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

So far, in our classroom on caring for a friend with depression, we have covered how to: spot depression in a friend, talk them about it and how to help them find help and go through treatment. This final lesson we will address two important topics. Firstly, how to respond if you believe your friend is at risk of suicide. Secondly, how to look after your own mental health when caring for someone with depression. Most of us don’t like to like to think about the idea that one of our close friend’s would even consider suicide. However, educating yourself about how to respond could help you save a life. With fast-paced Beijing life it is easy to get stressed and low anyway. The added stresses from caring for someone with depression can have severe toll on mental health. These guidelines can help you look after your mental health in a proactive way. Lesson 6.3 Caring for a friend with depression- reacting to suicide/crisis situations Be aware of the risk signs of suicide. Knowing common signs that someone is suicidal can help you know when to act. Remember different people show different signs of being in a crisis state and for some the signals may be more subtle. Trust your gut feeling and if you think something is wrong take action. If you believe your friend is at an immediate risk of suicide, do NOT leave them alone! Call emergency services as your friend may need to be admitted to hospital. In their 2016 national suicide awareness month campaign the American organization also suggest 5 evidence based actions for responding to a friend in crisis. Ask: Ask your friend directly if they are considering suicide. Many people worry about putting the idea of suicide in someone’s head, but studies show asking about suicidal thoughts does not increase risk of suicide (e.g. Mathias et al., 2012). Be there: Talk to your friend about their suicidal feelings “listen without judgement and with compassion and empathy”. You can go Classroom 6.1 for more info on this. Follow up: contacting and checking in with a friend in the days and weeks after a crisis can help reduce the chance of suicide. Try to contact them on a regular basis. Help them connect: help your friend reach out to a support system such as therapists, helplines, friends or family. Keep them safe: If your friend is feeling suicidal. Ask if they have thought about how they would do it. Keep them away from anything they have thought about harming themselves with. Looking after yourself To conclude our final lesson we are going to bring you some guidelines for how to balance caring for a friend with looking after your own mental health. “Is it selfish to focus on my wellbeing while my friend is suffering with depression?” Actually, looking after your own mental health is one of the most important things a carer can do. It’s easy for carers to become over stressed and face burnout. To give your friend the best support you can it is important to be proactive about looking after your own wellbeing. Be realistic about what you can do: As much as you would like to, you cannot “fix” someone else’s depression. You are not responsible for your friend’s mood, good or bad. Set boundaries: Although you want to help you can’t look after your friend all the time. Set clear limits about what you are able to do for your friend so you don’t get overwhelmed. It’s very important not to burn yourself out and make sure you take a break when you need! Get support: Many people caring for a friend with depression find talking to someone they trust about their experiences the most important step for protecting their mental wellbeing. Although be aware you might want to be careful about how much information you share about the friend you’re supporting. This brings to an end our lesson 6 on caring for a friend with depression. The chapter will be structured in three parts. Lesson 6.1 we talk about spotting the signs and talking about your friend’s depression. Lesson 6.2 we discuss helping your friend seek help and supporting them through treatment. Lesson 6.3 we conclude with responding to suicide/crisis situations and looking after your own wellbeing while caring for a friend. We hope that the lesson has given you the tools to help you respond proactively if your friend ever faces depression and to know that however small your impact feels the support you give to your friend can make a world of difference.

