DEVASTATED, NOT DEPRESSED
NOTES ON DEPRESSION
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Depression is much ore than being "depressed." Instead, it is a chronic state, that does not go away easily or quickly, resulting from biochemical or psychochemical imbalances or deficiencies in the brain itself. Real depression almost always requires professional treatment, so this booklet is to be seen, never as a replacement for that treatment, but only as a supplement. Nothing matters at all. This is a common attitude of those who suffer from chronic depression. Thy use words such as "overwhelming," and "paralyzing" when describing even the ordinary activities of everyday life.

In depression, there are three liberating truths that you need to realize:

1) The ways in which you are viewing the world do not represent a discovery or revelation, but rather a distorted and false picture of reality, the result of biochemical imbalances. Make certain minor alterations in the brain, and low and behold, the world can become once a gain a happy, creative, and unfullfilling place.- * Also, the way in which you now view the world is soon going to change, and you will feel better.

2) You are not evil or bad, but ill.

3) You are never worthless. God doesn't make any junk, and the universal Mind has created you for a particular and specific purpose. And you are not "crazy," but are suffering from a relatively common chemical problem involving a complex multilevel composition of hormones, neurotransmitters, and thousands of other molecular and cellular components.

The world will not always look to you as it does when you are in the midst of depression. Know that all things change, continuously, and the condition in which you find yourself, if depressed, is no exception. That, too, will change in time.

One factor that can enormously exacerbate the effect of depression is the need to pretend always not to be depressed. So, it is therapeutic to talk to professionals about your feelings. Depression is no simple feeling. It contains many sub-complexes within the overall feeling-tone, including anger, pain hopelessness, irrationality, hyper-emotionalism, and apathy. Among these sub-systems complex patterns and relationships exist.

The good news is that depression is one of the most easily and readily controlled of the mental disorders. Since it is not a conscious process all the way, conscious attempts to change have somewhat limited success. Still, a significant number of very competent men and women have made successes out of their lives despite the presence of depression.

Depression is not necessarily a lifelong problem; it can be transitory. But during any six-month period, about twenty-four million people in the US will be wrestling with depression in some form.

It appears to have many causes and contributory factors, including genetic predisposition, the use of certain drugs, altered sleep-patterns, extreme stresses, and biochemical or matabolic disorders. There are no simple solutions, and thinking "good thoughts" is no viable solution, for this is only a conscious process. When symptoms arise, one often feels out of control, which increases irritability. And, although staying busy can help, in the end, hyperactivity alone is not a final solution. What might be a longer-lasting and even a permanent solution is the attempt to lose the self in service of others.

Depression is often affiliated with horrible "what if" games, visualizing horrible events. If one can prevent this situation by refusing those thoughts, to their cultivation, one may solve many attendant problems. Here, meditation can be of great assistance. Being diagnosed with depression may bring simultaneously a sense of relief and shame. First, there is relief that the condition has a name, but here is shame because it is seen as a form of "mental illness."

It is a fairly universal and uniform disorder, and crosses all racial, socioeconomic, educational, and other barriers. It makes crystal clear, in a poignant way, the old adage that money cannot buy happiness. For many who are depressed already have an abundance of the material prosperity of money and things; and buying them new things, or adding to their prosperity, does not a single thing to change their depression a single iota.

At times, depression may be accompanied by other symptoms, such as paranoia, or even pain in the arms and legs. Effects on memory and concentration may also be obvious. Sleep-patterns are disturbed on such a regular basis that one of the main marks of depression is the rising from sleep early in the morning hours.

Almost every depressive has contemplated suicide. When this signal occurs, attention should be paid to it. Depression is also often accompanied by, fatigue but is not the same as, physical or emotional exhaustion. Admitting depression is NOT a sign of weakness, but indicates a certain inner strength. Some forms respond to drug-treatment, but a drug can take from three to six months to "kick in" and have discernable results. Further, once a regimen of anti-depressants begins, it might be a matter of a lifelong program. At least, however, a drug can show you exactly what it feels like to be "normal," and can provide you with a reasonable standard by which to measure your own feelings.

