Guest Articles Archives - Page 7 of 15 - Lawyers With Depression

Biology of the Binge: The Biochemical Link Between Depression and Food

Many of us have experienced the instantaneous connection between food and mood. We may find ourselves crunching nervously through bags of potato chips when under pressure for example, or slurping down containers of cool and silky chocolate ice cream in distracted attempts to soothe our sadnesses. However, while an occasional hankering for sweet or starchy “comfort foods” is both normal and expected, for some, the link between negative feelings and out of control eating is far more profound. Recent studies suggest that the suspicious overlap in symptoms of major depression and food addiction may be due to deep biochemical connections that have gone largely ignored in treatment programs until now.

The coexistence of psychiatric diagnoses and problems with appetite is shocking common. One research study concluded that approximately 80 percent of patients with binge eating disorder (BED) and 95 percent of patients with bulimia met the criteria for at least one other diagnosis outlined in the Diagnostic and Statistical Manual of Mental Disorders. Overweight men and women are 25 percent more likely to suffer from mood disorders than the rest of the population. Between 15 percent and 40 percent of patients with eating disorders also struggle with substance abuse.

Strikingly, 75 percent of patients with eating disorders also suffer from depression. For those individuals with binge eating disorder who are overweight, one study found that rates of depression are even higher than for individuals who are overweight but do not have binge eating disorder. In this particular study, researchers found that symptoms of depression led to binge eating episodes. Other studies have found that depressive symptoms, including low self-esteem, predicted increases in binge eating, demonstrating further evidence of the relationship between depression and binge eating. These results suggest that for some binge eating is a way to regulate emotion, however they also reveal that there is something more to the association between food addiction and depression than previously thought—something disruptive, persistent, and physiological.

A look into the intricate neurochemical underpinnings of depression and binge eating disorder provides a clearer understanding of the biological nature of their troubling comorbidity. Interestingly, depression and food addiction both involve alterations in neurotransmitters, the substances that relay messages from one brain cell to another and then to the rest of the body. We know that imbalances in any of the neurotransmitters can wreak havoc with brain circuitry and predispose individuals to mental and physical distress. Normal levels of serotonin, the neurotransmitter linked most closely to satisfaction, lead both to emotional satisfaction and a sense of fullness after a meal. Low levels, on the other hand, can lead to depression and a tendency to binge on sweet and starchy foods. In fact, one study looking at how depression and a gene associated with lower levels of serotonin related to binge eating found that depressed children and older females who carried this gene were more likely to engage in binge eating behaviors.

In the context of a biochemical perspective on binge eating, this correlation makes sense. For some binge eating foods begins as a way to find a moment of much needed relief from depressive tendencies, and to fill the emotional void left by a lack of serotonin. However, what begins as a seemingly innocent attempt to self-soothe, quickly gives way to a complex cycle of addiction in the body. The flood of endorphins from eating large amounts of food only temporarily alters the neurochemistry of the brain, providing brief periods of solace from emotional distress; but these are not lasting. Ultimately, the demand for food intake to achieve such pacifying effects only increases over time and the coping mechanism completely fails, exacerbating instabilities with mood.

More research is needed to examine the precise mechanisms by which a serotonin deficiency can affect food, appetite, weight gain, and mood, and the causal nature of this overlap. However it is evident from the current body of scientific literature, that a holistic approach to investigating the interplay between an individual’s relationship to food and co-existing mood disorders is essential in order for successful recovery opportunities to exist. Treating one problem in isolation is not enough. It is only by comprehensively assessing the neurochemical commonalities underlying such complex psychological conditions that sustainable treatment solutions become possible.

By Stephen B. Jones, M.D., psychiatrist.

Worry and Anxiety in Depression: Anxiety May Try to Help, But Then it Hurts: What Should You Do?

Anxiety is a normal human feeling.

Anxiety is what you feel when you are faced with uncertainty. When you do not know what is going on or what you should do about it, you react with a feeling of anxiety.

What makes anxiety pass? Resolving the ambiguity. Figuring it out. What’s happening or what to do about it. Then the feeling is gone, and you are relieved. You may still have work to do or a problem that needs to be fixed, but the anxiety about it is finished.

When people suffer from depression they often also feel anxiety and spend too much time worrying, which increases their depression. The parts of their brain that are involved in that normal reaction to ambiguity are working overtime. And the thinking brain, low on energy due to depression, cannot stop that worry train. When they worry too much and can’t exert enough control, then the feeling of anxiety persists beyond any situation that includes some uncertainty. In fact, the anxious feeling can be present before any uncertainty. Then it creates the nagging sense in your gut that something is wrong, so your helpful brain, the one that wants an explanation for every feeling you have, goes on a search to figure out what might be the source of that anxiety.

Because the natural response to anxiety is to try and figure out what to do, you may start to think over all the possible reasons you could feel worried, and you will inevitably find one. When you are depressed your brain generates too many negative thoughts and cannot effectively shove them aside. You can get stuck in a loop of worrying one worry after another. However, because real problems are not the reason you have the sensation of anxiety, you either think and rethink in an effort to get relief or you move on to yet another worry. Thus: rumination and “serial worrying”, hallmarks of anxiety fuel depression.

There is a lot you can do about this. You can use your brain to change your brain. Here are 2 ideas to start out:

1. If it is a real problem, you will not fail to notice it: In your “thinking brain” you can assess if the problem you are worrying about is a real problem. If it is not a real problem (perhaps just a potential problem) you can decide “not to believe everything you think”. This is a conscious, determined choice to disbelieve the sensation of anxiety that feels so real. In its place you put an intentional more positive thought: You are competent to know when you have problems that need attention. Then you move your thoughts along to something more positive.