“I can save the world! No, I am a coward.” |What is it like to experience bipolar disorder? The majority of people have not experienced bipolar disorder before and we want to share some real life experiences of what living with bipolar disorder is like. All of the following stories are true stories that patients have voluntarily shared. We hope to raise awareness, improve understanding, and better enable the support of those struggling with bipolar emotion. 1) I have been diagnosed with bipolar disorder for 8 years now. My emotions always transition between a depressed mood and a manic mood, just like a corsair in an amusement park. At the moment I am going though a depressive phase. I don't know how to describe it, maybe we can have a chat when I am in a manic phase. 2) People say this disorder is for geniuses, but I can’t even eat and sleep like an average human being. Sometimes confidence can leave a great legacy, and sometimes it can destroy the world. Maintaining a balanced life requires all of my energy. 3. I suffer from bipolar disorder. I am a senior in college majoring in Psychology. I was introduced to emotions associated with bipolar disorder a year ago in an abnormal psychology class, and when I thought about it carefully I realized that I had already experienced this myself 10 years ago in middle school. I was the leader of the class and my form tutor gave me a lot of freedom to develop. I was able to come up with many ideas and organize class activities. I liked talking to my teachers and my classmates about a lot of things. However, sometimes I would feel very depressed and was scared to communicate. I was like this until I started college. In college I had more independence so the problem became more obvious: I don't have a regular routine; I procrastinate on everything; I can’t cope with finals, internships or research papers; I feel more and more self-contempt and sometimes I can’t even take care of myself. Sometimes however, I am very active, have lots of ideas, make plans and show off to others. I am like two completely different people, one with a high level of confidence and one with an inability to do things. I frequently go to a counselor for help in order to better understand myself, but when I am depressed I can’t imagine how I perceive the world. Just recently, I have decided to use medication to help me to get through this. I am still looking for the right way to exist after a winter holiday of medication and self-observation. 4. I was diagnosed with bipolar disorder 7 years agoand I am only 17 years old now. Everyone’s situation is slightly different. When I am manic I can be funny and outgoing. I study even harder than usual without sleep. However, when I am in a depressed mood, I don't want people to remember me, tears run down my face while I lie on my bed doing nothing. 5. When depressed, all obstacles will destroy me. —Kafka When manic, I can destroy everything. — Balzac 6. When I am in a manic phase, I always want to express myself. I could talk about anything and am also very productive. When depression comes, I don't want to see people, nightmares make me choke and life is meaningless. I realized something wasn’t right after experiencing some physical symptoms 6 months ago. I finally had the courage to go to the hospital, and I was diagnosed with bipolar. “I can save the word, no I am just a coward.” 7. Sometimes I feel like I have depression. I don't want to go out, do anything or communicate with others. Sometimes I feel like I am very passionate about everything. I can do everything with a positive attitude and it can influence others, but I never know how long this state will last. It is like burning a candle, when the candle is burnt out, another extreme will occur. 8. I just experienced bipolar emotion a few days ago. After working hard for a whole year, I still did not get into graduate school. That afternoon, though the sun was warm, I was still very cold. Although the street was energetic, I still felt a sense of loneliness. Though I had many messages that needed to be replied to, I just wanted to get into bed and be isolated from the external world. I woke up early the next day, from 6 in the morning till 11 in the night, I could not stop working on my essay. I was like a machine, and I couldn’t stop writing, I wished I could be burnt out that day. This can be seen as a contradictory moment. 9. I can experience emotional ups and downs in a single day. When I want to write things, I cannot stop copying lyrics and writing things down. I do this to keep myself calm, but my mind cannot control my body. Sometimes when I fail to complete my homework, I feel like I am powerless. I have no energy to move or do anything other than lie on my table. I don't want to do anything and don't know what do to. I want to listen to music or read books but I am too down to do so. 10. During the holidays, I don’t have motivation to do anything: I don't go out, don't get out of bed and don't talk. When school starts, I study normally just like the others but sometimes I need to visit the school counselor for guidance. My emotions are like a swing. Sometimes I feel active, like I can achieve anything. Sometimes I am down, and sometimes I skip school. After talking to a psychiatrist, I came to understand that my emotions are affected by my family. I don't know who I am, I am like a puppet who is being controlled by my family. I never had the courage to break it, so I chose to give up. A few days ago I watched “Manchester by the sea”, a movie about “the past is the past, people don’t have to make up for it,” when I saw the character Lee saying “I can't beat it, I can’t beat it!” with a face full of sadness, I cried. I realised that I have wasted a lot of time, missed a lot of opportunities, but sometimes I still feel depressed. 