Depressed in Beijing? Sometimes we do not know if our bad mood has gone out of the norm and become a depression. Welcome to lesson 2.2: How do I know if I have depression? Please read lesson 2.1 if you need a refresher about what the symptoms of depression are. Today we will be speaking about self-assessment. When we speak about depression within a community or at an event, one of the most frequently asked questions is: “I sometimes feel sad, very stressed, and depressed. But how do I know if I have depression or not?” Do I have depression? Online depression self-assessment tools provide great access to awareness of your mental health. Sometimes, they are called “mood-assessment tools.” The tool is often designed in the format of a questionnaire, which with your answers generates a score to determine your mood, and, accordingly, to recommend some excellent resources to help you better understand how you feel. While there are many tools available online, the quality of these platforms varies. It’s very dangerous to use tools from unknown resources as they can misguide or mislead you. Find out about your mental state by using the Patient Health Questionnaire (PHQ) One of the most recognized, reputable, well-researched, and widely used tools is the Patient Health Questionnaire (PHQ). It was designed for use in the primary care setting, but later became a public domain resource that is available without cost in several languages. If you want to take this test, we recommend you to take the test on the website of Mental Health America, a leading community based NGO in the United States since 1909 with the mission of helping people to achieve wellness by living healthier mental lives. Here’s PHQ-9 in an online assessment friendly format. Resources and reminders will be provided after your submission of your answers. We particularly like the remarks for results that show signs of depression: they recommend you to also take the bi-polar disorder screening to increase the accuracy of the self-assessment. It’s very important to know this, so as to consider the appropriate treatment (e.g.: medication, etc.). While the causes and effects of different psychiatric disorder are often worlds apart, their symptoms can be misleadingly similar. Important Reminder to our Audience Never ever trust an assessment from an unknown or unverified resource. Self-assessment tools are not diagnostic tools, they are meant only for self-assessment. You can use this questionnaire to monitor your moods and patterns over time but remember, it is not meant to replace a consultation with a psychologist if you are struggling. If your score comes out alarming, please know that it’s common to experience depressive episodes in life. Our “Depression Essential Series” provides you with the fundamental knowledge you need to cope with depressive moods or episodes: Lesson 1: an overview of depression around the world; ŸLesson 2: the symptoms of depression in detail to be used as a reference for your own moods; ŸLesson 3: the causes of depression in detail (looking at neurological, biological and genetic factors). Just know that when our brains are unwell, it takes time to get recover. There is no shame in experiencing difficulties with any organ (just like our liver or lungs), brains included. Your own awareness, patience and self-love during this time will help you to heal faster. Lastly, if you find yourself struggling alone, just know that you don’t have to struggle alone. We have a peer support group in Beijing that meets every other Tuesday, and we support each other when we go through episodes of depression, mania or anxiety. Take a look at what Kristen Bell recently said about anxiety and depression. It's a heartfelt and informative read. #Beijing #depression #China

For people in Beijing, have you noticed that your mood changes depending on AQI (Air Quality Index)? Yes, environment has a big influence on our mood, and when it’s getting too much, we say: the pollution in Beijing really makes me depressed! So what else makes us depressed? Let’s begin today’s lesson by looking at the most common causes from the angle of environment. The causes of depression are probably the most difficult one to explain. There are so many factors involved: genes, biology, and psychology (which we have it in a separate lesson.) Not to try to complicate things, today we are adding one more fact: environment. Oh yes, this one more factor of environment alone is like an ocean. So many fish is in here, but we are going to pick out only the biggest and most obvious ones for you folks. We are dividing the environment factors into the following categories, which we will go into details one in each lesson: Life events Early losses and trauma, medical problem In today’s class, we are going to take at the various life events that can lead to depression. Life Events Some of our life events are adverse that can increase our chance for depression. We list here the most common factors cross culture, nations, and race in this chart. These are all major life events that can cause a great deal of stress in a short period of life. In some situations, this environment can be more long lasting than one likes it to, and that’s chronic adverse life situations. (This list is not exhaustive) Now, sometimes we might have more than just one stressor at one time. That’d increase our chances for depression. One stressor weighs down like dozens when even just one more is added on life. Once these stressors are removed, one would start to feel better. However, it takes great deal of energy, patience and time to remove that especially when you are recovering from a major relationship breakup, or trapped in a bad job. It’s also important to know that, just having stressors do not cause you depression. Your own threshold for depression holds the bar. This is where other factors are important: genes, psychological factors (https://candlex.org/2016/07/01/depression-essentials-series-lesson-3-symptoms-of-depression/). When we talk about personal resilience, we mean our resilience to life adverse. (it’s okay. We put it here just so you know how difficult it is to peel off the depression factors as they are so intertwined. The chart only shows the relationship between two variables: gene and adverse events. Don’t forget we are not looking at psychological factors, air pollutions, and biological factors here yet. So the treatment is complicated and healing takes time too.) So really don’t place too much blame on yourself or label you as weak. Some people got the long genes; while some of us got the short ones. Yes, you can partly blame it on your ancestors temporarily and partially. Self-blame is the enemy for self-healing. Now you know the importance of life style, or life choices. These are often situations that you get into little by little, and sometimes without even realizing it. How do we make sure that we are on the right track? Self-awareness is the foundation for all other building blocks. Realize your strength and weakness and fully accept yourself, cultivate love and kindness in our life value that underpins all key pillars that hold up your life, and setting boundaries in your social and professional life can all help. We are all different, but these things have proven to be effective in building up a healthy life. In our next class, we will explore how trauma and childhood loss can be related to depression. (This article is edited based on Harvard Medical School Mental Health article：what causes depression? http://www.health.harvard.edu/mind-and-mood/what-causes-depression )

Welcome to the third class in our “Depression Essentials” series. In our first lesson, we learned about the prevalence and general background of depression. In our second lesson, we learned about the symptoms of depression. Now, today we will jump into the next lesson of CandleX Classroom series, the causes of depression. What are the causes of depression? One often asks why depression happens. Is it a real sickness? Does depression only happen to people with weak will power? Can I get it from my family? What’s happening when someone is depressed? What do you mean that your brain get sick some times? Well, mental illness is an outcome of a complex malfunction of the brain. Science has made significant progress in understanding the causes, but there’s no single answer. We now know that, mental health is related to genes, biology, neurology and psychology. Neurological Changes But why do these symptoms happen when someone experiences depression? What is going on inside that brain that causes it? As it turns out, depression affects the connection between the cells in your brain, called neurons. [1] So what that means, is depression can cause a decrease or increase in these connections and increase or decrease in cell growth in three areas of the brain: the hippocampus, the amygdala, and the thalamus. The picture above shows you where the Hippocampus is. The hippocampus is in charge of your mood and your memories. Depression causes decrease in cell growth here. The amygdala is associated with emotions, such as anger, fear, and pleasure. When you are remembering past experiences, your hippocampus brings back the memory, and the amygdala brings back how you were feeling when you experienced a memory. The thalamus receives most sensory information and sends it to the cerebral cortex. Think of the thalamus like the secretary that sorts out your emotions and sends the information to the rest of the brain. Depression can cause too much cell activity here. Biological Changes Depression has biological explanations, and can be triggered by environmental factors, like stress. When depression is triggered by stress, it affects the hippocampus. That’s why treatment that uses the molecule serotonin can be helpful for people with depression! Serotonin is a chemical molecule (neurotransmitter) made in the brain