These drugs may be taken orally every day, throughout the menstrual cycle, or just taken when premenstrual syndrome (PMS) symptoms are present in the 2 weeks before a woman's period:

Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)

How It Works

These drugs, called selective serotonin reuptake inhibitors (SSRIs), improve mood by affecting the levels of a chemical messenger in the brain (neurotransmitter) called serotonin.

Why It Is Used

SSRIs may be used when:

• Depression, mood changes, and other behavioral or emotional disturbances are major symptoms of PMS.
• Depression becomes worse during the premenstrual phase.

How Well It Works

Studies have shown that the SSRIs make depression, irritability, and other behavioral and mood-related symptoms of PMS less severe. For some women, these drugs may also improve physical symptoms such as fatigue, appetite, bloating, breast pain, or insomnia.

Controlled studies have shown SSRIs are effective in relieving PMS symptoms. It may be that taking SSRIs in the 2 weeks before menstrual bleeding is more effective than taking them every day. Further studies are being done.

Side Effects

Side effects of SSRIs can include:

• Nausea, appetite changes, weight loss.
• Headache.
• Insomnia, fatigue.
• Nervousness.
• Loss of sexual desire or ability.
• Dizziness.
• Tremors.

SSRIs have not been shown to cause birth defects or other complications if a woman becomes pregnant while taking these medications.

What to Think About

These drugs may take 2 to 3 weeks to effectively relieve PMS symptoms. Studies seem to show that an SSRI used in the 2 weeks before menstrual bleeding may relieve symptoms better than an SSRI used every day.

Recent studies have shown that SSRIs can be very effective in treating PMS. A new SSRI, similar to fluoxetine (Prozac) is pending approval by the Food and Drug Administration to be used for treating PMS.

The benefits and effectiveness of SSRIs need to be compared with the side effects and costs of treatment. You can discuss this with your health professional.

See Also:

• Depression and Your Period: What You Need to Know

In spite of the fact that many people have never heard of dissociative identity disorder (DID), there are celebrities and famous people with DID. It is a rare disorder and one that not many people would likely choose to share with the world, but pro football star, Herschel Walker, has. Counting Crows frontman, Adam Duritz, has also opened up about having a dissociative disorder. Finally, the extremely famous best-selling book and miniseries, Sybil, tells of the dissociative identity disorder suffered by Shirley Mason. (Also see Real Dissociative Identity Disorder Stories and Videos and Dissociative Identity Disorder Cases: Famous and Amazing)

Shirley Mason and Sybil's Tale of Dissociative Identity Disorder

Shirley Mason, born January 25, 1923, describes having a horrible childhood with the actions of her mother being nothing less than barbaric. This transcript from a therapy session speaks to its horror:

"What about Mama?" the psychiatrist asks her patient. "What's Mama been doing to you, dear? . . . I know she gave you the enemas. And I know she filled your bladder up with cold water, and I know she used the flashlight on your, and I know she stuck a washcloth in your mouth, cotton in your nose so you couldn't breathe . . . What else did she do to you? It's all right to talk about it now. . . ."

"My mommy," the patient says.

"Yes."

"My mommy said that I was as bad little girl, and . . . she slapped me . . . with her knuckles."

As an adult, Mason spoke to her therapist of "coming to" in antique shops, her mind blank, facing dishes or figurines that were smashed to pieces. She also spoke of finding herself in strange hotels with no idea of what city she was in. These types of symptoms initially provoked a diagnosis of fugue states – a state in which a person may forget who they are entirely and go on to do things completely out of character, after which they "wake up" with little or no memory of what has happened.

It was only 10 days after that diagnosis that Mason appeared in an alternate personality in her therapy session. This new personality, "Peggy," was said to be more confident, had the ability to get angry and could also stand up for herself, whereas Mason couldn't. It was after this that multiple personality disorder was diagnosed (now known as dissociative identity disorder).

Countless therapy diaries and therapy session transcripts were turned into the best-selling book Sybil about Mason's dissociative identity disorder in 1973. The book was turned into a miniseries that was seen by one-fifth of all Americans making Sybil and dissociative identity disorder extremely famous.

Since Mason's death in 1998, however, many questions have been raised about Mason's diagnosis and the book, Sybil Exposed: The Extraordinary Story Behind the Famous Multiple Personality Case, has challenged the facts of the case saying that much of it was fabricated.

Celebrities with Dissociative Identity Disorder: Herschel Walker

It was in 2008 that the world learned of Herschel Walker's dissociative identity disorder diagnosis in his book: Breaking Free: My Life with Dissociative Identity Disorder. This 1982 Heisman Trophy winner said his life went off the tracks shortly after his football career ended. Walker said to CNN, "My life was out of control. I was not happy, I was very sad, I was angry and I didn't understand why."

In his book, Walker talks about his alternate personalities (alters) in terms of their function. He has the Hero, the Coach, the Enforcer, the Consoler, the Warrior and the Daredevil, just to name a few.

Not all alters were negative parts of Walker's life, but some caused extreme and violent behavior which Walker mostly doesn't remember.

According to CNN:

"Walker said a competitive alter caused him to be a danger to himself, playing Russian roulette more than once. In the book, he describes another incident, the very late delivery of a car, that made him so angry he had thoughts of killing someone. It was that moment that he realized he had to seek help, he said, which ultimately led to his diagnosis."