11. I started running every day in March, I am afraid to stop. After spending spring festival home alone, I felt lonely and could not do anything. I had no motivation to do things other than eat and sleep. The person who exercises every day has now disappeared. 12. Last year in high school. My therapist told me to make a plan after school started. So I followed this advice passionately. As a result I had a good time. I couldn't stop doing my homework and I was very healthy. However, a few days ago, I failed to follow my plan. I was sad. Now I am suffering from bipolar emotions, I can’t make myself calm enough to study. I know I need to work hard, but I don't know what to do. 13. The week before school started was horrible for me. I could be on my phone 24/7. I was always tired but could not go to sleep. Sometimes, I even woke up in the middle of the night. I got better after school started and felt more energetic. But my mood still swings back and forth: negative and positive. I could not control my emotion, even when I tried to. It was useless. 14. This is my first time writing about this. I hope to live a happy life, but the opposite always turns out to be the case. Sometimes I think everything is bright; sometimes, everything seems so awful. Having these two extreme emotions is torturing me spiritually. But I believe the future is going to be bright. Photographer Pere Ibañez took some photos of the people around us, expressing bipolar emotion. These photos are being exhibited. Ibañez’s photos reflect his subject’s mental and physical suffering. However, we can also see that everyone who suffers in this way yearns to be cured. They wish to get through this with support and help of others. Our Emotional Wellbeing Moodlab Bipolar Awarenss Raising Project hosts workshops to help participants to get to know our emotions. Being aware of emotions and managing them not only helps those with bipolar emotions, but are also important skills for everyone in society. #beijing #bipolar #depression

“She is sometimes a ranged shrew, with shrieks pierced my ears and frightful expressions in her eyes; standing on the stage, she forgets her lines, sings the wrong words, assaults other actors and falls into frustration from time to time. While she comes to a silence, her suffering martyrdom reveals her facet of a child.” Vivien Leigh may leave us with an impression of the sprightly, shining Scarlet in Gone with the Wind. However, the fact that she suffered from bipolar disorder is not a secret. Swinging in this bi-polar state, she exchanged for a dazzling but brief life at the expense of her health. So today, let us talk about all things related to bipolar disorder. What is bipolar disorder? Bipolar disorder, also called manic-depression, is a severe mental illness characterized by alternating periods of mania and depression. Mania is a remarkable characteristic of bipolar disorder, which commonly features: A heightened state of mind: an individual’s mind is extremely high but easily enraged. Racing thoughts: an individual’s pace of thinking is much faster than the frequency of language expression; individuals may speak very quickly often making quick changes between different topics. Sometimes individuals even find it hard to express themselves as their brains are too full of ideas. Increased activity: an individual becomes extremely talkative, fast-talking, and exaggerated in their words and content. Elevated self-esteem with impulsive behavior. Little need for sleep: the individual never gets tired even after prolonged activity and after working for a long time; they do not need to sleep, or only sleep a little. The main character of Skam — the Norwegian TV series, suffers from bipolar disorder. When he is in a manic episode he never sleeps at night and runs around naked at midnight. He, on a whim, breaks into other people’s houses to swim, and speaks unceasingly in an unconstrained style. Depression is the second characteristic of bipolar disorder. Depressive episodes of bipolar disorder tend to be very similar to single-phase depression (major depressive disorder) and they are difficult to distinguish clinically. Low state of mind, loss of interest, and decreased activity also appear when patients enter episodes of depression. Only when they feel depressed, do people with bipolar disorder tend to seek help. In fact, it is exactly because they only go to the doctor when they feel depressed that many people suffering from bipolar disorder are wrongly diagnosed as having depression. So, if you notice symptoms of depression in your family or friends, you had better pay attention to if they show manic behavior as well. The most painful truth for bipolar disorder patients is that they are alternately attacked by mania and depression. Sometimes you may see them living in an extreme high state of mind — so high that they feel like they are the master of the universe. In contrast, they sometimes get so depressed that they no longer want to carry on living. One bipolar disorder sufferer said to us, “Someone bleeds all his energy to keep living — that person is me.” Some misconceptions about bipolar disorder: Those who experience the pain will feel empathy towards those people suffering it. People without such experiences may easily have some misunderstandings and confusion about mental illness. This is especially true for bipolar disorder, which may give people a large space for imagination, and leads many misconceptions to arise. 