We have many personal stories of depression on the HealthyPlace website. Amazingly, Laura's is similar to other depression stories in this aspect - even though she suffered from the symptoms of depression, she never thought of herself as being depressed.

Laura's depression story starts with this quote:

"I never considered I was depressed. I just thought I lost control." ~ Laura, age 34

Laura's Personal Depression Story

I was first diagnosed with major depression at the age of 30. The roots of the depression were multiple: a dear friend of mine died of breast cancer, I just moved to a new city to work and go to graduate school, and my marriage was falling apart. There were too many competing priorities/stresses and one can only take so much. I had extreme loss of appetite and lost a lot of weight. I would cry very easily at the most inappropriate times. I felt as though I lost my total sense of being.

Believe it or not, at the time I actually never considered that I was depressed - It was just that I was losing control of a very busy schedule and was unable to grieve for my friend properly. My life changed when I went to my school's pastoral counselor to talk about spirituality and losing my friend to cancer. At these sessions, I cried uncontrollably. It was as if a huge bubble burst from inside me and out poured this sadness that was buried deep within. The priest said to me that he thought I was experiencing depression. I just fell apart right there because I never put it all together before. He made an appointment through student health to meet with a psychiatrist that week. She confirmed my depression symptoms and made a diagnosis. It was so strange because I was slightly relieved to know that I wasn't going crazy (I felt so guilty for losing so much control), but I was also petrified because I didn't know what the future held. Was I every going to be the same person again?

Depression: A Sign of Weakness?

It took some convincing on the part of the psychiatrist, but I ended up doing a combination of depression therapy and pharmacology as my depression treatment regimen. I really had to work through the stigma of taking medications though because I thought I was deficient for taking them. Again, I was worried about losing control. I slowly began taking an antidepressant and an anti-anxiety pill whenever I felt very nervous.

My therapy sessions were once a week, and they were life-saving. Thank goodness someone was there who knew what I was going through. My therapist was non-judgmental and really helped me plan small activities to bring me back to a functional state.

Story of Overcoming Depression

Healing was a long process. I marked every day on a calendar for the first 3 weeks until the antidepressant took effect. (learn about antidepressant medications for depression) That was excruciating, but afterwards things got much better. I described it to my therapist as wearing muddy glasses that slowly were cleaned up. I started to see the colors of the world again. I could laugh at little things again, especially at my therapy sessions. Things slowly got better. I refer to the experience as my second set of baby steps because it really took about 8 months to get to the point where I was not depressed and able to continue my schooling and work.

Another important part of my healing process was reaching out to some friends. Once I got over the stigma, I disclosed to a few people that I was in crisis. Two wonderful friends told me that they too had taken meds for psychological issues. It was a relief to think that these people were okay and there to reach out to. These people are very important to me to this day.

Through the years, I have been aware of the symptoms of major depression and had one major reoccurrence about a year ago that lasted about three months. Though it felt lousy, I knew how to get help and in some ways it was easier. Now I take my antidepressant everyday and see the therapist on occasion just to check in. I can't say that my life is perfect, and I do get scared when I feel sad. At the same time, I know that we all have an emotional continuum - there is a range of experiences and our mental health is not either just good or bad. I know that if a major episode happens in the future, I'll try to deal with it like I did five years ago. Depression is a horrible thing to go through, but it did make me appreciate life.

I hope this helps someone else understand that there is hope.

Many people don’t know that stimulants can be used for treatment-resistant depression. Stimulant medication (such as methylphenidate) is primarily used to treat attention deficit hyperactivity disorder (ADHD), while other stimulant-like drugs are often prescribed to ease the effects of narcolepsy, obstructive sleep apnea, and other sleep disorders. However, stimulants have also been used to treat patients with major depressive disorder (MDD) – particularly those who do not respond to traditional antidepressants. So how do stimulants for treatment-resistant depression work, and are they safe?

How Stimulants for Treatment-Resistant Depression

Stimulants are often used for treatment-resistant depression, usually along with another oral antidepressant, such as an SSRI.

Stimulants and psychostimulants for treatment-resistant depression (particularly amphetamine and methylphenidate) have been used in addition to conventional antidepressants for decades, and with great success. In a study carried out on those with treatment-resistant depression, 38 out of 65 patients showed significant improvement in response to psychostimulants. Despite concerns in the medical field, none of the subjects in this study showed serious side-effects or developed drug dependency.  

