“To optimize the function of the healing system, you must do everything in your power to improve physical health, mental/emotional health, and spiritual health…One of the disappointments of my professional life is meeting so few teachers who see the whole picture of health, who understand the importance of working on all fronts.”
-- Andrew Weil, M.D.,
"Eight Weeks to Optimal Health"
Despite the recent advent of Prozac and other designer drugs, depression is on the rise. Since World War II, rates of depression have doubled in the U.S., and depression is now the second most disabling illness in the Western world after heart disease. According to the surgeon general, one in five Americans experiences a mental disorder in any given year, and half of all Americans have such a disorder at some time in their lives.
While antidepressants continue to be the mainstay for the treatment of depression, “20 percent of people don’t get more than a modest benefit from any of our therapies” according to Steven Hyman, director of the National Institute of Mental Health. Moreover, Time Magazine recently reported that only one third of those surveyed said they were very satisfied with their medication. Meanwhile, 80% complain that depression still impairs their social life, while 72% say their workplace performance continues to suffer.
Fortunately, depression can be treated on a variety of levels. A good analogy is the way we approach heart disease. If you went to a cardiologist and wanted to know how to prevent a heart attack (or to recover from one), he or she might prescribe a cholesterol-lowering medication and tell you to eat a low-fat diet, exercise three to four times a week, and cut down on the stress in your life.
What follows is a holistic program for the prevention and treatment of depression. I have developed it:
- from my own experience (both during and after my depressive episode).
- from talking with others who are successfully managing their depression and anxiety.
- from researching the medical and psychiatric literature.
This “brain maintenance” program is meant to serve:
1) Those individuals who have experienced one or more episodes of major depression and wish to stay well. Although there is no guarantee that this program will keep depression at bay, it can strengthen your “psychological immune system” and therefore enhance your resistance to the illness.
2) Those individuals who suffer from dysthymia (low-grade chronic depression) and desire to elevate their mood, as well as prevent a major depression.
3) Those people who are experiencing a major depressive episode and wish to use these strategies as an adjunct to medication and/or psychotherapy.
I have organized this treatment plan into five areas — physical self-care, mental/emotional self-care, spiritual self-care, people support, and lifestyle habits.
As you read through the material, think of my recommendations as guidelines, not hard-and-fast prescriptions. Each person’s healing journey is unique. It is up to each individual to sift through the available treatment options and discover what works.
Now, let’s begin.
Our body is a temple for the living spirit. If we are to experience wholeness and vitality, it is important that we take care of and honor our body’s needs. Being in good health will enhance your ability to do the remaining steps of this program.
Diet & Nutrition
Good nutrition supports the optimal functioning of your brain and body. To insure that you are meeting your nutritional needs, eat a balanced diet of healthy foods. Eating as much organic produce as possible will help to minimize the intake of chemicals and preservatives which can cause problems in sensitive individuals.
Another part of nutritional self-care is cutting back on the sweets. Studies have shown that too much sugar can foster anxiety as well as depression. Reducing intake of sugar may also bolster your immune system, reduce allergies, and cut the risk of diabetes and reactive hypoglycemia.
Finally, there seems to be a loose connection between depression and food sensitivities. Although no one has proven that allergies can cause depression, it seems reasonable to assume that allergies can aggravate a depressive condition since both conditions are known to involve similar biochemical imbalances (low norepinephrine and high acetylcholine levels). Common food allergens include dairy products, wheat, and corn. If you think you have food allergies, consult a doctor who specializes in allergies or environmental medicine.
Vitamin & Mineral Supplementation
In addition to eating a balanced diet, you might want to take a good multi-vitamin and multi-mineral supplement with special emphasis on the antioxidants — vitamins A, C and E. The entire vitamin B complex is known to maintain and promote normal mental functioning, so it may be helpful to take a good B complex tablet. Calcium and magnesium, which help to calm the nervous system, are especially helpful to anxiety-prone individuals. Deficiencies of the B vitamins, as well as of magnesium, manganese, zinc, and iron, can be a factor in depression.
Exercise — any activity that promotes endurance, flexibility, or strengthening — is a natural antidepressant. Aerobic exercise in particular improves circulation, brings increased blood flow and oxygen to the brain, and releases endorphins, the body’s natural pain-killing chemicals. Studies have shown that exercise works as well as pharmaceuticals in healing mild to moderate depression. The only “side effects” of aerobic exercise are a stronger cardiovascular system and better overall health. As little as three hours a week can reduce the level of depression. Even if you have no history of mood disorders, regular exercise can profoundly improve the quality of your physical, mental, and emotional well being. Researchers like Candace Pert have shown that “molecules of emotion” are located not just in the brain, but throughout the body.