1) Bipolar is just the normal ups and downs of moods. Many people may simply regard bipolar disorder as a state of “sometimes happy, sometimes sad”. Some people may put the label of “bipolar” on themselves and others at their will. This is very unfair for those who are actually suffering from bipolar disorder — just as some wrongly believe that patients with depression will get better merely by “being more positive”. It minimizes what it is actually like to live with bipolar. Sufferers of bipolar disorder are always swinging between heaven and hell in their lives. The feelings of surging and falling follow them, along with the struggle through day and night. As people who have not experienced bipolar, we may seek excitement by playing Mega Drop. But what if you imagine that you spend your entire life on the Mega Drop? This would probably be somewhat like the reality of a bipolar disorder patient. 2) Bipolar disorder favors genius (maybe I want some too)? Some people think that bipolar disorder is a kind of “genius disease”, which is the price people pay in exchange for intelligence and creativity. Many anecdotes and biographies show a tendency for people suffering from bipolar disorder or schizophrenia to show signs of genius and of being in possession of an “incomparable vision of world.” Some believe that an abundant imagination and creativity are the silver lining that keeps sufferers alive in the darkness of the disease. In the book Bipolar Disorder and Temperaments of Artists by American psychologist Kay Redfield Jamison, a list of celebrities who may suffer from bipolar disorder is shown. Writers, artists, and composers make up the majority.. In reality, bipolar disorder is a severe mental illness; the pain brought by it is strong enough to beat a man down. The “genius patients of bipolar disorder” reported by the media is a survivor bias. Though the ability to create incomparable arts sounds really captivating, bipolar is definitely not worth looking for. There are also many sufferers of bipolar disorder who do not demonstrate any exceptional genius or creativity – this expectation is simply false. 3) Is there a switch to alter the moods? Many people think it incredible that bipolar disorder patients can switch between mania and depression. Actually, some patients themselves can dimly perceive a “switch” in their brains, by which they can choose to turn on the manic state. In fact, the “switch” does not exist. Only in some conditions when the patients are doing certain activities, hormone secreted in their brain affects neural activities and accordingly trigger the mania. It is actually a switching process. Normally, patients are not able to anticipate the state in the next few seconds. Mood swings cannot be absolutely controlled. The road after bipolar disorder Bipolar disorder cannot be completely cured. Patients treated by medication have a quite high recurrence rate one year after treatment. In addition to the physical treatment by medication, psychological therapy plays an important supporting role during the rehabilitation period. In the case of emotional stability, the corresponding psychological counseling and treatment can greatly decrease the rate of recurrence. Mindfulness techniques and cognitive behavior therapy have proved to be effective measures for the treatment of bipolar disorder. For the family and friends of patients, their symptom of swinging between mania and depression is a heart-breaking and grievous problem. This situation seems “unreasonable” to them and it may consume all of their care and patience. Above all, for the patients themselves, the tolerance from both their families and the society in which they live is a crucial factor to alleviate the illness. Support, comprehension, and companionship from family and friends will provide the patients with a better environment for their recovery, and they are also useful indicators for predicting patients’ emotional stability. All the changes start from understanding All changes start from understanding. We participate in the MoodLaB-Bipolar Awareness Raising Project initiated by CandleX. We hope that this project is able to raise people’s awareness of bipolar disorder and also reduce the social stigma attached to it. Being devoted to a charity project related to psychology requires a lot of courage. People’s disdain, misunderstanding and so on can turn into significant obstacles for the project. We are very excited that CandleX is willing to make efforts, together with 简单心理, to eliminate the social stigma surrounding bipolar disorder. We know this stigma exists and we are determined to change it. Pere Ibañez, a renowned photographer, is now working with the project and exhibiting his photos, each of which shows a single man expressing their bipolar moods through facial expression and gesture. Perhaps not everyone can understand what these photos stand for, but for those who are getting troubled by bipolar, they are very impressive. We want to send people experiencing bipolar disorder the message that they are not alone; some people are