From Maesk Counseling in Fort Lauderdale - Anxious Depression

From Psychcentral:

Experiencing Anxious Depression

By LaRae LaBouff 

Depression is a part of bipolar disorder. It is, in fact, one of the poles. The question of experiencing depression is not “if” but “when.” Depression on its own is a horrible experience, but sometimes other problems pile on. More than half of people with bipolar disorder also have some form of anxiety disorder. These can include generalized anxiety disorder, panic disorder, post-traumatic stress disorder, obsessive compulsive disorder and social anxiety. When anxiety occurs during a depressive episode of bipolar disorder it is called depression “with anxious distress.” Distress is exactly the term to describe how it feels.

When I experience anxiety, I communicate how I am feeling by comparing my mood to a pot of water. When I am feeling fine, the water is ambient temperature. The more anxiety I feel, the hotter the water becomes. Lately I’ve been sitting at a simmer with occasional panic attacks that put me into a rolling boil. This is in addition to the depressive symptoms I feel like depressed mood, loss of interest, weight gain, fatigue and feelings of hopelessness. It’s a debilitating combination.

In order to be qualified as an episode with anxious distress, you have to experience at least two of the following: 

  • Feeling keyed up or tense.
  • Feeling unusually restless. 
  • Difficulty concentrating because of worry. 
  • Fear that something awful may happen. 
  • Feeling that you might lose control yourself.

If you experience two of these symptoms, the anxious distress is considered mild. Three symptoms is moderate and four or more is moderate to severe. If physical restlessness is involved, it’s considered severe.

Having bipolar disorder with anxiety can lead to extra complications with the disorder. People who have episodes with anxious distress typically have longer episodes, don’t respond to treatment as well and have a higher suicide risk. 

Experiencing severe anxiety mingled with depression is incredibly distressing.  On the one hand my brain is telling me that all I can do is to go to bed and not do anything. On the other hand my anxiety is telling me how horrible I am for ignoring other responsibilities. The two sensations fight each other and leave me frozen, not knowing what part of my brain I should listen to. The anxiety is usually louder than the depression, but that doesn’t mean I succeed at getting out of bed. It just means I end up having a panic attack while I’m there.

I’m continuing to talk to my therapist and psychiatrist about my situation. My therapist gave me a list of ways to combat distress and my psychiatrist gave me additional medication to manage the anxiety acutely. In the meantime, I hope this is a short phase and that I will reach a level of normality soon.

From Maesk Counseling in Fort Lauderdale - Depression and Exercise

A great article from the NY Times on the connection between exercise and relief from depression:

How Exercise Might Keep Depression at Bay


Exercise may be an effective treatment for depression and might even help prevent us from becoming depressed in the first place, according to three timely new studies. The studies pool outcomes from past research involving more than a million men and women and, taken together, strongly suggest that regular exercise alters our bodies and brains in ways that make us resistant to despair.

Scientists have long questioned whether and how physical activity affects mental health. While we know that exercise alters the body, how physical activity affects moods and emotions is less well understood.

Past studies have sometimes muddied rather than clarified the body and mind connections. Some randomized controlled trials have found that exercise programs, often involving walking, ease symptoms in people with major depression.

But many of these studies have been relatively small in scale or had other scientific deficiencies. A major 2013 review of studies related to exercise and depression concluded that, based on the evidence then available, it was impossible to say whether exercise improved the condition. Other past reviews similarly have questioned whether the evidence was strong enough to say that exercise could stave off depression.

A group of global public-health researchers, however, suspected that newer studies and a more rigorous review of the statistical evidence might bolster the case for exercise as a treatment of and block against depression.

So for the new analyses, they first gathered all of the most recent and best-designed studies about depression and exercise.

Then, for perhaps the most innovative of the new studies, which was published last month in Preventive Medicine, they focused on whether exercise could help to prevent someone from developing depression.

The scientists knew that many past studies of that topic had relied on people providing reports about how much they had exercised. We human beings tend to be notoriously unreliable in our memories of past workouts, though.

So the researchers decided to use only past studies that had objectively measured participants’ aerobic fitness, which will rise or fall depending on whether and how much someone exercises. Participants’ mental health also had to have been determined with standard testing at the start and finish of the studies, and the follow-up time needed to have been at least a year and preferably longer.

