It is not news that depression has become a kind of invisible epidemic, afflicting approximately 121 million people worldwide. The World Health Organization ranks depression as one of the world’s most disabling diseases, and our best estimates from population studies show that approximately twenty percent of people will experience a serious, clinical depression during the course of their lifetime.
While depression receives a lot of publicity, its causes remain mysterious, and those who suffer from it tend to hide their condition. Although the medical community now approaches depression as a disease, many depressed people still feel a sense of shame and judge themselves as weak or self-indulgent for not being able to “will” themselves out of their sadness. When you’re in the throes of depression, it’s hard to escape the feeling that you are a failure and that the future is hopeless.
What depression isn’t
The word depression has become commonplace in our everyday conversations, with people using it to describe everything from a passing funk to deep disappointment. You might hear someone say, “I feel depressed about our football team losing,” or “I’m so depressed about not getting to see my daughter over the holidays.”
In fact, becoming sad or blue isn’t a sure sign of depression. Life brings difficulties that we respond to with a wide range of “normal emotions: sadness, anxiety, resignation, confusion, grief and frustration. Moods are cyclical, and if these feelings are your response to a tough event, they will subside on their own in time. If they linger, however, and there seems to be no definite cause or trigger, such as losing your job or the death of a loved one, depression is accepted as the conventional diagnosis.
Depression isn’t one single disorder; there are actually several types of depression. For a diagnosis of major depressive disorder, a person must experience at least five of the following symptoms during the same two-week period:
Depressed mood (feeling sad or empty; being tearful).
Markedly diminished interest or pleasure in all, or almost all, activities.
Significant weight loss when not dieting or weight gain; or decrease or increase in appetite.
Insomnia or hypersomnia (sleeping too little or too much).
Slowing of thoughts and physical movements.
Fatigue or loss of energy.
Feelings of worthlessness or excessive or inappropriate guilt.
Diminished ability to think or concentrate; or indecisiveness.
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide.
If you can count five or more of these as being present, know that your list must contain “depressed mood” or “diminished interest or pleasure” before you would be considered medically depressed. The DSM-IV, a manual doctors use to diagnose mental disorders, also recognizes other types of depression:
Dysthymia is mild, chronic depression. It must be present for at least two years for a diagnosis of dysthymia.
Seasonal effective disorder (SAD) is a form of depression that generally arises as the days grow shorter in the autumn and winter.
Postpartum depression begins after a woman has given birth and may get worse as time goes on.
Atypical depression is characterized by moods that worsen or improve in direct response to events. It is also characterized by overeating, oversleeping and fatigue.
Bipolar disorder (sometimes referred to as manic depression) is a complex disorder in which one cycles between periods of major depression and extreme elation or mania.
The factors that make it more likely you will become depressed form a long list: genetic predisposition, being female, death or loss of loved one, major life events (even happy ones, like a graduation), other mental illnesses, substance abuse, childhood trauma, certain medications, serious illness, and personal problems such as financial troubles or the loss of a job. What all of these things have in common is that they disrupt the normal balancing mechanisms of mind and body.
Even though no one knows exactly what causes depression, it is clearly a state of internal imbalance. Balance is essential for the healthy functioning of both your body and your mind, so a treatment that aims to restore balance to your mind-body physiology can help you return to a natural state of well being.
Beginning the healing journey
There are many things you can do to re-balance yourself. Some people choose to use natural remedies but others believe the first step is recognizing that you’re feeling depressed and seeking help. People sometimes experience depression as a result of an underlying medical condition such as thyroid dysfunction, vitamin deficiencies, or other health issues. Get a thorough medical checkup and let your health care practitioner know your concerns about depression.
The power of being heard
Psychotherapy, or talk therapy, works as well as medication for many people. It may be used alone or in combination with other approaches, including exercise and optimal nutrition. Studies have shown that psychotherapy can cause changes in brain function similar to those produced by medications. Focused, goal-oriented forms of therapy such as cognitive-behavior therapy appear to be the most effective in treating depression.
Meditation: connect to the part of you that isn’t depressed
Meditation has been shown to be a powerful treatment for relieving both stress and mild-to-moderate depression. Numerous studies have examined the effects of mindfulness meditation, designed to focus the mediator’s attention on the present moment. One study measured electrical activity in the brain and found increased activity in the left frontal lobe during mindfulness meditation. Activity in this area of the brain is associated with lower anxiety and a more positive emotional state.
Meditation trains your mind to become aware of the silent witness within you that is independent of the universe you are observing. This core self is not a philosophical or theological concept; it is an experience of your authentic existence. With an established sense of the silent witness, it will be easier not to become identified with the darkness of your depressed days.
If you have major or severe depression, it’s important to proceed with caution. To be of real value, meditation must take you inward; but the deeper you go, the more hidden material will be brought to the surface, including old wounds, difficult memories, and perhaps the contributing emotions that are linked to depression. It’s tempting to use meditation as an escape, but the results can easily backfire. For those coping with major depression, I suggest meditating in a group for only a few minutes a day; or if that is inconvenient, do a simple breathing meditation for about ten minutes, twice a day.
