Count Your Blessings
“A major task of adulthood is to balance striving to do your best while accepting your limits,”
Dr. Burns says. “Cognitive therapy has helped me accept my limits without feeling ashamed.”
“Cognitive therapy is simply a more organized way to implement traditional psychological
self-care advice,” says New York psychotherapist Alan Elkin, Ph.D. “It boils down to
counting your blessings. Most depressing or anxiety-producing events are not inherently
awful. What makes them feel distressing is the way we react to them. Counting your blessings
forces you to step back, get some perspective, and see challenges in a larger context. The problem with ‘count your blessings’ is that it’s vague. Cognitive therapy is a step-by-step program, and when you feel depressed or stressed by negativity, an organized program helps.”
Selected Sources:
NIH Depression Awareness, Recognition, and Treatment (D/ART) Program. Cooper, Robert. Health and Fitness Excellence
The Feeling Good Handbook by David D. Burns, M.D.
Exercise as Therapy
Exercise helps treat depression in four ways:
1.It releases endorphins, the body’s own mood-elevating, pain-relieving compounds.
2.It reduces levels of the stress-depression hormone, cortisol, in the blood.
3.It helps provide perspective on life.
4.It provides a feeling of accomplishment, which enhances self-esteem.
Many, many studies demonstrate that exercise helps treat depression. Here are summaries of just afew:
• At the University of Illinois, researchers surveyed 401 adults about their health, mental health, andlifestyle. The more time the respondents spent in strenuous exercise, the less depression, anxiety,and insomnia they reported.
• At Harvard University, researchers divided 32 mildly-to-moderately depressed individuals over age60 into two groups. Half continued to live as they had. The other half enrolled in a weight-liftingclass. At the end of 10 weeks, everyone in the control group was still mildly-to-moderately depressed. But among the exercisers only two of 16 still were.
• At the University of California, at Berkeley, School of Public Health, researchers have been periodically assessing the health, mental health, and lifestyle of 6,000 residents of the San FranciscoBay Area since 1965. The ongoing survey clearly shows a strong association between a sedentarylifestyle and depression, and an equally strong association between becoming physically active and relief from depression.
• University of Nebraska researchers tested 180 college students for depression and then divided them into three groups. A control group continued to live their lives as they had. One test group enrolled in a swimming class that met twice a week for an hour. The other test group enrolled in an hour-long weight-training class that met twice a week. Seven weeks later, the researchers re-tested all the students for depression. Compared with the controls, both exercise groups were significantly less depressed, and showed improved self-esteem.
• At LaTrobe University in Bundoora, Australia, researchers tested 33 people’s mental health, and then enrolled them in a two-month tai chi class. Tai chi is a gentle, non-strenuous, dance-like, Chinese exercise program. After the class, the people were tested again. They were less depressed, anxious, tense, and fearful.
• Other studies have shown that for mild-to-moderate depression, regular aerobic exercise helps about as much as talk-based psychotherapy.
Which kind of exercise is best? Whatever you like. Do something that appeals to you personally. It doesn’t matter what you do as long as you do something physical for a half hour or so three or more times a week, ideally every day: take walks, ride a bike, swim, play volleyball, garden, go bowling, play golf—anything. Just do something. If no physical activity appeals to you, think back to when you were a kid. What kind of physical play did you enjoy? Bicycling? Roller skating? Jumping rope? Try your childhood favorites again. You might still enjoy them.
The most accessible exercise program is walking. You already know how to do it, and there’s no outfit or equipment to buy, no gym to join. Just open your front door and put one foot in front of th eother. In recent years, walking has become Americans’ most popular form of exercise.It takes about a month of regular exercise to notice a significant mood-elevating effect. Be patient. Stick with it, and you’ll feel better.
Also, be patient about your workout ambition. This isn’t a competition. Your exercise program should be enjoyable. Take it nice and easy. Don’t increase the strenuousness or duration of your workout more than 10 percent a month. Exercise shouldn’t be a chore. It should be fun.
Selected Sources:
NIH Depression Awareness, Recognition, and Treatment (D/ART) Program.
