At one time or another, everyone has been depressed. For this reason, it would not seem to be a mysterious malady, but it is. The latest studies on popular antidepressants like Prozac and Paxil indicate that about 50 percent of patients get little or no benefit. These are people with mild to moderate depression, which account for approximately 70 percent of depression cases.
Is there a way to help them and to get millions of other depressed people off the pill?
This is now an urgent question. Doctors keep writing prescriptions, but back in the research lab, the findings are discouraging. It turns out that antidepressants don't correct imbalanced brain chemistry. And there's no real proof that the brain chemistry of depressed people is any different that of people who aren't depressed. All of this is bad news for big pharma, but it opens the way for other approaches. So let's start from scratch.
If you met a young person with awful table manners, what would you think? It's natural to suppose that this behavior started in childhood and turned into a habit. What if the same is true for depression? Most patients who complain of depression cannot say when it started. They talk about depression running in the family. This indicates that depression has three components:
1. An early outside cause.
2. A response to that cause.
3. A longstanding habit.
Let's rid our minds of calling depression a disease, just for a moment. Severe, chronic depression can be approached like other mental disorders. But you aren't ill if you get depressed after a bad divorce. We commonly say things like "She's out of her mind with grief" when someone loses a beloved spouse, but grief is natural, and the depression that comes with it is also natural. What this tells me is that depression is a natural response that can go terribly wrong.
1. Outside causes: During the current recession, 60 percent of people who lost their job say it made them anxious or depressed. The number is much higher among workers who have been laid off for more than a year. Outside events can make you depressed. We all know that. If you subject yourself to enough stress over a long period of time, depression is much more likely—this includes a boring job, a sour relationship, long stretches of loneliness and social isolation and chronic disease.
2. The depressed response: An outside event cannot make you depressed unless you respond in a certain way. People who are depressed learned long ago to have the following responses when something goes wrong:
It's my fault.
I'm not good enough.
Nothing will work out.
I knew things would go wrong.
I can't do anything about it.
It was just a matter of time.
When a child has this response because something goes wrong, it can make sense. Small children have little control over their lives; they are weak and vulnerable. An unloving parent can create any of these responses, and so can a disastrous family event like a death.
But if you have these responses when you are grown up, the past is undermining the present.
3. The habit of being depressed: Once you start having a depressed response, it reinforces the next response. Did your first boyfriend dump you? Then it's natural to fear that the second one might, also. For some people this fear is minor, but for others it looms large. They keep having depressed responses, and after a while these turn into a habit.
Once it turns into a habit, depressed people no longer need an outside trigger. They are depressed about being depressed. A gray film coats everything; optimism is impossible. This defeated state tells us that the brain has formed fixed pathways. A small incident like a flat tire or a bounced check leaves no room for deciding, "Is this going to bother me or not?" Instead, the depressed response is already wired in. Depressed people can even feel sad about good events (they are always waiting for the other shoe to drop) because they are trapped in the habit of depression at the brain level.
How to avoid getting depressed
Let's say that these conditions sound reasonable. The key question is how to avoid getting depressed—that's number one—and how to reverse depression once it sets in. We can approach the whole question of prevention and getting better with the same three categories.
1. Outside events: People will say: "Did you see the evening news? I'm so depressed about the state of the world." Or, "I was depressed during the whole Bush era." This implies that outside events make us depressed, but in fact this ingredient is the least powerful in causing depression. Losing your job, for example, can be depressing if you are prone to the depressed response, but it can spur you to rise even higher if you don't turn to the depressed response.
Bad things are unavoidable, but some factors make them worse:
If the stress is repeated
If the stress is unpredictable
If you have no control over the stress.
These points are easily proved with mice given mild electric shocks. If you space the shocks at random intervals, give them over and over and provide no way for the mice to turn off the shocks, it doesn't matter that the shocks are harmless. The mice will soon give up, act lethargic and helpless and, in time, die. In other words, you have induced extreme depression to the point that the will to live is destroyed.
What does this mean for someone who wants to avoid or alleviate depression?
Stop exposing yourself to stresses that occur over and over. This could mean a bad boss, an abusive husband, a boring job or any other stress that is reinforced every day.
Avoid unpredictability and uncertainty. They say life is uncertain, but there's a limit to what is acceptable. A boss who unpredictably flies into a rage isn't acceptable. For many people, a sales job, where any customer might lash out or walk away, is too uncertain to bear. A spouse who may or may not cheat is unpredictable in the wrong way. Regular habits, including a good night's sleep, regular exercise, a steady relationship and a job you can count on, are necessary for everyone. They aren't just good for you. They help avoid depression.
As a doctor, I know that someone isn't depressed if they can answer a simple question about a bad situation: Is this something I can fix, something I should put up with or something I need to walk away from? Depressed people deny themselves those key decisions. They almost always put up with bad situations. When depression isn't present, you know what to fix, what to put up with and what to walk away from. Learn how to make such decisions now, and you won't be saddled with future situations that create depression.
How to respond differently to difficult situations 2. The depressed response: Now we step into a major cause of depression, which means that it is also more difficult to treat. If you don't want to be overweight, it's much easier not to put the pounds on than to lose them once they are on. The same holds good for depression. It's much easier to learn the right response than to get rid of the wrong ones.
We all have self-defeating responses, but we rarely take the time or effort to replace them with better alternatives. Here are the alternatives to the thoughts that automatically come to mind when you're depressed:
It's my fault.
Instead, you could think: "It's not my fault; it's nobody's fault; the fault hasn't been determined yet; it may be nobody's fault; or finding fault does no good—we should be focusing on the solution."
I'm not good enough.
Instead, you could think: "I am good enough; I don't need to compare myself to others; it's not about good or bad; 'good enough' is relative; I'll be better tomorrow; or I'm on a learning curve."
