Depression and Loss of Energy: A Waiting Game

Reversing the downward spiral of depression takes less energy than you think.

Depression and loss of energy — it is the beginning of a waiting game that does not end well.

Sometimes depression is born from loss of achievement, loss of goals, and loss of positive feelings about oneself. When low energy plays a role, a person who is not blessed with high drive and physical energy can see a spiral into depression start quickly. But even people with more energy lose it while bearing the weight of the losses. And, without a lot of energy, people begin to wait for things to get better around them rather than take action to make a change.

The Downward Spiral

Spiraling — the word makes it seem like a gentle way to go down, but when it comes to depression, going down is hard to stop, and once at the bottom, reversing the spiral takes intention and support. I hear about this often from my younger depressed clients — those adults who started out of high school or college ready to be successful but who found the world did not fulfill the vision they had.

Jeremy (not his real name) was one such young man. He never had to work too hard to get a passable grade point and was popular enough to have a solid romantic relationship. He was ready happy with his life. But, as commonly happens, the college romance did not last, which made him feel down in the dumps. Then the company he worked for, facing hard times, cut his hours. He now did not earn enough to live on but he expected the company, not himself, to change and he took no action. He waited for work to increase his hours, but in the meantime, he felt like a failure, and the waiting sapped him. His self-esteem, already suffering from being single again, took another hit as he saw his money dwindle to nothing. He started to isolate himself from friends without funds for fun and without a date to go along. Waiting was his enemy. Without meaningful activity beyond limited work hours, that isolation increased his depressed mood.

Waiting also intensified the mental and physical fatigue, so he slept later in the morning since he did not have to get to work early. He began to think he had a lot of time every day to work on his situation, so he did not start on possible job hunting and, as the day melted away, it was too easy to let himself decide that tomorrow was a good day to start fresh. But that waiting also increased his fear that nothing could change and his mood became very depressed. That depression and his situation robbed him of the very things he needed to reverse the spiral: meaningful work (purpose, as well as money), positive interactions with others, pride in his achievements, sense of competency, and a feeling of being loved.

This spiral is one I have seen repeatedly in young adults who have not met with easy success out of high school or college. They often did not have to work at jobs during those years to obtain phones or cars or clothes or do costly activities, such as attend concerts or sporting events. One young man I worked with as he finished high school, Casen (again, a pseudonym), felt literally terrified of applying for a part time job so that he could begin developing job skills and a resume and have some spare cash. Without classroom demands, he moved into waiting mode: waiting to apply to community college, waiting for a job that might fall into his lap. (The job that a friend would provide not that Casen would go search for since the friend said he could get his boss to hire Casen). Waiting did not bring him the job or the college acceptance letter, and he felt even more scared and more depressed. And he judged himself rather mercilessly: believing he would never succeed. That negative mindset robbed him of even more energy, and the more time he spent watching shows on his laptop, the less energy he had to reverse the downward spiral to depression.

What can be done about this? It is typical that an outside force will help. If you are reading this you might be saying to yourself phrases like, “Yeah — the outside force of getting evicted or starving! That would work!” If so, you would be correctly identifying motivators! At times, though, a person in a downward spiral ends up living with family or friends who are being helpful to them in averting disaster, but the pattern of waiting on something outside themselves does not change until motivation can pick up.

Reversing the Downward Spiral

How is it possible to reverse the spiral? Raising energy is a primary initial goal — with or without motivation. To start the spiral on an upward trend, simply:

Stop telling yourself negative things: you only reinforce the belief they are true. Interfere with negativity, saying, “Stop! I choose to believe I will solve this!”

Stop isolating. Get in contact with people, any interaction with others will help you also get outside of your own negative thoughts or mood.

Stop talking about your own life for a short while. When you only ruminate on your troubles, they seem larger. Ask someone else about his or her life. Hearing about another’s life, you can look at your reactions. I love the saying that troubles shared are cut in half and joys shared are doubled.

Then start the upward spiral with attention to developing a sense of purpose. Don’t assume this is a deep spiritual quest. In fact, it can be initially as simple as scheduling your day and meeting some regular commitments. An important brain change toward a less depressed mood occurs results from intentional activity. You get a blip of glutamate, an activating neurochemical, and one of dopamine, the feel-good neurochemical, and the combination is energizing. The bigger the step you take, the more you get. And any action will supply enough energy to do a little more.

My Tips

If you are underemployed — set a daily schedule that begins with a reasonable wake-up time.

Have a pattern to the day what news show you listen to or watch when you have your coffee when you feed a pet or meet a friend for tea.

Leave the house — you might have to start with leaving your room and interacting with others in your home- but forcing yourself toward less isolation is important.

At work, be sure to talk to your colleagues and ask them how they are; It improves the chance of a positive social exchange that can increase your self-esteem a bit and moves the spiral upward a fraction.

Set small goals — like walking the dog an extra 5 minutes — and notice you achieved them. There’s a bit more glutamate and dopamine!

Do something physical. When you move your depressed body you gain energy rather than lose it, so even a few minutes of tidying up can raise enough energy to do a bit more.

The above ideas tend to work best when you are working with another person who supports you, such as a therapist, a 12-Step sponsor, or a good friend who knows your goals and will help you keep track of them.

As you stop the waiting game — that passive waiting for life to change without you doing something to change it — the spiral reverses. You will be surprised that you will slowly feel your energy rise so you will be more able to take the next steps toward success.

 

By Dr. Margaret Wehrenberg, Psy.D.

This article first appeared in Psychology Today website.

Dr. Wehrenberg is the author of 5 books published by W.W. Norton, including The 10 Best Ever Anxiety Management Techniques, The 10 Best Ever Depression Management Techniques and her most recent 10 Best Anxiety Busters, an ideal book for the general public. She earned her M.A. studying psychodrama and bioenergetics, and had years of experience as a certified drug and alcoholism counselor, before earning her Psy.D. She now specializes in treating anxiety and depression and has a private practice in Naperville, IL. She is a frequent contributor of articles to The Psychotherapy Networker magazine, has contributed a chapter to Clinical Pearls of Wisdom (Ed. M. Kerman), and has produced CD for breathing, muscle relaxation and imagery for anxiety management. Check out her website at www.margaretwehrenberg.com.

 

 

The Creativity Cure for Depression: An Interview with Dr. Carrie Barron

Today’s guest is Dr. Carrie Barron, a board-certified psychiatrist/psychoanalyst on the clinical faculty of the Columbia College of Physicians and Surgeons who also has a private practice in New York City.  She has published in peer-reviewed journals, won several academic awards, and presented original works related to creativity and self-expression at national meetings of the American Psychoanalytic Association. Along with her husband, Alton Barron, M.D., a hand and shoulder surgeon, she co-authored the book, The Creativity Cure: How to Build Happiness with Your Own Two Hands.

Dan:

Why is depression such a problem in our culture?

