Ideas to Help - 30 July 2014 - Welldoing.org

HOW FOOD CAN AFFECT DEPRESSION

POSTED ON JULY 28, 2014 BY RACHEL KELLY • 0 COMMENTS

There is no one answer to treating depression and anxiety. A recent visit to MQ, a new charity funded by the Wellcome Trust to assess different approaches to treating mental illness such as depression, convinced me that my best bet is to combine multiple approaches: drugs if need be, mindfulness, exercise, therapy, but also to be careful with the food I eat.

I have never considered myself a bad eater. It wasn’t as though I ate poorly before I became ill. At the height of my depressive episodes I couldn’t eat at all but as I recovered, instinctively, I felt I could no longer take food for granted. If food is fuel, depressives need premium-grade help.

But it is hard to rigorously overhaul your diet during the worst of a mental illness. It is nonsense to tell someone suffering from acute depression to choose the fruit, vegetables and fish that might help them to feel better. When you’re that ill you are in no position to decide what you eat, let alone find the right shops to buy the right ingredients. You are no different to someone suffering any other serious illness who struggles to eat anything at all; your best hope is to be fed soups, smoothies or soft foods that can be eaten easily.

Few pleasures with depression

Even as you get better, it is still hard to change your diet. There seem to be few enough pleasures in life when you are feeling low. Our emotional brains can associate eating sweet food with reward, reminding us of being comforted as a child. If eating a chocolate biscuit cheers you up, finding a healthier substitute when life is bleak is going to be difficult.

Anxiety can affect digestion, too. Our stomachs are often referred to as our second brain. When I was especially nervous, I found it hard to digest anything solid, just as I had when I was first ill.You also need to find a diet that fits into your life: in my case, a busy one with five children.

The answer for me has been to draw on the expertise of the nutritionist Alice Mackintosh at The Food Doctor, who has helped me switch from a typically English, meat and two veg diet to a Mediterranean-style one, full of tasty things cooked simply. Studies suggest that our brains are developed for a diet many of us no longer eat, but which sustained us for about 99 per cent of human history and 30 million years. The Mediterranean-style diet balances healthy sources of protein with complex carbohydrates.

In practice, this means lots of pulses, fruits, fish, nuts, cereals and olive oil. Sweetened desserts, fried foods, processed meats, refined grains and high-fat dairy products are to be avoided. This helps in two ways. The nutritional needs of your brain cells are satisfied by the antioxidants, vitamins, minerals, enzymes and phytochemicals that a Mediterranean-style diet provides. Secondly, this diet helps increase the amount of tryptophan in your system, the molecule from which serotonin, the brain’s chemical messenger, is synthesised.

Post-alcohol low

I cut out alcohol. It can appear to help with anxiety in the short term by raising the levels of certain neurotransmitters in the brain (though the research is inconclusive). On a day-to-day basis, we need those chemical messengers to be busy sending messages brain cell to brain cell saying ‘I feel happy.’ Chemical receptors can also be affected by low iron levels. But after drinking, these neurotransmitters are broken down and excreted, which may make people feel low afterwards.

It is especially dangerous for those like me who feel most anxious in the mornings, since hangovers create a cycle of waking up feeling even more nervous and ill. I hardly drank before and certainly had not done so when ill; now I have stopped altogether.

There is strong evidence linking depression with good and bad fats. Fat is essential to the brain, which is itself 60 per cent fat. We want our brains to be made up of the good, unsaturated fats known as omega-6 and omega-3 essential fatty acids, rather than animal-based fats. We also need the correct ratio of omega-6 to omega-3 oils: most of us eat too little of the omega-3s.

Foods to add and subtract

I found the easiest way to put my research into practice was to make lists of what to eat more of and what to avoid, meal by meal.

At breakfast I go for sugar- free muesli with berries, porridge, wholegrain or sourdough toast spread with peanut butter, oatcakes with goat’s cheese, eggs or other protein. Breakfasting well, combining protein and complex carbohydrates, is a good way to balance your brain chemistry for the rest of the day.

At lunch I eat protein-rich food such as chicken, turkey, fish or pulses with vegetables and salad are good. I avoid sandwiches, instead sprinkling nuts and sesame seeds on to salads to better combat anxiety.

