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at Harvard Medical School. “Even as more companies offer wellness programs to promote good health, depression continues to take a toll in the workplace.”

      Interestingly enough, depression doesn’t always manifest as sadness. Indeed, some chronically depressed people may just feel empty and apathetic, losing their passion for life. Trouble sleeping, loss of interest in pleasurable activities, feelings of guilt or hopelessness, decreased energy, trouble concentrating, appetite changes, and even suicidal thoughts or attempts have all been reported. One in six people will develop major depression in his or her lifetime. Surprisingly, two out of three individuals with depression do not receive adequate treatment, but it’s important to realize that help is available and you can get better.

      Clinical depression is generally caused by a combination of genetic, biological, environmental, and psychological factors. Furthermore, people with depression are more likely to have other medical conditions such as heart disease or diabetes, and they are also less apt to follow therapy for those problems, adding to their disease burden.

      If you suspect depression, it’s important to be diagnosed by a physician and explore treatment options. If you and your doctor determine that taking an antidepressant is the best course of treatment, Callie Carter, a specialist pharmacist in the Express Scripts Neuroscience Therapeutic Resource Center, suggests a few important tips to keep in mind:

       • There is usually a lag of two to three weeks before medications begin to relieve symptoms of depression. It may take up to six weeks to see the full benefit, so be patient.

       • Discuss symptoms that have not improved with your doctor. A different dose or medication may be needed.

       • Antidepressant medication generally should be taken for at least six to nine months after a first episode of depression. The duration may be longer for subsequent episodes. Talk with your healthcare provider about the length of treatment, since early discontinuation increases the risk of depression recurrence.

       • When antidepressants are discontinued, they should be tapered over two to four weeks to minimize side effects associated with abrupt cessation of therapy.

      Chronic depression may be a terrible disease to live with, but once you find the right therapy you will happily discover a life that is indeed better.

      At the end of the day, it is important to follow your doctor’s orders. But be sure to be your own doctor, as well. I am a strong believer that taking your health into your own hands is not only empowering—it’s an essential part of your journey to improved wellness.

      

      

RUNG 2

       Emotional Well-Being

       “Emotional Well Being—it’s a choice. And when you bring awareness to any aspect of your life, you will reap benefits, because awareness tells you how you are doing. It’s an infallible kind of radar, if you turn it on. The most important thing is knowing what you want.”

      —Deepak Chopra, M.D.

      Here’s to Your (Emotional) Health

      With Dr. Chopra’s words in mind, whenever I give a lecture on how to be Better Than Before, at some point I survey the room of (mostly) women and ask them what they want most out of life. The answer is almost always a resounding “We want to be happy!” Not to have more money, not to have more bags and shoes—although those are things that might make some people (ahem!) happier—but to feel happiness itself. To that end, I am often posed two questions: “Is it really possible to become happier?” And, “Can I do it overnight?”

      The response to the first is a resounding “Yes!” As for the second, there are no instant fixes. In order to overcome life’s emotional challenges, you must first take responsibility for your own life. Above all, you have to understand that your emotional lifestyle has consequences on your physical health, as well as your mental well-being. In other words, if you feel better about how you live, you will live better!

      As we discussed in Rung 1, there is a direct link between emotional health and heart health. In fact, researchers at the Barbra Streisand Women’s Heart Center at the Cedars-Sinai Heart Institute have found that emotional stressors may trigger changes that can cause such health issues as coronary artery dysfunction, headaches, digestive problems, insomnia, and even cancer.

      Stress is both inevitable and ubiquitous in most of our lives; yet we seem at a loss for ways to modulate it for ourselves. We all have so many responsibilities that we rarely allow ourselves a moment to think, to experience—to dream. And unless we get a handle on our lives, emotional angst can have serious consequences. But, what can we realistically incorporate into our daily lives to help get us through the difficult days? This rung is devoted to finding those ways and means.

      The Kaizen Secret

      The whole concept of being Better Than Before implies change—and the best place to start is in your mindset. Granted, it’s not possible to become the pure, innocent five-year-old you, who (hopefully) never experienced an emotional crisis. But you can constantly try to be better than a day ago, an hour ago, or even a minute ago. The secret is to take small steps, what the Japanese call Kaizen (from the ancient Chinese words meaning “change to make good or better”). It is all about making an effort to continually improve each day in very small increments. You can begin by gradually replacing the negative self-talk that keeps you from becoming the person you truly want to be.

      You Are Not Alone

      We all suffer from something, be it as simple as cuticle biting, jaw clenching, or smoking; to more complex issues such as chronic stress, fears, low self-esteem, neuroses, and phobias. In response to these universal complaints, everywhere you look there’s something either written or broadcast about stress management. What not to eat, what not to drink, what not to think. The fact that you know you shouldn’t be stressed—and you are—can cause even more stress. Take The Lawyer, for example, and his Orwellian theory on ice cream: “Forcing myself to resist my natural urges to eat it will cause more harmful stress than the physical LDL damage of eating it. So therefore, it will be even worse for my arteries to not eat ice cream!”(Huh?)

      Chances are you are one of the millions of people who are overwhelmed in every aspect of their lives—at work, at home, in relationships, financially, and even by the little yet annoying things such as traffic jams and people with too many food items in the express checkout line. Unfortunately, the stress epidemic sweeping our country is not only widespread; it’s also on the rise. Perhaps that’s because the sources of stress are also multiplying.

      Stress is epidemic. According to the American Psychological Association, 77 percent of Americans say that they “regularly experience physical symptoms,” 73 percent have “experienced psychological symptoms,” and 48 percent feel that “their stress has increased over the past five years.”

      Stress Comes in Many Forms

      The major personal stressors are well-known: Illness, dating and marriage, breakup and divorce, and the death of a friend or loved one. Then we all have career and financial worries. And for the more emotionally fragile, almost any change from their normal pattern can set emotional anguish in motion. Additionally, there are environmental stressors, such as smog and noise pollution. In today’s digital world, stress may also come from a constant bombardment of e-mails, texts, and voice messages that gives us the feeling of being on-call 24/7.

      However, the

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