When you are depressed it is often very hard to think clearly or make any decisions. It is also hard to think of anything to do to help yourself feel better. This article will help you take positive action in your own behalf.

Keep in Mind

• Depression is not your fault.
• Depression is a temporary condition. You will get well. You will feel happy again.
• The best time to address depression is now, before it gets any worse.
• It's up to you, with the help of your supporters, to take responsibility for getting better.

See Your Doctor

Depression is serious. You need to see a general physician as soon as possible-- don't wait longer than a few days. The sooner you get treatment, the sooner you will feel better. You need an appointment with your physician for a complete physical examination to see if there is a medical condition that is causing or worsening your depression, to plan your treatment and for possible referral to a specialist. If you do not have a physician, contact a mental health organization in your area for a recommendation.

If any of the following apply to you, insist on an appointment within 24 hours or ask a friend or family member to do it for you (it's hard to do things for yourself when you are depressed).

• You feel absolutely hopeless and/or worthless.
• You feel like life is not worth living anymore.
• You think a lot about dying.
• You have thoughts of suicide.
• You have been making plans to end your life.

Ask a family member or friend to stay with you until it is time for your appointment. Make sure you keep the appointment.

When you see your doctor, take a complete listing of all medications and health care preparations you are using for any reason, and any unusual, uncomfortable or painful symptoms.

Self Help Techniques You Can Use To Help Yourself Feel Better

1.Tell a good friend or family member how you feel-ask them if they have some time to listen to you. Tell them not to interrupt with any advice, criticism or judgments. Assure them that you can discuss what to do about the situation after you get done talking, but that just talking with no interruptions will help you feel better.

Your friends and family members may not know what to say. You can tell them to say any of the following:

"I'm sorry you are having such a hard time."

"What can I do to help?"

"Tell me how you feel."

"I'm here to listen."

"I love you."

"You are very special to me. I want you to get well."

"You will feel better. You will get well."

2. Get some exercise. Any movement, even slow movement will help you feel better-- climb the stairs, take a walk, sweep the floor.

3. Spend at least one half hour outdoors every day, even if it is cloudy or rainy.

4. Let as much light into your home or work place as possible--roll up the shades, turn on the lights.

5. Eat healthy food. Avoid sugar, caffeine, alcohol and heavily salted foods. If you don't feel like cooking, ask a family member or friend to cook for you, order take out, or buy a healthy frozen dinner.

6. If you are having lots of negative thoughts or obsessing about difficult issues and hard times, divert your attention away from these thoughts by doing something you really enjoy, something that makes you feel good--like working in your garden, watching a funny video, working on a craft project, playing with a small child or your pet, buying yourself a treat like a new CD or a magazine, reading a good book or watching a ball game.

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7. Relax! Sit down in a comfortable chair, loosen any tight clothing and take several deep breaths. Starting with your toes, focus your attention on each part of your body and let it relax. When you have relaxed your whole body, notice how it feels. Then focus your attention on a favorite scene, like a warm day in spring or a walk at the ocean, for at least 10 minutes.

8. If you are having trouble sleeping, try some of the following suggestions: drink a glass of warm milk, eat some turkey and/or drink a cup of chamomile tea before going to bed before going to bed:

• read a calming book
• take a warm bath
• avoid strenuous activity
• avoid caffeine and nicotine-both are stimulants
• listen to soothing music after you lie down
• eat foods high in calcium like dairy products and leafy green vegetables
• avoid sleeping late in the morning, get up at your usual time

9. Ask a family member, friend or co-worker to take over some or all of your responsibilities for several days--like child care, household chores, work-related tasks so you have time to do the things you need to take care of yourself.

10. Keep your life as simple as possible. If it doesn't really need to be done, don't do it.

11. Avoid negative people who make you feel bad or irritated. Do not allow yourself to be abused in any way. Physical or emotional abuse can cause or worsen depression. If you are being physically or emotionally abused, ask your health care provider or a good friend to help you figure out what to do.

12. Avoid making any major decisions like career, relationship and housing changes until you feel better.

Things To Do After You Begin Feeling Better

1. Educate yourself about depression so that if you ever get depressed again, you and your supporters will know exactly what to do.

2. Become an effective advocate for yourself--figure out what you need and want for yourself, and then work toward it until you get it.

3. Develop and keep a strong support system of at least five supporters, people you feel comfortable with, trust and enjoy. If you don't have five supporters, make some new friends by joining a support group, attending community events, or taking an interesting course.

4. Write a plan to keep yourself well. Include lists of:

• things you need to do every day to keep yourself well, like get a half hour of exercise and eat three healthy meals
• things that may not need to be done every day, but if you miss them they will cause stress in your life, like buying groceries, paying bills or cleaning your home
• events or situations that, if they come up, may make you feel worse, like a disagreement with a family member or loss of your job, and an action plan to follow if these events occur
• early warning signs that you are starting to get depressed again, like feeling tired, sleeping too much, overeating, and dropping things, and an action plan to follow if they come up
• signs that things are getting much worse, you really are depressed, like you can't get out of bed in the morning and you feel negative about everything, and an action plan to follow if this happens

Ask your health care providers, family members and friends for help in developing these plans.

next: Shocked! ECT Homepage
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~ all articles on depression

Interview with Joel Metzger

Joel Metzger is the coordinator of the Online Noetic Network. I also encourage you to read the "Thread of Life."

Tammie: What led you to launch the Online Noetic Network?

Joel: I came online and found little that interested me. Everyone talking. Lots of My Favorite Is... , My Hobby Is... , My Story Is... , I Believe In... , but few sources of talk about what this life is. What life is for all of us! We all have something in common. Let's celebrate in that! I started ONN to be a source for the articles that I want to read.

Tammie: What people have been the most influential in your life, and how?

Joel: The people who have taught me the most about myself, my life, as it is. In other words, the people who most influenced changes in my life are the ones who showed me that I don't need to change!

Tammie: You wrote an incredibly powerful account of your near death experience. I was hoping that you'd share a bit about your experience and its impact on you. How has it changed you?

Joel: When everything in your life changes -- and I mean *everything*: family, friends, home, abilities, personality, body, interests -- then you're sure to see the one thing that is consistent. I was still alive. That life is my treasure. Know it. Anyone interested in this story should read it at the ONN site.

Tammie: You also wrote that simplicity is your sanctuary. How so?

Joel: I love this question. Because I love this sanctuary. It's mine. I own it. I am the child of that simplicity, that simplicity that keeps me alive.

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Tammie: If you were to have explained to your daughter when she was ten years old what the meaning of life was, what would have you said to her?

Joel: Meaning? Depends what meaning you give to it. I guess the phrase "meaning of life" doesn't do much for me. I sure haven't figured out any meaning to life. Now, if you were to ask what the beauty of life is, ahh, that I could answer!

Tammie: So what is the beauty of life from your perspective?

Joel: When I talk about life, I mean this feeling I get inside myself, just the simple flow of life itself. For me, this has a presence of its own and a beauty I find nowhere else.

Tammie: What are your hopes and fears regarding the future of our world?

Joel: I hope that everyone can learn the beauty and simplicity they have. I hope everyone can gather around that beauty. It would change everything. It has changed my perspective, goals, efforts.

Tammie: What have been the primary lessons of your life experiences?

Joel: I think the article states that very well. Please read The Thread of Life.

next:Interviews: Bruce Elkin on Simple Living

"When we got organized as a country and we wrote a fairly radical constitution with a radical amount of individual freedom to Americans, it was assumed that the Americans who had that freedom would use it responsibly." - Bill Clinton

To get out of the bottle we need radical common sense. Radical common sense is common sense deliberately encouraged and applied. Radical common sense reflects the growing realization that individual good sense is not enough—that society itself must make sense or decline. Radical common sense is a spirit. It respects the past, it pays attention to the present, and therefore it can imagine a more workable future.

On the one hand, it looks as if modern civilization hasn't the time, resources, or determination to make it through the neck of the bottle. We can't get there from here. We can't solve our deepest problems through such traditional strategies as competition, wishful thinking, struggle, or war. We can't frighten people (including ourselves) into being good or smart or healthy. We find we can't educate by rote or by bribery, we can't win by cheating, we can't buy peace at the expense of others, and, above all, we can't fool Mother Nature.

On the other hand, maybe the answers lie in the problem—our thinking, especially our ideas that nature is to be mastered rather than understood. We have tried to run roughshod over certain powerful realities.

Radical common sense says let's ally ourselves with nature. We have nothing to lose and a great deal to gain. As the old saying has it, "if you can't beat 'em, join 'em." We can apprentice at nature's side, working with her secrets respectfully rather than trying to steal them. For example, scientists who observe natural systems report that nature is more cooperative ("Live and let live") than competitive ("Kill or be killed"). "Competing" species, it turns out, often co-exist by food- and time-sharing; they feed at different hours on different parts of the same plant. Among moose and some other herd animals, the old or injured members offer themselves to predators, allowing younger and healthier members to escape.

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Altruism appears to serve an evolutionary function in living creatures. In its inventiveness, nature—including human nature—may be on our side.