In the afternoons I’ve found the best snacks are fruit and nuts, Brazil nuts in particular. If you can’t resist chocolate (and I can’t), at least make sure it is dark chocolate. It’s never worth going hungry, as the brain needs that steady supply of nutrients to keep your mood on an even keel.

At supper I find that a meal rich in carbohydrates with the addition of some protein helps me to sleep better and improves my mood. Protein is important to help balance blood sugar before bed. Wholegrain pasta with a tomato and prawn sauce, a stir-fry with brown rice and chicken, or a baked or sweet potato with some cheese, even porridge sprinkled with nuts, are all good choices.

Ideas to Help - 25 July, 2014 FROM THE COUCH BY RACHEL KELLY

From how to sleep to how to wake up: It might seem easy enough, but we know that those who suffer from depression and anxiety are at their worst in the mornings. Psychiatrists call it ‘Diurnal mood variation’; Snoopy said he thought he was ‘allergic to mornings’. For me, it means that sometimes I can start the day with a racing heart and sweaty palms. I can feel breathless and I occasionally throw up. The sides of the bed can feel like a cliff-face. I’ve learnt to diffuse such fears partly thanks to awareness: this is what happens, it is what it is, but it will pass. In practical terms, there’s nothing for it but to force myself up, to let go finger by finger of the pillow I am hugging with its faint reassuring scent of my husband. The very action of rising helps reverse the negative thoughts willing me to get back under the duvet. It’s important that I get out of bed instantly. Even a second’s delay could mean that I end up staying in bed for hours. Drinking water helps. So does opening the window and leaning outside: we know exposure to daylight is crucial to help combat low mood. A line of inspiring verse stuck to the bathroom mirror is another tool: at the moment, it’s from ‘Desiderata’ by Max Ehrmann. ‘You are a child of the universe, no less than the tress and the stars; you have a right to be here.’ And a morning routine, at roughly the same time each day, is crucial. This is not the moment to experiment with decision-making, bad at the best of times. By about nine o’clock, the worst of the anxiety has ebbed away. Oh, and don’t forget the cappuccino with an extra shot.

Ideas to Help - 24 July 2014 - Huffington Post

How to Sleep Well

When do manageable fears become terrifying obsessions? For me, it is when I am sleep-deprived. When we don't get enough sleep, the emotional centre of the brain becomes more active. This is particularly unfortunate if you suffer from anxiety and depression.

In one study a set of increasingly disturbing images were shown to people who had slept normally, and to others who had been deprived of sleep for thirty-five hours. It found that the emotional centre of the brain, the amygdala, was about 60 per cent more active in people who had been sleep-deprived. The study also found that the connection between the amygdala and the frontal lobe of the brain had been disrupted by lack of sleep. The frontal lobe slows down the brain's emotional centre. When you are sleep-deprived, you lose control over your emotions. (1)

My experience of depression began with insomnia. I found it hard to get to sleep, hard to stay asleep, and had a tendency to wake up early - feeling sick with exhaustion. My insomnia needed to be dealt with if the illness was to end.

The reassuring news is that learning to sleep is a skill like any other. But it's a skill you can probably only acquire as you start to get better. When I was in the grip of acute depression, there was nothing for it but to take tranquilisers. But as this enabled my body to get more sleep and start to recover, my psychiatrist advised that I should start trying to understand the situation for myself in more biological terms.

Our bodies are cleverer than our minds. When we are truly tired, we will fall asleep. Sleeping is a natural action. You don't have to do anything to get to sleep. It is not humanly possible to stay awake forever. The one topic that mustn't be on one's list of worries is sleep itself. That is what can stop you from sleeping and make you ill, both physically and psychologically.

Lying awake in the dark, we are robbed of normal cues. We may not be able to see reassuring prompts of our familiar surroundings, and we may experience time differently. We may be fearful as we feel we are alone, even if we share a bed with someone. When they are asleep, we are alone with our insomnia.