Ultimately, the researchers found several large-scale past studies that met their criteria. Together, they contained data on more than 1,140,000 adult men and women.

Among these million-plus people, the links between fitness and mental health turned out to be considerable. When the researchers divided the group into thirds, based on how aerobically fit they were, those men and women with the lowest fitness were about 75 percent more likely to have been given diagnoses of depression than the people with the greatest fitness. The men and women in the middle third were almost 25 percent more likely to develop depression than those who were the most fit.

In a separate study (some of the scientists were involved in each of the reviews), researchers looked at whether exercise might be useful as a treatment for depression. In that analysis, which was published in June in the Journal of Psychiatric Research, they pooled data from 25 past studies in which people with clinically diagnosed depression began some type of exercise program. Each study had to include a control group that did not exercise and be otherwise methodologically sophisticated.

The pooled results persuasively showed that exercise, especially if it is moderately strenuous, such as brisk walking or jogging, and supervised, so that people complete the entire program, has a “large and significant effect” against depression, the authors wrote. People’s mental health tended to demonstrably improve if they were physically active.

The final review offers some hints about why. Published in February in Neuroscience and Biobehavioral Reviews, it took on the difficult issue of what happens within our bodies during and after exercise that might affect and improve our moods. The researchers analyzed 20 past studies in which scientists had obtained blood samples from people with major depression before and after they had exercised. The samples on the whole indicated that exercise significantly reduced various markers of inflammation and increased levels of a number of different hormones and other biochemicals that are thought to contribute to brain health.

But the researchers also caution that most of the physiological studies they reviewed were too small and short-term to allow for firm conclusions about how exercise might change the brain to help fight off gloom.

Still, the three reviews together make a sturdy case for exercise as a means to bolster mental as well as physical health, said Felipe Barreto Schuch, an exercise scientist at the Centro Universitário La Salle in Canoas, Brazil, who, with Brendon Stubbs, a professor at King’s College in London, was a primary author on all of the reviews.

Many more experiments are still needed to determine the ideal amounts and types of exercise that might help both to prevent and treat depression, Dr. Schuch said.

But he encouraged anyone feeling overwhelmed by recent events, or just by life, to go for a run or a bike ride. “The main message” of his and his colleagues’ reviews, he said, “is that people need to be active to improve their mental health.”

From Maesk Counseling in Fort Lauderdale - Depression Therapy

If you are suffering from depression, and are interested in depression therapy or counseling in the Fort Lauderdale area, this article is for you.

It is estimated that two-thirds of people in the U.S. suffering from depression never seek treatment.  That seems strange given that of those who do get help, 80 percent find a noticeable improvement in their symptoms within a few weeks.  Lack of knowledge about treatment options  and stigma are two of the reasons why people tend not to seek help.  

So, we already know that depression therapy works.  Here are some other facts:

  • Cognitive Behavioral Therapy (CBT) is an effective tool for addressing depression.  It involves working with a professional (therapist) to identify thought and behaviour patterns that are contributing to become depressed, or stopping you from getting better when you are depressed.
  • Depression is often masked as anxiety.  The proper diagnosis is therefore important as it has an implication for treatment options.
  • Depression distorts your thinking.  It can tell you "my depression isn't really that bad," or "I'm just sad like everyone else is once in a while."  Trust your gut.  If you feel something isn't right, i.e. you might be suffering from depression then you probably are.
  • Therapy will help you regain control and get pleasure back in your life as you learn effective coping skills.

Finally, you didn't choose to become depressed, but you do have a choice about what to do now. Contact Maesk Group Counseling to set an appointment, and get on the path to start living again.  You owe it to yourself to feel better!!

From Maesk Counseling in Fort Lauderdale - Depression Screening

Just a few days ago, the American Psychological Association formally recommended making screening for depression standard practice for teens and young adults.  This really did not surprise me, as my Fort Lauderdale practice sees many patients seeking help for depression in this age group.

The good news is that depression treatment is highly effective.  There are many different therapeutic techniques available, as well as the option for a medication evaluation for anti-depressants.  

The bottom line:  if you think you may be depressed, seek help.  You deserve to be happy!

Here is the link to the APA article:  Depression Screening 

From Maesk Counseling in Fort Lauderdale - Depression and Self-talk

“I have depression, and I just can’t do ANYTHING right,” my client sighed as she settled further into the couch.  I've been in Fort Lauderdale for three years and have no friends.  Maybe I should just accept that I am fat, depressed and a failure at relationships. Nothing will help me.”