By documenting the health benefits of such traditional virtues as persistence, hard work, forgiveness, and generosity, scientific research is validating both common sense and idealism. People who have discovered a purpose feel better, like themselves more, age more subtly, and live longer.

Radical common sense derives its conviction from science and from the inspired examples of individuals.

Excerpt 2:

The Lessons of "Living Treasures"

Japanese society has an admirable habit of honoring its outstanding contributors as if they were national resources. Individuals who have developed their abilities to a high level or who have given generously of themselves

Every nation, indeed every neighborhood, has its living treasures, people who find their greatest reward in contributing to the society. Some are well known, but millions are quietly going about their heroic tasks perfecting their work, trying to serve more, not less.

Most of these people grasp the content of the body of wisdom Aldous Huxley called the Perennial Philosophy. They recognize that their fate is tied to that of others. They know that they must take responsibility, maintain their integrity, keep learning, and dream boldly. And they know that this knowing is not enough.

They are making clear that what they need now is the so-called "nitty gritty," the small steps that precede a leap. They want a technology transfer from the people who make their dreams come true.

Radical common sense says that we should collect and disseminate such secrets for the good of the whole. And, not surprisingly, that most capable people are not only happy to share what they have learned; they are also eager to benefit from the experience of others.

It is little wonder that our individual discoveries don't become common knowledge. When we stumble across certain tricks and short-cuts we usually don't think to tell anyone else. For one thing, they probably already know. Or we're competitive.

The more successful we become at our chosen tasks, the less time there is for analysis and reflection. The coach may recall that the gold-medal figure skater was once graceless or fearful. Certain psychological and technical breakthroughs made the difference. The champion, also a subtle observer of change, is too busy mastering new moves to spell out the anatomy of a winning performance. The same could be said of the outstanding entrepreneur, statesman, or parent. They aren't teaching because they are so busy learning.

Think for a moment of your own breakthroughs. Did you record and track your learning? Most of the time we notice improvement in retrospect, if at all. And we rarely think to mark the trail for others to follow. "Live and learn," we say, acknowledging the value of experience. We usually forget about "Live and teach."

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Radical common sense says that our collective survival may depend on our ability to teach ourselves and others. By pooling and organizing the wisdom of many scouts we can assemble a kind of guide and companion for travelers everywhere.

Apply certain laws of life, and you have nature on the side of your dream. You are less reliant on luck and, at the same time, better equipped to take advantage of it. You can contribute your best without compromising your values, undermining your health, or exploiting others. You can be an explorer and friend to humanity.

Achievers have an enabling attitude, realism, and a conviction that they themselves were the laboratory of innovation. Their ability to change themselves is central to their success. They have learned to conserve their energy by minimizing the time spent in regret or complaint. Every event is a lesson to them, every person a teacher. Learning is their true occupation, and out of it flowed their profession.

These four-minute-milers of the spirit insist that they are not unusually endowed, that others can do what they have done. They know factors of success more reliable than luck or native ability.

The not-so-hidden agenda is the conviction that leadership must become a grassroots phenomenon if our societies are to thrive. If that strikes you as unlikely, consider first of all that nothing else is likely to work. And secondly, be aware that people already secretly suspect that they are capable of taking charge. Sociological surveys have shown repeatedly that most people believe themselves smarter, more caring, more honest, and more responsible than most people.

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Apparently we can't show these traits because "it's a jungle out there." It's as if to be "smart" we must hide our caring lest we try to live up to our responsibility in the jungle. So the dangerous jungle persists as a self-fulfilling prophecy from our collective self-image. One of the ways we can spring the goose from the bottle is to unite as free and honorable individuals who have the nerve and good sense to challenge defeatist assumptions. In so doing we have to pierce the veil that separates our heroes from the heroic in ourselves.

As our societies go through their identity crises, we can view the chaos as a sign of life, the turbulence as a healing fever. Radical common sense paraphrases Socrates: The unexamined collective life is not worth living.

The more sensitive I am as an individual, the more permeable I am to healthy new influences, the likelier that I can be molded into an unprecedented Self. That Self is the secret of success of a society. It sees the ways in which its fate is joined to the whole. It has the attributes we sometimes call soul and the passion we have called patriotism.

Radical common sense is the wisdom gleaned from the past that recognizes the perishable opportunities of the moment. It is the willingness to admit error and the refusal to be deterred by failure. Heroism, it becomes apparent, is nothing more than becoming our latent selves. Victory doesn't lie in transcending or taming our nature but in progressively discovering and revealing more of it. Great problems, like the wars of old, may be a stimulus to achievement, but we don't have to rely on external challenge. Radical common sense says we can challenge ourselves. Or as the Taoist tradition puts it, we can embrace the tiger.

When asked for his most important discovery, a famous corporate trainer said, "I finally realized that people learn from only one thing: experience. And most people aren't very good at it." Beyond a certain point all education is self-education. New learning comes slowly unless we choose it. A self-defined challenge is an irresistible teacher.

In encompassing the simple secrets of the visionary life, radical common sense may be the long-sought Grail, a powerful vessel in which we might shape ourselves and be shaped.

Above excerpt from Chapter 1, Aquarius Now by Marilyn Ferguson (Weiser Books, November 2005). Aquarius Now by Marilyn Ferguson; Published by Weiser Books; Publication date: November, 2005; Price: $22.95; ISBN 1-57863-369-9; Hardcover; Category: New Age/New Consciousness

"All human suffering is an experience based on value judgements of what is good and bad."

A judgment is labeling some thing, person, or event as good or bad, based on your belief system. Lets take a look at the concepts of good and bad.

Does anything carry with it a value of good or bad, independent of human evaluation? Are good and bad inherent qualities or human assessments? Is any event, person, thing, circumstance inherently (exists as a permanent condition) good or bad? Or are they labels we use to define what we want and don't want?

How does Webster define "good?"

good (gud) adj. serving it's purpose well || having desired qualities || virtuous, kind, well-behaved, agreeable, pleasant, beneficial, worthwhile, profitable, efficient, competent, capable, safe, and valid.

The key phrase in that definition is "having desired qualities." We define good as being something we want. And look at the words used to define good. Are they not what we desire? For example, we want our children to be well behaved .We want our lives to be easy, to be around people who are pleasant and kind. We want what we do to be worthwhile, efficient, and hopefully, profitable. We want to feel safe, etc.

What about "bad?"

bad (bæd) wicked, evil || defective, inadequate || not prosperous || unwelcome || distressing, disagreeable, upset, harmful, and unskilled.

Again, look at the words. Aren't they simply defining what we don't want as "bad"? We don't want items that are defective. We don't want a corrupt government. We don't want to be "poor". ....on and on...you get the idea. Good = Want. Bad = Don't Want

"What disturbs people's minds is not events, but their judgments on events."

- Epictetus, 100 A.D

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If good and bad were inherent qualities (true regardless of our assessments), then they would remain the same throughout time. History has shown this to not be true. Through out lineage, what we've called good and bad has changed.

So if "good and bad" are assessments, then you are free to re-evaluate those assessments. When you look at situations (and yourself) in terms of desires, and not as value judgments, you remove the negative connotations associated with "good and bad". The examination of the situation becomes less volatile and hostile. You can simply make an observation, notice what you want or don't want, and respond according to those desires.

Observation And Value Judgments

Some people say we need judgments to be able to live in this world. "How could I make decisions if I didn't judge? Isn't that how we make decisions?" Let's make a distinction between a value judgment and an observation.

In an observation we see, hear, feel what is happening around us. We then state what we see. When we're judging something, we go one step further in the process of observation and add in a subjective evaluation. We label the event as either good, or bad. THAT, is the value judgment. You're not removing the decision making process, you're simply replacing "good and bad" with "I want, I don't want."

How does this apply to accepting yourself? Well, you do the same thing to yourself. You first make an observation about yourself, ("I am fat") then decide if it's a good or bad thing to be ("It's bad to be fat"). When we judge something about ourselves as "bad", it becomes impossible for you to accept (be okay with) that part of yourself. BUT, it is possible to accept (be okay with) your weight and still know you WANT to be thinner. Make sense?

"Judgment stands as an obstacle to self-love.
When you form judgments about another person,
for instance, "this person looks like a lazy person,
or a failure, or has terrible clothes," you create
a message to your subconscious that the world
is a place where you had better act in certain
ways if you want to be accepted...that you are
only going to accept yourself under certain
conditions. This leads to an inner dialogue of
self-criticism."

- Orin

What if you were to drop your value judgments and simply saw "what is" then identified what you wanted and why? It could totally transform your experience. What are the ramifications of doing so? Perhaps you would find a well of love for yourself and others that you never knew existed. Perhaps you'd notice the less you judge yourself, the less you'll judge others. And maybe, just maybe, the experience of acceptance would give you the solid foundation to move forward in creating yourself and your life the you've always dreamed.

next: You Are Always Doing Your Best

• Letters of Hope
• Letters of Pain
• Letters of Parents
• Letters of Recovery

Letters of Hope

Claire Age: 15 Anorexia

I don't exactly have one eating disorder. I have bulimic and anorexic tendencies. I don't know how common that is, but it's what my current situation is. I've had it since I was about 12. So, it's been 3 years now.

