. If you could poof away greed (while at the same time overlooking my greedy wishes), that would be simply awesome.

Second, as long as you’re eliminating human greed, it makes perfect sense for you to also get rid of the human revenge impulse. Like greed, there are so many basic problems with the revenge concept that it’s really just starting to look like a creative design flaw. Please take the revenge gene up to the North Pole and bury it somewhere no one will ever find.

Third, I’d like every child, everywhere, to feel loved, every day. I’d also like all these children to never doubt their parents or caregivers love for them, but that’s just part of gift 3 and not a new request. I know that’s a lot to ask . . . but hey, it’s Christmas and you’re Santa.

Fourth, would you please wipe away the effects of trauma? It’s bad enough that so many people on the planet have experienced rape, war, physical and sexual abuse, natural disasters, and countless other horrible things, but to make matters worse, they also have the added burden of carrying around physical, psychological, and emotional trauma burdens into the future.  Life is hard enough without having to deal with flashbacks, nightmares, and other unpleasant symptoms.

At the risk of being too demanding, I’d like to request that you deliver these gifts to everyone and not just Christians. I know you’re mostly a Christian icon and that conflicts among different religious groups might make universal delivery rather complex, but if you could take care of everyone I would really appreciate it. Basically, I think universal delivery of these gifts would go a long ways towards fostering a sense of fairness and inclusivity.

Please tell Sandra and the elves hello. I miss you.

Love,

John S-F

A Few Facts about Children and Teenagers and Antidepressant Medications

Information about Antidepressant Medications: What Parents and Concerned Adults Should Know

By John Sommers-Flanagan, Ph.D.

Why You Shouldn’t Have Your Sad, Cranky, or Depressed Child Take Antidepressant Meds?

Several million American children and teenagers take antidepressant meds. This use of antidepressants is unjustified. Here’s why:

1.   Commonly used antidepressants (like Prozac, Zoloft, Paxil, Celexa, Cymbalta, etc.) don’t have much scientific support. Much of the research shows that antidepressants are no more effective than a sugar pill for reducing depressive symptoms.

2.   Antidepressants have side effects that include hyperactivity, insomnia, stomach pain, agitation, and increased suicide potential.

3    Sexual side effects are of special concern. For example, most antidepressants delay orgasm and can be used to effectively treat premature ejaculation in males; they also may inhibit orgasm in females. No one knows how these side effects influence sexual development

4.   Several years ago the FDA released a Public Health Advisory warning about increased reports of suicidality in youth who had been treated with antidepressants.

5.   Even psychiatric journals acknowledge that non-drug approaches to treating child and adolescent depression should be used before trying medication treatment.

6.   Generally, adding antidepressant medications to non-drug treatments are no more effective than the non-drug treatments by themselves.

7.   As we all know, life is hard and we all have to face challenging situations—situations that can make us feel sad, angry, and guilty. The problem is that antidepressants don’t teach young people anything about handling difficult emotions and coping with life. As our behavior therapy friends like to say, remember, “a pill is not a skill.”

Why You Should Consider Putting Your Child on Antidepressant Medications?

Here are some reasons you might ask a doctor to prescribe antidepressants to your child.

1.   When other, less risky approaches to dealing with depression, such as exercise, a healthier diet, more time listening and caring about the huge stresses of the teen years, and family assistance coping with life’s joys and disappointments have not provided relief.

2.   When counseling or psychotherapy with a credentialed professional who has a positive reputation working with youth has been tried for at least 10 sessions with no improvement. Studies have shown that counseling or psychotherapy is effective in treating depressed youth and the effects may be maintained after the treatment has ended (in contrast to medications, which often must be continued indefinitely).

3.   Your child is actively suicidal and other options haven’t helped. As strange as it may sound, although newer antidepressants appear to increase suicide risk among non-suicidal youth, they can sometimes reduce suicide risk in youth who are already suicidal.

4.   You, or another parent, have a strong history of depression and that depression was dramatically relieved by an antidepressant drug; if so, it may be reasonable, if your child becomes severely depressed, to begin the same medication. Of course, the medication should be closely monitored and you should make sure you’re not confusing your personal struggles with depression with your child’s unique condition.

5.   For personal reasons, it may be your preference and your child’s preference to try medications. If so, you should proceed with caution and work with a physician with a positive reputation.

This information is provided, in part, to balance most of the promotional advertising generated by pharmaceutical companies. It’s very important for consumers to have access to balanced information. Of course, much more information is available on the internet, but I recommend that you do your best to find balanced informational sources. Pharmaceutical companies tend to overstate antidepressant effectiveness and other organizations may demonize antidepressants. The truth is that antidepressant medications help some young people, but they’re not generally very effective, and they produce disturbing side effects. Choosing whether to have your children or teens take antidepressants is a very difficult decision. This handout is designed to provide you a small amount of information that may be helpful to you as you face this challenging decision.