This doesn't mean that stimulants are always safe, or that they always work. These kinds of medications can have severe side-effects and dangerous interactions with other drugs, so they must always be taken under guidance from a medical professional.

Stimulants As Treatment of Treatment-Resistant Depression

The stimulants most commonly used for treatment-resistant depression include:

Lamictal/Lamotrigine

Lamotrigine (also known as the brand name Lamictal) is an anticonvulsant medication used to treat epilepsy. It can also be prescribed as a mood stabilizer in those with bipolar disorder as a replacement for Lithium, which has been relatively under-prescribed in recent years.

Studies have shown that the mood-stabilizing component of Lamotrigine is effective in treating treatment-resistant depression. The drug works by accelerating the onset of antidepressant action.

Ritalin

Ritalin is a trade name for methylphenidate. Some doctors prescribe Ritalin for treatment-resistant depression, but it is typically a stimulant used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy.

Although the adjunctive use of psychostimulants like Ritalin is still being investigated for the treatment of treatment-resistant depression, there is no clear evidence that methylphenidate is effective at easing the symptoms. Although some promising results were seen in case studies, controlled studies have not demonstrated significant improvement in patient outcomes. As such, most doctors do not recommend Ritalin as a first-line treatment for depression. You should never take methylphenidate medications without guidance from your doctor.

Adderall

Adderall can also be prescribed for treatment-resistant depression because it helps to alleviate lethargy. However, Adderall is not an antidepressant, and it should not be used as a replacement for conventional depression treatments.  It also potentially interacts with many medications including monoamine oxidase inhibitors, blood thinners, alpha blockers, antacids, antihistamines, anticonvulsants and some pain killers.

Adderall can also be highly addictive. According to the National Institute of Health, when taken for some time, patients may develop a tolerance, necessitating increased doses to have the same desired effect. What's more, doctors warn that regular use of Adderall followed by suddenly stopping can trigger worse bouts of depression.

The Final Word on Stimulants for Treatment-Resistant Depression

Stimulants can be effective at treating depression, but they can also be dangerous when not taken correctly or taken over a long period of time.

Recently, the FDA issued a warning for anyone taking stimulants like Adderall, Ritalin or Lamactil. This comes after research indicated that children and adolescents who took stimulants might be at increased risk for cardiac events like stroke, heart attack and sudden death, especially if they had pre-existing cardiac problems.  

This same research highlighted a risk of psychosis or mania in patients who took stimulants. As such, the risks and benefits of taking stimulants for the treatment of treatment-resistant depression should be weighed carefully by a doctor, and you should always follow your physician's instructions.

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Dissociative identity disorder (DID), as a diagnosis, is controversial. People sometimes ask, is dissociative identity disorder real? While many healthcare professionals believe it to be genuine, to the point where it is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (the book used to guide all psychiatric diagnoses), other professionals feel it doesn't exist and should be removed from the DSM-5. According to a 1999 study, only 21% of board-certified American psychiatrists felt that there was strong evidence for DID's scientific validity and 58% of surveyed psychiatrists were either skeptical of the diagnosis or felt it should be removed from the DSM-5 altogether.

There are many arguments both for and against DID. This article will outline some of the dissociative identity disorder controversies.

IS DID Real? Are the Causes of DID Real?

In 2004, Piper and Merskey did an extensive literature review and in spite of some sources saying that up to 99% of people with DID report childhood abuse, they found:

• No proof that DID results from childhood trauma
• Consistent evidence that some proponents of DID likely cause the symptoms of DID through the treatment ("blatant iatrogenesis"); in other words, the diagnosis and treatment of dissociative identity disorder caused memories of childhood abuse.

The dissociative identity disorder debate here, is, if we cannot find a solid link between a diagnosis of DID and trauma, then what is the basis for these symptoms and can they be explained by other diagnoses (such as borderline personality disorder which has the symptom of identity disturbance as addressed in schema therapy)?

Dissociative Identity Disorder Controversy: Is a DID Diagnosis Valid?

The basis of this DID controversy is that first-person reports of dissociation based on existing diagnostic scales are invalid due to the crafting of said scales. It is argued that the way these scales are designed, increase false positives.