I was overweight for awhile when I was younger. Then I leveled off and when I entered junior high, I started putting on weight again. In junior high, it's a fate worse than death to be fat. So I began to diet. I went from a size 14 to a size 8, and then began to take diet pills. I then went from an 8 to a 1.

Only 2 people know about my eating disorder. My mom and one of my best friends. They are very understanding, but I don't think they fully understand what I'm going through. Sometimes they try to make me eat, which always results in a round of yelling and fuming.

Actually, what made me decide to get outside help was the story a Concerned Counseling friend of mine told me about her eating disorder experience. It was an eye opening experience and scared me.

I have tried therapy, but I have had bad experiences with most therapists and nutritionists. Concerned Counseling has been the one place where I have a good experience with a therapist. I am getting ready to seek help outside of Concerned Counseling, and it's kind of scary to me, but I'm willing to try.

I don't think I'll ever be fully recovered from my eating disorder. An eating disorder is something that's with you for life. I think I'm going to have to stay committed to it in a way. I'll always have to fight it, but it's a fight I'm willing to do.

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Anne Age: 20 Anorexia

I am a recovering anorexic and bulimic who, for at least eight years, has lived with the monster of ED (eating disorder). Those years were not always complete hell, but often, they were. Anyone who spent extended periods of time with me would attest to this without question or hesitation.

I was in denial most of the time, but part of me always knew something was wrong -- or at least different. After suffering quietly for about four years, I eventually got into eating disorder therapy with a psychologist and a psychiatrist. In addition, I have been hospitalized and have spent time in a residential eating disorder treatment center.

It was really helpful for me to be in the accepting and caring environment of the center. It provided me with a kind of rebirth to be with others in similar situations and the opportunity to share a mutual understanding of what we were fighting daily; suddenly my eating disorder didn't seem so powerful, knowing that we were all in on the battle and preoccupation together.

On the other hand, I hated the hospital because I felt even more alone, helpless, and hopeless there. Even though it probably saved my life at the time, it nevertheless was not beneficial for long-term help with the disease.

I continue to be in therapy and on medication. While I am working against this deadly enemy, I've experienced relapses. However, I now know that there is hope out there and that instead of ED killing me, I can kill ED.

With this in mind, I have learned to take not only one day, but one thing, at a time and to make the most of whatever I am presented with. Easier said than done, I often remind myself of what Emily Dickinson wrote:

"Hope is the thing with feathers

That perches in the soul,

And sings the tune without words,

And never stops at all."

 

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Sue Age: 33 Binger

I'm 33 years old now, and I've had my eating disorder for around half my life, since I was 17 or 18, and in college. I was a slender girl in high school and able to eat all I wanted. All of a sudden, I gained 15 pounds my freshman year and 10 my sophomore year.

Funny thing is, compared to now, I wasn't really that fat then. In fact, I'm still not obese. I'm about 20 pounds overweight.

Back then, I tried to diet and started to binge. I would go to three different vending machines to get junk food, then sneak it into the library. For awhile, I alternated between dieting a few days and all out binges. Then, I descended into bulimia. I discovered laxatives could make me feel "clean" again after my binges.

Until I was 22, I binged once, sometimes twice a day, using 10-15 correctols at a time. I remember visiting a professor and having dizzy spells; I almost fainted. After a few more near-misses, I realized the laxatives were taking their toll. Through student health (I was in a graduate program), I went through some eating disorder group therapy. It enabled me to quit using laxatives, but the binges were still there. I relapsed into laxative use for a brief stressful time, but overall since then I have managed to stay off them with only a few one-time use lapses a year.

When I began therapy, I was diagnosed with bipolar affective disorder, or manic depression. I started to see the first of quite a few psychiatrists and to take medication. For a while, the binges lifted to maybe one a week, and then they'd come back. I find it interesting that my moods don't really coincide with my binges. I could feel happy and still binge, and be depressed and not. I have had periodic remissions of the binge eating for a few months at different times over the years, and I don't know why.

The most recent thing I tried was a Breaking Free workshop by Geneen Roth. It worked for awhile. What I have come to realize is that sometimes the binge eating is useful and it helps me get through the day. Sometimes I allow it to exist. Other times I want to fight. I find that the chat room at this site has helped me resist binges. Someday I will beat this thing, I just need to keep trying different ways.

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Letters of Pain

Anna Age: 19 Anorexia

I am a nineteen year old female. I was anorexic when I was fifteen, but I still have to deal with this disease to this day.

At times I have to make myself eat and at other times I just have to decide that I won't listen to people's comments..

People's comments are what triggered this whole disease for me. I have always been skinny, but not as skinny as my older sister. I would look at her and think that I had to be skinnier than her since I was younger. People used to tell me that I was going to be fat when I got older. It was a big joke to a lot of people, but it affected me more than they will ever know. They made stupid comments like," Anna, you are getting so big that soon you won't be able to fit through the double doors."

Of course, I was not gaining weight but I just had to prove to everyone that I was not going to get fat. In the summer before ninth grade, I stopped eating. I tried to see how long I could go without eating anything.

I remember, one time I didn't eat for three weeks. I would chew gum and drink water, but never too much water because I thought that I might gain weight from the water. I liked to let people know that I had not eaten in three weeks and that I was just not hungry.

No one, except my sister, seemed to care that I was not eating. Her boyfriend's mom was a nurse so she talked to me about what I was doing to my body by not eating. I really didn't listen to her at first. Then I realized that by not eating I was not getting the attention that I wanted. I realized that there was other ways to get attention rather than starve myself.

At the beginning of the summer I weighed 105 lbs. By the end of the summer I weighed close to 85 lbs. and yet no one was really concerned about me.

I never had any treatment, but I wish that I had. I still have to make myself eat at times. I try to ignore people's comments. No matter how small they may seem, I know that they will affect me.

At times, I find myself not eating so I force myself to eat. My boyfriend knows all about my problems with eating and he strongly encourages me to eat. He knows when I haven't eaten in awhile and he makes me sit down and eat with him. I have problems eating with a lot of people especially if they are strangers.

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Lisa Age: 35 Compulsive Overeating

I have suffered from an eating disorder for about 8 years now! I am an overeater and a binger. When I get nervous or depressed, I tend to stuff my face with everything in sight until I get sick or diarrhea. Then I look at pictures of when I weighed between 110 and 120 and I go into severe manic depression.

Sometimes I just stay in bed for days and don't answer the phone or the door. When my kids and my husband ask me what is wrong, I just cry and tell them that I am a failure at everything and I wish I was dead! Of course, I then find solace in food or cigarettes. At other times, I go on diet binges and practically starve myself for days. Most times, I hide food from myself and everyone else and late at night I sneak out of bed and gorge. Then the cycle begins again!

I look in the mirror at myself and want to throw up. I am so disgusted with myself. Everyone that knows me says that I am a beautiful giving woman with a heart as big as Texas and that there isn't anything I wouldn't do for the people that I love. I just look at myself and see a butt as big as Texas!

This has caused many problems in my marriage and with our sex life. I won't let my husband even look at me with the lights on and our love making has dwindled down to practically nothing. Then I start thinking that he doesn't love me anymore and wants someone else because this has affected his performance too! He is afraid that if he can't perform, I will start thinking that it's because of my FAT! This is usually a correct statement. Thus, no sex life!

The kids really pussyfoot around me and basically stay out of my way or wait on me hand and foot when I get this way. I know I have a problem. I just don't know how to solve it! I have been to psychiatrists, counselors, doctors, and talk groups. I have tried every diet that has ever come out, even the quick weight loss program designed for patients who need surgery and starvation diets. I have tried exercise programs and walking. I have even tried taking laxatives!

PLEASE HELP me if you can, although at this point I feel there is no help! I am not a rich person and I don't have Richard Simmons helping me like I see all those people getting help on all those talk shows!

My family thinks that I am being silly and that I don't have any reason to feel depressed, so I keep it inside and eat some more.

 

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Karen Age: 27 Bulimia

I am currently afflicted with bulimia. I have been with this disorder for nearly 6 years. This disorder was a cure-all for my excessive weight in college. In fact, at first it wasn't a disorder at all. It was a gift. One that I did not, could not, let go. Now it is a curse, one I own.

I soon discovered this was consuming me and it was taking every essence of my being. I became obsessed with finding all I could about eating disorders. I was one who had control of it, not it of me. I researched for hours, denying myself of friends, of life. When I wasn't reading about it I was acting it out. I became involved with an eating disorder support group at the University of Northern Iowa. Not to get support but to satisfy my own obsession in hearing other people's stories. I could offer advice that would help but never needed any myself.

I finally admitted I more of a problem than I could 'solve' on my own. In the spring of my junior year I decided to go to a counselor. After a few sessions she urged me to go into an inpatient treatment facility. I shied away from this, but eventually entered.

I remained in for 9 weeks. I went through several methods of treatment. Antidepressant medication, psychotherapy and eating disorder group therapy. I came out of treatment with renewed strength and faith. After six months, I relapsed. I was continuing my counseling, but that ceased after a year. I was only getting worse.

My professional life was on the up and only getting better. My personal life was shot! I was becoming my disorder in a severe way. I began stealing food for my disorder. I continue to deteriorate and act out my disorder during any free minute I get. It is a compulsive habit that has become a full blown addiction.