After his diagnosis, things got worse and, ultimately, DID symptoms led to the end of his 19-year marriage to Cindy Grossman. Grossman says that Walker held guns to her head, threatened her with a straight razor and threatened to kill her. Walker doesn't remember these events but doesn't deny them, as blackouts are a part of dissociative identity disorder (read about dissociative amnesia).

After 10 years of therapy for DID, Walker is doing much better. Walker told CNN, "I'm okay. I love me -- Herschel Walker. You know, 10 years ago I probably couldn't say that. But today, I can say that. I'm not going to say I'm great or I'm good, but I'm okay."

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Having a depressed wife or husband can be worrying and stressful. While we may believe that the stigma is falling away from mental illness, and that our partners can open up about their struggles with depression, this isn’t always the case. Due to surviving stigma and the isolating nature of mental illness, many people suffer depression in silence. If you’re worried your husband or wife is depressed, here are the signs and symptoms to look out for and what to do when they occur.

How to Tell If You Have a Depressed Wife or Husband

Is your wife depressed or just sad? Is your husband just having a stressful time at work or could he be clinically depressed? Of course, the only way you can answer these questions is to encourage your partner to visit the doctor and discuss their symptoms. Sadness, stress, anger and low self-esteem are all common, and experiencing them doesn't necessarily mean your partner is depressed. Rather than being a state of mind, depression is a mental illness which has specific diagnostic criteria.

According to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5 criteria), which is used by mental health professionals, the signs your partner is depressed are as follows:

1. Feelings of emptiness and hopelessness. These often manifest in tearfulness or outburst of anger
2. Loss of interest or pleasure in usual activities, such as sex, hobbies they used to enjoy or exercising
3. Sleep disturbances, such as sleeping too much or too little
4. Appetite changes that result in weight loss or weight gain
5. Feelings of worthlessness, guilt and self-blame
6. Slowed thinking, as well as difficulty concentrating and remembering things
7. Recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

Depression can also cause physical problems such as headaches or back pain. Symptoms will vary in severity, but in most people with depression, these symptoms are experienced most of the day, nearly every day. Memory problems, physical aches and pains and personality changes are common in older adults with depression.

My Wife Is Depressed: What Should I Do?

According to Mental Health America, depression affects 12 million women in the United States every year; roughly twice the rate of men, with depression occurring most frequently in women aged 25 to 44. This means that approximately one in every eight women will experience clinical depression in their lifetime.

Many women also experience Premenstrual Dysphoric Disorder (PMDD: a condition that causes major depressive symptoms in the weeks surrounding menstruation) and perinatal depression, which affects 10-15% of new mothers.

The good news is, depression is both common and treatable. You cannot diagnose your wife or provide the solution, but there is plenty you can do to help a depressed wife by offering practical and emotional support, taking on the burden of household chores, accompanying her to medical appointments and cooking her healthy meals. 

My Husband Is Depressed: Should I Be Worried?

Although depression rates are lower in men, suicide rates are higher in males with depression than in women. In the U.S., of the 38,000 people who took their own lives in 2010, 79% were men. No one knows precisely why this is, though one hypothesis states that men have a higher tendency to act impulsively than women.

If you’re worried your husband is depressed, the best way you can help is to encourage and foster open communication. It can be scary to hear someone you love tell you how bleak and hopeless they feel, but depression is a serious illness that must be tackled head-on. Listening without judgment helps destigmatize depression and encourages those affected to make and maintain healthy connections with others.

You can find more advice on how to help your depressed husband or wife at "What to Do When Your Boyfriend, Girlfriend, Partner is Depressed".

Loving someone with depression isn't easy, but you can call the NAMI helpline at (800)-950-6264 for advice and support. If your wife or husband is depressed and suicidal, you can call the National Suicide Prevention Lifeline (1-800-273-8255) or contact your local emergency services.

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If you’re experiencing depression from work, your symptoms might be joined by anxiety. If you can’t do your job, will you lose it? You might have mixed thoughts and feelings, too. It might be a relief to be fired from that job. But if you need the job, losing it could have dire consequences. Everything swirls together in a perfect storm that deepens depression. Understanding depression from work can help you know how to deal with it.

Causes and Effects of Depression from Work

When you can identify some of the reasons for work-related depression, you can address them and lessen their negative impact on your mental health. Some factors involved in having depression from work include:

• A job that’s a poor fit for your interests and skills
• A toxic environment with bosses and/or coworkers who bully you
• Unreasonable demands, unclear guidance, and little support
• Negativity and low morale
• Poor communication among employees/employers
• A workload that disrupts a healthy work-life balance and creates feelings of guilt for spending so much time away from your family
• Low pay that keeps you struggling to make ends meet
• Working for a company whose values don’t match yours, resulting in ethical dilemmas
• Having no sense of meaning or fulfillment
• Feeling that you have no power to change your situation

Job-related depression is hard to deal with. Often, people resort to unhelpful behaviors because they don’t know what else to do or because their depression is interfering with their ability to function. Chronic absenteeism or tardiness, isolating on the job and ignoring coworkers, and communicating in passive-aggressive ways all lead to more discord on the job and deeper depression.

