Up, Up and Away: Lifting Depression By Tweaking Your Antidepressants

In my last post, I wrote about a recent downward turn in my mood. While not severe, it still sucked: low energy and motivation,  sadder more often than I’d like, and lack of joy in things that formerly made me happy.

If felt like I had one foot in gooey, hot asphalt. I keep trying to yank it out to no avail. Finally, I called my trusty psychiatrist. His name’s Chris.

We hadn’t seen each other for six months. Over the past ten years or so since he’s been my shrink, that was about normal because not much had changed in the past decade: we’d found a combination of two pills seven years ago that was effective in managing my depression.  Sure, there had been some ups and downs over that period of time. But nothing like the psychic hurricane that blew through my brain when I first experienced major depression years ago.

He suggested I stay with my two old friends: Cymbalta and Lamictal. But, he said that we could “tweak” my treatment by adding

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

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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.

 

On Depression, Hope, Hopelessness, and Freedom

Hope is a desire for something combined with an anticipation of it happening, it is the anticipation of something desired. To hope for something is to make a claim about something’s significance to us, and so to make a claim about ourselves.

One opposite of hope is fear, which is the desire for something not to happen combined with an anticipation of it happening. Inherent in every hope is a fear, and in every fear a hope. Other opposites of hope are hopelessness and despair, which is an agitated form of hopelessness.

Hope is often symbolized by harbingers of spring such as the swallow, and there is a saying that ‘there is no life without hope’. Hope is an expression of confidence in life, and the basis for more practical dispositions such as patience, determination, and courage. It provides us not only with aims but also with the motivation to attain those aims. As the theologian, Martin Luther said, ‘Everything that is done in the world is done by hope.’ Hope not only looks to the future but also makes present hardship easier to bear, sustaining us through our winters.

At a deeper level, hope links our present to our past and future, providing us with an overarching narrative that lends shape and meaning to our life. Our hopes are the strands that run through our life, defining our struggles, our successes and setbacks, our strengths and shortcomings, and in some sense ennobling them. Running with this idea, our hopes, though profoundly human—because only humans can project themselves into the distant future—also connect us with something much greater than ourselves, a cosmic life force that moves in us as it does in all of nature. Conversely, hopelessness is both a cause and a symptom of depression, and, in the context of depression, a strong predictor of suicide. “What do you hope for out of life?” is one of my most important questions as a psychiatrist, and if my patient replies “nothing” I have to take that very seriously.

Hope is pleasant in so far as the anticipation of a desire is pleasant. But hope is also painful, because the desired circumstance is not yet at hand, and, moreover, may never be at hand. Whereas realistic or reasonable hopes are more likely to lift us up and move us on, false hopes are more likely to prolong our torment, leading to inevitable frustration, disappointment, and resentment. The pain of harboring hopes, and the greater pain of having them dashed explains why most people tend to be modest in their hoping.

In his essay of 1942, The Myth of Sisyphus, the philosopher Albert Camus compares the human condition to the plight of Sisyphus, a mythological king of Ephyra who was punished for his chronic deceitfulness by being made to repeat forever the same meaningless task of pushing a boulder up a mountain, only to see it roll back down again. Camus concludes, ‘The struggle to the top is itself enough to fill a man’s heart. One must imagine Sisyphus happy.’

Even in a state of utter hopelessness, Sisyphus can still be happy. Indeed, he is happy precisely because he is in a state of utter hopelessness, because in recognizing and accepting the hopelessness of his condition, he at the same time transcends it.

Neel Burton, M.D., is a psychiatrist, philosopher, writer, and wine lover who lives and teaches in Oxford, England. He is a Fellow of Green-Templeton College, Oxford, and the recipient of the Society of Authors’ Richard Asher Prize, the British Medical Association’s Young Authors’ Award, the Medical Journalists’ Association Open Book Award, and a Best in the World Gourmand Award.He is author of Heaven and Hell: The Psychology of the EmotionsHide and Seek: The Psychology of Self-Deception, and other books.