My future? I wish I knew. I can only hope and envision myself becoming strong enough to overcome this. I have serious doubts that this will ever happen. I spend a vast amount of energy planning, covering up and acting out my other persona. I wish I could become a 'normal' person. I don't think that will ever happen.

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Shannon Age: 15 Anorexia

I suppose I do have an eating disorder. I have been depressed and I don't really know what kind of eating disorder I have.

I used to sort of be bulimic, but now I'm an anorexic overeater. I try to keep it from my friends and family, but it has affected me in a lot of ways. It's very frustrating and hard to deal with.

I do have a psychologist, but, because I am neither under weight or overweight, no one really takes me seriously. Last year and the year before, people thought I was anorexic. Now, everyone thinks everything is okay as long as I'm eating. No one really seems to understand that when I'm overeating, its just as bad as when I'm not eating at all.

I generally try to protect those around me, so I keep it hidden. I've never really figured out why eating is such a problem for me, but I always have a really hard time with food. I hope to someday be able to eat normally, without worrying about calories, or completely binging, but first I need to find the right help.

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Lynn Age: 33 Anorexia

I'm 33 years old and weigh 87 lbs, and I'm 5'3.

I guess you would say that I'm still in denial about having anorexia. I've had two doctors and one dietician tell me that my problems come from my low weight. When I initially went to the doctor because my heart beats too fast, he told me it was the result of an eating disorder. He put me on heart medication.

I haven't had any treatment for eating disorders. I refused to go because I don't think that's my problem. However, deep down, the more I look at things and talk to people, the more the doctors may be right. It's a fight within yourself, that I don't know who will win.

The crazy thing is: I'm 33 years old, a wife and the mother of two children. I'm a kindergarten teacher who asks the little guys what they eat for breakfast. I teach them that they need good food to grow nice and big and strong. Now they're saying that I'm anorexic.

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Lexie Age: 27 Compulsive Overeating

I am obese. I am 5'4" and weigh from 190 to 242...depending on the week. As a child, my parents were constantly after me to gain weight. As an adult, people feel the need to encourage me to lose weight.

The biggest problem I have is eating large quantities of food until I am sick. I don't want the food. I'm not hungry and it doesn't taste or feel good. I'm not sure why I do it. I have been told it is "self-medicating" to ease emotional pain.

It has GREATLY affected my relationships with others in that I cannot stand for people to touch me or stand close to me. When they do, I feel like I am so ugly and so dirty that it will "rub off" on them. I also feel like no one really wants to touch me or be around me because I am so disgusting. I punish myself physically for eating...cutting, hitting, and burning myself so that I won't eat again.

I guess part of the problem is that I go for days at a time eating nothing and then eat uncontrollably for a day or two, then eat nothing again. I hate myself. I hate how I look. I cry when I see myself in the mirror. I feel like I can never see exactly what I look like and I am constantly measuring and comparing myself to others to see if they are bigger or smaller.

I cannot eat out with others because I have to go to the restroom to throw up and I am afraid someone will hear me. At work, my boss recently asked if I was sick because she noticed an odor in the bathroom. So now, I have had to find another place to throw up so she won't know. Please excuse the graphic nature. I don't know how else to put it.

I want help. When you're low-income, it's hard to get.

 

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Letters from Parents

Michelle Daughter-16 Bulimia

I found out that my 16 year old daughter was bulimic approximately 2 years ago after I found a journal that she was writing. Actually, in my ignorance at the time, I thought she was just "going through a phase". I didn't believe that she was doing it often, nor did I believe that it would continue very long. These opinions were based on the fact that I never saw or heard her do it and she didn't appear to be losing weight.

I did not approach her with my discovery- and at about the same time she began counseling for depression. Her therapist confirmed to me that she was binging and purging.

She lost a classmate to suicide, then her beloved grandfather died suddenly of a heart attack. I know she started making herself throw up as a way of "having control" over her life, and "getting rid of the bad stuff". She never wanted to have me find out because she said that it is disgusting and she was afraid of disappointing me. In fact, it's only within the last few months that she became aware that I know about it.

She has seen a counselor for 2 years, which hasn't helped much. She says he doesn't understand. She took Prozac for 1 1/2 months, then refused to take it anymore-said it didn't make her feel better. She does access your message board and chatrooms which I think has helped her because she is able to talk to people who "understand".

No other members of the family are in counseling at this time. It seems like I am the only other person affected by it. I feel a tremendous amount of guilt! I feel like if I would have tried harder to give her a stronger self-esteem, she wouldn't be trying to hurt herself. I feel like I have failed her in some way. It scares me to think of the long term problems she is subjecting herself to. I also don't understand what would make a person want to do that.

That is why I access your channel, because I am desperately searching for ways to help my daughter before this gets completely out of control. I want to make her feel good about herself, and realize that she is a wonderful person.

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Letters of Recovery

Den Age: 34 Anorexia

Due to an 'on-going' horrendous childhood, I entered my teens with a very low opinion of myself.

I suppose I was around 12 when I first stopped eating. Looking back, I am not certain why? Only that I could, so I did! I think most people then considered it a 'teen' thing and that I would outgrow it. By the time I was 16, my periods had stopped and I weighed 84 pounds. I had full-blown anorexia.

My family doctor had me hospitalized. By then, it was no longer a choice element. The thought of food would bring on immediate nausea. I recall clearly one doctor that came to see me. He told me I was wasting his time and that my parents should 'do something' with me. That incident made me very wary of approaching medical people for a long time.

Over the years, I have received medication on and off, but I have quickly relapsed into my anorexia once support is withdrawn. The real crunch for me came in Spring '95. I collapsed. It was a heart attack. The years of self starvation had damaged my body irreversibly. I was in the hospital for 5 months. This time I received therapy for eating disorders as well as medication.

It has taken the 18 months since to regain my strength. I am now just over 105 pounds. I now do the grocery shopping. I couldn't face that for years. I even cook for my family.

To aid in my recovery, I was given extensive therapy on a one-to-one basis. I have to say that the therapy was the best treatment. The sub-conscious mind is an extraordinarily strong thing and my emotional difficulties needed to be addressed. I still have to use beta-blockers for my heart as I am left with a 'murmur' and morphine-based painkillers on occasion. I no longer though use medication for the anorexia.

Two things that I avoid that help me, weighing scales and mirrors. Both can bring about strong negative responses. It is a little like alcoholism. I will always have the tendency towards anorexia, but by avoiding certain triggers I can live a "normal life".

I will never be able to associate pleasure and food, but through education I can understand the necessity for it. I now acknowledge that eating is a task I must attend to and I've established a daily eating routine.

For me, it has always been about control, never weight. I do worry about relapsing and have never had the opportunity to talk to other people who have experienced this type of illness. Support is paramount and recovery can be tough as I often feel isolated. Few people understand how hard it is living with anorexia.

I hope that one day all kids will receive the help they need before their problem becomes deeply embedded. I now focus on today and worry about tomorrow when it arrives. I thank my husband and my kids for their support and belief in me.

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Amy Age: 28 Anorexia

I was 18 years old and off to college. I was overweight when I entered college, but by the end of my sophomore year I had lost over 100 pounds. I was diagnosed with anorexia nervosa.

What started as a "FAD DIET", became a compulsion for me. I had gotten so bad at school with my starving, laxatives and diet pills, that I was forever passing out in my dorm room. I was in treatment at school with a psychiatrist at a local hospital that was pushing for hospitalization.

After passing out in my dorm room, ending up in the emergency room with low potassium, I was hospitalized on a general psychiatric unit for one month.

Besides the "fad diet", the big thing that really triggered my eating disorder was being raped at college. After 30 days of continued weight loss, my family was called to take me home to a hospital in New York that specialized in eating disorders.

I suffered from my eating disorder for 8 years with multiple hospitalizations ( I gave up counting after 12). I was tube fed on IV's and miserable. I was placed on antidepressant medications including Anafranil, Disipramine, Prozac and .

At the height of my illness, the eating disorder consumed my entire life. I gave up my friends, isolated myself in the house, dropped out of college (temporarily) and spent 5 days a week at the eating disorders' clinic for nutritional counseling and group therapy. Add to that, medical appointments three times per week. My family didn't understand this. To them, being thin was desirable at ANY COST.

I suffered many relapses and my eating disorder progressed to the point that I wanted to die. I reached that point of death and woke up in the ICU in 1994... that was when my recovery really began. My last hospitalization was in 1995.

I'm currently on Elavil. I'm also in out-patient psychotherapy on a weekly basis with my psychiatrist.

I have great hope for the future. I'm as close to eating disorder free as I think I can get. I refuse to let my eating disorder get out of control.

I went back to school and received my Master's Degree in Social Work. I am a practicing social worker and my intention is to help others fight this battle. My hopes and dreams for the future are to work with a non profit organization here in New York to help people with eating disorders get the treatment they need, even when they can't afford it.

I'm now married. I now have 2 1/2 years free of hospitalizations. Relapses happen with ED's and the media doesn't help at all...it's a never ending battle.

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Michelle Age: 27 bulimia

I am a 27 year old female who has been bulimic since I was 11.