Nothing will work out.
Instead, you could think: "Something will occur to me; things have a way of working out; I can ask for help; if one thing doesn't work out, there's always something else; or being pessimistic doesn't help me find a solution."
I knew things would go wrong.
Instead, you could think: "No, I didn't know; I'm second-guessing; I'm just feeling anxious; it will pass; or looking backward is only good if it leads to a better future."
I can't do anything about it.
Instead, you could think: "I can do something about it; I can find someone to do something about it; I always have the option of walking out; I need to study the situation more thoroughly; or being defeatist isn't helping me make things better."
It was just a matter of time.
Instead, you could think: "I'm not a fatalist; this was unpredictable; this too shall pass; it never rains all the time; or being fatalistic robs me of free choice."
To prevent depression, you have to recognize a depressed response and then learn new responses to counteract it. I am not saying that all the alternatives work all the time. The goal is flexibility. The nasty trick of the depressed response is that it paints everything with the same brush. You feel helpless about repairing your car's broken alternator (who wouldn't?) but also about getting out of bed to face the day (a sign of depression). To become flexible, you must beat the depressed response at its own game.
How to do that? Refuse to believe the first reaction you may have—such as sadness, helplessness and hopelessness. Go to the list of alternative responses, and find one that works. This takes time and effort, but it pays off handsomely. Learning a new response forms new neural pathways in the brain. It also opens doors.
What kinds of doors? When you are depressed, you tend to be isolated, lonely, apathetic, inactive, passive and closed to change. The new doors are exactly the opposite. By introducing a new response, you resist the temptation to fall back on old, stale beliefs. Instead of being isolated, you realize that other people are good for you. Instead of being passive, you see that taking charge is good for you.
Thus, you can break down the depressed response, which feels so overwhelming that it blankets everything, into manageable parts. Inertia is depression's best friend. There's always a hump to get over before you can actually change. So pushing yourself over the hump is like opening a door to a new brain pattern. To put it simply, you alone have the power to change. Depression weaves the illusion that the power has been stripped away. In truth, you can reclaim it, step by step, once you know how.
Breaking the habit of depression 3.The habit of depression. If you have ever lived around an alcoholic or any other addict, you know that there's a predictable pendulum swing in their behavior. When sober or off the drug, they sincerely repent and never want to return to their habits again. But these good intentions fly out the window when addicts are faced with the temptation to drink or shoot up or overeat or fly into a rage, depending on what their habits happen to be. Willpower disappears, the habit takes control and only getting a fix matters.
Depression also has its addictive side, in that sadness and hopelessness take charge. "I can't be any other way" is the common cry of both the alcoholic and the chronically depressed. In every case, there's a "good me" and a "bad me" warring against each other. For the alcoholic, the "bad me" drinks while the "good me" is sober. For the depressed person, the "bad me" is sad and hopeless while the "good me" is happy and optimistic. But, in truth, both sides are the "bad me" because it casts its shadow over everything. The best moments are a prelude to a relapse. The "bad me" is going to win in the end; the "good me" is merely its pawn.
The war is unwinnable, in short, which is why the pendulum keeps swinging back and forth, and why every so-called victory is always temporary. When a war is unwinnable, why fight? The secret to beating any habit is to stop fighting with yourself, to find a place inside that isn't at war. Meditation opens the way to finding such a place; all the world's wisdom traditions affirm that there is a core self that is at peace, calm, silent and full of joy and reverence for life.
When people frown and tell me they don't believe in meditation, my response is that they must not believe in the brain, because four decades of brain research has proven that the brain is transformed by meditation, and now there's newer evidence to suggest the genetic output also improves. That is, the right genes get switched on and the wrong ones switched off.
But breaking the habit of depression involves both inner work and outer work, as follows:
Examine and change your negative beliefs
Reject self-defeating responses to life's challenges
Learn new responses that are life-enhancing
Adopt a higher vision of life and live by it
Recognize self-judgment and reject it
Stop believing that fear is right just because it's powerful
Don't mistake moods for reality.
Change stressful conditions
Find fulfilling work
Don't associate with people who increase your depression
Find people who are close to who you want to be
Learn to give of yourself, be generous of spirit
Adopt good sleep habits and exercise lightly once a day
Focus on relationships instead of distractions and endless consumerism
Learn to re-parent yourself by finding people who know how to love, who are accepting and nonjudgmental.
The real road to recovery
As a doctor, I've met hundreds of depressed people who desperately want help, but how many of them were on the road to recovery? Most had put their faith in a pill or a psychiatrist. In some cases, symptoms can be relieved and progress can be made (although current studies show that taking an antidepressant offers no help in supporting other treatments or making therapy work better). But pills and therapy both have the same flaw: They approach depression as a disease.
As we saw, in mild or moderate depression, the disease model isn't needed and often does no good. The three ingredients we have been focusing on—outside stress, the depressed response and the habit of depression—take a new approach. They give you the power to reverse the underlying conditions of depression. I won't say the cause of depression has been found, because in the end your depression is entangled with everything else in your life. Because of that, you must reshape your life on many levels. Sometimes it takes very little to get out of depression—that is, if escaping a bad job or a toxic marriage can be seen as simple. At least it's direct.
Other times, depression is like a fog that cannot be grabbed in any one place. But fogs, too, can lift. The best news is that the real you isn't depressed and never has been. By setting out on the path to find 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.
From deeper matters of the soul to how to handle a toxic relationship, dietary concerns, parenting issues, health and well-being, sexuality and everything in between, spiritual teacher Deepak Chopra wants to hear from you! Every week, he'll be answering your questions and offering insightful, thought-provoking solutions to all of life's challenges. Send Deepak your questions now!