Aerobic exercise is extremely effective for depression. Research has found that moderate aerobic exercise done just thirty minutes a day, three times a week, can reduce or eliminate symptoms of mild-to-moderate depression and can help with severe depression.
It’s well known that exercise stimulates the release of endorphins, the “feel good” chemicals that function as neurotransmitters. Less well known is the startling effect of exercise on the structure of your brain. Exercise stimulates the creation of new nerve cells in the hippo campus, your brain’s center of learning and memory, so that it actually increases in size. This is especially relevant because depression, unless countered with effective therapy, causes the hippo campus to shrink. Exercise has also been shown to raise levels of serotonin and nor epinephrine and to multiply the number of dendrite connections in neurons.
Restore balance through yoga
When we’re coping with emotional pain, a purely mental or intellectual approach usually isn’t enough. Although our mind may try to think its way out of pain, it can quickly become confused or trapped in repetitive thought-patterns that actually intensify our emotional turmoil. When we invite our body and spirit to be part of the healing process, however, transformation can unfold.
The ancient wisdom tradition of yoga offers practices that unite the mind, body and spirit, allowing us to experience deep emotional well-being and restful awareness.
When your physical, intellectual, and spiritual selves are working in union, our life becomes more balanced and we become more flexible – both physically and emotionally.
How yoga releases emotional blockages
Every experience in the mind is accompanied by shifts in the body’s chemistry. When you say, “I feel depressed,” you are acknowledging that your body is generating disturbing sensations. Feelings are so named because we feel them in our body. These sensations result from changes in hormone levels and in the pattern of nerve firings within your nervous system. These physiological shifts can persist long after the emotionally upsetting experience that first triggered them. Over time, your mind-body system reflects your emotional history.
Through yoga, you can release the emotional toxicity stored in the body. Just as changing thought patterns can influence the body, changing the position of the body can influence the mind and facilitate emotional release. As you stretch your muscles and expand your range of motion, you shift the bodily patterns that trap emotional pain. Yoga poses, breathing practices, and meditation release the constriction and free the flow of the vital life-force energy known as prana. For instance, slow, deep, conscious breathing is very effective in prompting the relaxation response to counter elevated levels of stress hormones.
An important component of yoga is paying close attention to what’s going on in the body at all times and locating and releasing any areas of tension. Although you can feel thehealing effects of yoga after just one session, a regular practice is required if you want to experience the full benefits yoga offers. In addition, yoga should ideally be practiced with the guidance of an experienced teacher.
There are many yoga styles and traditions to choose from. Some have a greater focus on physical fitness, while others are more meditative and spiritually-based. It’s important to explore and find a practice and teacher that resonate with you.
Examine your reactions to difficult situations
You will often find that reacting with helplessness, retreating inside, and turning passive lie at the root of your depressed state. We all have self defeating responses, but we rarely take the time or effort to replace them with better alternatives. Here are some alternatives to the thoughts that automatically come to mind when you feel depressed.
Example 1: I’m not good enough.
You can replace this response by telling yourself: I am good enough. My essential nature is whole, perfect, and complete. I am completely lovable as I am. I let go of the need to compare myself to others.
Example 2: Nothing will work out.
Instead, you can repeat to yourself: Life always leads me in the right direction. The universe is conspiring in my favor. The perfect solution is unfolding for me right now.
Example 3: I can’t do anything
Instead of getting stuck in feelings of helplessness, start to affirm: I always have choices and opportunities. My life is constantly improving. I see new possibilities in every moment.
Start to recognize your depressed responses and learn new healing responses to replace them. Be patient with yourself and know that at first, you may not believe what you’re telling yourself. Do the affirmations anyway and you will notice a shift. Refuse to believe the dire messages your mind is generating; they are simply conditioned thought patterns that you have created – and you have the power to create new, more nurturing beliefs. This takes time and effort, but the rewards are well worth it.
Eat a mood-boosting diet
Diet may play a part in protecting against depression. Mediterranean countries have low rates of depression compared to countries farther to the north — and it isn’t just because they get more sunlight or have a more relaxed way of life. One large-scale study tracked almost 3,500 people living in London for five years and found that those who ate a Mediterranean diet were thirty percent less likely to develop depression.
Researchers speculate that the foods in the Mediterranean diet may act synergistic-ally to enhance mood. Olive oil, nuts, and fatty fish are rich in omega-3 and other unsaturated fatty acids that can help restore balance to the body. Fresh fruits and vegetables contain flavonoids and phytochemicals that are full of antioxidants and folates (B vitamins).
