about depression...

After my last post about the autumn, a lot of questions about depression have been coming up. Naturally, people are curious what they can do about seasonal depression, and likewise about their mood in general. 

It's late winter now--we're past the new year and most people's enthusiasm for cold and dark seems to wane sometime around this point. A colleague of mine recently thoughtfully noted to me though that we're actually past the worst part: the solstice--Dec 22nd--is the longest night. We're on our way out now. If you're dealing with seasonal depression, keep this in mind. It will be coming to an end soon. 

Different people experience seasonal depression differently: for some the worst part is the fall. For others, it's the mid-winter darkness. For yet others, it's the sheer longevity of winter or the contrast between the urge to nest and the demands of work and life. Whatever your experience, remember to be kind to yourself. Vitamin D supplements, light therapy, and being around warm people all will help. But something easily overlooked is curiosity about your experience: it's very easy to jump into a mode of fixing things. When it comes to the mind, fixing things doesn't always work. 

More about depression in general...

The most important take home message about depression: 

If you're dealing with depression, you're not alone. Depression is very common. A BBC News article came out last November about the global impact of depression. Depression, is, perhaps surprisingly, a global issue. 
I say "perhaps surprisingly" because a common feature of depression is a feeling of aloneness, alienation, or lack of support or understanding from others. It can be hard to believe others feel exactly the same. Other common symptoms are hopelessness, self-blame, feelings things will just continue like this forever (remember what I said? winter is going to come to an end), lethargy, poor (or over-active) sleep, changes in appetite, certain kinds of obsession, and (in some cases) suicidal thoughts.  Culturally we also tend to sweep depression under the rug, which can add feelings of shame and the need to hide. In truth, these feelings are symptoms, you might say, of something all-too-common. 

It didn't always used to be so common. We don't know why, but depression has increased significantly over the last century. Nobody (as far as I know?) clearly understands why. Perhaps it's something to do with modern lifestyles? Or with lack of community? Other changes in social structures? The industrial revolution?... There are many theories.

In contrast, I talk to many people who understand depression (and most mood problems) as the result of a chemical imbalance. Usually people are referring to the theory that mood is tied to serotonin levels in certain parts of the brain. SSRIs (Serotonin Synaptic Re-uptake Inhibitors) work based on this theory... Though, truthfully, at this point, nobody is sure how exactly neurotransmitters, especially in relationship to one another and to experience.

One very important thing to remember is that brain chemistry (in whatever form) is not a one way street. Often, when someone tells me he or she has a "chemical imbalance" it's a way of saying, "It's not my fault I feel this way--it's biological!" On the one hand, I agree with the sentiment of blamelessness: it's not going to help to say it's your fault you're depressed. Remember self-blame is a symptom of depression (I listed it above)--getting mired in self-blame usually worsens the depression. On the other hand, when someone says his or her depression is biological, it's usually a way of saying nothing can be done about it except a pill.

In a perfect world where antidepressants worked like antibiotics or athletes feet creme, that would be fine: you could say, "it's a biological problem!," take a pill, and be better. But depression isn't like that. Antidepressant medications, when they work, may address a chemical imbalance, but they re-balance it only temporarily. Don't get me wrong--antidepressants can be great tools on the path of recovery, but the real work of depression is to change brain chemistry by changing how one thinks. 

This isn't as hard as you might imagine. We've actually been changing our brains for thousands of years. It seems that that's what our brains are actually built for. We used to think that people would learn stuff and their brains would change until they hit their mid-thirties and then their brains would start dying and it was all downhill from there. We know now that this is very far from the truth. In fact, neuroscientists have been noticing how much what we do with our minds changes our brains. A great layperson's book about this is The Brain That Changes Itself by Norman Doidge. In both classical Buddhist thought and in Cognitive Behavioral Therapy, the idea that thought creates mood (and even one's experience of reality) is well established, and both traditions contain powerful techniques for changing how one thinks. Happily, psychotherapists (at least ones like me) are learning from both of these lineages.

If you're looking for a practical take-away, remember how I started: first to remind yourself that you're not alone. Get yourself whatever kind of help you need: see a therapist, a psychiatrist, or your doctor and talk to warm friends. If you're noticing suicidal thoughts, utilize lifeline or contact emergency services for your area (link is for Western MA). Like my colleague pointed out, the darkness will come to an end.

 

Fall, depression, grief, and abundance

Fall can be a rough time for people. There are lots of interesting studies and anecdotal evidence about winter being a time when people deal with Season Affective Disorder (a term used as a fancy name for seasonal depression, usually). I think Fall sometimes gets under-considered compared to winter in New England. Of course, what season can compete with winter in New England? But I've been talking to a lot of people struggling with their mood this fall, so I wanted to discuss it.

It's late fall now.

In the hills where I live, it's frosted a few times, the time change has happened, and the leaves are all gone. I think of Fall as having two distinct phases: early fall, when the leaves are changing and it's windy and crisp--there's the sense of things coming--things happening.

