As spiritual comic Wavy Gravy says, “If you don’t have a sense of humor, it just isn’t funny anymore.” In our current cultural state, we’re working more hours than ever, our debt is expanding, political woes abound and relationship support systems are challenged by stressful schedules. Small wonder that every year, 19 million American adults are diagnosed with some form of depression.
Coupled with this diagnostic boom, prescriptions for antidepressants have skyrocketed in the last decade: In 2002, every third visit to a doctor by a woman ended in an antidepressant prescription. Today, 10 percent of adult women and 4 percent of adult men currently take some kind of mood-stabilizing drug.
This suggests that not only are we feeling down, but we’re also feeling an overwhelming pressure to try to correct that feeling as quickly as possible. After all, given the mounting pressures so many of us experience, who has time to let things get too far off track?
But growing controversy over the safety and efficacy of prescription antidepressants has some people wondering whether drugs are really the instant solution they once seemed. Side effects can range from the mildly troubling — weight gain, loss of libido, headaches and stomach problems — to the gravely serious.
In 2004, the FDA directed the makers of all anti-depressants to add suicide-risk warnings to their labels, after a number of cases where anxiety, agitation and suicidal behavior actually increased during the first few months of treatment with the drugs. While pharmaceutical antidepressants do prove helpful for some, they’re far from the panacea they were originally promised to be. Such mixed results have led to a widespread search for treatment alternatives. In general, both alternative and conventional approaches perceive depression as a similar problem — a chemical imbalance that affects our neural communication systems, preventing positive messages from transmitting from one brain cell to the next, and resulting in an overall systems shutdown that negatively affects both body and mind.
But alternative approaches are less likely to assume that these chemical conditions arose on their own, or even that they necessarily originated in the brain. Rather, more holistic views tend to allow that an imbalance in neurotransmitters may in fact be a symptomatic condition — a physiological indicator of one or more chronic body-mind imbalances.
It’s well established that mental, emotional and physical experiences can produce a significant response (for better or worse) in our neurotransmitters, peptides, endorphins and other biochemical messengers. So it makes sense that changing our experience — whether through exercise, diet, cognitive and emotional patterns, or lifestyle adjustments — might naturally restore better communication in our brains. In some cases, such natural approaches can be as effective as antidepressant drugs (but without the side effects). In other cases, they might help improve the performance of a drug, or help moderate the side effects it produces.
The suggestions on the following pages are meant to be helpful either as alternatives or complements to antidepressant drugs. If you are currently being treated for depression, it’s critical that you consult your health professional before making any changes. Meanwhile, take heart: As powerless as a struggle with depression can make you feel, these strategies show that you probably hold more keys to relieving depression than you realized.
Move Through It
Anyone who has experienced depression knows how hard it can be to get to the gym when you’re having trouble just getting off the couch. But there are solid neurological reasons that exercise should be among your first steps to busting through depression.
In fact, a number of studies show that for many people suffering from minor depression, regular exercise can be as effective as antidepressants in rebalancing endorphin and neurotransmitter levels, and in relieving depressive symptoms.
The body responds to moderate-to-intense exercise by releasing a torrent of chemicals that act on the body’s neurological pathways to improve mood, outlook and pain tolerance. For example, the phenomenon known as “runner’s high” is actually a neurological response to pain — a flood of beta-endorphins (often called “natural painkillers”) produced in response to the run. Of the wide variety of peptides, endorphins and other chemical messengers produced by the body’s glands and organs during and following exercise, many appear to help blunt the body’s pain signals and contribute to an overall sense of euphoria or well-being.
Such chemicals are present in the brain all the time, of course, not just after a big workout. But in people with depression, they tend to run chronically low, which explains the low pain threshold that’s so often a part of the experience: Everything hurts, and it gets pretty scary to move around. But an increase in endorphins can improve this fast, so if you’re going to do one thing, try to make it sweaty — take a Spinning class, ride your bike to work or run.
A 2001 study by the Department of Life Sciences at Nottingham Trent University showed that subjects running on a treadmill at 70 percent of their maximum heart rate experienced a 77 percent mean increase in the concentration of phenylacetic acid in their urine, reflecting a rise in phenylethylamine — a neuroamine known to increase the body’s release of the natural antidepressant and “feel-good” hormone dopamine.
A 2000 study by researchers at Duke University reported that 30 minutes of brisk exercise three times a week may be just as effective as medication in relieving the symptoms of depression and also reduces the risk of relapse.
But even if cardiovascular rigor is beyond your present capacity, there are other forms of movement that have shown great results in shifting depressed thought patterns. While vigorous exercise is beneficial for firing off endorphins that increase resistance to pain, many gentler forms of exercise, such as yoga, qigong and tai chi, can work by different means to effect a rebalancing of the body’s chemical stores and emotional equanimity.
Such forms of exercise encourage the body to shift from a sympathetic (“fight-or-flight”) nervous-system response (known to trigger a pro-depression hormonal profile of glucocorticoids) into a parasympathetic (“rest-and-digest”) response more promoting of calming, cheering and healing biochemical states.
Yoga, in particular, appears to have positive results on both the mental-emotional and neurological- biochemical components of depression, as well as on stress, anxiety and some nervous disorders. The combination of physical postures and exertion, breathing exercises, conscious relaxation and mental focus may positively affect levels of both brain and blood chemicals, including monoamines, melatonin, dopamine, cortisol and GABA (gamma-aminobutyric acid).
While definitive research has yet to be completed, wide-ranging studies of yoga practitioners’ results demonstrate everything from reduced stress-hormone levels to increased positive brain-wave activity.
