What in the World is Depression Anyway?

Are you suffering with depression? Is that what you’ve been told? Is that what you believe? Are you aware that “depression” may not be what you think it is?

If you are like many of the people I see, if you’ve been told you have depression, it has probably been explained as a brain chemistry imbalance. And that means that prescribing a medication to “correct” the imbalance is the right path to pursue.

Now, don’t get me wrong. Prescription medications can be an important component of an appropriate treatment plan that is right for you. Sadly (excuse the pun), depression is rarely reducible to unbalanced brain chemistry. For example, a lack of serotonin is the neurohormone in the brain that is said to make us feel happy. Therefore, a supposed imbalance of the neurohormone serotonin is described as the target of the psychotropic (i.e., state of mind and mood-altering) medicines typically prescribed to “restore” healthy serotonin levels in the brain (Zoloft, Celexa, Prozac, etc.).

But wait a minute! How does that make sense when more than 90% of the serotonin produced in the body is manufactured in the gut, not the brain? Medications operate in our gut long before they can ever reach the brain. So, where is the serotonin-boost we supposedly get from medication exerting its therapeutic impact? Is the effect of these medications brain-based or is it perhaps exerting its influence elsewhere in the body in a way that eventually impacts our mood and outlook on life?

Recent research advances suggest that most of the serotonin circulating in the body is not even made by our physical body at all. The biggest suppliers of serotonin are the trillions of microscopic bacteria that live inside our digestive tract and that outnumber our human cells by a margin of 10:1 (over 100 trillion bacterial cells)! This discovery turns everything we believe about serotonin and depression on its head.

Something infinitely more complex must be going on if we are to truly understand what’s involved in healing depression. Author Stephen Kiesling*, with a bit of tongue-in-cheek, says that any true understanding of what is going on when we are depressed or ill in other ways, must adopt a focus that includes a “nutritional-gastrointestinal-microbial-toxicological-immunological-inflammatory-mitochondrial-environmental-structural” perspective. To that lengthy list, I add mental-psychological-relational dimensions, too.

With all these intersecting biological and social systems operating within us on a moment-to-moment basis, how do we know where to begin to overcome the indisputably devastating impact that depressive disorders have on people’s lives? I agree that you can’t do everything all at once. But, adopting a holistic perspective that respects you as a uniquely complex individual is a good start.

By recognizing that depression can arise from many different health stressors, you are already moving away from a one-size-fits-all perspective that says a pill should make everything better all by itself. In addition, because these various bio-psycho-social systems are always “talking” to each other, a relevant change made in one of the systems can create a domino-effect that impacts all the other parts of this complex biological and social network. In turn, these types of changes offer alternative paths forward for managing depressive difficulties more effectively.

What follows are a list of 10 changes you can make in your life that all have measurable, noticeable, and significant positive effects on lightening the burden of depression.