Our bodies were made to move. Whether it is a daily walk in the park, a water aerobics or yoga class, or dancing to your favorite music, get into motion. Start with small steps and remind yourself that you don’t have to be perfect. At the pool where I swim, I see many disabled, elderly, and overweight people taking part in water exercise classes. Thus, even if you have a physical disability or carry extra pounds, it is usually possible to engage in some form of movement.
One of the most powerful ways to impact the emotions and the involuntary nervous system is through the breath. In Sanskrit, the word for breath is prana, which also means “life” or “spirit”. Most people in our society breathe rapidly and shallowly, using only the upper part of their chests. This is especially true for depressed individuals, whose life force is at a low point.
Abdominal breathing (also called diaphragmatic breathing) involves using your entire chest and abdominal cavity to breathe.
I first learned about abdominal breathing in a yoga class many years ago. You can also learn diaphragmatic breathing techniques in any stress reduction clinic, biofeedback center, pain clinic, or from any individual who has practiced yoga.
Part of staying physically balanced means developing regular sleep patterns that give you adequate amounts of rest. (Studies show that most Americans are sleep-deprived.) Try to develop a sleep schedule — a regular time of going to sleep and arising — and stick to it. Sleep irregularities are among the early warning signs of both mania and depression. These symptoms include:
- trouble falling asleep.
- trouble staying asleep.
- early morning awakenings (followed by ruminations).
- sleeping too much.
Sleep medication can be useful in trying to break a pattern of sleeplessness, but it is only designed for short-term use. Behavioral changes, such as those listed in the book "No More Sleepless Nights" by Peter Hauri, can be extremely effective. In addition, you may wish to get evaluated at a sleep clinic to rule out the possibility of physical problems such as sleep apnea. (Sleep apnea is a temporary suspension of breathing that occurs repeatedly during sleep and often affects overweight people or those who have an obstruction in their breathing tract.)
To maintain healthy body functioning, it is important to drink adequate amounts of fluids, at least two quarts a day. Your body is composed of 70 percent water. Water is essential to proper metabolism, circulation, and elimination. It flushes out toxins and restores chemical balance to cells, tissues, and organs. Many people report a direct improvement in mood once they increase their fluid intake.
If antidepressant medication is part of your treatment plan, it is important to take it as prescribed. Medication is not a miracle cure or a replacement for psychotherapy. What medication can do is to create an inner stability (“take the edge off” as a friend described it) that will allow you to make use of therapy. Some people need to take antidepressants on a long-term basis, while others are able stop the medication after their depression lifts. Consult your medication prescriber to determine the plan that is right for you.
For those people who cannot tolerate antidepressants or for whom they simply do not work, there are other "natural medications" you can try. These include St. John’s Wort and the amino acids 5-Hydroxy-Tryptophan (5-HTP), L-tyrosine and S-Adenosyl-Methionine (SAM). Because even “natural” substances can produce strong reactions in sensitive individuals, anyone taking these remedies should do so under the supervision of a nutritionally oriented physician (psychiatrist, family doctor, chiropractor, naturopath, etc.).
Metabolic & Endocrine Disorders
Finally, untreated endocrine problems of all sorts are recognized as having the potential to cause mood difficulties. The most common of these is depression caused by hypothyroidism (underactive thyroid), which can be successfully treated using thyroid medication. Other medical conditions which may exacerbate or even cause depressive symptoms are chronic fatigue syndrome, candidiasis, reactive hypoglycemia, hormonal imbalances, vitamin and mineral deficiencies, and amino acid deficiencies. Thus, you may want get a complete physical to rule out any of the above conditions before you decide on a diagnosis of clinical depression.
The new science of psychoneuroimmunology clearly documents the impact of the mind and emotions on the nervous system and immune functioning. Developing positive habits of thinking and feeling is an essential part of the success of your “Brain Maintenance” program.
Monitor your self-talk
Words and beliefs have the power to change body chemistry. (Think of how the words “I love you” make you feel.) Examine your beliefs about yourself, the world, and the future, and determine if any of them need changing. Examples of irrational and self-defeating beliefs include “It is important for everyone to like me all the time,” “I must be perfect in all that I do,” “I shouldn’t have to suffer,” and “It is my fault that I am depressed.” Since upsetting feelings come from upsetting ideas, if you question and challenge the beliefs behind your uncomfortable feelings, you can become more and more free of negative emotions.