An example of one such question on a scale is, "I get so wrapped up in watching TV, reading, or playing a video game that I don't have any idea what's going on around me."

This statement, of course, would be true for many, if not most, people.

DID Debate: Can a Dissociative Identity Disorder Harm the Patient?

According to Dr. Gharaibeh MD, a psychiatrist,

"A DID diagnosis has been blamed for misdiagnosis of other entities, patient mismanagement, and inadequate treatment of depression. Even when DID is treated with the best of intentions, undesired negative effects may result from psychotherapy, and some patients experience worsening of symptoms and/or deterioration of functioning."

Is DID Fake? Do DID Proponents Have a Conflict of Interest?

Some healthcare professionals ask if dissociative identity disorder diagnosis proponents have a conflict of interest, such as monetary gain. People diagnosed with DID tend to have very long-term, intensive psychotherapy care and this can create an income of up to $20,000 per year per patient. This creates a great incentive to diagnose DID.

Should People Diagnosed with DID Try to Find Another Diagnosis?

While the debate around DID will continue, people who are concerned with their diagnosis may be best served by working with a treatment provider that they trust and/or getting a second opinion. People should also keep in mind that there is some medical evidence of the existence of dissociative identity disorder:

• In 2006, Vermetten et al found significant differences in amygdala and hippocampus volumes in people diagnosed with DID.
• Reinders et al (2003, 2006) also found blood flow differences in the brain that corresponded to specific personalities.

Full coverage of dissociative identity disorder controversies can be found here.

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Many people assume there is no medication for treatment-resistant depression (TRD). However, the term "treatment-resistant" is only applicable after two or more conventional antidepressant medications have been used without success; it doesn't mean that medicine will never work for you. There have been many advances in the medical field for the treatment of major depressive disorder (MDD) – most notably a new medication for treatment-resistant depression that could relieve symptoms almost instantly. Let's explore the options available.

Medication for Treatment-Resistant Depression: What’s Available?

Until recently, there has been no alternative medication for treatment-resistant depression. Instead, patients with recurring major depressive disorder who failed to respond to conventional antidepressants would need to either experiment with other forms of antidepressants, taking each one for more than six weeks at a time, or undergo neurostimulation therapy.

When treating depression, doctors are most likely to start with newer antidepressants, such as SSRIs like Zoloft and Prozac, as well as medicines from other classes like Wellbutrin and Effexor. If these do not work, your doctor may try you on an older tricyclic antidepressant, such as Elavil or Pamelor, or an MAO (Monoamine Oxidase) inhibitor. Although these medications can be effective for those with treatment-resistant depression, they tend to have more severe side-effects than other drugs. For this reason, most doctors are reluctant to try older forms of antidepressants unless they have exhausted all other options.

See Also: Do Stimulants Work for Treatment-Resistant Depression?

Exploring New Treatments, Such As Esketamine for Depression

Symbyax was the first medication for treatment-resistant depression to be approved by the FDA in 2013. This drug combines the active ingredient in Prozac with an antipsychotic medication often used to treat type 1 bipolar disorder. This medication works by helping to restore the balance of neurotransmitters in the brain. It has been proven to help patients sleep, improve their mood, boost concentration and decrease nervousness and anxiety.  

Most recently, the FDA approved esketamine (Spravato) for depression, which can be used to treat major depressive disorder in cases where other antidepressants have not been successful. Esketamine contains a low dose of ketamine for treatment-resistant depression, which is administered in the form of a nasal spray.  

Due to the risk of drug dependency and the potential for adverse side-effects, the nasal spray cannot be taken at home. Esketamine for depression is given at your doctor's office under medical supervision, where you will need to remain for at least two hours in case side-effects occur. Although this can be time-consuming, most patients in clinical trials only had to take a dose every 1-2 weeks to see substantial improvements in their symptoms. The treatment is also expensive, but the results are promising enough that many patients (if they are able) will be willing to pay for it. It is unclear yet whether insurance companies will cover the drug.

When it comes to medication for treatment-resistant depression, there are more options than you might think. Talk to your doctor about alternative medicines you can try, as well as the availability of new treatments, like esketamine for depression, and ask to see a specialist who deals with TRD patients if you haven't already.

