Do I Have Anxiety or Depression?

By Julie Hanson, Psy.D., LMHC

We often approach difficulties with the idea that there is one right answer. While this is the case some of the time, it cannot be applied to every scenario. This is especially true when we are talking about ourselves, complicated human beings.

The truth is, anxiety and depression are very close cousins to one another. They impact similar neurological pathways, can have similar symptoms, respond to similar medications and psychological treatment, and, like siblings, can trigger one another. You can have both anxiety and depression, sometimes showing up at the same time and sometimes taking turns.

It is common to experience moments of anxiety (say, giving a presentation at work when you don’t really like public speaking) or depression (like that really low feeling you get after learning you aren’t getting the job you really wanted and worked hard for). These states of anxiety and depression are typically tied to something easily identifiable and are transitory. They don’t necessarily significantly impact how you experience your life more days than not.

It’s time to get help from a professional when anxiety or depression are having a more lasting impact on your life. If your anxiety is making it difficult for you to go to crowded places, talk to people, or do things you really want to do it’s time to get help. If your depression is making it difficult for you to make decisions, to feel connected to other people, to get things done that are important to you, or to feel like you can continue living a professional can be really helpful.

The type of treatment that is provided for you should be tailored to you. Not everyone needs medication. Not everyone responds well to habit changes. Not everyone finds mindfulness techniques helpful. There are many different ways to overcome debilitating anxiety and depression and positive change is very possible!

Antidepressants for Mild Depression?

Not everyone with mild depression feels much benefit from antidepressants, although some do. To find out what may work best for you, feel free to seek out a specialist, like a Psychiatrist (MD) or Psychiatric Advanced Registered Nurse Practitioner (ARNP), and have your questions answered. You can call Bluestone at 425-775-4059 and ask to meet with our psychiatrist to learn more about your options. Your medical doctor or mental health provider may also be able to offer guidance. Here’s what Daniel Hall-Flavin, MD at the Mayo Clinic offers on the subject:


“Antidepressants don’t work for everyone. For some people with mild depression, antidepressants seem to have little effect. However, for people with more severe depression, antidepressants often make a big difference.

Although antidepressants generally aren’t as effective for mild depression, that doesn’t mean that they never help. Depression affects each person differently, and each person responds to medications differently. Finding the right medication may take some trial and error.

If an antidepressant seems to ease your symptoms, it may be a good treatment choice for you. If you’re taking an antidepressant, don’t stop taking it without talking to your doctor.

For many people with mild depression, talk therapy (also called psychotherapy or psychological counseling) appears to be an effective treatment. Some people benefit from a combination of talk therapy and medications. Lifestyle changes — such as stress reduction and regular exercise — also can make a difference.

If you have signs and symptoms of depression, don’t ignore them. Even mild depression can take a toll on your enjoyment of life, your performance at work or school, and your relationships with other people. And, left untreated, depression can get worse.”



Do Antidepressants Cause Weight Gain?

Starting an antidepressant can bring up many questions, weight gain being a common concern. Read on for answers from Daniel K. Hall-Flavin, Mmedication questionD from the Mayo Clinic.
Weight gain is a possible side effect of nearly all antidepressants. However, each person responds to an antidepressant differently. Some people gain weight when taking a certain antidepressant, while others don’t.
Generally speaking, some antidepressants seem more likely to cause weight gain than others. These include:

  • Certain tricyclic antidepressants, such as amitriptyline, imipramine (Tofranil) and doxepin (Silenor)
  • Certain monoamine oxidase inhibitors (MAOIs), such as tranylcypromine (Parnate) and phenelzine (Nardil)
  • Paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI)
  • Mirtazapine (Remeron), which is an atypical antidepressant — medication that doesn’t fit neatly into another antidepressant category

While some people gain weight after starting an antidepressant, the antidepressant isn’t always a direct cause. Many factors can work together to contribute to weight gain during antidepressant therapy. For example:

  • Overeating or inactivity as a result of depression can cause weight gain.
  • Some people lose weight as part of their depression. In turn, an improved appetite associated with improved mood may result in increased weight.
  • Adults generally tend to gain weight each year, regardless of the medications they take. Getting regular exercise and watching what you eat will help you maintain a healthy weight, whether you take an antidepressant or not.