Nicoloff, G. and T.L. Schwenk. “Using Exercise to Ward Off Depression,” The Physician and
Sportsmedicine. 9-95, 44-56
Ross, C.E. and D. Hayes. “Exercise and Psychological Well-Being,” American J. of Epidemiology (1988)
127:762.
Jin, P. “Changes in Heart Rate, Noradrenaline, Cortisol, and Mood During Tai Chi,” J. Psychosomatic Research (1989) 33:197
Support Groups
Support groups turn life around wonderfully. They take depression, or any other illness or
challenge, things that usually leave people feeling sad, frustrated, and isolated—and turn them
into the sole criterion for membership. In this powerful way, people can come together with
dignity, compassion, and cooperation to lighten the burdens of depression, disability, bereavement—whatever. Typically, the results are better information about surviving the situation, and profound healing.
“Doctors and psychologists can’t be all things to all people,” says Edward Madara, M.S.,
director of The American Self-Help Clearinghouse in Denville, New Jersey. “When you sit
down with others who have shared your experience—no matter whether it’s depression, diabetes, multiple sclerosis, or an unfaithful spouse—you feel a sense of comfort and closeness no professional relationship can match.”
Many scientists were skeptical of support groups until the 1970s and the development of
pyschoneuroimmunology, the study of how emotions influence the central nervous system and
the immune system. Now we know that social support has profound psychological benefits
that can help anyone who feels depressed.
Over the last 25 years, many studies have shown that social isolation releases a flood of
stress hormones into the blood that trigger many psychological and physiological changes,
including: feelings of depression and anxiety, increased heart rate, higher blood pressure, and
impaired immune function.
“These hormones normally ebb and flow,” says David Spiegel, M.D., a professor of
psychiatry at Stanford University and director of the Psychosocial Treatment Laboratory
there. “But when social isolation becomes chronic, they remain consistently high, impairing the
body’s ability to cope with depression, emotional stress, and physical illnesses.”
On the other hand, well-developed social networks dam the flood of depression-stress
hormones, minimizing their presence in the bloodstream, and allowing the body to heal more
efficiently and cope with stress more effectively.
“The relationship between social isolation and early death, including suicide, is as strong
statistically as the relationship between dying and smoking or having high cholesterol,” Dr.
Spiegel says. “It’s as important for mental health to have a strong network of family and
friends as it is for physical health to quit smoking. Unfortunately, medical science has greatly
underestimated the value of social support.”
In previous generations, social support came largely from family and the communities where
most people spent their entire lives. But in mobile America, family and old friends may be
thousands of miles away. To replace the support they provide, hundreds of thousands of support groups have mushroomed across the United States.
Beyond fellowship, support groups can provide important information about depression: the
names of good psychiatrists and psychotherapists, first-hand accounts of antidepressant medication side effects, and self-care tips about surviving the depression.
The camaraderie, laughter, and back-and-forth bantering support groups encourage help
banishes feelings of isolation. When you ask, “Has anyone every felt--?” Or, “Has this ever
happened to you?” The answer is almost invariable “Yes.” Support groups legitimize members’ feelings and experiences. They provide a welcome framework for coping.
Since the helper and beneficiary are peers, everyone can be both. This exchange of support
has a special meaning, and some believe it’s therapeutic in itself, especially for those who feel
depressed, because helping others boosts self-esteem. “There are a lot of selfish reasons to be altruistic,” says David Sobel, M.D., the San Jose-based director of preventive medicine for the Kaiser Permanente Health Maintenance Organization of Northern California. “You get the personal satisfaction of making a real contribution to someone else’s life. But you also get other benefits—emotional uplift, perspective on your own problems, significant stress reduction, and as a result, better physical and mental health yourself.”
“Support groups reduce isolation,” Madara explains. “They’re empowering and comforting.
They teach practical coping skills. Sometimes they change laws and public perceptions. And
usually, they’re low cost.”
Selected Sources:
NIMH Depression Awareness, Recognition, and Treatment (D/ART) Program
American Self-Help Clearinghouse. The Self-Help Sourcebook. St. Charles-Riverside Medical
Center, Denville, NJ.
Spiegel, David. Living Beyond Limits. Fawcett-Columbine, NY, 1993.