Many painful feelings are often the result of distorted negative thinking, known as “cognitive distortions”. Some common distortions are: all-or-nothing thinking (seeing things in black-and-white categories); mental filter (picking out a single negative detail and dwelling on it exclusively); disqualifying the positive; jumping to conclusions (making a negative interpretation, even though there are no definite facts that support the conclusion); mind reading (arbitrarily concluding that someone else is reacting negatively to you without checking it out); emotional reasoning (assuming that negative emotions reflect the way things really are — i.e., “I feel it, therefore it must be true; should statements; and personalization (seeing yourself as the cause of some negative external event which you are not responsible for).
Stay in touch with all of your feelings
To remain emotionally healthy, it is necessary to feel the full range of all of your emotions, even the so-called “negative” ones of sadness, fear, and anger. Entering individual or group therapy can provide a safe place where you can learn to identify your feelings and express previously repressed emotions.
Keep a mood journal
A mood journal provides a way for you to monitor your moods and emotions on a daily basis, as well as the external and internal events that accompany them. Tracking subtle shifts in your moods can alert you to the early signs of a depressive downturn, and thus allow you to take action to prevent another episode.
Create a library of positive memories
This is a wonderful, self-empowering technique. Make a list of the ten happiest moments of your life. Go back in time and relive them, using your five senses to recreate, in exquisite detail, those joyful experiences. Then, when you are feeling a bit low or need some inspiration, you can call up those pleasant memories. Because the brain cannot differentiate between a real or imagined experience, its neurochemicals will take on the same configuration as they did when the original events occurred. This deceptively simple, yet powerful exercise, can enhance your mood regardless of the external circumstances.
Unfinished Family of Origin Issues
Work on your unfinished family of origin issues (when appropriate). Unhealed trauma from the past (abandonment, neglect, abuse, etc.) can be an underlying cause of overt or covert depression. One of the most common forms of unfinished business is unexpressed grief. In his famous paper "Mourning and Melancholia", Freud postulated that depression was caused by incomplete mourning. Elizabeth Kubler-Ross identified the five stages of death/grieving as denial, anger, bargaining, depression, and acceptance. When we do not fully grieve a serious loss, we can get stuck in the depression phase. Hence, the incidence of depression in people who have experienced a significant loss in childhood — e.g., the death of a parent — is much higher than in those who have not. Therapy can help you to more fully resolve any incomplete grief you may be carrying, so that a more complete healing may occur.
Find a good therapist
The work of emotional healing requires that we find an ally. There are many types of guides to choose from — psychiatrists, psychologists, social workers, pastoral counselors, licensed professional counselors, drug and alcohol counselors, etc. Locating the right therapist means finding the right fit, just as in a marriage or business partnership. Take the time you need, and trust your instincts. The person you work with will be an indispensable part of your healing journey.
It is also okay to take time with a therapist before you decide if you want to continue with that person. At the very least you should feel safe, respected, and understood by your counselor. The therapist should also be willing to explain his or her therapeutic philosophy, and why he or she is using specific techniques.
Expect ups and downs
The road to recovery is an upward path, but it is not always smooth and steady. Often we take two steps forward, then one step backward. Be patient with yourself and with the healing process. As poet Jack Kerouac said, “Walking on water wasn’t built in a day.”
In my book, "When Going Through Hell…Don’t Stop!", I emphasize that social support is an essential requirement for surviving a depressive episode. Having healthy relationships not only helps to alleviate depression, but also helps to prevent its recurrence. Isolation, on the other hand, makes one more vulnerable to mental and physical illness.
In a groundbreaking study at Stanford University, psychiatrist David Siegel found that women with breast cancer who attended an emotional support group lived twice as long as women in a control group who received no support. In addition, cardiologist Dean Ornish has discovered that intimacy has a pronounced effect on both preventing and healing cardiac disease.
Building a good support network takes time, and the process is unique to each person. It means surrounding yourself with people who can validate what you are going though and who can unconditionally accept you. Some of the members of a support system may include:
- family and close friends.
- an ally such as a counselor, psychologist, psychiatrist, rabbi, minister, priest, 12 step sponsor or friend in whom you can confide.
- group support.
Here is where you can gain (and give) help and encouragement from (and to) others who are going through experiences like yours. In a support group, you learn that you are not alone in your suffering, and that there are others who truly understand your pain. To find a depression or anxiety support group in your area, call your local mental health clinic, hospital, the National Alliance for the Mentally Ill (800-950-NAMI) or the Depressive and Related Affective Disorder Association (410-955-4647).