Notice what you’re experiencing. If you find yourself increasingly suffering from work depression and acting in unhelpful ways, it might be time to change your situation.

If You Have Depression Related to Your Job, Should You Stay or Go?

Perhaps the most important guideline in deciding to leave your job because of depression is that there isn’t a correct answer, and “should” doesn’t apply. Everyone is a unique person, every workplace is different, and depression is an individualized illness. The best decision is the one that is right for you and your life.

In deciding whether to leave your job, reflect on all the ways your job contributes to depression as well as what has kept you there so far. Can you experience more of the things that keep you there? Can you make any changes to improve your situation?

Consider, too, how approachable your boss and coworkers are. Sometimes, having an open discussion about your depression can lead to positive changes and better understanding. Sadly, sometimes honest conversations about mental health make a problem worse because people don’t understand. Know your environment to decide if a conversation would help.

If you decide to leave and begin to look for another job, be gentle with yourself. Job hunting can be difficult and stressful. A job search can aggravate depression. The good news is that there are ways to handle depression from work or job hunting.

Handling Depression from Work

Depression can destroy self-esteem. When you can’t do your job or find work, you might have thoughts like these:

• I’m worthless.
• I can’t do anything right.
• I’m not good enough to have a job.
• No one respects me.
• No one wants to work with me.
• There’s something wrong with me.

Thoughts like these are known as irrational beliefs. They’re inaccurate and don’t represent who you are and what you do; however, depression makes you believe them. Working with a therapist who uses cognitive behavioral therapy (CBT) can help you change your negative self-talk, ease your depression, and believe in your ability to take charge of your situation. Therapy can also help you see your strengths and use them at work or to find a new job.

Among other things you can do to handle work-related depression:

• Tend to your physical and mental health by eating nutritiously and exercising
• Learn new job skills, including resume-building
• Develop healthy outlets to release stress, like working out or getting creative
• Develop a friendship with at least one coworker
• Practice mindfulness by being present where you are now (be at work when you’re at work, and be at home when you’re at home)
• Identify what bothers you the most right now, and take action to change it

Depression from work can be hard to handle. It can make it so you can’t do your job, which makes you feel worse. This can continue in a vicious cycle, but you can break it. While it’s true that depression makes it hard to make positive changes, it’s also true that when you start with one small action, you’ll gain momentum to lift your depression and change what needs to be changed at work.

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Depression tattoos are becoming increasingly popular. With the body as a canvas, people are using their creativity, a character strength that helps people thrive despite challenges, to cope with depression in a positive way. Depression tattoos are highly personal, messages from people to themselves or sometimes to make a statement to others. Anything that has personal significance makes an inspiring depression tattoo. Here’s a glimpse of some art that others have embraced.

The Purpose and Power of Depression Tattoos

More than just pictures or words, tattoos about depression convey a deep message. Their purpose is as diverse and individual as their artistic expression. In general, this skin art serves multiple functions. Depression tattoos can:

• Be coping strategies, reminding people of something important or providing encouragement whenever needed
• Be conversation starters, encouraging others to remark or inquire and leading to open conversation.
• Be a badge of honor, a continual reminder that you’re surviving
• Act as a personal vision board, always with you and reminding you of what you’re living for
• Honor a value or an ideal that you hold dear
• Signal to others who are also living with depression, a way of silently but boldly reaching out for solidarity
• Serve as personal symbols of victory over your illness (some who have contemplated suicide depict reminders of what they didn’t do)
• Prompt you to take care of yourself, like the proverbial string around your finger
• Be a personal coach who’s always with you, reminding you of your purpose, your reason for persevering despite the pain
• Be a beautiful way to cover emotional and physical scars, not to hide the scars in shame but to make them beautiful  
• Ground you and remind you that depression hasn’t robbed you of who you are
• Symbolize your depression at its worst
• Symbolize your recovery
• Serve as mindfulness or focus objects to help you change your thoughts in an instant
• Be celebrations honoring important recovery milestones

Let the deep purpose of depression tattoos move you as you view these beautiful works of art.

Samples of Inspiring Depression Tattoos

Each individual selects tattoos that are personally meaningful. They take many forms, from the simple to the ornate.

You’ll notice the semicolon symbol in many of the tattoos below. This semicolon has become a powerful symbol of mental health struggles. The semicolon is a type of punctuation used to indicate a strong pause between two complete sentences. A writer could choose to end a sentence; instead, though, they choose to pause rather than end. So, too, do many people struggling with depression. Rather than choosing to end their “sentence,” they see their illness as a pause, and then they keep going, keep surviving, keep living.

• 1. Semicolon transforming into birds

• 2. Semicolon sunflower

• 3. PQRST waves

• 4. Fighter ]

Sometimes, tattoos are words. A single word, a phrase, an inspiring quotation, line from a book, or lyric from a song.

• 5. Breathe

• 6. Be strong

• 7. I am enough

• 8. And here you are living despite it all

• 9. I’m fine/Save me

• 10. Darling you’ll be okay

• 11. I am terrified by this dark thing that sleeps in me

• 12. I found within me an invincible summer

• 13. Just live

• 14. Still ill

• 15. She is a soldier at war with herself ]

Tattoos can be simple, yet strong, symbols. Some people even depict serotonin and dopamine, the neurochemicals that can play a big role in major depression.