In order to stop being anxious about sleep, I had to start believing that in due course I would get the sleep I needed. I had to accept that this might not always happen conveniently at night, so I had to arrange my life as far as I could to make this possible. If I was awake at night, I needed to make it feel normal as opposed to frightening. One obvious resource for me was to remind myself that I wasn't alone.

I now try to enjoy lying awake in the dark with my feelings, even going a step further and contemplating that I am awake for a reason and it is safe to be so. I practise breathing techniques. I try to meet my own needs for reassurance and calm, and have a conversation with the scared person who is sweating at four o'clock in the morning.

Being compassionate to myself is sometimes enough. When I am sufficiently calm, I can then try to change the narrative of my thoughts. Every time the worries return, with steady willpower I guide my excitable mind elsewhere, as if I am on a train and have to move along the carriages until I find a comfortable berth. I then try to anchor my thoughts to something more positive and pleasant, something complex enough to hold them for a long time.

Sometimes I get up, put the light on and try to learn a new poem by heart. When I was first ill William Butler Yeats's 'The Lake Isle of Innisfree' and its evocations of quiet helped me relax, my unconscious mind eventually ceasing to distinguishing between real or imagined experience as I listened to the shimmer of lake water.

I recall being young in my grandparents' house as a relaxation technique, retracing my old steps, remembering the hall table upon which were invariably a few small envelopes addressed in my grandmother's purple ink and bearing a second-class stamp. I taste the thinly sliced and buttered bread for tea and hear the heavy tread of my grandfather winding up the clocks. Room by room, I travel back in time and recollect the peace of a happy childhood.

As you recover, you can take further steps and practise what doctors now call good 'sleep hygiene'. All the clichés apply: a completely dark room (I put up blinds); a milky drink (dairy products are rich in tryptophan, an amino acid that also acts as a hypnotic); doing nothing too stimulating before bed (a wind down routine); and going to bed at roughly the same time every night. It wasn't as though I didn't know about such approaches. The difference was that now I rigorously put them into action.

In Macbeth, one of Shakespeare's most anxious plays (in all senses), the leading man believes he has killed sleep itself. He introduces a wonderful string of comparisons about the value of sleep which are possibly the most beautiful ever written: sleep is, variously, 'The death of each day's life, sore labour's bath/ Balm of hurt minds! Great nature's second course/ Chief nourisher in life's feast.' It also - possibly the most ingenious yet - 'knits up the ravell'd sleeve of care.' Maybe some of the approaches above will help you knit up that unravelled sleeve of care, and terrifying obsessions will once again become manageable fears.

References:

1)'The Human Emotional Brain Without Sleep: A Prefrontal-Amygdala Disconnect,' Current Biology, 2007.

http://www.huffingtonpost.co.uk/rachel-kelly/how-to-sleep-well_b_5612863.html

Ideas to Help - 19 July, 2104 FROM THE COUCH BY RACHEL KELLY

Sleep is such an important Key to Calm that I am returning to the topic. It is particularly relevant to those dogged by anxiety and depression: when we are sleep-deprived, our emotional brain (the amygdala) becomes more active and we can no longer regulate feelings effectively, locking us into a downward spiral of over-sensitivity and yet more anxiety.

We established last week that insomnia itself is not the problem per se: it is worrying about not sleeping that feeds our insomnia and chokes us with stress like angry ivy covering a ruined house.

The question is then what to think about instead. For me, reciting a poem is one answer. In repeating Wordsworth or Yeats, Herbert or Emily Dickinson, I soothe my hurt mind and tell myself a more positive story. I feel less alone, hearing a new and welcome voice in my head which teaches the virtues of acceptance and hope rather than struggle and despair. I’ve been particularly calmed in the last few weeks by George Herbert’s ‘The Flower’. One of my favourite lines is ‘Grief melting away/ Like snow in May.’ Another favourite is ‘Who would have thought my shrivelled heart/ Could have recovered greenness.’ Herbert is my friend in the small hours of the night. I hope he might become yours.

http://nottinghillpost.com/news/kellys-keys-calm-7/

Ideas to Help - 15 July 2014 - Huffington Post

How Poetry Can Prove a Lifeline

Would you read poetry when you are suffering from severe depression? What if you don't have the energy to cross the room? This is something people have asked in relation to my memoir Black Rainbow, which describes how poetry proved a lifeline during my seventeen-year battle with depression.