A Few Favorite Parenting Quotations

I like these comments about parenting. They’re a little longish, but capture some challenges and insights about parenting (John S-F, 2011).

If I wouldn’t want to be slapped across the face, why would I slap my son? If I wouldn’t want to be screamed at when I made a mistake, why would I scream at my daughter when she dropped the cake I had decorated for my mother-in-law? If I wouldn’t want to be ridiculed when I attempted to learn to roller-blade at age 43, why would I ridicule my daughter as she jerked the car out of first gear into second after being shown ten times how to do it smoothly. If I wouldn’t want my gardening skills to be compared with my neighbor’s, why would I compare my son’s math performance with his older sisters’? (Coloroso, 1995, p. 14).

It is usually assumed in our society that people have to be trained for difficult roles; most business firms would not consider turning a sales clerk loose on the customers without some formal training; the armed forces would scarcely send a raw recruit into combat without extensive training; most states now require a course in driver’s education before high school students can acquire a driver’s license. Even dog owners go to school to learn how to treat their pets properly. This is not true of American parents. (E. E. LeMasters, 1977, p. 18)

. . . we have inherited a tradition of discounting children’s feelings simply because children are smaller, less rational, less experienced, and less powerful than the adults around them. Taking children’s emotions seriously requires empathy, keen listening skills, and a willingness to see things from their perspective (Gottman & DeClaire, 1997, p. 31)

. . . it’s not easy to ignore your parental agenda in the face of misbehavior—especially when you can feel the sermon on the tip of your tongue. But moralizing about a misdeed without addressing the feelings behind it is usually ineffective. It’s like putting a cold compress on your child’s fevered brow without treating the infection that’s causing the fever in the first place (Gottman & DeClaire, 1997, p. 115)

We must realize the futility of trying to impose our will upon our children. No amount of punishment will bring about lasting submission. Today’s children are willing to take any amount of punishment in order to assert their “rights.” Confused and bewildered parents mistakenly hope that punishment will eventually bring results, without realizing that they are actually getting nowhere with their methods. . . . The use of punishment only helps the child to develop greater power of resistance and defiance (Dreikurs & Soltz, 1964; pp. 69-70)

I secretly believed that sibling rivalry was something that happened to other people’s children

Somewhere in my brain lay the smug thought that I could outsmart the green monster by never doing any of the obvious things that all the other parents did to make their kids jealous of each other. I’d never compare, never take sides, never play favorites. If both boys knew they were loved equally, there might be a little squabble now and then, but what would they really have to fight about?

Whatever it was they found it. (Faber & Mazlish, 2004, p. 1)

To most people, the premise that the first mental structures created by experience are preserved indefinitely, like a scratch on a table, seems reasonable. But, in fact many early ideas and habits either vanish or undergo such serious transformation that they cannot be retrieved in later life, any more than the first strokes of a seascape can be discerned from the larger scene, once a painting is complete (Kagan, 1998,  p. 3).

. . . never lose sight of the homely – and scientifically supported – truth that a good, warm, mutually respectful relationship with your child makes all the difference (Kazdin, 2008, p. 146)

When Mrs. McCormick held Tim in her lap at the playground, she sat alone on a bench across from the other mothers as if she were ashamed of Tim’s clinging. She knew that if she sat by other mothers, they would all give her advice: “Just put him down and let him cry—he’ll get over it.” “MY little girl was just like that before she finally got used to other kids.” “Get him a play date. He can learn about other children that way.” (Brazelton & Sparrow, 2001, p 8).

Even before I had children, I knew that being a parent was going to be challenging as well as rewarding. But I didn’t really know.

I didn’t know how exhausted it was possible to become, or how clueless it was possible to feel, or how, each time I reached the end of my rope, I would somehow have to find more rope.

I didn’t understand that sometimes when your kids scream so loudly that the neighbors are ready to call the Department of Child Services, it’s because you’ve served the wrong shape of pasta for dinner.

I didn’t realize that those deep-breathing exercises mothers are taught in natural-childbirth class don’t really start to pay off until long after the child is out. (Kohn, 2005, p. 1).