• 16. Butterfly

• 17. Green ribbon hope

• 18. Person

• 19. I am I am I am The Bell Jar

• 20. Serotonin

• 21. Serotonin with phrase

• 22. Serotonin and dopamine

• 23. Skeleton hand

• 24. Storm cloud

• 25. Storm cloud with sun ]

Depression tattoos can be elaborate, big and colorful with intricate designs covering large areas of the body.

• 26. Ship in a bottle

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• 27. Tapestry ]

For those who wish to express themselves and find inspiration through this art form but are unsure about the committing to something this permanent, consider trying your hand at temporary tattoos. Kits for creating beautiful, short-term tattoos are available from retailers. These look just like the real thing (they’re not the stickers of childhood), plus they offer the added benefit of allowing you to be the artist.

Tattoos are all different, and all are deeply personal and deeply meaningful. They have in common their symbolism and their ability to let people wear their heart on their sleeve and their soul on their skin.

For all their deep purpose, meaning, and expressive beauty, depression tattoos are powerfully simple in a very important way. If nothing else, tattoos about depression can be merely something that makes you happy and brings a little smile to your face when life does not.

When it comes to pill-splitting, here's how to correctly split a pill.

Researchers at the Veterans Administration Medical Center in Asheville, N.C., studied patients to determine how effectively they were able to cut various types of splittable pills, and whether arthritis, a common disorder of aging, hampered that ability.

"Patients' perceptions of having conditions that affect their hands didn't seem to be as big a problem as we thought," said Brian Peek, the clinical pharmacist who led the VA study. "We knew some of them had arthritis, and that did not turn out to be a significant predictor" in accurately halving tablets.

The researchers also wanted to know if detailed instructions from pharmacists made people better pill splitters.

"We had them use two fairly common splitting devices," Peek said of a hinged cutter and a special razor blade, both of which can be purchased at pharmacies.

All too often, Peek said, patients buy splitters from pharmacies and never ask for individual instruction. He and his colleagues set up the study to take that reality into account.

In the analysis, 30 men between the ages of 50 and 79 were assigned to rotating groups: splitter A with instruction and splitter A without instructions. The two groups used the hinged cutting device. There were also two splitter B groups, with and without instructions, using the razor.

Participants who were in the "instructed" groups were read how to split pills, followed by a demonstration of the practice. Pill splitters in the instructed groups were allowed time to ask questions. The groups receiving no instruction were simply read general information about the study itself.

Patients then were asked to split 14 tablets of each of these types: flat round tablets, irregularly shaped tablets, small oblong tablets and large oblong ones. Tablet weight before and after splitting was determined by an analytical weight.

In the end, regardless of group, researchers found patients' tablet-splitting resulted in dosage deviations between 9 percent and 37 percent from those intended. Peek said about 47 percent of patients in the study reported experience with having split pills on their own. And those with experience, regardless of instruction, were most acccurate at splitting flat, round tablets. More deviations in dosage were found with the more irregularly shaped pills.

However, Peek added that an approximate deviation of as much as 10 percent may not be clinically significant with many medications that are split. Larger deviations in the study could prove hazardous for medications with a "narrow therapeutic index." Such an index, Peek said, refers to medications that can have under- or overdoses when inaccurately cut.

Warfarin, a powerful blood thinner, is a prime example of a narrowly indexed drug. Cutting away even slightly more than half of the drug eliminates the medication's therapeutic ability, leaving the patient vulnerable to dangerous clots. When too much of the medication is left on the split "half," patients are in danger of hemorrhaging.

"We hope that this study, along with others in the medical literature, will help health care providers make decisions about tablet splitting, especially when tablet-splitting is looked at as an option," Peek said.

Warning: Do not make any changes in your medications or the way you take your medications without first talking it over with your doctor.

WORST Things to Say to Someone Who Is Depressed

Some people trivialize depression (often unintentionally) by dropping a platitude on a depressed person as if that is the one thing they needed to hear. While some of these thoughts have been helpful to some people (for example, some find that praying is very helpful), the context in which they are often said mitigates any intended benefit to the hearer. Platitudes don't cure depression.

Here is the list from contributors to ask:

0. "What's your problem?"

1. "Will you stop that constant whining? What makes you think that anyone cares?"

2. "Have you gotten tired yet of all this me-me-me stuff?"

3. "You just need to give yourself a kick in the rear."

4. "But it's all in your mind."

5. "I thought you were stronger than that."

6. "No one ever said life was fair."

7. "As you get stronger you won't have to wallow in it as much."

8. "Pull yourself up by your bootstraps."

9. "Do you feel better now?" (Usually said following a five minute conversation in which the speaker has asked me "what's wrong?" and "would you like to talk about it?" with the best of intentions, but absolutely no understanding of depression as anything but an irrational sadness.)

10. "Why don't you just grow up?"

11. "Stop feeling sorry for yourself."

12. "There are a lot of people worse off than you."

13. "You have it so good, why aren't you happy?"

14. "It's a beautiful day!"

15. "You have so many things to be thankful for, why are you depressed?"

16. "What do you have to be depressed about."

17. "Happiness is a choice."

18. "You think you've got problems..."

19. "Well at least it's not that bad."