Herbal Medicine
Several medicinal herbs have antidepressant effects. The most powerful is St. John’s wort, a
natural MAO inhibitor. In addition, ginkgo, and caffeine may also help.
St. John’s wort.
“Wort” is Old English for “plant.” St. John’s wort was named for John the
Baptist, whose birthday, June 24, falls around the time this plant produces its yellow flowers.
St. John’s wort (Hypericum perforatum) has been used in traditional herbal medicine for
centuries, primarily for wound healing. Some years ago, German scientists discovered that the
plant is also a monoamine oxidase (MAO) inhibitor, one class of antidepressant medication.
A major recent study shows that St. John’s wort is an effective antidepressant. The 1996
report published in the British Medical Journal, was compiled by researchers at the Audie
Murphy Veterans Hospital in San Antonio, Texas, and colleagues in Germany, who
conducted a meta-analysis of the herb’s effectiveness. Meta-analysis is a sophisticated
statistical technique that allows studies with small numbers of subjects to be mathematically
combined as if they were all part of one big study. Size is important because the larger the
group tested, the more reliable the results. The researchers combined 23 methodologically
sound studies of St. John’s wort that had a total of 1,751 participants. Among those who
took the placebo, 22 percent reported mood elevation. Among those who used St. John’s
wort, the figure was 55 percent, a highly significant difference. Among those who responded
to St. John’s wort, the relief obtained was similar to that experienced from pharmaceutical antidepressants.
In Germany, where herbal medicine is more mainstream than it is in the U.S., doctors often
prescribe St. John’s wort for mild-to-moderate depression.
On the plus side, the herb costs only about $10 a month, considerably less than
pharmaceutical antidepressants, and it does not appear to cause the side effects of other
MAO inhibitors, notably hazardous interactions with foods containing tyramine, among them:
cheeses, yogurt, sour cream, liver, sausage, bologna, pepperoni, salami, game meats, meats
prepared with any tenderizer, caviar, salted or pickled herring, shrimp paste, beer, ale, red wine, sherry, vermouth, distilled spirits, avocados, bananas, figs, raisins, sauerkraut, soy sauce, miso soup, tofu, fava beans, coffee, tea, colas, chocolate, and ginseng.
On the minus side, MAO inhibitors have been largely replaced by newer drugs, and some
people find these newer medications more effective. In addition, St. John’s wort may cause
side effects: upset stomach, dry mouth, fatigue, dizziness, rashes, and itching. Finally, anyone
taking St. John’s wort should err on the side of caution and observe the food restrictions required of those who use other MAO inhibitors.
Do not take St. John’s wort if you are already taking a pharmaceutical antidepressant. Do not
use the herb if you are pregnant or nursing, or planning to become pregnant while taking it.
Ginkgo.
Ginkgo improves blood flow through the brain, accounting for its major uses as an
aid to stroke recovery and mental acuity in the elderly. But it also appears to normalize
neurotransmitter levels, and as a result, can help treat depression. In one study, European
researchers recruited 40 elderly individuals who had both depression and poor cerebral
blood flow. After a few months of taking 80 mg of ginkgo extract three times a day, their
depression lifted and their mental faculties improved significantly. If you use gingko, don’t
take more than 240 mg/day or you might develop diarrhea, restlessness, and irritability.
Caffeine (coffee, tea, colas, chocolate).
Coffee is the nation’s most popular “pick-me-up.” In addition to waking people up in the morning, it also has a mild, but noticeable antidepressant effect. Caffeine’s mood-elevating action plays a role in two of its proven, but lesser-known effects—pain relief and weight loss. The addition of caffeine to aspirin has been shown to produce better pain relief than aspirin by itself. Caffeine is not known to have any pain-relieving action, so researchers believe its mood-elevating action accounts for its pain-relieving benefit. (Excedrin is a combination of aspirin and caffeine.)
Caffeine has also been used in some physician-supervised weight-loss programs with modest, but statistically significant success. The drug has no known appetite-suppressing action, so scientists attribute its action to its mood-elevating effect. If you use caffeine, do not exceed your own individual tolerance or you may experience insomnia, agitation, restlessness, and irritability.