I didn't have the energy to read a book when I was at my worst, but I could listen. My mother would read to me by my bedside, or recite poems she knew by heart. Words were what I knew, what I had always relied on: loving poetry when I was growing up, writing essays at school and university, and churning out copy as a Times journalist.

'My grace is sufficient for thee; my strength is made perfect in weakness,' she would repeat from Corinthians. And even as a bored child at church I always appreciated the poetry of the Bible. In The King James Version the sound and rhythm of the words is often as beautiful as their meaning: take this from the famous Psalm 23: 'He maketh me lie down in green pastures: he leadeth me beside the still waters.' You are lulled by that gently running stream of language.

During my depression I clung to the words I heard and repeated them like mantras. Another mantra was the last lines of Arthur Hugh Clough's poem 'Say Not The Struggle Nought Availeth,' which was a favourite of Churchill during the war: 'In front the sun climbs slow; how slowly/ But westward, look, the land is bright.' These lines began to reverse the malicious narrative in in my head. Rather than wishing to die, I would recover, and indeed be stronger. There might even be a point to the suffering.

Of course, I couldn't have recovered without medication, and I couldn't have fully understood the context of my illness without undergoing therapy later. But drugs need time to take effect, and there will be a long gap between starting to get better and being well enough for therapy. Indeed, there is a period of a depressive episode in which nothing seems to work. It is then that you need the most willpower, and, ironically, the most belief in your own ability to recover.

In the middle of the night, and subject to the double sense of isolation which depression and wakefulness at that time brings, I would repeat snatched lines of poetry to myself. I wasn't alone after all.

It was only when the antidepressants began to work that I could concentrate on full short poems. I read Gerard Manley Hopkins, who is himself thought to have suffered from a bipolar illness. As I contemplated poems such as 'The Windhover,' 'Pied Beauty,' and 'As Kingfishers Catch Fire,' it was as though nature was announcing itself and restoring me to my former sensitivity. Hopkins's ecstatic language bathed my own dormant powers of expression in light. I could newly appreciate the simplest things, such as the motion of clouds across the sky. Take these rolling lines from 'That Nature is a Heraclitean Fire:' 'Cloud-puffball, torn tufts, tossed pillows flaunt forth, then chevy on an air-/ built thoroughfare: heaven-roysterers, in gay gangs they throng; they glitter in marches.' There were words there I'd never seen, but they seemed to communicate their meanings through their very exuberance.

The most important poem I read during my depression was George Herbert's 'Love (III)'. The first lines sent a bolt of electricity through me: 'Love bade me welcome: Yet my soul drew back,/ Guilty of dust and sin.' The idea that my soul was 'guilty of dust and sin' seemed the most perfect description of what I was suffering. Why did I have the right to be depressed when I was blessed with a loving, healthy family and good career? It seemed Herbert and I had been to the same place and spoke the same language, albeit that his visit was centuries ago.

In the last lines of the poem, the compassionate voice of 'quick-eyed Love' asks the sufferer to 'sit and eat.' This was a particularly appropriate welcome for me: I hadn't been able to eat properly for a while.

Herbert may well have been diagnosed with depression had he lived today, and his poems are only with us because he intended them for the emotional and spiritual wellbeing of others. Shortly before his death he sent them to a friend, requesting he publish them only if he believed they could 'turn to the advantage of any dejected poor soul.' I would certainly count myself as among those dejected souls that his words have healed and even validated.

Great literature can reassure you that what you're going through is serious and real. If you are having psychological or emotional trouble, it is often invisible to others. The written words of others are testaments to the reality of what you are going through.

There's even scientific evidence that poetry changes the way we think. The arrangement of poetry, even the clearest, has different conventions to continuous prose. This presents enough of a challenge to get our brains working differently.

Research by Philip Davis and the neuroscience department of Liverpool University discovered that readers of Shakespeare, when they came across an unusual but totally comprehensible grammatical construction, would show a spike on the graph of their neural activity. (1) Even though the readers understood what was being said, their brains were shocked into activity. It is this activity which takes your mind off the spiral of negative thinking which depression induces. In this way, poetry can work in a similar way to mindfulness techniques, forcing us into the present.