And then late fall, when it's certain that winter is on it's way, the leaves are gone (or at least thoroughly brown) and the air, though still crisp with the sense of coming winter, isn't charged in quite the same way. One can, I think, feel that the energy of life is retreating, moving away from the exposed natural world deeper into the ground, into our bodies, and into our houses.

Traditionally in Chinese Medicine, fall is associated with grief. I think grief is an interesting idea to contemplate. One way of thinking about grief is in terms of what's happened over the course of the year: Summer is the time for play, opportunity, and possibility.

When fall really gets into swing, and the energy of life starts moving inward, this can trigger a sense of grief for what's being lost, and also for what's been missed: the opportunities not taken, the possibilities not explored.

A basic rule of psychology is association:

One feeling of grief or regret can remind you of another--griefs and regrets forgotten can resurface again because of the grief of the season.  The very blowing of the wind through the brown leaves can trigger this feeling. But it can also be more subtle. Even if you're not watching the turn of the season, there's something about the quality of the air that can bring up all sorts of grief and regret. An acupuncturist friend of mine says he can see fall in how people hunch their shoulders. Even if they aren't aware of it, he says, he can see the inward movement in their postures.

In my office, I see fall as trouble sleeping, thinking about things from the past, people evaluating their lives, and people experiencing strong grief or regret about the paths they've taken and not taken. Sometimes this arises in small ways: the vacations they took or not or the summer. Sometimes in large ways: how they've lived their lives or the choices they make 15 or 30 years ago that still affect them now. This is the energy of fall.

If you have many regrets, or are simply sensitive to the nature of things, this can take a lot out of you.

Many people I talk to have trouble keeping up the fast pace of their lives with this sort of inward movement of retreat and grief going on. Usually, I suggest people give themselves a break if they can: the fast pace of our lives these days is not so great for us in any case. So if you can slow down a little (not stop entirely, mind you, but slow down) and feel the pangs of the loss of the warmth in the world, or the loss of some aspect of your life you never lived, do so.

Like all feelings and seasons, the grief will pass. Actually, depression this time of year is the result of trying to clamp things down--trying not to feel the grief and regret, or trying to avoid it at all costs. Chinese medicine would say that this does much harm to our systems--tensing your systems when they should be naturally preparing for what comes next, winter.

Other specific recommendations from my experience and from Chinese medicine are as follows:

  • Move your sleep cycle earlier
    Use the fall time change (fall back!) as an opportunity to go to bed earlier and then get up a bit earlier. The autumn mind is often clearer in the morning, and fall morning air is supposed to be good this time of year to prepare the immune system. Likewise, if you have any tendency toward being a "morning person", you'll be able to use the little extra time in the morning to slow down a bit and prepare--pull out your scarves and hats from the closet--or to at least treat yourself kindly by eating a good breakfast and thinking about your day.
  • Consider not just the regrets and grief but also the joys
    Our minds have a fascinating tendency to look at what's gone wrong. That's alright. But while you're thinking about regrets, consider also what has gone well. If you can't think of anything, look a little deeper. There's no story without at least moments of spring.
  • Welcome the “return of the dead” (a real Halloween)
    Sometimes I think that Halloween was a wonderful idea crafted by smart people who wanted to give people a way to acknowledge the way the past resurges as late fall arrives. Metaphorically, the dead return. Same idea I've been talking about, right? Our modern Halloween is not so contemplative and usually involves dressing up and gorging on sweets (or beer) instead.
    If you can, take a few moments (whether at the end of October or some other time this fall) and acknowledge the dead, so to speak. I often will use the kitsch of Halloween to remind me: I'll look at the costumes and the lawn decor and I'll say to myself something like, "Fall is really here" and let the what comes up come up.
  • Celebrate abundance, the other aspect of fall
    Just like Halloween seems like it could have been invented by brilliant people, Thanksgiving seems like it could be a great opportunity to make the transition into early winter: you've reconciled with regrets and now you're looking at the abundance of what the season has left you: food, friends, family. If you can sort through your feelings and you have the outward circumstances to have such a meaningful thanksgiving, great! More often than not, in my experience, this is not a typical thanksgiving experience. Instead, thanksgiving can highlight the opposite: what's gone wrong, crazy families, regrets, lack. Typically we deal with some performance of family and then retreat into the consumerism and glitz of the holiday season. Sometimes, when I know someone is about to embark on terrible holiday season, I encourage them to make predictions and lists of everything that will come up and go wrong: all the family antics, all the problems and petty arguments or dynamics that will come up. You can try this too: write down everything bad you expect to happen. After doing this, people sometimes also notice the good things (or at least find the humor in the bad things). If you have friends in the same boat, you can also make a game out of it by seeing how accurate the list is: as the holidays happen, check things off. You can see who got the most "points." Then you can have a real thanksgiving (or Christmas or whatever) in which you celebrate your friendship.

Being aware of abundance in this way is great preparation for the winter. Winter, according to Chinese medicine, can give people feelings of anxiety and lacking. Western psychology considers this to be where the real seasonal mood issues set in. You'll do best if you can come into winter with eyes open, focusing on what you've got.

 

-Nick