It's not news that depression has become a kind of invisible epidemic, afflicting millions of people. We live at a time when depression is approached as a disease. That has a good side. Depressed people are not judged against as weak or self-indulgent, as if they only need to try harder to lift themselves out of their sadness. Yet depression, for all the publicity surrounding it, remains mysterious, and those who suffer from it tend to hide their condition -- the medical model hasn't removed a sense of shame. When you're in the throes of depression, it's hard to escape the feeling that you are a failure and that the future is hopeless.
Before considering how to handle depression, let's ask the most basic question: Are you depressed? The bad side of the medical model arises when people rush to be medicated because they don't like how they feel. Doctors barely bother to get a correct diagnosis, because the easiest thing to do -- and the thing that patients demand -- is to write a prescription.
Let's see if we can get beyond this knee-jerk reaction.
Becoming sad or blue isn't a sure sign of depression. Life brings difficulties that we respond to with a wide range of normal emotions: sadness, anxiety, resignation, grief, defeated acceptance, helplessness. Moods are cyclical, and if these feelings are your response to a tough event, they will subside on their own in time. If they linger, however, and there seems to be no definite cause or trigger, such as losing your job or the death of a loved one, depression is accepted as the conventional diagnosis.Depression isn't one disorder, and even though an array of antidepressants have been thrown at the problem, the basic cause for depression remains unknown. For a diagnosis of major depression, which is more serious than mild to moderate depression, at least five of the following symptoms must be present during the same two-week period:
- Depressed mood (feeling sad or empty; being tearful)
- Markedly diminished interest or pleasure in all, or almost all, activities
- Significant weight loss when not dieting, or weight gain, or decrease or increase in appetite
- Insomnia or hypersomnia (sleeping too little or too much)
- Slowing of thoughts and physical movements
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Diminished ability to think or concentrate, or indecisiveness
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide
If you can count five or more of these as being present, know that your list must contain "depressed mood" or "diminished interest or pleasure" before you'd be considered medically depressed. We've come to recognize different kinds of depression that fit certain circumstances:
- Dysthymia is mild, chronic depression. It must present for at least two years for a diagnosis of dysthymia.
- Seasonal affective disorder (SAD) is a form of depression that generally arises as the days grow shorter in the autumn and winter.
- Postpartum depression begins after a woman has given birth and may get worse as time goes on.
Even though no one knows exactly what causes depression, it is clearly a state of internal imbalance. Balance is essential for the healthy functioning of both your body and your mind. The upsetting factors that make it more likely you will get depression form a long list: genetic predisposition, being female, death or loss of loved one, major life events (even happy ones, like a graduation), other mental illnesses, substance abuse, childhood trauma, certain medications, serious illness, and personal problems such as financial troubles. What these things have in common is that they disrupt the normal balancing mechanisms of mind and body. A treatment that aims at restoring balance therefore makes the most sense, and you can participate in these.
Re-balancing yourself forms its own long list of things you can do:
- Be aware that you are depressed and seek help.
- Treat your body well, including exercise.
- Reduce stress.
- Get enough sleep meaning a minimum of eight hours a night.
- Address situations that would make anyone sad, such as the wrong job, a bad relationship, normal grief, and serious loss. Don't passively wait for time to heal your wounds.
- Regain a sense of control.
- Examine your reactions to difficult situations. You will often find that reacting with helplessness, passivity, retreating inside, and turning passive lie at the root of your depressed state.
- Spend time with people who give you a reason to feel alive and vibrant. Avoid people who share your negative responses and attitudes. Depression in some sense is contagious.
- Rely to a minimum on antidepressants and apply your main efforts to other therapies. Pills should be as short-term as possible. They work best in removing the top layer of sadness so that you have a clear space to address the real underlying issues.
- Talk about your problems and share your feelings with those who can listen with empathy and offer positive steps.
- Make friends with someone who has recovered from depression or is handling the condition well.
Find a wise person who can help you to undo your most negative beliefs by showing you that life has other, better possibilities.
Because everything on this list requires a choice, bringing yourself back into balance means that you are aware enough to make decisions and have the ability to put them into practice. Quite often depressed people feel too helpless and hopeless to face the right choices, in which case outside help is needed, meaning a therapist or counselor who specializes in depression.
Here's a general picture of how to make a plan for your own healing.
Psychotherapy, or talk therapy, works as well as medication for many people. It may be used alone or in combination with other forms of treatment. Studies have shown that psychotherapy can cause changes in brain function similar to those produced by medications. Focused, goal-oriented forms of therapy such as cognitive-behavior therapy appear to be the most effective in treating depression.
Diet may play a part in protecting against depression. Mediterranean countries have low rates of depression compared to countries farther to the north--and it isn't just because they get more sunlight or have a more relaxed way of life. One large-scale study tracked almost 3,500 people living in London for five years and found that those who ate a Mediterranean diet were 30 percent less likely to develop depression. Researchers speculate that the foods in the Mediterranean diet may act synergistically together. Olive oil, nuts and fatty fish are rich in omega-3 and other unsaturated fatty acids, and fresh fruits and vegetables contain flavonoids and phytochemicals that are full of antioxidants and folates (B vitamins).
Aerobic exercise is a very effective for depression. It's been shown that moderate aerobic exercise done just 30 minutes a day, three times a week, can reduce or eliminate symptoms of mild-to-moderate depression and can help with severe depression.
It's well known that exercise stimulates the release of endorphins, the "feel-good" chemicals (which function as neurotransmitters). Less well known is the startling effect of exercise on the structure of your brain. Exercise stimulates the creation of new nerve cells in the hippocampus, your brain's center of learning and memory, so that it actually increases in size. This is especially relevant because depression, unless countered with effective therapy, causes the hippocampus to shrink in size. Exercise has also been shown to raise levels of serotonin and norepinephrine and to multiply the number of dendrite connections in neurons.
Yoga has been shown to lessen stress and anxiety and promote feelings of well-being. Communication between your body and your mind is a two-way street. Certain yogic practices can signal the brain that it's all right to relax and prompt the parasympathetic nervous system to initiate the relaxation response. For instance, slow, deep, conscious breathing is also a vital element of yogic practice. This form of breathing is very effective in prompting the relaxation response to counter elevated levels of stress hormones. Someone with depression might be advised to practice "heart-opening" postures that elongate their thoracic spine. They may be told to stand with their shoulder blades drawn together so that their lungs are lifted and they are able to breathe more freely. An important component of yoga is paying close attention to what's going on in the body at all times and locating and releasing any areas of tension. Yoga should ideally be practiced with the guidance of an experienced teacher.
Meditation can be a useful treatment for both stress and mild-to-moderate depression. Numerous studies have examined the effects of mindfulness meditation, designed to focus the meditator's attention on the present moment. One study measured electrical activity in the brain found increased activity in the left frontal lobe during mindfulness meditation. Activity in this area of the brain is associated with lower anxiety and a more positive emotional state. Subsequently, the researchers tested both a group that hadn't meditated as well as the meditators for immune function. They did this by measuring the level of antibodies they produced in response to a flu vaccine. The meditators had a significantly greater reaction, which indicates they had better immune function.
I know that the easiest solution is to pop a pill, and in this country powerful forces back up the promise that drugs are the answer. Keep in mind that antidepressants only alleviate symptoms, and that in the long run couch therapy has proven just as effective in changing the brain responses associated with depression. The real goal should be to re-balance your life, gain control over the disorder, understand who you are, and elevate your vision of possibilities for yourself. All of that is harder than opening a pill bottle, but every positive choice leads to real healing and a much better life in the future.
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