Beyond the Burns Depression Checklist

I’ve continued tracking my depression symptoms using the Burns checklist for another month. The oscillations have been a bit less extreme: There was a period of higher (worse) scores near the end of August when we had to put Trouble (our 2-year-old pet rat) to sleep. This was followed by lower (better) scores at the beginning of September when I got to spend some time with Banji and had my first in-person session with Wakana in about a month. Then I started a new game in The Sims 3 (my current family) and, well, I think the scores pretty much speak for themselves. I’m noticing that I tend to have much better (lower) scores when I go out and socialize; this is in part because some of the items on the checklist are basically asking “Did you interact with other people today?” but I think it tends to help my overall mood, too. My average for this month is 32.

Ziya’s scores on the Burns Depression Checklist August 17, 2014 to September 15, 2014

Ziya’s scores on the Burns Depression Checklist August 17, 2014 to September 15, 2014

The items on the checklist are organized into 4 categories: Thoughts and Feelings, Activities and Personal Relationships, Physical Symptoms, and Suicidal Urges.

Thoughts and Feelings

The first category consists of 10 items describing one’s subjective experience, including: “feeling unhappy or blue,” “feeling hopeless,” “criticizing yourself or blaming yourself,” and “difficulty making decisions.” I’ve been scoring fairly high in this category (relative to the others), with no particular items standing out as more or less problematic than the others.

Activities and Personal Relationships

The second category consists of 7 items that describe behavior and subjective experience related to work/hobbies and social life. Although I feel worse on days when I withdraw from my social network, the items I struggle with most consistently with are “motivation” and “avoiding work or other activities.”

Physical Symptoms

There are 5 items related to sleep, appetite, sex, and “worrying about your health.” This is the category I seem to consistently score the highest in. Even on really good days when my thoughts, feelings, and behavior would suggest otherwise, my body seems to be depressed. Hopefully soon I’ll learn whether that’s (in part?) because of a sleep disorder.

Suicidal Urges

The final category asks 3 questions: thoughts? desire? plan? Fortunately this is the category I score the lowest in – usually.

Instead of tracking each item separately, I decided to look at my scores for overall categories. To standardize the scores, I divided the total score for each category by the number of items in said category. As a result, all the scores represented on the graph below are between 0 and 4. (Well, 0 and 3, but they could go up to 4. I really hope they don’t!)

Ziya's (standardized) scores on the subcategories of the Burns Depression Checklist from August 17, 2014 to September 15, 2014.

Ziya’s (standardized) scores on the subcategories of the Burns Depression Checklist from August 17, 2014 to September 15, 2014.

Unlike the month I tracked last year, there seems to be a disconnect among my subjective experience, behavior, physical symptoms, and suicidal ideation; the lines don’t move with any kind of pattern that would suggest they have anything to do with each other (correlation?). One thing I do notice is that my Suicidal Urges are the worst (highest) when my Thoughts and Feelings are as painful as or worse than my Physical Symptoms. I can deal with having low physical energy, but when I feel really sad, hopeless, and hating on myself on top of that, it becomes pretty tempting to just stop existing. I think it’s way past time for me to start engaging in cognitive behavioral therapy (CBT)!

Finally, as I wrote when I first posted about this in Measuring Recovery: Part One, the Burns Depression Checklist doesn’t include everything I believe is important to consider when assessing my mental health (such as symptoms of anxiety). My goal is to eventually develop a way to keep track of changes in various indicators of mental health, including signs that I am becoming more healthy and not just less mentally ill.

I’ve started tracking other symptoms that concern me, rating them on the same scale: 0 = “not at all”, 1 = “somewhat”, 2 = “moderately”, 3 = “a lot” and 4 = “extremely”. Some of them are symptoms of anxiety, others have to do with depression … it’s actually kind of confusing. I’ve heard irritability described as a symptom of depression, anxiety, and mania/hypomania! I guess the point isn’t so much to associate them with the correct disorder as to be aware of how much they’re affecting me. This is an imperfect numerical representation of my recent subjective internal experiences.

