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Depression requires a multifaceted approach to help lift symptoms and reduce the risk of relapse [Image: Bigstock]

Depression – feeling your way out of the darkness

For many the experience of depression is nothing more than yesterday’s bad mood. For others it is a debilitating, chronic illness which affects them and those around them.

A “bad” mood becomes a major health problem when it is severe enough and persistent enough to interfere with work, friendships, family life and even physical health.

An episode of severe depression can last for several weeks or several years and new age definitions of depression such as “having nowhere to put your love” deny the genuine depth of symptoms such as misery, despair, guilt and a feeling of total worthlessness. They also deny the facts – According to the the World Health Organization (WHO), by 2030, the amount of disability and life lost as a result of depression will be greater than that resulting from any other condition, including accidents, war, suicide, cancer, and stroke.

Depression is one of the least well understood and least well tolerated emotional states in our culture.  In a time where positivism is the name of the game, people who feel even mildly depressed are told to “snap out of it”.

Those with chronic mild to moderate depression are also in a double bind since drug treatment is likely to be little more effective than placebo – setting up a dilemma about to how best to treat them. Individuals suffering from severe clinical depression are sometimes the ones least likely to receive support. Instead they are given drugs to suppress their symptoms and otherwise left to fend for themselves in or out of an institutional setting.

Different types of depression

Broadly speaking there are two types of depression: unipolar, characterised by low moods only, and bipolar, characterised by extreme highs and lows, sometimes called manic depression.

Within these two broad categories are varying levels of severity and regularity.

For instance, some may experience depression only in the winter months as in the case of Seasonal Affective disorder (SAD) others may experience moderate depression which doesn’t appear to be linked to any external occurrence.

Mild depression is sometimes called dysthymia. It is chronic but so mild it is often difficult to distinguish from a personality trait – yet up to 25% of those who go on to develop major depression are already suffering from dysthymia

We preoccupy ourselves with questions like, do faulty neurotransmitters (the chemicals which send messages between the brain and the nerves) disturb thought and feeling or do disturbed thoughts and feelings upset the neurotransmitters? The answer is that it probably doesn’t matter. Body and mind constantly affect one another.

No single cause

A vulnerability towards depression maybe the result of a combination of genetics, neurochemical imbalances, childhood losses, adult disappointments, and immediate social conditions the combination of which will be slightly different in each individual.

Each of these things constantly influences the others in ways we still don’t fully understand. Symptoms in one person which look similar to symptoms in another may have entirely different sources. The real issue is what to do about depression once it occurs.

What we might think of as more scientific, more sophisticated ‘cures’ – drugs or in extreme cases electroconvulsive therapy (ECT)  – are not scientific at all. We simply don’t understand enough about how the brain works to label drug treatment as either scientific or proven, especially for the majority of depressed individuals who suffer from mild to moderate symptoms.

The same, of course, can sometimes be said for many alternative treatments since not everyone responds the same way to the same treatments.

Depression is an emotional state which both practitioners and patients sometimes have to “feel” their way through. The good news is that it does not have to be a lifelong problem. There are effective alternative means of dealing with it and relapse is not always inevitable.

Along with the usual list of suggestions for causes and treatments (see further below) it’s worth considering two things that are rarely discussed in popular articles on depression, but which may make a significant contribution to its context.

Depressed = Deep rest?

We all focus on the symptoms and negative aspects of depression but what would happen if we refocused on what depression is asking us to do. Symptoms like withdrawal and deep tiredness may have a message that is worth listening to. Resisting the message may make depression worse, while finding the meaning in them can feel like a miraculous release.

Author Jeff Foster who himself experienced depression, famously points out that the verb has the similar phonetic sound as ‘deep rest’. He believes that depression is a hidden opportunity to confront and release the false face that so many of us wear so that you can ‘rest deeply in the core of who you are’.

Says Foster: “We can view depression not as a mental illness, but on a deeper level, as a profound, and very misunderstood, state of deep rest, entered into when we are completely exhausted by the weight of our own false story of ourselves. It is an unconscious loss of interest in the second-hand – a longing to ‘die’ to the false. This longing needs to be honoured, not medicated, meditated or analysed away.”

If this resonates with you, working with a therapist on understanding the message of depression can help shed that false self.

Environmental loss

The world is changing rapidly. Species that many of us took for granted would be there to surprise and delight our great, great, great, grand-children, are becoming extinct. Beautiful landscapes are being degraded and destroyed. The climate is morphing in ways we cannot accurately predict and our food is becoming associated with words like crisis and poison.

We see news footage of this loss every day and it takes its toll on our mental health.

The idea that ecological strain might translate into psychic distress is something that forward-thinking biologists and psychologists have been trying to point out for close to half a century.

EO Wilson coined the phrase biophilia to describe our innate affiliation with the natural world, and he noted that – after living “totally and intimately involved with other organisms” for over 99% of our history – it would be extraordinary to think of the human need for nature as simply disappearing within a few generations.

We know that we have sharp physical and psychological reactions to images of environmental loss – we experience this every time we open the paper to see a photo of a sea turtle strangled by plastic or a rhino or elephant brutally murdered for its horn.

We also spend long days indoors under fake lights in climate controlled environments, out of touch with the natural environment that made us. And yet we know that our  need for connection to the natural world remains. Studies show that time in nature is an important way to lift depression

That things like ‘forest bathing’, spending time by the sea and digging the soil bring us into contact with microbes and electrically charges molecules (ions) that not only help bring perspective about our place in the scheme of things, but deeply and positively affect our moods.

