Here’s an excerpt from blogger John Folk-Williams excellent piece on anger: “It took me a long time to understand the connection between depression and anger. One psychiatrist I visited would often ask a simple question toward the end of a session: How’s your anger? I couldn’t understand why he asked. I hadn’t been talking about anger. Depression was my problem.” Read his entire blog.
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Hi, I’m Dan Lukasik from LawyersWithDepression.com.
Today’s guest is Tom Roberts. Tom is a mental health speaker and writer living in Huntington Beach, California. He’s the author of “Escape from Myself: A Manic-Depressive’s Escape to Nowhere” Tom earned his Master’s Degree in Radio, Television, and Film from the University of Kansas. He worked for several years as a broadcast journalist for local stations and freelanced for National Public Radio’s popular newscast “All Things Considered,” “The Voice of America,” and “ABC Radio News.” Tom has been a professional actor on stage, screen, and television and currently does voice-over work in the L.A. area. He is the creator of the website Tom Speaks Out!
When I talk about medicine and mental health to large audiences, I often start with the following imagery and facts: think of a woman you know who is radiantly healthy. I bet your intuition tells you she sleeps and eats well, finds purpose in her life, is active and fit, and finds time to relax and enjoy the company of others. I doubt you envision her waking up to prescription bottles, buoying her way through the day with caffeine and sugar, feeling anxious and isolated, and drinking herself to sleep at night. All of us have an intuitive sense of what health is, but many of us have lost the roadmap to optimal health, especially the kind of health that springs forth when we simply clear a path for it. The fact that one in four American women in the prime of their life are dispensed medication for a mental health condition represents a national crisis.
Humans have used mind-altering substances to try to dull and deaden pain, misery, sorrow, and suffering since time immemorial, but only in the last few decades have people been persuaded that depression is a disease and that chemical antidepressants are the remedy. This is far from the truth. Many of my patients have been to multiple doctors, bumping up against the hard ceiling of what conventional medicine has to offer. Some have even tried integrative medicine, which aims to combine both traditional medicines (i.e. prescriptions) with alternative treatments (e.g. acupuncture). After all, they are told that there are great natural complements to all the wonders pharmaceutical products have to offer. But the reason they can’t find a solution is because nobody has asked why. Why are they unwell? Why are their bodies creating symptoms that manifest as depression? Why didn’t they stop to ask this important and obvious question the first time they experienced a flat mood, anxiety, insomnia, and chronic exhaustion?
Before I even get to the answers, let me be the first to tell you that the only path to a real solution is to leave the medical world you know behind. This, the journey I will take you on, is not just about symptom suppression, it’s about health freedom. First let me tell you that I was once a typical doctor, not to mention a typical American who loved pizza, soda, birth control, and ibuprofen. My message is from a personal journey and thousands of hours of research that has compelled me to share the truth about prescription-based care: we’ve been duped.
Yes, my entire training was based on a model of disease care that offers patients only one tool – a drug – and never a shot at true wellness. We’ve handed over our health to those who seek to profit from it, and we’ve been buying into a paradigm based on the following notions:
I call this collective set of notions the Western Medical Illusion. It sets up a vicious system that ushers you into lifelong customer status, dependent and disempowered.
As you can likely guess by now, I love to rant. But I do so with the best evidence science can offer, and there’s a lot we know today about the real root cause of depression – and how to treat the condition safely and successfully – without a prescription pad. If there’s one lesson I will drive home, it’s this: shed the fear, take back your inner compass, and embrace a commitment to your best self, medication free. Even if you don’t already take a prescription drug, I bet you still doubt living the rest of your life prescription free and reliant on your own inner intuition to know what’s best for you. The idea of supporting your body’s innate wisdom may sound quaint at best or like dangerous hippie woo-woo at worst. From now on, I want you to embrace these new ideas:
How can I make these statements, and what do I mean by life-style medicine? I’ll be presenting scientific proof. When I first meet with a woman and her family, I speak about how to reverse her anxiety, depression, mania, and even psychosis. We map out the timeline that brought her where she is and identify triggers that often fall under one or more of the following categories: food intolerances or sensitivities, blood sugar imbalances, chemical exposures, and thyroid dysfunction, and nutrient deficiency. I forge a partnership with my patient and witness dramatic relief within thirty days. I do this by teaching my patients how they can make simple shifts in their daily habits, starting with the diet. They increase nutrient density, eliminate inflammatory foods, balance blood sugar, and bring themselves closer to food in its ancestral state. It’s the most powerful way to move the needle because food is not just fuel. It is information (literally: “it puts the form into your body”), and its potential for healing is a wonder to me every single day.