Selected Sources:
Linde, K. et al. “St. John’s Wort for Depression: A Meta-Analysis of Randomized Clinical Trials,”
British Medical Journal (1996) 313:253.
Castleman, M. The Healing Herbs. Bantam Books, 1995.
Duke, J. The Green Pharmacy. Rodale, 1996.
Dietary Supplements
Certain vitamin deficiencies can cause depression:
Vitamin B6. Even a minor B6 deficiency can reduce the availability of serotonin, a neurotransmitter involved in depression, according to Karl Goodkin, M.D., an associate professor of psychiatry and neurology at the University of Miami School of Medicine. Several studies show that depressed individuals tend to have low blood levels of this nutrient.
As little as 10 mg of supplemental B6 a day can relieve depression. In one study, 19 depressed women with low B6 levels were given a supplement. Sixteen of them reported improved mood.
Other B vitamins. At the University of Arizona, researchers divided 14 elderly people
taking antidepressant drugs into two groups. In addition to their regular medication, one took
a placebo, while the other took 10 mg each of vitamins B1, B2, and B6. The supplement group showed greater relief from depression.
Folic acid. Folic acid, another B vitamin, also helps elevate a depressed mood. Several
studies have shown that depressed individuals tend to have low blood levels of this nutrient.
Other studies have shown that supplementation helps relieve their depression. In one, 24
people with major depression and low blood levels of folic acid were divided into two
groups. One received a placebo, the other, 15 mg a day of folic acid. After three months, the
folic acid group was significantly less depressed.
The Weil regimen. Andrew Weil, M.D., is a professor at the University of Arizona College
of Medicine. He is also a noted advocate of non-drug therapies. Here’s what he recommends
for depression: Upon waking, take 1,500 mg of DLPA (DL-phenylalanine), an amino acid
available at health food stores that increases synthesis of neurotransmitters. In addition, take
500 mg of vitamin C, 100 mg of B6, and a small piece of fruit or glass of juice. In the evening
take another round of vitamins C and B6. Dr. Weil says his supplement regimen can be used
by people taking antidepressant medication.
Selected Sources:
Bal, I.R. “Vitamins B1, B2, and B6 in Augmentation of Tricyclic Antidepressant Treatment,” J. Am.
College of Nutrition (1992) 11:159.
Andrew Weil’s Self-Healing, 1-97.
Godfrey, P.S.A. et al. “Enhancement of Recovery from Psychiatric Illness by Methylfolate,”
Lancet (1990) 336:392.
Werbach, M. Nutritional Influences on Illness. Third Line Press, 1991.
Acupuncture
The United Nations World Health Organization endorses acupuncture as a treatment for
depression. At the University of Arizona, John J. Allen, Ph.D., an assistant professor of
psychology studied 34 women diagnosed with major depression who were not being treated
with antidepressant medication. One-third met with the researchers but received no
acupuncture. The second received acupuncture, but not on points recommended for treating
depression. The third received acupuncture on the depression points. Compared with the two
control groups, the women receiving acupuncture on the depression points showed significantly greater mood elevation.
Source:
Steefel, L. “Treating Depression,” Alternative and Complementary Therapies, 1-96, 1-4.
Music as Therapy
In the Bible’s Book of Samuel, King Saul shows classic symptoms of depression: persistent
sadness, listlessness, and irritability. To ease his melancholy, the future King David plays music for him.
David had the right idea. In one study, people suffering serious depression received one of
the following: weekly visits from music therapists who played music and taught them stress
management techniques; taped music to play on their own, with weekly phone calls from
music therapists; or no music. Compared with the control group, participants in both music
groups showed significantly improved mood.
Source:
Hanser, SB, et al. “Effects of a Music Therapy Strategy on Depressed Older Adults.”
Gerontology (1994) 49:P265.
Massage as Therapy
Touch is the only sense human beings cannot live without. Children born blind or deaf can
lead normal lives. But infants deprived of touch become withdrawn, listless, and stop smiling,
classic symptoms of depression. If touch deprivation continues unchecked, it may prove fatal.
At the Touch Research Institute at the University of Miami Medical School in Florida, psychologist Tiffany Field, Ph.D., had massage therapists give 20-minute Swedish massages twice a week to women hospitalized for serious post-partum depression. Their blood levels of stress hormones decreased, and they reported improved mood.