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Many people with treatment-resistant depression (TRD) feel that their options are limited or even non-existent. Today, however, there are many alternative approaches to treating TRD that can help ease the symptoms of major depressive disorder and improve patient outcomes. In March 2019, a new nasal spray medication was approved by the FDA to work alongside oral antidepressants for sufferers of depression who have failed to respond to conventional treatments. This is a significant breakthrough in the mental health field, but it's not the only treatment option for treatment-resistant depression.

Treatment-Resistant Depression: Am I Out of Options?

When it comes to treatment-resistant depression, it can seem like you're out of options, but this is rarely the case. Being diagnosed with TRD can feel hopeless, but it’s important to gain some perspective before you write off all possible treatments.

Firstly, treatment-resistant depression affects around one-third of all patients treated for major depressive disorder, so it is more common than you might think. Secondly, the term "treatment-resistant" doesn't mean you'll never respond to treatment; this is merely the label given to depression that doesn't improve after two or more antidepressant medications are tried.

Having treatment-resistant depression means that you and your doctor may need to work a bit harder to find ways of managing depression that work for you. There is no quick fix, but there are plenty of options to try – even if you have recurring major depressive disorder (MDD).

Treatment-Resistant Depression: Options to Ask Your Doctor About

The options for the treatment of treatment-resistant depression include:

Making changes to your medication: It may be that you need to try a new medication for treatment-resistant depression, or that you need to increase your current dose. Your doctor might suggest a different type of antidepressant or consider tweaking your drug schedule before exploring other treatment-resistant depression options.  

Psychological counseling: Most patients with moderate to major depression see a counselor, and many find it to be instrumental in managing their depression symptoms. Some people are reluctant to try counseling, or else they think that because they've attempted one form of counseling without success that it doesn't work for them. Of course, talking therapy may not work for everyone, but it is a vital part of treatment in most cases. 

Testing for other health conditions: Depression can be caused or worsened by underlying health conditions like thyroid problems, eating disorders or chronic fatigue syndrome. In rare cases, it can also be linked to heart disease or certain types of cancer. As a result, your doctor may decide to run other tests before diagnosing you with treatment-resistant depression.

Electro-convulsive therapy (ECT): ECT for treatment-resistant depression is often used to treat life-threatening or severe cases of depression, mania or psychosis. The treatment involves an electric current being sent through the brain to trigger a seizure. It is given under general anesthetic using muscle relaxants, so your body only twitches slightly rather than convulsing. In a survey of 78 ECT clinics conducted in 2012-2013, the ECT Accreditation Service reported the procedure to be effective or highly effective in 1712 out of 1789 patients.

Transcranial magnetic stimulation (TMS): Transcranial magnetic stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells to improve symptoms of depression. TMS for treatment-resistant depression has proven efficacy in adult, pediatric and geriatric patients.

New medication for treatment-resistant depression: In March 2019, the FDA approved a new esketamine nasal spray named Spravato for treatment-resistant depression, which can be taken alongside oral antidepressants under medical supervision. It is unclear whether insurance policies will cover esketamine, and the medication is expensive. However, most patients in clinical trials found that they only needed one dose of the nasal spray every 1-2 weeks to ease symptoms.  

New options for treatment-resistant depression are being researched all the time. The latest medication approved by the FDA is a breakthrough for those with TRD, and there is more hope than ever before for those who don't respond to conventional treatments. Depression doesn't have to be a life sentence; talk to your doctor about exploring new options for treatment-resistant depression, and don't give up hope.

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Dissociative disorder symptoms can range from mild, such as feeling out of one's body for a short period of time, to severe, such as long periods of dissociative amnesia or alternate personality states. No matter what, though, symptoms of dissociative disorders tend to be upsetting and take a toll on a person's work, home and personal life. Read some personal accounts of what it's like to live with a dissociative disorder, below.

Symptoms of a Dissociative Disorder

Dissociative Identity Disorder and Dissociative Amnesia Symptoms

A major characteristic of dissociative disorders is dissociative amnesia wherein a person will not remember important personal details that may be surrounding an event, time, person or another area. Additionally, in dissociative identity disorder, multiple alternate personality states ("alters") present themselves when a person is dissociative (often during times of stress).