It can also be very therapeutic to discuss your problem, especially with a loving, supportive person. This will help to erase the terrible ignorance that exists, as, for example, when people claim that depression is self-created.

More good news: Ninety-five percent of people who suffer from depression find workable solutions. The important thing is to get help. This is usually of a professional nature.

The word "depression" describes an entire spectrum of conditions. Some of it is "exogenous," that is, caused by the environment. Thus, a person who has a crisis will undergo a temporary state of depression, as a natural response. Chronic depression is marked by three factors:

1) how you have experienced your symptoms;

2) how long they have lasted; and

3) how much they interfere with everyday functions of life.

In "bipolar" depression, sluggish states alternate with those of excessively high, uncontrollable energy; but in "mono-opolar" depression, it remains a steady state.
A major symptom of depression is the loss of interest in things that previously gave pleasure. In some cases, this leads to the inability to enjoy anything; a condition called "anhedonia." In order to quality as a symptom, this must occur every day, most of the day, for at least two weeks. It must also be accompanied by a loss of appetite and change in sleep-patterns. These are usually accompanied by fatigue, loss of energy, feelings of worthlessness, guilt, difficulty in thinking or concentrating, and thoughts of suicide or death.

Headaches, stomach disorders, tingling in arms and legs, or fainting might also be a part of the profile. (The technical name for bipolar disorder is "psychothymia," while that for depression is "dysthymia.") If a depressive state lasts for two weeks or more, it is called "dysphoria."

SUBCLINICAL CASES.

Some people have symptoms similar to, but milder than, those mentioned. In these cases, there might be a case of "subclinical" depression. While not as serious as other forms, it still interferes with every day life. These cases generally include people who complain too often of fatigue, and have problems with eating and sleeping.

Most diagnoses are made on the basis of history, not on the basis of clinical or lab tests. Purely medical causes can include drugs, thyroid disease, adrenal disease, and some forms of hypoglycemia. Stress might not cause the se conditions, but certainly exacerbates them. A rule of thumb is: the longer that you have had the illness the less relevant stresses are. (See the booklet, "The Distress of Stress," in this same series.) Due to contributing biochemical factors, females are twice as likely as males to suffer from clinically chronic depression. Significantly, after menopause, many forms of depression simply disappear.

People who have never experience depression cannot possibly understand what it feels like. For, in its deepest throes, nothing can make you feel better. This deep profound depressive disorder is often marked by tearfulness, hopelessness, over-eating and over-sleeping. People in this state might become addicted to their own adrenaline, and may run from their problems over and over again. On the other hand, they might just as easily hibernate; and they often suffer from panic attacks.
Since self-blame and self-loathing might be a major contributory factor, it helps to recognize the disease is a chemical and physiological one. The total solution is psychobiological. That is the answers are partly found in biology, and partly in psychology.

Depression is universal, and found everywhere. But when it becomes regular and chronic, it becomes a syndrome. It comes in many forms: 1) Circumstantial, coming form the environment 2) developmental, arising from childhood experiences 3) as part of another, larger syndrome, i.e., post-traumatic stress disorder. In some people, not being able to express anger in some real, but unharmful way is a cause. This is especially true in the case of people who claim never to be angry, who mistake that for a virtue.

Depression, however, has no single cause because there is no such ting as a typical human being. An event that affects one person not at all might send another into a tailspin of depression.