I first learned about bulimia during a school orientation. Several of my friends and I tried it and I was the only one who liked it. I liked the fullness and sudden emptiness, the complete high feeling afterwards and also the instant relaxation that comes after throwing up.

I really was not an overweight child. I was very athletic and also never really paid much attention to my body until I began binging and purging. I did it occasionally until the age of 13. That's when I was raped by a family friend.

I then began purging without binging and anorexia. I was anorexic until I was 21. I entered the hospital at age 21 with a ruptured esophagus at 5 feet 6 inches and 100 lbs. I had maintained this weight for several years. I was insistent that I did not have an eating disorder and that I had the flu for several months. They did not believe it and called my parents.

I was out-of-state, going to college, and my mom flew to see me. She gave me an ultimatum, move home or go for treatment. I moved home. It was a mistake. I can see that now, 6 years later. But at the time, I was not ready to admit that I even had an eating disorder much less get treatment for it.

After moving home, I entered counseling for depression. I began to see that I did have an eating disorder and that was the first time I talked about the rape.

Several years later, I left home again after taking a job in my field of study. I had decreased my bulimic behavior to several times a week and also began using prescription drugs and cocaine to substitute for the relief of the bulimic behavior. I had a suicide attempt about 6 months after moving away from home. At that time, I was binging and purging approximately 15-20 times a day and wasn't working and obviously not paying my bills. Actually I wasn't doing anything but being bulimic.

I was committed to a treatment facility for several months. I just could not let go and stop purging. Then the court system forced me into drug treatment. I was told at that time that I was chronic and that I would never get better. I really did not care. I was ready to let bulimia kill me. I went to drug treatment, entered a half way house and attempted suicide again, also binging and purging many times a day and was committed to a state institution.

It was at this time that I took a serious look at my life and decided that I did not want to be bulimic anymore. I just could not seem to stop the behavior. I felt as if I was addicted. I could not maintain a healthy weight and I was severely depressed. Medication did not do much good for me because I was purging so much that it never had an opportunity to get into my system. I spent several months in this state hospital and was released. I moved back near my family with the hopes of working things out and maybe that would "cure me".

I have found that the only cure for me is to be honest about my feelings and to not "throw them up". Bulimia is a way I punish myself. I punish myself for feeling sad, happy, succeeding, failing, not being perfect and for doing a good job. I am learning that life is just one moment at a time and that often I can only say: "okay, for the next 5 minutes I will not binge or purge."

After having serious health problems several months ago with my heart and my kidneys, I faced the ultimatum, was I going to listen to my body or my eating disorder. I have chosen to listen to my body. It is hard and not always what I do. I am finding that the more I do listen to my body, the less my head tells me to binge and purge.

I think the hardest part for me is letting go of what I thought my eating disorder represented in my life: "stability, love, nurturance and acceptance". Trusting myself, and others, to find those things outside of food, and also learning to accept my body, has been very freeing.

I am not at a place where I can honestly say I love my body, but I can accept it for what it does for me and stop punishing it for what it doesn't do. My expectations today of life are: "one day at a time"; and I am finding that at the end of the day, if I slip and purge, I can forgive myself, look at why it happened and know that tomorrow is another chance for me to choose to be healthy.

I hope that one day there will be a place where people with eating disorders can go to find support, help and love for where they are at at the moment and not for where everyone thinks they should be. That was the hardest part of recovery. Today I am grateful that I have the experiences I have and I look forward to finding out what life is like when I live on life's terms and choose to do that bulimia free.

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Mary Age: 17 Anorexia

I had anorexia for about two years. It started as a weight thing. I thought I needed to lose a little weight to look better. Everyone around me and in magazines seemed to be so thin and gorgeous.

I started eating less, maybe one meal a day. Sometimes I would have snacks in between, but soon, that ended, too.

In the beginning, I weighed about 100 lbs. In a few months, I was down to 90. This didn't seem to be enough. I had to lose it quicker. So I started exercising every night, like a maniac. I did about two hundred sit-ups, a hundred leg lifts, and several other small exercises.

I also started eating even less. One day, I would eat maybe half a sandwich, then I wouldn't eat the next. I finally thought I'd reached my goal! 80lbs. But I still thought I was big. To me, though, the problem had changed from wanting to be thin, to an obsession with depriving myself of everything, mainly food.

My parents sent me to a psychiatrist, but it didn't help. So after a few weeks, I was on medication. They changed my medication four times, trying desperately to get me to eat, but nothing worked. I had slowly gone downhill. I was depressed all the time, only thinking about my weight. I was so hungry, but the guilt seemed worse than the starvation, so I continued.

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My older brother had always been my hero, but one night, he cut his wrists. He lived, but it left a very vivid picture in my head. I could just kill myself and not have to worry anymore! I tried overdosing on muscle relaxers, but was only sent to the emergency room. A month later, I, too, cut my wrists. Nothing worked.

I ended up going to a hospital for other people with my problem, depression. But when I was in the hospital, I realized that nobody else had the two problems I had, depression and anorexia. I left the hospital after a week, unchanged. The psychiatrist changed my medication again, to Prozac. At this point, I was probably 75lbs. Three weeks passed, and I was slowly eating more, about a sandwich and a half each day. I pulled my weight up to 90 again. When I weighed myself, I started crying. I relapsed and dropped back down to 80lbs.

I cried all the time. Nothing was helping me and there was no way out. Everything seemed hopeless. A voice in my head constantly monitored what I ate, or even drank.

I returned to the hospital and this time listened to everything, and tried to actually learn what was causing this problem and what I could do to get out of the nightmare I had made for myself.

Now, a few months later, I feel somewhat relieved that most of this is over. I can eat more now and only hear the voice, if I let myself. Knowing that you can eat healthy, and stay thin, makes a big difference. You don't have to starve yourself to be that way.

I weigh 105 lbs. now and I feel happy about it. Every once in awhile, the voice will try to creep back in, but I just ignore it and continue trying to stay healthy.

I'm 17, but it seems like I've been through an awful lot. Thanks for asking me to write. I hope you can use it to help anyone that might have the same problems. They have to know, they're not the only ones, that's for sure!

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Denise Age: 17 Bulimia

It all started as an obsession with diet pills, but they never worked. So I started to starve myself. When I couldn't do that anymore either, that's when I decided that I can eat all I wanted and get "rid" of it. That's bulimia in a nutshell.

It was really easy at first and I had no problem doing it until I got weak and constantly felt sick. Not to mention the sore throat. In the beginning, I was 116 pounds. I'm 5'4". Now I realize that wasn't bad at all. I got down to 98 pounds and I was even more upset when no one had noticed that I had shed a pound.

I was constantly miserable and everyone around me had noticed. I also had an obsession with laxatives. Sounds gross, but it was another way to lose weight.

In my eyes, I think I still look horrible and I will never be perfect. I'm trying my hardest to stop this and slowly I am.

To most girls it sounds so perfect, but it's not. It's disgusting and painful and I would not want anyone to go though what I have been going through for the last few months.

I know it sounds like I am an old woman preaching this to you, but I'm not. I'm 17 years old and I'm really glad that I'm taking control of my problem before it got too serious.

next: Eating Disorders: Anorexia Nervosa - The Most Deadly Mental Illness
~ eating disorders library
~ all articles on eating disorders

The intention of this page is to speak to those who may not yet be in, or who've recently begun, depression treatment.

If you're not getting treatment for depression

Let's assume, right now, that you are reading this because you are pretty sure you have depression. I doubt that a page with this title would appeal to you, otherwise. Let's also assume that you haven't looked for depression treatment yet.

Having said that, I encourage you, as strongly as I can, to get help! Call your doctor, a crisis line (a suicide-prevention line will do--even if you aren't suicidal, they can help), a clergyman, or anyone listed in the Yellow Pages as a psychologist, social worker, or psychiatrist. Any of these people will be happy to help, either by beginning your treatment, or referring you to someone who will.

I know all of the reasons why you don't think you can, or should, do this. Here are some of the thoughts you may be having about it and my responses to them:

• I don't have depression, this is just "a phase" which will pass.

If your lousy mood has gone on for more than a few weeks, it's not going to "pass" all by itself. Get help.

• All I have to do is "get my act together." I can snap out of it.

Doesn't work that way. First of all, "get your act together" is meaningless. The reason you feel as though things are out of control is the depression itself. Until you address the depression, you cannot just "snap out of it." Get help.

• I don't need a pill to make me feel better.

Anti-depressants don't "make you feel better." They simply take the edge off of the depression so that you can work your way out of it. A professional, not you, is better able to tell if medication will help. Talk to one; get help.

• But I don't want to become addicted!

Anti-depressants are non-addicting. Get help.

• Therapy won't do any good, I can always talk to my friends.

Really? Hmm. How is it that you are depressed, then, if the help you need is there when you want it? Obviously this approach doesn't work for you! Get help.

• I don't feel like going to therapy and dredging up the past.

All the more reason to go. You may be depressed because of those things you don't want to talk about. Get help.

• If people find out I'm depressed, they'll think I'm nuts.