that sends messages between brain cells that affects things such as mood, also known as the happy chemical because when you are feeling good, there is serotonin being released. More importantly, serotonin helps to trigger a process called neurogenesis, which pretty much means that it helps your brain cells make new connections, as seen in this picture below. Our brain has SO many neurotransmitters that help us function, and serotonin is not the only neurotransmitter that can be affected when someone has depression. Some other important neurotransmitters include dopamine, norepinephrine, and GABA. When our neurotransmitters are out of balance, they can change the signals between our neurons, and can make them either too strong of a message or too weak of a message. We focused mainly on serotonin here, but for more avid learners, we will release a more detailed explanation of neurotransmitters in the future! Genetic Is depression genetics relevant? Yes. When looking at genetics, studies have found that changes in certain spots of your genes can make you more vulnerable to depression. According to the National Institute of Health, the serotonin transporter gene can have a long version or a short version. Having the short version makes people more vulnerable to depression, because the shorter gene will cause the cells to produce less serotonin. [5] This can explain why depression can possibly run in the family, since you get a copy of the gene from each parent. There is psychological factor that plays a big role in mental health. Stress, trauma, anxiety also contributes to depression. There are much more factors involved than we explored today. So we are going to expand on these later in this column one by one. By now, we hope that you would stop thinking that depression is a sign of weakness. We all get sick sometimes, some people are more prone to breast cancer or a heart disease, and others might be prone to depression. It’s tied to the genes, and the environment. Next time you see someone with depression, be kind and caring like you would be to a patient with cancer. After all, depression already takes away their ability to love and care for themselves, your love and care for them can help them to recover. Reduce the stigma, don’t take part in the stigma! Stay tuned for our next CandleX Classroom lesson, where we learn what to do when someone is depressed, and how to seek support. Class dismissed! Reference ASAP Science (2014, August 19) The Science of Depression http://v.youku.com/v_show/id_XNzU4NzUxMjIw.html?f=20321745 http://www.health.harvard.edu/mind-and-mood/what-causes-depression Medscape http://img.medscape.com/news/2015/dt_150204_hippocampus_800x600.jpg https://www.mdc-berlin.de/40955216/en/news/archive/2013/20130513-serotonin_mediates_exercise-induced_genera/Nervecells_After_Running.jpg Short Serotonin Transporter Gene Increases Risk of Depression NIH Study http://www.nimh.nih.gov/news/science-news/2003/gene-more-than-doubles-risk-of-depression-following-life-stresses.shtml

Meet Lin. She is in her 30’s and living in Beijing, China. Lin is successful, smart and likeable. She has many of the things she always wanted: a great job, a loving husband, a nice apartment and a car. But recently Lin has been suffering from depression. She has been feeling low, hopeless and has very little energy. Even daily tasks seem like a huge challenge. She thinks, why do I feel this way when I am so lucky? Why do I have these feelings and not my friends? You may think that depression only happens to those who are unfortunate, mentally weak, or traumatized. The truth is, it can happen to anyone (according to our CandleX’s mental health peer support group review 2016, many who seem to have it all can also be suffering from depression). Many of us have been in a similar situation to Lin where we question why we experience depression even when things seem to be going well and we know the intense guilt that goes along with this question. If life events and family history (genes) don’t fully explain who is at risk of depression, what are the other factors that can contribute? In today’s class, we are going to tap into another factor: psychological factor. We are going to present to you two opposite words: vulnerability and resilience. Some people have a higher vulnerability to depression than others. This is not their fault or due to personal weakness. People with high vulnerability have a higher risk of developing depression, especially when they experience stressful life events that can trigger depression such as, the end of a relationship, losing their job or losing a loved one (Go to Lesson 3.1 for environmental factors). On the opposite end of the spectrum some people have high resilience. Resilience is the term psychologists use for the ability to adapt to stressful life events and ‘bounce back’. Having higher resilience reduces the risk of depression and other mental health problems. Our vulnerability/resilience to depression is linked to our genes, social support and environment but it is also linked to psychological factors: how we think and respond to stress. There are many psychological factors that affect resilience. In this lesson we will be looking at 4 factors from the smallest level, our individual thoughts, to more holistic factors such as self-esteem. Thinking patterns Personal vulnerabilities Self esteem Coping style All of these factors are important because factors at the higher levels can affect factors at the lower levels and the other way around. We will also explain practical steps that you can take to help strengthen your psychological resilience. Thought Patterns Let’s start by looking at the smallest level we can: our individual thoughts. Can the thoughts we have make us more vulnerable or resilient to depression? The short answer is yes. According to Cognitive Behavioural Therapy (CBT) principles what we think has a big influence on our emotions and our emotions effect how we behave. It’s not just the external events that happen to us that make us feel a certain way – it’s the thoughts we have about them. David Burns (1981) developed a list of common “thinking errors” or “cognitive distortions” still widely used in CBT today. These thinking errors increase our vulnerability to mental health problems and negative emotion. Any of these sounds familiar to you? Mathew Whalley, 2008, www.psychologytools.com//unhelpful-thinking-styles.html CBT is an evidence based treatment which helps to prevent unhelpful thinking through several techniques including straight talking- becoming aware of our own thinking errors and using sets of questions to see if they are really true or not. Using CBT techniques to combat thinking errors can help reduce symptoms of depression and build resilience. If you are interested in learning more about thinking patterns and CBT try Moodgym, a free CBT skills development program produced by the National Institute for Mental Health Research (NIMHR) at the Australian National University. The program includes exercises and quizzes to identify your own thought patterns and is totally free. Just follow the link below and create an account. https://moodgym.anu.edu.au Note this program is not designed to treat clinical levels of depression and should not be used as a replacement for seeking advice from a health professional. Areas of Personal Vulnerability Moodgym looks at areas of personal vulnerability that can feed into or result from our thought patterns. These areas are bigger than just our individual thoughts and tap into the needs and beliefs we have. These are: The need for approval The need to be loved The need to succeed The need to be perfect The sense of feeling deserving The sense of being able to influence all things The sense that happiness is contingent upon external things People who score highly in these areas tend to be more vulnerable to depression. Some of the areas may seem surprising. For example, we all have a need to be loved- why should that make us more vulnerable to depression? It’s true we all need to be loved but if this need is very high it can make us more psychologically vulnerable because when others reject us or don’t show us love we think this means we are unlovable and are likely to have thinking errors such self-blame and personalization. The need to succeed and the need to be perfect can both be seen as great things, especially here in China where the school system pushes students to aim for perfection all the time. Both of these needs can be positive but at very high levels they make us more vulnerable. When we have high levels of perfectionism we see anything that doesn’t meet our own high standards as a failure and often don’t see the positives we have achieved (filtering) and beat ourselves up or are self-critical when we don’t succeed or reach perfection. You are highly encouraged to use Moodgym for self-awareness on areas of personal vulnerability. https://moodgym.anu.edu.au Your thought patterns, and value sets directly affect your two important indicators for your psychological residences: self-esteem, and coping style. Self esteem So our thoughts can affect our emotions- and these feed into our needs, beliefs and goals. All of these influence and can be influenced by our self-esteem, which is how we view ourselves: positively and deserving of happiness or more negatively. Many studies have linked low self-esteem to depression. Low self-esteem is a symptom of depression. When we are depressed we often feel inadequate and worthless. But much research also shows that low self-esteem is a risk factor for developing depression in the future. This is called the vulnerability model: low self-esteem reduces our resilience which makes stressors (difficult experiences) more likely to trigger depression. Jessica Hunt, 2014, www.slideshare.net So why is self-esteem so important for resilience against stressful life events? It