Depression has been described as sadness amplified. It can be so paralyzing that a person does not want even to get up in the morning. People in this depressive "pit" do not want to do anything, or to see anyone. This usually involves some component of deep self-obsession, a self-involvement with one's own feelings to the exclusion of other factors. Thus, it can appear as a form of ego-pain. In this condition, a sense of time might disappear, and one may lose sense of personal hygiene. It is no less than astonishing just how quickly the mind's negativities can take over. Also, the desire to communicate may disappear. One might not care at all about what others think. Inthis extreme form, depression might be even a kind of karmic self-punishment, a kind of self-imposed emotional "exile." or deprivation. Ther is usally as ense of heaviness, oppression and self-pity (as in, "No one understand me.")

Depression is not so mucha a way of thining as it is a different way of feeling. In some cases, it is marked by over-sensitivity, over-reactivitity, or even paranoia. At this serious phase, workaholism often appears, anditself is a danger-sign.

MANIC PHASES.

In bipolar conditions, these can be of long or short duration. One may set superhuman goals, and patience may be non-existent. One might feel "on top of the world," and since one feels that help is unnecessary, it is necessary to get professional help as soon as possible. Whenone finally crashes back into depression, it may last as long as a year. Sometimes this phase includes biolence, and people always say things tht thye do not mean. Theymight go for days without sleep. Some become sexually hyperactive. When they findally do 'CRASH," Hhowever, they are so humiliated that hrie depression is even deeper. Usually, this is exacerbated by exhaustion. This is NOT schitzophrenia. However, some manic people do become psychotic during the manic phases. In extreme cases, they might even hallucinate, or become delusional.

The good news here is that peoplewith bipolar problems rtend to get completely well when treated.

CRASH' INTO DEPRESSION.

When depression returns, ambition often dries up entirely, and mone might have to have friennds "push" one towards goals. Sometimes, in depression,t hereis the fear that it will never end or stop. Fortunately, however, it is a self-limiting and self-correcting condition The mindis always drivin itesel towrds balance.

If appropriate, this problem mightt need to be discussed with an employer. Emphasize that a depressed person is not necessarily a poor employee, but is simply suffering from a chemical disorder. For many people can be "functional depressives," which means that htie conditionsdoes not necessarily affect job-performance.
Since depression is very treatable, people who have it can lead normal and active lives, if they get treatement.

SUBSTANCE ABUSE

is comon among depressives, to dull their pain. Butit tends to make maters muc worse andmore complex. Further, some durugs can mask, hide, oreclipse a real problem with underlying depresison by keeping symptoms artificially at bay. On the positive side, for some peple, treatment with lithium compounds have made all the difference in the world, inthe treatment of bipolar conditions.

To believe that yhou must remain medication-free is very short-sighted,and can dangerously lengthen the problem. Some people even try to "self-medicate" with alcohol. But alcohol is a cause, not a solution, for depressive problems. Its effect on the brain is that of a depressive. So it is bounfd to make matters much worse in the long run, and will demand its own payment sooner orlater.

Dissociation from society is a false "soulution" that has a terrible and high payment. For when one is suffering from derpession, human contact, and human love, is MOST needed. Any durug, in fact,t hat make syou "high" is very likely to cause aor create depression, andnever will solve it. For drugs that crate "highs" have reboudn effects, including depressions, anxieties, and stresses.

In some cases, the brain's natural reward-systemseems to shut down, so that no matter what one does, the brain no longer rewards by produding natural good feelings. A cause of this kind of phenomenon might be perfectionism. Never demand more than your best. It is all right to demand your human best, but remember that this will always be flawed, never perfect. If you must, allow yourself xUDL number of errors daily, in recognitionof your humanity, and freely forgive yourself.

The glorious day that one finally sees beyond the gloom of deepression,the world grows instantly brighter. Anti-depressants are drug-agents designedto do exactly this, and are not addi tivve, and do not make one "high." The use of drugs, such as lithium, however, is onlya beginning, and should be combined with tgherapy to maximizetheri effects. On the other hand, therapy must often becomibined with psychoactive drugs; therapy and chemistry ar like the two wings ofthe same bird.
Whateve the path, one this is certain: The bipolar or depressed person does need extra emotional support.

SUICIDE.

