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    My Final Post as a "Guest Expert": A Change of Mind and Heart
    Michael D Yapko, PhD posted:
    My month as a "Guest Expert" on the WebMD Depression Community site is now at an end. It's a bit strange to be saying goodbye seemingly just as I was in the middle of my hello, but such is the way of short term participation.

    I was glad to have the opportunity to share some ideas and perspectives. I was particularly interested in presenting some ideas beyond the many postings about medications, medication side-effects, medication dosages, medication withdrawal, medication switches and medications for improving medications.

    I was amazed to see how adamant some people still are about the notion of depression being the result of a brain chemical imbalance despite no supportive evidence and growing contradictory evidence. The drug ads clearly work. I don't want to stop people from taking medications. I simply want to make the point that even when medications help with some symptoms, no amount of medication can help people be better problem solvers, which is necessary in dealing with life's challenges.

    So, in this final post I want to point some things out that I hope will give people a boost in a helpful direction. Look over peoples' posts. So many of them say, in essence, "I can't deal with this." Whether referring to a depressed spouse, a depressed child, a death in the family, the stress of some troubling situation, too many people uniformly attribute their depression to being unable to cope.

    My main point from my first entry on is that learning to cope is essential. If you feel you can't cope with something, that means you are missing the coping skills that would allow you to manage the situation more effectively, without sinking into depression. It doesn't necessarily mean the problem is unsolvable or unmanageable. It just means you don't know how to solve or manage it.

    Psychotherapy with a really good therapist, experienced in treating depression and proactive in style, can teach coping skills. Medications can't. Waiting for the drug to work isn't coping. Trying another drug isn't coping, either. Wishing you were dead is the virtual opposite of coping- it's giving up. Don't!!

    It requires a change of mind and heart to actively take the initiative to learn skills for managing life well, especially if you are convinced the problem is your biology and not you. There are lots of excellent books and websites that provide information and the means for developing the skills to move through the inevitable adversities of life. I have posted some of my favorites in the resources link.

    With best wishes...

    Dr. Yapko
    susiemargaret responded:
    hello, dr. yapko --

    i appreciate the provocative discussions we have had while you are here. thank you for giving us your time and energy.

    -- susie margaret
    what good is gold, or silver too, if your heart's not good and true -- hank williams, sr.
    downhigh responded:
    I've given up. Absolutely. The best people like you, with all the years in medical school, have to offer is THIS? "Don't give up"? Yea. Whatever. I quit. 14 years I've tried to find help, and now that no Dr.'s can help, they just say "Don't give up", i.e. "Don't kill yourself on my watch, I don't need the lawsuit." Fine. It's disheartening to feel like the people who are supposed to help you are just sitting back and watching you die. And yes, I've been to the best in the country, Mayo Clinic, Stanford, UCSF, taken every med, been to years and years of different types of counseling and everyday is just on/off suicidal. One hour I'm ok, the next, I feel totally abandoned and just want to die. So sorry if that's the virtual opposite of coping, but life doesn't seem worth coping with.
    teawithme replied to downhigh's response:
    Dear downhigh,

    I'd be angry, too, if I'd made my best efforts to find an effective mode of therapy, find a helpful counselor, find the "right" medication and I still felt as bad as you write that you feel.

    As you know, humans vary so much, and the ideas that Dr. Yapko offers are no doubt helpful to some folks. They are interesting, but not helpful to me. And I don't think he had any years in medical school; he's a PhD and not an MD.

    I can see that you have some things good things going for you, and one of them is your obvious intelligence. Another is that you are able to express your anger; many people's depressions are compounded by the fact that they hold that anger in. Another is that you have a sense of humor: "Don't kill yourself on my watch, I don't need the lawsuit."

    All right, so tell me how you feel in the "one hour I'm ok" - I think it's good to work from your strengths. During those hours when you don't want to die, what are you doing? What are you thinking? What are you enjoying?

    I have a wicked impulse to say: "Don't give up!" but you would give me a cyberfrown, so I will just say:

    downhigh replied to teawithme's response:
    I retract my medical school comment then. That's what I get for thinkin' I'm too damn smart. But anyways, in the only times I feel ok I'm usually just stoned outta my mind. I run alot, don't mind that, but I don't enjoy it much either. So yea, pretty much just get stoned. That's all I've got at the present time. I keep the house clean, do whatever chores I can find, etc, but I find nothing fulfulling. I've always felt this way, only been smoking for 2 years, so I don't buy the whole "it's the weed thats making you apathetic" argument. I generally hate to bring it up, because theres such a variety of opinions and it's a controversial subject, etc. But yes, honestly, what enjoyment do I get out of my day? Getting high.
    MsJoanna replied to downhigh's response:
    In 2007 a thoery was put forth supporting a cyclical dopamine dysregulation. Basically, an increased drive of dopamine during mania and then the opposite during the depressive phase. In reality, this may actually be an increased secreation of dopamine during heightened mood and, over time, a down regulation with a decreased sensitivity to said dopamine; thereby, the effect of depression. This cycle continues to repeat itself, as the lack of "enough" dopamine to illict a positive response creates an up regulation for more dopamine, begining a new cycle. This is only a theory, but it may lead to new and exciting treatments in the future.
    teawithme replied to downhigh's response:
    Dear dh,
    Thank you for your honesty. I can't make any intelligent comments on getting high, because my experience there is limited.

