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6 Myths about Antidepressants

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In My Story, I described my lifelong struggle with depression and anxiety and how I suffered for many years before I was willing to go to therapy. It took even longer before I was willing to try antidepressants. And even though the meds helped tremendously, I still went on and off of them for many years because I didn’t like it that I needed them to feel “normal.”

In my work with students, it is very rare that a client enters therapy wanting to take an antidepressant. In helping them decide whether or not to try meds, I tell them to ask me whatever they want about antidepressants. In this Q & A, there several myths that come up repeatedly. So I thought it might be helpful to dispel these myths so that you can form your opinion about antidepressants with accurate information.

Myth #1: Meds are for people who want a quick fix.

Fact: I have rarely, if ever, met a client who wanted to bypass therapy and start with antidepressants. Sometimes they will meet with me for several years before they are open to trying medication. I would hardly call that a quick fix.

Myth #2: I don’t want to take something that is going to artificially make me happy.

Fact: Antidepressants don’t work that way. Think of a person who is depressed or anxious (since they are used to treat both conditions) as someone who has a lowered threshold for stress. The meds help to raise the person’s threshold so that it is in the “normal” range. This means that they don’t get upset over things that used to bother them. And when they do get upset, the feelings aren’t as intense and they don’t last as long. But you still feel depressed and anxious at times.

Ironically, people who make this argument have no problem using other, more addictive drugs that do actually artificially make them happy. Like alcohol. Or marijuana. Or stimulants.

Myth #3: I don’t want to become dependent on antidepressants.

Fact: As I stated above, many people who don’t want to take antidepressants have no problem “self-medicating” with other, more addictive drugs. I would equate taking antidepressants to taking meds for high cholesterol or blood pressure. You’re not dependent on them, but you may be putting yourself at greater risk for harm without them.

Myth # 4: I don’t want the meds to change me as a person.

Fact: When you are depressed or anxious, you are not yourself. You are so focused on your pain that you don’t have the energy to do the things you would normally do. You are necessarily self-focused and therefore cannot focus on other people. You are not fully present. So if anything, antidepressants help to free up more of your energy so that you can act more like yourself.

Myth #5: I don’t want to have to be on meds for the rest of my life.

Fact: Most people don’t have to be on antidepressants for the rest of their lives. Even in my case, my psychiatrist prescribes my antidepressant as needed. Although there are a bunch of supplements that he insists I take for the rest of my life, ironically.

Myth #6: It is more noble to suffer.

Fact: When someone comes to therapy, I assume it’s because they don’t want to suffer. I tell clients that life is full of suffering that they cannot avoid. We will all experience grief, loss, sickness, and crushing disappointments in the course of our lifetime. You will not miss out on your share of suffering. So make it easier on yourself and reduce whatever suffering you can. If there’s a chance that trying an antidepressant will reduce some of your suffering, you might as well give it a shot. You can always change your mind.

 

Everyday Miracles

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Today I read a chapter from Harold Kushner’s book, Nine Essential Things I’ve Learned About Life. The reading was about the importance of helping others as a way to live a meaningful, purposeful life. That wasn’t particularly helpful to me because, if anything, I think I focus too much of my energy on helping others, to the detriment of caring for myself. But it’s still good advice, nonetheless.

There was a section of this chapter that gave me pause, however: his description of the miracles that occur in everyday life. The predictability and reliability of nature. The fact that we can count on the sun to rise and set every day, the waxing and waning of the moon, the changes of the seasons. They happen with such accuracy we know sometimes down to the minute when they will happen. According to Kushner, “a faith system attuned to the natural world celebrates the orderliness that makes our lives livable.”

I’ve had the sense of awe and wonderment about these very things, though not every time they happen. I’m not that mindful. But I guess no one is. Like, when I meditate, I begin by focusing on my breathing, and then I shift my focus to my heart, because for some reason, feeling my heart beat, feeling my pulse throughout my body, makes me acutely aware of the life force that is my heart. How, even when I’m sad, when I’m heart-broken, when I can barely summon the will to live, my heart keeps beating for me, carrying me through life. I know the heart isn’t as immutable as the sun, moon, and seasons, but it fills me with a sense of wonderment and awe, just the same.

In a previous blog post I’ve written about how the weather is a metaphor for our feelings–how it varies from day to day, moment to moment. Some weather conditions are more desirable than others–rain during a tennis match is highly undesirable, for example–but we ultimately accept whatever the current conditions are because we have faith that at some point, the weather will change. Plus, we don’t really have a choice.

We can have the same faith in our feelings, but it does not come as naturally. It takes a lot of practice. When I’m anxious or sad, I’m better able to remind myself that if I wait, at some point my feelings will change. It doesn’t really make the pain go away, but it keeps me from wasting energy on wishing I were feeling something else–a small way I can reduce my suffering in the moment. Perhaps this is a miracle, too–the fact that having compassion for our pain has the power to reduce our suffering.