No one is more susceptible to an expert’s fear mongering than a parent. Fear is in fact a major component of the act of parenting. A parent, after all, is the steward of another creature’s life, a creature who in the beginning is more helpless than the newborn of nearly any other species. This leads a lot of parents to spend a lot of their parenting energy simply being scared (Levitt & Dubner, 2005, p. 149)

Before my children were born, I was convinced that I would be patient, kind, and nurturing—the quintessential earth mother. But I failed to live up to the ideal mother image that I had pictured for myself. I was daunted by the enormous gulf between the perfect parent that I wanted to be and the flawed parent that I actually was. Since then, I have learned that such feelings are quite common. Scratch any parent, and you’ll find guilt. It’s lurking just beneath the surface, ready to spring out when we lose patience with our children, fail to make them happy, feel resentful of their demands, or believe that when they misbehave its’ all our fault. (Samalin, 2003, p. 265).

A well-educated, cultured man and his wife beat their own child with a birch rod, a girl of seven. I have an account of it. The father was glad that the birch was covered with twigs. ‘It stings more,’ said he, and so he began stinging his daughter. . . . They beat for a minute, for five minutes, for ten minutes, more often and more savagely. The child screams. At last the child cannot scream, it gasps, ‘Daddy! daddy!’ (Dostoyevksy, Fyodor; The Brothers Karamozov, 1881/1957,  p. 234)

“Have Phillip come down after school and I’ll give him a bottle of Show-off Powder. For the next few days sprinkle a little on him before meals, especially when you are having company, and just before he leaves for school in the morning. I’m sure you won’t have any more trouble.”

“But what is this show-off powder? Will it hurt Phillip? Asked Mrs. Carmody fearfully.

“Show-off powder is guaranteed to be harmless,” said Mrs. Piggle-Wiggle. “But it will stop showing off. You see it makes the showing-off invisible>”

“Invisible!” wailed Phillip’s mother. “You mean I won’t be able to see my own little boy?”

“Not when he’s showing off,” said Mrs. Piggle-Wiggle matter-of-factly. “Nobody will be able to see him. But when he stops showing off and is normal he’ll come back into focus.” (MacDonald, 1957, p. 16).

Having the Sex Talk with your Kids

This is an old newspaper column from about 11 years ago when I was writing about parenting for the Missoulian.

                                                  Everything You Already Knew About Sex

(But were afraid to talk about)

                                                             By John Sommers-Flanagan

I’ll never forget the night my older sisters saved my life. I was 12 years old. My sisters were babysitting me while my parents went out. They said, “Sit down, we’ve got something serious to talk about.”

I was a compliant little brother and because my sisters enjoyed dressing me up like a girl as I sat down, I was silently hoping that I wouldn’t have to do the girls clothing thing again. To my surprise, their serious topic had nothing to do with girls’ clothing and everything to do with what’s underneath girls’ clothing.

They pulled out a gigantic book. In our family, it was called the DOCTOR book and we only got it out when someone was sick. I started to worry . . . mostly because I wasn’t feeling sick.

They opened the book and showed me anatomically correct pictures of naked men and women. Then I started feeling sick. While looking at various body parts they explained the relationship between male and female sexual organs. I remember thinking “There’s no way this is true.” My sisters, one 16 and the other 14 suddenly looked like the wisest people in the world and I eventually realized they had more knowledge in their little toes than I had in my entire brain. They explained: “Mom says it’s Dad’s job to tell you about this sex stuff. But Dad’s too shy to talk about it. So tonight, we’re telling you everything.” And they did.

At some point in their explanation that night, I understood several school jokes that everyone had been laughing about the week before. But more than anything else, I remember them saying: “Sexual intercourse is very special. You only have sex with someone you really love!”

Sex education in America is like a crapshoot. I got lucky. I learned a big lesson about sexuality from two people who deeply cared about me and whom I respected. Not everyone gets so lucky.

If you’ve got children, you should directly discuss sex and sexuality with them on an ongoing basis. If you don’t, you can bet they’ll learn about sex anyway, indirectly and from other people. Given this choice, most parents decide, despite their discomfort, to talk about sex with their children.

Direct discussions about sex are easy to avoid. So, before you drop this essay and rush off to talk to your children about sex, take a moment to mentally reflect on your answers to the following questions.

1.         What did you learn about sex from your parents and family?

2.         What did you learn about sex through school sex education?

3.         What did you learn about sex from friends and peers?

4.         What did you learn about sex from television, magazines, and the movies?

Now. . . if any of you are still with me, you’re probably realizing you didn’t learn the same sex lessons from your parents as you did from your friends or from television. Many people learned (from parents) not to talk about sex. In contrast, many people are learning today (from television) that they should constantly think and talk about sex. Hardly anyone learns consistent and reasonable lessons about sex. Most people learn about sex in extremes. . . either you avoid it or you’re bombarded with it.