Carrie:

I think the level of stress has gone up enormously because we have so much to do and we’re on twenty-four hours a day. So I think because of technology, which offers us so many great things, but gives us much to do. I think that’s part of it. I also think, especially for children, we’re in a striving, ambitious, be productive all the time mentality – for children and adults. We need to play, we need to hangout, we need to have spontaneous time. I think spontaneous thought does a lot for alleviating depression and anxiety.

Dan:

We have so many different words in our culture for unpleasant experiences. We might say things like, “I’m sad,” “I’m burnt-out,” “I’m stressed-out,” or “I’m depressed.”  But what is the difference in your mind, as a clinician, between sadness, say, and depression?

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Carrie:

Sadness is a normal emotion. We don’t have to treat everything and be afraid of sadness. We don’t have to pathologize everything. There is a range. I mean, life can be very hard and it’s appropriate not only to have it, but let yourself have it. Sometimes it is actually moving towards the authentic feeling, rather than running away from it, that actually makes it go away. You first have to experience it, and then when you understand it, and you’re in it, it runs its course. Now, this is separate from a true major depression where you can’t get up in the morning. That’s another story. But sadness is a normal part of life.

Dan:

In your clinical practice, how often would you say depression has played a role in why people have come to see you?

Carrie:

I think it plays a role often. The categories that we have in the DSM-5, I think they’re useful so that clinicians can communicate with others. But nobody is fully described by a category or diagnosis. There’s a lot of overlap. When people are depressed, they’re also often anxious and also stressed, and sometimes it’s more one than the other. But depression does come up a lot for people and it’s very painful. I think not being able to get up in the morning, not feeling like doing anything, not being able to enjoy the sunny day or the view of the water, or whatever else people are getting into, it makes you feel very separate and alone when you are depressed and other people around you are not.  So it has, kind of, a trickle-down effect, too.

Dan:

Why did you write the book, The Creativity Cure? I found it such an interesting book, a fascinating read. You wrote it with your husband who is a surgeon. Can you tell our audience why you wrote it?

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Carrie:

There are two things.  I talk about this now, I didn’t talk about this in the book, when I was a kid, I had some problems. I was depressed. I was anxious. We weren’t taking meds at that time. There was some chaos in my world.  I really had to find a way to survive. When I look back on it now, all those things that I recommend in my book are things I was doing, or trying to do, like using my hands. I would cook a lot. I would take long walks.  Then, later in my practice, maybe ten years ago, patients were saying, “You know, I went home and I fixed my sink and I became euphoric! I felt great!” I started to realize that meaningful hand use has a lot to do with happiness. And yet, because so much of what we do now is accomplished with a click on a device, we’re deprived of the process. And process, being deeply immersed in making, or making music, brings with it the possibility for euphoria, and satisfaction, and feeling good about living. So creativity is really about a way to have an optimal life. How you define creativity is another matter.

Dan:

What’s going on in the body, in particular, the brain when someone is struggling with depression? And how does creative action interact with that?

Carrie:

I think a lot of studies have been done, and serotonin and neurotransmitters, there’s a depleted state, and that we need to boost it up with medication or activities that do the same. Vigorous exercise can create the same biological state that antidepressants can. I want to qualify this and say that one must see their physician and make an informed decision, but certainly exercise can help a lot. Also, meaningful hand use has been shown to boost mood. Dr. Kelly Lambert wrote a book, Lifting Depression: A Neuroscientist’s Hands-On Approach to Activating Your Brain’s Healing Power, and she was the one who talked a lot about how purposeful hand use can affect brain chemistry and make people feel happier.

Dan:

What would be some examples of using your hands? When we think of creativity, many people might think of painting, for example. They might say to themselves, “Well, I’m not a good painter,” or “I don’t play an instrument.” But creativity isn’t really limited to that. Can you expand on that?

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Carrie:

Sure. I am so glad you asked that. I think this is the crucial question. And I think you hit the nail on the head. A lot of people say, “I’m not creative.” Well, first of all, I think we’re all born creative. It’s a matter of finding what you can do. It can be applied to business. You can be amazing. You could be a genius at figuring out what the team needs to be. That’s very creative. You could be an amazing cook. You could have a tremendous talent for decorating. Gardening, the design of a garden. It doesn’t have to be on a professional level. It’s really a matter of figuring out what you can get into. You may find that if you put some time into mastering a skill that you find a certain pleasure and freedom with it. That could be something like painting, but it doesn’t have to be. Knitting, crafting, it could even be fixing things. All of that involves meaningful hand use.

There are many definitions of creativity.  My definition of it is allowing most natural self to emerge to make a positive contribution. It’s allowing you a freedom, a spontaneity in the way that you live, a feeling of safety that allows you to do that so you’ll throw out an idea, you’ll say something funny in conversation, so that you are just yourself and it works. That’s really optimal living.

Dan:

You talked earlier about when you were younger and growing up having some difficult childhood experiences and learning some creative coping skills.  Myself, when I think about this, I had a very difficult childhood as well with an alcoholic, abusive father. Over time, I didn’t have what I would now think of as depression as a young adult. It developed more at midlife when I turned forty.  It seems that there’s a lot of research that suggests that when people in their childhoods have difficult experiences, either emotional abuse, or physical abuse, or deprivation, there’s some kind of linkup with adult-onset depression. Have you found you found that in your experience?

Carrie:

Yea, I think so. I think because in certain ways when you’re in your twenties and your thirties and you’re striving, and you’re distracted and you have a strong goal, that, in and of itself, that kind of commitment to a goal or emotion can stave off certain aspects of your memory or your inner life and it might get triggered in your forties.  Maybe when you have a little bit more time to contemplate or think back. I will say that there are certainly ways, I just like to not be falsely optimistic, but be really optimistic and really encourage people to understand that there are ways to look into your particular history, your particular form of depression, and work with it to get to a much better place at any age.

Dan:

In your book, you talk specifically about not only being creatively engaged, but the use of one’s hands, a physical activity, and how that somehow connects to creativity, no matter your history, or the causes of your depression. This seems to work for just about anybody with depression or unhappiness. Would you say that’s the case?

Carrie:

I do. I think it’s mild or moderate depression. I think if you have a very severe depression, you might need some medical intervention or an intense therapy. But what I like to say is that if you develop a creative habit, it’s very useful to fall back on it when you are depressed. You may not be able to master a new habit when you’re severely depressed, but if you’re mild to moderate, and you work on your knitting, or you work on your painting, or you go into the kitchen and you are inventive about your cooking, it really can shift mood, but not if you’re in a very crippled state. In a crippled state, you need to get to, sort of, a better place, and then use the creativity after that.

Dan:

You’re living in New York City, but you’re soon to be on the move. Tell us a little bit about that.

