Beyond Prozac: A Holistic “Brain
Maintenance” Program for the Treatment of Depression
by Douglas Bloch, M.A.
“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.
*****
Physical Self-Care
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
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.
Abdominal
Breathing
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.
Sleep
hygiene
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:
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.)
Water
intake
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.
Medication
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.
*****
Mental/Emotional
Self-Care
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.”
*****
People Support
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.
*****
Spiritual Self-Care
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.
Spiritual
Community
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.
Service
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.
 This article is
excerpted with permission from:
When Going Through Hell.... Don’t Stop!:
A Survivor’s Guide to Overcoming Anxiety and Clinical Depression
by Douglas Bloch, M.A.
Send $14.95 plus $3.00 postage to Pallas Communications, 4226 NE 23rd
Ave., Portland, OR 97211 or call (503) 284-2848.
Info/Order this
book (at 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. Author's
email is
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