2. Stop and Interrupt: You will also have to use your thinking brain to stop and interrupt the worrying. As they say in the 12 Step programs, this process is simple, but it isn’t easy. You must plan what you prefer to think about on a daily basis and then when the unnecessary worry pipes up, you stop, interrupt yourself, and replace it with the preferred thought. The hard part is doing this every time an anxious feeling creeps in or a worry pops into your head.

There are many ways to use your brain to change the brain. Learning various methods and putting them into place starts a process that is the first step to lifelong change. You might need some outside help to achieve this persistence in the face of such distress, but controlling anxiety is doable over time. As you get more control of anxiety, your depression will diminish too.

Margaret Wehrenberg, Ph.D.
Author of The 10 Best-Ever Anxiety Management Techniques and The 10 Best-Ever Depression Management Techniques

Depression: Is Critical Thinking Part of the Cure?

One of the most well-known strategies for dealing with depression is the use of the class of medications know as SSRI’s. For many people, Prozac, Paxil, Zoloft, and the like have been incredibly helpful in dealing with depression.

Given this, why would a philosopher such as myself have something to say about depression? One reason is that there is another resource which may be helpful in dealing with depression, perhaps in concert with SSRI’s and other forms of treatment. That resource is sound critical thinking, and this is something that I am familiar with as a philosopher.

My claim is not that unsound or illogical thinking is the cause of depression, or that the depressed person is blameworthy for how she thinks, but rather that the thinking that is characteristic of someone suffering from depression is sometimes illogical thinking. Such thinking can perpetuate depression.

In cognitive therapy, an individual can come to recognize these illogical patterns of thought. Then, through a variety of means, she can begin to change those patterns. We all fall into these patterns of thought at times, but for the depressed they are perhaps more severe or exert more power over their lives. But what sorts of patterns of illogical thought are present in depressed thinking?

All or Nothing Thinking

Here, we tend to see black and white where they do not exist.

For example, someone might believe something like this: “Either I’m a total success, or I’m a total failure.” A successful person might lose out on a promotion, and then think that because of this he’s a complete failure. However, this type of thinking commits a logical fallacy, the fallacy of the false dilemma. When committing this fallacy, a person is assuming that only two options exist when there are more than two. So in the promotion example, rather than seeing himself as a failure, he would see himself as someone who is successful, but has suffered a professional setback

Disqualifying the Positive

Consider the depressed student who doesn’t think that anyone likes her. She discusses this with her roommate, who says “I like you, and so does your family and your 3 friends down the hall.” This is evidence that her belief is false, but the depressed person often persists in this thinking by believing that they don’t really like her, or they only like her because they have to, or something along these lines. This type of thinking is an example of the fallacy of suppressed evidence. This fallacy occurs when we overlook or ignore or unjustifiably discount relevant evidence that supports a different conclusion than what we believe.

Emotional Reasoning

This is when we believe that our negative feelings about something reflect reality, when they do not. For example, someone feels like they have nothing to offer anyone else, when this is not in fact that case. Feelings are powerful, and important, and they can reflect reality. But when they fail to reflect reality and we believe what they tell us anyway, we commit the fallacy of insufficient evidence. This fallacy occurs when we believe a conclusion even though there is not enough evidence to warrant that belief.

Should Statements

Depressed thinking often includes these types of statements: “I should exercise 3 times this week,” or “I should never feel angry with my children.” This type of self-talk can be harmful and demotivating, and may helpfully be replaced with statements like “It would be good to exercise 3 times this week,” or “It would be nice for my kids if I were more patient with them.” Sometimes, should statements exhibit the fallacy of the false dilemma: “I should exercise 3 times this week or I’m worthless and undisciplined.”

This is a false either-or type of reasoning. At other times, should statements reflect the fallacy of unacceptable premise, which occurs when one accepts a premise that is unwarranted by the evidence. For example, a depressed person might think that “Anyone who feels angry with their kids is a very bad parent and should feel very guilty. Since I sometimes feel angry with my kids, I’m a very bad parent and should feel very guilty.”
The unwarranted and unrealistic premise is that “anyone who feels angry with their kids is a very bad parent and should feel very guilty.” This is not to condone anger or belittle patient love, but it is to point out that feelings of anger are sometimes appropriate, and even when they are not it does not follow that one is a bad parent merely for having such feelings.

There are many issues here worth pursuing. How much can correcting these illogical ways of thinking help the depressed person? How can a depressed person begin to correct this thinking, when it occurs in her mind? I will leave it to the experts in psychology to answer these types of questions, but there is at least good philosophical evidence that sound critical thinking belongs in the toolbox of the person who is dealing with depression, as well as the toolbox of those who are seeking to help such an individual.

Michael W. Austin, Ph.D., is a professor of philosophy at Eastern Kentucky University. Austin has published numerous books and journal articles related to ethics, philosophy of religion, philosophy of the family, and philosophy of sport. He speaks on these and a variety of other topics related to the connections between character and human fulfillment.

Six Truths About Depression

A common misconception about depression is that it is something people can just “snap out of.” Unfortunately, for those people who experience major depression disorder, it’s not that simple. While depression can be serious, it is far from hopeless. There are effective treatments and actions people can take to overcome this disorder. There are certain truths about depression that are important to understand; as we target this debilitating disorder that often spans generations.

1) Depression is a more than just a bad mood.

It’s important for friends and relatives of those struggling to understand that people who suffer from depression can’t just feel better. People experiencing a major depression really need professional treatment. Depression is a mind/body issue and should be treated with the same self-compassion and treatment-seeking with which we would treat any major illness. Different forms of therapy and/ or medications work for different people. According to the American Psychological Association (APA), psychotherapy can benefit depressed individuals by helping them uncover the life problems that contribute to their depression, identify the destructive thinking that makes them feel hopeless, explore the behaviors that exacerbate their depression and regain a sense of pleasure in their lives.

2) Depression is affecting younger people.