has been suggested that people who feel better about themselves less likely to internalize stressful events and blame themselves or be overly self-critical. This might make them less likely to have “thinking errors” such as personalization and self-blame. Luckily, low self-esteem is something we can all work on. One technique to try is this self-affirmation exercise. This exercise aims to help you focus on our positive attributes rather than the negative. Make a list of at least five qualities or attributes you know you have and that you value. Write a short paragraph about why the quality is important and how you tend to express it. Also try noticing your negativity. Try to talk to yourself like you would someone you love. So when you notice a negative thought directed at yourself try to change it to something more positive that you would say to a friend. Coping Style So according to CBT our thoughts affect our emotions but and our emotions affect our behaviors which can reinforce our resilience or make us more vulnerable. For example: what do you do when you face a stressful event? The answer depends on a lot of things including: the type of stressful event and the resources you have at hand. However, it also so depends on your personal ‘coping style’. That is the types of thoughts and behaviors you tend to use to help get you through difficult times and minimize stress. This could be anything from calling a friend to watching a happy film. Some coping strategies make us feel better in the moment but are unhelpful in the long term. This is called negative coping. These coping methods can include actions such as, being aggressive to others, drugs, alcohol, excessive eating and self-harm or mental states such as, denial, withdrawal and blaming others. Relying on negative coping skills increases vulnerability to depression as they do not address the problem or how we think about it. One of the best ways to change the coping techniques you use is to make a coping plan- a list of coping strategies. Here’s how: What do I do now? Write down the coping strategies you use now when you are stressed or something bad happens. Are any negative (help at the time but not long term)? If so cross out the negative coping strategies. If you want you can put them in “try not to….” box. What else could I try? If you want to try some new coping strategies write down some other positive coping strategies you could use. Crisis Plan- sometimes our own coping skills aren’t enough so finish your coping plan with some outside sources who can help in a crisis such as family and friends, hotlines or emergency services. Keep the list somewhere easy to get to when you need it. It is important to write these things down before we feel overwhelmed or are faced with a crisis and can’t think clearly. Two Steps We wanted to finish this lesson with 2 straight forward steps you can do today to have a positive impact on your psychological resilience. Try Moodgym: follow this link https://moodgym.anu.edu.au and sign up for a free CBT skills development program. Make a coping plan: to help you use positive coping strategies next time your stressed. This wraps up the whole lesson 3 on “Cause of Depression”. The reason we name is “causes” is because that’s what’s asked. However, there’s no direct causal relationship that can be simply explained. The “causes” are messy! What we do know is that, your genes matters, your environment matters, and your psychological factors matters. While we cannot change the genes (thus, do not blame yourself for everything), we can do something about our environment, and our psychological patterns. So stay hopeful, work on yourself. Lesson 3.1 Causes of Depression- Neurology, Biology and Genes Lesson 3.2 Causes of Depression- Environmental Factors (Part 2: Life Situations) Lesson 3.3 Causes of Depression- Psychological factors

Mental health in China for expats has been an under supported sector. In the capital alone, there are over 200,000 expats (Xinhua Net, 2012). Many are facing the constrains of limited number of psychologists in Beijing, let alone qualified and English Speaking ones; On top of that, mental illness in China is heavily stigmatised, and the ignorance of depression basic knowledge stops the majority to even seek help. One of the great fears for those living with mental illness is that in revealing their struggles to others, even close family and friends, it will result in incomprehension at best and severe judgment and social derision at worst. To open yourself to someone near to you and be judged as weak, melodramatic, crazy or even worse is certainly a terrifying proposition. But what is so easily forgotten is that discovering the compassion of others is how we truly know friendship, and how we know who are true family are, both in blood and heart. And more importantly, that this fear is what may hold us back from an even more amazing experience, the opportunity to show compassion to others. Welcome back to CandleX Classroom! In this session, we’ll discuss the important topic of self-care by answering the Frequently Ask Question #1: “Should I tell others that I have depression?” followed by to who, when, what and how. Lesson 4.1: The Art of Telling- to tell, or not to tell This is the common question people ask themselves when in times of depression, when they know they need help, but have many concerns: My friends probably will think that I am weak if I told them, wouldn’t they? Am I going to lose my job if tell them? But if I don’t, I am not really performing anyway… I don’t want my parents or spouse to worry about me. This is our advice, for major depression, please do tell others. It’s the first step in seeking help, and just be aware that not everyone will understand, or know how to respond to that. But some will, and they’ll be your life pillars through the episodes. Level of Depression is the Primary Factor for Consideration There are different levels of depression: mild, moderate and major depression (for more details on the symptoms, please go to “CandleX Classroom” lesson 2 in classroom) Regardless of what level you are at, the purpose of telling others should always be helping yourself. Everyone has different personalities, environment and coping mechanisms that might work just for them. So there’s never a general yes or no in terms of deciding whether to tell, whom to tell, what to tell and how to tell. It’s to be reminded that, if the possibility of you doing it or not doing it in a certain only serves the “getting out of your chest but not to help you to get support” or saving face” etc., you are not doing it right, it’s not a good decision. Just always use “would this help me to cope with depression better?” as a primary principle. ACTION: Yep, it’s now time to write it on a sticker and put it on the bedroom wall! However, here are general guidelines: For mild-moderate depression: telling others is not as important as following the doctor’s advice: good night sleep, exercise, nutrition, and mental health counseling, etc. If you can manage to get these done, you are on the way to recovering on your own. Telling is only very much needed if you think you need external supervision/support to get you on a healing track. Focus your energy on getting things on track in life, instead of being stuck on the dilemma of telling or not. For severe depression: you have to tell others! One symptom of unavoidable symptom is repetitive suicidal thoughts, which is life-threatening. On top of that, severe depression comes with severe cognitive impairment. It has a substantial negative impact on your social life, intimate relationships, work performance and even daily routine functions like getting out of bed or taking a shower. By that, we mean, you need external help to get you through it because you’ve lost the basic functions temporally. There shouldn’t be any shame in this. Just like any other organs in our body, our brain does get sick, it’s just invisible and less understood by our society. (Go to CandleX Classroom Depression Essentials Series: Lesson 3 Causes of Depression​ to understand why it happens). So when we are sick, we tell people that need to know so your boss will allow you to take sick leave, and your loved ones will bring your chicken soup, for the soul. You remember Marco, CandleX’s Representative, revealed his story of opening up in hope to encourage you to take the step too. 3 years ago, having suffered a severe breakdown, I responded by opening up to my family and friends, of whom there were many, purely as a matter of survival. If those around me were not aware of what was happening to me during a severe episode, they would have no way to help, and if they weren’t there to help, I might not make it the next time. The effects were lasting. I quite quickly had a support group that I could rely on as my faith in them had not been misplaced. What’s more, my openness led to others to reveal to me that they had similar struggles that they had always been too afraid to share, and it was my honesty and lack of humiliation that allowed them to speak up as well. They knew that I had some sense of what they were going through; I would not be one to judge. And I began to see myself as one among a group of people that formed a special sort of club, one in which we shared a language of adversity that only we could truly understand, but to which those who were willing could also listen to. In receiving empathy and compassion I found courage, and in giving it, I found meaning. For it is in the light that we can enjoy the company of others, but only in the darkness that we find true friendship. For Marco’s full story, you can find it in CandleX column: My Story with Depression. Do not forget, our peer support group for people with depression in Beijing is a safe and confidential space for you to start the conversation. Take baby steps. We are here to hold your hand.

