Out of the Blue: Six Non-Medication Ways to Relieve Depression (Norton Professional Books) (2 page)

But, you might ask, people taking antidepressant medications get better, don’t they? Doesn’t that show that depression is a biochemical disorder?

No, not really. We have to be careful not to confuse effect with cause. If you feel better after ingesting cocaine, does that prove you have a cocaine deficiency? No, that would be clearly ridiculous.

Although depression is described by the popular press and the pharmaceutical industry as though it were a single effect illness such as diabetes, it is not. Diabetics produce insufficient insulin, and diabetes is treated by increasing and stabilizing insulin in the bloodstream. Depression is
not
the consequence of a reduced level of anything we can now measure. (Solomon, 2002, p. 21)

There is a substantial debate that has yet to be settled about how much of the benefit of taking antidepressants is due to the placebo effect, but we won’t get into that here except to mention that the placebo effect for taking antidepressants has risen dramatically over the past twenty years, regularly matching or beating the positive effects of medicines in various experiments (Kirsch, 2010; Walsh, Seidman, Sysko, & Gould, 2002).

Before you write me an indignant letter about how you are convinced that depression is biochemical, let me be clear that I am not saying that depression is not biochemical, just that this has not yet been scientifically established. Neither am I in the camp of skeptics who don’t believe that medications work at all (as you shall see in a later chapter). While it is true that the pharmaceutical companies obviously have a stake in convincing people that medications are the only or best choice for treatment and that depression has already been established as a biochemical disorder, and while I believe that one should always be skeptical of claims made by people who stand to gain so much by selling their point of view, I am not in agreement with the belief that “medications are evil inventions of the pharmaceutical companies designed to sell us a bill of goods.” I am merely saying that the cause of depression is probably more complicated than simple biochemistry, and that not everyone benefits from medications or can tolerate them (Lacasse & Leo, 2005; Leo & Lacasse, 2007).

In his moving memoir on surviving depression, William Styron writes,

The psychiatric literature on depression is enormous, with theory after theory concerning the disease’s etiology proliferating as richly as theories about the death of the dinosaurs or the origin of black holes. The very number of hypotheses is testimony to the malady’s all but impenetrable mystery. (2008, p. 141)

Did you know that the rates of depression have increased radically in recent years? Treatment for depression increased by 300 percent between 1987 and 1997; by 1997, 40 percent of psychotherapy patients—double the percentage of a decade before—had a diagnosis of a mood disorder. The percentage of the population diagnosed with depression grew from 2.1 percent in the early 1980s to 3.7 percent in the early 2000s, an increase of 76 percent (Klerman & Weissman, 1989).

Did people’s genetics or biochemistry really change that much in that time? And, yes, this may be an effect of more screening, more diagnosis, or the broadening of the definition of depression, which is part of my argument—that depression has cultural, environmental, and other elements intertwined with it.

There are many theories as to why depression has increased in recent decades, but it is especially surprising to find this increase despite the fact that we now have better medications for depression with fewer side effects. Shouldn’t we now have less depression in our society?

And did you know that immigrants tend to have the same rates of depression as the overall rate in their adopted culture or country rather than the rate of the place from which they came (Wega & Rimbaut, 1991)? And that there are fewer depressed people in poorer nations than there are in richer ones?

Does moving to another country change genetics? Could moving to another place really change one’s biochemistry enough to cause depression? Or prevent depression? Does living in a wealthier or poorer country change your brain, your genetics, or your biochemistry enough to cause or stave off depression?

It seems unlikely, which is why I say that the story is clearly more complicated than simple genetics or biochemistry (Peen, Schoevers, Beekman, & Dekker, 2010).

Having said that, it seems clear that the effects of depression show up in the brain and in neurobiology. Brain scans of long-term sufferers of untreated depression show lesions, scars, and damage in the brain.

But those lesions also develop with long-term stress. And of course, really everything in life is biochemical and neurological. We have bodies and brains and a nervous system. All of those are involved in everything we do—including reading these words.

What I am saying is that it has not been clearly established that a problem with certain brain chemicals—notably serotonin, norepinephrine, and dopamine, the popular suspects these days—is the cause of depression. The cause remains unknown. Perhaps we will discover one cause someday, but it seems unlikely.

Here is what one articulate and famous sufferer wrote:

I shall never learn what “caused” my depression, as no one will ever learn about their own. To be able to do so will likely forever prove to be an impossibility, so complex are the intermingled factors of abnormal chemistry, behavior and genetics. Plainly, multiple components are involved—perhaps three or four, most probably more, in fathomless permutations. (Styron, 2008, p. 49)

I concur.

A No-Fault Model of Depression

Depression has been significantly destigmatized in recent years. People talk about it on TV, over the radio, in newspaper interviews. Celebrities admit they have suffered or do suffer from depression.

But still, many people who are depressed feel they are somehow to blame; that they are weak or basically bad. One of the appeals of the biochemical/genetic model is that the person doesn’t get shamed for being morally weak or blamed for being depressed.

Alcoholics used to be seen as morally weak or bad people. Then the Alcoholics Anonymous movement came along and convinced most people that alcoholism is a disease, lifting much of the moral shame from the problem.

It helps no one with alcohol dependency or depression to be blamed or shamed by others. People with these issues are often blaming themselves or feeling ashamed already.

So, I will make a plea here for compassion for people experiencing depression. We don’t need to espouse a particular theory of what causes depression to see that people who experience it are suffering enough without adding shame and blame to the mix. If they believe their depression is biochemical or genetic, that’s fine, but we don’t have to have the same view to treat them with compassion.