caring about them, and ready for help. Hope you will stand by us and CandleX, to raise the public awareness of bipolar disorder, and eliminate the social stigma of it. References: American Psychiatric Association (2013). DSM-5. Andreasen, N. C. (1987). Creativity and mental illness. American journal of Psychiatry, 144(10), 1288-1292. Ball, J. R., Mitchell, P. B., Corry, J. C., Skillecorn, A., Smith, M., & Malhi, G. S. (2006). A randomized controlled trial of cognitive therapy for bipolar disorder: focus on long-term change. The Journal of clinical psychiatry, 67(2), 277-286. Gale, C. R., Batty, G. D., McIntosh, A. M., Porteous, D. J., Deary, I. J., & Rasmussen, F. (2013). Is bipolar disorder more common in highly intelligent people? A cohort study of a million men. Molecular psychiatry, 18(2), 190-194. Salvadore, G., Quiroz, J. A., Machado-Vieira, R., Henter, I. D., Manji, H. K., & Zarate Jr, C. A. (2010). The neurobiology of the switch process in bipolar disorder: a review. The Journal of clinical psychiatry, 71(11), 1488-1501. Zammit, S., Allebeck, P., David, A. S., Dalman, C., Hemmingsson, T., Lundberg, I., & Lewis, G. (2004). A longitudinal study of premorbid IQ score and risk of developing schizophrenia, bipolar disorder, severe depression, and other nonaffective psychoses. Archives of general psychiatry, 61(4), 354-360. #Moodlab #bipolar #depression

Going through depression can feel like the loneliest place in the world, especially when you live in hectic Beijing. For many, they are living alone here fresh off the boat from overseas, without a sufficient support system. Others are going through significant life changes, such as divorce or job loss, without a space to check in with themselves. The stigma around mental health here in China means people often don’t feel like sharing what they are going through with their colleagues, friends or even family and it can be difficult to find a safe space to talk freely about difficult emotions. In response to this issue, in Oct 2015, CandleX started the English speaking Bi-Weekly Mental Health Support Group in Beijing. The group runs on the 2nd and 4th Tuesday of each month. It is facilitated by CandleX. It gives participants a chance to talk about their experiences in a safe, empowering environment where peers share their struggles and stories. To date, the peer support group has been going for 1.5 years. At the 1 Year anniversary of the support group, we started a review of this group in Aug 2016, looking at the outcome of the group, participants’ dynamics, and significant cases. Our purpose is to provide better support From Nov 2016- Jan 2017, we’ve released 8 infographics reviewing our project. These are based on a 23-page report our research advisor produced. We want to give special thanks to Sally Souraya, an occupational therapist and mental health professional from Lebanon, who generously donated her time and expertise. We have compiled this Peer Support Group Review to look at the demographics of participants, how the support group has helped them, and to highlight areas in which we can improve. If you are still reading, we have a few requests: 1. If you are currently going through depression or severe anxiety, it’s tough. We know it. So come join us and let’s do this together. Please see our support group poster above. 2. If you are a counselor, please write to us. We receive requests every now and then asking for information about high quality, affordable services in town. We need to know who you are. 3. If you are media, please help us to spread the word. There are people in the dark who need this kind of support, now! Contact us and we’ll let you know what other depression based projects we are involved in. #mentalhealth #supportgroup #depression #anxiety #supportgrouppage

Since 2015, CandleX has been hosting annual Mental Health Support Groups. It is a vital part of our initiative because the large scale of it contributes to raising awareness for people with depression, mania and severe anxiety. After two years of biweekly support group meetings, we come to our second annual group-review. We invite you to take a look at our review of the first 2 years! Here’s a letter from Xiaojie,founder of CandleX and facilitator of the support group.

It's beginning to look a lot like Christmas. Well it certainly did on December 2 when CandleX hosted its inaugural 'Carols by Candlelight'. More than 70 people gathered at Portal Cafe to sing along to Christmas carols led by singers from acapella group Jing Sing. With songbooks and candles in hand, they sang a selection of favourite Christmas songs including Away in a manger and Jingle Bells. Jing Sing also performed a few songs, captivating the audience with their amazing harmonies. The MC of the evening was Xiaojie who is the founder of CandleX. She explained that funds raised from this event would go towards the Moodlab art education book. She also showcased a series of striking images that will feature in this book. It was a wonderful evening filled with music and joy. CandleX would like to thank Portal Cafe for providing their lovely space, the singers from Jing Sing and of course the volunteers at CandleX. Merry Christmas!

This Christmas, come along to a special CandleX event: Carols by Candlelight. From 7-8pm on December 2, join us at Portal Cafe and sing along to some favourite Christmas songs, accompanied by live music. All welcome and entry is free​. #China #Beijing #depression #support