Black Rainbow began life as a series letters and emails to friends, recommending them poems to suit their pressing emotional needs of the time. With the book's publication,strangers have been sending me poems that have helped them. It gives me hope that so many are aware of, or are willing to try, the restorative effects of poetry.

1) 'Syntax and Pathways,' by Philip Davis in Interdisciplinary Science Review Vol 20, issue 4 (2008)

http://www.huffingtonpost.co.uk/rachel-kelly/how-poetry-can-prove-a-li_b_5583756.html

Ideas to Help - 11 July, 2014 FROM THE COUCH BY RACHEL KELLY

Holidays are here: in theory, I should sleep more soundly given I no longer have to fret about the school run. But like many who battle with anxiety, insomnia remains a constant challenge. I can have trouble getting to sleep, trouble with waking in the night, and trouble waking up too early. I crave the deep, oblivious sleep that helps keep my Black Dog at bay, what Shakespeare called ‘the balm of hurt minds’.

The reassuring news is that learning to sleep is a skill like any other. My psychiatrist has helped me understand that not sleeping very much is not the problem. The danger is worrying about it. That is what can stop you from sleeping and make you ill. Our bodies are cleverer than our minds. When we are truly tired, we will fall asleep. Sleeping is a natural action. You don’t have to do anything to get to sleep. It is not humanly possible to stay awake forever.

But the one topic that mustn’t be on one’s list of worries is sleep itself. It is the ultimate paradox: to achieve sleep, you have to abandon the imperative to achieve it. I also believe in taking more practical steps and practise what doctors now call good ‘sleep hygiene’. All the clichéd approaches help: a completely dark room (I put up blinds); a milky drink (dairy products are rich in tryptophan, an amino acid that also acts as a hypnotic); doing nothing too stimulating before bed (a wind-down routine); and going to bed at roughly the same time every night. Here’s hoping your hurt mind receives the balm of a good night.

Ideas to Help - July 9, 2014 FROM THE COUCH BY RACHEL KELLY

So we’ve dealt with the pesky topic of school reports (last week’s column – the gist: ignore them) but July also brings Sports Day. Naturally the only race that matters is the Mother’s: as one wise ten-year-old said to his mater in her spiked running shoes, it’s all about taking part – as long as you win. I didn’t take part. Competitive sport is not my thing. We all know we need to exercise/ the endorphin highs/ health benefits/ blah blah blah… But we must all find what works for us. For me, it’s dance. As I left my Santhosh class this week (Sanskrit for happiness), here’s why it is a key to calm. Mastering the steps requires concentration, much like poetry, and that stops me worrying. I feel natural and unforced moving to the beat, just as children dance instinctively, and indeed also love poetry, rhyme and rhythm. Dancing is the closest any ‘exercise’ can come to being an art form. My fellow dancers are warm (literally), supportive, and encouraging: it’s therapeutic to be part of such a group. I’m too old to ‘win’ or ‘lose’. And yes, you’ve guessed it: I’m off to suggest a Mother’s Dance at my child’s school …  santhoshdance and santhoshretreats.

GUEST BLOG - 7th July 2014 - Jo Johnson

Can you shrink your Smirch?

Jo Johnson is a consultant neuropsychologist with a special interest in MS. Here she explains the thinking behind her forthcoming book, Shrinking the smirch, and introduces a new Facebook group where people can share practical tips for living with long term conditions

 Shrinking the Smirch is a new workbook for helping people cope with physical and mental health challenges as well as everyday stress. 

The workbook asks you to imagine that the source of your troubles is an imaginary creature called a smirch. A smirch means a smudge that makes your life less good than it could be. Here is Kevin, my smirch, in the workbook there are many different shaped and sized smirches, they are all different.

This sounds like a strange idea but externalising your mental or physical health challenges is not a new idea. Perhaps Winston Churchill's Black Dog which represented his depression is a good example of this.

Shrinking the Smirch firsts asks the reader to imagine what your smirch might look like and what it makes you think, feel and do. The book includes a yearbook of examples from other people. 