Carrie:

I’m very excited because I am going to be moving to Austin, Texas soon.  I’m going to be involved in, and working with the great people to try to develop a creativity/wellness program together. I’m not sure exactly, I haven’t submitted a proposal to them about human flourishing and aspects of human flourishing, but from my research, I outline 10 principles that are based on scientific research, but also on ancient philosophies that really help people with optimal living. Most of those are, actually, linked to creativity and linked to better health. So I’m really excited to get to work with people there.

Dan:

You actually have a website. Where can our podcast listeners and readers find you?

Carrie:

At carriebarronmd.com and we have a pretty active Facebook page has a wide following. People make lots of comments and have lots of pretty interesting things to say on that.  So that might be a place to look. And I do have an active Psychology Today blog. I try to keep it lighter for Facebook, kind of short for my website. On Psychology Today, I try to deal with deeper, more complicated issues, but try to be useful.

Dan:

Carrie, it’s been a real pleasure speaking with you today on this very important topic of depression and what we can do about it with creativity.  And we look forward to following your future work.  I hope everybody follows Carrie on her website and reads her blogs. This is Dan Lukasik from Lawyers with Depression. Join us next week for another interesting interview.

The Neuroscience of Depression: An Interview with Dr. Alex Korb

new-korb

The following is an edited transcript of the podcast recorded interview with Dr. Alex Korb.  This transcript has not been reviewed and is not a word-by-word rendering of the entire interview.

Hi, I’m Dan Lukasik from lawyerswithdepression.com. Today’s guest is Dr. Alex Korb.  Dr. Korb is a neuroscientist, writer, and coach.  He’s studied the brain for over fifteen years, attending Brown University as an undergraduate and earning his Ph.D. in neuroscience from UCLA. He has over a dozen peer-reviewed journal articles on depression and is also the author of the book, The Upward Spiral: Using Neuroscience to Reverse the Course of Depression One Small Change at a Time. Interesting, he’s also coached the UCLA Women’s Ultimate Freesbie team for twelve seasons and is a three-time winner for Ultimate Coach of the Year.  His expertise extends into leadership and motivation, stress and anxiety, mindfulness, physical fitness, and even standup comedy. Welcome to the show.

Dr. Korb:

Thank you, great to be here.

Dan:

Let’s begin for our audience.  You’re a neuroscientist. What is neuroscience?

Dr. Korb:

Neuroscience is simply the study of the brain and nervous system. It’s a branch of biology, but it also incorporates aspects of psychology, psychiatry, and neurobiology.  It’s anything that’s going on in the brain and nervous system all under the purview of neuroscience.

Dan:

You’ve studied depression as a neuroscientist?

Dr. Korb:

Yes, that’s what I wrote my dissertation on. The aspect of neuroscience that I’m most interested in is what underlies the neural basis for our moods and emotions, behaviors, and psychiatric illnesses. Some peer-reviewed articles look at schizophrenia as well as other psychiatric disorders like depression which have a lot of basis in neuroscience and we just don’t fully understand what is happening in the brain.

Dan:

Based on your research, can you tell us what’s going on in the brain when someone is suffering from depression?

Dr. Korb:

The best way to describe it is a dysfunction in frontal-limbic communication. To simplify it, there’s a problem with the way the thinking, feeling, and action circuits in the brain are communicating with each other.  Those all have different regions of the brain that are more dedicated to each aspect of thoughts, feelings, and actions. But, normally, there’s a dynamic of how these regions are supposed to communicate with each other, and there’s something with depression that’s a little bit off.

Dan:

Can the same be said for anxiety as far as what’s going on in the brain?

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Dr. Korb:

Yes, anxiety and depression have a lot of overlap regarding the neuroscience and neurobiology behind them.  A lot of the same brain regions are involved. For example, the amygdala, which is often called the fear center of the brain, but is involved in a lot of emotional expressions, that’s one of the core emotion regions in the brain, and it plays a role in both depression and anxiety.  And there’s just a lot of overlap in brain regions, and neurochemistry that underlies these disorders and it’s one of the reasons why anxiety is one of the most common features of depression and they often co-occur together.

Dan:

When I’ve tried to explain what I was suffering from, and my symptoms and I called it “depression,” most people didn’t have any frame of reference for that. They usually thought of it as “sadness.” With respect to sadness and depression, are there different areas of the brain that pertain to sadness that are different from clinical depression?

Dr. Korb:

There’s a lot of overlap between sadness and depression, but a lot of the misunderstanding that people have is that we use the term depression and sadness, “I’m feeling depressed” or, “I’m feeling sad,” we use those colloquially, very interchangeably.

But medically, or neuroscientifically, they’re very different.

Depression and the diagnosis of depression are a lot more than simple sadness.  In fact, a lot of people who suffer from depression don’t feel sad per se. They can often feel an emptiness where emotion should be.  They have a lot of other symptoms such as hopelessness and feelings of helplessness, guilt and shame, isolation, and anxiety can be a part of it.

They can have fatigue, problems falling asleep or staying asleep or even sleeping too much and, generally, the things that they used to find enjoyable they no longer find enjoyable. Everything just feels very difficult.

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It’s hard to explain to someone why it’s difficult because it seems like it shouldn’t be. It’s a much deeper feeling of being stuck than most people experience.  I think the average person if you can think of how you felt after the week of your greatest heartbreak, that sort of touches the edge of what it means to be depressed. It’s not the depth of how badly you feel, but that you can’t escape it. For example, I like to think of depression as a traffic jam.  When you enter a traffic jam, sometimes there’s an accident. The cars are stopped, and you sit there and wait.  And you don’t know how long the traffic jam is going to be. But for most people, it was just a little stoppage on their way. But for people with depression, it’s something that their brain just can’t quite escape. They can try and try, but their brain is stuck in the pattern of activity that just drags along, and the traffic jam just continues.

Dan:

That’s a great explanation of the experience of depression. Both what’s going on in the brain and psychologically. I think people want to know what are some of the causes of depression? Many people once they’ve often been diagnosed try to figure out for themselves, and people who care about them try to figure out?

Dr. Korb:

Depression can have a huge number of different causes. This is where the traffic jam analogy does a lot to help us understand depression. If you see a traffic jam, you can say, “Oh, what caused it?” Well, a traffic jam can come from any number of causes. There’s construction on the freeway, or there was an accident, there was heavy rain or fog, or it could just be that everyone decided to leave work at the same time, and there’s no specific “cause,” it’s just that the interaction – the dynamic interaction – of all those cars just reaches a tipping point.

With depression, it’s the same way. Often, it can be precipitated by a big life event such as a divorce, or breakup, or death in the family. Or smaller life events such as a perceived emotional embarrassment or you didn’t get that promotion.  But, often it’s not “caused” by anything.  It’s just the dynamic interaction of your brain circuits with each other, combined with the sum of your current life circumstances, which causes the brain to get stuck in a certain pattern of activity and reactivity.