Toril writes of her dissociative disorder symptoms:

"At the end of July, I had a really nasty argument with my sister one night because I wanted to stay up late but she said that if I did, I'd be grumpy in the morning, and she didn't want to deal with me being grumpy. It put me in a really bad mood and I went to bed at about 11pm. While I was talking to my significant other via Facebook in bed, I began to feel my protective alter, Alois, starting to wake up, wanting to cause trouble. Because I was already tired and grumpy, I didn't resist. Then suddenly, I could remember very clearly being knelt on a cold, hard floor in front of a naked skinny man. I won't go into explicit detail of what was happening, but I could feel it again as I was lying in bed. I wanted to scream but I couldn't open my mouth because that made the feeling more intense. After that night, Alois disappeared for about a month."

"Then, towards the end of August, I found a door in my mind, blocking out a memory. I instinctively knew that there was rape behind the door, but I couldn't quite believe it. For a few weeks, a new protector appeared, and he held the door shut for me when I needed him to. Then, on Sunday evening, I found out that a man who I have a personal connection with tortured and killed two boys, in front of his sons, one of which is a close friend of mine, and got away with it. Finding out about that really freaked me out. Then, in the middle of all of that, I could suddenly feel the rape happening, but not fully. I couldn't feel the pain, which I know must have been involved. Occasionally, I catch glimpses of the pain, but I haven't unlocked it fully yet."

Symptoms of a Dissociative Disorder: Depersonalization Disorder

Depersonalization disorder feels like an "out of body" experience and a major characteristic of depersonalization disorder is feeling like you're watching your life happen rather than living it.

Tony talks about depersonalization:

"One day I was walking around the city, minding my own business, when suddenly I found myself looking down at myself from somewhere near the awning of a store. It was unreal and the weirdest thing in the world!" he exclaimed, his hands shaking. "Since then, and that was 20 years ago, I've had one experience like that after another and never completely felt like I was back in my body. I constantly feel spaced out."

Depersonalization disorder can also be associated with drug use, such as the use of marijuana.

Brian writes about his symptoms of dissociation:

"My experience with some of these symptoms started one evening after smoking marijuana and having a panic attack while still under the effects of the drug. I freaked out, vomited, took a cold shower, and went to bed. From that point, it felt like time stopped. I literally thought I had died and entered the afterlife, because it felt like I had been suspended in time. I would look at the digital clock beside the bed, close my eyes for what seemed like forever, then reopen my eyes to discover a single minute had passed."

"I was distraught to still have the same feeling when I awoke the next morning. Over the next several weeks, I had severe issues with depersonalization/derealization. My body felt foreign to me. I felt like I was living inside of a dream. I felt completely disconnected from the life that was continuing around me."

". . . Although some of my symptoms lingered for a few years, they gradually subsided. The problem that hung on the longest occurred when I was driving at night. I would suddenly get a feeling that the world outside my windshield existed only in 2D, like playing an old-fashioned video game. It would cause such a surge of panic in my body that I would have to pull over and let someone else drive. Having conversations about eternity and space would often have the same effect."

The important thing to know about the symptoms of a dissociative disorder is that they can be treated, and go away.

Brian sums it up by saying,

"Today, I have little to no residual symptoms. I usually don't even think about it . . . even when it seems overwhelming and impossible to endure, there is hope. Talk to your doctor. Talk to your parents. Don't suffer in silence. You will get better!"

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Treatment-resistant depression (TRD) is a chronic and disabling condition that affects around a third of patients being treated for major depressive disorder (MDD) in the U.S. Although depression in all its forms can be debilitating, those who don't respond to conventional treatments have been found to carry a higher suicide risk than those who do respond to depression treatment. Here's how to tell if you have treatment-resistant depression and what you can do about it.

What Is Treatment-Resistant Depression: Do I Have It?

You may have treatment-resistant depression if you have been treated for depression but your symptoms haven't improved after six weeks or longer. Conventional treatments include antidepressant medications taken by mouth (such as SSRIs, SNRIs or MAOIs), as well as psychological counseling. In cases of mild to moderate depression, your doctor may recommend a lifestyle change to ease your symptoms, such as changing your diet, socializing more or doing exercise.  

So, what exactly is treatment-resistant depression? Although there is no fixed definition of TRD, U.S. databases typically define treatment-resistant depression as the "failure of two medications as evidenced by their replacement or supplementation by other medications." In other words, if you have tried two antidepressant medications without success, your doctor may diagnose you with treatment-resistant depression and help you explore other options.   