Achieving radical wellness takes sending the body the right information and protecting it from aggressive assault. This isn’t just about mental health; it’s about how mental health is a manifestation of all that your body is experiencing and your mind’s interpretation of its own safety and power. It’s also about how symptoms are only the visible rough edges of a gigantic submerged iceberg.
Not that none of these concepts connects with substances in the brain that might be “low.” If you had to define depression right now, before reading further, chances are you’d say something about it being a “mood disorder” or “mental illness” triggered by a chemical imbalance in the brain that probably needs to be fixed through medications like Prozac or Zoloft that will lift levels of brain chemicals associated with a good mood. But you would be mistaken.
So many patients today who are being shepherded into the psychiatric medication mill are overdiagnosed, misdiagnosed, or mistreated. Indeed, they have “brain fog,” changes in metabolism, insomnia, agitation, and anxiety, but for reasons only loosely related to their brain chemicals. They have all the symptoms that are mentioned in a Cymbalta advertisement that tells them to talk to their doctor to see if Cymbalta is right for them. But it’s like putting a bandage over a splinter in the skin that continues to stir inflammation and pain. It’s absolutely missing an opportunity to remove the splinter and resolves the problem from the sources. And it’s an iconic example of how conventional medicine can make grave mistakes, something the pharmaceutical industry is more than happy to encourage.
In holistic medicine, there are no specialties. It’s all connected. Here’s a classic case in point: Eva had been taking antidepressants for two years but wanted to get off it because she was planning to get pregnant. Her doctor advised her not to stop taking the drug, which motivated her to see me. Eva explained that her saga had begun with PMS, featuring a week each month was she was irritable and prone to crying fits. Her doctor prescribed a birth control pill (a common treatment) and soon Eva was feeling even worse, with insomnia, fatigue, low libido, and generally flat mood dogging her all month long. That’s when the doctor added the Wellbutrin to “pick her up,” as he said, and handle her presumed depression. From Eva’s perspective, she felt that the antidepressant helped her energy level, but it had limited benefits in terms of her mood and libido. And if she took it after midnight, her insomnia was exacerbated. She soon became accustomed to feeling stable but suboptimal, and she was convinced that the medication was keeping her afloat.
The good news for Eva was that with careful preparation, she could leave medication behind – and restore her energy, her equilibrium, and her sense of control over her emotions. Step one consisted of some basic diet and exercise changes along with better stress response strategies. Step two involved stopping birth control pills and then checking her hormone levels. Just before her period, she had low cortisol and progesterone, which were likely the cause of the PMS that had started her whole problem. Further testing revealed borderline low thyroid function, which may well have been the result of the contraceptives – and the cause of her increased depressive symptoms.
When Eva was ready to begin tapering off the medication, she did so following my protocol. Even as her brain and body adjusted to not have the antidepressant surging through her system anymore, her energy levels improved, her sleep problems resolved, and her anxiety lifted. Within a year she was healthy, no longer taking any prescriptions, feeling good – and pregnant.
I require my patients, and I implore you to think differently about health-care decisions and consumerism. Part of my motivation in writing about depression was to help you develop a new watching, questioning eye that you can bring to every experience. For my patients to be well, I know that they will need to approach their health to an extreme commitment to the integrity of their mind and body. Personally, I have no intention of ever returning to a lifestyle that involves pharmaceutical products of any kind, under any circumstances.
Why?
Because we are looking at the body as an intricately woven spider web – when you yank out one area of it, the whole thing moves. And because there is a more powerful way to heal.
It’s so simple that it can be considered an act of revolution.
You might think of yourself as adverse to conflict – someone who wants to keep the peace, keep your head low, and do what’s recommended. To be healthy in today’s world. However, you need to access and cultivate a reliance on yourself. And you’re going to do that by first shifting your perspective forever. Look behind the curtain and understand that medicine is not what you think it is. Drug-based medicine makes you sick. I will go so far as to say that hospital care makes you sick; though estimates vary, it’s reasonable to say that hospital care claims tens if not hundreds of thousands of lives annually due to preventable medical mistakes such as wrong diagnoses and medications or surgical errors, infections, and simply screwing up an IV.
