Parker Palmer, Ph.D., writes, “When you’re depressed, it seems insulting, even insane for someone to suggest that the soul-sucking spawn of Satan that has sunk its claws into you is your BFF. And yet, as time went by, the image of depression as a befriending force began to work on me, slowly reframing my misery and helping me find a way through. Something in me knew what my therapist knew: down is the way to well-being.” Read the Blog
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.
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.
A new study has found that following two sessions combining meditation and aerobic exercise per week for two months can reduce the symptoms of depression by 40 percent. Read the News
Most folks with depression have a complicated relationship with their antidepressant medications.
I certainly do.
If I feel tired and flat on a particular afternoon, is it depression, the side effects of my meds or a jumble of both? Or maybe, it’s just my persistently pensive nature?
I think about this a lot these days – and maybe you do as well.
While the one-two punch of Cymbalta and Lamictal have kept me out of the dungeon of major depression for years, its comes with a cost. I have interludes of passivity, numbness, and fatigue. Maybe a low-grade depression at times, as well. If I ditch the drugs, maybe I will feel more “alive,” I think. I fantasize that cutting my ties with meds could lessen the days lost to the deadening grayness of a medically induced sense of normalcy I sometimes go through.
But I also feel anxiety. If I went cold turkey and lived medication-free, would it end, well, in disaster? A return to the swampland of depression? A deadman’s land if ever there was one. Can I take that chance? Should I?
There’s scary research that suggests once you stop antidepressants that work (or sort-of-work) for you and try to go back on the same ones because being off of them caused your depression to return (or you just couldn’t tolerate the horrible side effects that can come with discontinuation), there’s a good chance they won’t be as effective.
So, what’s a depressed person supposed to do? What should I do?
There are two camps that offer some guidance on this issue. Both have persuasive arguments about why those afflicted should or shouldn’t stay on meds.
The Stay on the Meds Camp
If depression is an “illness,” like diabetes or heart disease, I need these meds to balance out my of whacky neurochemistry. Given my risk factors: a family history of depression (genetics), a crazy childhood with a nutty, abusive and alcoholic father, and a high-pressure job with too much stress, I should stay on the pills.
In his insightful essay in the New York Times, In Defense of Antidepressants, psychiatrist, Peter Kramer, author of the best-selling books, Listening to Prozac and Against Depression, suggest that studies show this: for mild or moderate depression, talk-therapy is as or more effective that medication. But for the Moby Dick sized sucker called Major Depression? Medications are warranted, and, indeed, lifesavers. They help many to function and live productive lives, albeit with a range of mild to more severe side effects.
The Get off the Meds Camp
Some people (including psychiatrists) see meds as the devil’s handiwork: supposed chemical solutions to emotional problems that flat-out don’t work. Many psychiatrists’ (and family doctors who write the overwhelming majority of scripts for these drugs in the U.S.), they maintain, are “pill pushers” who do the bidding of “BigPharma”, a multi-billion dollar industry in this country. Antidepressants aren’t so much a cure as a curse.
Irving Kirsh, Ph.D., author of The Emperor’s New Drugs: Exploding the Antidepressant Myth, writes:
“Putting all [the research] together leads to the conclusion that the relatively small difference between drugs and placebos might not be a real drug effect at all. Instead, it might be an enhanced placebo effect, produced by the fact that some patients have broken [the] blind and have come to realize whether they were given drug or placebo. If this is the case, then there is no real antidepressant drug effect at all. Rather than comparing placebo to drug, we have been comparing ‘regular’ placebos to ‘extra-strength’ placebos.”
The remedy from this group? Psychotherapy. They see depression as the result of off-kiltered, negative thinking patterns. The way out of these ruminative, pessimistic thoughts involves working with a therapist who uses, most often, Cognitive Behavioral Therapy, to challenge and encourage patients to replace such thoughts with more realistic and positive ones.
In his book Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You, Richard O’Connor, Ph.D. argues that both therapy and medication are effective, but limited in certain respects. He advocates an additional factor often overlooked in depression recovery: our own habits. Unwittingly we get good at depression. We learn how to hide it, how to work around it. We may even achieve great things, but with constant struggle rather than satisfaction. Relying on these methods to make it through each day, we deprive ourselves of true recovery, of deep joy and healthy emotion.
The book teaches us how to replace depressive patterns with a new and more effective set of skills. We already know how to “do” depression-and we can learn how to undo it.
Some Recent News on the Meds and Therapy Conundum
The New York Times reports that a large, multicenter study by Dr. Charles Nemeroff, then a professor of psychiatry at Emory and now at the University of Miami, found that for depressed adults without a history of abuse, there was a clear ranking order of treatment efficacy: Combined psychotherapy (using a form of cognitive behavior therapy) and an antidepressant (in this case, Serzone) was superior to either treatment alone. But for those who had a history of childhood trauma, the results were strikingly different: 48 percent of these patients achieved remission with psychotherapy alone, but only 33 percent of these patients responded to an antidepressant alone. The combination of psychotherapy and a drug was not significantly better than psychotherapy alone.