The symptoms of TRD are the same as the symptoms of major depressive disorder, except they do not respond to treatment. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), these include:

• Persistent sad or “empty” mood
• Prolonged feelings of hopelessness or pessimism
• Feelings of guilt and worthlessness
• Loss of interest in once-enjoyable activities, including sex
• Changes in appetite accompanied by weight loss or gain
• Restlessness and/or irritability
• Difficulty concentrating, remembering things or making decisions
• Loss of energy
• Changes to sleep habits, including insomnia, early-morning waking or oversleeping

Of course, suicidal thoughts and ideations can occur with all forms of depression. If you have thoughts about harming yourself, you can call the National Suicide Prevention Lifeline at 1-800-273-8255, 24 hours a day, 7 days a week.

What Are the Causes of Treatment-Resistant Depression?

No one knows exactly what causes treatment-resistant depression. It may be a mix of different factors, many of which are beyond your control.

The causes of treatment-resistant depression might include:

• Not taking medicines correctly: For example, skipping doses or not staying on a treatment regimen for a long enough period of time. Alternatively, you may need a higher dose than what was initially prescribed.
• Drug interactions with other medications: You should talk to your doctor if you think this is the case.
• Your genetics: You may be genetically predisposed to major depressive disorder, or your DNA could make certain medicines less effective. Researchers have begun to look into the link between treatment-resistant depression and genetics.
• Other health factors: Depression can be caused or worsened by existing health issues, such as thyroid problems, cancer or heart disease. It's important to get tested for underlying conditions so that you can seek the appropriate treatment.
• Misdiagnosis: Some people think they have treatment-resistant depression, but their symptoms are a result of another condition like bipolar disorder, anxiety or a substance-induced mood disorder.

Treatment of Treatment-Resistant Depression

If conventional treatments haven't worked for you, don't give up. Treatment-resistant depression may not be easily treatable, but you still have treatment options for TRD. You may need to try other medications, attend psychotherapy, go to support groups or ask your doctor about neurostimulation treatments like electroconvulsive therapy (ECT) or vagus nerve stimulation (VNS). The FDA has also approved a new nasal spray called esketamine (Spravato) for treatment-resistant depression, which can be taken alongside oral antidepressants under supervision from your doctor.

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

Should you split your antidepressant pill?

In the scramble to cut rising prices for prescription drugs, consumers and insurers are taking a new look at an old but controversial practice - splitting pills in half.

Purchasing large amounts of medications in high doses and cutting them in half saves money because bigger-dose pills of many drugs often sell for the same price or only slightly more than smaller doses.

Consumers can purchase 30 10-milligram doses of the antidepressant Paxil for $72.02 at Drugstore.com, for example. The site sells the same number of 20-milligram doses for $76.80. Cost-conscious customers can buy the larger-dose pills, split the pills in half and get twice as much medication for $4.78 more.

Pill splitting is not without risks. Because they may suffer from physical, mental or emotional problems, not all patients can correctly split their pills.

And not all pills should be split. Some must remain intact to be absorbed properly. Others can't be split accurately because of their shape. Even tablets with scores - those small grooves down the center - don't always split evenly, which could result in over- and under-dosing.

But with prescription-drug spending projected to jump 13.5 percent this year to $161 billion, health-care plans are warming to pill splitting as a low-tech method to curb rising drug costs.

The Veterans Affairs Department allows pill splitting for its patients. Last week, the Illinois Medicaid program began requiring patients who take the antidepressant to purchase higher-potency pills and split them in half. Since 100-milligram tablets cost about the same as the 50-milligram pills - $2.79 vs. $2.73 - the state will reimburse pharmacies only for the higher dose.

The move will trim about $3 million off Illinois' projected $1.4 billion Medicaid drug budget, said program spokeswoman Ellen Feldhausen. Private insurers such as Kaiser Permanente, United Healthcare, Health Net and Wellpoint Health Network also have voluntary policies allowing doctors to permit pill splitting if patients approve.

"I think it's inevitable that health plans will take a closer look at this. When they do so will vary and be determined by their own needs," said Dr. Randall Stafford, a professor of medicine at Stanford University who recently studied the cost-saving potential of pill splitting.

The savings must be balanced against the risks of improper dosage. A recent study of 11 commonly split tablets found that eight, after splitting, did not meet industry guidelines for content uniformity - between 85 percent and 115 percent of the intended dose. Even scored tablets did not assure accurate dosages.