A major problem with suicide is that it affects far more peoplethan simply the one wanting to leave this world. It is also just as morally or spiritually erroneous to kill the self as it would be to kill any other living, sentient being. It shows a fundamental disregard for life, and tht one does not love oneself. (Of course,t here are exceptions, but it is hardly up to us to judge when and what those may be.) For far too many, suicide is an "easy way out," an avoidance of problems. But, inthelong term, it will gain them nothing, since they will come back,, sooner or later, to the exact same predicament that led tot heir suicide. Since this life is comprised of vbarious lessons, an attemtpto avoid themthrough suicide cannot work, inthe long run.

MATERIAL PLEASURE.

In deep depression, it does notmatter what you have, since you cannot enjjoy any of it. UDL FROM 'DOES.'... So, a depressive might be given the whole world on a silver platter,and not become even the tiniest bit more satisfied or happy. The solution does notlie in material provisions, but in treatment and the approaches of psychotherapy and biochemistry.

THE DEPRESSIVE.

His or her personality can move from "heaven" to "hell" in a second. And even if there seems to be nopain, the pointlessness and weariness ofthis life are painful enough. Sometimes,then,the problem has deep philosophic and existential roots, and, ehwn it does, psychospiritual education or counseling are called for. This should be done under the supervision of a non-sectarian, andone should always avoid extremists of any variety. Be ccareful to avoid "help" offered by cult-groups and their gurus. Instead, seek answers in the great and multicultural Way of love. For everyone, no matter how rich or famous, soon discovers that living for trhe self alone is never enough.

A relentless dread, which has no definite object, can accompany some form sof depression. Thismight be connected withthepassage of time, with the occurrence of death, with disease, or with existential emptiness. Like any physical illness, it can return. Only a continuous loss of th self in active, meaningful service seems to comprise an ultimate answer.

When not activated and engaged, the mind can be kept distracted, andthis, in moderation, can also be therapeutic in the short term. Finding, or creating, a meaning for one's life, however, is the only final solutiosn for existential depression.

THE HEART.

People who suffer from major heart-events, such aas surgery, can suffer depressive episodes as a result or side=effect of the heart-problem. All heart-patients are vulnerable and susceptiable to major psychological shifts. For a cardiac event is the best teacher in the world for certain very crucial spiritual lessons, involving the value of physical life, the importance of love, the whortness of physical life, the importance of every moment. It teaches us that the material world is and can be no substitute for a rich inner and spiritual life shared with other living beings. For no material thing int the world can begin to equal the value of the treasure of a deep heart, filled with love.

Besides teaching us ourpersonal mortality in a way that cannot be ignored, a cardiac event can also teach thatwe do not, need not, control everything. Instead, we must learn to trust theprocesses that are controlled by the Mind that is greater than ourselves. Only then can we learn again to relax in comfort in this unpredictable universe. Itis for this reason that inexperienced teen-agers are considered to be the best soldiers. Thy are still suffering fromthe "immortality complex," which states that death and pain can come to other people, but never to me. Facing your own mortality, then, might create a state called healing or awakening depression. For it stimulates the creation of meaning in your life,and this can be found onlythrough the Way of compassion, goodness, kindness, and sharing. So, this form of depression tends to be rather transient, although in extreme cases it can go on for months. It might arise while one is still in the hospital,and is accompanied by a great deal of crying. (Hospitals are neither designed nor equipped to handle one's emotional needs.) The extreme exhaustion, or need to rest, that follows any major surgery may contribute to the state of healing depression.

LOSS AND GRIEF.

Unlike depression, natural grief is considered to be a naturl and healthy response to a situation of great pain, such as the loss of aloved one. While depression often has a narcissistic element, grief often does not. Sadness can rise to incomprehensible heights,a nd be quite overwhelming. If it leads to healthy grief, thenthis form of transient depresison can also be healthy and positive.