OK, I won't lie to you here. Depression carries a stigma in our culture. There will be people whose opinions of you may change if they hear you have depression. However, are those the type of people you really want to have around you? Of course not--they are ignoramuses. Besides, getting help doesn't mean everyone has to know you are depressed. Even if some people think you are "nuts," this is nothing compared to the depression. Get help.

• It won't work for me.

That's the depression talking. Tell it to "shut up" by getting help.

• I deserve this, I ought to suffer, I shouldn't get rid of it.

I've heard the "punishment from God" stuff before, and believe me, it just isn't so. The God most people worship doesn't want people to suffer. He wants them to be happy. Get help.

• I've heard it takes a long time to get better and I'm at the end of my rope, now; I can't wait.

I won't lie about this either. It will take a few weeks for you to feel noticeably better. But at least you know you're getting somewhere. Sitting around moping certainly isn't any better than trying treatment. Get help.

The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week. Or for a crisis center in your area, go here.

next: What To Do If You Are Suicidal
~ back to Living with Depression homepage
~ depression library articles
~ all articles on depression

"Some people find fault like there's a reward for it."
- Zig Ziglar

Self acceptance is being loving and happy with who you are NOW. Some call it self-esteem, others self-love, but whatever you call it, you'll know when your accepting yourself cause it feels great. Its an agreement with yourself to appreciate, validate, accept and support who you are at this very moment, even those parts you'd like to eventually change. This is important...even those parts you'd eventually like to change. Yes, you can accept (be okay with) those parts of yourself you want to change some day.

The Motivation Behind Your Lack of Acceptance

If acceptance feels so good and is so good for us, then why don't we accept ourselves? The answer is motivation. We use our lack of acceptance (punishment - cause it feels bad) as motivation to get us to do, not do, be, and not be what we think we should. Many people believe that if they accepted themselves as they are, they wouldn't change or that they wouldn't work on becoming more of who they want to be.

Typically, we judge ourselves unfavorably with the hope it will motivate us to change. We hope if we feel bad enough about ourselves, that maybe that will motivate us to change. Does this work? Sometimes, but only short term. Most times all it does is cause us to feel bad which saps the energy you might have used to make changes. It can be a vicious cycle. It works exactly counter to what you wanted to do.

"Acceptance allows change. The 'acceptance mode' includes everything, even my judgments. It allows me to be okay now, even before I reach my goals."

"When you begin to accept yourself the way you are right now, you begin a new life with new possibilities that did not exist before because you were so caught up in the struggle against reality that that was all you could do."

- Traveling Free, Mandy Evans

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So if it doesn't work, why do we keep doing it? Because we hope it will work. And if you don't know any other way to change, what options do you have? We've been trained to believe that in order to change, we need to first feel bad about it. That if we're accepting and loving of that particular quality, that we won't do anything to change the situation, which is not true! You don't have to be unhappy with yourself to know and actively change those things you'd like to change about yourself. Acceptance is actually the very first step in the process of change. For more about this, see "an interview about acceptance"

Think of acceptance of yourself like being okay with where you live now. You may want a bigger house one day. You may dream about that new home. But there ARE advantages to living in a smaller home if you only took the time to think about it. It is possible to be happy with the home you're in now, while still dreaming and working to make your new home a reality.

Process Of Acceptance

Acceptance exists at the core of your being. It is your default status. In order to reach this base level of acceptance, you need only remove the items laying on top. To do this, you must first identify all the things you do not accept about yourself. Then, one by one, eliminate them by examinging and questioning your beliefs around that issue.

• Know yourself and your beliefs
• Take a good hard look at your honesty level
• Know you are doing the best you can
• Relax your value judgments
• Examine guilt
• Understand your motivations
• Ask yourself questions about what you don't accept

next: Society and Acceptance

If you are feeling depressed or suicidal, here is a list of sites that provide contact information for depression and suicide crisis centers and hotlines in your area.

• National Suicide Prevention Hotline
  1-800-273-TALK (1-800-273-8255)
  For U.S.

• National Hopeline Network
  (1-800-SUICIDE, 1-800-784-2433)
  For U.S., Canada, UK, Singapore

• Befrienders International
  Crisis Lines
  41 countries worldwide

next: Conversation Techniques
~ back to Apocalypse Suicide homepage
~ depression library articles
~ all articles on depression

Learn about the dietary supplement folate and signs and symptoms of folate deficiency.

Table of Contents

• Folate: What is it?
• What foods provide folate?
• What are the Dietary Reference Intakes for folate?
• When can folate deficiency occur?
• What are some common signs and symptoms of folate deficiency?
• Do women of childbearing age and pregnant women have a special need for folate?
• Who else may need extra folic acid to prevent a deficiency?
• What are some current issues and controversies about folate?
• Caution About Folic Acid Supplements
• What is the health risk of too much folic acid?
• Selecting a healthful diet
• References
• Reviewers

Folate: What is it?

Folate is a water-soluble B vitamin that occurs naturally in food. Folic acid is the synthetic form of folate that is found in supplements and added to fortified foods [1].

Folate gets its name from the Latin word "folium" for leaf. A key observation of researcher Lucy Wills nearly 70 years ago led to the identification of folate as the nutrient needed to prevent the anemia of pregnancy. Dr. Wills demonstrated that the anemia could be corrected by a yeast extract. Folate was identified as the corrective substance in yeast extract in the late 1930s, and was extracted from spinach leaves in 1941.

Folate helps produce and maintain new cells [2]. This is especially important during periods of rapid cell division and growth such as infancy and pregnancy. Folate is needed to make DNA and RNA, the building blocks of cells. It also helps prevent changes to DNA that may lead to cancer [HealthyPlace.com Mental Health Communities]. Both adults and children need folate to make normal red blood cells and prevent anemia [4]. Folate is also essential for the metabolism of homocysteine, and helps maintain normal levels of this amino acid.

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What foods provide folate?

Leafy green vegetables (like spinach and turnip greens), fruits (like citrus fruits and juices), and dried beans and peas are all natural sources of folate [5].

In 1996, the Food and Drug Administration (FDA) published regulations requiring the addition of folic acid to enriched breads, cereals, flours, corn meals, pastas, rice, and other grain products [6-9]. Since cereals and grains are widely consumed in the U.S., these products have become a very important contributor of folic acid to the American diet. The following table suggests a variety of dietary sources of folate.

References

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Table 1: Selected Food Sources of Folate and Folic Acid [5]

Food	Micrograms (μg)	% DV^
*Breakfast cereals fortified with 100% of the DV, ¾ cup	400	100
Beef liver, cooked, braised, 3 ounces	185	45
Cowpeas (blackeyes), immature, cooked, boiled, ½ cup	105	25
*Breakfast cereals, fortified with 25% of the DV, ¾ cup	100	25
Spinach, frozen, cooked, boiled, ½ cup	100	25
Great Northern beans, boiled, ½ cup	90	20
Asparagus, boiled, 4 spears	85	20
*Rice, white, long-grain, parboiled, enriched, cooked, ½ cup	65	15
Vegetarian baked beans, canned, 1 cup	60	15
Spinach, raw, 1 cup	60	15
Green peas, frozen, boiled, ½ cup	50	15
Broccoli, chopped, frozen, cooked, ½ cup	50	15
*Egg noodles, cooked, enriched, ½ cup	50	15
Broccoli, raw, 2 spears (each 5 inches long)	45	10
Avocado, raw, all varieties, sliced, ½ cup sliced	45	10
Peanuts, all types, dry roasted, 1 ounce	40	10
Lettuce, Romaine, shredded, ½ cup	40	10
Wheat germ, crude, 2 Tablespoons	40	10
Tomato Juice, canned, 6 ounces	35	10
Orange juice, chilled, includes concentrate, ¾ cup	35	10
Turnip greens, frozen, cooked, boiled, ½ cup	30	8
Orange, all commercial varieties, fresh, 1 small	30	8
*Bread, white, 1 slice	25	6
*Bread, whole wheat, 1 slice	25	6
Egg, whole, raw, fresh, 1 large	25	6
Cantaloupe, raw, ¼ medium	25	6
Papaya, raw, ½ cup cubes	25	6
Banana, raw, 1 medium	20	6

* Items marked with an asterisk (*) are fortified with folic acid as part of the Folate Fortification Program.

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^ DV = Daily Value. DVs are reference numbers developed by the Food and Drug Administration (FDA) to help consumers determine if a food contains a lot or a little of a specific nutrient. The DV for folate is 400 micrograms (μg). Most food labels do not list a food's magnesium content. The percent DV (%DV) listed on the table indicates the percentage of the DV provided in one serving. A food providing 5% of the DV or less is a low source while a food that provides 10-19% of the DV is a good source. A food that provides 20% or more of the DV is high in that nutrient. It is important to remember that foods that provide lower percentages of the DV also contribute to a healthful diet. For foods not listed in this table, please refer to the U.S. Department of Agriculture's Nutrient Database Web site: http://www.nal.usda.gov/fnic/cgi-bin/nut_search.pl.

References

 

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What are the Dietary Reference Intakes for folate?