  • Nutrition Upside: Adding more fresh vegetables to your diet provides a significant source of beneficial “nutraceuticals” to your diet, which feels the good bacteria living in your gut, which increases their production of serotonin. A good quality probiotic can support this change, as well, as can prebiotics that contain healthy levels of dietary fiber.
  • Nutrition Downside: Current research is pointing to inflammation as a major component of depression. Therefore, elimination of processed sugars and other processed foods is a powerful anti-inflammatory action you can take to reduce the presence of inflammatory pressures on mood.
  • Nature: Our connections to nature go much deeper than we realize. The sun’s daily cycles of light and dark are a major regulator of the release of many hormones that, in turn, regulate appetite, sleep, energy, activity, mood, and more. As a result, getting outdoors on a regular basis, even if only for a walk, becomes a powerful mood regulator and synchronizer of our overall health. If you can’t get outside, using a good quality light box on a daily basis, especially during winter’s shorter days can help.
  • Movement: Our bodies are designed for movement. Moving our bodies is integral to remaining healthy. For much of our history, movement was a given for much of our waking hours and essential to our very survival. Today’s sedentary lifestyle runs counter to our biology’s needs. In addition, movement, whether in the form of leisurely walks after a meal to vigorous workouts in a gym, is a major regulator of mental, emotional, and physical health. Movement is also one of the most powerful mood elevators we know of. So, get up and get moving. Every step you take is another step toward overcoming depression.
  • Sleep: Sleep is perhaps our single most important health regulator. Poor sleep over a six-month period raises our vulnerability to depression many times over, even with no prior history of depression. Making good sleep a priority and practicing good sleep hygiene is a wellness gift that keeps on giving throughout a lifetime. Like the setting sun, which is a gradual and gentle cycle repeated every evening, transitioning from our hectic and stress-filled days into restful, sleep-filled nights entails gradual and gentle practices (watch for future blogs for more suggestions) that prepare our minds and bodies for deep, restorative sleep.
  • Stress Management: Living exposes us to daily stressors. Stressors are inescapable: we will encounter stressors of one sort or another every day. But, when we define stress as exposure to anything that demands an adaptive response from us, we begin to appreciate the importance of developing helpful and healthful stress management strategies. One of the most powerful antidotes to stress involves reshaping our perspective and attitude toward stressors, which is especially important when it comes to managing depression. Martin Seligman, PhD, world-renowned psychologist, taught us that 1) just because a stressor exists in one area of our lives, it doesn’t have to exist everywhere; 2) just because we experience a stressor now, doesn’t mean it will persist indefinitely; and 3) just because we may play a role in creating a stressor, doesn’t mean we are to “blame,” that it is always our “fault,” or that bad things occur because “we are bad or undeserving.”
  • Empathy: There is a paradox in depression, a condition that can make us consumed by our own inner suffering. One of the most powerful ways of managing depression involves honing our capacity to be attentive to the plight of others. Being able to attend to others, to feel compassion for their difficulties and circumstances can break the stranglehold that depression can have on our own pain. Empathy toward others reconnects us to others and to the larger world. Being able to feel empathy toward others lessens our sense of isolation, disconnection, and loneliness, all of which act as powerful “anti-depressants,” and obtaining a lifetime prescription to empathy doesn’t cost you a penny.  
  • Connection: People are inherently social. It doesn’t matter whether you are a major extrovert or private introvert. None of us is an island. Depression, on the other hand, often leaves us feeling alone on a deserted island no matter how much we are surrounded by love. Seeking the company of even one other person has been shown to have a positive impact on reducing depression. Seeking regular connections to others or learning to build them – connections that are rooted in trust, empathy, respect, and loving attention – weaves an emotional safety net beneath us. Even when life knocks us down, sitting beneath us is the social connection safety net to break our fall and help us to regain our footing.
  • Playfulness: A common feature of depression is called anhedonia. The term describes difficulty feeling pleasure, which can rapidly turn the world into lifeless shades of grey while simultaneously draining our capacity for joy. Children have an innate capacity for joy. And, since all of us were children once, our capacity to feel joy again remains within us. One key to access joy is play, an activity that children naturally engage in for hours a day. Young animals do, too, illustrating the important role that play serves throughout the animal kingdom. According to Stuart Brown, MD, keys to being playful involve doing things just for the sake of doing them, not because they have a built-in purpose beyond being enjoyable; doing things you have found to be attractive and that are not bound by time limits or deadlines; doing things that are not scripted, rule-bound, or too structured. Free. Easy. Light. Fun. Indulge and enjoy yourself!
  • Psychotherapy: None of the previous nine actions involve professional assistance. But, depression, whatever else it may be, also hurts and those hurts are often rooted in the struggles, setbacks, or traumas that people have encountered in their lives. Sometimes, an indispensable part of getting yourself and your life back on track is to work privately with a professional trained in the art and science of psychotherapy. Author Andrew Solomon** writes that “depression is the flaw in love.” To love in life also means to encounter loss and the suffering that accompanies it – loss of dreams, of health, of relationships, and more. When you are hurting, psychotherapy can help. Don’t go it alone. You won’t regret reaching out. At Partners in Healing, we are here to assist you in getting back to being your best self.

Stay tuned and take care…

Dr. David Alter

*Stephen Kiesling, writing in Spirituality & Health, March/April 2019, pp. 30-31
**Andrew Solomon, writing in The Noonday Demon: An Atlas of Depression, pp. 15

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