As I read about these everyday miracles, my Inner Critic was quick to point out my failure to appreciate them. You should be thankful for these things more often! You shouldn’t be taking them for granted! My inner critic often turns practicing gratitude into something that leaves me feeling ashamed and inadequate–as far from awe and wonderment as you can get.

So I’m thinking maybe I’ll practice mindfulness by noticing these everyday miracles more often–to pay attention to the changes of the season, the sunrise and sunset, the waxing and waning of the moon. In practicing mindfulness, there is no expectation that you should feel any particular thing at any given moment; you simply notice what’s there. But even the act of noticing creates an opportunity to experience wonderment and awe. So I’ll try it out and see what happens.

Olympic Dreams and Self-Esteem

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I’ve really enjoyed watching the Olympics over the past 2 weeks. During the Winter Olympics 0f 2014 I wrote a post about my dream of being an Olympic athlete. I didn’t so much care about being the greatest athlete of all time, but I wanted to be a part of the opening ceremonies, live in the Olympic Village (without getting stuck in an elevator for 40 minutes like Del Potro), and exchange pins with other athletes.

During this year’s Olympics I was struck by how many stories there were about gold medalists (usually men) who felt lost, depressed, even suicidal after their success. How they turned to drugs, alcohol, got in trouble with the law, wandered around purposeless, sometimes homeless, not knowing what their next goal should be. Michael Phelps’ story is probably the most surprising one of all. What would the greatest Olympian of all time have to feel depressed about?

This is the myth that continues to haunt us in our search for happiness. We believe that achieving greatness will transform us into someone who we will finally like. It will bestow upon us a sense of self-worth and belonging. We will feel purposeful, useful, and lovable.

In a previous post I wrote about how I had a similar experience after I got my Ph.D. I was expected to get an education beyond college. Preferably medical school, but in one of my few acts of rebellion, I chose clinical psychology instead. Even in my first year of grad school I had fantasies about how smart and accomplished I’d feel after getting my doctorate. Only to find out that instead I felt…exactly the same. Actually, maybe even a little worse. Because if having a Ph.D. didn’t make me feel better about myself, I realized that nothing would. I had nothing left to channel my energy into. No fantasies about how I was just one accomplishment away from achieving my dream of not feeling sucky.

There are other versions of the dream of transformation. They involve six figure salaries, weight loss, a youthful appearance. The perfect job, the perfect spouse, the perfect children. Everything we ever wanted is waiting for us…right after we accomplish this one thing. Oops. Not that one. The next one. Or maybe the next one.

Yesterday on the ride home from our annual Cincy Tennis Tournament trip, I was telling my friend that my job in therapy is to tell my clients over and over again that they are OK, just the way they are. Every week they bring in a different set of problems, different flaws, different confessions, and I say those are all OK, too. You’re still fine. On the one hand, that may seem like a strategy that is too simple to be transformative, but you should try it some time. It’s surprisingly difficult to believe we’re fine the way we are. That’s why change takes so long; we need to hear it all the time. We are never fully confident that we are good enough.

It’s clear that Michael Phelps still enjoys winning gold medals. It’s obviously still a thrill to train to be the best, to see that his hard work has paid off, and to know that he’s still the greatest. But he also seems more at peace about retiring. After all, he is not just the greatest Olympic athlete of all time; he is also a father and a soon-to-be husband. Will he come back to the Olympics in 4 years? Maybe. But if he does, it will be because he loves the competition–not because he is nothing without it.

I, too, think about accomplishing goals differently than I used to before my Ph.D. I’m still competitive and I want to win, but now it is more about the process of getting better than the result of any particular match. I do think that competing hard, playing fair, and executing my game plan say something about my character. But win or lose, when I walk off the court, I’m still the same person I was before the match began. I’m still me.

And I’m becoming increasingly comfortable with that.

Darkness and Light, Part 3

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Now that I am at the end of my summer break, my sleep cycle is officially fully out of whack. I go to bed at 4 am and often wake up after noon. I’m getting better at not berating myself for this because this luxury is about to end in a few days. And because, since I’m a night owl, I feel the best in the wee hours in the morning. This is when I have my moments of clarity. When my demons lose their power to convince me that I suck. Ironically, for me, seeing the light happens in the darkness of night.

It got me thinking about all of the good/bad dichotomies. Darkness and light. Angels and demons. Joy and pain. As I mentioned in a previous blog post, I’ve been reading all these books about God, trying to understand what it means to be good, and the answer seems to be to accept everything about ourselves–even our sins and our vices. I write about acceptance all the time, but I guess in my mind self-acceptance was still something more along the lines of, don’t hate this thing about yourself because it’s a part of you. But it’s still bad. I mean, how can you think of something like depression as good? How can I embrace something that causes me so much suffering?