In our depression support group in Beijing, the new comers often express that they’ve never told anyone about their depression. In our last class, we tackled this “to tell or not to tell” issue. To better help equip you with the skills, in today’s class, we are going to look at “The How and The What” -Xiaojie So you’ve decided to tell someone, finally. First of all, we’d like to congratulate you for seeking help, an important step on the journey towards healing. However, it can be nerve racking, especially as mental illness is still a very sensitive topic in China and the people around you might not be equipped to respond to you appropriately. To make the process easier and more effective, here are a few steps to take before the actual conversation. We are going to use Marco’s story. By now, you may be familiar with Marco Brundelre, CandleX’s representative, who’s been through depression and is an advocate for it now. With his full support, we use his story, Love in the Time of the Universe-Marco’s Story with Depression, to guide you through each step. Step 1: Consider How and What to Talk About You can get the best support possible by planning the conversation. Consider including three items: 1. “Process” talk “Process” talk means “talking about talking,” rather than talking to share information. Prepare your listener for an important conversation by using “process” talk. Here are some ways to begin a process talk: “I want to talk to you about something important. I’m not sure how to talk about it, though. Can you just listen to me and try to understand? I’m hoping I’ll feel better after talking about it with someone, but I need you to be patient.” 2. Specific problem Concrete examples of what you mean by “mental illness.” Every case of mental illness is different. To get the best support possible, share one or two examples of what’s causing you stress: “I think something’s wrong because I can’t sleep more than a couple hours at night. It’s hurting my work and I feel out of control.” “I’ve started skipping classes sometimes. I’m worried I’ll stop leaving the apartment if I don’t get help.” 3. Suggestions for how loved ones can help Suggest ways to support you. Family and friends may not know what they can do to help. You can get the best support by asking for specific help: “I’m scared to make an appointment because that’s like admitting there’s something wrong. But I need to see a doctor. Can you help me find one and follow through. Marco's Story One of the scariest moments in the life of someone suffering from mental illness is the moment that an individual finally faces the reality that silence is no longer an option. The stigma surrounding mental illness is so great that even the best promises of relief, support rehabilitation are no match for the embarrassment, shame and rejection a sufferer might experience in their desperation for help. And while the possibility of that might actually be quite small, the fear can be completely debilitating, and ultimately irrational. My story is quite different, atypical really. For me it was easy actually. But then again I didn’t really have a choice. When you hide your illness for 16 odd years, and then one fateful day your brother and good friend have to escort you to the hospital because an alcohol and rage infused episode almost ends your life, there’s really not many places you can hide. Pretty soon, your whole family knows about it, but not before a therapist you have never met, but that your sister (who you trust deeply) has recommended, has given you a direct instruction to tell your parents that they nearly lost a son and you were the idiot who was responsible. Survival: The word that needs to be adopted when discussing revealing your mental suffering is not choice, but survival. You don’t have a choice. Daily suffering is too great, and suicide rates are much too high. This is not about pride or fear, but about enduring, accepting and maybe, just maybe, conquering a mental condition that is not your fault. And this begins with that first step, by opening up that first line of communication, a lifeline, to someone who can catch you when all hope is lost, and bring you back to the light when you might be consumed by the great abyss of suffering or even death. And it gets easier. Nothing is worse than telling your parents. That was really, really bad. After that, it just made sense to tell a few close friends. After all, why not have a few more allies in the fight against mental illness? Then you tell more friends, because why the heck not? They’re valuable too. Why not let them know that you occasionally have bad days and you’re not trying on purpose to kill the mood. Then your boss, as work productivity becomes an issue. Then, even the public. Because you know what the conclusion eventually is? It’s not a big deal. The only way to end the stigma and fear around mental disorders is to understand what a natural problem it all is. And for those who don’t understand, criticize or judge? Get rid of them. You don’t have a choice. This is a matter of survival. – Marco Brundelre By telling the right people and suggesting concrete ways for loved ones to help, you can start building a strong social support network. At first, you might be afraid to talk about your experiences. But don’t give up on looking for support and encouragement from others. You’ll discover that many people want to help you. They will even be curious about your situation. You don’t have to share everything. Decide in advance what parts of your experience you’ll talk about and what parts you won’t. Stand by your decision. It’s perfectly understandable to answer a question with a statement like “I’d rather not talk about that right now.” Once you have decided to tell somebody and prepared yourself for the conversation, the next steps are to think about whom you will tell and when you will tell them. In our next article we will lay out a process to help you figure out the “who and when”. #Beijing #depression #China

In our CandleX Depression Support Group in Beijing, we have people from different backgrounds coming in to seek support and help. I have noticed one thing that most participants have in common, and that is that that people who are more out going, higher achieving or better connected seem to find it more difficult to tell others about their mental struggle. In the previous two classes, we started the topic of “The Art of Telling”, with the goal to provide some insight on: To tell or not to tell The How and The What Today is the third class in “The Art of Telling” series and we will be looking at When and Whom to Tell. -Xiaojie First Read: Lesson 4.2 The Art of Telling – The How and What Step 2: Consider Whom to Tell Talking about mental illness can be risky. When thinking of telling someone you need to weigh all the pros and cons. The positives and negatives are different for everyone and thinking them through can help you decide what’s right for you. Being able to offer emotional support is not something that everyone knows how to do. It’s a skill that takes practice. Some people may not be able to offer emotional support. If you have relatives or friends who lack this skill, that doesn’t mean they don’t love you. You might want to make a list of the people you’re considering telling. Include the people you feel closest to. Also list the most emotionally skilled people you know, even if you don’t know them very well. Consider the names. Which of your close friends and family are most skillful at offering understanding? Which ones are best at listening or giving a hug when you’re down? What about the people who are good listeners? Which of these “A grade” people could you talk to? Again, we’ve invited -Marco Brundelre to share his experience. Marco Brundelre is the CandleX representative that bravely shares his story to encourage others to seek help, and raise awareness on depression. For his personal experience, you can visit CandleX “My Story with Depression” column and read his full story. Now, telling people of your condition is that first step in the process, but there’s no guarantee that it’s going to be a blowout success. The worst case scenario is to be judged or shunned by others, but we’ve covered this already: get rid of these people. Find a new job, get new friends and don’t accept abuse from family members. It’s your life, not theirs, that hangs in the balance. Remember, when you finally make that decision to take action that might make others uncomfortable, it’s because you value yourself first, and it’s important to remember that as you bravely push forward. My own experience was that it really wasn’t nearly that scary. So far I am happy to say that I have never had to reject anyone in my life, and that everyone I have told has at least been sympathetic, is usually supportive, and if they truly understand, is incredibly compassionate. Even at work. But, I also recognize that I have been very, very lucky. Many people do not have the social network that I have been able to build with good, decent people. I am very blessed in that regard, but maybe that’s happens when you, mostly, stay open to good people coming into your life, and you assume the best in people (until they obviously prove otherwise). The closest problem I have had actually is with my parents, who love me deeply but are still inexplicably convinced that even after 5 separate diagnoses of Bipolar including one intensive psychological evaluation, I am actually ADHD, and I need to see a specialist. Fortunately, I am not completely insane. I did not listen to my parent’s bizarre ideas, only the good ones. There is quite a difference in the reaction you will receive from different groups of people, and this is what I have discovered. There are three basic groups (maybe more but I really like the number 3 so we’re just going to roll with that): those who understand, those who want to but can’t, and those who won’t. The first two have become my allies, but my easiest support came from the first. And do you know who are in that first group? People with other mental illnesses (shocking!). These are the people that can relate to you immediately, that will open up because you are unlikely to judge each other, that may have tools for you to use in your struggle, and when things get really bad and you start talking about some seriously scary s**t, have probably had the same thoughts and can be right there with you to bring you back down to Earth. And how do you find these people? You find them by coming out about your problems. My entire social support group of fellow mental illness sufferers came from just being honest to everyone around me. People are afraid to talk about their personal problems, but when