The Cochrane Collaboration, a London-based network of more than 31,000 researchers from more than 130,000 countries, conducts the world’s most thorough independent analysis of health-care research. Based on the data from the British Medical Journal, the Journal of the American Medical Association, and the Centers for Disease Control, it has found that prescription drugs are the third leading cause of death after heart disease and cancer. And when it comes to psychotropic drugs, the Cochrane Collaboration’s conclusions are compellingly uncomfortable. In the words of the Collaboration’s founder, Dr. Peter Gotzsche, “Our citizens would be far better off if we removed all the psychotropic drugs from the market, as doctors are unable to handle them. It is inescapable that their availability creates more harm than good.
By and large, doctors are not bad people. They are smart individuals who work heard, investing money, blood, sweat, and tears into their training. But where do doctors get their information? Whom are they told to trust? Have you ever wondered who’s pulling the strings? Some of us in the medical community are beginning to speak up and to exposed the fact that our training and education is, for the most part, bought.
“Unfortunately in the balance between benefits and risks, it is an uncomfortable truth that most drugs do not work in most patients.” Before I read this quote in the prestigious British Medical Journal in 2013, I had already begun to explore the evidence that there really isn’t much evidence to support the efficacy of most medications and medical interventions, particularly in psychiatry, where suppressed data and industry-funded and ghostwritten papers hide the truth. Another 2013 study published in the equally respected Mayo Clinic Proceedings confirmed that a whopping 40 percent of current medical practice should be thrown out. Unfortunately, it takes an average of seventeen years for the data that exposes inefficacy and/or a signal to harm to trickle down into your doctor’s daily routine, a time lag problem that makes medicine’s standard of care evidence-based only in theory and not in practice. Dr. Richard Horton, the editor in chief of the much-revered Lancet at this writing, has broken rank and come forward about what he really thinks of the published research – that it’s unreliable at best, if not completely false. In a 2015 published statement, he wrote: “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.”
In 2011 the British Medical Journal performed a general analysis of some 2,500 common medical treatments. The goal was to determine which ones are supported by sufficient reliable evidence. The results:
The treatments in the remaining 46 percent, the largest category, were found to be unknown in their effectiveness. Put simply, when you visit a doctor or a hospital, you have only a 36 percent chance that you’ll receive a treatment that has been scientifically proven to be either beneficial or likely to be beneficial. Such results are strikingly similar to those of Dr. Brian Berman, who analyzed completed Cochrane reviews of conventional medical practices, finding that 38 percent of treatments were positive and 62 percent were negative or showed “no evidence of effect.”
Are these exceptions? I would like to argue that they aren’t. This is because the whole pharmaceutical approach is predicated on wrong-headed information. Pharmaceutical products as we know them have not been developed or studied with modern science’s most relevant principals in mind, such as the complexity and power of the human microbiome, the impact of low-dose toxic exposures, autoimmune disorders as a sign of environmental biochemistry. Because medicine operates under the now antiquated one gene, one illness, one pill rubric, efficacy will be measured through a skewed lens, and safety cannot be accurately assessed or discussed with individual patients.
Many of us move through life with a sneaking fear that the other health shoe could drop at any moment. We can easily fall prey to the belief that our breasts are ticking time bombs that infections are just a cough or handshake away and that life is a process of adding more medications and drugs to put out small fires as we age. Before I stopped prescribing, I had never once cured a patient. Now people are cured every week in my practice. As I mentioned, my patients are my partners. We collaborate, and they work hard. They work hard at a time when they can’t lift a finger – when the prospect of walking to the corner drugstore with a slip of paper twinkles like the North Star in their dark sky. They follow my lead because they feel inspired by my conviction and hope in this new model – one that asks the question “Why?” and has the goal of not only symptom relief but an incredible boost in their vitality.
Excerpted with permission from the book, “A Mind of My Own,” by Kelley Brogan, M.D.
All rights reserved.
KELLY BROGAN studied cognitive neuroscience at MIT before receiving her MD from Weill Cornell Medical College. Board certified in psychiatry, psychosomatic medicine, and integrative medicine, she is one of the only doctors in the nation with these qualifications. She is the author of the best-selling book, A Mind of Your Own: What Women Can Do About Depression That Medication Can’t. She practices in Manhattan and is the mother of two young daughters. Check out her website.
