In this SERIES of monthly COLUMNS Dr. Stephen will help you:
• Finding out more about your depressed mood
• Naming that tune: A description of depressive and mood disorders
• Change your depressed mood through action
• Decide if you need medication

SPECIAL NOTE: Dr. Stephen has added a DAILY SUPPORT feature to her
Doctor Flamingo Online website. Visitors to the website can fill out a
simple form about their goals for the next day around food plans,
exercise, limit setting, and new behaviors. Submissions sent by 7:00
P.M. (PST) will receive a next day response from Doctor Flamingo, aka
Dr. Stephen, with acknowledgement, encouragement, or suggestions. Being
accountable to someone besides oneself is a great help with habit
change. Go to: http://www.doctorflamingo-online.com/id19.html

COLUMN THREE: CHANGE YOUR DEPRESSED MOOD THROUGH ACTION

When you think therapy do you imagine lying on a leather couch
five days a week for twenty years or doing the California touchy-feely
thing with a guru sitting in the lotus position?

For heavens sake, you\’re in midlife! You don\’t have twenty years to
waste. And you would rather spend your money on one good outfit from
Saks Fifth Avenue—if you could just get over this depression thing and
go shopping.

Are you good at following straightforward common-sense advice? At least
willing to try? Then COGNITIVE-BEHAVIORAL THERAPY, along with
medication (when appropriate) may be just the ticket.

Cognitive refers to the thought-changing part of this therapy.
Behavioral refers to the action-changing part of this therapy.
Cognitive-behavioral therapy can be accessed in many ways. Although the
in-person support and expertise of a helping professional is great, it
isn\’t always necessary. There are several excellent books that provide
suggestions for self-help (see the Recommend Reading pages on the
Doctor Flamingo Online website at http://www.doctorflamingo-online.com).

Addressing your depression involves practicing new skills.
You practice new skills throughout your life—from taking your
first step to taking your last breath. Better feelings emerge from the
combination of new thoughts and new actions.

The hardest part of treating your own depression, is overcoming the
inertia and lack of energy that keeps you from making even the simplest
improvements in your life.

When a woman fails to improve:
• It is NOT because she doesn\’t want to change,
• It is NOT because she isn\’t capable of change,
• It is because she hasn\’t found A SMALL ENOUGH STEP to start with.

Start by separating function and feeling.
Are you WAITING to take that first step until you FEEL better?
Are you avoiding that walk because you FEEL too tired? If so, you are
trapped in a model of illness that applies to physical illnesses or
injuries. Mom and the doctor always told you to rest until you FELT
better. This approach is truly deadly when it comes to depression.

Restin\’ is for creaky bones,
Restin\’ is for old folks homes,
Restin\’ is for stomach flues,
Restin\’ ain\’t to cure the blues.

In the treatment of depression, function always comes before feelings.
You have to change your behavior or how you are functioning,
FIRST. The Nike slogan Just Do It applies here. Have someone buy you a
Nike T-shirt. Better yet drag yourself to the outlets and buy yourself
one. With the slogan emblazoned across your chest, forge out into the
world. Don\’t ask yourself how you FEEL. The answer will always be,
“LOUSY!”

One sure cure. Put on the walking outfit, at least the shoes, and stand
outside your front door. Yes…that\’s the ONLY goal. Just outside the
front door. You\’ll discover that 99% of the time you WILL take that
walk.

TIP: Try tracking changes in FUNCTION separate from changes in FEELING.

Every day, rate your FUNCTION and FEELING on a monthly calendar.

Use this self-anchoring scale:
• 1 = Much worse than average
• 2 = Somewhat worse than average
• 3 = About average for me
• 4 = Somewhat better than average
• 5 = Much better than average

Each evening, rate how you FUNCTIONED that day:
• Did no more or no less than usual? Give yourself a three.
• Took a walk for the first time and did the breakfast dishes? Give yourself a four
• Had been walking daily but stayed on the couch all day? Give yourself a two.

Then, rate how you were FEELING that day:
• Felt just as depressed as usual? Give yourself a three.
• Laughed at a TV show? Give yourself a four.
• Cried for six hours instead of the usual two? Give yourself a two.

Focus on upping your FUNCTION scores as the days go by. I guarantee that your FEELING scores will follow along in a few weeks.

Next, try to structure your days.
You\’ve been trying to improve your functioning but the hours roll
on by and you\’re still on the couch. You\’ve lost your TO-DO list along
with your marbles. If someone doesn\’t remind you, you don\’t even comb
your hair or take a shower.