In what’s been referred to in the field of psychology as “the greening of depression,” younger people are reporting increased levels of stress and depression. According to the Federal Center for Mental Health Services, “depression affects as many as one in every 33 children and one in eight adolescents.” APA’s additionally reported that higher numbers of college students are seeking treatment for depression and anxiety, with the number of students on psychiatric medications increasing by 10 percent in 10 years.

As I highlighted in my recent blog “Depression in Mothers,” babies born to women who struggled with depression while pregnant have “higher levels of stress hormones … as well as other neurological and behavioral differences.” Thus, whether it’s based on biological factors or new social and academic demands, the vulnerability among younger people makes it all the more essential that we target depression earlier and more effectively. Studies have shown promising results to early intervention among school-age children who showcased symptoms of depression.

3) Mindfulness helps with recurrent depression.

There are a lot of great treatments out there that have proven effective for dealing with depression. Research by psychologist Mark Williams, co-author of The Mindful Way Through Depression, has shown that mindfulness-based cognitive therapy (MBCT) can have a positive effect on preventing relapse in recovered depressed patients. His research indicates that if you teach people with recurrent depression mindfulness skills, such as meditation and breathing exercises, it reduces their chances of having another depressive episode.

Mindfulness practices don’t change our feelings or thoughts, but they do change our relationship to our feelings and thoughts. This enables a person who has a tendency toward depression to not get swept up in the thoughts and feelings that contribute to his or her depression. Another way mindfulness skills can benefit people struggling with depression is by helping them to be better able to regulate and tolerate emotion.

4) Anger often underlies depression.

Often, one strong emotion behind depression is anger. Anger can be a hard emotion to deal with, but it is actually a natural human reaction to frustration. Getting angry may seem like it would only make you feel worse, but when you don’t deal with anger directly, you tend to turn it on yourself. It is important to allow yourself the freedom to fully feel your feelings, but at the same time, to control yourself from acting them out in any way that is harmful. You can recognize and accept your anger in a healthy way that releases the emotion without allowing it to fester or be turned into an attack on yourself.

5) Depression is fueled by an inner critic.

We all have an inner critic, what my father, psychologist Dr. Robert Firestone, refers to as your “critical inner voice.” For people who are depressed, this critical inner voice can have a powerful and destructive influence on their state of mind. It may be feeding them a distorted commentary on their lives: You are too fat to leave the house. You are so stupid. No one will ever love you. You aren’t capable of being happy. You will never succeed at anything. The critical inner voice may then persuade you to act in destructive ways: Just be by yourself; no one wants to see you. Have another piece of cake; it will make you feel better. You shouldn’t even try for that job; you’ll never get it. Finally, once you’ve listened to its directives, the critical inner voice will attack you for your actions: You are such a loser, staying home alone on a Saturday. You messed up your diet again. What is wrong with you? You’ll never get a decent job. You’re so lazy.

To combat depression means taking on this internal enemy. This may involve looking into your past to help determine where these critical thoughts came from. How do these thoughts affect the actions you take in your life? How can you challenge these “voices” on an action level? On Oct. 8, I will be hosting a free online presentation on “Overcoming the Inner Enemy that Causes Depression,” which further explores how your critical inner voice leads to depression.

6) There are active steps you can take to alleviate depression.

One of the worst symptoms of depression is a feeling of hopelessness. This very feeling can inhibit someone suffering from taking the steps that would help them combat their depression. In my blog “Eight Ways to Actively Fight Depression,” I outline a series of actions people can take to fight depression. These include:

Recognizing and challenging your critical inner voice
Identifying and feeling your anger
Engaging in aerobic activity
Putting yourself in social or non-isolated situations
Doing activities you once enjoyed, even when you don’t feel like it
Watching a funny movie or show
Refusing to punish yourself for feeling bad
Seeing a therapist

For people struggling with depression, it’s important to have compassion for yourself and to take actions to overcome this state, including seeking help. Remember that no matter what your critical inner voice may be telling you, the situation is far from hopeless. There is good help available and many active ways to treat your condition. For more help or information visit the National Institute of Mental Health.

Lisa Firestone, Ph.D., is a clinical psychologist, author, and the Director of Research and Education for the Glendon Association. She studies suicide and violence as well as couples and family relations. She is the co-author (with Robert Firestone and Joyce Catlett) of Conquer Your Critical Inner Voice, Creating a Life of Meaning and Compassion, and Sex and Love in Intimate Relationships.

The Scientific Reasons Why You’re Feeling Depressed

Are you waking up just feeling “blah”? Like you don’t want to do anything except lie like a couch potato and watch TV, and even that is unsatisfying? You not only feel low energy, but kind of miserable. Perhaps you’re mad at yourself for not getting the house cleaned or not getting your work done and papers filed. Perhaps you’re feeling a bit lonely, left out by friends or unsupported by family. You may dwell on mounting bills or the fact that you’re 10 or 20 pounds overweight. You may feel aches and pains in your neck or back. Or you may just may feel grouchy and want to remain undisturbed by life’s demands and conversational opportunities. You may compare yourself unfavorably to your friend, roommate, cousin, or neighbor, who always seems to be on time, well-groomed, and on track to meet her goals. We all have those “blah” days, but why do they happen and what can we do about them?

Brain Chemicals

Some of us have brains that are more sensitive to the effects of stress. Researchers are just beginning to uncover the biochemistry behind this differential. The most common forms of antidepressants target the neurotransmitters serotonin and norepinephrine because research shows that low levels of these chemical motivators are part of what makes us depressed. However, only some people respond well to the most common forms of antidepressants, while others try drug after drug with no substantial mood improvement. A recent research study may reveal the reason why. A study published earlier this year in Proceedings of the National Academy of Sciences suggests that differences in the way our brain’s process a chemical called galanin makes some of us less resilient and able to bounce back after difficult experiences.