20. "Maybe you should take vitamins for your stress."

21. "There is always somebody worse off than you are."

22. "Lighten up!"

23. "You should get off all those pills."

24. "You are what you think."

25. "Cheer up!"

26. "You're always feeling sorry for yourself."

27. "Why can't you just be normal?"

28. "Things aren't *that* bad, are they?"

29. "Have you been praying/reading the Bible?"

30. "You need to get out more."

31. "We have to get together some time." [Yeah, right!]

32. "Get a grip!"

33. "Most folks are about as happy as they make up their minds to be."

34. "Take a hot bath. That's what I always do when I'm upset."

35. "Well, everyone gets depressed sometimes!"

36. "Get a job!"

37. "Smile and the world smiles with you, cry and you cry alone."

38. "You don't look depressed!"

39. "You're so selfish!"

40. "You never think of anyone but yourself."

---

More of the Worst Things to Say to a Person with Depression

41. "You're just looking for attention."

42. "Have you got PMS?"

43. "You'll be a better person because of it!"

44. "Everybody has a bad day now and then."

45. "You should buy nicer clothes to wear."

46. "You catch more flies with honey than with vinegar."

47. "Why don't you smile more?"

48. "A person your age should be having the time of your life."

49. "The only one you're hurting is yourself."

50. "You can do anything you want if you just set your mind to it."

51. "This is a place of business, not a hospital." (after confiding to supervisor about my depression)

52. "Depression is a symptom of your sin against God."

53. "You brought it on yourself"

54. "You can make the choice for depression and its effects, or against depression, it's all in your hands."

55. "Get off your rear and do something." -or- "Just do it!"

56. "Why should I care?"

57. "Snap out of it, will you?"

58. "You want to feel this way."

59. "You have no reason to feel this way."

60. "Its your own fault."

61. "That which does not kill us makes us stronger."

62. "You're always worried about *your* problems."

63. "Your problems aren't that big."

64. "What are you worried about? You should be fine."

65. "Just don't think about it."

66. "Go Away."

67. "You don't have the ability to do it."

68. "Just wait a few weeks, it'll be over soon."

69. "Go out and have some fun!"

70. "You're making me depressed as well..."

71. "I just want to help you."

72. "The world out there is not that bad..."

73. "Just try a little harder!"

74. "Believe me, I know how you feel. I was depressed once for several days."

75. "You need a boy/girl-friend."

76. "You need a hobby."

77. "Just pull yourself together"

78. "You'd feel better if you went to church"

79. "I think your depression is a way of punishing us." &emdash;My mother

80. "Sh_t or get off the pot."

81. "So, you're depressed. Aren't you always?"

82. "What you need is some real tragedy in your life to give you perspective."

83. "You're a writer, aren't you? Just think of all the good material you're getting out of this."

84. This one is best executed with an evangelical-style handshake, i.e., one of my hands is imprisoned by two belonging to a beefy person who thinks he has a lot more charisma than I do: "Our thoughts and prayers are with you." This has actually happened to me. Bitten-back response: "Who are 'our'? And don't do me any favors, schmuck."

85. "Have you tried chamomile tea?"

86. "So, you're depressed. Aren't you always?"

87. "You will be ok, just hang in there, it will pass." "This too shall pass." --Ann Landers

88. "Oh, perk up!"

89. "Try not being so depressed."

90. "Quit whining. Go out and help people and you won't have time to brood..."

91. "Go out and get some fresh air... that always makes me feel better."

92. "You have to take up your bed and carry on."

93. "Why don't you give up going to these quacks (i.e., doctors) and throw out those pills, then you'll feel better."

94. "Well, we all have our cross to bear."

95. "You should join band or chorus or something. That way you won't be thinking about yourself so much."

96. "You'll change your mind."

97. "You're useless."

98. "Nobody is responsible for your depression."

99. "You don't like feeling that way? So, change it."

Compiled by bw@cv.hp.com.

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Best Things to Say to Someone Who Is Depressed

It is most tempting when you find out someone is depressed, to attempt to immediately fix the problem. However, until the depressed person has given you permission to be their therapist (as a friend or professional), the following responses are more likely to help the depressed.

The things that didn't make me feel worse are words which 1) acknowledge my depression for what it is (Not 'it's just a phase') 2) give me permission to feel depressed (Not 'but why should you be sad?')

1. "I love you!"

2. "I care"

3. "You're not alone in this"

4. "I'm not going to leave/abandon you"

5. "Do you want a hug?"

6. "I love you (if you mean it)."

7. "It will pass, we can ride it out together."

8. "When all this is over, I'll still be here (if you mean it) and so will you."

9. "Don't say anything, just hold my hand and listen while I cry."

10. "All I want to do know is give you a hug and a shoulder to cry on.."

11. "Hey, you're not crazy!"

12. "May the strength of the past reflect in your future."

13. "God does not play dice with the universe." --A. Einstein

14. "A miracle is simply a do-it-yourself project." --S. Leek

15. "We are not primarily on earth to see through one another, but to see one another through" - (from someone's sig.)

16. "If the human brain were simple enough to understand, we'd be too simple to understand it." --a co-developer of Prozac, quoted from "Listening to Prozac"

17. "You have so many extraordinary gifts; how can you expect to live an ordinary life?" --from the movie "Little Women" (Marmee to Jo)

18. "I understand your pain and I empathize."

