Almost all of my clients, and I now have 12, are depressed, or depressing themselves, or exhibiting depressive symptoms – whatever you like. Some of them refer to the handy television commercials in lieu of a description of their actual symptoms –  “I feel like that commercial with the black cloud,” they tell me. Then, it’s up to me to sort out whether to refer them for medication evaluation, or, they ask for a referral, or they might say they will never take medication for depression. It just depends.

Depression is, indeed, a collection of symptoms with physical causes. What is neglected in that statement and the cloud commercials is the connection between mind and body. We think, the thought triggers an emotion, i.e. a chemical reaction in the brain. The more we think we are helpless, hopeless, or hapless, the more we feel that way. The more we feel that way, the more we interact with the world that way, and the more negative responses we get that lead to negative thoughts, and more emotions, and more choices…you see the pattern. It’s a downward spiral. We can only take so much of this negativity until the body shuts down to take a break from the load. By slowing down and withdrawing, it numbs us enough to take a break from the suffering. Our bodies are much smarter than we realize!

I am not personally one who thinks everyone with depressive symptoms should be on medication. I think it always makes sense to try to address the underlying causes, but sometimes medication can help if someone can’t even muster the energy to pull themselves out of bed or whatever black hole they are in to examine what’s making them feel this way. With that in mind, I want to share my perspective on some things to consider before deciding whether depression meds are for you.

1. Depression can be a side effect of some medications, like blood pressure medication, for example. Read the insert that comes with your prescription, or ask your pharmacist. Don’t be discouraged by a response of “that’s really rare” – just because most people don’t experience a certain side affect doesn’t mean no one does! Rare means some people do have it, and there’s no law that says it can’t be you. Especially if you are: a sensitive person, on a lot of medication that could interact, or have reacted to other medications. Ask your doctor to help you find one that works better for you. There are lots of other drugs to try.
2. Depression could be a reaction to continuous messages of “I’ll never be good enough”. These messages stem from various sources, such as perfectionism, hypervigilance, and an endless stream of self contempt in thoughts and actions. Lack of self-acceptance and kindness toward ourselves can have dramatic consequences. Brow beating ourselves for every mistake leads to lack of compassion for others, as well. The messages might be aimed at protecting us by forcing us to try to be our best, but this all-stick-and-no-carrot approach is little more than psychic violence. Who wouldn’t eventually give up or have a nervous breakdown being held captive and tortured this way?
3. Depression can be a result of living in a situation that is stressful, and seems to have no end in sight. Like the battered woman who can’t stay or go, any time we feel trapped we can put ourselves at risk for depression. Staying in the job we hate, the marriage that is over, the friendships that bring us down, can all contribute to feeling hopelessness, one of the hallmarks of depression. Delaying resolution to ethical dilemmas, or any major decision, for that matter, will have its price. It wears us down, sapping our energy and making it harder and harder to take action.
4. Depression can be a result of poor self care. We pay lip service to self care, when, at least in my book, it is king when it comes to mental health. Skimp on sleep and your coping, patience, focus, decision making ability and mood all suffer. Skimp on food, and you get more of the same. If you are a sensitive person, have a history of trauma, or are in a stressful occupation, and you don’t practice intentional periodic relaxation or exercise, expect your mental health to suffer. If you eat nothing but fast food, live on coffee, skip meals, smoke, do drugs or drink a lot, or eat a lot of sugar, any one of these can wreck your feelings of mental well being. If you have crappy boundaries and can never say no to anything, expect your mood to suffer.
5. Depression can result from isolation. And being depressed makes us want to isolate. It’s a vicious cycle. The cycle can only be broken by reaching out or letting others in. We humans aren’t meant to live in isolation, and our bodies let us know this when they become depressed.
6. Grief can become depression. Are you experiencing the sadness that can accompany a loss, or are you stuck? It can be difficult to tell the difference sometimes, and despite clinical descriptions of the time length for mourning, there is no rule for its duration. But, if you feel like you’ve been grieving a long time with little or no relief, it may be time to talk with someone about it to sort out whether it’s grief or depression.
7. Some legs of our spiritual journey can resemble depression. We might experience the kind of dampening of our emotions and senses that accompanies a spiritual transition, but is not depression per se. It has some similar features, but it is essentially about our spiritual process and not necessarily related to any of the factors listed here. It’s just a sort of emptying out, to prepare for the new. Again, you can check this out with a spiritual teacher or mental health professional if you have concerns.
8. Natural remedies are readily accessible and have been found very helpful by many people. EFT, meditation, and exercise have been found to be at least as effective as prescription medication, and are free and fairly easy to accomplish. If you are looking for a supplement, you might investigate SAM-E, Valerian, St. John’s Wort, fish oil, vitamin d3, and GABA, all shown to positively affect mood. If nothing else, take your multivitamin, or at least a b complex supplement. Chronic stress depletes your b vitamins, and your brain is fairly dependent on these water soluble nutrients to maintain balance. Since they are water soluble, that means they flush out of the system and you need to replace them regularly. Some people describe the effect of adding a daily b complex to their diet as “like somebody turned the lights on”, and they don’t cost much.
9. Item #2 revisited: cognitive distortions. This is a fancy word for errors in thought, like black and white thinking, generalizations, and catastrophizing. In short, we all have habitual patterns of thought, to some degree, that are flawed or incorrect, and that cause us continual pain. A common example is when we think since something isn’t the way we expected, then it must be wrong, bad, or ruined. Extreme words like “always” or “never” can be clues. Errors in thinking are ubiquitous, something I teach all of my clients about, and their impact on mood cannot be understated. This will be the subject of an upcoming post. Stay tuned.