they know you truly understand what they are going through, they will start to open up to you, and you’ve gained a new ally. You can help each other. And I gave this support group a name: the Club. A club where you would need to be on the inside to speak and understand the same language, but it was a language that those outside could at least listen to. And it’s a somewhat more difficult experience working with those on the outside who are kind and supportive but, let’s be honest here, don’t quite get it. And how could they? Dealing with a chemical imbalance is something that has to be experienced in order to appreciate how debilitating it is. You’re not sad; you’re depressed. People who are sad don’t stay in bed all day because they have given in to the meaninglessness of life and the best they can hope to accomplish in a 24 hour period is making a cup of coffee. You’re not worried; you’re having a panic attack. People who are nervous don’t start looking for the exits on a plane because they’ve just lost it and need to get out immediately, whatever the cost. No, quite frankly they don’t understand, and probably never will. But, that doesn’t mean that they won’t listen. And that’s the crucial difference between one who is an ally and one who isn’t: They try. It takes a bit of work for them to really become a resource to you but you can get there with patience. Explain to them the differences between emotions and chemical imbalances. Get them to understand that you probably need more sleep, and shouldn’t be drinking too much alcohol. And, if necessary, explain to them that someone who is just frustrated and jokes about killing themselves is worlds apart from someone who has started taking active steps to complete a plan that they’ve been thinking about for months. I have created several of these allies, and I love these people. There was one ally in particular who really made a great impact on my life. She, as far as I know, does not suffer from a mental illness. But she listened, and connected me with someone who did. And that’s how I was brought into CandleX. -Marco Brundelre Step 3: Consider When to Tell If you are compelled to disclose during a period where you are unwell, try to locate the most supportive person in your life. This person can help you tell others. Otherwise, the time to tell someone is going to depend on several things: When you’re well. Most people only tell when they don’t have a choice anymore. One common scenario is being brought to an emergency room in the hospital because of suicide attempts. Instead, we should tell earlier when we can still think logically. This helps provide a calm environment to introduce whomever you speak with to adjust to the idea, especially if they don’t know a lot about mental illness. When it serves a purpose. People disclose for different reasons, often depending on whom they’re telling. You may tell a loved one because they’ve worried about your behavior or thinking. You may tell a friend so that they understand why you sometimes can’t hang out with them, or if you worry they think you’re growing distant. You may tell your employer in order to receive accommodations at work. There are nearly as many reasons to disclose as there are to stay silent. Different people have to decide when and if the risk is right. Don’t wait until you are “ready”. For people who are already seeing therapists, you are in good hands already, hopefully. However, a large proportion of people with depression still do not go to a therapist, do not accept that they may suffer from depression, and there’s no way that they’d tell anyone. So, for this particular group. Our advice is that don’t wait until you are ready. Push yourself out of your comfort zone. Beat down the fear. As long as you follow the points that we list in this guidance, you will be fine. Why not do it now? There’s really no great time to reveal to someone that you are struggling, except for now. Don’t wait. I waited for 16 years, and nearly died as a result. There are opportune moments for sure, but you have to create those moments, not wait for them to happen. The two times I waited had potentially disastrous consequences, but in the end everything, luckily, turned out well for me. When I was first hospitalized I told everyone because I really didn’t have a choice, but I could have saved myself years of suffering if I had just spoken up in high school. Immediately after doing so I discovered what a wonderful family and group of friends I had. And when work found out, it’s because I had a manic episode on an antidepressant that I had essentially prescribed for myself (stupid, stupid stupid…) and I nearly lost it in the office. Immediately after my boss and colleagues helped me out when I needed to make hospital appointments and leave the office for doctor visits. I was even granted medical leave. Speaking up and seeking help are not actions to be taken lightly, but they are necessary ones. Choose wisely, speak wisely, act wisely, but there’s nothing more dangerous than waiting until it’s over. Choose life on your own terms, not your mental illness’. -Marco Brundelre We have now completed the lesson on “The Art of Telling”. Being able to talk about it is the first step towards healing. For those who need to prepare themselves, writing about it is a good option. You can read our CandleX community member’s stories in our “My Story with Depression” column. We encourage you to write yours too, and perhaps take an extra step and share it with us. Don’t forget, you can always get help from our mental health peer support group that’s held every other Tuesday. Stay open, stay healthy. #Beijing #depression #mentalhealth

The first thing that people usually say to us after mustering up the courage to speak about their depression is at one of our events is, “Thank you for hosting this event. I have never told anyone, but I think I have depression and I don’t know what to do. Can you give me some advice?” In response, we are writing this article. Initially, we were going to write an article based on scientific findings, which is consistent with the style of our “Classroom” column. However, we think you know the answers: exercise, eat well, sleep well, talk to your friends, journal, etc After months of debate, we decided to change the approach for this one. We don’t want to give you a to-do list, like most depression self-help online resources have already done. We want to simply bring some light into the dark area of coping, and then you can create your own list. Different levels of depression exist. Here we are going to focus on major depression disorder (MDD). It takes more mental energy and a more drastic change of attitude and knowledge than moderate to mild depression to overcome, but it is still absolutely possible. Rather than lecturing, we invited our Founder Xiaojie into the classroom to talk about her own story in dealing with depression. Sometimes it’s not about the knowing, it’s about the feeling. We hope her stories can be a reference for you when dealing with depression. We are going to structure this chapter with the DOS and DON’TS In lesson 5.1, we talk about the DON'TS In lesson 5.2 we talk about the DOS, with 2 pointers. In lesson 5.3, we continue with the DOS, and give you 2 more pointers. Let's welcome Xiaojie. As someone who has had multiple episodes of depression over the past 9 years, I’m kind of a “know-it-all” in dealing with it. You might already know that multiple episodes of depression are very damaging to the brain, and may only get worse as time goes by. But you can still rehabilitate your brain. It takes time, patience, effort, faith, and persistence. It does get a bit less confusing and scary, and slowly you will recover. I will tell you this: I hate self-help guidance! It may be well-intentioned guidance, but it makes me feel worse knowing that I am not able to do any of these activities. Lists like this are well intended, but when I was depressed, reading these kinds of lists resulted in the following reactions: Exercise When I am at my major depression period, I can’t even walk without taking a break every 5 minutes. That was 2012, when my mom came to Beijing to take care of me. If I could get myself out of bed, I would take a short walk around block. I remember that whenever I saw a bench on the side of the road, I had to sit down. Not only that, I would lean on my mom because I was too weak to hold my head up. During another episode in 2014, I remember going to work on my bike, I felt like my tires were flat and I found it hard to breath and ride at the same time. I was on a marathon, involuntarily. Do Something that you Enjoy Interesting, if I am well, I would of course do something I enjoy. Why wouldn’t I? During each major depressive episode, even the simplistic of life’s joys, I simply can’t follow. I love jazz music, but I can’t listen to it when I am depressed, my heart doesn’t respond to the music like it usually does. There’s no joy coming out of it, just my numbness telling me that I am so depressed that nothing can bring me joy. Even going for a massage becomes very difficult. Normally I’d go once every week for relaxation, but guess what: I have to get myself out of bed first for that to happen. So you’ve guessed it, that didn’t happen as much. Humor Humor takes a functional brain to listen, process and understand the words. No, it doesn’t happen in major depression. I remember occasionally being at regular a gathering of friends at dinner or over a drink, everyone’s talking and laughing. I couldn’t even process the information. What comes then is this despair trying to hide it that I am dysfunctional by faking a smile. Social anxiety comes in immediately. Then you no longer want to get together with your friends because it’s super painful and exhausting to put on an “I am okay” face. To quote Tommy, who’s in our documentary on depression “The Tiny Little Box” “My brain is like a box of ice. It’s slow to process and slow to react.” Think like an optimistic Least helpful advice ever! The symptom of depression is negativity. (If you are interested in what that means from the perspective of neurology, go to lesson 3.2, causes of depression, genes and biology.) Once you have MDD (major depressive disorder), you lose the ability to “think positively”. You wouldn’t tell someone who has lost their legs to try walking, so you shouldn’t tell a MDD patient to “think positively”. Don’t be that voice abusing yourself. Allow yourself to be permissive sometimes, and remember you are not your thoughts or feelings. Please don’t fall into the trap of appearing to be optimistic. You are sick and it’s totally normal to say that you don’t feel well. Tell your friends to be sensitive about your situation, and those that are close to you will understand. They will help you cope. It’s very dangerous to fake optimism. If heart attack victims don’t fake not having a heart attack, you shouldn’t fake that you are still optimistic. It’s okay to be broken. There are many other pieces of advice that are just simply not helpful… In our next class, we are going to look at the DOS. In lesson 5.1, we talk about the DONTS In lesson 5.2 we talk about the DOS, with 2 pointers. In lesson 5.3, we continue with the DOS, and give you 2 more pointers. #depression #moodlab #mentalhealth