The Weather

Less sunshine during the winter months can give us the blues, and this effect is more pronounced for some people than others. Researchers Keller and colleagues studied hundreds of people and found that during the spring, moods improved along with doing more outdoor activities. We are also more cognitively flexible and able to think creatively about solving our problems in the spring, compared to winter. A subgroup of us suffer from Seasonal Affective Disorder in which the winter blues turn into full-blown depression along with associated changes in sleep, appetite, and motivation. Sufferers are more likely to be women. Exposure to outdoor sunlight also provides us with vitamin D; a substance with clear links to depressed mood.

Vitamin D

Most people in the US have insufficient or deficient levels of Vitamin D. The reasons are not clear, but could be related to nutrition and insufficient sun exposure. People with dark skin are more vulnerable to vitamin D deficiency, due to a decreased ability to process vitamin D from sunlight. Vitamin D deficiency has been statistically linked to depression. In a large Dutch study by Hoogendijk and colleagues (2008) of over 1,200 persons aged 65 and older, levels of vitamin D were 14% lower in persons with minor depression or major depressive disorder when compared to those not showing depressed mood.

Hormones

Hormones are substances produced by the endocrine glands that influence many bodily functions, including growth and development, mood, sexual function, and metabolism. Levels of certain hormones, such as those produced by the thyroid gland, can be factors in depression. In addition, some symptoms of depression are associated with thyroid conditions. Hormones fluctuate during the menstrual cycle and may create vulnerability to sad or depressed mood in the premenstrual period, as well as during peri-menopause, and menopause. There are individual differences in how much our moods are vulnerable to the effects of hormones. If you are more vulnerable, you may want to consult a physician to see if medications are needed to help regulate your hormones. Or you could try alternative medicine treatments, such as acupuncture to reduce hormone-related mood imbalance.

Expectations

Our moods are not only a function of what happens to us, but also of how we view the events in our lives and the meanings we assign to them. There are stages in most of our lives in which we seem to be working hard and doing all the right things, but don’t see many external rewards coming our way. We may not be paid what we feel we are worth or be able to afford as nice a house, car, or vacation as our friends. We may struggle to find the right partner while our friends or siblings seem to have no problem finding love. We may have to work longer and harder than our friends to get the same grade on a test or earn a living. We may experience a difficult breakup or loss. Life just naturally isn’t fair and periods of struggle, suffering and loss are inevitable. If we expect fair or special treatment all the time or expect things never to change, we are bound to be disappointed. So if you’re feeling sad because of recent events, remind yourself that hard times are part of life and will pass. Or deliberately broaden your view and focus on the good parts of your life or the experiences you are proud of.

Childhood Adverse Events

Stressful life events can wear down our physical and mental resources, making us more vulnerable to both depression and physical illnesses. A history of childhood trauma, including abuse, poverty, or loss of a parent, can reset our developing brains to be less cognitively flexible. It seems that our brains naturally go into a “fight, flight, freeze” response to stress or threat and we often have to use our prefrontal cortex or executive center to get out of this state. Prolonged stress in childhood can make our brains less interconnected and resilient.. Our brains can more easily get “stuck” in negative thinking patterns or stressed out states and we become less able to change tracks.

Stresses Piling Up

As Robert Sapolsky argues in his book Why Zebras Don’t Get Ulcers, our human stress response systems were designed to respond to acute, time-limited stressors that normally require a physical response. When our ancestors had chased off that marauding tiger, they could relax and eat. The stressors in today’s world are much more chronic and less controllable by taking action, and we often don’t get the break afterwards to recover and regroup. Financial stress, loneliness, constant fighting with loved ones, being bullied, long commutes, academic or job demands, or unemployment can drag on and have a cascade of effects across many areas of our lives. When stresses hit us one after the other without time for recovery, they can leave us depleted and despondent, with insufficient pep to bounce back.

Negative Ruminations

You may be feeling bad because you’re sitting around brooding about life’s disappointments or trying to find a reason why things aren’t going your way. Research studies by University of Michigan psychologist Susan Nolen-Hoeksema and colleagues show that sitting around thinking about your negative mood or negative events just makes everything worse! One negative thought leads to another until you get buried in a mountain of problems and negative predictions. This leads to a loss of perspective and motivation that interferes with actually doing something about the problem! If you find yourself in a negative thinking cycle, get up immediately and do something else pleasant or neutral to engage your mind. This can be as simple as emptying the dishwasher, rearranging your closet, going for a walk, talking to a friend or getting on with a work project.

Your Inner Critic

Do you have a critical inner voice constantly judging and criticizing everything you do, especially when things don’t go your way? The inner critic compounds the effect of anything negative in your life by blaming you for it. It keeps drawing your attention to the negative and spoils your pleasure when something positive happens by telling you ”it won’t last” or “you don’t deserve it”. This negative dialogue takes you out of the moment and makes you feel depressed. Negative thinking is, at minimum, a symptom of depression, and may be a causal factor in interaction with negative life events. The first step to combat an inner critic is to become aware of what it’s saying. Second step is to externalize it. You could give your critic a name and imagine what it looks like (e.g., a grumpy old crone or a vicious barking dog). Then begin telling it to back off or talk back to it. The inner critic generally has a negatively biased perspective and overestimates your responsibility for and control over outcomes in your life. It also often has perfectionistic expectations. Tell it to give you a break for a change!

Loneliness

Our human brains are wired of be part of a social group, and we experience loneliness as chronically stressful and depressing. Unfortunately, some of us have toxic or neglectful families that don’t provide support or presence when we need it. Or we may feel that our friends are moving on in finding romantic relationships or having kids and leaving us behind. Research using fMRI brain scans shows that even minor social rejection lights up the same areas of our brains as physical pain. Feeling left out, rejected, or excluded makes us sad and can also lead to rumination about what is wrong with us that further darkens our moods. We become scared of further rejection and isolate ourselves, perpetuating the negative cycle. While there may not be a immediate cure for loneliness, it helps to get out in the world and pursue your natural interests, which can lead to expanding your social network. Staying in touch with old friends or family and deliberately seeking opportunities to connect may help as well.