That’s much more likely to happen for some people than others because some people’s brains are just more at risk for falling into that pattern. This can be based on the genes you got from your parents, and your early childhood experiences and the coping patterns you’ve been doing your whole life shaped the neurocircuitry and neurochemistry of your particular brain.  So, it’s not always a specifically, identifiable cause.  I think that’s one of the reasons why people, sometimes, don’t quite believe that it’s real or don’t think they should be suffering it. But, it’s very similar to that traffic analogy where it just “sort of happened” for seemingly no reason. It’s just caused by the fact that is vague, nonlinear, dynamic system.

Dan:

Why did you write the book, The Upward Spiral? There are plenty of scientists out there who study depression, but not many of them write a book for the general public on the topic.  What is it that led you to write this kind of book?

Dr. Korb:

I just realized that there was so much useful neuroscience out there that wasn’t being effectively delivered to the people who needed it most. One of the things that made me realize that is from when I was coaching Ultimate Freesbie. After a few months, one of the girls on the team revealed to me that she had been suffering from major depression and that she’d been suffering for years, and, tragically, many months later she ended up committing suicide. It was a devastating event in my life. This was back when I was still studying neuroscience, but before I had decided to go to grad school and study depression. That event led me to want to understand exactly what was going on in her brain that could lead her to do something like that. How could the brain get stuck in a disease like this?

That lead me to going to grad school and doing my dissertation on depression to try and understand and share some of these things with other people. As I was doing my dissertation, I realized that, yes, it’s good to advance the science, but there was already so much good science out there that was so beneficial. I didn’t think that anyone was doing a good enough job communicating clearly exactly about what was happening in the brain in depression and about all the little life changes that you can make that have measurable effects on brain activity and brain chemistry.

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Dan:

The second part of your book is devoted to eight specific things you can do to alleviate depression. Quickly, they exercise your brain, set goals and make decisions, give your brain a rest, develop positive habits, biofeedback, develop the ‘gratitude circuit,’ the power of others, and your brain in therapy. We don’t have enough time to focus on all eight, so why don’t we focus in on one or two. What I thought was fascinating is that you give the backdrop for what is going on in the brain when you do these things.  A few things that popped into my mind were gratitude and your brain in therapy. What about gratitude? How can it help depression?

Dr. Korb:

Gratitude can have a lot of powerful effects on the brain. And one of the reasons going back to why I wrote this book, is that there are tons of books out there that will tell you different life changes that you can make that will help with depression, but I’ve found that a lot of them are unsatisfying because they don’t explain, why. Therefore, it’s not as convincing, and it’s very easy for people to dismiss.

So when I talk about gratitude and how practicing gratitude can be so powerful in overcoming depression, a lot of people can resist that idea because it sounds so hokey.  But if I can point to specific neuroscience studies that show that it has measurable effects in changing brain activity and brain chemistry, then you’re much more likely to do it and it gives you a much better understanding of what’s going on. Gratitude has been shown to, if people who keep a gratitude journal, improve the quality of their sleep, and sleep symptoms of depression are one of the causes of depression. The reason why I called my book, The Upward Spiral because depression can sort of be seen as a “downward spiral” where one symptom or one event can lead to seemingly to a whole cascade of events that keep you stuck. So, gratitude can help break the downward spiral that’s coming from sleep problems that are leading to difficulty in concentration, and that’s one place to break the loop.

Dan:

After reading the chapter on gratitude, I picked up a spiral notebook and started a gratitude list. It was more of a lifetime gratitude list. It’s amazing. I came up with eighty things. I was surprised. So often my experience with depression is that we ruminate about negative things. We just don’t take the time, or don’t have the skill to savor and reflect on the good things in our lives.  It seems what you’re saying is that this practice has effects in the brain.

Dr. Korb:

Yes, when you’re in a depressed state it’s much harder to see the positive aspects of your life. But that’s why it’s all the more important to build a habit of looking for those positive things because often the most important feature of gratitude is not finding something to be grateful for. It’s remembering to look in the first place because that activates the prefrontal cortex which is the more thinking part of the brain which helps it to regulate the emotional regions of the brain that are going haywire in depression.

And gratitude increases activity in the key region of the brain called the cingulate cortex that sits at the intersection between the emotional limbic system and the rational prefrontal cortex and helps modulate communication between those. Remembering things in your past that you are happy or grateful for actually increases the production of the neurotransmitter serotonin in that same brain region and serotonin is one of the most common targets for antidepressant medications.  Practicing gratitude is having effects in key brain regions that we know contribute to depression and in the neurotransmitter systems that are contributing to depression.

Dan:

I also found it interesting your chapter on our brains and therapy. What’s interesting is that many people who treat with a therapist find comfort and solace in going to therapy when they are struggling with depression. They walk out, and they often do feel better at times don’t’ always understand why they feel better.  Or, we know, there’s a recent study from National Institute of Mental Health, which concluded that as many as eighty percent of people in this country get no treatment for depression whether it be antidepressants or therapy.  So, why is it important, if at all, for people to go to therapy who struggle with depression?

Dr. Korb:

The chapter that I wrote on therapy encompasses not just psychotherapy – going to talk to someone – but it also includes medical therapy such as antidepressant medication or other forms of therapy like neuromodulation techniques. These have been demonstrated through rigorous, double-blind studies that show they have powerful effects on treating depression.  Going to see a professional if you think you are depressed is a hugely important step because they can put at your disposal all the advances of western medicine.

What’s interesting – and it’s the last chapter in the book – and it’s funny how many comments I get because they say, “You left antidepressants to the end because it’s not that important and there are other life changes people can do.” Another psychiatrist will say to me, “Why are you so dismissive of antidepressant medication? They are hugely important in the treatment of depression.”  It’s neither of those. I agree that antidepressants and psychotherapy are extremely important in the treatment of depression, and if you think you are suffering from depression, you should go to see a health professional whether it’s just your doctor or you go to see a psychotherapist.

I just don’t think antidepressants are the entire answer.

For some people, I would say about one-third of people suffering from depression; antidepressants are the answer. You can get over your depression completely simply be taking a pill. You don’t know if you might be one of those people. So, you might as well see a doctor and find out.

For the other half or two-thirds of people, antidepressant medication can still be a huge part of the answer, even if it’s not the entire answer. Taking antidepressants can also help you make these other small life changes such as increasing exercise, or changing your sleep habits, or practicing gratitude.  As you make the other small life changes, then things can start to spiral upward.

Dan:

It’s been an informative and very interesting interview with you Dr. Korb.  I want to thank you for being on the show and I highly recommend listeners to pick up and read his book, The Upward Spiral: Using Neuroscience to Reverse the Course of Depression One Small Change at a Time.  Join us next week for another interesting interview at Lawyerswithdepression.com.

I encourage everyone to check out Dr. Korb’s website at alexkorbphd.com.