Other types of group support you may wish to seek out include a 12-step groups, women’s groups, men’s groups, group therapy, or any a self-help group that focuses on a challenge in your life.
In addition to the support of human beings, we can receive from our animal friends, especially domestic pets. The unconditional love that we give to and receive from these beings can be as healing as human love. (This is why pets are increasingly brought to hospital wards and nursing homes.) A loving relationship with a cherished pet provides bonding and intimacy that can strengthen one’s psychological immune system and help keep depression at bay.
Mental health researchers have defined a phenomenon known as “religious coping” — a reliance on a spiritual belief or activity to help manage emotional stress or physical discomfort. It was this type of spiritual coping that led me to my ultimate healing. Here are some aspects of spiritual self-care that can be used to promote emotional serenity.
Prayer & Meditation
The eleventh step of the 12 steps suggests that we “seek through prayer and meditation to improve our contact with our Higher Power”. (It is helpful to think of prayer as talking to God, and of meditation as letting God talk to you.)
If you believe in prayer, take regular time to pray, both by yourself and with other people. Meditation involves stilling the mind so that we can hear the “still small voice” of God within and be open to spiritual guidance. There are many forms of meditation available — TM (transcendental meditation), Zen centers, the books of Buddhist priest Thich Nhet Hahn, or the simple form of meditation described in Herbert Benson’s work, The Relaxation Response. Since many people in the modern world are so mentally active, a walking meditation (consciously focusing on each step) is an excellent way to calm the mind while burning off nervous energy. Spending time in nature is also a fine way to commune with one’s spiritual source.
Whatever your spiritual path, worshipping with others in spiritual community is a powerful way to deepen one’s faith. All spiritual traditions have emphasized joining with others as a way to gain assistance in strengthening one’s spiritual life. One of the Buddha’s main teachings was to “seek the sangha” — i.e. a community of like-minded believers. Similarly, one of the greatest spiritual movements of the 20th century — Alcoholics Anonymous — has made community fellowship the foundation of its healing work. Moreover, as I have discovered, the power of prayer can be enhanced in a group setting.
All spiritual traditions stress service as a part of one’s spiritual path. A fundamental symptom of depression (and unhappiness in general) is self-absorption. Service allows us to transcend our suffering by shifting our focus away from ourselves. As author Tracy Thompson writes in regard to her own recovery, “Help others. Be of service. Only in this way will you find your way out of the prison of self.” In this vein, an article in Psychology Today reports that volunteer work leads to a phenomenon called “helper’s high” — a physiological change in the body that produces physical and emotional well being, as well as relief from stress-related disorders.
The amount of service that you perform does not have to be large. If you are feeling limited in your capacity to give, start with some form of service that requires a low level of commitment — such as nurturing a pet or a plant. Extending yourself even a little bit will be good for the recipient and good for you.
LEADING A HEALTHY LIFESTYLE
Here are some lifestyle habits that can help you to maintain balance and stability in your emotional life:
1) Find ways to create structure/routine in your daily activities. Optimal amounts of structure seem to decrease anxiety and help stabilize emotions.
2) Find ways to connect to the natural world. Whether it’s watching a moonrise over a mountain peak, a sunset over the ocean, or simply taking a leisurely walk in your city park, spending time in nature can elicit a healing connection to Mother Earth.
3) Part of connecting to nature means getting enough exposure to natural light. Many spiritual paths teach that God and light are one and the same. For those people who are light-sensitive, inadequate exposure to light can create depressive syndromes such as Seasonal Affective Disorder (SAD). If you live in a dark climate and suffer from SAD, use full-spectrum lights or halogen lamps to enhance your exposure to light. An hour of exposure to outdoor light in the early morning can also make a difference. Some people find that lighting candles on a dark winter’s day brings warmth and coziness to the environment.
4) Find ways to reduce the stress in your life. Take time to rest and regenerate so that you do not overextend yourself with too many projects or commitments. Because our culture puts so much emphasis on doing, it is important to schedule in periods of time to relax and just “be”. You may wish to meditate, walk, listen to your favorite music, or engage in a hobby where you can relax in a focused way.
One type of relaxing experience that is also good for the body is therapeutic massage. Massage relaxes the muscles, promotes lymph drainage, and stimulates the immune system. Human touch is profoundly healing for body, mind, and spirit.
5) Avoid using drugs and alcohol as a means of alleviating discomfort. While it can be tempting to use alcohol to relax or get to sleep (or to use caffeine to focus), you run the risk of developing a new problem — chemical dependency. Apply the tools described in this section — e.g., deep breathing, exercise, massage, self-talk, 12-step groups, prescribed medication, etc. — as an alternative.