Depression the most common mental health disorder in the United States with nearly one in 10 U.S. adults experiencing some form of it. Depression is affecting younger and younger generations, and sadly, it is on the rise. According to the World Health Organization, by the year 2020, depression will be the second most common health problem in the world. With October being Depression Awareness Month, I’m probably not the first to bring this subject to your attention, but what if we took pause to think about what these numbers really mean?
Once we recognize the real impact of depression, not just on a broader world health level, but on the individual lives that it affects every day, we must abolish whatever remains of the stigma that depression is something to be ashamed about, or that it’s just a bad mood, so “snap out of it.” And we must start thinking about what works in terms of treatment, a subject I’ll talk more about in a free Webinar “Empowering Strategies to Fight Depression.” How can each of us take up arms against this painful condition and offer ourselves, our children, and our loved ones their best chance at overcoming depression?
When it comes to finding ways to empower ourselves against depression, I believe that one of the most important things to consider is the effect of the “critical inner voice.” The critical inner voice represents a damaging internal thought process, a form of destructive self-talk that perpetuates feelings of shame, self-hatred, negative rumination, and low self-esteem. Studies have shown that low self-esteem predicts depression. Even in toddlers, a negative self-concept has been found to be associated with depression.
Although, most of us experience low self-esteem and are familiar with the commentary of a critical inner voice, for those who are depressed, this critical inner voice can have a powerful, debilitating influence on their state of mind. The critical inner voice can cause people to dwell on perceived problems or sorrows. It can also make it even more difficult to take actions that would help individuals emerge from a depressive state. This voice is often critical and highly distorted. In a blink of an eye, it can fill our heads with thoughts like: “You’re so pathetic. You’re just a drain on everyone. You’re worthless/ stupid/ ugly. Why can’t you just be normal? You don’t really have anything to look forward to. There’s nothing to feel good about.”
The critical inner voice is also tricky, as it can seem both self-soothing and self-punishing. It lures us into engaging in actions or situations that then perpetuate our anxiety and depression. “Just go home and be by yourself,” it suggests. “You should just have a drink and relax. There’s no point in trying to be active. Why go through all the trouble of going out and seeing those people?” When we give in to these “voices,” our inner critic is then there to punish us. “What’s the matter with you? All alone again. What a loser. You never succeed at anything. No one wants you around anyway.” This type of cyclical thinking turns us completely against ourselves and leaves us at the mercy of a mean and ruminating inner enemy. To combat depression means taking on this inner voice or “anti-self.”
My father, Dr. Robert Firestone, created Voice Therapy as a therapeutic approach to conquer your critical inner voice, and in our book of that tile, which I co-authored with my father, we discuss specific ways people can start to challenge this inner enemy. Here are some of the valuable steps that can help people to start to recognize and counter these destructive thought processes.
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One of the most important principles you can adopt in facing off against this inner critic that fuels depression is to practice self-compassion. Research findings have consistently shown that greater self-compassion is linked to less anxiety and depression. Despite the fact that people who suffer from depression may have lower levels of self-compassion, studies also show that practicing self-compassion can reduce symptoms of depression, in large part because it helps us not get stuck in our negative thoughts.
Dr. Kristin Neff describes three key elements of self-compassion: 1) self-kindness over self-judgment, 2) mindfulness over over-identification with thoughts and feelings, 3) common humanity versus isolation. Self-compassion asks us to value ourselves as human beings without judgment or evaluation. It allows us to notice our suffering and to feel compassion for ourselves without getting caught up in the rumination that comes with assessing ourselves or our state of being. Dr. Neff’s research has confirmed the benefits of this practice when fighting depression. One of the rewards of self-compassion is that it’s proven to better help us to achieve change in our lives.
Depression is a real disorder, but there are real ways to fight it. And when we do, no matter what treatment approach we take, we must be on our own team. We must see our critical inner voice as the enemy it is and reconnect with our real selves, the part of us that embraces our basic human right to live our lives on our terms.
By Linda Firestone, Ph.D.
Dr. Firestone is the Director of Research and Education at The Glendon Association. An accomplished and much requested lecturer, Dr. Firestone speaks at national and international conferences in the areas of couple relations, parenting, and suicide and violence prevention. Dr. Firestone has published numerous professional articles, and most recently was the co-author of Sex and Love in Intimate Relationships(APA Books, 2006), Conquer Your Critical Inner Voice (New Harbinger, 2002), Creating a Life of Meaning and Compassion: The Wisdom of Psychotherapy (APA Books, 2003) and The Self Under Siege (Routledge, 2012).