Although lately I have had a better appreciation of my depression. I pride myself on being mentally tough–on being a warrior. My greatest strength in tennis is not my athletic ability but rather my mind. My determination to not let my opponent get in my head. To fight, even when I’m down 0-6, 0-5. To be able to see what I’ve done well in a loss and to learn from my mistakes.

One of the things I take the most pride in is that players on my team appreciate me as a captain, and continue to be on my team even if we lose every match, because they think I’m positive and encouraging. I mean, I award a Player of the Game and Honorable Mention in matches where we’ve lost 0-5. That is really looking on the bright side. But my bright side would not be possible without my dark side. My mental illness has strengthened my character. It has shaped the parts of me that people admire the most.

If boot camp prepares soldiers for war, then depression is the boot camp for hardship. When I look back on each depressive episode, I realize how strong I was, even though I thought I was weak at the time. How hard I was trying, even though I thought I was being lazy. How much hope I had that things would get better, even though a part of me was telling me to give up–that life was not worth living.

Having said all of this, I can’t say that I have fully embraced my depression. I’m not thrilled when it shows up. But I’m trying to accept it in the way people sign up for the military, knowing that it may cost them their life. Or the way that people choose to get married for richer or poorer, in sickness and health. The way parents choose to have children, knowing the heartache that comes from loving so deeply.

Joy and pain. Angels and demons. Darkness and light. I will choose all of these, because I believe our task in this life is to fully embrace what it means to be human.

Recovering Control Freak

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So in addition to all of the books I’m reading about God, I am also reading Rick Springfield’s memoir, Late, Late at Night. Because Rick Springfield was my first love. It’s funny, because some of my friends scoffed at how I could love someone I didn’t know, but it turns out that Rick and I (hopefully he doesn’t mind if I call him Rick) are actually very similar: we both struggled with depression since high school, have both named the part of ourselves that is always telling us that we suck. Mine is the Inner Critic. His is Darkness. So perhaps it is possible to sense the darkness in others, whether we know them well or not.

One of the ways people cope with self-hatred is to try to have control over things that they don’t actually have control over. And since this is a futile strategy, it tends to exacerbate one’s suffering.

I am intimately familiar with this strategy. My Inner Critic demands that I control every aspect of my life. That’s why I had straight A’s. Why I’ve never used drugs. Why I had to start a blog to let people know what I’m really like–because my “confessions” reveal just how imperfect I am. I’ve also tried to control other people–particularly the ones I’ve dated. I haven’t quite figured out how to stop doing that, so for now I’ve just decided not to be in a relationship at all.

One of the best things about practicing mindfulness is that it teaches me how not to listen to my Inner Critic. People don’t practice mindfulness because they’re afraid they’ll do it wrong, when in reality there is no right way. There is no particular result you’re aiming for. No specific amount of time you must be focused. I compare it to Weather on the 8’s on the Weather Channel: you’re just checking in with yourself, seeing what’s going on in there. There’s no expectation about what the dew point should be.

When you practice mindfulness, you begin to realize how much of your thoughts are not your own. Random stuff just pops into your head. You can’t stop it from happening. You begin to realize that just because you have a thought–like you suck–that doesn’t mean it’s true. It doesn’t mean that it came from you. And since it’s just one of the hundreds of thoughts that will enter your mind while you meditate, you can just observe it and let it go, just like you do with all the other thoughts.

As I begin to let go of all of the things I can’t control–which are far more numerous than I thought–I realize there is one thing I can control. I can choose my intentions. I can choose to be kind to myself, kind to others. I can choose to live mindfully, to be fully present. And when I become seduced by my Inner Critic once again, I can recommit to my intentions again.

And I have to say, I like myself a lot better this way.

Head Games,Part 2: Sportsmanship

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I have always prided myself on not using head games to win. However, this morning, as I started obsessing the moment I became conscious, I realized that this is not completely accurate. If head games are something you use to affect your opponents’ behavior, then I am guilty as charged. But not in the way you might think.

Last month while I was at districts, I played a match in which my partner and I were frustrating our opponents with our game. They tried to make adjustments, but they weren’t working. I could see that they were starting to lose it. They started arguing with one another. A few points later, they went ballistic when I called a ball out. As I have mentioned in previous posts, I tend to be overly generous with line calls because I’m afraid of going to hell. But it was so obvious that this was a ploy to disrupt our concentration that I was uncharacteristically dismissive of their protests. Then, during the changeover, they complained to the official that we were taking too much time. At that point, I actually started laughing, their tactics were so transparent.