And as long as she chooses to continue talking to, and about, herself that way, she WILL be overweight, depressed and alone, and most importantly, unable to change, regardless of her therapist’s skills. For the fact is that every cell in our body responds to what we think and say about ourselves.

Although most of us are familiar with the “love our neighbors as ourselves” directive, we miss the meaning of the last part. Most of us wouldn’t dream of calling our neighbor names or criticizing them point-blank to their faces, yet we look in the mirror and do it to ourselves every day. We feel compassion for our friend’s struggles with food, relationships or other issues, yet we are merciless and impatient with our own. Self love is a vital key to health, and self condemnation the thing that most often keeps us from our goals. For instance, if you are having trouble ending an unhealthy relationship, AND you “beat yourself up” for your “weakness,” we now have THREE issues to overcome—the relationship, the self loathing, AND the damage done to your self image by the insult! Self love, forgiveness for our mistakes, and patience with our failures leads to the strength and discipline necessary to move forward into a healthy, balanced life.

To become your own encourager and best friend requires a deep examination of who taught you to be self-critical in the first place. Where did the “I’m not OK” message come from? It is most often from one of two sources—either what was said about you by your parent, or what a parent said about themselves in front of you. If you heard negativity modeled in your growing up years, the pattern was set for you to live that way as well. Children really do learn what they live. But like any learned behavior, this thinking pattern can be changed; sometimes by yourself, and sometimes with the help of a counselor if the pattern is persistent or severe.

To remain vital and healthy in your thinking throughout your lifetime, practice catching yourself when you are saying or thinking self-critical things. Immediately visualize a big red STOP sign to interrupt the pattern. Replace the self-criticism with a positive, encouraging thought, such as “I’m proud of myself for trying to change.”

 If you focus on what you DON”T like about yourself, you will get more of it, but focusing on the successes in your life will lead to more success. Congratulate yourself on victories, whether it’s a ten minute walk when you really just wanted to watch television, or keeping your temper in traffic.

All of us respond to love and encouragement, including when we give it to ourselves. Give yourself the gift of acceptance!  And let us know if we can help.


From Maesk Counseling in Fort Lauderdale - Loneliness and Sadness

This is a link to an interesting article exploring the connection between loneliness and health problems.  And yes, there is a connection.  The article can be found here:  "Loneliness as Deadly as a Lack of Exercise and Diabetes." 

If you are struggling with loneliness, sadness or depression, know that there is help.  Maesk Group Counseling is eager and willing to help.  Call 954-353-4680 or email to schedule an appointment.

From Maesk Counseling in Fort Lauderdale - Exercise and Mental Health

This time of year in South Florida, many people find themselves a little blue, or even outright depressed.  From shorter days to the memories of holiday seasons past, it can be a tough time for many.  One solution:  workout!  This is a great article on the value of exercise during the holidays, written by fitness trainer Michael Shaw:

"Typically this time of year I tend to write about all the good things about the holidays and all the positive things we can all do with our families. I stand by all the advice I’ve given, but this year I want to discuss the elephant in the room: Holiday Depression. As much as many of us would like to shrug it off, the truth is that depression this time of year is very real.

There can be any number of triggers that bring it on: stress in spending money you don’t have; missing relatives who are no longer with us; spending time with people you don’t want to see; feeling hopeless; or a combination of these things. Folks who are suffering from clinical depression may feel an exacerbation of anxiety and sadness from a pre-existing condition, but others go through this illness during holiday time (Thanksgiving to New Year’s). Pictured with this article is Steven, one of the fitness models I manage, representing the frustration and sadness that holiday depression can bring on.

You all know my feelings about the importance of exercise and the role it can take in our mental and physical well-being. In the case of holiday sadness, combining the mental with the physical can make a huge difference. For example, in the morning take deep breaths and focus on either clearing your mind or on a memory that’s bound to make you smile. Taking deep breaths relieves stress and triggers relaxation.

The next thing is utilizing the outdoors. Taking a walk during the morning or the day will provide sunlight and cool air, the combination of which increases endorphins, allowing us to feel better and bring us a little happiness. Jogging or running will additionally help by increasing the heart rate, burning calories, and relieving additional stress.