Final Thoughts

The reasons for a down mood may be multifaceted and difficult to determine. If you feel depressed for two weeks or more, seek a medical consult to rule out or treat underlying biological factors. Consider consulting a mental health professional for help in managing stress and expectations, negotiating life changes, or dealing with the emotional aftereffects of past traumas and dysfunctional families. If you can’t afford therapy, antidepressants may help to change the underlying biology. Exercising outdoors can provide both sunlight and mood elevation. Develop a toolkit of stress-reducing activities, such as regular exercise, yoga or meditation, watching funny movies, playing team sports, doing something creative or novel, hanging out with and/or confiding in understanding friends.

By Melanie Goldberg, Ph.D.

Dr. Goldberg is a clinical psychologist with a private practice in Mill Valley, California.

The 7 Reasons Why Depression Is More Common In Women

In recent decades depression has become increasingly common in industrialized countries such as the US and the UK, and is often referred to by physicians as ‘the common cold of psychiatry’.

Figures for the lifetime prevalence of depression vary according to the criteria used to define depression. Using DSM-IV’s criteria for ‘major depressive disorder’, which are similar to the ICD-10 criteria for ‘moderate depression’, the lifetime prevalence of depression is about 15 percent and the point prevalence about 5 percent. This means that an average person has about a one in seven (15 percent) chance of developing depression in the course of his or her lifetime, and about a 1 in 20 (5 percent) chance of suffering from it at this very point in time.

However, these figures mask a very uneven gender distribution as depression is about twice as common in women than in men. The reasons for this uneven gender distribution are not entirely clear, but are thought to be partly biological, partly psychological, and partly sociocultural.

Biological explanations

1. Compared to men, women may have a stronger genetic predisposition to developing depression.

2. Compared to men, women are much more subjected to fluctuating hormone levels. This is especially the case around the time of childbirth and at the menopause, both of which are associated with an increased risk of developing depression.

Psychological explanations

3. Women are more ruminative than men, that is, they tend to think about things more—which, though a very good thing, may also predispose them to developing depression. In contrast, men are more likely to react to difficult times with stoicism, anger, or substance misuse.

4. Women are generally more invested in relationships than men. Relationship problems are likely to affect them more, and so they are more likely to develop depression.

Sociocultural explanations

5. Women come under more stress than men. Not only do they have to go work just like men, but they may also be expected to bear the brunt of maintaining a home, bringing up children, caring for older relatives, and putting up with all the sexism!

6. Women live longer than men. Extreme old age is often associated with bereavement, loneliness, poor physical health, and precarity—and so with depression.

7. Women are more likely to seek out a diagnosis of depression. They are more likely to consult a physician and more likely to discuss their feelings with the physician. Conversely, physicians (whether male or female) may be more likely to make a diagnosis of depression in a woman.

Neel Burton, M.D., is a psychiatrist, philosopher and writer who lives and teaches in Oxford, England

Be Mindful This Autumn

Autumn is the season we associate with harvest and abundance. It is also a time we connect with nature’s waning energy as it prunes and cultivates.

This year, autumn began in the Northern Hemisphere on September 22. Where my family and I live in the Berkshire Mountains, mornings open with a chill in the air and the crackle of dry leaves scattered on the ground. Afternoons are warm early in the season—they can still feel like summer sometimes. Depending on where you live, you can see some people walking around shorts and t-shirts and others wearing sweaters and heftier coats, until the latter becomes the norm. Autumn nights get colder and deepen into a dark, clear, star-studded sky. The chill in contrast to the heat we felt all summer brings with it the smell of cider, wood smoke and bonfires, and many other seasonal scents. Days begin their descent into darkness much earlier and the nights and mornings get progressively colder.

Amidst all of autumn’s loveliness, we have to remember to cultivate and conserve our own energy.

As nature’s energy cycle dips and your world of relationships, work, sport, family, friends and more … does not lessen its demands an iota, perhaps increases the pressure—and add to that the upcoming holidays and all of their special demands—it’s easy to over-do things and/or miss something important.

One way to avoid the yearly imbalances that are often predictable during this season is to be mindful of how they manifest. The following is a list of five important areas to pay attention to

1. Feelings of low or no inspiration.

When you are low in energy you can feel low in inspiration. If that happens, especially in situations in which you need a more adaptable, inspired mindset, you may experience gridlock and the difficulties that it generates in relationships, the ability to move forward with a good idea or rid yourself of a bad one, as well as feelings of detachment and even depression.

Take action: First thing, get your energy flowing. Try adding exercise or a new exercise program. How about: Tai Chi, Yoga, or Chi Kung. These are all good as are jogging, swimming, hiking (absorbing the brisk seasonal scents and colors), and many more. One friend of mine tells me she simply cranks up her stereo and dances.

Take action: Be social and accept congeniality and hospitality form other.

Take action: Watch your nutrition and especially check your cravings that come around the holidays. Over-eating this time of year is a common problem. Try drinking lemon and water, particularly warm, to help curb your appetite.

Take action: Autumn is perfect for introspection and self-awareness. Try this to get you fueled: As yourself—what if tomorrow you could do whatever you want with your life? What if financial concerns were of no matter? What would you do differently to be the person you want to be? I know this may sound impossible for most of us, but roll with the possibility for just a few minutes. What would you do to grow yourself if money were suddenly of no concern? After all it’s just a thought. The reason I am asking you to do this is that this playful thought can give you direction and inspiration to see and begin pursuing what is meaningful for you. Then start scaffolding your way.

