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Sporadic photos and notes from a Psyche-midwife, cheerleader, anthropologist--aka clinical social worker in therapy practice. Photos are usually mine except for those of historical events/famous people. Music relevant to the daily topic is often included in a web video embedded below the blog. Click on highlighted links in the copy to get to source or supplemental material. For contact information, see my website @ janasvoboda.com or click on the button to the right below. Join in the conversation.

Wednesday, March 16, 2011

Fading Blues II: Understanding and Addressing Depression

  "I feel so ashamed."  "It's ridiculous I should be so unhappy.  Others have it so much worse." "I shouldn't be so weak".
     These are common comments in my office made by persons in the throes of depression.  Because it is a mood disorder, and because people assume moods  have causal links to what's happening in their lives, depression leaves people bewildered when they cannot link the feelings to situational events.  Even when they can, the other common depressive ruminations (guilt, hopelessness and helplessness) reinforce a very personal responsibility for the symptoms.
 "I feel like a burden."
"I should be able to handle this."
"I'm broken."

These thoughts are symptoms that arise from the disorder.

When one has a fever, one doesn't usually think "I shouldn't be so hot."  A person with Type 1 diabetes doesn't tell themselves or their doctor "I really should have my pancreas under better control."  But when our brains are screwing up, we take it really personally.  We confuse our mind/soul/personality with our brain.  And we think we are supposed to be in charge of it.

The brain is an organ; a very complicated one. It interlinks with a intricate endocrine system over which we have little conscious control.  That system tells our body such things as "wake up", "be energetic", "get drowsy".   In his Feb 2011 New Scientist article "Days of Wonder", Roger Highfield charts the mysteries of the complicated chemical factory that is our human body as it goes about an average day.  From the moment we wake up, when perifornical orexin neurons start our day by alerting the sympathetic nervous system to get going, to the time we ready for sleep and the dark triggers a chemical dose of drowsiness to quiet the system, hundreds of complex biological processes are happening.  Like Japan's nuclear power plants, there are dozens of redundant mechanisms to prevent the inevitable mishaps from collapsing us.  And like Fukushima, sometimes there are enough failures of those mechanisms that there are catastrophic results.

In depression, there is many potential failures (or more benignly, design issues) that can happen.  As psychiatrist Jim Phelps explains (buy his book already!), "A big part of depression is a single gene."
A person no more chooses to carry this particular gene than the one for say, hairy knuckles or that one that makes your pee smell funny after you eat asparagus.

Other things that can increase likelihood a person has a depressive episode are as varied as season and latitude, daylight savings time (!), hormonal changes (pregnancy and postpartum, menstrual cycles,  and menopause for women), and medication (including some you'd never think of-- even certain antibiotics, such as Cipro).  The linked list doesn't include antihistamines, which seem to cause depressive symptoms for me.  Every body is different.  If you notice you have a consistent negative response to a medication, consider reporting that to the FDA here.   These anecdotal reports add up and make a difference if there are enough of them.  I remember back in the day it was commonly thought that there was no such thing as a withdrawal syndrome for folks on antidepressants.  It wasn't until enough people complained to FDA and doctors that they were having serious issues that guidelines for slow tapering of SSRIs became common.

A more obvious causal relationship can be made for depression in a person who has been through one or a series of traumatic or stressful events.  Even then, it is likely the physical response of the body's bombardment with stress chemicals that explains the lethargy, mental fogginess and emotional reactivity of severe depression, not just the psychological effects.

How can you mediate the body's reaction to these difficulties?  There are a few straight-forward paths to wellness, whether your symptoms are aches of the physical or psyche:
  1. Practice good sleep/wake habits  to support the endocrine system's ability to do its complex job.  
  2. Minimize late night light and get a reasonable amount of daily fresh air and sunshine.
  3. Eat well:  adequate nutrition is essential for good mental health.
  4. Exercise is neurogenerative. There are dozens of studies showing its benefit to mental well-being.
  5. Social connection is very predictive of happiness.   Depression encourages withdrawal.  While reflection is good to a point, don't isolate.  Find ways to increase community.  If you are too shy or depressed to go out, at least go online, and find a support group/chat where you can connect with others.
  6.  Count your blessings.  Pay attention to what is going well in your life and keeping a journal of gratitudes.
  7. Address the unproductive inner focus by finding ways of being in service. 
  8. Find and practice ways of giving your life meaning.
  9. Develop a spiritual discipline that supports compassion to self and others.
  10. Learn to recognize depressive cognition (thoughts) as symptoms rather than reality.
  11. Minimize your exposure to avoidable stresses as you would to secondary smoke. 
  12. When stress is unavoidable, learn ways to decrease its impact through Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, meditation, prayer, focused distraction, creativity or other means.
As always, click on highlighted links for more information.


    Anonymous said...

    I really agree with this post. I suffer from severe clinical depression. I have dealt with it in the past, but this time it is likely because of medications I am on for a health condition. I felt SO much better after talking to my counselor when she told me that it was the medication causing my depression. I guess I otherwise feel very guilty for being depressed. I hate thinking that it is somehow my fault. Thank you for this series of blog entries. I have found them very helpful.

    Jana Svoboda, LCSW said...

    Thanks for your comment; I appreciate you taking the time to give it. I do want to add, though, that even in cases where it's genes, severe or unremitting stress or other factors-- guilt is an extra, unnecessary burden. As I mentioned in a previous post, the person with type 1 diabetes isn't likely to be feeling guilty about their crappy pancreas. We all need to work on decreasing the stigma for persons with mental disorders, including depression. It's a barrier to getting help, and adds insult to injury.