Another important thing is doing exercises that require us to use our brain. For instance, doing multiple exercises in a circuit like squat and press, kettlebell swings, and barbell presses requires our brains to stay aware and in the moment. The act of using our brains can relieve stress and give us purpose. In context, if we compare doing exercises like those I mentioned to simply running on a treadmill, you can see how easily it would be for our minds to wander during the treadmill exercise, versus keeping our brains sharp during compound exercises.

Including active rest is also important. Active rest is typically light exercises that don’t directly involve specific muscle groups. In the general sense, vacuuming, cleaning the house, raking the lawn, doing construction around the house are all examples of active rest. In the holiday sense, this could be delivering meals to the homeless, spending the day walking and talking with someone who is all alone, or collecting canned goods for those in need.

Obtaining a sense of purpose and helping others are good ways to combat Holiday Depression. Another thing that can help is strength training. Doing light resistance training with dumbbells and body weight can improve our bodily strength as well as our mental strength.

Yoga is another exercise that helps depression.  Many of you know how I feel about Yoga. Its benefits can never be overstated. It protects the body from injury, increases flexibility and strength; and improves respiration, energy, and vitality. Yoga can also help with weight loss and keeping a good and balanced metabolism.

There really are a number of different ways for us to help ourselves and those we know who are suffering from holiday sadness. For anyone whose depression is more severe, assistance from your doctor, which may include taking specific prescriptions and working with a therapist or counselor, is the proper way to go. That doesn’t exclude exercise, as many doctors would still want you doing light to moderate exercise.

The holidays are a wonderful time of year. Imagine it without all the sales marketing, “It’s a Wonderful Life” type movies, and dozens of people you know talking about presents and shopping. Different right? Stripped down to just basics: being around people you love, sharing a meal, celebrating your religion in its purest sense, being happy to be alive and see a new year arrive, it can be beautiful. But the reality is that the trappings of what we know as the modern day holiday can be suffocating to a lot of people.

Having the courage to help ourselves or help someone else is probably one of the best spirits of the holidays that I love. In the words of Aristotle, “You will never do anything in this world without courage. It is the greatest quality of the mind next to honor.”

I know the mere act of doing this article will make a difference in someone’s life. I believe that. I wish you all a wonderful and joyous holiday."

From Maesk Group Counseling in Fort Lauderdale - Untreated Depression

Untreated Depression is a Threat to your Mental and Physical Health

Depression creates chaos in the entire body by throwing the stress response system out of alignment. The risk of heart disease, osteoporosis, diabetes and cancer are all raised as normal immune function is disturbed by anxiety, stress and /or depression. Difficult relationships, parenting and work issues all contribute to this situation. 

This post contains my“prescription” for becoming (and staying) healthy.  Here’s what we should all be doing for a healthy, happy lifestyle:

  • Get a yearly physical exam.  Depression and anxiety can be related to thyroid and other issues;
  • Exercise: it relieves stress, raises endorphin levels. It’s even better if you get outside in natural light to exercise;
  • Journaling: research shows it increases hopefulness, releases stress, and calms the brain;
  • Regular Sleep: essential to mood stability and a healthy immune system;
  • A good social or family support system increases longevity and raises immune system function; and
  • Professional Therapy: coming for a session BEFORE symptoms are out of hand and regular follow-ups. 

Now maybe you are thinking, well, if I could MAKE myself do all of these things, I’d be fine! What you may not realize is that a mental health provider is trained, licensed and qualified to be a resource to help you do these things. A therapist can be your encourager, your supporter, and your guide in prioritizing and planning your best, healthiest life. 

Therapy helps uncover the roadblocks to your success that exist outside of your awareness. These roadblocks include childhood messages, both told to you and modeled by your parents, and negative experiences that impact your habits to this day. Together we can gently uncover and examine these self-defeating beliefs without shame or judgment. When “the truth sets you free,” you are then able to move forward and achieve new levels of well being.

Maesk Group Counseling is here to help.  Call 954-353-4680 to take that first step.