    I didn't mean you should retract your medical school comments; I just wanted to point out that this guy is not an MD, because people's backgrounds influence their ideas, and I'm skeptical about some of his. You are indeed smart, and you SHOULD think that you're smart.

    When you say that you've always felt this way, I wonder if that includes your childhood, too? Was there some point at which you enjoyed life, and then you didn't? Those are personal questions and you certainly don't need to answer them. I'm just wondering if there was joy in your life at some point and if there's a way to recover that.

    I sure wish you felt better.
    downhigh replied to MsJoanna's response:
    I'm not sure I understand?
    downhigh replied to teawithme's response:
    Hi T,
    I was only joking about the medical school thing. Thank you so much for your kind words. I don't mean to complain so much, I've been trying not to...I just feel trapped. Im in a place that offers nothing to do. I know that alot of my problem is having no focus in life, nothing to do on a day to day basis. I try to invent things, and I search for a job on and off, but I'm so down and have no confidence at all in my ability to HOLD a job, that I reach a point of desperation seemingly everyday. I seem to only see death, my own and everyone elses, everywhere I look. Not in the sense that I hallucinate anything, just that I always have the thought in the back of my head that either I am going to die or whoever it is I'm talking to will one day be dead so theres no point getting close to them. I realize that the thought process' are very messed up, it's just ALOT to try to fix on your own... I feel like I've read every self help book ever written... As far as joy, I don't think so, I think I've been depressed as long as I can remember. What kept me going was dreams of what I would do in the future, what I would accomplish, but after years and years of failure and not getting any better, none of those things really mean anything to me anymore, nor are they available to me. Things like school, sports, etc, don't really hold any meaning to me anymore. I don't feel like I fit in in any way with any college kids, and I'm not really interested in college. I have a computer and google, so I figure I'll learn what I want for free. Sports, I wrestled, and I enjoyed it but it's nothing I'm looking to do again. I run alot, but don't enjoy it much. So... I really don't know. I don't have access to any social activities other than the crappy bars in my town, which I've had enough. I'm at a loss really, I'm a musician and everyone goes on about what a pretty boy i am or good looking or whatever, but I don't see it, and I just don't believe it. I'm popular, but I don't like hanging out with anyone, because I don't feel like I can relate to them at all and I'm always sad. That plus being broke isn't helping with finding a girlfriend, or even dating at all. It's a pretty crappy time.
    susiemargaret replied to downhigh's response:
    hello, D --

    i'm so sorry that you've been feeling so rotten. i wish there was something i could do to help other than to say from personal experience that i know how you feel and it is indeed horrible.

    i send you caring thoughts and the hope for a peaceful night.

    -- susie margaret
    what good is gold, or silver too, if your heart's not good and true -- hank williams, sr.
    teawithme replied to downhigh's response:
    Again, thank you for being so honest and open. As far as your feeling that you wouldn't "fit in in any way with any college kids" - I don't know if you would find college kids that you enjoyed socially, but believe me, as a university professor, I assure you that you would more than hold your own academically.

    I don't know that always having "the thought in the back of [your> head" that you are mortal and that everyone else is, too, is messed up, unless all the world's philosophers and founders of religion have been equally messed up. They've come up with a gajillion ways to deal with those facts. Our mortality is a challenging reality to come to terms with. And maybe it doesn't make sense to get close to anyone, because that's opening ourselves up to the eventual pain of loss. You're a philosopher, clearly, and you're exploring the deepest existential mystery: what do we do with the time that we do have? You're courageous enough to ask that question, and I think you will find answers to it.

    Am I right that you are around college age? If so, in my humble opinion, that is one of the hardest times of life in our culture. So when you say "it's a pretty crappy time" I think you speak for a lot of people your age. I look out at the students in a lecture hall, and I would not trade my age for their youth and (better fashion sense!) Some of the people who look so together work so hard to keep up that facade, but when they are in my office telling me they don't know what to do with their lives, they are lonely, confused, frightened. It's just a really hard time for most people. If it's any comfort, I don't think you're alone in the way you feel.

    You seem to me to have a great deal of insight into yourself and understand a lot of the reasons that you are feeling so down. I wish that you had a really, really good friend. I wish you had a really good friend you trusted who could be a mirror for you, and help you believe that you are good-looking and bright.