TIP: Try to complete ONE activity for EACH hour of the day. Example:

6am: Shower or wash face and hands and put on sweats
7am: Eat cereal, milk, and strawberries
8am: Take 10 minute walk around block
9am: Wash the breakfast dishes
10am: Eat muffin and yogurt
11am: Sit outside on the patio for 15 minutes
12noon: Eat turkey sandwich, carrots with dip, ice tea
1pm: Take the cleaning to the cleaners
2pm: Call Judy and ask her to walk with me tomorrow
3pm: Eat piece of fruit and string cheese
4pm: Take Fluffy for 10 minute walk
5pm: Fix the meatloaf and put it in the oven
6pm: Eat meatloaf, baked potato, vegetables, and salad
7pm: Eat dessert and watch Jeopardy
8pm: Watch one favorite TV program
9pm: Take warm bath with lavender in water and put on PJs
10pm: Put Fluffy out and kiss Bill (or vice versa!)
11pm: Go to bed

Helpful hints for structuring your day:
• Complete your schedule for the next day at your most energized moment the day before
• Post your schedule on the refrigerator
• Make each activity very specific as in the examples above
• Include both recreational activities and chores
• Include meals and snacks
• Include grooming and dressing
• Absolutely include exercise, starting with 10 minutes
• An activity can take as few as 5 minutes or as much as an hour
• Have at least two activities a day scheduled for OUTSIDE the home
• Check off DID IT even if you\’ve made only a minimal effort to do the activity

About going to work when you are depressed.
Staying on the job, as difficult as it may be, is a good way to
fill some of those hours. If you are able to stay on the job:
• Work only your scheduled hours
• Walk on your breaks
• Take your lunch hour
• Keep more notes about TO DO and DONE to compensate for poor concentration
• If he or she is a decent sort, talk to your supervisor about
temporary workload reduction, time off for doctor appointments
(including ongoing therapy), or reduced work hours
• If your supervisor is not approachable or your company requires
it, bring in a written modified work plan ordered by your doctor

Consider taking sick leave from work if:
• Your concentration is so impaired that you cannot perform your duties
• Staying on the job poses a risk to you (for example, you drive a delivery van)
• Staying on the job poses a risk to others (for example, you\’re in charge of dispensing medications at a nursing home)

When you do stay off work:
• Be sure you obtain a signed doctor\’s note BEFORE you take off
work or as soon as possible afterwards. Doctors, in general, will NOT
grant you work leave after the fact.
• Check with your Human Resources Department to see if you are
eligible for any type of short-term disability. It is your
responsibility to obtain this information and take the appropriate
forms to your doctor to complete.
• Check with your Human Resources Department for FMLA (Family
Medical Leave Act) paperwork to be completed by your doctor. FMLA does
not provide for you to be paid. It does guarantee your position will be
held for up to 12 weeks a year. FMLA can also cover for time off for
ongoing treatment.
• Most states have laws (in addition to the FMLA) prohibiting
employers from terminating an employee when they are officially off on
sick leave. Talk to your Union, the Department of Labor, or an attorney
if you have concerns.

Getting your body in motion.
The most important single action you can take to alleviate the symptoms of depression is to EXERCISE.
• Exercise can take the form of any kind of movement.
• The goal is to increase your heart rate and breathing rate.
• This type of exercise is called aerobic exercise—think of aerobic as bringing more healthy air into your body.

Walking is the easiest exercise to add to your day. You need the least
equipment—only low-heeled walking shoes, although running shoes offer
the best cushioning for knees and hips. You don\’t have to go to a
special place. You don\’t have to put out money. You just have to DO IT.

If you are limited by pain or other health conditions and cannot walk,
the next best bet is doing chair aerobics, designed for seniors or
folks with physical limitations. Water aerobics and swimming are also
kinder to worn knees, hips, and achy lower backs than walking. Running
or jogging is only for those with hardy joints or an excellent
orthopedist. Roller blading, downhill skiing, bungee jumping, or
skydiving should only be attempted on a major birthday, with your will
updated—but they WILL increase your heart rate!

Your goal should be to walk or do some type of movement 20 minutes
every day if possible, but at least three or four days a week. But
don\’t start with 20 minutes; start with 5 or 10 minutes. If you haven\’t
exercised for months, or ever, your muscles will feel it even with 5
minutes.

Don\’t like to walk? Try dancing to the radio in your kitchen, doing
step aerobics with your telephone book, having sex (full credit),
thinking about having sex (sorry, only half-credit), or hanging up the
wash on an outside line (bonus of fresh smelling sheets).

Don\’t have a safe place to walk? Make a walking date with a friend (a
big, burly one if necessary) or walk in the mall (most indoor shopping
malls are open one hour before the stores open for just this purpose).

For Additional TIPS and a place to request DAILY SUPPORT for habit change, go to Doctor Flamingo Online.