If you gain weight after starting an antidepressant, discuss the medication’s benefits and side effects with your doctor. If the benefits outweigh the side effect of weight gain, consider managing your weight by eating healthier and getting more physical activity while enjoying an improved mood due to the medication. You can also ask your doctor if adjusting the dose or switching medications might be helpful — but again, be sure to discuss the pros and cons before making such a decision.


Dr. Michael Ruthrauff is available to discuss any questions or concerns regarding starting or maintaining your antidepressants. Call 425-775-4059 or email to schedule an appointment.

Your Fear Will Define You

By Julie Hanson, Psy.D., LMHC

How bold and true a statement is that!? Your fear will define you.
I just coached a young man who wanted to start his own company. For years he has wanted to do this and for years his fear of getting in over his head kept him bound in employment that had him feeling stuck, frustrated by a system he couldn’t improve, and under-earning. He was also surrounded by others who reinforced his fears by listing the many reasons they would never start their own business in their shared field. These reasons were, of course, accompanied by every business related horror story any of them had ever heard.
In his last coaching session before taking the leap, we took stock of the specifics of his own fears and reflected on his tendency to seek opinions from colleagues who had NOT done what it was he was looking to do. His professional identity and trust in his own abilities were being limited by his fears as well as those of others. They defined him as incapable of taking a desired risk, of being able to create what he wanted, or of being able to handle trails that would inevitably come. The result was an unnecessarily limited professional life that lead him feeling personally disappointed and unfulfilled.
By addressing your fears head on, writing them down, taking a good hard look at them, you can begin to overcome self-limiting fears. You will discover that some of them are unfounded and can be counteracted by skills you can easily learn. You will also discover that some of your fears are healthy and possibly realistic. This does not mean, however, that you should not pursue a goal. All it means is that you will need some help from others who know more than you do about certain things.
While your fears will define you, addressing them will release you. Is it your time to fly?

Sleep Better Tonight: Visualizing a Relaxing Place

relaxing mountain lodgeBy Veronica VanCouwenberghe, MA, LMHC, CMHS

With all the stresses people have in their lives it can be very difficult to “turn off” and fall asleep at night. Here is a technique to assist with falling asleep when our minds have a tendency to remind us of everything we either need to do or forgot to do. This will help focus your thoughts on something peaceful, making it easier for your body to relax, let go of the day, and fall asleep.

First, make yourself as comfortable as you can in your bed. Second, think about your favorite place or picture a scene in your mind where you would be calm and relaxed. Some examples would be a beach, in the mountains, on a lake, relaxing at home or playing with a pet. Look around the scene and paint the most vivid picture you can by using all five of your senses.

Here is an example of a mountainside lodge:

  • Sight: There is a roaring fire in a stone fireplace and I am sitting in an oversized red leather  chair. There are hotel staff behind me at the desk but otherwise the lodge is empty. The fire is large and the flame is a bright yellow.
  • Sound: I hear the staff behind me answering the phones and shuffling papers, but overall I hear the roar of the fire. I hear the crackling of the wood that is burning in the fireplace.
  • Touch: I feel the soft leather under my body and the heat of the fire is warm on my whole body, but mostly my face. I feel the warm cup in my hand and the warm liquid as it goes down my throat.
  • Taste: I can taste the warm cocoa I am sipping with a slight hint of peppermint.
  • Smell: I can smell the chocolate from the cocoa and the firewood from the fire.

As you are thinking of this relaxing place, other thoughts will begin to creep into your mind such as, what’s for lunch tomorrow? Did I print that document? I forgot to water the plants. As you notice that you are thinking about your “to do” or your “didn’t do” list, gently bring your thoughts back to your relaxing place and really concentrate on this place with all five senses. Hopefully, before you know it, you’ll be sound asleep. Sweet dreams!

P.S. This works great with children too!

Can Antidepressants Lose Effectiveness?

medication question

Experiencing a loss of effectiveness of your medication is not an uncommon concern. Read on for more information about possible causes for changes in your medication’s effectiveness:

Dr. Daniel K. Hall-Flavin, of the Mayo Clinic, shared the following patient’s question about antidepressants loosing their effectiveness:

I’ve taken fluoxetine (Prozac) for several years. But recently, the medication doesn’t seem to be having the same effect. Can antidepressants lose effectiveness?

