Saturday, March 01, 2008

Coping Strategies for Treatment Resistant Depression (TRD)

In a previous post: Reviewing Treatment Plans for TRD I borrowed a list of 9 treatment guidelines used to help with the management of depression that had been posted earlier on the Dr Shock MD PhD blog.

Dr. Shock, having read my post, responded in another post that he saw an important aspect of depression management missing from the list; that is coping with the depression. He suggested , "Some ordinary but useful measures can also help, such as running, light therapy, daily activity scheduling". He then asked if I had anymore ideas.

I have mulled this over for several days. My first thought was that I was unclear on the concept of coping. I remember a post where he commented "glad to see you are coping well" and I thought I was coping very poorly. At the time my understanding of the definition of coping was that in order to cope, one had to have strategies in place that were successful. In my mind, that meant strategies that rid me of my depression.

I looked up the definition of "cope" in two dictionaries last night:

Merriam-Webster Dictionary: "to struggle to overcome problems or difficulties" (this reads like my previous belief about coping....I have to "overcome" in order to be coping).

Webster's New World Dictionary: "1. to fight or contend (with) successfully or on equal terms 2. to deal with problems, troubles, etc."

The Webster's New World Dictionary's 2nd definition is more encompassing and fits with how I cope. This is the "cope" I will write about. These are strategies that I use to survive and that help me continue trying to get better.

I am sure as you read my list you will recognize I have positive ways of coping, and not so positive ways of coping. I will reserve being judgemental about all my ways of coping and allow the reader to decide for themselves what might be in their best self-interest if they want to incorporate some of my coping mechanisms into their lives.