What these references to rest and engagement with the natural world suggest is that in addition to treating symptoms with the suggestions below, the way out of depression lies in deep reflection and then, importantly, action to understand and ‘change’ whatever it is that is getting us down. A multifacted approach involving some or all of the suggestions in this article may be the most beneficial way to help lift the darkness.

Here’s some suggestions:

Talk it out The effectiveness of talking cures, as compared to drugs is well established, and after many years this approach has begun to be accepted as an important first line. Talking cures and may be especially helpful where drugs haven’t worked.

A recent analysis of 67 studies comparing drugs and talking cures found no difference between the two, suggesting that therapies like interpersonal psychotherapy, counselling and cognitive behavioural therapy (CBT), which are just as effective.

Talking cures may take a little longer to work but the results are usually long lasting. In fact studies show that people on anti-depressants are more likely to relapse than those using other methods and by talking it out you avoid the multiple adverse effects associated with long-term drug use.

Hypnotherapy, which combines hypnosis and talking therapy is also an effective, if underused treatment for some.

Think food If you are prone to depression attention to diet is paramount. A large 2013 study found that the risk of depression dropped with higher intakes of folate, omega-3 fatty acids and monounsaturated fatty acids; foods such as olive oil and fish; and a diet rich in fruits, vegetables, nuts and legumes.

Another in 2010 looked at the quality of diet as it related to the development of depression. What was termed a “traditional” diet, which included fresh vegetables, fruit, beef, lamb, fish, and whole grains was associated with a 35% low risk of major depression and 32% lower risk of anxiety disorders.

In another study researchers in Britain looked at depression and diet in more than 3,000 middle-aged civil servants over the course of five years. Compared to an average diet those who ate a mostly junk food diet,  high in processed meat, chocolates, sweet desserts, fried food, refined cereals and high-fat dairy products were more 58% likely to report symptoms of depression. Those who ate a diet rich in fruits, vegetables and fish were 26% less likely to report being depressed.

Supplements Depressed individuals are most likely to be low in B vitamins with folic acid deficiency being the most common problem. Increasing vitamin C can also lift depression. Your magnesium and potassium levels may also be low.

In Europeans a diet high in oily fish has been linked to lower levels of depression. There is even some evidence that fatty fish in the diet can make antidepressant therapy more effective, suggesting that adequate essential fatty acids such as omega 3 may have a role to play in mental health. In addition supplements that contain amino acids also reduce symptoms, because they are converted to neurotransmitters that alleviate depression and other mental disorders.

Herbs that help St John’s wort, lemon balm, damiana and skullcap are all important herbs to help deal with the symptoms of depression. St John’s wort in particular has been proven to be more effective than placebo and better tolerated than conventional antidepressants. It is also specifically indicated to relieve the ‘winter blues’ (SAD).

Siberian ginseng has consistently demonstrated an ability to increase the sense of well-being for those suffering from a variety of psychological disturbances including depression and insomnia. Siberian ginseng has been shown to increase the monoamine content in the brain. See also our article Depression – gentle herbs that help for more suggestions.

Homeopathy Homeopathy and psychoanalysis have much in common since both disciplines place a high value on the personality and temperament of patients. Also, both believe that presenting symptoms can be part of a self-healing response. Using individually selected remedies has a long history in the treatment of depression and the British Homeopathic Association provides a list of remedies that may work alongside other treatments such as psychotherapy.

Aromatherapy massage Massage brings with it a sense of connectedness to others, often missing in the depressed individual’s life.

Most of the research into the benefits of massage has been done on elderly institutionalised patients and those who are severely ill, often with significant results. In one study of elderly patients, for example, massage was shown to more effective than conversation alone. Likewise, in a study of hospitalised depressed children, those receiving a simple 30 minute back massage experienced better night time sleep and decreased depression and anxiety compared to those who were given relaxing videotapes to watch.

The right essential oils appear to play a significant part in the success of massage therapy. If citrus fragrance is used during massage it is likely to raise both mood and immune system function. Lavender, is known to have sedative effects and has a long history of use in relieving anxiety and depression.

In one study a 20 minute foot massage with neroli oil elevated the moods of heart surgery patients, whereas massage with simple vegetable oil failed to produce the same results. In another the addition of Roman camomile to a weekly massage was shown to enhance the benefits of the massage in term of lifting mood. For more on using essential oils see our article Essential oils for
health and wellbeing

Relaxation techniques Whether it is regular exercise, listening to your favourite music, enjoying an engaging hobby or a regular massage, relaxation does wonders to help lift depression.

For more focussed relaxation consider mindfulness meditation. In fact, a recent study has shown that mindfulness-based therapy could offer an effective alternative to antidepressants for preventing depression relapse. Conducted over 2 years the study showed that a drug regime has no significant benefits over mindfulness-based cognitive training (MBCT) – a structured training for the mind and body which aims to change the way people think and feel about their experiences. MBCT also had the important advantage of helping patients feel as if they were in charge of their own recovery.

There is evidence that regular meditation or other spiritual or religious practice alters the structure of the brain in a way that offers protection against depression – particularly in people who are at high risk from the disease.

Let there be light We now recognise that some depression is seasonal, as in Seasonal Affective Disorder or SAD. Light is thought to significantly modify the processing of serotonin signals in the brain. Using full spectrum light therapy early in the season, before the days get really dark, can help prevent SAD from developing into full blown depression. Most recently light therapy has also been shown to help those with non-seasonal depression as well.