Everyone has his/her own individual time-period required for mourning and recovery. After a major loss, a grief-period might last up to two years, or even longer. But the usually intense depression that follows a loss is about six weeks; anything longer than that,if chronic, may represent an onset of real depression. Yet, in rarer cases, grief-periods of greater intensity might last four to five months, without being considered abnormal or pathological. Still, after this period, one should at least begin to live, to "pick up the pieces," to start to live again, to find joy inat least some pursuits and people. During a period of bereavement that lasts longer than this, one should never permit pride to keep one from seeking active professional help-- perhaps spiritual as well as medical.

Of course, low self-esteem only pours gasoline onto the fires of depression, and atherapy should include self-image reconstruction, if necessary.

PEOPLE WITH PROBLEMS.

Depressed people should always be recognized as people first, who happen to have a case of depression; they are not cases of depression carrying people around with them, secondarily. Strive to see the human being within any conditionof loss or suffering. Be careful not to amke depressiontoo important when you define that human being. Do not over-emphasize or over-rate it. Remember that it is not a sign of weakness or instability. Being able to cry readily, as most depressives can, should be seen as a strength. This is much better than botling up all one's feelings and then "exploding" at age fifty, which is a tactic used by far too many men.

Estrogen is related to a woman's life-cycle,not onlly in thematter of menopause, but in everyday life. For it is related to a neurotransmitter called "serotonin," and can induce "rapid cycling" in some biochemistries. So, oral contraceptives or other hromaonal changes can contribute to depression in some sensitive women.
Women with a history of PM S are more likely to experience a menopausal depressive period. (A significant drop-off of similar hormones is responsible for the notorious "post-partum" depression following the birth of a baby.)

Many depressed people are homeless. If they could simply "snap out of it," they woudl do so. They do not want to live the way in which they are living.
Some are made much worse by alcohol and other drugs. One of the worst andmost dnagerous drugs in thre world is valium. It is highly addictive, and very difficult to kick. For one thing, withdrawal leads to regular states of panic. It also creates hyperactivity.

Most people are interested in "quck fixes," and think that some kind of drug will make them instantly feel better. But drugs an be highly dangerous,adn almsot never work asa a quick solution to complex problems. Some people might actually need rather extensive psychotherapy. Others desperately need spiritual counseling.
At any rate, evaluation must be thorough and there must be a cooperative doctor-patient collaboration.

GETTING WELL.

So, make sure that you choose carefully your physician. Look not only for professional and technical expertise, but for human warmth, compassion and understanding. Make sure that he/she has the highest standard of ethics. Talk to other patients about their experiences. While alternative techniques such as massage, yoga, breath-work, herbs, etc., can serve as valuable ancillarei to medical and professional treatment, they cannot by any means replace that needed treatment.

Changing mood-states can lead to changes in biochemistry. For some, this comes with an increased sense of control; for toehrs it arises with the art of learning to trust, and even tolove, the unconsciousmind that indwells them and guides their lives. Cognitive therapy can be a most useful tool. By changingthe way you think, you can chnage how you feel. When combined with psychopharmacology, this form of treatment can be incredibly effective.

The first step is monitoring or mindfulness. Just ask, "Is it possible that I might be wrong in the ways in which I talk to myself?" While avoiding quirky or cultic "self-help" groups, you can rest assured that there are many valid groups who will and can help you. Remember that therapies often fail,a nd if one does, simpoy go on to another. Also, remembe that medicines are not designed to remove natural feelings or pains. Become a n educated mental-health consumer.

You can also do other things onlyour own. Reading and singinghave much therapeutic value. So does regular exercise, and good nutrition can be a rich source of healing. Associate with good, kind, compassionate, loving, tender people who are supportive.
following this advice, you will discover that both yourhealth and your "luck" improve.

*******

For more information, see the book On the Edge of Darkness:Conversations About Conquering Depression, by Cathy Cronkite (New York; Doubleday, 1994)

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