When depression symptoms improve after starting an antidepressant, most people need to continue taking medication long term to prevent symptoms from returning. However, treatment may seem to stop working over time. This can happen for a number of reasons. These include:

  • Worsening depression. It’s common for depression symptoms to return or worsen at some point, despite treatment. Called breakthrough depression, symptoms may be triggered by stress or may appear with no apparent cause. The current dose of medication you’re taking may not be enough to prevent your symptoms when depression gets worse.
  • Another medical condition. Underlying health problems, such as hypothyroidism, can cause or worsen depression.
  • A new medication. Some medications for unrelated conditions can interfere with the way your body breaks down and uses antidepressants, decreasing their effectiveness.
  • Undiagnosed bipolar disorder. Bipolar disorder, also called manic-depressive disorder, causes periodic mood swings. While an antidepressant is sometimes used to treat bipolar disorder, a mood-stabilizing or antipsychotic medication is generally needed along with an antidepressant to keep emotional highs and lows in check.
  • Age. In some people, depression gets worse with age. As you get older, you may have changes in your brain and thinking (neurological changes) that affect your mood. In addition, the manner in which your body processes medications may be less efficient. You’re also likely to be taking more medications. All of these factors can play a role in depression.
  • Loss of drug effectiveness. In some people, a particular antidepressant may simply stop working over time. Doctors don’t fully understand what causes the so-called “poop-out” effect — known as tachyphylaxis — or why it occurs in some people and not in others.

In most cases, depression symptoms get better with adjustments to medication. Your doctor may recommend that you change the dose of your current antidepressant, change to another antidepressant or add another antidepressant or other type of medication to your existing treatment. Psychological counseling (psychotherapy) also may help.

Because there are so many reasons depression treatment can stop working, you may need to see a medical doctor who specializes in diagnosing and treating mental illness (psychiatrist) to figure out the best course of action.


If this is happening to you, Dr. Michael Ruthrauff is available to discuss your questions with you and see if other options or changes in your dosage are appropriate for you. Feel free to call 425-775-4059 or email to schedule an appointment.

Because I’m Happy! Music for Mood Management

By Mysti Coccia-Eddy, MA, LMHC

happy music dancingMy intention here is to share a great tip about using music to improve mood and increase wellness – my apologies to anyone who got an unwanted ear-worm from the title. Most of us can agree that few things seem to hold the power to tap into our minds and emotions like music does. Research has given us evidence that we can use this power to our benefit. It’s inexpensive, easy to access, and it really works!

Remember the mixed tapes from decades gone by? How many loves were expressed, friendships cemented, lives soundtracked by the magnificent mixed tape? Today, most of us have moved on to I-Tunes playlists or recordable CDs to hold our treasured musical mash-ups. I’m encouraging you to make a playlist or two specific to your desired mood alterations.

The best way to utilize this approach is to keep it simple; 3-5 songs in each playlist. Choose songs that cut right to the feeling you’re going for, and none that may hold double connotations (an upbeat song that invokes sad or angry memories, for instance).
Singing along and moving your body have added benefits. Singing regulates your breathing, which can bring about a different state of mind all by itself. Moving your body (especially if you can dance up a sweat for 20 minutes or so), can improve sleep, mood, and overall health. If you can incorporate these elements into your experience, you’ll get the most benefit from your “music for mood management” practice.

Feeling down? Turn to your “Happy Tunes” playlist or CD, crank up the volume and move your body. Even if you’re in the car, you can sing along and wiggle in your seat (please drive safely – better if you’re at home or another environment where you can really cut loose). Feeling keyed-up or anxious? Turn to your “Mellow Yellow” playlist, regulate your breathing to the rhythm, and allow yourself to experience the calming effects. Gentle yoga or stretching with this is great too.

Remember, just like any other wellness tools, you’ll need to follow through on utilizing it for it to work for you. Push play when you need it, and make adjustments to your mixes as necessary or desired. Music is an inexpensive, accessible way to support your well-being, so try it today!
Footnote: There have been several studies in the last few decades which have demonstrated the efficacy of music for mood management. Learn more at and

Bluestone’s Summer Reading Recommendations

The beautiful Pacific Northwest summers are unrivaled and often a time when people come to therapy less often. With such gorgeous days to take advantage of, we often feel more energized and less distressed. With kids home from school, day trips and vacations to enjoy we also often find ourselves at home and available for appointments less often. Ahhh…the joys of summer!