So what’s a depressed person supposed to do?
I don’t know, really.
We’re in a pickle, aren’t we?
Maybe there’ll be a soon-to-be discovered test that can guide us on precisely what to do. But for now, many of us will stay-the-course and, for better or worse, stick to the “plop, plop, fizz, fix”.
I see myself somewhere in the middle of all this. I’ve never been hospitalized or tried to commit suicide. But I have known depression’s scorching winds, gales that have torn the flesh from my body. I will never forget this pain. It’s scarred me. And I never want to return to it.
If you’re thinking of discontinuing your meds, here’s a great article on how to do it safely.
I welcome your comments about your depression journey with or without medicaton.
by Daniel T. Lukasik
A new study shows that peer support interventions by a previously depressed person to provide support and guidance to a currently depressed person really helps. Read the Blog
Depression blogger, Therese Borchard writes about her recent visit to a holistic health fair and concludes that while holistic doctors and naturopaths offer valuable advice and treatment, it’s only part of a very complicated puzzle of what works for each individual. Read the Blog
From The New York Times, Diana Spechler writes, “My depression habits include avoiding pain and courting diversion. During every bout of depression, I grasp – at yoga, therapy, medication, romance – and hope that my tiny firefly of pleasure won’t wriggle from the cup of my palms.” Read the News
Antidepressants can help relieve depression’s symptoms. But there’s limits to what they can provide. Read the Blog
Most folks describe depression as a weight they carry around: dumbbells lodged in their pockets that drag them down body, mind and soul into a stinking swamp.
There’s no humor in this bayou; no levity, no sense of the sweet exuberance life can bring. Instead, there’s a collapsing inward, an inertia in which we can’t imagine . . . well . . . anything good happening to us.
We have a yearning to be free of depression; a deep desire to cut our losses and spit in its eye. It has cost us enough heartache – no more, we think. We pine for a way out of it, but sometimes don’t know the way.
But if we are to recover, we need to think about a different kind of life for ourselves. One where we take the “UP” to happiness escalator instead of the “DOWN” one to depression.
Imagining a Life without Depression
Envisioning freedom is part of the journey out of the dark woods. So often, depressives imagine a future with uninterrupted bouts of depression. This sorrow is what leads so many to a state of hopelessness. We need, with the help of wise others, to begin to imagine what our life would look like without depression and walk, step by step, that way.
I used to say to my therapist when depressed, “Why am I being punished?” It was as if I had done something “bad” and was a “bad person” (though I didn’t know and couldn’t articulate whatever that was) and now the Karmic Universe was going to dish out the punishment I thought I surely deserved.
As depression author Dorothy Rowe writes,“Depression is a prison where you are both the suffering prisoner and the cruel jailer.” Start to see, just a little bit at a time, that depression is not just happening to you. It’s an inside job too. This took me years to learn. Our thoughts and style of thinking help create and sustain depression. When we feed it with negative ruminations, it grows larger – like an algae plume. Withhold this noxious nourishment — and it can, slowly, wither away or at least become more manageable.
Happiness Skills Can Help
Before even imagine the promised land of happiness, however, we may need medication to lift the more onerous physical symptoms of depression to give us enough focus and energy. No doubt, antidepressants aren’t the only way to do this. Many have accomplished the same results with exercise, nutrition and/or psychotherapy.
In her book, The How of Happiness, Sonja Lyubomirsky, Ph.D., writes:
“Even the most the most severely depressed individuals can improve by doing a simple daily happiness-increasing exercise such as taking time to recall three things that went well each day. Although the exercises are not designed to ‘cure’ depression, if you are depressed, trying one or more of these activities affords a strong chance of lightening the burden and darkness of depression and producing positive feelings.”
We can also look back further than just what went right on a particular day to increase our sense of happiness. There is a powerful connection between how we view our past and present day happiness says Rick Nubert, Ph.D. In a study of 750 people, he found that highly extraverted people are happier with their lives because they tend to hold a positive, nostalgic view of the past and are less likely to have negative thoughts and regrets than their neurotic counterparts. Howell says that while it may be difficult to change one’s personality to being an extrovert, he found that savoring happy memories or reframing past painful experiences in a positive light could be effective ways for people to increase their life satisfaction.
Other ideas offered up by Dr. Lyubomirsky include avoiding overthinking – a big problem for lawyers: “Very happy people have the capacity – even during trying times – to absorb themselves in an engaging activity, stay busy, and have fun. To practice this strategy, pick a distracting, attention-grabbing activity that has compelled you in the past and do it when you notice yourself dwelling [on the bad stuff and your problems]”. Check out her other ideas in her blog.
You deserve to be happy. You don’t have to keep riding the down escalator. While going up to the second floor, just wink and wave at your depression as it goes down into the bargain basement.