 

Wiring of ‘Little Brain’ Linked to Multiple Forms of Mental Illness

Having a single mental illness like anxiety, depression or schizophrenia is hard enough on its own. But studies consistently show that up to half of people with one mental illness also experience one or more additional forms of mental illness at the same time.The high numbers of patients who suffer from multiple forms of mental illness has many researchers shifting focus away from studying individual disorders and instead hunting for common mechanisms or risk factors that might cause all types of mental disorders. Read the rest of the news here.

How to Prevent Stress From Shrinking Your Brain

 

Have you ever felt so stressed out and overwhelmed that you can’t think straight? We now know that prolonged stress or trauma is associated with decreased volume in areas of the human brain responsible for regulating thoughts and feelings, enhancing self-control, and creating new memories. A new research study, published in today’s issue of Nature Medicine, is a first step in uncovering the genetic mechanism underlying these brain changes.

Depressed People’s Brains are More FragmentedIn this study, conducted by Professor Richard Dumin and colleagues from Yale University, scientists compared the genetic makeup of donated brain tissue from deceased humans with and without major depression. Only the depressed patients’ brain tissues showed activation of a particular genetic transcription factor, or “switch.” While each human cell contains more than 20,000 genes, only a tiny fraction of them are expressed at a given time. Transcription factors, when activated, act like light switches, causing genes to be turned on or off. This transcription factor, known as GATA1, switches off the activity of five genes necessary for forming synaptic connections between brain neurons. Brain neurons or nerve cells contain branches or dendrites that send and receive signals from other cells, leading to interconnected networks of emotion and cognition. The scientists hypothesized that in the depressed patients’ brains, prolonged stress exposure led to a disruption of brain systems involved in thinking and feeling. Depressed brains appeared to have more limited and fragmented information processing abilities. This finding may explain the pattern of repetitive negative thinking that depressed people exhibit. It is as if their brains get stuck in a negative groove of self-criticism and pessimism. They are unable to envision more positive outcomes or more compassionate interpretations of their actions.

Glucocorticoids Damage Brain Neurons 

The stress response involves activation of a brain region known as the amygdala, which sends a signal alerting the organism to the threat. This results in activation of the HPA (hypothalamic-pituitary-adrenal) axis and release of a cascade of hormones, including cortisol, widely regarded as the quintessential “stress hormone.” While short-term cortisol release prepares the organism to sustain “fight or flight” and fend off an attacker, long-term exposure appears to cause brain neurons to shrink and interferes with their ability to send and receive information via branches called dendrites. In animal studies, under chronically stressful conditions, glucocorticoids such as cortisol can remain elevated for long periods.

Traumatic Experiences Can Shrink the Hippocampus in Those Who Don’t Recover

This finding is another piece of the puzzle regarding how stress and prolonged distress may impair our ability to think in creative and flexible ways. Research in both mice and humans has demonstrated an association between stress exposure (foot shock in mice, life events in humans) and shrinking of the hippocampus – the brain center responsible for forming new, time-sequenced memories. Studies in women with PTSD resulting from childhood sexual abuse and Vietnam veterans with PTSD have shown 12-26 percent decreases in hippocampal volume, relative to those without PTSD. In another study, patients recovered from long-term major depression showed a 15 percent decrease in volume of the hippocampus, compared to non-depressed patients.

Major Life Stress Damages the Prefrontal Cortex

In addition to hippocampal shrinkage, major life stress may shrink brain neurons in the Prefrontal Cortex (PFC), the brain area responsible for problem-solving, adaptation to challenge, emotional processing and regulation, impulse control, and regulation of glucose and insulin metabolism. In a study of 100 healthy participants conducted by Dr. Rajita Sinha and colleagues at Yale University, and published in the journal Biological Psychiatry, those with more adverse life events had greater shrinkage of gray matter in the PFC, compared to their less-stressed peers. Recent major life events, such as a job loss, make people less emotionally aware while life traumas, such as sexual abuse, seem to go further, in damaging mood centers that regulate pleasure and reward, increasing vulnerability to addiction and decreasing the brain’s ability to bounce back.

Summary 

While the evidence is not yet conclusive, these studies suggest that prolonged exposure to stress can shrink the brain, both via the damaging effects of cortisol on brain neurons and by disrupting expression of genes that facilitate neuronal connections. This raises the question of whether there is anything we can do to prevent such damage. Since we can’t always control how much we are exposed to financial, relationship, or illness stress, are there preventive activities we can do to maintain cognitive resilience so we can continue to deal effectively with the stressors? It is not known if we can reverse the damage by these methods, but we may lessen it and make our brains more resilient to stress.

Brain-Enhancing Activities to Combat Stress

While the below list is not exhaustive, the three activities below have enhanced brain functioning in controlled studies.

Take a Daily DHA Supplement – DHA or Docosahexaenoic acid is an Omega-3 fatty acid that is a central building block of brain tissue. DHA is thought to combat the inflammatory effects of cortisol and the plaque buildup associated with vulnerability to Alzheimer’s disease. According to Dr. Mehmet Oz, in one study, a dose of 600mg of DHA taken daily for 6 months led the brain to perform as if it were three years younger.

Exercise Most Days – In studies with mice exercise led to a more improved performance on cognitive tasks than exposure to enriched environments with lots of activities and stimulation. Exercise leads to increases in BDNF or brain-derived neurotropic factor, a substance that strengthens brain cells and neuronal connections. BDNF is also thought to promote neurogenesis or the creation of new brain cells from existing stem cells in the hippocampus. Although these effects can’t be studied in living human brains, researchers have found increases in BDNF in the bloodstream of humans following workouts.

Do Yoga, Meditate, or Pray – These activities can activate what scientist Herb Benson at Massachusetts General Hospital calls “the relaxation response,” which lowers blood pressure and heart rate and lowers subjective anxiety. Benson and scientists from a genetics institute showed, in a recent study, that inducing the relaxation response can beneficially alter the expression of genes involved in inflammation, programmed cell death and how the body handles free radicals. The effects shown were in the same genes implicated in PTSD and depression. According to Jeffery Dusek, Ph.D., co-lead author of the study, “Changes in the activation of these same genes have previously been seen in conditions such as post-traumatic stress disorder; but the relaxation-response-associated changes were the opposite of stress-associated changes and were much more pronounced in the long-term practitioners.”

About the Author

Melanie Greenberg, Ph.D. is a licensed Clinical Psychologist and expert on Mindfulness and Positive Psychology.  Dr. Greenberg provides workshops and speaking engagements for organizations,  life, weight loss, or career coaching, and psychotherapy for individuals and couples. Visit her website: http://www.drmelaniegreenberg.biz

This article originally appeared in Psychology Today.

 

How Exercise Reduces Depression, Anxiety, Cynicism, & Anger

Exercise is good for you. If you’re procrastinating a run or putting off a walk, then we recommend that you close your computer and get outside, content in the knowledge that you have fully grasped the thesis of our article. If you are still here, then we assume that you would like to know more.