Follow Dr. Firestone on Twitter or Google.
From the website The Mighty, depression blogger Rob Harper writes: “Now, don’t get me wrong. Depression is a hole — a deep, dark place of isolation, loneliness, and confusion (amongst countless other negative things). But does this mean nothing good can come from having depression?” Read the rest of his blog.
Psychologist, Ellen Hendriksen, Ph.D. writes in Scientific American, “In our psychological backpack, we all carry around beliefs that shape how we move through our days. The heaviest weight in our backpack is the beliefs about ourselves. And when it comes to setting the stage for depression, a 2009 study in the journal Cognitive Therapy and Research found there are two biggies that are particularly devious.” Read the rest of her article.
Therapist Will Hall writes, “One of the great sadnesses I encounter in my work is when people, struggling to find their own language, have adopted the language of others, or doctors, or the media in a way that only obscures and confuses the sense of who they are. Their very description of self has been usurped. I don’t have contact with the person, I have contact with a cloud of terms and jargon repeated from someone else. But just using the word “depression” does not always have to mean someone else’s language – sometimes people have their own definitions that are clearly personal and intimate revelations of their direct experience.” Read the rest of his blog.
A new multinational study involving researchers from the United States and Denmark revealed last week that daylight saving time clock changes have another potential disadvantage to them, and a serious one at that. Based on their findings, shifting to standard time leads to an uptick in depression cases in the fall. Read the News.
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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I’m Dan Lukasik from Lawyerswithdepression.com. Today’s guest is Dr. Margaret Wehrenberg. Dr. Wehrenberg is a clinical psychologist in Naperville, Illinois. She is the author of six books on the treatment of anxiety and depression published by W.W. Norton, including, “The Ten Best-Ever Depression Management Techniques: Understanding How Your Brain Makes You Depressed and What You Can Do to Change It” and “Anxiety + Depression: Effective Treatment of the Big Two Co-Occurring Disorders.” An international trainer of mental health professionals, Dr. Wehrenberg coaches people with anxiety via the internet and phone. She’s a frequent contributor to the award-winning magazine, Psychotherapy Networker and she blogs on depression for the magazine Psychology Today.
Dan:
What is the difference between sadness and depression and why do people confuse the two so often?
Dr. Wehrenberg:
Because depression comprises sadness. Sadness is a response to a specific situation in which we usually have some kind of loss. The loss of a self-esteem, a loss of a loved one, the loss of a desired goal. Depression is really more about the energy – whether it’s mental energy or physical energy – to make an effective response. So, sadness is an appropriate and transient emotion, but depression sticks around and affects all of our daily behaviors and interactions.
Dan:
What causes depression? Sadness, as you say, is an appropriate response to loss. What is depression a response to? What are the causes of depression?
Dr. Wehrenberg:
Over the course of my career, I’ve developed the idea that there are four potential causes to depression. This comes from working with people for forty years; it comes from reading a lot of research.
The first part is genetics. You are born with a brain that is going to tend toward depression because of the function of neurotransmitters in your brain. It’s a genetic predisposition towards depression. With poor self-care, poor nutrition, you may end up stimulating or starting that feeling of low energy, of low interest in the world around you. Then if you pull back from the world around you, now you start to have fewer experiences that keep you interested in the world.
Another possible and probable cause is with people who are experiencing situational stress that goes on, and on, and on. That could be the stress of not being able to earn enough money, and you’ve got two jobs, and kids, and a life filled with stress. It could be the stress that comes on while caring for someone in your family circle who’s got a disability, or a chronic illness; that increases with severity over time. So, you’re stuck in stress, and you deplete yourself. And you can become depressed.
The state of the depression is a lot like the state of being sick. If you had the flu, you wouldn’t feel like sitting around eating and drinking; you wouldn’t feel like playing a round of tennis. If somebody says, “Let’s watch a really interesting T.V. show” and you say, “No, I want to go to sleep instead,” that’s pulling back from the world is healing. People have the same feeling when they’re depressed, but those feelings don’t lead toward healing because they’re persistent.
Two other causes that people would certainly be aware of are trauma or coming from early childhood adversity where early in your childhood you were not treated well, you were neglected, had some other abusive situation, and those two very difficult situations can lead people to function in a depressed way.