 

 

 

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

13 Ways of Defining Depression

From the Storied Mind website, blogger John Folk-Williams writes, “With all the conflict about defining depression, it’s not surprising if you’re confused about what it is, where it comes from and how best to treat it. There may not be much disagreement or confusion about what it does to you. But there is a difference of opinion about whether those impacts are a good or bad influence in your life.” Read the Blog

How Faith Helps Depression

Blogger Therese Borchard writes, “A substantial amount of research points to the benefits of faith to mitigate symptoms of depression. In one study, for example, researchers at McLean Hospital in Belmont, Massachusetts, found that belief in God was associated with better treatment outcomes. Of all my sanity tools, my faith is what has kept me alive during severe depressive episodes. When I’m convinced that no one else could comprehend the intense suffering I’m experiencing, I cling to my belief in a God who created me for a reason, who knows my pain more intimately than any other human being, and who will see me through to the other side.” Read the Blog

North of 50 – Depression at Midlife

IMG_6849When first diagnosed with depression fifteen years ago at the age of 40, I thought I would recuperate and, more or less, go back to my busy life as a lawyer and husband with a young family. It didn’t work out that way. I soon found out it was going to be a long haul. And I’m still truckin’.

What’s changed in my experience of depression over the past decade and a half? A lot.

I know much, much more about the illness; it’s contours, triggers, and wily ways. I know what will help when I’m in the thick of it, more often than not. I also accept there will be times when there’s little I can do to make a dent in depression’s cold armor.

My depression doesn’t last as long as it used to. Nor is it typically as deep. In the early days, it seemed like it went on forever. I couldn’t remember a time before it when I’d been happy. And couldn’t envision a future of being anything other than depressed. I felt I was barely living. Nothing gave me pleasure. Even eating good food, one of my favorite things. Everything tasted like ashes in my mouth. Death felt preferable, at times.

I didn’t feel much compassion for my depressed, younger self. I’d slap myself in the head and say, “What the hell’s wrong with you?” I had my own inner medieval-like inquisitor ready to burn my soul at the stake for some unknown sins depression’s twisted thinking had convinced me I’d committed.

The verdict: my depression was my fault.

I don’t believe that anymore. I now understand it’s a bunch of hooey cooked up by my depressed head. After all, depression’s a terrible liar. There’s a cruel irony to all of this. We need our minds to recover – but sometimes it’s this very organ that’s turned against us. Depression isn’t who we really are, but we can feel that way. As Parker Palmer once wrote about his experiences with this affliction, “I wasn’t walking in the darkness, I had become darkness.”

I have the upper hand on depression now. It isn’t the giant that once pummeled me. It isn’t as scary. Because I know know that depression will, yes, always be a part of my life, but it isn’t my life.

I am more than that.

And I have a good and full life that I’m determined to live.

 

The Connection between Depression and Trauma and Neglect

Why do people become depressed? A popular theory is that it is the brain chemistry that is in disarray. But this way of thinking often obscures the issue.

Depression rarely comes out of nowhere. It almost always has an explanation, even if it is not apparent to us. Also, read “What is Your Depression Telling You?”

A better explanation for why many people become depressed is, in my opinion, that we develop vulnerabilities earlier on in our life that predispose us to live a life that is lacking in zest, enjoyment, and meaning.

Oftentimes these earlier vulnerabilities point us to experiences of trauma, neglect, or interpersonal disappointments that may or may not be fully apparent to us.

We almost all undergo some kind of trauma, neglect, or serious interpersonal disappointments at some point in our life, and how we deal with these events can prepare the ground for a later depressive episode. To understand why this is is to understand how humans function.

 Responding to Trauma by Losing Ourselves:

When we go through difficult events that we don’t know how to deal with, our psyche responds just like a lizard that loses its tail because it is afraid of a predator. It helps us make an adaptation out of fear, but always at the cost of making us a little less human, or little less ourselves.

Overwhelming shame, for example, might make us abandon a piece of who we are, or in the worst case, our entire person.

How Sexual Abuse Can Lead to Depression:

If I was sexually abused, for example, and didn’t know how to deal with my conflicted emotions and loyalties, it might make me feel bad about wanting and desiring. I might be confused about whether I myself sent out the wrong signals, and might question if the sensation of pleasure I felt, really meant that I desired the abuse, or that my desires are bad.

The psychological compromise I can make to rid myself of my shame is to begin to live a passive life where my awareness of my desires and wants is dimmed, or totally banished. This might mean that I get involved in relationships that are not particularly good for me, that I put up with mistreatment or one-sided relationships because I am reluctant to say “no”, or that I unconsciously seek out bad relationships because I at some level believe I should not get what I really want, or deserve to be punished in some way to atone for my badness.

This compromise I have made to deal with the unbearable experience of sexual abuse has now prepared me for life of lackluster results and lack of enjoyment.

If I become depressed, this is therefore not because there is something wrong with my brain. It is because some part of me doesn’t want the life that I have. My depression is like the last call to me deep from within that indicates that I need to make changes to my life situation because the status quo is antithetical to life. My adaptations to a difficult situation, have now become destructive to what life is really about. Life has turned against life, and my depression is thankfully alerting me to this fact.