    I worry that it's going to be hard to find that friend if you don't hang out with people. And you're right, you're probably not going to find friends at the crappy bars in your town. Where in your crappy town do you think would be the best places to look for friends (people who are going to die someday, but might be fun to hang out with before they do)?

    I'm glad that you identify yourself as a musician. It's good to hear you say something positive that you do know about yourself. You're a musician!

    But in saying this, I am not agreeing with your third sentence about trying not to complain. My favorite writer, Ursula Le Guin, calls complaint a form of coping. I think she's right. If you can't articulate what's bothering you, what's hurting you, how are you going to find solutions to your problems? It's very, very healthy to have the insight, intelligence and articulateness that you do. It's a great strength, and you need to play from your strengths.

    You say you think lack of focus is a root of a lot of your problems. So how are you going to find a focus?

    You'll obviously have better ideas about that than I can. I've personally found that when I'm confused about my path, it helps me to be around people who do have a focus. I think it's contagious. Are there any people in your crappy town doing things you admire? Maybe people volunteering for something that you see as worthwhile?

    If you were in my office, I'd give you a cookie. It's pumpkin ginger snaps this week. My husband says I spend all I earn on baking supplies. Since I can't give you a cookie, I want to give you something else. This is special. I haven't told this to anyone; I haven't been able to get my sister on the phone. Our younger daughter will have her second baby in February. She already has a four-year-old boy, the light of my life; when I'm feeling down like you are, he's what keeps me alive. Okay. She had an ultrasound today, and IT'S A GIRL!

    Write back. I'll ask your advice on my problems, okay?
    downhigh replied to teawithme's response:
    Hello, and thank you very much, again, for the kind words. And congratulations to your entire family and your daughter! That's fantastic, nothing better in the world. I'm truly happy for ya.

    Thanks for all the nice things you said about me, I get so down on myself that I don't see anything good. I don't really have a "close" friend, from my side of the fence. I have alot of friends, but everyone comes to me for advice. I suppose that I am a philosopher of sorts, and that I put alot of time into thinking about things from a very different perspective than anybody I know. I have this tendancy to drive straight to the real truth of things, because I feel like I've been lied to alot by alot of people.It's not the brightest view in the world that everyone will die, etc., but it's inarguably true. All of this, combined with depression, leads to some dark and very lonely times. But when that happens, I'm alone. I've tried talking to 2 friends at different times about being suicidal and depressed and whatnot, but they just don't get it. They CAN'T. It's not within their realm of understanding. They play XBox and think about cars all day, so they have no idea what to say. This is problably the root cause of alot of my problems, I feel very alone and isolated from any meaningful relationship. Everyone thinks I'm a little "different", but in a good way. To me, I'm just lonely. I hurt all the time. The more I get noticed for my music, I play country music, the less people are apt to ask "are you ok?". Nobody sees any problem with me running myself into the ground, cuz hell, Hank Williams did it. Well, I bet if you'd asked Hank Williams if he'd wanted to be miserable his whole life and die alone before he was 30, he'd say "No." But I'm afraid that'll happen to me too.
    teawithme replied to downhigh's response:
    Thank you so much for sharing our happiness with us. I sure love being a "Nana" and I appreciate my daughters for providing the grandchildren.

    I'm sorry that you've been lied to by a lot of people. It's awful to feel betrayed like that. But I see your "tendency to drive straight to the real truth of things" as a strength. Honesty and a desire to be real are admirable qualities.

    Boy, I wish that you had friends with whom you had more in common. It's compassionate of you to realize that they are not helpful because they don't know what to say, and not because they don't care.

    When I think about your present and your future, college just keeps coming into my mind. In terms of the future, you probably know that your earning power as a college graduate is WAY higher than it is without a degree. Money does not buy happiness, that's for sure, but being able to maintain a pleasant standard of living is nice. And in terms of the present, I think you're more likely to find friends whom you can really talk with. And the reading and writing and discussion for classes seems like it would provide you with stimulating things to think about. If you are thinking about things, you don't have time to feel some of the hurt. Have you taken any college classes? Is there a college or university near you?

    I know that right now you are not feeling a lot of confidence in yourself. The way to get confidence is to succeed at things.
    You're bright, you're a thinker, you write well, you have a lot of interesting ideas; I think any professor would be pleased to have you in a class.

    The first university class I taught, I didn't feel confident about. I was very well prepared for the class. But I was absolutely certain that the students would walk out of the classroom as soon as I opened my mouth, that they would say to themselves, "What does this little woman who can hardly see over the podium possibly have to communicate that's worthwhile." I was greatly relieved when we got through the "roll call" and a general description of the class and the syllabus, and there was not a mass exodus. Please realize that while you are not feeling too confident right now, that most people aren't that confident.

    Please forgive me if I am making too many suggestions.

    Your friend,

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