Dan:
Let’s talk about the issue of stigma. As a person who’s had depression for the past 15 years, it’s something that I’ve had to deal with. Why is there so much stigma surrounding depression?
Dr. Wehrenberg:
Part of it is because we have this mentality in this country that you should be able to pull yourself up by your bootstraps. And we look at people who are low energy, who aren’t completing tasks, and we judge them as doing it on purpose. People who aren’t depressed are of the impression that you could just decide to do it differently.
I was speaking with a 21-year old client of mine the other day who said, “I can’t make myself do the work, and I hate it that I am that lazy.” So, he judges himself as lazy, even though it’s the depression that’s robbing him of energy and mental tenacity. So, even depression sufferers judge themselves to be wrong, lazy, and bad and believe they should do better. So, I think the cultural expectation that you should be more productive. Also, people don’t see it as the medical problem it is. It’s just that it’s not a very “visible” medical problem.
Dan:
In the past 40 years or so that you’ve been a therapist and have treated people with depression, what have you observed about the rate of depression in our country and our understanding of it?
Dr. Wehrenberg:
I think the rate of depression, everybody would agree, is growing. More and more people are suffering depression.
There are different reasons why when we look at this.
Culturally, one of them is that American culture is a highly stressed culture. But it’s stress not over life and death, but that’s certainly the case for many living in poverty who have to worry where their next meal is coming from, but usually, what we look at is the stress of always needing to be more, to do more, to get more status and money. That’s not a very good way to feel good about yourself because there’s a limit, a human limit of time, a limit of money, a limit of talent or ability, a limit to resources or access to achievement.
Dan:
Following up on what you just said earlier, you talked about some possible causes of depression including genetics and family of origin issues. Now you’re talking about American culture and its connection to depression. What is the connection?
Dr. Wehrenberg:
We have a culture that values productivity, money, and status, and not everybody can achieve goals of status or financial success and it gets depressing to see how valuable those seem to be in our country.
We don’t value something everybody can do. Like, be a person of good character. We value how much status you’ve got, which is very different.
Dr. Andrew Weil, who is a real guru of physical health and mental health, says he thinks that stress equals inflammation in your whole body and that inflammation is a trigger for depression.
Dan:
Why did you write the book, “The Ten Best-Ever Depression Management Techniques?” It’s a great read. I recommend all my listeners and readers at lawyerswithdepression.com to pick it up.
Dr. Wehrenberg:
I wrote it because I believe both consumers and therapists need ideas for what to do right now other than to investigate, in some more general way, a life history, what do you do today that will make you feel somewhat better, to start you moving out of the depression. I wanted to present as many practical ideas as I could that would help people start to lift out of depression with the help and advice of a therapist and also for the general public that could read this book and say, “Oh, there are things I can do that would make me feel better.” And they’re simple; they’re not complicated.
Dan:
Can you share with our listeners some of the techniques you recommend in your book?
Dr. Wehrenberg:
Let’s start with somebody with low energy. Almost everybody who is depressed is doing something even while they are depressed. Playing a game on their phone, watching T.V. or watching Netflix. They are doing something. Unless, they are sleeping, of course. But I want to use what you’re already doing to help motivate you to do something you think you should do. So, for example, I often see people with depression that aren’t doing good health care, they’re not doing good care of their environment, they are not doing dishes, they are not doing laundry, stuff like that. So if you just think about household stuff for a second, what I want my clients to do is to break down the task into its parts.
If you’re going to do laundry, the first thing you have to do is pick it up off the floor. So, I don’t want you to think, “Oh, I’ve got to get all the laundry done.” If you’re depressed, that won’t work. What I want you to do is think is, “All I have to do is pick up the dirty clothes in the family room and then I’m going to sit down for 15 minutes and do what I’m willing to do anyway – play a game on the phone, turn on Netflix. Set a timer for 15 minutes of enjoyment of your show and then when the timer goes off, you just get up and pick up the clothes off the floor of your bedroom. Little pieces, okay.
What we know about depression is those small accomplishments are perceived in the brain as positive and encouraging, and you start to feel, “Oh, I can do something for myself.” You begin to have just a little rise in your overall energy. If you can do that consistently, then pretty soon, you get the task of doing the laundry over with. It may take a few days, but it’s done. Then you have a positive self-appraisal. That’s what I’m going for, for example, with a very simple way to think about raising your energy through small increments.
