Hello Darkness, My Old Friend

There are a number of saddening stories out this week on a topic close to my heart: Depression.

Some drug companies are giving up on antidepressant research, many natural cures are not working, and yet another doctor has clambered onto the anti-medication soapbox. Sigh.

I have early-onset double depression (major depression and dysthymia), and I can tell you that antidepressants are certainly helpful, and that the placebo effect is not always the curative factor. Antidepressants work, and they saved my life and the lives of many people like me. Antidepressants rock!  Of course, they are also problematic, but to throw them under the placebo bus is irresponsible in the extreme.

After leaving my career in 2003, I was grateful to be able to come back and rewrite my previous book, Emotional Genius, and correct my misconceptions about depression.  In my earlier career, I wrote from within a cultural framework (metaphysics and the New Age) that was deeply prejudiced against conventional medicines, and I’m afraid that I just repeated the party line. No one questioned me about it at the time (probably because my books were read by like-minded people), but it was one of the reasons I left my New Age career. My stance against conventional treatment, and my support of what amounts to magical thinking in the face of serious mental and emotional disabilities is something that grieved me tremendously.

Thankfully, Tami Simon of Sounds True asked me to revisit my work and to rewrite it from my current understanding. Now, the depression chapter in The Language of Emotions: What Your Feelings Are Trying to Tell You, and in fact many of the emotion chapters, supports the use of medical interventions. I have also been able to understand and articulate the many differing forms of depression, and this is something that is sorely missing from media stories about antidepressants and their efficacy.  I still call depression Ingenious Stagnation, but I have more clarity and depth in my approach to it now, thank goodness. Here’s an excerpt from the book:

Depression is not a single emotion, but a constellation of emotions, postures, decisions, and health issues that erect what I call the “brilliant stop sign of the soul.” Depression is an ingenious (albeit overwhelming) movement in the psyche that takes you out of commission for crucial reasons. It’s important to understand the difference between despair, which arises when your natural sadness has become blocked or trapped – and depression, which is a cyclical and unresolving movement through any number of blocked or overemphasized emotions (the emotional mix is different for each individual). Depression arises in response to exterior and interior conflicts that destabilize you, and while it can be crushingly disruptive, depression has a vital healing purpose.

When people are dealing with depression, there are nearly always four or five deep and painful situations or health concerns transpiring at the same time. Though depression can and does spin out of control and destabilize bodily systems, emotions, and cognitive functions, there is nearly always an inception point at which the depression arose in a very manageable way as a response to trouble or injustice that was already occurring. Treating the depression as a separate disease entity without addressing the very real situations it points to is an incomplete way to manage it – because depression is a natural protective response to disheartening or destabilizing stimuli. The practice for depression is not to launch yourself toward happiness for the sole (and ultimately joyless) sake of happiness, but to understand what has occurred – inside and outside of you – to disturb you. Your first task is not to erase your depression, but to focus yourself in the center of the village inside you so that you may view your depression not as a negative comment on your intrinsic value, but as a brilliant message about the specific (though obscured) issues you face.

If you’re currently taking antidepressants (including St. John’s wort or any other herb), you are welcome here. There is still plenty of work to do in the emotional realm when you’re on antidepressants. In fact, you’ll probably be better at working with emotions if you’re on the right antidepressant. If you’re on a suitable one, you won’t be a zombie – you’ll just be protected from falling into a bottomless pit. I empathize with the need for medication, because I wrestled with my own intense suicidal depressions for over three decades – and relief of any kind was a godsend. However, until recently, I was too brainwashed against conventional medicine to go near a conventional doctor, so I had no choice but to learn to deal with severe and debilitating suicidal depressions without medical help. This was excellent training for the work I did with people who would not or could not tolerate medications, but it did cost me a great deal.

Current research is showing that untreated depressions, especially major depressions, can teach the brain how to fall into depression more easily the next time. Untreated depressions can wear a path in the brain, just like other repetitive or poorly managed emotions can. Unfortunately, this pathway also affects the endocrine system, sleep patterns, memory, and even the DNA in your brain cells. You can actually damage your brain with untreated depressions, so they’re nothing to fool around with. Get help! I did, finally, and not only am I now being protected from recurrent major depressive episodes, but I’m working my way back to proper sleep patterns and endocrine balance as well. There is also some preliminary data showing that antidepressants – specifically the SSRIs (selective serotonin reuptake inhibitors) – can reverse the damage that major depression wreaks on the DNA in brain cells. This is a relief!

Now, after having advocated for medical intervention in cases of depression, it’s important to understand which type of depression you have. I suffered from have early-onset major depression (my first suicidal episode occurred when I was 11), but I have no manic features or cycling anxieties. Depression that cycles with manic features is called bipolar depression, and it requires different treatments than major depression does. Bipolar is a very tricky condition, and it’s important to get it properly diagnosed and treated (treatments for major depression can actually make bipolar depression worse).

Depression that cycles with anxiety, phobias, or OCD (obsessive-compulsive disorder) symptoms requires yet another form of treatment – and is often helped with anti-anxiety medications and short-term cognitive behavioral therapy. Low-grade chronic depression that lasts for two years or more is called dysthymic depression, and in some individuals, low light conditions can trigger seasonal affective depression. Additionally, women can experience hormone-related depressions, either as a part of their monthly cycles (Premenstrual Dysphoric Disorder), or after the birth of their children (Postpartum Depression). Psychotic depression can look something like schizophrenia, with hallucinations or hearing voices; and atypical depression (which is currently being linked to either dysthymia or a mild form of bipolar depression called cyclothymia) involves heightened sensitivity, social phobia, weight or appetite gain, and oversleeping.

Remember, too, from the chapters on anger, that cycling rages often mask an underlying depressive condition (especially in men).  If you flare up with rage and righteous indignation a great deal of the time, please check in with your doctor, or find an online depression questionnaire and take an honest self-assessment. Again, depression is nothing to fool around with.

In contrast to the above conditions, situational depression is the form of depression most of us understand. It occurs when we feel down and sad not just for specific reasons, but about everything. Situational depression is something that most of us have experienced: We feel continually down, unmotivated, isolated, teary, agoraphobic, or unable to sleep, eat, or function. Many people who deal with situational depression swear by a certain drug, herb, meditation practice, exercise, dietary restriction, or just about anything else. As it turns out, they’re not wrong.

Situational depression is amazingly malleable and will respond to just about any change in routine. When mental health studies show that nondrug modalities such as therapy and meditation are just as effective as antidepressants in relieving symptoms – those studies are often being done on situational depression! Those of us with major depression, bipolar depression, hormone-related depression, and anger- or anxiety-linked depressions may require more intensive interventions. Bless yourself for moving through depression in whatever way you’ve been able to thus far, and know that proper diagnosis will protect your brain and your body.

The depression practice in this chapter works very well for situational depression, but it shouldn’t be the only practice you use if you‘re experiencing the more serious forms of depression.The serious forms of depression can be disabling, and you should treat them as disabilities and not as character defects. Love yourself, take care of yourself, and don’t tough it out. Help is available.

I once thought erroneously that dealing with depression the “natural” way made me stronger, better, deeper, or more spiritual than others. Actually, all it did was pull me into an increasingly debilitating health condition that could have been alleviated if I had access to unprejudiced medical care. But better late than never, right?

If you’re dealing with any depression other than situational, and you’re toughing it out, I empathize, baby! But there’s no need. There’s good help available to protect your health, your brain, and your life. Please reach out!