Sex is exciting and confusing. One way that many soap operas and sitcoms keep us tuned in is by keeping us wondering who will be sleeping together. When, on “That 70s Show,” Kelso tries to grab Donna’s breasts even though her boyfriend is one of Kelso’s best friends, young viewers undoubtedly feel twinges of both excitement and confusion. Sex makes for great comedy. Unfortunately, great comedy is usually poor sex education.

Teaching children about sex should begin early. There are many natural opportunities for discussing sex with your children – including television, magazines you see at the grocery store, and occasionally, our local and national politicians. Other opportunities occur around ages four or five, when young children begin talking, sometimes excessively and inappropriately, about poop, pee, penises, and vaginas. Although addressing such topics with your children can be uncomfortable, you should begin this process while your child still respects you. About 10 years later, when your child returns to thinking about these topics with rapt interest, he or she may be less inclined to listen to a wrinkly old adult.

Of course if you’d rather not deal with the issue, you can always use the approach my parents used. Give me a call. I’ll put you in touch with my sisters.

Positive Thinking is Not (Necessarily) Rational Thinking

This past Saturday I got a phone call from a former Counseling student (who will remain unnamed). He said that he and another student were heading to the University of Montana gym to play basketball at 1pm and wondered if I’d like to join them.

I should have recognized I was in trouble when I somehow decided NOT to tell my wife that my sudden reason for going to the gym was to play basketball. She would have reminded me that the odds of injuring my back while playing basketball are better than any odds you can get in Vegas. But I didn’t want her to rain on my positive thinking fantasy world. Do you know what I mean? Have you ever had a time when a part of you knew better and so you decided not to tell any other rational human being what you were planning?

I also should have recognized a few other obvious flaws in my positive thinking: (a) my age is approximately the sum of the two young men with whom I planned to play; (b) I quickly began developing a handicapping system through which I could compete with them; (c) for a few minutes I was visualizing myself leaping into the air without hurting myself.

In his book, The Elements of Counseling, Scott Meier, an old friend of mine and professor at SUNY-Buffalo, wrote that positive thinking is not rational thinking. This is a great point . . . and one that’s easy to forget. Despite the many cultural messages that we get about having “no limits” or being “able to accomplish whatever we can imagine,” it’s not really true. No matter how much visualizing (and personal training) I do, I’ll never be able to keep up with any professional . . . or college . . .  or high school . . . or middle school basketball player. I can practice “the secret” ( a visualizing strategy) all I want, but Obama will not ask me to replace Joe Biden on his 2012 campaign. These are limitations; they are SIMPLY NOT HAPPENING.

Typically, when positive thinking fails, many of us begin rationalizing away because we want to jump back on the positive thinking horse. This is a form of denial that even happens to cult members who are planning for the end of the world. When the end doesn’t come they develop a reason why . . . and often set a new date.

In my case, as I limped and slumped home in humiliation, I was already rationalizing my glorious return. And this is my second point: Rationalizing is generally irrational. What this means is that when we catch ourselves excusing our behavior or re-writing history, we’re probably fooling ourselves. In this case, I quickly began telling myself that the main reason I hurt myself was because I just wasn’t in good enough shape to play on this particular day . . . but that if I rehabbed and worked on my conditioning (for the next year!), I could return to the court and teach those young whipper-snappers a lesson they wouldn’t soon forget. Of course, I forgot to factor in (a) I’m already in pretty good shape; (b) in a year, I’ll be a year older (duh!); (c) I can’t reasonably spend all day rehabbing; and (d) there aren’t many bionic body parts for sale at the local hardware store.

Positive thinking and rationalizing are, quite naturally, at the heart of most of our temptations. For some, the temptation is alcohol, drugs, sex, or chocolate. We may tell ourselves we can have one drink, one bowl, one sexual indiscretion, or one bite and then find ourselves suffering the consequences. This doesn’t mean we shouldn’t engage in positive thinking. It’s just that we need to balance or moderate it with real rational thinking. And one way to get a dose of rational thinking — even if we don’t want to admit it — is to ask someone who really loves us and cares about us if we’re sounding reasonable or not. Another way is to engage in honest self-scrutiny.

Personally, I plan to remain a positive thinker, but in the future I will moderate it with spousal consultation and honest personal reflection. This isn’t nearly as fun as pretending I’m younger and more capable than I really am . . . but right now the pain, ibuprophen, ice, and physical therapy are inspiring me to think more rationally and live more mindfully. I share this story as a reminder to myself and others of what Norman Vincent Peale referred to as the power of positive thinking. In fact, positive thinking is so powerful that it’s actually one more good way for us to get ourselves in trouble. Really, it may seem depressing, but it’s perfectly okay to know our limits and live within them. In the spirit of reality therapy, that’s my new plan . . . and I’m sticking with it.

Author, Speaker, University of Montana Professor