First, let’s review exercise’s benefits for the body.

Individuals who exercise a total of 7 hours per week have a premature mortality rate 40 percent less than those who exercise less than 30 minutes per week. Physical activity also appears to reduce your risk for colon and breast cancers. Furthermore, there is evolving evidence that physical activity may also reduce your risk for endometrial and lung cancers.1–3

Research also suggests that health benefits may be appreciated from even modest exercise programs. As little as 2.5 hours of exercise per week significantly reduces your risk of type 2 diabetes and cardiovascular disease. When it comes to exercise, half a loaf really is better than none. In fact, physical inactivity is estimated to cause one in 25 deaths worldwide each year.1–3

And yet despite all that is known about the health benefits of exercise, a little more than 50 percent of Americans do not meet the current CDC recommendations of 2.5 hours of moderate-intensity (50-70 percent maximal heart rate) or 1.25 hours of vigorous intensity (70-85 percent maximal heart rate) exercise per week.1

For reference, maximal heart rate can be calculated by taking 208 – 0.7 x age (an older, unvalidated version of this equation used 220 as the base).4 As an example, a 30-year old’s maximal heart rate is calculated to be 187 beats per minute (“bpm”). This means that in our 30-year old example, a moderate-intensity activity should achieve a heart rate of at least 94 bpm while a vigorous-intensity exercise should aim for a target of at least 131 bpm.

We will return to these parameters in a moment, but for now, let’s turn to the benefits of exercise for the brain.

Before diving in, it is necessary to review the concept of effect sizes. An effect size expresses the difference between two groups; usually between a treatment group and a control group. Effect sizes are calculated as numbers but can be represented categorically as “small,” “medium,” “large,” and “very large.”5–7

Very generally, a medium effect size should be able to be “seen” by the naked eye. For example, in Professor Jacob Cohen’s pioneering work on the subject, he cited the difference in average height between 14-year-old and 18-year-old females to be an example of a medium effect. As an example of a large effect, Professor Cohen cited the difference in IQ between a “typical” college freshman and a “typical” Ph.D. holder.5 For the purposes of our discussion, the larger the effect size, the more likely it is that the treatment (e.g. exercise) is better at treating depression than the control condition (e.g. no exercise).

With our introduction to effect sizes out of the way, let’s study the effects of exercise on the brain.

Studies have demonstrated a strong antidepressant effect for exercise. For example, one meta-analysis that examined well-controlled studies of exercise as an intervention for clinical depression found a very large effect size when compared to nonactive control groups. Notably, previous work had demonstrated a large effect size for study populations of undifferentiated clinical and non-clinical subjects with depressed mood.8

We wish to pause at this point to put these antidepressant effect sizes for exercise in perspective. Let’s turn briefly to effect sizes associated with various psychiatric and general medical pharmaceuticals and treatments. We will use the most optimistic estimates of efficacy for the various classes of interventions so as to level the playing field as much as possible. We fully acknowledge that we will not be comparing apples to apples. The following discussion is not meant to be a definitive statement regarding the efficacy of various treatments. Instead, we hope that the comparisons will help place the magnitude of exercise’s effect size in context.

To begin, let’s compare exercise’s large or very large effect size with antidepressant medication’s small effect size in acute depressive episodes.9 Psychotherapeutic interventions have similar effect sizes to psychopharmacologic medication in the treatment of depressive episodes. However, the combination of psychotherapy and psychopharmacologic medication yields a medium effect size; a value notable for its superiority to either intervention offered in isolation.10 Electroconvulsive therapy for an acute depressive episode has a large effect size.11

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There are numerous potential confounding variables in this very brief comparative overview. Despite every effort to control for the various confounds, it is likely that depressed cohorts who were able to exercise were qualitatively different in some ways from some of the populations included in electroconvulsive trials for example. Researchers have employed various techniques to try to eliminate these confounds, and there are reasons to treat much of the data as valid, but caution is certainly warranted.

Antipsychotics for acute psychosis, antihypertensives for high blood pressure, and corticosteroids for the prevention of asthma exacerbations all have similar medium effect size. Whereas, antibiotics for ear infections and metformin for diabetic mortality have small effect sizes. To find a general medicine medication with an effect size on par with exercise we have to turn to proton pump inhibitors and their large effect size in the treatment of esophagitis.9 In fact, the mean effect size for all general medical medications corresponds to a small effect.10

Research has revealed benefits for exercise in other domains of mental health as well. Meta-analytic reviews have found a small effect size for exercise on state or trait anxiety.8 However, upon closer examination research reveals that exercise has a stronger effect on state anxiety than on trait anxiety.12

Evidence also suggests a broader application of exercise beyond strictly pathological states.13–15 One large non-clinical population-based study demonstrated that individuals who exercised more than two times per week experienced reductions not only in depressive symptomatology, but also in cynical distrust, anger, and stress when compared to individuals who exercised less often.15

There is also significant evidence for a dose-response relationship between exercise and mental health. Exercise regimens with higher intensities, greater frequencies, and longer durations tend to lead to greater response rates in depressed populations. Interestingly, depression remission rates seem to peak at moderate levels of intensity, frequency, and duration suggesting that sustainability of a regimen is an important ingredient to consider when developing a program.8

The setting that one exercises in also appears to play a role. Research has demonstrated that exposure to nature and so-called “green space” exerts powerful effects on mood and self-esteem. Exercising outdoors in a natural setting with trees and plants appears to be superior to exercising in an environment devoid of such “green” qualities. The positive effects rapidly develop with even just five minutes of outdoor time offering a very achievable goal even for busy individuals.3

Interestingly, natural settings with bodies of water present (e.g. streams, rivers, lakes, etc.) appear to offer enhanced benefits over and above those seen in other natural settings.3 Natural settings seem to exert their positive effects on health through a variety of mechanisms; however, it should be noted that the effects are not fully explained by the association of green space and exercise.16 In fact, greater exposure to nature, in general, has been associated with as much as a 12 percent reduction in all-cause non-accidental mortality!17

How does exercise exert these far-ranging effects?