The other side of this coin is that people with depression are accountable for what they
do
in relationship to their depression. They may feel irritable, but it’s not okay for them to hit people around them and blame it on their depression. I once had a client who came to a session drunk and told me, “You don’t understand, I’m an alcoholic. I can’t help myself; I have to drink.” I told him I didn’t think that AA meant it that way. They meant that he was accountable for his behavior because he was an alcoholic and should therefore avoid drinking that first drink.

It’s a little different in depression in that the depressed person usually hasn’t ingested anything to bring on the depression, but my view is that people are accountable for their actions even while they’re depressed. They’re not to blame for their feelings or their bodily experiences—that stuff just happens. But what they say and do, even under the stress of feeling so hopeless or upset, is their responsibility.

Myth #2: Antidepressants Are the Only Effective Treatment for Depression

The use of antidepressants has grown to be the main intervention for depression in recent years. According to a report by the CDC’s National Center for Health Statistics, the rate of antidepressant use in the U.S. among teens and adults (people ages 12 and older) increased by almost 400 percent between 1988–1994 and 2005–2008. According to this report, antidepressants were the third most common prescription medication taken by Americans in 2005–2008, the latest period for which the National Health and Nutrition Examination Survey has collected data on prescription drug use. In that report we also find that 23 percent of women in their forties and fifties take antidepressants, a higher percentage than that for any other group (by age or sex), and that women are two and a half times more likely to be taking an antidepressant than men (Centers for Disease Control and Prevention, 2011).

Despite such high usage of antidepressants, they don’t work for everyone. In a recent study of people who didn’t respond to the first medications they were given for depression, 30 percent had persistent depressive symptoms even after trying different medications, and about 5 percent got worse on medication (Howland, 2008; Sinyor, Schaffer, & Levitt, 2010).

This myth that medications are the only solution for depression is one of the primary raisons d’étre of this book. If you have followed my arguments above, you will be open to the idea that there are many ways to effectively help people who are depressed in addition to the use of medications.

Brain Plasticity and Depression

When I attended undergraduate studies in psychology, I learned from my professors and textbooks that the brain, after a period of rapid development and change during childhood and adolescence, essentially remains fixed (or even deteriorates) as we age. But since those ancient days of my college years, it has been established that people’s brains can and do change in response to their experiences all throughout their lives. Talking changes our brains. Taking a new route to work changes our brains. Learning a new language changes our brains.

It has been shown that depression is associated with decreased brain plasticity and slower brain growth. Fewer brain cells are born when people are under stress—and being depressed is certainly stressful.

So I’m going to propose some ways to change the brain and the depressive experience that don’t involve taking medications, since, as I mentioned above, medications don’t always work, often involve unwanted side effects, and are wholly unacceptable to some people.

Myth #3: Cause Determines Intervention

If you believe in the “mind-body connection” that has become a popular notion these days, you can understand that even though a lack of massage, for example, doesn’t cause anxiety, massage may help in decreasing anxiety (Bauer et al., 2010). Acupuncture can reduce pain. My point is that there are many entry points for relieving depression, and many of them have nothing to do with the causes of depression. We don’t always need to nail down precise causes before coming up with interventions. Indeed, one of the first antidepressants, iproniazid, was originally developed to treat tuberculosis, but was then found to have mood-elevating effects (Lopez-Muñoz, Alamo, 2009).

Even though we know that people diagnosed with manic depression or bipolar disorder don’t have a lithium deficiency, this substance helps them at times. Why? Well, we’re not quite sure, although there are theories about it. Lithium has been used in treatment for over seventy years, even though psychiatrists don’t know exactly how it works. Luckily for those who have benefited from taking it, practitioners didn’t wait until they knew why it worked before they prescribed it.

I make the same case for many of the interventions I will detail in this book. Some haven’t been empirically validated yet, but they may well be the thing that helps someone desperately in need of relief. And they definitely have fewer side effects than medications.

Okay, so what are these alternative treatment approaches? There are six of them, and I will list them in the next section and detail them in subsequent chapters.

THE SIX STRATEGIES: NEW POSSIBILITIES FOR EFFECTIVE INTERVENTION

A while ago, I came across a quotation by Emile Chartier: “There is nothing as dangerous as an idea when it is the only one you have.” That made me chuckle, but there is deep wisdom in those words.

Because each person experiences his own variety of depression, we need to help each individual discover his own path to healing and getting better—a path that perhaps no one has ever taken before and may never take again. This doesn’t mean that we can’t have general guidelines and ideas, but it does mean that not every approach works for everyone and that we ought to be flexible enough to let go of what doesn’t work and embrace what does, as long as it doesn’t cause more harm or suffering or treat anyone with disrespect.

As the title of this book indicates, there are six strategies that I and others have found helpful in relieving depression. These alternate approaches may prove helpful for clients or patients whom your usual treatments have not helped or as a supplement to your current methods and approaches. All of these approaches can be used singly or in any combination.

The strategies are:

1.
Marbling depression with non-depression

2.
Undoing depression

3.
Shifting your client’s (or your own) relationship with depression

4.
Challenging isolation and restoring and strengthening connections

5.
Envisioning a future with possibilities

6.
Restarting brain growth

Each of the next six chapters will take up and detail one of these strategies. If any of these strategies helps even one person find her or his way out of intense suffering and experience relief, I will consider this book well worth the time and effort it took me to conceive and write it.

CHAPTER TWO

Strategy #1: Marbling Depression With Non-Depression

There is evidence that people in certain states have associated memories, thinking styles, coping styles, and activities. This is called “state-dependent learning.” Since people in depression tend to remember mostly depressing memories and lack ready access to important resources that could help them move out of depression, this first non-medication strategy for relieving depression involves going back and forth between discussions and investigations of depressed experience and non-depressed experience, marbling together different states to help people get unstuck.