For these reasons, groups such as the American Medical Association, the American Pharmaceutical Association and the American Society of Consultant Pharmacists have opposed mandatory pill-splitting policies by health plans.

But if the doctor, patient, and pharmacist all agree that pill splitting is workable, the practice can be safe on a voluntary basis, said Susan Winckler, vice president for policy with the pharmaceutical association in Washington.

Stafford's research, which tracked prescription records on 11 drugs, found that a Massachusetts HMO with 19,000 members could have saved nearly $260,000 a year by having its clients regularly split pills. Savings ranged from 23 percent to 50 percent, depending on the medication, Stafford said.

Tom Clark, director of professional affairs for the American Society of Consultant Pharmacists, said Stafford's study overstated the cost savings and understated the risks. He said there had been no studies on the health of patients who split pills.

"Our position is that it's irresponsible to promote this practice without any studies to show it's safe," Clark said.

For years, many people have split their regular-dosage tablets with razors, knives and pill-splitting devices to stretch their prescriptions when they couldn't afford refills. Groups such as the AARP frown on the practice, because patients don't get the proper dosages.

Kaiser Permanente, an Oakland, Calif.-based HMO, has been the industry leader in splitting higher-dose pills since it adopted the practice on a patient-voluntary basis in the early `90s. In 1, Kaiser was sued over the practice; several patients and a Kaiser physician claimed that patients were being forced to split pills. Kaiser denies the allegation. The lawsuit is expected to go to trial next year.

Dr. Charles Phillips, an emergency-care physician in Fresno, Calif., and a former Kaiser physician, is a plaintiff in the lawsuit. While working for Kaiser, Phillips said, he frequently saw patients with diabetes and hypertension whose health was harmed by inaccurately split medications. He still opposes the practice because of the potential for error.

"It's bad medicine," Phillips said. "It saves money at that moment in time, but if the patient gets worse (because of improperly split dosages) then society is losing money, because they've got to pay for the patient's care down the line."

Kaiser officials, who have continued the practice of pill splitting, said the Stanford study validated it.

"It confirms our view, which is that a well-designed tablet-splitting initiative has the potential to improve the cost-effectiveness of care without impairing quality," said Tony Barrueta, senior counsel for Kaiser.

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: Reuters Health - Sept. 29, 2002

Knowing what to do when you're depressed can mean the difference between slipping into a serious depression or turning things around early. When you're feeling depressed it can be difficult to take positive steps, but even the most depressed person can find even tiny steps useful.

Professional help should always be sought for any serious depression or any depression that lasts more than two weeks. However, even while getting professional help, there are things you can do to stop feeling depressed.

Note: Any feelings that you may harm yourself or others should be dealt with by a mental health professional immediately.

Why Do I Feel Depressed?

Sometimes there is a direct cause for feeling depressed. This could be a life event, a circumstance or simply feeling lonely and depressed. Most times, depressed feelings begin due to a stressor. Example stressors that might make someone feel depressed include:

• Stress at home, work or school
• Moving
• Birth of a child
• Death of a loved one
• Social disruption
• Being diagnosed with an illness

Sometimes knowing why you feel depressed can help begin the process of relieving the depression. If, for example, you feel depressed because of the loss of a friendship, it may be helpful to spend time with other friends and talk about thatevent's impact.

Sometimes people feel depressed for no reason. This happens more often in people with severe or chronic depression. However, even if feeling depressed for no reason, you can still take action to try and stop the depression.

What To Do When You Feel Depressed

When feeling depressed, most people want to sit around the house and do nothing, but this can actually worsen depression. Knowing how to feel better when depressed involves learning about depression, knowing yourself and understanding what works for you.

The important thing to remember when trying to feel better is to make reasonable goals. Anything has the possibility of making you feel more depressed if you set an unrealistic goal. For example, exercising is positive, but setting the goal for yourself to run five miles a day might make you feel more depressed if that's not something you're able to accomplish. Small goals and small steps forward work best. You can always set bigger goals as you start to feel less depressed.