2. Feelings of worry.

It is common during this season when energy is in decline to experience worry. Some individuals express this in the inability to let go of certain facets of their life—including ones that are damaging. Other individuals may become driven to the accomplishment of certain goals to the detriment of others that may be of greater importance. Worry will disturb your sense of flow and positivity and will leave you drained if you don’t keep it in check. Be aware of the tendency toward feel-good compulsions, especially as to the holidays approach. A gentle self-reminder can prevent you from chasing after some risky rewards and better soothe anxieties.

Take Action: Step back. Ask yourself what’s going on? Ask: Are my feelings evolving from internal or external aspects of my life? What are these? Ask: Are they reasonable? Ask: How are they affecting other aspects of my life? Ask: How have similar worries affected me in the past? Do I need to change that? What part? Ask: What life-style changes do I need to make to stave off my ruminations? Start making these changes and reward yourself in an appropriate way for making them. Adding exercise to your daily regiment will help build positive energy and keep it flowing. If you already exercise, add something new: a new routine, a new piece of equipment, etc.

3. Narrow Focus.

Attention can generally be an issue during times of low energy. During autumn it is easy to get focused too tightly on one thing or another you are pushing yourself to accomplish before the year’s end. This can dry up your energy reserves fast and negatively influence your thoughts, feelings, and responsibilities.

Take action: Do pay attention to your goal but not to the point of fatigue. Step back every now and then and widen your lens. Be sure you are not missing other important information regarding your goal as well as other responsibilities and concerns. Also, remember by sticking only to your comfort zones, you may be missing out on something new and potentially very good.

4. Feelings of Sadness.

Sadness and grieving frequently manifest in autumn. These can begin a downward cycle that gets bigger and harder to control. The easiest thing for us to do is deny we are experiencing sadness and grief. But then that abdicates stewardship of your own mind to someone (or something) else.

Take action: Use distraction. Perhaps it is through high torque sport or through socialization or music or film or theater. Sometimes just a walk in the chilly air or a swim in colder water is sufficient to reset your compass long enough to help you step back. Then ask: What is the source of my feeling? Ask: What personal lenses (values, opinions, beliefs etc.) am I putting on the situation? Ask: Which of these are driven by my sadness? Ask: What other filters (culture, associates, etc) are telling me I should feel sad? Why? Ask: Is this true? Is this responsible? Is this particular to my case? Am I being swayed? How is their situation like my own? Unlike? What are the immediate and long-term benefits or liabilities of such thinking? To me? To others? Take action: Make yourself aware of how this sadness affects your daily goals. Take action: Challenge the filters you were using to justify your initial sadness.

5. Burnout. When the year is coming to a close, energies are declining, days are shortening and the holidays are around the corner, it is easy to want to get certain jobs out of the way. Burnout this time of year is not only predictable but can come on like clockwork. Take action: Make yourself aware. But don’t do less with your time. Instead do more – more satisfying things. So you may need to focus on time-management and be sure to make space for plenty more activities that will make your spirit soar.

To optimize your activities, seek tranquility this season and preserve your energy. Spend time centering and exploring more about who you are, what you have and what you need—and especially how this can all fit together. Spend more time outdoors to experience the seasonal patterns of slowing down: from cool and less light, to warm and more light, to cooler and earlier dark. Let these patterns sink into your own mind. Use them to help you energize and organize your own activities and stay in balance.

By Joseph Cardillo, Ph.D.

Regain Motivation With A Depression Action Plan

Everyone feels down at some point in their lives. But if you have major depression (also called major depressive disorder), you likely feel depressed every day for most of the day, especially in the morning. You might wake up and have no energy to get out of bed. And even when you do get up, deciding what to do first can feel like a mountainous task.

At those times of inertia, it’s easy to get discouraged. But giving up the idea of getting anything done can make you feel powerless and perpetuate feeling depressed. Instead, fight back with an action plan that propels you ahead, even when you’d rather lag behind.

Creating a Depression Action Plan

A depression action plan can help take the guesswork out of where to get started each morning. It can also empower you to see just how much you can do, which is important because people with depression tend to compare their current levels of activity to past ones.

“For an action plan to be effective, you first have to understand that major depression is an illness, not a weakness,” says Stephen J. Ferrando, MD, a professor of clinical psychiatry and clinical public health in the department of psychiatry at the New York-Presbyterian/Weill Cornell Medical Center in New York City. Stop comparing yourself to the past. “It’s not your fault you have depression,” he says.

To get started creating an action plan, it’s best to work with your doctor or therapist. “When you’re depressed, it can be difficult to determine where to begin,” says Randy Auerbach, PhD, ABPP, a researcher, an assistant professor in the department of psychiatry at Harvard School of Medicine, and the director of the Child and Adolescent Mood Disorders Laboratory at McLean Hospital in Belmont, Mass. Your doctor or therapist can help you identify both short-term and long-term goals to work toward.

Consider these steps you might want to include in your daily action plan:

Tasks you need to do

Make a list of four or five things you need to get done today, such as work and chores. To avoid getting overwhelmed, break down each goal into small parts. For example, instead of making cleaning the entire house your goal, decide to clean just one room today, says Brian Iacoviello, PhD, an assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai Hospital in New York City.

Activities you enjoy

If depression has taken the enjoyment out of all activities for you, write down what you once found pleasurable. Working toward doing the things you once enjoyed can help you slowly regain momentum. You can also try adding new activities, such as soothing stress-coping experiences (e.g., meditation, yoga, and tai chi).

Time with your support network

Research shows that a support network is critical for depression recovery. Make plans with friends and family and show up even when you don’t feel like it. It helps to have a friend who will hold you accountable. “Social support can be an enormous ally when you’re in dealing with depression,” Dr. Auerbach says. A local or online depression support group can also be a good resource.