Recommendations for folate are given in the Dietary Reference Intakes (DRIs) developed by the Institute of Medicine of the National Academy of Sciences [10]. Dietary Reference Intakes is the general term for a set of reference values used for planning and assessing nutrient intake for healthy people. Three important types of reference values included in the DRIs are Recommended Dietary Allowances (RDA), Adequate Intakes (AI), and Tolerable Upper Intake Levels (UL). The RDA recommends the average daily intake that is sufficient to meet the nutrient requirements of nearly all (97-98%) healthy individuals in each age and gender group [10]. An AI is set when there is insufficient scientific data available to establish a RDA. AIs meet or exceed the amount needed to maintain a nutritional state of adequacy in nearly all members of a specific age and gender group. The UL, on the other hand, is the maximum daily intake unlikely to result in adverse health effects [10].

The RDAs for folate are expressed in a term called the Dietary Folate Equivalent. The Dietary Folate Equivalent (DFE) was developed to help account for the differences in absorption of naturally occurring dietary folate and the more bioavailable synthetic folic acid [10]. Table 2 lists the RDAs for folate, expressed in micrograms (μg) of DFE, for children and adults [10].

Table 2: Recommended Dietary Allowances for Folate for Children and Adults [10]

Age (years)	Males and Females (μg/day)	Pregnancy (μg/day)	Lactation (μg/day)
1-3	150	N/A	N/A
4-8	200	N/A	N/A
9-13	300	N/A	N/A
14-18	400	600	500
19+	400	600	500

*1 DFE = 1 μg food folate = 0.6 μg folic acid from supplements and fortified foods

There is insufficient information on folate to establish an RDA for infants. An Adequate Intake (AI) has been established that is based on the amount of folate consumed by healthy infants who are fed breast milk [10]. Table 3 lists the Adequate Intake for folate, in micrograms (μg), for infants.

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Table 3: Adequate Intake for folate for infants [10]

Age (years)	Males and Females (μg/day)	Pregnancy (μg/day)	Lactation (μg/day)
1-3	150	N/A	N/A
4-8	200	N/A	N/A
9-13	300	N/A	N/A
14-18	400	600	500
19+	400	600	500

The National Health and Nutrition Examination Survey (NHANES III 1988-94) and the Continuing Survey of Food Intakes by Individuals (1994-96 CSFII) indicated that most individuals surveyed did not consume adequate folate [12-13]. However, the folic acid fortification program, which was initiated in 1998, has increased folic acid content of commonly eaten foods such as cereals and grains, and as a result most diets in the United States (US) now provide recommended amounts of folate equivalents [14].

When can folate deficiency occur?

A deficiency of folate can occur when an increased need for folate is not matched by an increased intake, when dietary folate intake does not meet recommended needs, and when folate excretion increases. Medications that interfere with the metabolism of folate may also increase the need for this vitamin and risk of deficiency [1,15-19].

Medical conditions that increase the need for folate or result in increased excretion of folate include:

• pregnancy and lactation (breastfeeding)
• alcohol abuse
• malabsorption
• kidney dialysis
• liver disease
• certain anemias

References

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Medications that interfere with folate utilization include:

• anti-convulsant medications (such as dilantin, phenytoin and primidone)
• metformin (sometimes prescribed to control blood sugar in type 2 diabetes)
• sulfasalazine (used to control inflammation associated with Crohn's disease and ulcerative colitis)
• triamterene (a diuretic)
• methotrexate (used for cancer and other diseases such as rheumatoid arthritis)
• barbiturates (used as sedatives)

What are some common signs and symptoms of folate deficiency?

• Folate deficient women who become pregnant are at greater risk of giving birth to low birth weight, premature, and/or infants with neural tube defects.
• In infants and children, folate deficiency can slow overall growth rate.
• In adults, a particular type of anemia can result from long term folate deficiency.
• Other signs of folate deficiency are often subtle. Digestive disorders such as diarrhea, loss of appetite, and weight loss can occur, as can weakness, sore tongue, headaches, heart palpitations, irritability, forgetfulness, and behavioral disorders [1,20]. An elevated level of homocysteine in the blood, a risk factor for cardiovascular disease, also can result from folate deficiency.

Many of these subtle symptoms are general and can also result from a variety of medical conditions other than folate deficiency. It is important to have a physician evaluate these symptoms so that appropriate medical care can be given.

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Do women of childbearing age and pregnant women have a special need for folate?

Folic acid is very important for all women who may become pregnant. Adequate folate intake during the periconceptual period, the time just before and just after a woman becomes pregnant, protects against neural tube defects [21]. Neural tube defects result in malformations of the spine (spina bifida), skull, and brain (anencephaly) [10]. The risk of neural tube defects is significantly reduced when supplemental folic acid is consumed in addition to a healthful diet prior to and during the first month following conception [10,22-23]. Since January 1, 1998, when the folate food fortification program took effect, data suggest that there has been a significant reduction in neural tube birth defects [24]. Women who could become pregnant are advised to eat foods fortified with folic acid or take a folic acid supplement in addition to eating folate-rich foods to reduce the risk of some serious birth defects. For this population, researchers recommend a daily intake of 400 μg of synthetic folic acid per day from fortified foods and/or dietary supplements [10].

Who else may need extra folic acid to prevent a deficiency?

People who abuse alcohol, those taking medications that may interfere with the action of folate (including, but not limited to those listed above), individuals diagnosed with anemia from folate deficiency, and those with malabsorption, liver disease, or who are receiving kidney dialysis treatment may benefit from a folic acid supplement.

Folate deficiency has been observed in alcoholics. A 1997 review of the nutritional status of chronic alcoholics found low folate status in more than 50% of those surveyed [25]. Alcohol interferes with the absorption of folate and increases excretion of folate by the kidney. In addition, many people who abuse alcohol have poor quality diets that do not provide the recommended intake of folate [17]. Increasing folate intake through diet, or folic acid intake through fortified foods or supplements, may be beneficial to the health of alcoholics.

Anti-convulsant medications such as dilantin increase the need for folate [26-27]. Anyone taking anti-convulsants and other medications that interfere with the body's ability to use folate should consult with a medical doctor about the need to take a folic acid supplement [28-30].

Anemia is a condition that occurs when there is insufficient hemoglobin in red blood cells to carry enough oxygen to cells and tissues. It can result from a wide variety of medical problems, including folate deficiency. With folate deficiency, your body may make large red blood cells that do not contain adequate hemoglobin, the substance in red blood cells that carries oxygen to your body's cells [4]. Your physician can determine whether an anemia is associated with folate deficiency and whether supplemental folic acid is indicated.

Several medical conditions increase the risk of folic acid deficiency. Liver disease and kidney dialysis increase excretion (loss) of folic acid. Malabsorption can prevent your body from using folate in food. Medical doctors treating individuals with these disorders will evaluate the need for a folic acid supplement [1].

References

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What are some current issues and controversies about folate?

Folic Acid and Cardiovascular Disease
Cardiovascular disease involves any disorder of the heart and blood vessels that make up the cardiovascular system. Coronary heart disease occurs when blood vessels which supply the heart become clogged or blocked, increasing the risk of a heart attack. Vascular damage can also occur to blood vessels supplying the brain, and can result in a stroke.

Cardiovascular disease is the most common cause of death in industrialized countries such as the US, and is on the rise in developing countries. The National Heart, Lung, and Blood Institute of the National Institutes of Health has identified many risk factors for cardiovascular disease, including an elevated LDL-cholesterol level, high blood pressure, a low HDL-cholesterol level, obesity, and diabetes [31]. In recent years, researchers have identified another risk factor for cardiovascular disease, an elevated homocysteine level. Homocysteine is an amino acid normally found in blood, but elevated levels have been linked with coronary heart disease and stroke [32-44]. Elevated homocysteine levels may impair endothelial vasomotor function, which determines how easily blood flows through blood vessels [45]. High levels of homocysteine also may damage coronary arteries and make it easier for blood clotting cells called platelets to clump together and form a clot, which may lead to a heart attack [38].

A deficiency of folate, vitamin B12 or vitamin B6 may increase blood levels of homocysteine, and folate supplementation has been shown to decrease homocysteine levels and to improve endothelial function [46-48]. At least one study has linked low dietary folate intake with an increased risk of coronary events [49]. The folic acid fortification program in the U. S. has decreased the prevalence of low levels of folate and high levels of homocysteine in the blood in middle-aged and older adults [50]. Daily consumption of folic-acid fortified breakfast cereal and the use of folic acid supplements has been shown to be an effective strategy for reducing homocysteine concentrations [51].

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Evidence supports a role for supplemental folic acid for lowering homocysteine levels, however this does not mean that folic acid supplements will decrease the risk of cardiovascular disease. Clinical intervention trials are underway to determine whether supplementation with folic acid, vitamin B12, and vitamin B6 can lower risk of coronary heart disease. It is premature to recommend folic acid supplementation for the prevention of heart disease until results of ongoing randomized, controlled clinical trials positively link increased folic acid intake with decreased homocysteine levels AND decreased risk of cardiovascular disease.