6) When asked for his definition of mental health, Sigmund Freud replied, “The ability to work and to love.” Employment is therapeutic for a variety of reasons; it draws us outside of ourselves, brings us into contact with other people, and gives us a sense of identity and independence. As one middle-aged woman recently testified at a mental health conference, “The most important factor in my recovery was being able to return to work!” Conversely, I have seen depression brought on by a person’s lack of employment, or being involved in work that does not express a genuine passion.
The need for fulfilling work was confirmed by writer/researcher Betty Friedan in her book, The Fountain of Age. Friedan discovered that people aged gracefully when they had close personal relations and were involved in a series of creative projects that gave full expression to their abilities and talents.
7) Closely related to work is the process of goal setting. Goal setting gives you the means to take that imagined future and bring it into the present. In setting goals, we define what we want, and then develop a concrete plan by which we can manifest that good. Goals should be realistic and attainable by small, incremental steps. Having a positive vision of the future gives life purpose and meaning-a powerful antidote to depression. In addition, achieving small goals, especially after a period of depression, can help you to believe in yourself and your ability to change.
8) Try to find small ways to experience joy or pleasure. Create a "Play/Pleasure Inventory Chart." Write down those activities that are enjoyable and sprinkle your life with them-e.g., eating a good meal, working in the garden, nurturing a pet, spending time with friends, etc. Think of things that are fun, used to be fun, or might be fun. You can then schedule times for these activities into your weekly routine.
One type of pleasurable experience that is also good for the body is therapeutic massage. Massage relaxes the muscles, promotes lymph drainage, and stimulates the immune system. Human touch is profoundly healing for body, mind and spirit. While many people are "touch hungry", those folks who have experienced physical violence or sexual abuse may need to be "desensitized" to their negative conditioning around touch before they feel safe and open to its healing benefits. If you think this may be true for you, consult with your therapist or someone who specializes in treating survivors of physical/sexual trauma.
9) Begin and end each day with an uplifting thought or word. You may choose a prayer, an affirmation, or a statement of thanksgiving. There are a host of daily affirmation books and collections of inspirational stories that you can refer to. This simple ritual of focusing on and affirming the good helps to create an optimistic attitude which strengthens the immune system and the body’s ability to cope with stress.
* * * *
As you may have surmised, there is nothing new or radical in what I have suggested. The plan is a simple common sense approach to living a healthy and balanced life. But simple does not mean easy. Developing and sticking to good habits requires persistence, discipline, and diligence (ask anyone who has quit smoking). But the dedication is worth it. Having spent too many days in the dark house, I do not wish to return; and I am confident that neither do you.
There is one final point that I would like to emphasize. No matter how many episodes of depression you have experienced, you are not your illness. The label “depression” does not define who you are but how you are suffering. If you start to believe that having depression makes you inherently defective, remind yourself that you are a normal person responding to an abnormal condition. Your spiritual essence transcends depression and cannot be touched by it or any illness. As the great 20th century visionary Pierre Teilhard de Chardin put it, “We are not human beings having a spiritual experience. We are spiritual beings having a human experience.”
Above all, try to be at peace with your condition. Some people have diabetes, others heart disease; you get to deal with depression. By applying the strategies described in this section, and by drawing upon other resources in my book "When Going Through Hell.... Don’t Stop!", you can take small steps to improve the quality of your life. Remember, life is not always about fairness, but about how gracefully we learn the teachings of our unique path. Best wishes on your transformational journey.
Copyright 1999. Reprinted with permission.
When Going Through Hell.... Don’t Stop!:
A Survivor’s Guide to Overcoming Anxiety and Clinical Depression
by Douglas Bloch, M.A.
In addition to his compelling story, Mr. Bloch outlines a fourteen point "brain maintenance" program--a holistic approach to the treatment of anxiety and depression that includes: diet; nutrition; exercise; stress-reduction; medication; vitamin, mineral, and herbal supplements; and the importance of creating strong bonds of social support (social isolation is both a cause of and a consequence of depression).
Click here for more info and/or to order this book (on Amazon).
About The Author
Douglas Bloch, M.A., is an author, teacher, and counselor who writes and speaks on the topics of psychology, healing, and spirituality. He is the author of ten books, including the inspirational self-help trilogy Words That Heal: Affirmations and Meditations for Daily Living; Listening to Your Inner Voice; and I Am With You Always, as well as the parenting book, Positive Self-Talk for Children. Visit his website at healingfromdepression.com