Exercise

In a review published in in 2013 in the American Journal of Preventive Medicine, researchers reported that even low levels of physical activity, such as walking or gardening for 20 to 30 minutes a day, can help ward off depression. If you’ve stopped exercising, set reasonable goals to allow yourself to slowly get to the level of physical activity you want to reach. You might even combine exercise with socializing by picking a workout activity to do with a friend.

Healthy meals

Eating a balanced diet may help alleviate depression symptoms. Include steps in your depression action plan to create healthy meals each day. To maximize benefits, aim for three meals that include whole grains, fresh fruits and vegetables, beans, lentils, nuts, seeds, lean meat, fish, eggs, and low-fat or fat-free diary. Never skip breakfast. Be sure to drink plenty of water because even mild dehydration can affect mood. Limit your alcohol intake.

Medication

If you’re taking medication, include specific times to take it in your depression action plan. Sticking to your prescribed treatment plan is the best way to speed recovery.

Journaling

Your entries can provide insight for you and your doctor or therapist to review together to determine patterns of behavior that may be holding you back from doing everything you want to do. Record behaviors such as what you’re doing, how successful you’re being at doing those things, and what you think about when you’re doing them. Once you’ve identified any negative patterns, you can work with your doctor or therapist on how to let them go.

Rewards

Implement a system of rewards to give yourself when you’ve accomplished a goal in your depression action plan. Self-care activities — such as a massage, a new haircut, a movie, or any other activity that makes you feel good and follows your plan for recovery — make good rewards.

How to Stick to Your Depression Action Plan

When the temptation to do nothing crops up each morning, realize that you’ll have to push yourself to take the first step to get started. Once you do that, know that your level of motivation will likely increase. To stay on track, be sure to schedule activities at specific times so you don’t get overwhelmed about what to do next or how much you have to get done. Post your depression action plan in a visible place, and set up reminders by programming alerts on your phone.

Also, remember that your depression action plan may not follow a straight path. There may be setbacks, and that’s okay — just do your best to keep going. Then at your regular doctor appointments or therapy sessions, you can discuss your progress and work together with your doctor or therapist to identify what may still be getting in your way and figure out what to do to change it.

At the end of each day, focus on what you’ve accomplished instead of what you haven’t. “The greatest challenge for a person with depression is to overcome pessimistic thinking, helplessness, and hopelessness,” Auerbach says. “But with proper treatment and a good action plan, depression can be conquered.”

By Barbara Sadick

Copywrite 2014, EverydayHealth.com

Listening to Depression

Those of us who suffer from depression tend to think of this state of mind (and being) as an obstacle to moving forward. Is there a useful purpose to be found when we are depressed?

Lara Honos-Webb, Ph.D., thinks so. Her book, Listening to Depression, is full of stories and examples of showing that depression is not only not a mistake, but can yield powerful messages that unlock our life purpose. The central themes she explores are: Depression symptoms are communications to you from yourself, about yourself.  Depression is a time-out to re-vision and re-figure your life.  Depression is a signal that something new has to come into your life.    I met Lara almost three years ago, when she came for coaching. At that time she was working as a clinical psychologist and professor. Since then she has added author and mother to her resume.

Lara’s passion for this subject was fueled by her own struggle with depression in college—which led to getting back on track with her life’s work. “I came from a family which was not at all stable financially. Because of that I wanted to choose a career that would be sure to give me financial security, so I was planning to major in business. However, before long I started feeling very depressed. I had lost interest in business very quickly. Luckily, I decided to take some psychology classes. I found psychology is where my real interests lie, and this is my life path. I still thank God for that depression, which I now see as a signal of being out of alignment.”

After developing her own clinical practice and supervising hundreds of cases on depression, Lara’s skills and mission came together. She says, “A lot of the time, clinical psychologists don’t take into consideration that depression may be an accurate reflection of what’s going on with a person. Ironically, a person’s friends can easily point out why they are depressed, but clinicians sometimes miss the obvious! In most cases, I believe that depression is not a mental disorder, but a reflection of choices that people are making that don’t fit.”

Lara makes it clear that, in cases where depression is severe or the person is suicidal, he or she must be stabilized before addressing the roots of their depression. Similarly, anyone dealing with depression resulting from external problems and situations, such as addictions, on-going physical or emotional abuse, debilitating ethnic or gender discrimination, or poverty and homelessness must first address these conditions. Depression is a Wake-up Call About How You Are Living your Purpose . According to Lara, our feelings of depression are a call to bring our life into alignment with our own needs, values and desires. How do people get off track in the first place?

Operating from a sense of loyalty.

While loyalty allows people to belong and feel connected, it could hamper our individual choices. Think of people who just slide into a family business because it’s there.   If you are depressed, notice where you might be conforming in order not to rock the boat. To get back on track, differentiate between how you genuinely agree with your family or social milieu, and where your dreams and interests are different.

Not believing in yourself

Many people feel they are not “good enough” to go for their dreams.   For example, someone may want to be a doctor, but comes from a working class family. The message from their parents and milieu might be, ‘Who do you think you are?’ Adding unconscious loyalty to self-doubt builds a powerful justification for not going further than their parents or friends.

Lack of reflection

If we never take time to ask ourselves what we really want, or to notice how we may be different from those in our upbringing, we never take time to get on track.  Need for security.   Is our choice of career based solely on the financial reward? We build real security by investing in ourselves, learning new things, and being willing to take on new challenges.

Fear of the unknown

To move past fear, we have to have a compelling reason to move forward—such as, a creative urge that won’t go away, a desire to have our own business, or an urge to live according to our own values. If those compelling urges are suppressed, depression follows. If we don’t listen to our inner voice, we sink deeper into depression, or even find that we have an accident or illness that amplifies the message that something has to change. Lara quotes the philosopher, Heiddegger, “‘Breakdown is always in the service of breakthrough.’”