In the next game, one of the opponents hit a good shot, and I acknowledged it, because that’s what I always do. My partner said they don’t deserve compliments, but I explained to her that if I let their behavior affect my behavior, they win. Their head games worked. It’s not that I wanted to be nice; I wanted to send the message that there was nothing they could do to disrupt my concentration. That I was mentally tougher than they were.

Interestingly, my good sportsmanship was so disarming that they, too, started acknowledging our good shots. And by the end of the match we shook hands cordially, and our opponents did not show a trace of the animosity they had demonstrated earlier. And I have to say, I was prouder of myself for the way I handled their head games than I was for the way I played. Although the win felt good, too.

What a revolutionary idea. That good sportsmanship can be as contagious as poor sportsmanship. It is the most effective head game you can use. It makes you look foolish if you continue to yell and complain when your opponent is complimenting your shots. It calls attention to your bad behavior. So unless you want to feel like a bad person, there’s nothing left to do but to be fair in return. In social psychology, this is called reciprocity: people give back the kind of behavior they have received from another.

Can you imagine if we applied this strategy in real life? If, whenever someone accused us of doing something that upset them, instead of getting defensive, we say I’m sorry I’ve hurt you. If, when someone tries to pick an argument with us about politics or current events, we say, well that’s an interesting perspective. I can see why you would feel that way. Not because we like them or agree with them, but because we don’t want to give them any more ammunition. Because we want to disarm them. That would be a much more powerful weapon than retaliation.

And when it comes to mental toughness, I’m all about winning.

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Stargazing

Sometimes the best things in life emerge from our biggest disappointments. Last month I took my nieces on our 1st annual vacation, which we decided to call The Barongan Girls Take D.C. This trip would not have been possible if the trip to Germany that my niece Paloma and I were supposed to go on hadn’t been canceled due to the craziness in Europe. A friend suggested that I take a trip with her and go somewhere else, but I wasn’t sure a trip with me would be as appealing as a trip to Germany. Fortunately for me, it was, and since my other niece Sadie was there when I brought it up, I figured I’d invite her, too.

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A Monumentous occasion

I have found that in life it is rare for things to turn out exactly as you expect them to. When I imagine the worst, things often turn out better than I expected. And when I think something is going to be great, I often end up feeling disappointed. But this was one of those rare times when everything was as perfect as I imagined it would be. We enjoyed some great meals…

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Sadie and Paloma enjoying a light dinner

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Anxiously awaiting our cheesecake at The Cheesecake Factory

and took in the sights of the city….

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Sadie enjoying some high end window shopping

But surprisingly, the best moments were the ones between the museums, the monuments, and the meals. They were the times when we were hanging out in the room, and Sadie and Paloma were building a fortress with the couch cushions. (Remember how fun that used to be?) The times when they sang, danced, talked about friends and boys, and discussed how many children they wanted. They were the unspoken ways they expressed their desire to be together all the time–like the fact that they wouldn’t put their luggage in their bedroom, preferring that we all get dressed in the living room instead.

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Sadie’s fortress of solitude. And my bed.

As a fitting end to a perfect trip, on the drive home I saw a falling star. And then a few hours later I saw a shooting star. In my entire life, I’ve seen one other falling star and shooting star, so this seemed significant to me. My nieces were asleep at the time but when I told them about it later, they assured me it was lucky.

And truthfully, I was going to need some luck. All of the problems and decisions I had left behind were awaiting me. Frantic phone calls and intense email discussions were about to ensue. I was going to be expected to perform miracles. The magic of the trip was fading, and feelings of helplessness and hopeless were returning.

I was telling a friend about the shooting star and falling star, and he asked if I had made a wish. Which I totally forgot to do. He thought it still counted if I made the wish a week later. I’m not sure what the rules are on wishing upon stars, but I didn’t want to miss this opportunity to capitalize on the possibility of miraculous solutions.

But then the scientist in me wanted to know what the difference was between shooting stars and falling stars, so I looked it up and found out that they weren’t stars at all. They’re meteors! And even though it’s all make-believe anyway, I was disappointed, because I was pretty sure that wishing on meteors didn’t count.

But then I saw my niece Sadie last weekend for my dad’s birthday and broke the bad news about how I saw 2 meteors instead of stars and now my wishes weren’t going to come true. She assured me that my wishes still counted. And then she asked me if I had wished I could meet Federer. Damn! I can’t believe I didn’t think of that myself!

But perhaps the point of seeing the shooting star and falling star at the end of our trip wasn’t about meteors and wishes and luck. Perhaps it was meant to be appreciated as is, in the moment, as something rare and wondrous. Which still made it a perfect end to a perfect trip. Because my nieces are like stars to me–beautiful, brilliant, and awe-inspiring. Whatever the next moment may bring, in this moment, I am thankful for my time with them.

But I still hope my wishes come true.

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