Summer can be the perfect time to read material or practice skill building relating to the issues or concerns you have been working on. You can pick up a book, journal or workbook and put it back down at any time. Each of the therapists at Bluestone have contributed to the following reading list. See if any of them interest you and let us know if you would add any you have found particularly helpful.

Julie Hanson, Psy.D., LMHC Recommends:


jpegHealing From Trauma: A Survivor’s Guide to Understanding Your Symptoms and Reclaiming Your Life. by Jasmin L. Cori (2008)

Dr. Hanson is so grateful to a client for reminding her of this book. Healing From Trauma is written by a therapist, who is also a trauma survivor, for trauma survivors. This author did a wonderful job explaining the way traumatic experiences of all kinds impact us biologically, emotionally, cognitively, and interpersonally. There are question prompts and other suggestions by the author that can be helpful but should be considered only if you are far enough along in your recovery. Otherwise, save the exercises for when you can also meet with your therapist. Whether you do the exercises or not, this can be helpful for any trauma survivor.


jpeg-1The Power of Habit: Why We Do What We do in Life and Business, by Charles Duhigg (2014)

Rather than shaming ourselves with judgments against our moral character, Dr. Hanson encourages her clients to understand their repetitive patterns in terms of habits. This can be difficult to accept as true. Reading this book will give you another perspective on how we form these habits and why they are so difficult to break. Based soundly in research about how and why habits (one’s we appreciate as well as ones we wish would go away) develop this book also gives sound suggestions on ways to change and then maintain new habits.

Veronica VanCouwenberghe, MA, LMHC, CMHS Recommends:


jpeg-2Love, Limits and Lessons: A Parent’s Guide to Raising Cooperative Kids, by Bill Corbett (2011)

Raising kids today is not easy. Veronica recommends this book (either volume and workbook too) to help parents raising kids from toddlers to teens. Parents get help identifying their parenting and family values, how to coach more and preach less, and create greater family closeness by understanding their children’s behavior more.


kids reading imageVeronica also recommends reading, reading, reading with your children. Especially fun can be finding a series that is appropriate for your child’s age level, reading skill, and interests. Talking to your local children’s librarian or the children’s book department specialist at a book store can yield many ideas. Your child’s school teacher or school librarian can also be great resources.

Mysti Coccia-Eddy, MA, LMHC, CMHS Recommends:


jpeg-4Taming Your Gremlin: A Surprisingly Simple Method for Getting Out of Your Own Way, by Rick Carson (2003)

This is a workbook I often recommend to clients as an adjunct to counseling. In this book, the “gremlin” is a metaphor used to help conceptualize the way in which we think and talk to ourselves that sabotages our progress or keeps us stuck in places we wish to move out of.  Simply noticing, choosing and playing with options, and being in process are the main tenants of gremlin taming. Carson takes us through these with activities, case examples, interesting drawings and humorous anecdotes, which I find helpful when exploring what can be challenging territory.


jpeg-5 The Gifts of Imperfection; Let Go of Who You Think You’re Supposed to Be and Embrace Who You Areby Brene Brown, Ph.D. (2010)

In this book, Dr. Brown helps us explore the “shoulds”, and to uncover what our true values are. Oftentimes, the same things we view as “imperfections” can instead be viewed as strengths, and seeing them this way can lead us towards a fuller, more joyful existence. Dr. Brown leads the reader through a series of guideposts (such as “Cultivating Authenticity; Letting Go of What People Think”) towards living a wholehearted life.


Terri Buysse, Ph.D. Recommends:


jpeg-6Beyond The Birth: A Family’s Guide To Postpartum Mood Disorders, by Juliana Nason, Patricia Spach and Anna Gruen (2010)

This slim volume is perfect for all families with a new baby. Perinatal (pregnancy and postpartum) mood disorders are the most common complication of the transition to parenthood. This book outlines the risk factors, symptoms and treatment for women dealing with pregnancy or postpartum complications.

This book is available for free upon request through the Warmline: 888-404-7763 (PPMD). This line is sponsored by Postpartum Support International.


jpeg-7Parenting from the Inside Out:  How a Deeper Self-Understanding Can Help You Raise Children Who Thrive, by Daniel Siegel and May Hartzell (2013)

This is a different kind of parenting book.  It examines how the psychological life of the parent affects the next generation, and what parents can do to facilitate healing in themselves and attachment with their children.