I put the symptoms into categories that sort of mirror the ones on the Burns, but I haven’t done the kind of empirical testing that’s necessary to determine whether my “checklist” measures anything meaningful. For that reason I have decided to track each item separately, even though it makes for fairly messy charts. Here’s what I have for the first half of September:

Ziya's scores on anxiety-related symptoms September 1, 2014 to September 15, 2014

Ziya’s scores on anxiety-related symptoms September 1 – 15, 2014

Ziya's scores on physical symptoms September 1, 2014 to September 15, 2014.

Ziya’s scores on physical symptoms September 1 – 15, 2014

Ziya's scores on irritability-related symptoms September 1, 2014 to September 15, 2014

Ziya’s scores on irritability-related symptoms September 1 – 15, 2014

Ziya's difficulty concentrating and communicating September 1, 2014 to September 15, 2014

Ziya’s difficulty concentrating and communicating September 1 – 15, 2014

I’m inclined to see my tracking method for the additional symptoms as a work in progress, but I do like using one graph per category and graphing each symptom separately. I think I’ll stick with it as-is for a while, and make changes as I feel inspired. For example, I originally had 10 items; I added “excessive or out-of-control worrying” and “difficulty relaxing” on September 3rd. Though the graphs don’t reflect this, I also needed to re-arrange the items to create the existing categories.

The new items use the same scoring as the Burns specifically so I can compare them. Is there any relationship (correlation?) between my scores on the Burns Depression Checklist / its subcategories and the additional symptoms I’ve chosen to track? Honestly, I have no idea.

Relaxation: There’s an App for That

I’ve been taking some steps toward taking better care of myself, largely relying on the apps that are available to me now that I have an Android tablet.

Icon for the app "Stop Panic and Anxiety" by Excel at Life

Icon for the app “Stop Panic and Anxiety” by Excel at Life

The app I’ve found most useful so far is called “Stop Panic and Anxiety” and is available for free. It plays “audios” (streamed from the internet, which admittedly is not always ideal) for panic assistance, emotion training, and relaxation. I’ve been listening to one of the relaxation audios – essentially, guided meditation with music – to help myself fall asleep at night. My muscles seem to melt as I listen to it and I start to feel better. It should help even more if I listen to the other audios (not the one I use to fall asleep) at different points during the day.

Icon for the app "Depression Inventory" by Handcarved Software

Icon for the app “Depression Inventory” by Handcarved Software

I’ve also been using 2 other free apps, “Depression Inventory” and “eMoods”, to track my symptoms. My score on the Depression Inventory has been remaining steady in the mid-40s, securely in the “moderate depression” range.

Icon for the app "eMoods" by Yottaram LLC

Icon for the app “eMoods” by Yottaram LLC

eMoods is nice because I can track some contributing factors (medication, hours slept, verbal therapy, etc.) as well as my depression, irritability, and anxiety. I’m not entirely sure how useful tracking is right now as I’m not really seeing any change, and it can be very easy to keep giving the same responses. I think eMoods would be more useful if I had a way to measure my anxiety and irritability, as I’ve been using the Depression Inventory to measure depression. Back to the app store!
(eMoods is intended for people with bipolar and also measures elevated mood.)

Icon for the app "Assistant" by Speaktoit

Icon for the app “Assistant” by Speaktoit

Another app I’ve been using is “Assistant”, which I found by searching for Android equivalents of Siri. It’s the only one I’ve found that lets you set reminders that repeat every day (but not weekly, e.g. every Thursday). In theory it’s very useful, except that I find it way too easy to just ignore the reminders. If I pay $3/month or $20/once I’ll be able to teach it my own commands, customize its appearance and voice, etc. I’m still debating whether I think the upgrade is worth the cost. It might be if I can teach it what “every Thursday” means – and decide to stop ignoring the reminders!

Finally, I’ve renewed my commitment to actually using all the prepaid massages I’ve accumulated at Massage Envy. The way their membership works, you pay about $60 per month and can get a 1-hour massage at no extra cost (other than tip/gratuity). Any additional massages you get that month are at a reduced cost. If you don’t use your prepaid massage one month, it carries over to the next. And so on.