According to Jin Liu, Hong Ma, et al., (World Psychiatry 2011: 10:210-216) throughout the entire world and among all illnesses, the treatment gap for mental disorders is huge. This number in China is unacceptably high, with 91.8% of all individuals with any diagnosis of mental disorders never seeking help. For psychotic disorders, 27.6% never sought help and 12% saw non-mental health professionals only. Depression falls in this sector. When suffering from depression and unable to function normally it is exceedingly difficult to help yourself. Continuing with the theme of this chapter: I have major depression, what do I do? let’s explore some of the approaches you can take to cope with major depression disorder (MDD). Again, there’s no one single route to recovery. Each individual might have his or her own way of dealing with it. This lesson is about what worked for Xiaojie In lesson 5.1, we talk about the DON’TS In lessons 5.2 and 5.3 we will talk about the DOS Lesson 5.2: I have major depression - The DOS (Part 1) Major depression disorder is a serious illness and dealing with it is challenging. The social stigma and ignorance attached to it makes it even more difficult to treat. It takes time to heal and it is helpful to remember that as time passes and your life situation changes your depression will start to lift. Lesson 3.1- Part 1 speaks about the environmental causes of depression and this may help you to adjust your situation in life. Studies have shown that if you have had multiple episodes of depression, you can start to have a depressive episode out of the blue. To understand more, take the standard University open online class on depression by Professor Sapolski . It is similar to a physical injury. If you sprain your ankle multiple times then it may be more susceptible to future injury – you could sprain it just by walking down the street. MDD is the same. It is a chemical imbalance in your brain and if your body is prone to this sort of imbalance it may be sparked by very normal life activity. I spent the majority of the time during my MDD feeling confused, fearful, and anxious. Even during moments when I was feeling well, I had a feeling of impending doom and was expectant of my depression’s return. During other moments I felt completely hopeless. My depression took all of my physical energy and it is very frustrating to feel that your body is not working properly. I also felt guilty for burdening those around me with my troubles and as though I had let everybody down. After 9 years of depressive episodes I had to find a way out. I had to try something different regardless of the result. I had to become active so that I could stop feeling helpless. It was during the time when I was suicidal, every day brought the same question: “Should I live another day?” It is common for suicidal people to feel that life is nothing but hell. Life felt like endless torture and never-ending despair. One day brought another mental breakdown, and I texted my boss, who offered care and support. Please refer to Lesson 4.1 for guidelines about telling people about your depression. She invited me to her house and asked me to draw a picture of a tree and to write some positive affirmations. At the time I didn’t believe what I wrote. I knew that logically I should believe it and so I wrote it anyway. The picture I drew in 2014 at my boss’s home. Hours later, I walked out of her house and into the late afternoon of Beijing hutong on a blue sky day. There were cotton candy fluffy white clouds against a pure blue backdrop. I still felt disconnected from the world, but I heard this voice inside me: How about trying to live How about trying to live with this madness It’d probably take 2, 3 years if you are lucky If not, it’d take longer…(I know, sweetheart) Even when you get better, I know, you might get back here again, I know But how about trying to live Not just for a day, but for a while This voice was so weak and trembling. I tried to silence other voices and stay with this positive yes-voice, until it was strong enough and became an answer. I didn’t really believe that my depression would heal, but I tried to be hopeful and to pretend to myself. From that moment on, I started to focus on dealing with it, not running away from it. Depression Strategy #1：Acceptance Accept the fact that depression takes a long time to heal. That’s where patience comes in. Patience brings space to allow curiosity to emerge, curiosity may inspire you to learn about depression and this will empower you. It turned out that it didn’t take years. 2 months later, I was no longer depressed. In fact, not only did I return to my norm, I was so energetic, motivated and happy. I remember going dancing one weekend, and dancing for 14 hours! I had a full day workshop, and a night filled with social dance. I danced so much that I ended up losing 3 toenails, and injuring my hips due to overuse. I had to go to physical therapy for 5 weeks. I became a different person. Something was not right. Entering a depression without much environmental stimulus, and then coming out of depression without a single thing changing in life is atypical. I remembered something a psychiatrist, who I saw back in 2012 because of my rapid mood changes, had said: “It seems like you may have bi-polar disorder.” “What? That’s a fashionable word!” I thought to myself. “Psychologists are good at coming up with theories and names for things that they haven’t fully understood. I don’t even know if you are qualified to diagnose me with your insufficient 2 sessions of counselling.” That was my reaction; I had a lot of resistance to the proposed diagnosis. I ignored what she had said and never went back. The flashback got me to rethink what she had said. I though that perhaps it was time to do some research on this. I began searching online, and there it was: the pattern of my emotions and symptoms seemed to match the description of bi-polar II. “Oh my gosh. So I am not a crazy person. I just have bi-polar disorder. Yeah, that’s a real thing!” Knowing that it is a recognized medical disorder calmed me down. I sought to learn more about it. In the following months, I started to read about psychology, especially neurology. I got hooked on online courses, TED talks, university open courses, and documentaries. I took a deep dive into an ocean full of words that I never thought I’d care to know. One day, while I was watching a TED talk, the neurologist speaking explained how she felt while she had a stroke. I burst into tears as she described her sensations during the stroke. I felt it! For the first time, I realized that I wasn’t crazy. I just had a medical condition. My brain was sick and that was the problem. Jill Bolte Taylor's Stroke of Insight Throughout the years of my depression I had heard the same abusive voice telling me that I was a weak person and couldn’t get it together. Now I had a response to that voice. No, I am not a weak person, I just get sick sometimes, like everyone else. For some people it might be a heart attack, but for me, it’s depression. One never tells a person with a heart conditions that they are weak, and one should never tell a person with depression that they are. In that moment of acceptance, self-blame and self-shaming disappeared. For the first time, I made peace with having depression. Depression Strategy #2: Knowledge Empower yourself with knowledge about depression. It helps you to further accept who you are, and to diminish the confusion. Knowledge gives you the tools to cope, a crutch to lean on. #depression #Beijing #China

For the members of the international community in Beijing suffering from depression, external resources are limited. Quality counselling and psychiatry is available at international hospitals but the cost is prohibitive. Treatment at Chinese hospitals is more affordable but there is an obvious language barrier. This is why knowing how to deal with major depression disorder is so important. Self-help plays a very important role in recovery, and one can even come out of it with stronger self-awareness that can improve life significantly. Our previous two lessons, have been trying to answer the question: “I have major depression. What do I do?” • In lesson 5.1, we talked about the DON’TS • In lesson 5.2 we talked about the DOS • Lesson of 5.3 will continue with the DOS Everybody has different ways of coping. Instead of prescribing a (not-so-useful) manual, we decided to give you some real life examples by inviting Xiaojie to share her experiences. Let’s welcome Xiaojie back! Using the right attitude and knowledge to create charts and checklists to help structure your day can be useful provided that your current state of mind gives you the capacity to follow them. Everybody’s checklist will be different, but they generally look similar to the following: I tried to stick to the following list: Try to keep up my routine. I honestly didn’t feel like it at all. I was only able to keep up with about 10-20% of my routine. Here’s the thing: when you have MDD, you don’t even want to be awake. Everything is difficult; doing anything takes a toll on you. I knew I had to go out, but I couldn’t. It’s an hourly struggle to try to ”do the right thing”. I only managed go to a social dance once a week, do yoga and go to work. There were mornings that I woke up and couldn’t go to work. But on the majority of mornings I forced myself to go. Only now can I say that I am glad I didn’t quit. Imagine if I had to deal with the financial stress that this would have induced. Do more yoga, lots of yoga. I got into yoga in 2008, but was not a regular practitioner. It wasn’t until late 2013 that I started to do it weekly. In early 2014, I fell into a depression but I kept on doing yoga. Yoga seemed to be the one place that I could at least feel a tiny sense of calm. I remember one time going to the yoga class at my regular studio and crying during the practice. There were so many emotions coming up. I knew it was a good thing because I was able to let go of the negative emotions. The rest of the time, I couldn’t cry. I was not sad, not frustrated, and not resentful. I was