Trauma Comes in Many Forms:

Trauma does not have to imply a big dramatic calamitous event, but can refer to any moment when we felt overwhelmed with painful or distressing emotions we did not get the help to deal with. Sexual abuse, physical violence, or growing up with alcoholic parents are some of the more apparent reasons why a person might get exposed to emotional overwhelm, but there are many others.

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One of the more frequent causes of adaptations out of fear is the fear of losing love from the people we depend on. In Alice Miller’s book “The Gifted Child”, she describes how this can happen due to growing up with narcissistic parents.

A child, she says, has the need to look into their parent’s eyes and see themselves reflected. If I cry, I need my parent to validate that I am feeling sad, and if I am happy, I need my parents to be happy for me. Unfortunately, some of us look into our parents eyes, and see our parents feelings, not our own. When we are sad, they feel inadequate and get annoyed with us. When we are excited, they are too busy watching TV, and tell us to shush.

These kinds of experiences when they accumulate over time can create serious distortions to our self-image, and can make us abandon ourselves in a pursuit to become more acceptable to our parents.

Research has shown that threats to our sense of safe connection with a caregiver register in our brain as panic, and that losing our connection completely registers as pain. To avoid feeling these unbearable emotions, we will do a lot, even if it means ridding ourselves of our natural spontaneous desires and feelings.

Other ways to deal with the threat of loss is to become numb, or to become what the psychiatrist Karl Jaspers has described as a “dead person with wakeful eyes”.

What Does Depression Have to Do with It?

When we pay too big of a price to stay safe early on in life, we enter into adulthood ill prepared to deal with life’s challenges.

If we have gotten used to numbing ourselves to unpleasant emotions, we will likely also find it difficult to feel joy and excitement.

If we have learned to live our life in an effort to please our parents, our accomplishments won’t really mean much to us, and we will pursue goals that are not aligned with what we really want.

If we had to abandon ourselves because of shame about our needs or our feelings, we will forever have a sense of emptiness inside because we aren’t fully honoring and accepting who we are.

In many cases, when we really look at the reasons why people become depressed, we find a childhood history of trauma, abandonment, or neglect that has resulted in adaptations that are currently getting in the way of living a meaningful life.

Depression is often simply telling us that we are not really living our lives as ourselves.

To resolve this situation is to confront the underlying reasons why we make the choices we do, and to see to what extent we are really living a life based on avoiding shame, anxiety, guilt, and pain, and not a life based on our genuine feelings, needs, and aspirations.

Rune Moelbak, Ph.D., is a psychologist and depression specialist in Houston, Texas. He is the owner of Better Therapy, a therapy practice for people who want to discover the underlying roots of their current psychological problems.

 

 

Chronic or Recurrent Depression: Why Does Depression Go Away and Then Return?

Some people who experience a single depressive episode will fully recover, never to experience another. (Sign us up for that, right?)

For about 40-60% of us, however, depression is a chronic illness that will come back. By the time most people get treatment, they have experienced multiple depressive episodes already.

Good news: with treatment, recurrences can be less severe, occur less frequently and not last as long.

So why does depression seem to rear its ugly head over and over again for most of us?

Saying you have depression is like saying you have a terrible headache, in that you have disabling symptoms, but it says nothing about the cause of those symptoms.

For instance, in the case of a headache, you may have a migraine, a tension headache, a stroke, a brain tumor, a concussion, or something else. The underlying cause informs the prognosis and treatment of your headache, whether it will come back and the best course of treatment.

With depression, we are just beginning to understand the underlying causes and contributors – which could be medical, neurological, psychological or social – many of which are ongoing and lead to a propensity for depressive episodes.

Depression has a genetic basis, but whether that’s because of biological differences in brain chemistry or temperament or something else, we don’t know yet.

We do know that people in stressful situations or lifestyles have more depressive episodes. This could be stress brought on by work, it could be relationship-related, a traumatic or neglectful childhood, or an unsafe living or work environment.

Recurrence can be caused by psychological makeup – much of which can be based in how we view ourselves, others and everyone’s place in the world. Studies have shown that psychotherapy can change this brain makeup to positively influence our outlook.

There’s still so much to learn about the disease. We need to recognize that for many, it’s a biopsychosocialspiritual illness with multiple contributing components that must all be addressed to create the highest likelihood for treatment to work.

Psychotherapy remains the most effective treatment for depression, and should be part of every patient’s plan for recovery.