Source:
Steefel, L. “Treating Depression,” Alternative and Complementary Therapies, 1-96, 1-4.
Relaxation Response, Meditation, and Visualization as Therapy
People who meditate (or who practice the very similar Westernized, secular relaxation response) often report mood elevation and feelings of enhanced well-being.
In a study of 154 women who felt depressed because they were being treated for breast cancer, British researchers met with one-third, the controls. They taught another third a combination of the relaxation response and visualization therapy using pleasant, relaxing imagery. The final third were taught progressive muscle relaxation, another meditative technique. Before and after tests showed that the control group remained depressed, but both relaxation therapies significantly improved the women’s mood.
“Many studies have shown mood elevation in depressed people who regularly elicit the
relaxation response,” notes Herbert Benson, M.D., the Harvard researcher who popularized
the relaxation response, and introduced meditation into American medicine.
Selected Sources:
Bridges, LR et al. “Relaxation and Imagery in the Treatment of Breast Cancer,” Br. Med. J. (1988) 297:1169.
Benson, H. “The Relaxation Response,” in Mind-Body Medicine, Consumer Reports Books, NY,
1993, p. 250.
Phototherapy
Phototherapy is the use of bright artificial light to treat winter depression, or seasonal affective
disorder (SAD). It was discovered in the early 1980’s, when researchers noticed that SAD
sufferers who went south for winter vacations experienced relief that persisted for a week or
so after they returned home.
This observation led to the development of devices that produce bright artificial sunlight
(full-spectrum minus the ultraviolet, which causes sunburn and increases risk of skin cancer).
You sit in front of one of today’s bright light appliances as you have breakfast, and by the time you’ve finished, you’re protected from SAD for the day.
SAD symptoms typically begin to lift about a week after the start of phototherapy. But they
return shortly after discontinuing treatment, which is why authorities urge SAD sufferers to
use their bright light appliances daily from October through April.
In the mid-1990’s, scientists discovered that for some people with winter blues, ultrabright
light might not be necessary. Devices that simulate dawn often work just as well. Dawn
simulators are night lights fitted with timers and dimmers. At 4 a.m. the timer turns the light on, bathing the sleeping winter-blues sufferer in the faint glow of an artificial dawn. The light
brightens over two or three hours until the person awakens. In one early study, six of eight
SAD sufferers experienced substantial relief after two weeks of awakening to simulated sunrises. Since then, other studies have confirmed the effect.
Light therapy’s success in treating SAD has led to studies of its effectiveness for nonseasonal
depression—with promising preliminary results. At the University of California at San Diego,
psychiatry professor Daniel F. Kripke, M.D., divided 50 men with severe nonseasonal
depression into two groups. Half spent seven consecutive evenings in a room illuminated with
1,600 watts of bright light. The other half spent the time in a room with the lights turns low.
Compared with the dim-light group, symptoms in the bright-light group improved 18 percent.
Bright-light boxes and dawn simulators may be necessary for some seasonal blues sufferers,
but if you feel blue, experts in phototherapy offer other suggestions as well:
Get more natural sunlight. Trim the bushes around your windows and keep your curtains and blinds open. Use bright colors on walls and upholstery.
Sit near windows whenever possible. Do this at school, at work, on public transportation, and when dining out. If you exercise indoors, work out near a window.
Take a walk. People with SAD often spend unusually little time outdoors in winter. A Swiss
study showed that a one-hour walk in midday winter sunlight can significantly lift the spirits.
For winter blahs and winter doldrums, a daily outdoor winter walk may be all that’s necessary.
Take a winter vacation. Head for a sunny destination. “With a diagnosis of SAD,” Dr.
Freeman quips, “it might even be tax-deductible.”
Selected Sources:
Society for Light Treatment and Biological Rhythms, P.O. Box 478, Wilsonville, OR 97070.
NOSAD, the self-help group for people with SAD. P.O. Box 40133, Washington, D.C. 20016.
The SunBox Company, 19127 Orbit Dr., Gaithersburg, MD 20879.
Apollo Light Systems, 352 West 1060 South, Orem, UT 84058.
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