Dan:
So the small steps and small behaviors affect neurochemistry?
Dr. Wehrenberg:
They do, indeed. Because when you take action and it has a positive outcome, you have just changed the level of the neurochemical called dopamine, which I call the “James Brown” of the brain. It’s the “I feel good,” when dopamine is released in your brain you feel better. We know that people who decide, “I am going to do this,” and do it, they get a rise in dopamine and change your neurochemistry.
Dan:
I want to discuss your second book, “Anxiety + Depression: Effective Treatment of the Two Co-Occurring Disorders.” I struggle with both anxiety and depression with depression being the primary diagnosis. Many people I meet struggle with both. Why do the two co-occur together and sometimes not?
Dr. Wehrenberg:
Very often, if you are looking at brain function and structure, what you see in people who have both anxiety and depression, which, by the way, is about fifty-percent of the time, is that people who have one, have the other. Often, the anxiety comes first, and it’s not treated well. There’s a neurochemical called serotonin which is related to something called rumination or you might think of it as “brooding.” When people brood, when they go over and over a failure or fear, they get stuck mentally. It raises anxiety because it’s hard to solve a problem that you’re just brooding about and it raises depression because you don’t feel like you’re moving very much in your behavior or your thinking. That’s a pretty simplistic statement. And people will say, yes, but there are far more theories about the underlying neurochemistry. That’s true, but the chemistry that relates to brooding is related to both anxiety and depression, the repetitive, negative thinking.
Dan:
Regarding your history as a therapist treating people with anxiety and depression, are there some techniques that work better with anxiety versus depression? Or, do all these techniques work equally well with both conditions?
Dr. Wehrenberg:
I think you have to look at the energy level. Some people with anxiety and also depression have a fair amount of energy to cope with the depressive quality of repetitive, negative thinking. And you use the energy of that anxious person to be more assertive with yourself to say, “I’m going to take charge of this.”
But what I also find that works very well with anxiety and depression together is to work on mindful awareness, to try to stay in the moment, not to try to predict a negative outcome, but rather to pull yourself into the moment. And mindfulness, which can be done by meditating to stay in the present moment, but you can also just keep pulling yourself back to this moment by saying to yourself, “What’s happening now?” This pulls you back from predicting negative outcomes and then getting upset about what might happen. If you stay in the now, you can say I can do this activity now, this action now, and all I have to worry about is now. And then you tend to get better outcomes. So, that’s good for both for anxiety and depression.
Anxiety is “I worry about the future; I fret about the past.” And depression includes, “I think the future will be grim.” So if you stay in the moment, you’re addressing both of them.
Dan:
As a psychologist and therapist who’s worked with people with anxiety and depression for decades, tell us a little bit why a person struggling with depression and anxiety should see a psychologist, a therapist? What benefit could be obtained from seeing someone such as yourself and how does that work?
Dr. Wehrenberg:
We know that medication, which is often people’s first choice, can be extremely helpful. But what I say to my clients is that medication can help you feel somewhat better, but it doesn’t teach you anything about managing your life. Psychotherapy, when it’s practical, when I’m looking at it through the “The Ten Best-Ever Depression Management Techniques,” what it’s teaching you is how to handle your negative mood, what to do when you don’t have energy. It’s teaching you behavior that will rewire your brain. It talks about how and why exercise and nutrition are important.
But also why taking even a small action on your behalf changes your neurochemistry. So, psychotherapy immediately affects brain function. But, you usually need a psychotherapist to give you ideas, help you find ideas of how you stop yourself, how you block yourself, and to help you find the most effective tools for you in your specific situation. A psychotherapist can be very helpful in teaching you how to get rid of these negative symptoms and feel better for life.
Dan:
Dr. Wehrenberg, what’s the best way for our listeners and readers to get in contact with you?
Dr. Wehrenberg:
Well, if you’re able to spell my name, you can look me up on Margaretwehrenberg.com. I work in Naperville, Illinois. But my website has my telephone contact and a link. And if you went to the Psychology Today magazine website, you can look at my blog on depression, and you would be able to contact me through there as well. I have a really good “Contact me” on my website.
Dan:
On behalf of your listeners at Lawyerswithdepression.com., I want to take the time to thank you for this insightful interview. I think it’s going to help many people.
Dr. Wehrenberg:
Thank you for having me. I appreciate it.
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