From Maesk Group Counseling in Fort Lauderdale - Grief Counseling and the Seven Stages of Grief


A long period of "depression" (not clinical depression), isolation, and loneliness happen late in the grief process, months after the tragedy strikes. It actually is normal and expected for you to be very depressed and sad several months later.  Outsiders do not understand this, and feel that it should be time for you to "get over it" and rejoin the land of the living. Just knowing that your desire to be alone with your sad reflections at this time is normal will help you deal with outside pressures. You are acting normally. They just don't "get it".  Here are the seven stages of grief.  Keep in mind that sometimes a person may move back and forth among the stages, rather than progress through them in a linear fashion.


You will probably react to learning of the loss with numbed disbelief. You may deny the reality of the loss at some level, in order to avoid the pain. Shock provides emotional protection from being overwhelmed all at once. This may last for weeks.

As the shock wears off, it is replaced with the suffering of unbelievable pain. Although excruciating and almost unbearable, it is important that you experience the pain fully, and not hide it, avoid it or escape from it with alcohol or drugs.
You may have guilty feelings or remorse over things you did or didn't do with your loved one. Life feels chaotic and scary during this phase.

Frustration gives way to anger, and you may lash out and lay unwarranted blame for the death on someone else. Please try to control this, as permanent damage to your relationships may result. This is a time for the release of bottled up emotion.
You may rail against fate, questioning "Why me?" You may also try to bargain in vain with the powers that be for a way out of your despair ("I will never drink again if you just bring him back")

Just when your friends may think you should be getting on with your life, a long period of sad reflection will likely overtake you. This is a normal stage of grief, so do not be "talked out of it" by well-meaning outsiders. Encouragement from others is not helpful to you during this stage of grieving.
During this time, you finally realize the true magnitude of your loss, and it depresses you. You may isolate yourself on purpose, reflect on things you did with your lost one, and focus on memories of the past. You may sense feelings of emptiness or despair.

As you start to adjust to life without your dear one, your life becomes a little calmer and more organized. Your physical symptoms lessen, and your "depression" begins to lift slightly.

As you become more functional, your mind starts working again, and you will find yourself seeking realistic solutions to problems posed by life without your loved one. You will start to work on practical and financial problems and reconstructing yourself and your life without him or her.

During this, the last of the seven stages in this grief model, you learn to accept and deal with the reality of your situation. Acceptance does not necessarily mean instant happiness. Given the pain and turmoil you have experienced, you can never return to the carefree, untroubled YOU that existed before this tragedy. But you will find a way forward.
You will start to look forward and actually plan things for the future. Eventually, you will be able to think about your lost loved one without pain; sadness, yes, but the wrenching pain will be gone. You will once again anticipate some good times to come, and yes, even find joy again in the experience of living. 

After a period of time - say six months or so - if you are still feeling very depressed, or just not yourself, it is best to seek professional help.  Call Maesk Group Counseling to see up a consultation.  And above all, know that there is a way forward through the loss and pain.

From Maesk Group Counseling in Fort Lauderdale: Signs of depression in adults

PLEASE NOTE: this list is NOT intended to diagnose or treat you.  Contact Maesk Group Counseling for proper diagnosis and treatment.

Most people get “the blues” sometimes that last a day or two. However, Major Depressive Disorder is a SERIOUS and often FATAL illness that occurs in approximately 6.7 percent of US adults. Medications can be helpful, but come with side effects that many people cannot tolerate. Medications will NOT cure the mistaken belief system causing the depression.

 Without talk therapy to both uncover the root cause of the depression and learn ways to manage it, depression can persist despite medication. Cognitive Behavioral Therapy, or CBT, can help you uncover the beliefs you carry about life without even knowing it. These beliefs often contribute to depression below your level of awareness. Once uncovered, I can help you face and refute the irrational thoughts and replace them with healthy, logical thoughts.

If you are experiencing any of these symptoms on a frequent or daily basis, please contact me for a full professional evaluation:

1. sadness

2. pessimism

3. feeling like a failure

4. loss of pleasure

5. guilty feelings

6. punishment feelings

7. self-dislike

8. self-criticalness

9. suicidal thoughts or a sense of, It would be better if I  weren’t here*

10. crying, or unable to cry anymore

11. feeling agitated

12. no interest

13. hard to decide things

14. feeling worthless

15. no energy

16. sleep issues

17. irritable

18. appetite changes, up or down

19. can't concentrate

20. fatigue

21. no sexual interest

(Adapted from the Beck Depression Inventory)

Taking that step to call me for an appointment is hard, but can be the best decision you ever make.