19. "I'm sorry you're in so much pain. I am not going to leave you. I am going to take care of myself so you don't need to worry that your pain might hurt me."

20. "I listen to you talk about it, and I can't imagine what it's like for you. I just can't imagine how hard it must be."

21. "I can't really fully understand what you are feeling, but I can offer my compassion."

22. "You are important to me."

23. "If you need a friend..... (and mean it)"

Compiled by bw@cv.hp.com

Should you cut your antidepressant in half to save money? A look at pill splitting, cutting larger-dose pills in half.

Experts disagree on whether this cost-saving tactic is a safe and effective practice

The cost of some medications -- many of them widely used -- can be reduced by as much as 50 percent when patients split one high-dose tablet in half to achieve the potency of the prescribed lower dose.

It's a way of getting the medication you need at a significant savings. But pill-splitting is also at the heart of the prescription drug debate. Some experts say while it makes sense mathematically -- cutting one high-dose tablet in half to yield the dosage of two lower-strength pills -- they question whether it actually bodes well biochemically: Are patients really getting one-half of the higher dose?

Even as questions abound on do-it-yourself pharmacy, a growing number of studies have begun to show that pill-splitting is a feasible way to treat a wide range of ills and, at the same time, dramatically lower costs.

Picture right: A scored pill inside an EZY Dose Deluxe Tablet Cutter; some drug manufacturers score pills to make them easier to split into roughly equal doses.

"Sometimes, it is medically necessary, and it can be done," said Curtis Kellner, director of pharmacy at the University Hospital and Medical Center at Stony Brook.

Kellner, however, is not a fan of pill-splitting.

Some people have vision problems and can't split tablets, he said. Others have arthritis. "I can't imagine my own folks splitting tablets," Kellner said of his parents.

Cost was the only reason Kellner could find to justify splitting medications. He could see no sound medical reasons to endorse the practice.

But pill-splitting is catching on as more and more patients and insurers turn to it to beat back the rising cost of prescription drugs.

The idea behind pill-splitting stems from the way in which prescription drugs are made and priced. Many tablets are "scored," meaning they have a line running through the middle. When patients purchase the higher dose of their prescribed medication, cutting tablets along the score essentially yields two lower doses.

Tom Johnson, a pharmacist at Jones Drug Store in Northport, said pills are purposely scored by manufacturers. "This makes it easier for patients to take a lower dose," he said. "Midway through therapy, the doctor may decide the patient needs only a half dose. In that case, a patient can use a pill cutter to lower the dose." The score line through the tablets was added to help patients save money. However, pharmacists and physicians emphasize that patients should be trained in pill-splitting before they attempt it.

Some tablets should not be scored because they have extended-release properties built into their design. In fact, tablet function often dictates design, said pharmacist Vincent Terranova, also of Jones Drug Store. Having a drug remain active for 12 to 15 hours is vital in the treatment of several medical conditions.

While scoring does not interfere with the activity of dozens of types of medications, breaking pills that are not designed that way can destroy properties in the coating, resulting in too much or too little medication.

"Years ago, you might have gotten a prescription to take one tablet four times a day; now, you don't have to do that. You may take one capsule daily or two times a day," the result of extended-release properties in nonscored tablets.

"Every few hours, medication is released in a certain amount. If you break that tablet, you will interfere with the extended-release mechanisms," Terranova said.

Many -- but not all -- drugs that are scored can be cut in half. Patients can split pills, using a special blade that can be purchased at pharmacies for $5 to $10.

The practice becomes an economic strategy, some experts say, because the lower and higher strengths of any given medication usually cost about the same. For example, at drugstore.com, 30 10-milligram tablets of the antidepressant Paxil cost $72.02. The same amount of tablets in the 20-milligram dose sells for $76.80. With pill-splitting, patients can get twice as much medication for only a few dollars more.

Additionally, doctors have identified all manner of tablets that can be split: those that impede pain, those for high cholesterol, depression, hypertension, and male erectile dysfunction, to name a few.

Medications, like the antidepressant Celexa, generically known as citalopram hydrobromide, are so deeply scored on both sides, that a 40-milligram tablet can be easily snapped in half by hand to yield the lower, 20-milligram dose, doctors say.

Medical experts who favor pill-splitting say people have been doing it for years. "This is a practice that has been present at a low level for a very long time," said Dr. Randall Stafford, a professor of medicine at Stanford University Medical Center in Palo Alto, Calif.

Stafford, who led a major study on the feasibility of pill-splitting, said the practice renders high-cost medications imminently affordable. And he believes it is an idea worth considering by anyone lacking prescription-drug insurance coverage. He and his team identified a range of medications that could be safely split to yield a cost savings.

"The potential cost savings with pill- splitting are not trivial," Stafford said, "and are in the range of $25 a month for most of the drugs we identified." In his investigation, Stafford identified 11 commonly used medications that could be safely split.

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Increasingly, patient advocacy groups, insurers and health maintenance organizations have begun to embrace the practice. The Veterans Administration permits pill-splitting for its patients, as does Kaiser Permanente, the largest health maintenance organization in the country.