Things to do when depressed include¹:

• Engage in an enjoyable activity like going to a baseball game or attending a social gathering, even if you don't initially feel like it.
• Avoid spending long periods of time alone.
• Maintain a healthy, balanced diet.
• Take care of yourself. Pamper yourself.
• Break tasks up into small chunks spread out over time to make them more achievable.
• Spend time with friends or family. Talk to a trusted person about what you're going through.
• Postpone important decisions until you're feeling better. If you have to make an important decision, discuss it with others because feeling depressed can cloud your judgment.
• Get professional help when needed.

Remember, no matter what you do when you're depressed, feeling better takes time. You may have to get weeks of depression treatment before starting to feel better, but trust the depression will lift over time.

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Depression worksheets are outstanding tools for mental health. They inform, enlighten, clarify, pinpoint, and help you take back your life from depression. Perhaps the best thing about depression worksheets is that they allow you to take an active role in your treatment. You do a lot of hard work and honest reflection to pull yourself out of your depression and into the life you want to live and the self you want to be. This look at depression worksheets will show you some of the types and benefits of empowering yourself through written depression exercises.

Depression worksheets are often (but not always) part of mental health therapy. A counselor or therapist might assign worksheets as homework between sessions. This allows you to process and expand on work done during your sessions, and it provides a concrete discussion tool for you and your therapist.

You don’t have to be in therapy to use and benefit from depression worksheets, however. Many people use them as self-help tools. Helpful worksheets can be found in workbooks and online.

Whether you are using worksheets as a part of formal therapy or are completing them on your own, depression worksheets offer numerous benefits.

How Depression Worksheets Benefit Your Mental Health and Wellbeing

Depression worksheets serve a purpose. They help release you from the mental trap in which depression locks you. Depression involves, in part, ruminating over negative thoughts. A nasty effect of depression is living in your head, stuck in a holding pattern unable to land on solid ground and move forward. By engaging in worksheets, you begin to do something about your thoughts. When they’re on paper right in front of you, you can address them. You also are able to make plans for moving past them.

When you complete depression worksheets, you get specific with symptoms, thoughts, emotions, goals, values, hopes, and dreams. As opposed to open-ended journaling (depression journaling is another method of healing with numerous benefits), worksheets target specific things. In doing so, they help you:

• Recognize your depression symptoms
• Understand precisely how depression is limiting your life
• Identify values and goals
• See what needs to be done to treat your depression
• Plan action steps for moving forward
• See tangible evidence of progress, such as changing thoughts

No single depression worksheet accomplishes all of these things at once. That would be rather overwhelming and quite ineffective. Instead, different types of worksheets help you grow in specific ways.

Types and Examples of Depression Worksheets

Some depression worksheets accompany specific therapeutic approaches. Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), solution-focused brief therapy (SFBT), and rational-emotive behavior therapy are some common forms of counseling that often incorporate worksheets into the treatment.

Worksheets for CBT help you identify, confront, and change your negative thought patterns that are keeping you stuck. After you learn the types of automatic thoughts and distorted thinking patterns, a CBT worksheet might ask you to

• Identify an automatic negative thought
• Name the distorted thinking pattern
• Re-write the thought to one that is accurate and realistic

Acceptance and commitment therapy helps people accept certain situations that can’t be changed and separate themselves from their problems by living mindfully, identifying values, and taking effective action to create their quality life free from depression, anxiety, and other problems. An ACT worksheet could have you

• Reflect on your thoughts or emotions
• Describe how they affect your actions
• Consider how your depression is preventing you from living in your present moment
• List reasons why you want to be present (your values)

In SFBT, people focus much more on solutions than on problems. You might complete a worksheet that uses scales to rate the severity of your depression and use it to consider ways you can move down the scale toward freedom from depression.

Worksheets for REBT often focus on having people identify an “activating event,” a situation that triggered depressive thoughts and feelings. Next, you would describe the beliefs you have about the situation so you can see how depression clouds your perspective. Then you might write about the consequences of your beliefs and use all of your reflections to make changes in your reactions to situations.

Other worksheets for depression help you identify your strengths and character traits as well as explore how to use them. Still others provide general exercises to help you actively work through your challenges.

Depression worksheets are often hard work. They require a commitment to yourself to delve deeply into yourself and your experience with this illness. It can be difficult at times to examine yourself openly and honestly, but the benefits you reap are worth it. When you use worksheets to confront problems and work to intentionally define the life you want, you actively gain control over your life and how you live it.

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