just numb, and felt like a walking zombie. April 2015 at the foot of The Great Wall China Reaching out for help: I didn’t tell my friends about my depression (read Lesson 4.1, for To Tell or Not To Tell guidance). I may have briefly mentioned it to a few close friends but no one knew the degree of my depression. I felt like no one would be able to help me, what would they even say if I told them? It‘d just be an awkward conversation and I’d feel anxious. I looked online for support groups. I couldn’t find any in Beijing for the international community. There are Chinese-speaking communities, but given that I had reverse culture shock, I didn’t think it would be a good idea to place myself in an environment that might cause social anxiety. I did email a few people that I found online who were conscious of mental health and asked them for advice and information. A man replied with a very long and caring email. I felt genuine concern and care for me when I read his words. He had never met me but because of his own struggle with depression he was able to understand me and care for me as another struggling fellow. Emails turned into coffee conversations. He became my guardian angel that never judged me, but was just there to listen, to support. They say that people with depression withdraw but this is not always the case. People with depression can be concerned about others who are suffering. They know it is a lonely place. I didn’t want to socialize with others, not even through texting but being in daily contact with him made me less anxious and less lonely. I was in a dark place but I felt like he was waiting for me to come out. He became very worried one day when I didn’t reply to his messages. He was worried that I had committed suicide. He was not overreacting as just weeks before I had been calling the suicide prevention hotline. I have known people who have taken their own lives. In reality I was just in a meeting and hadn’t been checking my phone but I was touched that he cared and had been looking out for signs of suicide danger. There were many more instances like this that got me through my depression. I couldn’t have imagined going through it without him. Now he’s one of my best friends! I am glad I looked for support, and I was lucky to find it. Since Oct 2015, I have been running a peer support group for people with depression, mania and severe anxiety in Beijing. I couldn’t find one when I needed it and so a year later, I created one. Take a break from life: I wanted to take a break from everything. I googled “run away” “travel” “take a long break”. Nothing seemed like a good option. I felt so stuck and helpless. I couldn’t t just stay at home, or just travel without purpose. At an office lunch one day, my colleague mentioned a mindfulness center in Thailand. It’s yoga, meditation, agriculture, art workshops for people with addiction and depression. I looked up online, and sent out the email immediately. I finally found a place to lay down my soul. I registered in June, and earliest I could go was September. In between, I would open their website every day, just to look at the pictures and blog posts. It’s something that I actually was looking forward to, the only thing! Every day, I looked at their website, knowing that I was going somewhere allowed me to take a deep breath. Looking forward to something got me through each day in hell. I was no longer in my depression by the time September arrived. I still went to Thailand for the planned month. That turned out to be the best thing I’d ever done. Take a look at the center here. (http://www.newlifethaifoundation.com/). I integrated mindfulness into daily practice, and I met so many inspiring people each of whom had their own stories. It’s been two years since then. I am a lot more advanced in my mindfulness practice. This has helped me to stabilize my mood in a significant way. I am now an advocate for mindfulness as a tool for mental health. Continuing on from the strategies mentioned in Lesson 5.2, we will not look at some more methods. Depression Strategy #3: Practice Taking a break from stressors, keeping a routine, and reaching out for help are common ways to cope and heal. When you are on a break, manage your daily schedule with a healthy routine. If you can’t, go stay with people who can help you, or go to a mindfulness center or a rehab center that has a structure for you. At New Life Foundation in 2014 Medication: will it help? It had been a question for me for years! I had always been a bit anti-medicine, even when I was in the major depressive mood. “I don’t know if it will work”, “It will give me so many side effects”, “I don’t know if I can trust the doctors, what if I get a bad one?” “I have to take them for years, don’t I? I don’t want that” ”My friends who have been on meds told me to be careful…so I don’t know” these were the questions that I had in mind. It had been a long and slow process for me to think it through, and I still could never make up my mind. I read countless research papers about the effectiveness of anti-depressants and this only made me even more confused. Taking meds is trial and error and you cannot be certain about what will happen when you start. I decided that is was time to have an answer and that the only way to find out what that answer would be was to give meds a try if I had another encounter with major depressive disorder. The decision was based on: I will risk my life again if I don’t let the professionals try. I will be in no place to decide for myself. I can’t decide from fear. Hope for the best is a better strategy. Accept that meds won’t always work, and give space for failure. I started to get low again just a few months later and I adopted my new strategy, I responded accordingly. I went to the hospital, and the doctor prescribed me a mood stabilizer. Very fortunately, I responded to the meds so well that I felt normal again after just a few days. However, do not count on medication to do all the work for you. It can only help you get up on your feet. You will still have to do the walking. So going back to the well-being list, this is when you start to tick the things off. Depression Strategy 4: Don’t be afraid to try medication Go for professional help, and do not fear medication. The person prescribing the meds is a psychologist, or psychiatrist and they have the skills required to help you. Know that they are trying their best, but even so, will not always be able to find the best solution for you right away. They learn from the failed prescriptions, and this knowledge helps them to figure out what will be best for you. Give them and yourself the space and patience for failures. It’s very difficult to have patience in this sort of situation but there are ways to cultivate it. Mindfulness has been used in eastern culture for thousands of years for mental well-being. Mindfulness can help you to cultivate patience. I mentioned how yoga helped me to cope during my MDD, but it’s not only for when you are already in a depression. It can also be used to keep us healthy. I completely trust the healing power of our body and mind if we listen to its signals and nurture it. Meditation intro workshop by CandleX in March 2016 I have been practicing mindfulness intensively since late 2013. Now almost every day, I do yoga and/or meditation for at least 1 hour; I have been on many mindfulness trips to Thailand, and I am going to go on more. I have started to lead yoga session in Beijing as a volunteer teacher, and have organized workshops on meditation so more people can learn about this tool for their well-being. What have I gotten out of it? It pulls me out of burn out by quieting my thoughts for a moment on a daily basis. It’s like turning off your computer Meditation intro workshop by CandleX in March 2016every day to give it a rest so you can use it again tomorrow. Overuse of your computer can lead to serious crash. For our mind, we call this crash a nervous breakdown. Our mind is that computer, and any moment we create a space of emptiness, we are resting our minds so that we sustain optimal function. It stabilizes my mood and equips me with emergency toolkits. I am impatient, competitive, highly sensitive and a perfectionist. These are all characteristics of people who are at a higher risk of depression. Yoga has helped me to learn to be patient. In 2014, when my boss told me that meditation would help me, I didn’t think so at all. I was so depressed that I found meditation impossible. However, now mindfulness practice are the tool for me to use to cultivate all that I need to get me through difficult times. I think of this as a first aid bag. When times get rough, I need to open it. If I don’t cultivate self-awareness, acceptance patience, love, kindness, and forgiveness, on a daily basis then my bag will be empty. Depression Strategy 5: Mindfulness Practice You will find meditation difficult if you are already in a depression. So yoga is a better choice. When you are in remission, it’s the best time to embed a mindfulness practice into your weekly schedule to raise your threshold for depression. I made it. I came through depression. Never would I have imagined that I would create a community organization to advocate for mental health, and provide psychosocial support for people with depression. Looking back on my story with depression, it has torn everything down so I could build something even more beautiful. Trust life. So there it is, Xiaojie’s experience in dealing with depression. To summarize, there are 5 major factors that had an impact on her healing process: attitude, knowledge, medical care, practice and mindfulness. Attitude – accepting, patience Knowledge- understanding of depression Practice- Take a break from stressors, Keep a routine, reach out for help Medication- Don’t be afraid of professional help, but be prepared for try and error Mindfulness– prepare your first-aid bag With depression, there’s no going over it, or going around it, there’s only going through it. Live your life one day at a time, try to do the right thing. There is a light at the end of the tunnel even though you can’t always feel it, just trust it. #Beijing #depression #mentalhealth

