Friday, January 8, 2010

Deeper than down in the dumps

I want to talk candidly about something near and dear to my own heart and brain...depression.  First, let us be clear about what depression is not.  It is not some yuppie fad for people with way too much time to think on their hands and not enough interesting stuff in their lives to keep their minds entertained.  It is not people who think pessimistically and need to become happy campers living in a world filled with sunshine and butterflies.  It is not people who do not not go to church enough.

Depression has a real physical basis in the brain and it kills.  It almost killed me.  Suicide is the second leading cause of death in females aged 15 to 40.  Suicide takes more lives annually than traffic accidents, AIDS, or lung disease.  It kills about 800,000 people around the world every year.  Pretty staggering, huh, when put that way?

Depression is in the brain.  The standard theory is that it is a disease caused by imbalanced levels of essential neurotransmitter chemicals in the brain like serotonin, dopamine, and norepinephrine.  It has generally been assumed that depressed people have low levels of these key chemicals.  However, it is not really known exactly how the mood is disordered in depression. 

Doctors are far too happy to and careless in writing prescriptions for antidepressants.  They are the number one prescribed medication and their use has doubled in the last 10 years.  These are serious medications which alter the brain's chemistry.  I was two weeks into a new antidepressant when I tried to commit suicide.  Of course, they do have strong warnings which I totally ignored not to drink while taking - which most certainly would include a whole bottle of wine at one sitting.

Only about 50% of depressed people respond positively to antidepressants at all and their positive effect wears off pretty quickly over time.  Something else has to be going on here.

New research is showing that depression may not be so much a disorder of the negative emotions, but rather a disorder of positive emotions.  The basic idea here is that some depressed people cannot maintain positive emotions.  These recent findings effect which medications are used to sustain the reward system in the brain.

While medications can and do help some people.  Some people find success with altering their behavior through mindfulness, affirmations, positive thinking, prayer, meditation and other cognitive practices.  Remember, what you do repeatedly in your life will make real, physical changes in the brain.  Some people find beneficial results with a combination of these and or other methods, and some do not find relief at all, unfortunately.  It really is a mystery.

Personally, I weaned myself off of antidepressants within 6 months after my suicide attempt.  I also did not go to a traditional mental health counselor at all except the obligatory time frame right after the attempt.  Still do not. I had taken pills for years and talked until I was blue in the face with little success obviously.  It was not until I quit looking for a quick and easy fix in a pill or in a therapist that I really began to confront and work through my issues and make positive changes in my life. 

I would say that my problem was physically based while environmentally and socially reinforced for decades from an early age.  In this case, my brain injury actually helped me in that it erased the habitual pathways in my brain and, hence, well established behavioral patterns which had become the defaults for me.  I started with kind of a clean slate so to speak. I had to learn new ways of responding and make new connections in my brain.  The old ones were gone.

I did neurofeedback therapy which trains the brain to perform at optimum levels.  I believe this radically taught my brain to function properly and allowed it to make healthier connections.  Simultaneously, through mindfulness practices and meditation, I have amazingly changed my thinking and my approach to life which, in turn, also reinforced different connections and pathways.

I am not advocating that anyone get up off of the therapists' coach (although I never did lie down) and throw away their pills.  This is what finally worked for me.  Thank goodness.  Each individual has to find what works for them.

I am saying that depression is real problem with a real physical basis.  However, unlike a cancer victim or someone who has a heart attack, depressed people are generally negatively judged and blamed in society and there is a stigma that goes with the disease.  Believe me, I think most depressed people would be more than happy to just buck up and get over it if they could.

1 comment:

  1. I agree with you tremendously about this - the utilization of neuro-chemicals and psycho-tropic drugs as a 'cure' has reached a level of madness. They have a place, but probably far far less than is currently advocated. Furthermore they can and do cause great harm in themselves, many of these drugs have terrible side effects and cause agitation, suicidality and physiological problems that add to a persons burden.
    In brain injury there are multiple issues occuring in depressions - the emotional background, the organic injury and the response to the injury. It may be that depression is a necessary part of the process; providing it is not life threatening or never ending. But no one knows.
    Alternaitve therapies do work well - however I would say that a good neuropsychologist, especially one who focuses on a cognitive behavioral therapy approach can also make a difference and may be very helpful. This approach also looks to 'rewire' you in that it breaks out of the loops of thinking patterns that can cause depression or create problems for the individual and works to create new patterns. Our brain loves patterns and will adapt to that since patterns are efficient and we are geared to being efficient systems. A good plus of CBT therapies are that they may be covered under insurance and other CAM methods may not be. This can be a BIG difference - right now many CAM approaches are 'indulgences' from a financial perspective. THe down side is finding the right person to provide this help correctly.