The Illinois Medicaid program now requires patients who receive prescriptions for the 50-milligram dosage of the antidepressant to buy the 100-milligram tablets instead, and split them in half. This instantly doubles the number of tablets patients have available at about the same cost of the 50-milligram pills. Illinois Medicaid reimburses patients only for the higher-dose tablets.

However, the American Medical Association, the American Pharmaceutical Association and the American Society of Consultant Pharmacists have openly opposed mandatory pill-splitting by insurers. They cite potential underdoses or overdoses of drugs as a consequence.

A recent report in the Journal of the American Pharmaceutical Association on splitting nearly a dozen commonly used drugs, found the practice rests on the cutter's ability to accurately halve the medication. Most people tested, the study found, could neither accurately nor safely split the drugs.

John Broder, spokesman for Winthrop University Medical Center in Mineola, said neither pharmacists nor doctors there recommend the practice. However, pill-splitting is endorsed in instances when hospital physicians prescribe a dosage that is not available commercially.

"The emphasis here is that individuals should not take it upon themselves to split a dosage to make a prescription last longer," Broder said.

But patients, some doctors say, are expressly asking to be informed about the benefits and drawbacks of pill-splitting.

"The issue of pill-splitting first came to my attention," Stafford continued, "because patients came to me requesting it. By and large, these were patients who did not have insurance coverage for their medications."

Kellner, however, is more concerned about what patients obtain after they split their pills.

"There are other issues people have to be concerned with," Kellner said. Some drugs are film-coated, he said, and must remain intact to be properly absorbed. Still others, he said, are oddly shaped and cannot be split to yield two effective doses.

, Pfizer's small blue pill for male erectile dysfunction, is so small that a special splitter has been developed to permit patients to cut the dose in half.

Nevertheless, Kellner still sees a problem with splitting small tablets, especially those developed to treat serious maladies. "Even though digoxin is scored," he said of the drug also known as digitalis and prescribed for heart failure, "it is too tiny to safely split. So if you're going to endorse tablet-splitting, you'll also have to set rules about which tablets can and cannot be cut. With digoxin you'd wind up with two little crumbs."

He also emphasized that tablets do not contain the exact amount of medication in the two halves, a fact already well known by health officials at the Food and Drug Administration. People who need an exact dose of their medication could fall far short because of the way a tablet is manufactured, Kellner said.

Rather than patients splitting their pills at home, Kellner said he'd prefer to see an end to what he calls "predatory pricing" by pharmaceutical companies.

"Drugs are becoming more and more a significant cost of health care, and it is a tremendous problem," Kellner added. "Drug budgets of hospitals have more than doubled in the last couple of years because of the cost of pharmaceuticals."

But researchers such as Stafford say patients need relief from the costs. "We're not advocating this as a global solution," Stafford said of drug-splitting. "It needs to be conducted within the context of a doctor-patient communication." He highly recommends that anyone considering the practice use only a special pill-cutting blade and to be trained by a pharmacist in its use.

Stafford acknowledges that many groups of patients are not even candidates for the practice: those with poor eyesight, severe arthritis affecting their hands, dementia or psychosis.

But Stafford's analysis also revealed the dramatic sums that can be saved with drug-splitting. He and his team assessed the costs of a Massachusetts-based health plan before wide-scale pill-splitting and what could be saved if it were endorsed.

Only a few doctors in the plan encouraged the practice prior to the study and did so infrequently. The result was an average cost savings of $6,200 for the insurer. If, instead, the plan pushed pill-splitting for the 11 medications Stafford identified as safe to cut, the plan would save $259,500 a year.

The practice can prove equally dramatic for individuals. Stafford found, for instance, that patients prescribed the 10-milligram tablets of Zestril for congestive heart failure can realize a significant savings by buying the 20-milligram strength and splitting the pills.

For the 10-milligram strength, the cost is about $340 a year Stafford estimated. By cutting the 20-milligram tablet in half, the cost would be only $180, Stafford said.

Warning: Do not make any changes in your medications or the way you take your medications without first talking it over with your doctor.

Source: Newsday - Nov. 19, 2002

Depression drawings serve a high purpose. Depression art offers a sense of connection, and the gift of understanding—of understanding yourself at a level beyond words, and being understood by someone else, another person dealing with something similar and reaching out through art. Together, let’s view just a small sampling of depression drawings and art and experience the depths of depression as expressed by artists living before us and among us now.

Depression alters someone’s life, pulling them away from people, activities, and the true sense of themselves. As a result, people living with major depression often feel wholly isolated and alone; this, in turn, makes them feel that they are the only ones tortured by this illness and that no one understands the despair. That, though, is an illusion. In truth, as long as there has been humanity, there has been depression.

From History and Today, Depression Drawings and Art Reach Us

We know this through writings and texts from early civilizations (the ancient Greeks, for example, wrote medical and philosophical texts about melancholia, the affliction we now call major depressive disorder. We know this, too, by studying works of art that reach from the past to gift us with a message: Depression happens not because you are a bad person, but because you are a human being.

Art can show what words sometimes fail to tell. Words convey the thoughts of depression. Art expresses the emotions. Color, lines, patterns, form, and media show, rather than tell, that your depression is real, not made up or in your head and that you’re not in this alone.