The recent suicide of actor Qiao Ren Liang (乔任梁) this September, which grabbed media attention in China, reminds us that everyone is susceptible to severe depression, no matter how talented, successful or well liked they are. Even when our closest friends are affected we may not be able to pick up on the signs or know how to respond. Helen Keller once wrote “I would rather walk with a friend in the dark, than alone in the light.” The question for this week’s classroom is when a friend is going through the darkness of depression, or we think they might be, what is the best way to walk by their side and support them? Of course this question has no simple answer. No two people with depression are alike. The symptoms and the level of depression differ from person to person (see Depression Essential Series: Lesson 2.1 Symptoms of Depression). The best way to support your friend also depends on their personality and your unique relationship. That said, in today’s classroom we are going to present some key guidelines we have compiled about how to spot depression in a friend and discuss depression with them. The chapter will be structured in three parts. Lesson 6.1 will talk about spotting the signs and talking about your friend’s depression. Lesson 6.2 will discuss helping your friend seek help and supporting them through treatment. Lesson 6.3 will conclude with responding to suicide/crisis situations and looking after your own wellbeing while caring for a friend Depression has many faces and people present in different ways. For some this might be as dramatic as insomnia and weight loss in others changes are more subtle, such as not going to weekly activities or even not posting Wechat moments. To spot when your friend may be facing depression… Educate yourself about depression symptoms (Classroom’s article Depression Essential Series: Lesson 2.1 Symptoms of Depression). If you are concerned by changes in their behavior talk with them about what you have noticed, see the next section for tips about talking about depression. If you already know your friend is living with depression ask them about what the warning signs are for them when they enter a phase of depression. Are they aware of any changes in their behavior when they feel low? Do any particular events or situations tend to trigger their depression, e.g. work stress? This information can help you be vigilant about the onset of your friend’s depression and be proactive about offering support. Talk about Your Friend’s Depression The stigma surrounding mental health means talking about depression can be uncomfortable. Knowing what to say and how to bring up the subject can be difficult. The right way to talk to your friend depends on their personality and situation, but here are some general tips to help discuss depression in a sensitive and open way. Talk openly: Talk about the changes you have noticed using clear, honest language without trying to hide the subject. Talking openly helps show your friend they can express themselves without feeling ashamed. Listen: When talking to someone about their depression, being a compassionate listener and giving your friend space to express their feelings, is often more important than what you actually say. Try and ask your friend open questions that allow them to share, such as, “When did you start to feel like this?” and, “How can I support you?” Don’t be judgmental or assumptive: Part of being a compassionate listener is responding without judging your friend or making assumptions. Don’t presume you know the exact causes of their depression, the effects it has on their life or best treatment option for them. Avoid judgmental statements that minimize your friend’s experience like, “This is just a phase,” or “It’s not that bad.” Depression isn’t caused being weak, or not trying hard enough to get better, so avoid unhelpful statements like, “You need to snap out of it” or, “You just need to think positively.” Instead, try and respond in a supportive way that highlights the positive. Be patient: Let your friend set the pace. It’s probably not easy for them to talk about the difficult emotions they’ve been experiencing so don’t rush them. Allow long pauses without feeling you have to jump in. Don’t worry if you don’t cover all the details in one talk. Don’t take negative responses personally: It’s not easy for any of us to admit there is a problem so some people may respond negatively when you talk about depression with them. They may be distant or even angry. Try not to take this personally. Remind them that you are there for them if they ever need your support. Overall, this lesson shows how important it is to be aware of the signs and symptoms of depression and being able to discuss it openly when helping a friend. In our next lesson we will talk about more guidelines for helping a friend find treatment and supporting them through the treatment process. #Beijing #mentalhealth #depression

If you follow CandleX’s Depression story column you may have read “In the moment of Blur | Sam’s story with Depression”. In his story Sam remembers his friend who ended her own life after severe depression. He recalls that his friend mentioned she was trying to see a counselor, but never did. In her last words his friend apologized for not being able to bring herself to get therapy. Sam’s story shows that even when people with depression want to seek help they sometimes need the extra support and momentum from their loved ones to take the step. In Beijing, we believe each of us have a few friends who experience different level of depression. Some may make you feel baffled, while others have signaled to you. Nonetheless, giving this support can be the most important thing you can do for your friend. Welcome back to this chapter, “Caring for a Friend”. We divided it into 3 parts: Lesson 6.1 talks about spotting the signs and talking about your friend’s depression. Lesson 6.2 discusses helping your friend seek help and supporting them through treatment. Lesson 6.3 concludes the series by responding to suicide/crisis situations and also how to look after your own wellbeing while caring for a friend. Todays lesson is Lesson 6.2. We will focus on how to help a friend find help and then how to support them through recovery. As mentioned in the previous lesson, the best way to support your friend depends on their personality and your unique relationship. However there are general guidelines to help you approach the situation and we have compiled them in this lesson. Helping a friend to find help Here are some practical ways to help your friend take the first steps to getting support. Encourage your friend to find help: Reassure your friend that it is OK to ask for help, there is help available and let them know that you can support them in finding it. If they are reluctant: Try and discuss your friend’s concerns. Remind them of the impact their depression is having on their life and how treatment could help. If your friend seems determined not to seek help you could try encouraging them to see a doctor for specific physical problems associated with their depression (e.g. sleeplessness, headaches or lack of appetite). Addressing these issues with a doctor can make people more comfortable discussing emotional issues. Remember you can’t force anyone to get help: You can encourage your friend to get help but at the end of the day it’s their decision, not yours. If you believe you friend is a danger to themselves, see Lesson 6.3 which will discuss responding to suicide/crisis situations. Help your friend to find and book an appointment: People with depression often feel exhausted so finding the right doctor or service for them can seem overwhelming. Helping your friend research the services in their area and booking an appointment is a great way to help. Write answers to questions the doctor/counsellor may ask: Help your friend make a list of bullet point answers to key questions such as: How long have you been feeling this way? What symptoms/ feelings have you been having? Have you ever had depression before? This can help your friend feel more prepared and is helpful if they have difficulty expressing their feelings to a stranger. Offer to accompany them to the appointment: Going for a first appointment can be very nerve racking so, if you can, offer to go with your friend even if it’s just to sit in the waiting room. If your work schedule means you can’t physically accompany your friend try making plans to see them later that day, call them before they go or even send an encouraging text. Support a friend through treatment Check in: You can offer emotional support by asking your friend about their progress, mood and how they are finding their treatment plan. Try not to get frustrated when things aren’t going well. The path to recovery may not be easy and your friend may need to try different treatment options to find what works for them. Help your friend acknowledge small steps and achievements they have made. Try to help with practicalities: Depression can lead to fatigue so offering help with practical things is important. Ask your friend if there are any specific tasks you could help them with. For example: helping with a household task or organizing childcare. Talk about things other than depression: chatting about everyday topics outside depression is important to give your friend a feeling of normality and prevent your relationship becoming solely focused on their mental health problem. Encourage socializing and activity: try to keep your friend involved in social events and invite them to mood lifting activities (e.g. going to a funny film or out to eat). Exercise is also very beneficial so help your friend get moving (e.g. going for a walk together). If your friend is severely depressed these activities may seem out of reach. In that case, focus on smaller activities, e.g helping prepare a meal. Try not to get discouraged if your friend says no, be gently and kindly persistent and don’t stop asking. In CandleX’s mental health support group in Beijing, new members often report being caught in a cycle of social isolation. When their depression began they started to say no to friend’s invitations. Eventually their friends stopped inviting them at all. It is unlikely your friend will take up every offer but if they actually come to 1 event in 5. That 1 time can help them with connect to friends and stay active which is essential for healing Attend a local Peer Support Group: Attending mental health support group is a good way to build a social network in a safe environment with compassion and empathy. It helps the healing process to go smoother, and reduce the psychological burden one experiences. The power of connection among new friends can also help preventing relapse that occurs when life situation changes. Send them this poster, and encourage them to come to our bi-weekly mental health support group. Please email info@candlex.cn for information and registration. That concludes our second lesson on supporting a friend with depression. The next lesson cover the key issues of how best to help a friend in a suicide/crisis situation and how to look after your own wellbeing while caring for someone with depression. #Beijing #depression #China