It should be noted that while yoga is sometimes represented as a “gentle stretching practice,” in fact, many forms of yoga present an intense athletic challenge. So you can easily get the benefits of increased endorphins in addition to parasympathetic stress relief. Plus, you get another important mental-health bonus: yoga’s discipline of approaching the experience of discomfort — your personal “edge”— with equanimity.
Adding a reflective, explorative and self-accepting element to a fitness practice can help us experience, viscerally, an alternative to either running from sad feelings or falling prey to them. We can then apply this wisdom in other areas of our lives.
Eat Your Way Out
“Self-medicating” is a frequently used term when it comes to depression. Alcohol and junk food tend to be the “drugs” of choice, but what a lot of people don’t know is that these substances — and in particular the blood-sugar impact they present — have a direct, negative relationship with your brain’s ability to regulate itself.
In her book Potatoes Not Prozac: Are You Sugar Sensitive? (Fireside, 1998), addiction counselor Kathleen DesMaisons, PhD, outlines a condition called “sugar sensitivity” that she finds common among alcoholics and depression sufferers. Craving sugar and carbohydrates makes a kind of sense, she explains: Because sugar stimulates the release of endorphins, the production of serotonin and a rise in glucose levels in the short term, a chocolate bar or a cocktail can temporarily boost your self-esteem. So cravings derive from some knowledge of what you need: a dose of confidence and a sense of well-being. Sugar gives you that. So does crack cocaine.
DesMaisons recommends keeping a food journal, where you track your diet and your mood simultaneously, noting where sugar (or carbs or alcohol) and despair tend to join forces. Then she recommends shifting your diet to include more high-quality protein (a much slower-burning fuel), fresh vegetables and complex carbohydrates (such as whole grains and legumes), and ditching the sugar and refined carbs.
Slower-burning foods are the direct equivalent of a longer emotional fuse, at least as far as your glucose levels are concerned, which is helpful in overcoming the reactive habits that are so often a part of negative thought patterns.
The links between nutrition and depression are receiving increased attention these days. Multiple studies have shown a link between vitamin-B deficiencies and depression; correspondingly, vitamin-B supplements have shown dramatic results in effectively treating depression.
Essential fatty acids (EFAs), including omega-3s, have received similar attention and shown similar promise. These are the building blocks of brain tissue and the raw material for several neurotransmitters, and they tend to be in low supply in the serum levels of depressed individuals.
EFA supplements aim for the same target as many commercial antidepressants, but with fewer side effects. To get more EFAs into your diet, you can include more nuts and cold-water fish, or you can take a supplement such as ground flaxseed, or oils such as flax, evening primrose or fish in liquid or capsule form.
There are also a variety of other nutritional supplements, from amino acids to herbs, that have shown significant promise in treating depression (see below).
While persistent sadness and apathy hardly seem like helpful friends of health and happiness, they may — from a holistic point of view — be performing a service. Misery can be your system’s way of telling you something: that your body is undernourished or overloaded, that it needs to move more, that a relationship or job isn’t working, that you are suffering and in need of change. Depression can be a signal that the current conditions of your life are not sustainable — a signal from the heart that keeps sounding until you listen.
In The Depression Book: Depression as an Opportunity for Spiritual Growth (Keep It Simple, 2004), author and Zen teacher Cheri Huber suggests that the biggest problem with a conventional approach to depression is the tendency to reject and pathologize it completely — before we’ve listened to its underlying message.
Too often, she says, we see depression as just “one more thing wrong with us.” And when we reject our experience, she says, we wind up rejecting ourselves. Not surprisingly, when we practice self-rejection in place of compassion, we only end up more depressed. In fact, Huber sees depression as the result of repressing (or “depressing”) the feelings we find unacceptable.
The idea of accepting depression might sound crazy, or even dangerous, to anyone who has experienced its life-damaging effects — destroyed relationships, the inability to work, attempts at suicide. But what’s intriguing in Huber’s suggestion is the notion that truly recognizing and acknowledging our feelings, without judging them as sick or wrong, can quickly transform the depressive experience from unbearable to informative.
“We are responsible to how we feel, not for how we feel,” says Huber. “As long as we’re depressed, we don’t know how we’re feeling. It’s only when we say yes to ourselves and stop depressing that how we’re feeling becomes available to us.”
In a culture that prizes self-sufficiency, feelings like sadness, loneliness and desperation are often coupled with an intense feeling of shame. There’s a sense that feeling them means you’ve made some kind of mistake along the way. This leads to a frantic effort to stamp out the sensation before anyone sees it, but also before it can offer its message.
Quieting down and agreeing to be fully present with uncomfortable feelings — without judgment, whatever they may be — is an almost revolutionary disruption of the status quo. It’s also the exact opposite of what most everyone else is telling you to do: Snap out of it, get back to work, it’s all in your head.
But as Huber points out, “Depression can happen when you’re trying not to be unhappy.” In that case, it’s not the unhappiness, but the trying to avoid it, that becomes the problem. Lovingly accepting whoever and wherever you are, on the other hand, seems like a tough thing to make into a problem, no matter how you slice it. And once you’ve given yourself that freedom, seemingly intractable mental patterns may finally have the chance they need to unlock.
Entertaining the notion that there’s “nothing wrong with you” can seem counterintuitive when you are feeling miserable. Yet many alternative approaches suggest that the symptoms of depression are evidence your body is doing its job — actively sending signals that can help you restore it to a healthy balance, if you listen to them.
Whatever approaches you choose in responding to depression, choose them with kindness. Know that your body has not betrayed you, nor is it defective. It’s doing the best it can in a tough situation — one that offers more hope and more opportunity than you may think.