There are many gaps in our understanding of the mechanisms by which exercise exerts its anxiolytic and antidepressant effects. There is some evidence that exercise may increase turnover of serotonin, leading to an adaptive downregulation of the serotonergic 5-HT2C receptor. Activation of the 5-HT2C receptor seems to inhibit dopamine and norepinephrine release. Thus, a downregulation at the 5-HT2C receptor leads to an increase in availability of dopamine and norepinephrine. This effect is thought to be particularly important in the prefrontal cortex and is hypothesized to contribute to the anxiolytic and antidepressant effects associated with exercise.8

In addition to increasing serotonin turnover exercise seems to trigger a release of beta-endorphins. Endorphins are part of the brain’s endogenous opioid system and also tend to produce anxiolytic and antidepressant effects when released.8

From a more macroscopic scale exercise, like antidepressant medication, helps restore sleep patterns frequently disrupted in the setting of depression. Furthermore, evidence suggests that activity in the prefrontal cortex is reduced during exercise and that this modification of cognitive processing may correlate with the subjective anxiolytic and antidepressant effect of exercise.8

Finally, exercise engages an individual in an activation and approach set of behaviors that are diametrically opposed to passive and avoidant cognitive strategies classically found in depression and many other psychopathological states. In this way exercise seems to operate on a similar theoretical framework as the psychotherapeutic technique known as behavioral activation. Behavioral activation targets behavior first rather than cognition as many other forms of psychotherapy do.18 It must be noted that although exercise may be a component of a behavioral activation treatment regimen, the psychotherapeutic technique utilizes many other activation strategies to catalyze change.8

Let’s be optimistic and imagine that the preceding discussion helped you move from the contemplative to the preparatory stage of change and that you are preparing to make a change in your exercise habits.19 How much exercise do you need to get before you can appreciate the mental health benefits?

Evidence suggests that an optimal exercise program is about 30 minutes in duration, has a frequency of 2-4 times per week, and is of such an intensity level that an individual achieves 70-80 percent estimated max heart rate.8

Recall that our maximal heart rate from our 30-year old example was calculated to be 187 bpm. This means that the targeted intensity level of exercise for mental health should achieve a heart rate between 130-150 bpm.

Finally, the individual should commit to at least four weeks of the new exercise program to optimize the chances for long-term habit formation. Evidence suggests that while 70 percent of individuals maintain a short-term exercise program, only 50 percent maintain the program for six months.8

We have covered a lot of ground in our exploration of the varied health benefits associated with exercise.

We began by discussing the significant benefits of exercise for our general medical health. We learned that exercise reduces rates of mortality, some cancers, type 2 diabetes, and cardiovascular disease. For more on the mortality benefits of exercise visit our website Neuraptitude.org.

We next turned to exercise and mental health, studying depression as our archetype condition. We found that exercise can be considered a valid “antidepressant” or augmentation strategy in the treatment of depression and that its effects are comparable to antidepressant medication and psychotherapy.

As we discussed before, we are not comparing apples to apples, and direct comparisons between techniques are not fair outside of a given trial. Our point is not to assert the unrivaled superiority of exercise to psychopharmacologic agents, psychotherapeutic techniques, or other therapeutics. Rather, we wish to elevate exercise from a healthy lifestyle habit to an adjunct treatment.

And finally, let’s recall that exercising in natural outdoor settings, ideally in close proximity to a body of water, may enhance the health benefits associated with exercise.

The most effective treatment for a given mental illness is almost certainly to be pluralistic rather than singular. A holistic treatment strategy that targets biological, psychological, and sociological substrates of disease offers a significant synergistic advantage over a singular approach.

By Matthew Mackinnon, M.D.

Dr. MacKinnon is a psychiatric resident physician at the University of Washington who researches and writes about the neuroscientific intersection of mental health and mental illness. Dr. MacKinnon runs Neuraptitude.org, an online scientific publication dedicated to uncovering the natural capacities of the human mind by exploring topics that reveal, bit by bit, the intrinsic enormity latent within the brain.

 References

  1. Centers for Disease Control and Prevention (CDC). Physical activity and health. CDC.gov.https://www.cdc.gov/physicalactivity/basics/pa-health/. Accessed November 12, 2016.
  2. Penedo FJ, Dahn JR. Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry. 2005;18(2):189-193.
  3. Barton J, Pretty J. What is the Best Dose of Nature and Green Exercise for Improving Mental Health? A Multi-Study Analysis. Environ Sci Technol. 2010;44(10):3947-3955. doi:10.1021/es903183r.
  4. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37(1):153-156. doi:10.1016/S0735-1097(00)01054-8.
  5. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, N.J: L. Erlbaum Associates; 1988.
  6. Fritz CO, Morris PE, Richler JJ. Effect size estimates: Current use, calculations, and interpretation. J Exp Psychol Gen. 2012;141(1):2-18. doi:10.1037/a0024338.
  7. Sawilowsky S. New Effect Size Rules of Thumb. Theor Behav Found Educ Fac Publ. November 2009.http://digitalcommons.wayne.edu/coe_tbf/4.
  8. Stathopoulou G, Powers MB, Berry AC, Smits JAJ, Otto MW. Exercise Interventions for Mental Health: A Quantitative and Qualitative Review. Clin Psychol Sci Pract. 2006;13(2):179-193. doi:10.1111/j.1468-2850.2006.00021.x.
  9. Leucht S, Hierl S, Kissling W, Dold M, Davis JM. Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. Br J Psychiatry. 2012;200(2):97-106. doi:10.1192/bjp.bp.111.096594.
  10. Huhn M, Tardy M, Spineli LM, et al. Efficacy of Pharmacotherapy and Psychotherapy for Adult Psychiatric Disorders: A Systematic Overview of Meta-analyses. JAMA Psychiatry. 2014;71(6):706. doi:10.1001/jamapsychiatry.2014.112.
  11. Lisanby SH. Electroconvulsive Therapy for Depression. N Engl J Med. 2007;357(19):1939-1945. doi:10.1056/NEJMct075234.
  12. Paluska SA, Schwenk TL. Physical Activity and Mental Health.Sports 2000;29(3):167-180. doi:10.2165/00007256-200029030-00003.
  13. Stephens T. Physical activity and mental health in the United States and Canada: Evidence from four population surveys. Prev Med. 1988;17(1):35-47. doi:10.1016/0091-7435(88)90070-9.
  14. Taylor CB, Sallis JF, Needle R. The relation of physical activity and exercise to mental health. Public Health Rep. 1985;100(2):195-202.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1424736/. Accessed November 8, 2016.
  15. Hassmén P, Koivula N, Uutela A. Physical Exercise and Psychological Well-Being: A Population Study in Finland. Prev Med. 2000;30(1):17-25. doi:10.1006/pmed.1999.0597.
  16. Bowler DE, Buyung-Ali LM, Knight TM, Pullin AS. A systematic review of evidence for the added benefits to health of exposure to natural environments. BMC Public Health. 2010;10:456. doi:10.1186/1471-2458-10-456.
  17. James P, Hart JE, Banay RF, Laden F. Exposure to Greenness and Mortality in a Nationwide Prospective Cohort Study of Women. Environ Health Perspect. 2016;124(9). doi:10.1289/ehp.1510363.
  18. Cuijpers P, van Straten A, Warmerdam L. Behavioral activation treatments of depression: A meta-analysis. Clin Psychol Rev. 2007;27(3):318-326. doi:10.1016/j.cpr.2006.11.001.
  19. DiClemente CC, Prochaska JO, Fairhurst SK, Velicer WF, Velasquez MM, Rossi JS. The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol. 1991;59(2):295-304. doi:10.1037/0022-006X.59.2.295.