Compassion: Not Just for Others Anymore (Part 2)

heart2Unconditional love. Many of us hear about this frequently, but I’m not sure if we truly understand what it means. It’s often easier to grasp the concept with someone else.  Someone we love, a spouse or a boy/girlfriend fails an exam or forgets their lines during an important presentation. Instead of beating them up, we give them a big hug, and we tell them how much we love them. We are proud of them for trying and for allowing themselves to be vulnerable or take a risk, no matter the result. We couldn’t imagine doing or saying otherwise since we inherently value this person for who they are.

But try failing the test yourself or flubbing the interview, and we can often showcase the definition of conditional love: approval and love based solely on performing well. The “shoulds” begins to run rampant, “I should have studied harder or I shouldn’t have gotten nervous.” Or worse, the disparaging name calling that often includes “stupid”, “weirdo” or “idiot”. Somehow, our value as a person drops to nothing because we are nothing if we don’t do something “right” (no exceptions). Notice that we focus on our “doing” and not our “being and intentions” when we evaluate ourselves in this way.

Many of us have our very own special version of conditional love and the triggers that proceed it. The triggers may be related to our performance in social situations, or athletic ones, or perhaps how we feel about our intelligence, our weight, our beauty. The list is endless. This is a topic worthy of pondering about in your journal:

  1. What is your version of conditional love?
  2. How does it get triggered for you?

It may also be worthwhile to look at unconditional love, and the role it plays in people’s lives. To see how unconditional love affects people, we can experiment with giving positive self-messages and encouragement to loved ones. We can notice what they do well, and perhaps even more powerfully, what they are focusing on and attempting to do.  For example, you could notice how someone is trying really hard to be tactful and not hurt someone’s feelings.

  1. How do your loved ones respond when you genuinely see them for who they are with their best intentions in mind?
  2. How do you feel when you connect with them in this way?
  3. How do you respond to positive feedback?
  4. Does it feel good? Is it hard to take in? If so, why?
  5. Are there particular areas where you can take in positive feedback, but not others?

These are also questions that you can write about in your journal.

Compassion: Not Just for Others Anymore (Part One)

heartWe all live in a competitive society. We compete for the best schools, the best jobs, and the best neighborhoods in which to live. We also encourage our children to compete whether it be in sports, academics or otherwise. Unquestioningly, we believe that the judgment and harsh criticism will make us more successful. Yet when I ask others if that harsh voice actually makes them work harder or smarter, the answer is almost always an unequivocal “no”. They go on to say that the voice makes them nervous, makes them perform worse because of the anxiety of having to do well no matter what.

I want you to imagine that hard-nosed little league coach that you had as a child, or at least saw in movies. He rides your case when you make a mistake, he yells, he belittles.  He only approves when you do well. This is the definition of conditional love. This kind of coach is generally out of favor in our culture, except for the internal one that lives in our heads. (This internal voice is known by a variety of names including inner critic or self-talk.) Contrast this voice with that of the ideal kindergarten teacher. Her voice is soft, nurturing, encouraging and unconditionally accepting. 

Which voice would you want your own child or young neighbor down the street to hear regularly? Of course, the kindergarten teacher‘s! That is how children should be spoken to, you say. That is how you may wish you were spoken to too when you were a child.  And yet many, many individuals speak to themselves worse than they would to their own worst enemies. “Stupid, lazy, worthless, idiot, freakish” are just a few of the choice words that people hurl at themselves almost non-stop.

Constant verbal whippings affect more than just performance. Anxiety held in the body is stressful and very uncomfortable. If anxiety lives in the body for any length of time, your body may shut down, turning the anxiety into depression. The body cannot continue functioning in the fight or flight state forever. In overload mode, it shuts down taking your happiness and joy with it.

So what can be done? First, it can be helpful to notice one’s own process. Since the body never lies, you can begin by paying attention to it: 

  1. What does your body do after you berate yourself?
  2. Do you feel it in your stomach, chest, throat or elsewhere?
  3. How does your body respond when you talk more kindly to yourself?

 Pay attention to your body for a week and journal about it:

  1. Write down what you say to yourself and how your body responds to this self-talk.
  2. Write down your thoughts, feelings and any themes that you notice about yourself. 

 You may be surprised at what you discover!