Pause and Take In the Emotional Messages of People’s Depression Art

These are but a tiny handful of depression art from world history and today. These are meant to show the experience of depression without reducing it to words; therefore, each work below will stand alone without being reduced to verbal explanations. Together, they are powerful in how they make elusive concepts understood:

• The invisible torment in the mind
• Feelings of anguish, agony
• Living small, trapped in one’s own mind
• Living a life separate from life itself

Without further ado, experience this sampling of depression art and drawings from world history and today.

• Bust from Mohenjo-Daro (India) ca. 2400-2000 BCE

• The Purification of Orestes, ca. 400 BCE

• Melancholia by Albrecht Durer, 1514

• The Temptation of St. Anthony by Matthias Grunewald, 1512- 6

• The Sleep of Reason Produces Monsters by Francisco Goya y Lucientes, 1799

• Emotional Drawing by me #sad #emotion #depression #feelings #art #drawings by Robert Carter, present day

• Falling: Emerge by Clara Lieu, present day

• Overthinking by Robert Carter, present day

• Psychotic Depression by Destiny Blue, present day

• Stay Here by Haenuli Shin, present day

Art is powerful, and it is not exclusively for professional artists. Depression art and drawings belong to all of us, just as depression potentially belongs to all of us. Both are deep aspects of the human condition.

You can produce your own art about your experience with depression. Bypass words and thoughts. How do you feel? One of the many beautiful things about art is that it can be to share with the world, or it can be entirely private, for just you. Either way, if you are feeling stuck and having a hard time understanding what you’re experiencing, create depression drawings or art of your own.

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There are many famous dissociative identity disorder (DID) cases, probably because people are so fascinated by the disorder. While DID is rare, detailed reports of DID have existed since the 18th century. Famous cases of dissociative identity disorder have been featured on the Oprah Winfrey show, in books and have been seen in criminal trials. (See Real Dissociative Identity Disorder Stories and Videos and Celebrities and Famous People with DID)

A Dissociative Identity Disorder Case in Court: Billy Milligan

In 1977, Billy Milligan was arrested for kidnapping, robbing and raping three women around Ohio State University. After being arrested, he saw a psychiatrist who diagnosed him with DID (See how DID is diagnosed). It was argued in court that Milligan wasn't guilty as, at the time of the crimes, two other personalities were in control -- Ragen, a Yugoslavian man and Adalana, a lesbian (Understanding Dissociative Identity Disorder Alters).

The jury agreed with the defense and Milligan became the first person ever to be found not guilty due to dissociative identity disorder. Milligan was confined to a mental hospital until 1988 when psychiatrists felt that all the personalities had melded together.

An upcoming film, The Crowded Room, will be based on his famous case of dissociative identity disorder.

Famous Cases of DID: Kim Noble

Kim Noble was born in 1960 and, from a young age, was physically abused. As a teenager, she suffered many mental problems and overdosed several times.

It wasn't until her 20s that other personalities began to appear. "Julie" was a very destructive personality that ran Noble's van into a bunch of parked cars. "Hayley," another personality, was involved in a pedophile ring.

In 1995, Noble received a DID diagnosis and has been getting psychiatric help ever since. It's not known how many personalities Noble has as she goes through four or five personalities a day, but it is thought to be around 100. "Patricia" is Noble's most dominant personality and she is a calm and confident woman.

Noble (as Patricia) and her daughter appeared on The Oprah Winfrey Show in 2010. In 2012, she published a book about her experiences: All of Me: How I Learned to Live with the Many Personalities Sharing My Body.

A Dissociative Disorder Case Study

In 2005, a dissociative identity disorder case study of a woman named "Kathy" (not her real name) was published in Journal of the Islamic Medical Association of North America.

Kathy's traumas began when she was three. At that age, she would have terrible nightmares during which her parents would often entertain leaving the child to cry for hours before falling asleep only to awake a few hours later frightened and screaming.

At age four, Kathy found her father in bed with a five-year-old neighbor. At that time, her father convinced her to join in on the sexual activity. Kathy felt guilty and cried for several hours only stopping once she began to attribute what had happened to an alternate personality, Pat. Kathy would insist on being called Pat during the abuse the father committed for the next five years.

At age nine, Kathy's mother discovered Kathy and her father in bed together. Her mother insisted on the child sleeping in her bed every night thereafter leading to a sexual relationship with the child. Kathy could not accept this and created another identity, Vera, who continued the relationship for another five years.

At age 14, Kathy was raped by her father's best friend and began calling herself Debbie. At that time, she became very depressed and mute and was admitted to a hospital (read why some go to dissociative identity (DID) treatment centers).

According to the case study, "she showed a mixture of depression, dissociation and trance-like symptoms, with irritability and extensive manipulation which caused confusion and frustration among the hospital staff."

At age 18, Kathy became very attached to her boyfriend but her parents forbid her to see him. Kathy then ran away from home to a new town. However, she could not find a job and her need of money drove her to prostitution. She began to call herself Nancy at this point.

The alternate personality Debbie rejected Nancy and forced her to overdose on sleeping pills. It was then that Kathy was admitted to a psychiatric hospital and given the diagnosis of multiple personality disorder (as it was known at the time). (More on the history of dissociative identity disorder here.)

Kathy is now 29, married, and continues to struggle with mental health problems including dissociative episodes.

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