Someone with chronic, disabling depression may also benefit from a comprehensive evaluation at a center that respects all contributors to the illness to treat the whole person in an individualized, comprehensive way. One place to do this is at The Retreat at Sheppard Pratt, which also specializes in treatment-resistant depression.

Depression is an intensely personal experience. When pursuing treatment, be sure that you are being understood, and obtaining the level of support you need. For some, particularly those working in a highly stressful environment, that could mean getting away for a short time to focus on recovery, even though it can be a tough decision to make. Be open to all levels of care.

It can be disheartening to realize that your depression will likely come back. Know that you’re not alone, as about 6.7% of the U.S. population have had at least one depressive episode in the past year.

Keep working on your recovery, talking about it to reduce stigma, and supporting those who are studying mental illness. One day, we will know more.

By Thomas Franklin, M.D., Medical Director, The Retreat at Sheppard Pratt

Dr. Thomas Franklin is the medical director of The Retreat at Sheppard Pratt. He is a clinical assistant professor of psychiatry at the University of Maryland School of Medicine and a candidate at the Washington Center for Psychoanalysis. He is Board Certified in Addiction Medicine and Psychiatry and has extensive experience in psychotherapy, psychopharmacology, and addictions and co-occurring disorders. Dr. Franklin previously served as medical director of Ruxton House, The Retreat’s transitional living program, before assuming the role of medical director of The Retreat in 2014.

 

 

Hope Counts: Rising Up from Depression

Depression corrodes our sense of hope.

Elizabeth Wurtzel, in her her best-selling book Prozac Nation, wrote:

“That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end.”  

We can’t imagine a future without depression. When we’re in the thick of its slimy grasp, our deadened and bleak state seems to go on and on and on. Days become more about survival and meeting our most basic obligations. And nothing more because we don’t have anything left to give. Our life becomes smaller. We’re treading water because there doesn’t seem an end in sight. We’re hit by the stun gun of depression.

Our most urgent hope is . . . the absence of depression.

tunnel

But the absence of pain isn’t the presence of joy and all that makes life worth living. As Richard O’Connor, Ph.D. wrote in his book Undoing Depression:

“We confuse depression, sadness, and grief.  However, the opposite of depression is not happiness, but vitality – the ability to experience the full range of emotions, including happiness, excitement, sadness, and grief.  It’s not sadness or grief, it’s an illness.”

Amanda Knapp writes eloquently of her own experience:

“Depression, for me, is a miles deep crater that I believe I will never crawl out of.  It’s disillusionment born of an unfulfilled longing for peace.  It’s fear that hope will raise me up just to drop me even further down.  It’s a cocoon of despair snuggled all around me doing its best to keep me from breaking when the inevitable fall comes. The irony in all of that is that it precludes me from living and dreaming and hoping and praying. But I hold on to it so strongly at times, as if my life depends on it.  Because sometimes it feels like it does. But I sit here today, decently removed from the worst of those moments of despair, and I feel myself longing for hope.”

It’s critical that we deliberately nurture a hope better than just relief from our melancholy. We need to rise up out of the dust of our suffering. It’s not enough to exist. Our existence must matter. Living a life with meaning and purpose give us hope because it brings out the best in us – even with depression. And it’s a heroic journey.

hero reeve

I once wrote:

“In my view, folks with depression are not so much hapless, as they are heroes.What’s a hero after all? Someone who has a great challenge to confront? Check. Someone who must confront great adversity? Check. Someone who must get up every day and do battle with a formidable foe? Check. You see, for those of you who are struggling with depression right now, YOU ARE THAT PERSON. You’re the person who has to get up every day and cope with your depression. Others can help and support you, but it’s ultimately your walk to walk. And what a courageous walk it is; every single step of it.

Some of the best people that I’ve been privileged to know struggle with depression. While they don’t have shiny medals pinned on their lapels, there is an unmistakable strength in them – even if they don’t see it. I know it’s real because I see and feel it – just like when I am in a grove of giant and majestic pines during a walk in the forest.”

Dr. Anthony Scioli, author of Hope in the Age of Anxiety, writes that one of the things needed to build up our hope muscles is faith and a spiritual foundation (whether it be in God, nature or a higher power) to experience a more open attitude for developing faith in others as well as the universe.

Pope John Paul II once said,

“Do not abandon yourself to despair. We are the Easter people and hallelujah is our hope.”

So, nourish hope in your heart. Surround yourself with hopeful people, places and books.

And resolve to be hopeful.

Copyright, 2016 by Daniel T. Lukasik

 

 

 

 

 

 

 

 

 

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