I let so much time pass between massages that I estimate I have about 13 prepaid massages available to me after using 2 of them on hot stone therapy on Sunday. I can’t afford to keep paying the membership fee while I’m not working, but if I cancel my membership I’ll lose the prepaid massages and have wasted hundreds of dollars! Ideally, if I use the massages they will help me feel well enough to find and keep a job; then I might be able to afford to continue my membership. Otherwise, I’m hoping to gain some benefit while using up my existing massages so I can cancel my membership guilt-free.

The massage on Sunday was good, but I left feeling a bit disappointed. I think the biggest factor was that the muscles in my scalp and face were very tense, but my therapist didn’t massage them because doing so was not part of the hot stone therapy (nor, I learned later, one of his areas of expertise). It was very hard for me to feel relaxed and rejuvenated when my jaw was sore from clenching, even though I’d enjoyed most of the massage and felt the muscles that were massaged relax. I also think (and realized then) that I was wearing depression goggles: it’s really hard to feel good about something when you feel completely drained and sad.

The most useful part of Sunday’s appointment actually happened afterward. I politely told the receptionist that my face and scalp were very tense, but the therapist had not massaged them, and asked why. She suggested a different type of massage and went out of her way to schedule me an appointment with the best therapist available on my preferred day who specializes in the technique. We made it a 90 minute massage (using 1.5 prepaid massages), with 30 minutes of cranial sacral massage and an hour of full body. Based on the recommendation of the hot stone therapist, I might request that the hour be spent on just my upper body.

Ironically enough, Massage Envy also has an app. It’s not compatible with my device, though, and several of the reviews advise against using it because it’s not for making appointments. That’s okay, though, in this case I think I’d much rather talk to a human being.

Re-Igniting the Spark

I randomly decided to re-join SparkPeople today, and it was so worth it!

One of the first things I did was join “teams” focused on dealing with depression and anxiety, which I’m hoping might provide some additional information and social support. I also joined 7 other teams, set a plethora of goals, and proceeded to track everything I ate. And guess what – it’s telling me I need to eat more – calories and protein, to be exact.

Fox and I made an epic grocery shopping trip, during which we spent way too much money and – by conservative estimates – walked for at least an hour! Boom! That’s 1/3 of my exercise goal for the week! Booyah!

We came home with plethora of fresh fruits and veggies, yogurt, frozen veggies, and minimally-processed meat. I had a delicious apple (“Oh Spock! This is amazing! Why don’t I eat apples every day?”), and a little bit later, we cooked.

Namely, we made delicious tacos: ground beef, cheese, and bell peppers in spinach wraps. And Fox made a huge Caesar salad, which we enjoyed before the tacos. It was actually too much food – I doubt I’ll be hungry again in time to eat that last bit the tracker is saying I need. I loved every bite and felt really good eating it – in part because it was fresh and in part because I’d done half the work to make it. (When we cook, we cook as a team.)

I’d forgotten how much I love cooking. It’s so much fun, and so rewarding. 😀

Best of all, we have leftovers, so we get to enjoy our delicious cooking again!

And something about getting points for doing basic things I should do anyway (such as taking a few minutes for relaxation) makes them seem so much easier. “Yeah, sure, I can do that. It’ll only take a few minutes, and it will feel good.” That’s what I really like about SparkPeople – it’s not just about losing weight. You don’t have to make it about weight at all (though the weight-loss ads are kind of overwhelming). My goals are to get at least 8 hours of sleep a night and listen to music at least once per day and actually go tend to my garden each day and cook at least 3 times a week (and so on …).

And if it kicks my butt to exercise, all the better. If it inspires me to make healthier food choices, all the better. I’m feeling really good about this decision, really hopeful. Today felt wonderful – and it was just an ordinary day in which we ran some errands. Nothing special.

I know from experience that I’m high from starting something new. Over time – probably before long – my enthusiasm will wane. I wasn’t planning to get too involved in the community aspect of the site, but maybe I will. If I make friends, then they can encourage me to stick with it when I don’t want to be bothered, and I can do the same for them.

You’re welcome to visit my Sparkpage – and friend me, if you’re on SparkPeople. Let’s see where this rabbit hole goes!