 

Depression: A Psychiatrist’s Recommendations for Self-care

Psychiatrist Monica Starkman, M.D. writes, “In clinical research, one uses the scientific method and studies just one treatment alone in order to assess its effectiveness. But in clinician mode, I am convinced that a combination of effective techniques increases the probability of a strongly positive result – and I don’t really care which of them did the most good. Here are five simple yet powerful treatments I recommend because they are both scientifically valid and clinically effective. Read her entire blog.

Stress and Depression

Survival depends on the speed of noticing and responding to threats to our safety. In a depressed brain, the parts of the brain that are scanning for danger and responding to it are overly active. Perceiving threat comes too easily. There are several factors about this necessary and natural biological response that may contribute to depression.

  • The response time is one such factor. Humans are biologically geared to respond to threat with a physical response to it. Without thought or decision, the brain/body makes possible necessary, immediate action when a threat, or stressor, occurs. Regardless of the level of overt danger, when a person feels a threat, the body responds immediately with arousal in the nervous system, intensifying heart rate, respiration rate, and blood pressure to allow for rapid physical activity. This response is proportional to the threat and ends when the threat is gone. A person also gets a release of energy, the activity of the stress response system, needed to fuel the rapid physical activity. These responses are lifesaving when threats to safety occur – but they are also an underlying factor in developing depression when they are overly active. Some people are born with brain structure that commits too many brain cells to scanning for danger, making the threat response too active.
  • The intensity of the sympathetic response may be too great, meaning that the level of arousal and the way it triggers stress response is excessive proportional to the threat. This too can be genetic, or it may be an outcome of early childhood adversity causing high arousal to even smaller threats. It is also important to note that traumatic experience often results in hypervigilant attention to the environment and also a biological tendency to overreact to reminders of the trauma.
  • Another aspect of how the threat response system can contribute to depression is how hard it may be to calm the stress response or the nervous system arousal. When these two systems that govern response to stressors are insufficiently supplied with the neurochemicals that bring them back to homeostasis or that buffer brain structures from the impact of the arousal, a person may be negatively affected by the very systems that should otherwise be protective. Unable to calm down quickly enough, the strong and persistent arousal of the nervous system and the stress response system is damaging in several ways. One theory of depression is that the inflammation throughout the body will ultimately cause many kinds of physical and emotional outcomes, not the least of which is depression.

The threat in a modern world may not be the overt danger that human systems developed to cope with stress but rather any situation that calls for a response, even when the demand for physical energy is unnecessary. For example, the stressor may be a situation that is not unexpected or dangerous. It could be a boss who makes a demand for overtime hours when you want to be home with your family or a child who is sick and keeping you awake at night. Those may be temporary and insignificant in general, but when they are ongoing or when they are too frequent then the stress system becomes antagonistic to health.

Over-activation of the nervous and stress response systems ultimately exhaust the brain/body. You can help yourself be less affected by stress. A person may, by genetic predisposition, respond too intensely to a normal level of threat or ongoing life stress may exhaust the supply of energy and create distress. Since so many of us live lives that are filled with stressors that are not the life-death-get-up-and-run variety, we would be well advised to learn the means to diminish stress. While each person must apply these guidelines to his or her own situation, the outline is simple:

  1. If at all possible, eliminate your stressor. Deciding to change is often the hardest thing people do: Can you stop trying to do something that is just too difficult, that you do not have the capacity for? Can you walk away from things that you cannot control and then manage your guilt for not trying? You might need the perspective of an outside observer to help you figure this out.
  2. Manage your time or manage your environment. Learn to make good use of lists to create job tasks by prioritizing or stop saying yes to demands for your help when you have too much to do. And learn the skills to organize the environment. Trying up may be life-changing indeed for some, but the diminished stress of an orderly environment can be life-saving, especially when you combine it with using calendars, reminders, and lists to manage time.
  3. Manage your attitude. Lightening up and finding your sense of humor can go a long way toward lowering your stress level. So, can becoming more sanguine about life experience. Learn to tell the difference between what is urgent is important and then learn that urgent may sometimes just be ignored.
  4. Learn to relax. This is not just about ‘vegging out in front of a program or video game. It is about loosening those muscles and calming the mind. Whether you do best with brief and frequent breaks every day or relax with longer periods of muscle relaxation, either way, it is a relief to your brain/body to relax. People who develop apps know this, so, it turns out there are countless options to use technology to guide your relaxation practice. You may be one of those who relaxes via vigorous exercise. But relax. Daily.

When you have addressed these four means to diminish the intensity of your response to ordinary life stress, then you will be on your way to eliminating depression too.

By Margaret Wehrenberg, Psy.D.

Dr. Wehnrenberg is a coach and therapist, an author, and an international trainer and speaker on topics related to psychotherapy for anxiety and depression, stress management and optimizing anxiety for achievement. She is a practicing psychologist, coaching for anxiety management and providing psychotherapy for anxiety and depression disorders. She has been a trainer of therapists for 25 years, and she is a sought-after speaker for continuing education seminars, consistently getting the highest ratings from participants for her dynamic style and high-quality content. Her individualized coaching for panic, worry and social anxiety has helped professionals from entrepreneurs to corporate executives, from sales personnel to IT specialists.

Margaret is a frequent contributor to the award-winning Psychotherapy Networker magazine and has produced Relaxation for Tension and Worry, an audio file for breathing, muscle relaxation, and imagery to relax. Audio and DVD versions of her training are available for obtaining CEU’s. She has seven books on topics of anxiety and depression published by W.W. Norton, a and a workbook, Stress Solutions, published by PESI. Check out her website MargaretWehrenberg.com.

 

 

 

The Bald-Faced Lies Depression Tells Us: Part 1

Whatever the cause, clinical depression sufferers are often shackled to a prison of ruminative, negative thoughts about the world and themselves.

They are full of self-loathing, feelings of worthlessness, and a sense of failure.  Confidence in their ability to build and maintain successful relationships is eroded.  Their sense of competency about their work can plummet as they struggle to get things done, be productive and earn a living. Some may even hate themselves when lost in this destructive process.

If that weren’t tough enough, are brains actually work against in this negative spiral. Psychologist Margaret Wehrenberg writes:

“Brain function plays a role in rumination in several ways, but one significant aspect

What Effect Does Caffeine Have on Depression?

In tea and coffee, caffeine is often part of a daily ritual that helps people through the day. The medical world is divided, however, when it comes to the benefits and risks of caffeine. Its impact on mental health is hotly debated. Many believe that caffeine can relieve depression, while others warn it can make it worse. This article will seek to look at both sides of the debate while also looking at the effects of other foods on depression. Read the News.

 

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