Cultivate self-love and acceptance
Depression is sometimes described as “anger turned inward.” Many people were taught growing up that it isn’t polite to express anger and other emotions. They push their “unacceptable” feelings down for many years, but ultimately these disowned feelings may manifest as depression. If you have been suppressing or judging certain of your feelings as “bad” or dangerous, you may feel a sense of numbness and disconnection from yourself and others. If you can learn to remove that wall and accept, acknowledge and love yourself completely, you may find that depression natural dissipates.Re-establishing this connection inside you is not difficult, but if you have developed a habit of avoiding yourself or your feelings, it will require some discipline and commitment to overcome the old patterns and establish new patterns. Here is a practice that can help:
Begin by writing all your feelings, judgments and sensations in a journal at the end of the day. Pour it all out on the page without worrying about organization or whether it is worth writing down or not. Do this for nine days with the intention of being as complete as you can be each day. At the end of this period, you will have noted certain themes that have developed. For example, you might find yourself writing about how often you feel bored by people.
Now during the day, when you notice one of these themes, such as boredom, be aware of what you are feeling. Enter into the experience without judgment and allow yourself to feel how your body responds to it. Notice your breathing, your body language, your tone of voice, muscle tension, where you mind moves to distract you – notice everything you can with loving indifference. You are neither approving nor disapproving of your behavior, neither trying to change it nor keeping it the same.
Maintain this gentle self-awareness of those behaviors that are walling you off from yourself for two weeks. Without trying to change your habits, you will find that just by being fully present and aware, the grip of the old habits will fade and new fresh and spontaneous responses will take their place. Listen and notice the new growth of what is starting to emerge in you.
You will start to release a lot of physical and emotional tension at this point, so you will need channels to release it. You may want to try yogasanas, swimming, massage, dancing and singing. Let your heart guide you to any music, movies or natural surroundings that can also support your release process. When you feel you are ready and if you feel you have a friend who can understand what you are doing, tell them that you are working on opening up and feeling life more completely. Ask for their support and understanding during this transition. If you don’t already have a therapist, you may want to find one to help you with the release process.
When you wake up parts of you that have been anesthetized for years, the first things that you feel again are not usually pleasant and happy, but these difficult sensations are what you need to go through to reclaim your full feeling and functioning. So if you go through periods of dark despair and self-loathing, know that it is the toxicity of the repression that is being cleared out and after that is released, the genuine expression of yourself will shine through.
What about antidepressants?
For more than twenty years, the conventional medical model has held that low levels of neurotransmitters in the brain, such as serotonin, dopamine, and nor epinephrine, lead to depression. According to this model, antidepressants increase the levels of various neurotransmitters, thereby improving mood. However, researchers have yet to find a causal relationship between low levels of neurotransmitters and depression.
In fact, recent studies suggest that depression starts higher up than chemicals. It starts with the formation and function of neurons. In other words, the brain cells in Many depressed people are adapted to express their depression. This takes the form of neural pathways that carry a message of sadness and hopelessness instead of those pathways that carry a message of happiness and optimism. Some important research studies have found that antidepressants are only marginally more effective than the placebos (sugar pills or saline solution) to which they were compared. Other researchers have found that talk therapy is just as effective in changing the brain responses associated with depression.
Important note: I want to emphasize here that severe depression requires medical treatment of the most intensive kind. Millions of people testify that antidepressants have relieved their suffering when nothing else helped. On the other hand, many people who don’t truly need them are being prescribed antidepressants. Instead of undertaking cognitive therapy, looking at the underlying issues of their depression, or trying other approaches, they are taking pills because it’s easier to do that than to look at long-standing emotional patterns or difficult relationships. This trend is particularly prevalent in the U.S., whose population makes up approximately four percent of people on the planet yet consumes two-thirds of the world’s supply of antidepressants.
Seriously consider whether you need antidepressants and ask your health care provider about other options. In general, antidepressants should be used as a short-term aide. They work best in removing the top layer of sadness so that you have a clear space to address the real underlying issues. The real goal should be to re balance your life, gain control over the disorder, understand who you are, and elevate your vision of possibilities for yourself.
Further support for the journey
Since all of the suggestions above require a choice, bringing yourself back into balance means that you are aware enough to make decisions and have the ability to put them into practice. Be patient with yourself and don’t expect any single practice or technique to completely end the depression. What you are looking for is support for your inner healing intelligence to correct the imbalance, and that usually doesn’t happen instantly, especially if you’ve been suffering from depression for some time. Quite often, depressed people feel too helpless and hopeless to make the most healing choices, in which case outside help is needed, meaning a therapist or counselor who specializes in depression. Remember that the rewards of freedom and joy are worth the effort.
As you continue your healing journey, know that the real you is not depressed and never has been. Your essential nature is pure love, pure spirit, and pure potentiality. By setting out on the path to uncover the real you, you will accomplish more than healing your depression: You will emerge into the light and see life in a completely new way.
Deepak Chopra, MD, FACP, founder of The Chopra Foundation, a non-profit entity for research on well-being and humanitarianism, and Chopra Global, a modern-day health company at the intersection of science and spirituality, is a world-renowned pioneer in integrative medicine and personal transformation. Chopra is a Clinical Professor of Family Medicine and Public Health at the University of California, San Diego and serves as a senior scientist with the Gallup Organization. chopra.com