My Coping Strategies: (in no particular order)
  1. Having a regularly scheduled therapy session with my psychiatrist to review my treatment plan , my mood and to work through current difficulties and/or celebrate successes.
  2. Scheduled responsibilities and commitments. Like the volunteering I do. I am the type of person who absolutely will not break a commitment. This is often a healthy strategy for me as the external pressure gets me to leave the house and do things. However, and this is a big however, it is easy for this strategy to backfire for me because I have difficulty setting boundaries and will continue to keep my end of the deal, even if it is clear I am too ill to continue. I am working on developing better boundaries for myself.
  3. Schedule social and cultural activities: Buy the tickets for the symphony, or a play, or a concert. Make arrangements to meet people for lunch, or dinner on set dates. Sometimes I get cajoled into doing this. I almost always don't want to go do these things If I did not have the arrangements in place ahead of time I would stay home. However, I am almost always glad I went and/or participated in the activities I scheduled ahead of time.
  4. Setting boundaries. Knowing when to say no and when to commit to tasks, meetings, volunteering etc. (a work in progress)
  5. Working: I used this for years to cope. The more depressed I became, the harder I worked. In one way, having a very set, strict schedule helped me maintain some level of consistency in my life. This MDE however, I managed to work for two years while severely depressed and then my work threatened to drown me. This coping strategy became my enemy and I had to leave work to save myself. I know I NEED to work again, even if it means only volunteer work. I do better with more structure, but I need to work somewhere, or at something, that has the flexibility to allow for the ebb and flow of my moods as well as something I feel is meaningful and full of purpose. Also, I worry so much about my long term income security while on disability income. When I work this fear is minimized, although it is still always there. I always worry about being laid off or fired (even though in performance reviews I have consistently been reviewed as a hard working and high performing employee). This fear is an OCD thing for me.
  6. Volunteering: This is even better for me than working for money. I get to work so I have a sense that I am being useful. I have set responsibilities and 2 half days where I have committed to showing up, so I have the external pull to get me out of the house. On top of that I am helping others and that makes me feel really good.
  7. Having a dog: the responsibility for his care and knowing he needs me has literally saved my life a few times in the past year. Also, when he was well I lost 10 pounds in the first few months I had him because we went for long walks so often. Even now he gets me outside numerous times everyday and we go for short walks, rain or shine. I never thought I was well enough to accept the responsibility of a dog while I was this ill. Now I see I not well enough to NOT have the responsibility.
  8. My love for my sisters, my nieces and my husband. I stay alive because I do not want to hurt them
  9. Fresh air, long walks: If I can force myself to get out of the house going for a long walk always makes me feel better. I love the outdoors.
  10. Sleep: Sometimes as an avoidance strategy...if I sleep I will not kill myself. Also, getting enough sleep and keeping a regular sleep schedule as a strategy to regularize my mood (I have a really hard time staying asleep). This is almost impossible to do, but I do try to wake up and go to bed at the same time every night, regardless of whether I actually slept or not.
  11. An S.A.D. Lamp: I sit in front of one for an hour almost everyday. Does it work? I don't think it helps my mood, but I like sitting in front of it to read the paper and I can't see it hurting me.
  12. Lay on the couch and cling to life: sometimes, when I begin having obsessive and/or violent suicidal thoughts I curl up into a ball on the couch and just try to wait out, and get through, the thoughts.
  13. Drink alcohol: to relieve anxiety, to disappear, to forget. This is a dangerous strategy for me as I tend to use it when I am most depressed and anxious. It calms me, but also brings down my inhibitions making me at greater risk of committing suicide. I am working on losing this coping strategy.
  14. Write: In my blog, on my support group's website, in my journal. Writing helps me get all my thoughts out of my head and helps me search for a solution.
  15. Sex: Something has happened in the last year and I have given up sex. I am to tired and too depressed. I have to get this gift back again. It used to be, if I was really irritable it was the best time for me to have sex. The physical connection, the energy, the release almost always helped me feel better.
  16. Go for regular massages: I have a regular massage therapist that I see. I have seen him for years. I have told him all about my struggles with depression. I have known he has had troubles with depression before, but he recently told me he had a severe psychotic episode years ago and was treated as an inpatient for a very long time. This information really helped normalize me to myself, because he is doing so well now. Knowing this I feel I can be open and honest with him, and that helps me relax more throughout the massage. In a bizarre twist of fate his first name is the same as my pdoc' I call him my body "J" and my pdoc my mind "J". Just another funny coincidence. His wife had a baby on my sister's birthday, and my pdoc's wife had a baby on my birthday. I sometimes wonder if these cosmic coincidences indicate I was destined to have a strong relationship with these people.
  17. Have my husband hold me tight: Sometimes when I am really irritable I just ask my husband to hold me really, really tight. Something about him squeezing me in a big hug calms me.
  18. Pay someone to clean my house: It used to be I was depressed and could not keep up with the housework, but every once in a while I would get a spurt of energy, go crazy and clean it from top to bottom. I would berate myself in between these spurts for how disgusting the mess was. In the past couple years have not had any of those spurts of energy, so my house became even worse and I began berating myself more and more over my inability to manage and keep up. Even though I cannot really afford it, I now have someone come in once every few three weeks and clean my house for me. It has relieved me of my guilt and I have a cleaner house.
  19. Drop my laundry off: For the same reasons as the above.
  20. Lay in the sun: While I use sunscreen I do not worry about sun damage. The sun makes me feel better. I am more at risk of dying from my mood disorder than I am of getting cancer. Starting in February any time I get a chance I go into the greenhouse, climb up on top of the planting tables and lay down on a mat with my pillow and soak up the sun. It is relaxing. Come later spring I lay in the sun and fall asleep on the back deck.
  21. Eat chocolate and carbs: (mashed potatoes, chips, cereal)...all fill some void.
  22. Swim or Gym: I have not done either in at least two years. I actually stopped because I did not see my depression getting any better as a result of doing these things daily. I now recognize I was mistaken in the goal of doing each of these. They are not a means to an end. They are themselves the ends. While swimming I feel an intense calmness come over me. It is like a moving meditative exercise. While swimming and working out I feel strong and powerful. This is relief, if only for the time I am doing it. Also, while participating in both I like my body better even after I leave the pool or gym. This must affect my mood in some positive way even if it is not immediately apparent to me.
  23. Listen to music: To anyone who loves music this strategy needs no explanation.
  24. Get creative and enjoy creative things: draw, paint, creative writing, pottery, read, watch a good movie or an interesting t.v. show. I get lost in these activities IF I can manage to start them. Getting started is the hardest part, but once I begin my spirit becomes entwined in the creative process and all bad thoughts leave my mind.


jcat said...

Hey girl, good list. Quite a lot on there, made me think a bit.

Did you get mail from earlier? Saw your comment...had sent mail a few hours before.


Polar Bear said...

That's an amazing list. Well done! And thanks for sharing.

I'd agree with the working out one. I run almost everyday as part of my coping strategy.

Aqua said...

Hey Jcat, I did get your e-mail, but I had to run as I went to the symphony this afternoon. One of those "planned" cultural events to drag me out of the house. I will go and respond now.

Thanks Polar Bear,
I have never been able to run and am envious of people who do. I seem to always want to lean to far forward and I always feel like I'm going to fall over. Runner always carry themselves so well. I am going to try getting back into swimming. I'm more elegant in the water than on land.

Dr. Shock said...

Great post, thanks
Dr Shock

Anonymous said...

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