When It’s Dark Outside Follow the Inner Light of Life Purpose

Lara writes in her book, “Depression feels like all the lights have gone out. When the lights are out, the only thing you can see is that which is lit from within. And that which is lit from within is your life purpose.” One story describes Jamie, a young man who is married with children, thirty-five, and deeply depressed–almost suicidal. Through counseling (though not with Lara), he came to recognize that the only thing truly lighting his path was his desire to be a comic-book artist—though he had experienced no success so far, and did not believe that he could support his family from his creativity. He got the idea to start an on-line comic book, and was the first one to start such a site ( www.wantedhero.com.)

His is a good example of translating one’s personal pain into creative channels that help others. The site became a success, and is not only entertaining, but healing. His topics have individually and socially inspiring messages–the gift, so to speak, of his depression. “His original issue was being indiscriminately loyal,” says Lara, “Jamie had to learn to separate himself from what others think, and set boundaries that allowed him to do what he could do best”

Use The Four P’s to Heal Depression

According to Lara, depression can be healed by letting your life be guided by pleasure, presence, power and permission.

Increase Pleasure.

So many times depression is a call to re-enter life—instead of just going through the motions. Instead of focusing all your time on performance demands—which ultimately is one-sided and draining—be sure to give yourself a few simple pleasures, like browsing in bookstores, walking with a friend, playing with your child or bicycling.  Lara notes, “Since I wrote the book, I would add that having more pleasure in your life is actually very practical. Taking pleasure in something automatically brings its own sense of fulfillment.   You don’t have to wait to “make it someday,” to feel happy. When in a good mood, you also perform better in everything. You attract people and opportunities because you are operating at a higher energy level. You have the energy to see more possibilities and take more chances.”

Make a point of being present in the moment each day. It’s the difference between being and doing–performing. Lara says, “Presence happens when you are just having lunch with your child, just watching him make a mess, and not being concerned about it. Ironically, the work of depression pushes you into being, not doing. Some people who survive suicide attempts say that they learn that just being is a great gift. Therefore, the failure of one of your ‘doing” goals could be the thing that connects you to your being in this moment.”

Power reminds us to be the author of our own life. Lara says, “I call this re-writing the rules.   For example, women often think motherhood has to be a sacrifice, but there’s power in making authentic choices instead of simply conforming to a life that doesn’t work for you. You can re-write the rules for yourself and say, ‘I don’t have to solve everybody else’s problems.’ Or, ‘I don’t have to make every single choice based on security.’ Re-write the rules about having to get together for toxic family holidays; make taking care of yourself the highest priority.   Another example is a man who really wanted to work in a pet store. “ His main obstacle between himself and his life purpose,” says Lara, “was that he believed that men didn’t do those sorts of jobs. He found that he had the power to change his thinking.”

Permission.

Practice giving yourself permission to see life a different way. For example, some of us have to learn that life doesn’t have to be a struggle (despite our past experiences.) The future doesn’t have to be a repeat of the past. Give yourself permission to explore something, or simply to be happy (despite others who want to draw you into the misery-loves-company conversation.).

Healing Tragic Loss

Deep depression from loss takes us on a journey. How do we ever recover from the loss of a loved one, of losing our home, livelihood, or health? Lara says, “Finding meaning in a tragic loss is essential if you are to recover. For example, I have a story about a woman who survived a car crash caused by a drunk driver, in which her parents and sister were killed. She brought that tragic loss into her life purpose and became a lawyer and an inspiring public speaker about drunk driving. Sometimes these events are, mysteriously, a stepping stone to revealing a life purpose.”

 By Carol Andrienne, Ph.D.

One Attorney’s Journey Back From Depression

I have been a civil litigation attorney for 26 years. I am married with two children. For a number of years I had been struggling with depression, although never formally diagnosed. Over time I began to isolate and my ability to function at work diminished significantly. I tried very hard to hide my insides and simply put on a happy, easy-going facade. Sharing my feelings was simply not something I did, with anyone. The pressure continued to build until I felt the walls closing in around me.

I woke up one morning and after everyone left the house I simply drove off. I packed a few things, purchased some supplies at an outdoor store and disappeared into the woods about 150 miles from my home. No note, no message, no warning. While it was my intention at the time to never return, I did ultimately return home about one month later (the details of my journey are a whole other story for another day).

Upon my return, aside from dealing with the intense emotional and financial strain I caused my family, I finally sought out the help I so desperately needed. I spent five nights in an in-patient facility and then another eight weeks in an outpatient program. I presently see a therapist weekly and a psychologist on a bimonthly basis, mainly for medication management. I was also directed to the state lawyers’ assistance program.

Hearing the statistics about attorney depression at my initial meeting at LAP was both comforting and distressing. Even hearing the statistics, however, did not make it any easier for me to grasp that this was not just a personal weakness on my part. Others seem to handle the stress so well. Obtaining the proper medication, learning to accept my depression as a disease and not a weakness, and learning to express my feelings to others was a difficult process.

Over time, I found that my feelings do matter. It is not selfish to put my needs ahead of the needs of others at times. Yes, I needed to become a little selfish, but that is ok.

About a year into my “recovery” things really began to take a positive turn. I overcame the shame I felt around others (my disappearance was in the news papers, law journal and on the local TV news). I had to overcome the sense that others were constantly judging me.

A strong support system at home, a close friend, and a willingness to be open and honest have me on the proper road. I have begun to work on a per diem basis with a law firm that has a complete understanding of my history. A firm that has allowed me to transition back into the law at my own pace. A firm that understands that despite my depression, I have a valuable set of skills and can be an asset to the firm.

My hope is that I can use what I have learned to help others. As my relationship with my wife and children is more meaningful than at any other time in my life, I would like to share in my sense of well-being. If I can help just one other person, through my experience (strength and hope), it will give my journey a sense of purpose.

Featured In: