The Twin Pillars of Depression

“Once you choose hope, anything is possible.” – Christopher Reeve

There are two pillars upon which depression rests.

Helplessness

When in the grip of depression, we feel helpless despite our efforts to pull out. The more we struggle, the more exhausted we become. In her book Eat, Pray, Love, Elizabeth Gilbert writes, “They flank me – Depression on my left, loneliness on my right. They don’t need to show their badges. I know these guys very well . . . then they frisk me. They empty my pockets of any joy I had been carrying there.”

Hopelessness

Helplessness often leads to profound hopelessness about the future. In her book Prozac Nation, Elizabeth Wurtzel writes, “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 compounds daily that it’s impossible to ever see the end.”

What I have learned over the past twenty years of living with depression is we need to chisel away at these twin pillars. I began to discover helplessness and hopelessness are disempowering: I had no choice but to live my days under this rock of sadness. My healing involved learning that I did have options in how I related to life when depressed. And I found this power to choose empowering and life-affirming.

How did I leave helplessness and hopelessness behind?

Putting Pen to Paper: Writers on Depression

That terrible mood of depression, whether it’s any good or not, is what is known as The Artist’s Reward. Ernest Hemmingway

Others imply that they know what it is like to be depressed because they have gone through a divorce, lost a job, or broken up with someone. But these experiences carry with them feelings. Depression, instead, is flat, hollow, and unendurable. It is also tiresome. People cannot abide being around you when you are depressed. They might think that they ought to, and they might even try, but you know, and they know that you are tedious beyond belief: you are irritable and paranoid and humorless and lifeless and critical and demanding, and no reassurance is ever enough. You’re frightened, and you’re frightening, and you’re “not at all like yourself but will be soon,” but you know you won’t. Kay Redfield Jamison, Night Falls Fast

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.  Elizabeth Wurtzel, Prozac Nation: Young and Depressed in America

In depression . . . faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come – – not in a day, an hour, a month, or a minute . . . It is hopelessness even more than pain that crushes the soul. William Styron, Darkness Visible: A Memoir of Madness

They flank me-Depression on my left, loneliness on my right. They don’t need to show their badges. I know these guys very well. …then they frisk me. They empty my pockets of any joy I had been carrying there. Depression even confiscates my identity; but he always does that. Elizabeth Gilbert, Eat, Pray, Love

Depression is nourished by a lifetime of ungrieved and unforgiven hurts. Penelope Sweet

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.

 

The Crunch of Time and Depression

Time is the enemy of our synapse-challenged world.  This beast is always just a step behind us. And we keep losing ground as it nips at our heels and bears its sharp fangs.  Time, indeed, becomes an enemy.

We tap on the brakes to try and slow down, but even the vacations and weekends aren’t always terribly relaxing.

We attempt to break apart our days into manageable segments or, as the poet T.S. Eliot once wrote, “Measure out our lives with coffee spoons.”

We often experience time as a force outside of ourselves; as if the clicking clock on the wall or watch on our wrist had its own personhood that nags at us: “Do this not that, wait, what about that other that?”

As Will Rogers once wrote, “Half our life is spent trying to find something to do with the time we’ve rushed through life trying to save.”

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

Seeds of Hope

Reverand, Susan Gregg-Schroeder writes, “I now know that depression affects all aspects of life, including our spiritual well-being.  It strikes at our very soul, making us feel cut off from ourselves, from others, and from our understanding of God.”  Read the Blog

Losing Faith, Finding Hope: A Journey With Depression

Monica A. Coleman, Ph.D. is an AME minister, seminary professor and author of the book Not Alone: Reflections on Faith in Depression.  She blogs on faith and depression at www.monicaaparker.com.

Many people describe depression as a kind of intense grief. It is a deep sadness. It’s like heartbreak, agony and despair all at once. I think depression is worse than grief. Grief usually has an identifiable cause. There are stages. People understand why you are sad. It eases with time.

I find that depression is more like death. In every depressive episode, something is lost. Sometimes it’s the belief that I’m not that sick. Sometimes it’s a dream. Sometimes it’s a concrete plan or goal. Sometimes it’s who I desperately wanted and expected myself to be. Sometimes it’s a harmful lie I’ve told myself, or that someone told me. Sometimes what dies, needed to go. Most times, it seems I would have been perfectly fine without the loss. I would smile more. I would know how I spent the hours in my day. I would see fewer doctors. When people ask me how I am doing, my response of “fine” would only be a lie thirty percent of the time. Like most people, right?

I have lived with a depressive condition since I was a teenager, although I didn’t have a name for it until my 20s. I don’t know how many lows I’ve had — excluding the two suicidal bouts. I don’t count how many times I’ve been sad and desperate for months. I don’t make a list of what I’ve lost.

I do, however, remember when I lost my faith.

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Like many people who are raised in a religious environment, I was taught to believe that God loves me and protects me. I was taught that God punishes sin, and rewards those who are faithful. I learned about my religion by studying Holy Scriptures. I prayed. I worshipped. This was supposed to strengthen my faith. It was supposed to make me happy.

For many years, it did. I cherished Sundays spent in church — singing, kneeling and feeling inspired by the words of the preachers. My friends were made up of the other people I met in church. We volunteered at Vacation Bible School for the children, the food drive and tutoring programs.

Meanwhile, I prayed for peace. In my sleepless nights, I asked God to save me, help me and rescue me from my sadness. Just make it all better. I also heard the messages that my faith told me about depression: that I was be too blessed to be stressed; that depression was a lie from “the enemy”; that suicide is an unforgiveable sin. Somewhere between my unanswered prayers and the realization that I could not worship myself into happiness, my faith died.

I kept going to church. I kept saying the words of the prayers. I still sang the songs. I’m a minister — I have to. But I was a fraud. I stopped talking with God. What could I say to the One who was not delivering me? What praise did I have? I could list my blessings, but I could not feel gratitude. I hid my faithlessness like a bobby pin in an updo. Everything looked composed on the outside, but I was barely holding it together. I was not faithful or pious. I felt abandoned and alone.

As my depression worsened, I learned more about it. I read books. I found doctors who understood my condition. I stopped fearing medication. I met other people who struggled like me. We learned to hear sorrow in one “hello,” and how to sit with each other without words. I began to believe that depression was not a personal weakness or failure. By accepting it, I began to manage it. When I felt joy, I appreciated it all the more. I started to trust the healing process. But I missed my faith in God, religion and worshipping community.

depression_allow

Oddly enough, death is the purview of the religious. We call chaplains into hospital rooms. When someone dies, we go to the altar. Mourners bend their backs and wail. The spirituals express deep sorrow. We gather together with large meals. We don’t pretend like people aren’t in pain. In those times, we understand when people cannot praise God. We only ask people to be honest with God. And we don’t leave them alone. This is exactly what my depressed self needs: tears, music, good food, raw honesty, community. The same faith that demonizes my depression also teaches me how to have faith in the midst of it.

I lost the faith I once had. I stopped believing that God only loved me if I was happy and peaceful. I also gave up on the idea that depression was punishment or isolation from God. I can’t enjoy the same songs. I cannot bear the same sermons. That faith is gone. Just like the hours, weeks or months I lose to melancholy. And my incomplete plans. Or the image I’d like to have of myself.

In these moments when death prevails, I appreciate that so many religions have an understanding of life after death. Regrowth, reincarnation, resurrection. They all understand that there is a finality to death. We don’t get back what we lost. We get something or someone new.

My new faith is a deep trust that God is present with me and understands how I feel — especially when no one else can. I no more blame God for my sadness, than I credit God for happy days. This faith tells God how I really feel knowing that an offer of my true self is worship. I appreciate songs of sorrow more. I dance only when joyful. I am upheld by church community that can linger in pain without moving to fix it.

This faith is different than what died. But it’s just as holy.

This article first appeared in The Huffington Post on October 13,2012.

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