Folic Acid and Cancer
Some evidence associates low blood levels of folate with a greater risk of cancer [52]. Folate is involved in the synthesis, repair, and function of DNA, our genetic map, and there is some evidence that a deficiency of folate can cause damage to DNA that may lead to cancer [52]. Several studies have associated diets low in folate with increased risk of breast, pancreatic, and colon cancer [53-54]. Over 88,000 women enrolled in the Nurses' Health Study who were free of cancer in 1980 were followed from 1980 through 1994. Researchers found that women ages 55 to 69 years in this study who took multivitamins containing folic acid for more than 15 years had a markedly lower risk of developing colon cancer [54]. Findings from over 14,000 subjects followed for 20 years suggest that men who do not consume alcohol and whose diets provide the recommended intake of folate are less likely to develop colon cancer [55]. However, associations between diet and disease do not indicate a direct cause. Researchers are continuing to investigate whether enhanced folate intake from foods or folic acid supplements may reduce the risk of cancer. Until results from such clinical trials are available, folic acid supplements should not be recommended to reduce the risk of cancer.

Folic Acid and Methotrexate for Cancer
Folate is important for cells and tissues that rapidly divide [2]. Cancer cells divide rapidly, and drugs that interfere with folate metabolism are used to treat cancer. Methotrexate is a drug often used to treat cancer because it limits the activity of enzymes that need folate.

Unfortunately, methotrexate can be toxic, producing side effects such as inflammation in the digestive tract that may make it difficult to eat normally [56-58]. Leucovorin is a form of folate that can help "rescue" or reverse the toxic effects of methotrexate [59]. There are many studies underway to determine if folic acid supplements can help control the side effects of methotrexate without decreasing its effectiveness in chemotherapy [60-61]. It is important for anyone receiving methotrexate to follow a medical doctor's advice on the use of folic acid supplements.

Folic Acid and Methotrexate for Non-Cancerous Diseases
Low dose methotrexate is used to treat a wide variety of non-cancerous diseases such as rheumatoid arthritis, lupus, psoriasis, asthma, sarcoidoisis, primary biliary cirrhosis, and inflammatory bowel disease [62]. Low doses of methotrexate can deplete folate stores and cause side effects that are similar to folate deficiency. Both high folate diets and supplemental folic acid may help reduce the toxic side effects of low dose methotrexate without decreasing its effectiveness [63-64]. Anyone taking low dose methotrexate for the health problems listed above should consult with a physician about the need for a folic acid supplement.

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Caution About Folic Acid Supplements

Beware of the interaction between vitamin B12 and folic acid Intake of supplemental folic acid should not exceed 1,000 micrograms (μg) per day to prevent folic acid from triggering symptoms of vitamin B12 deficiency [10]. Folic acid supplements can correct the anemia associated with vitamin B12 deficiency. Unfortunately, folic acid will not correct changes in the nervous system that result from vitamin B12 deficiency. Permanent nerve damage can occur if vitamin B12 deficiency is not treated.

It is very important for older adults to be aware of the relationship between folic acid and vitamin B12 because they are at greater risk of having a vitamin B12 deficiency. If you are 50 years of age or older, ask your physician to check your B12 status before you take a supplement that contains folic acid. If you are taking a supplement containing folic acid, read the label to make sure it also contains B12 or speak with a physician about the need for a B12 supplement.

What is the health risk of too much folic acid?

Folate intake from food is not associated with any health risk. The risk of toxicity from folic acid intake from supplements and/or fortified foods is also low [65]. It is a water soluble vitamin, so any excess intake is usually excreted in urine. There is some evidence that high levels of folic acid can provoke seizures in patients taking anti-convulsant medications [1]. Anyone taking such medications should consult with a medical doctor before taking a folic acid supplement.

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The Institute of Medicine has established a tolerable upper intake level (UL) for folate from fortified foods or supplements (i.e. folic acid) for ages one and above. Intakes above this level increase the risk of adverse health effects. In adults, supplemental folic acid should not exceed the UL to prevent folic acid from triggering symptoms of vitamin B12 deficiency [10]. It is important to recognize that the UL refers to the amount of synthetic folate (i.e. folic acid) being consumed per day from fortified foods and/or supplements. There is no health risk, and no UL, for natural sources of folate found in food. Table 4 lists the Upper Intake Levels (UL) for folate, in micrograms (μg), for children and adults.

Table 4: Tolerable Upper Intake Levels for Folate for Children and Adults [10]

Age (years)	Males and Females (μg/day)	Pregnancy (μg/day)	Lactation (μg/day)
1-3	300	N/A	N/A
4-8	400	N/A	N/A
9-13	600	N/A	N/A
14-18	800	800	800
19 +	1000	1000	1000

Selecting a healthful diet

As the 2000 Dietary Guidelines for Americans states, "Different foods contain different nutrients and other healthful substances. No single food can supply all the nutrients in the amounts you need" [66]. As indicated in Table 1, green leafy vegetables, dried beans and peas, and many other types of vegetables and fruits provide folate. In addition, fortified foods are a major source of folic acid. It is not unusual to find foods such as some ready-to-eat cereals fortified with 100% of the RDA for folate. The variety of fortified foods available has made it easier for women of childbearing age in the US to consume the recommended 400 mcg of folic acid per day from fortified foods and/or supplements [6]. The large numbers of fortified foods on the market, however, also raises the risk of exceeding the UL. This is especially important for anyone at risk of vitamin B12 deficiency, which can be triggered by too much folic acid. It is important for anyone who is considering taking a folic acid supplement to first consider whether their diet already includes adequate sources of dietary folate and fortified food sources of folic acid.

Source: Office of Dietary Supplements, National Institutes of Health

next: Botanical Dietary Supplements: Background Information

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For more information about building a healthful diet, refer to the Dietary Guidelines for Americans http://www.usda.gov/cnpp/DietGd.pdf  and the US Department of Agriculture's Food Guide Pyramid http://www.nal.usda.gov/fnic/Fpyr/pyramid.html.

Disclaimer

Reasonable care has been taken in preparing this document and the information provided herein is believed to be accurate. However, this information is not intended to constitute an "authoritative statement" under Food and Drug Administration rules and regulations.

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Some ADHD adults are actually adapting better to increasingly busy lives while other adults with attention disorders face challenges.

ADHD Symptoms Can Emerge as Life Gets More Demanding

Barbara Eddy is used to swiftly "spinning" from task to task, from tending to her twins, to her work, to her husband. It's in her nature as someone diagnosed with an attention deficit disorder.

So she feels right at home in this fast and fragmented age of cell phones, Googling, and hand-held e-mail.

"Society is finally coming up to fitting me," said Eddy, from Pasadena, California. "The world is coming up to be perfect for me."

Any parent can be challenged by the pace of modern family life -- the blur of dropping the kids off at tae kwon do, picking up dinner and doing catch-up work on the laptop. But it can present particular possibilities and challenges for adults with attention disorders. Some, like Eddy, can take to it.

But others, like her husband, she notes, lack a consistent way to maintain focus when jumping from task to task.

"It's getting worse all the time," said Melissa Thomasson, a psychologist who runs a support group. "Sometimes we see folks who could handle it through school perhaps, and through young adulthood," she said. "And as they marry and they have children and they're working and they're handling so many things, they're not able to hold it all together."

Hallmarks of adult attention deficit/hyperactivity disorder (ADHD) symptoms can include a lack of focus and impulsiveness. It's also known as attention deficit disorder (ADD), a term many adults use because they are not hyperactive. Adults with attention disorders describe having great stores of energy and creativity, but trouble focusing it.

Attention disorders are usually associated with children; many people assume they just "grow out of it." But researchers say the conditions can persist into adulthood. Preliminary figures from a survey by Dr. Ronald Kessler of Harvard Medical School indicate adult ADHD affects about 4 percent of the population.

Some Adults with ADHD May Find Today's Technology-Driven World to be a Hardship

There's no evidence our faster, more fragmented lifestyle results in more cases of attention disorders. But Dr. Arthur Robin, a professor of psychiatry and behavioral neuroscience at Wayne State University, said ADHD symptoms may create greater impairment in a technology-oriented, fast-paced society.

"People with ADHD, while they're hyperactive, the high-energy component is there so they can cope with a fast-paced situation, but they can't always multitask without dropping some of the balls," he said.

Adults with attention disorders typically find coping strategies to get through the days, things like keeping reminder lists or detailed planners. They often have a spouse handle the bills and keep track of birthdays. At work, they'll have an office assistant mind the books.

New York City resident Anita Gold, who was diagnosed with the ADHD, said she relied on a housekeeper and secretaries to cope when she was raising her children and working as a publishing executive. Eddy keeps color-coded notebooks keeping track of her family and professional lives.

But those strategies become harder in a dual-income family where both spouses are stretched for time. Thomasson notes that the proliferation of e-mail and hand-held communications devices has led to many workers essentially acting as their own secretaries.

For Some with Adult ADHD, Technology Is Helpful

Dr. Edward Hallowell, who has written books about ADHD, said a rapid-fire lifestyle can actually be a good thing for maybe half the people with attention disorders -- such as Eddy -- because they can easily shift from task to task.

"When they get stimulation they get adrenaline and adrenaline is nature's own stimulant medication. Chemically, it's very similar to Ritalin," he said.

But everyone is different, and that same combination of one thing after another, day after day can overwhelm anyone, whether or not they have an attention disorder. Hallowell said time management, priority-setting and organization are more important than ever.

"If you're not careful," he said, "you can get lost in the thicket."

Source: AP

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