The smirch has lots of equipment it uses to trouble humans, like contact lenses to make everything look rubbish and a fatigue pipe to exhaust you, but it's most powerful weapon is its smirchiepod, an ipod to play tunes that upset. Popular tunes include ‘You will fail,’ ‘You are less good than others,’ ‘Everyone else is coping,’ ‘You will only get worse,’ and ‘What on earth are they thinking?’

The workbook asks you to notice your own negative spirals that lead you to behaviour that is not helpful like withdrawing, over-thinking, emotional eating or too much wine. So at the beginning of the workbook, the smirch has the most power and a large bag of accessories and the reader has an empty bag.

Shrinking the smirch then takes you through twenty shrinking tips drawn from approaches like CBT, ACT and mindfulness-based approaches to help you reduce the smirch's impact on your life. Each of the twenty tips include something to put in your bag to help you shrink your smirch. Chapters include ideas for managing tricky thoughts and feelings, time and fatigue management, as well as some commonsense ideas about diet and exercise and mental health. Thus by the end of the book, the reader has a bag full of strategies and the smirch, whilst still there, is much smaller.

Whilst its tone is intended to be fun it tackles many of the serious themes that crop up for people with anxiety, depression and other psychological symptoms. The last section allows you to create a personalised revenge plan of the ideas in the book that you feel will most help you.

Shrinking the Smirch can be purchased from amazon or Speechmark RRP £16.00 and is written by Jo Johnson, a consultant neuropsychologist and illustrated by Lauren Densham.

Ideas to Help - 3 July 2014 - Depression Alliance

There is hope

Written by Rachel Kelly on 2 July 2014

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There are no side-effects, it’s free, and it just may help someone. It was with this in mind that I travelled to Maidenhead a few weeks ago to host a Healing Words workshop for the dozen or so who had gathered as part of a Depression Alliance support group. An hour later, we had laughed, we had cried, and dare I say it, the bits of healing poetry and prose that we shared had worked some magic

Of course, in the battle we face with our own Black Dog, what works is different for everyone. For me, poetry helps: it has been at the heart of my recovery from two major breakdowns, or ‘depressive episodes’ as psychiatrists prefer to call them. The first time I was bed-ridden for six months, the second for a year. Others will find other strategies that help them – it might be baking or gardening, and actually I find them helpful too (as well, of course, as therapy and drugs on occasion). But I’m a passionate believer that words can heal. Apollo was the God of poetry as well as medicine. There’s even some neuroscience that proves that the concentration required to read a poem can help root us in the present, stopping us from regretting the past or worrying about the future. (Sounds familiar?)

Here are some one-liners to get you started but once you’ve begun, you will find bits of verse and prose that answer your own needs, not mine. I would start with some healing mantras or short lines: some of my favourites are‘This too will pass’ (from Corinthians); ‘My strength is made perfect in weakness’ (ditto) or ‘Westward look, the land is bright’ – from the poem ‘Say not the Struggle Naught Availeth’ by Arthur Hugh Clough. When I feel the loss of all hope, I keep repeating these lines and they help change the dialogue in my head to something more positive.

If you’re feeling well enough, then try the poem ‘Love” by George Herbert, with the opening lines: “Love bade me welcome, but my soul drew back/ Guilty of dust and sin”. That’s what depression feels like to me: I’m guilty of “dust and sin”. But in the poem Herbert says allow “Love” to talk to you instead, develop a more compassionate voice. It’s what CBT tries to do, but far better expressed. Next up “Invictus”, supposedly recited by Nelson Mandela to fellow inmates when he was incarcerated on Robben Island. It has a very good opening description of the darkness of depression “Out of the night that covers me/ Black as the Pit from pole to pole…”. The last two lines are helpful for trying to regain your own sense of self, so often crushed by depression. “I am the master of my fate/ I am the captain of my soul”. Finally, try “Hope” by Emily Dickinson. Here’s the first verse:

‘Hope’ is the thing with feathers
That perches in the soul
And sings the tune without the words
And never stops at all

There is hope. And I hope these poems help you as much as they’ve helped me.