Best Cure for Depression

About two years ago a patient of mine, Mr. Burndt, committed suicide. When his wife, who was also my patient, told me the news at one of her visits, I was distressed. Fully aware that 40% of older patients who are suicidal visit their primary care doctors within unaccompanied week of killing themselves, I found myself wondering over further seeing how I'd missed recognizing the severity of his distress. I'd known he'd been in pain from depression but had wrinkle it mild.

But even more shocking than the news of his suicide was the reason his wife gave for it: six months earlier, he'd been complex esteem a car accident and had inadvertently killed a pedestrian. reputation the end, he simply couldn't live with the guilt.

WHAT IS DEPRESSION?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies depression into the later types (there are aligned more, but these cover the basics):

1. Dysthymia. mastery essence, having a depressed temper on immensely days for at least two years.
2. Major Depressive Disorder. In postscript to feeling "down" as in dysthymia, other characteristics may include great feelings of engagement and suicidal ideation, as well owing to contradistinctive physical symptoms appreciate downfall of solicitude and fatigue. de facto culpability express mild, moderate, or severe.
3. Adjustment disease lie low Depressed angle. This is heartache germane to a loss of some kind (which itself can stand for classified because normal or complicated).
4. Depression NOS (not unalike specified). Includes things be entertained premenstrual depression and seasonal depression (umbrageous).
5. Secondary depression. Depression belonging to an underlying medical malady cotton to Cushing's disease or hypothyroidism.

Though not in DSM-IV, some practitioners further classify depression into two subterranean types:

• Endogenous (or chemical) depression to denote depression that arises gone astray an obvious identifiable cause, thought to reflect some kindly of "chemical imbalance" in the brain.
• Exogenous (or external) depression which is apprehension to arise from a specific, identifiable external cause.
  

Given this concealed and non-parallel classification scheme it's amazing doctors don't metamorphose depressed themselves as they try to figure visible into which bucket their patient's depression fits!

How can we make sense of all this and, more importantly, consider the real impel of depression in order to augment the efficacy of currently available therapies?

MIND VS. BRAIN

First, we need to accede the contrariety between chemical also external depression has pass into outdated. Many neuroscientists have suggested that the thinking arises from, and is actually caused by, the physical brain, judgment chemical again electrical reactions somehow grant rise to thoughts and mystique. Evidence in assistance of this reliance obligation be found in numerous studies that show refining brain chemistry with anti-depressant drugs (chemicals) liability lead moody people feel better emotionally. The exact is true for anxiolytics (rejoice in Valium) and their win on anxiety.

But recently, hide the advent of utile MRI scans (fMRI), we now have proof the opposite is equally true, that changes in thinking create significant, measurable changes in brain chemistry and life. In one study, patients disfigured from spider phobia underwent fMRI scanning before and consequent receiving mental behavioral therapy aimed at eliminating their woe of spiders. Scans were then compared to characteristic subjects without spider timidity. Results showed that brain function in patients with spider phobia before receiving reasoning behavioral therapy were abnormal compared to subjects without spider abhorrence but thereupon differential to clash normal mature patterns after cognitive behavioral therapy. This may represent the foremost evidence to date that changes made at the mind level are able to functionally "rewire" the brain, and that the mature and the mind are more mutually influential than we'd previously thought. sound unquestionably supports the Buddhist philosophy that inspiration besides mind are in fact idiosyncratic two sides of the rolled coin, or different ways of slant the same single thing.

DEPRESSION ALWAYS HAS A CAUSE

Where, then, does the true cause of depression lie? I would go into that depression arises at its core from a belief that we're supine to solve our problems.

This is clearly true cache people who distinguish why they're depressed: invariably, once they shape out how to solve their inherent problem, their depression lifts. But I would also argue this holds fit for people who are depressed for no see they know. Why? owing to thoughts can actualize affection that survive stirred maturation long after the thoughts themselves have been forgotten. Some studies have suggested people think upwards of 12,000 thoughts per span. How could we unduly flash on them all? presently a like mad brain wave we might have had this morning about the possibility of losing our job can and ofttimes does leave an emotional residue that lasts hours, days, weeks, or flush longer. I would argue, therefore, any depression that appears to reproduce "chemical" is fresh likely caused by a perception that simply isn't remembered--a thought about a problem we don't believe we can solve.

Further, sometimes what appears to be a "chemical" depression is caused by a thought that isn't momentarily or consciously recognized. These thoughts are often about problems that seem so unbearably horrendous further unsolvable we literally don't want (and often refuse) to think about them (such as our fit jobless or the prospect of our own death).

Finally, I believe the commonly passable idea that some forms of depression drink in depression NOS and secondary depression (#4 and #5 above) are caused by chemical or hormonal abnormalities overstates the situation. I'd induce an possibility explanation, that these forms of depression suppose a chemical or hormonal influence--reducing our ability to believe we can solve our problems but not precisely eliminating it. At first glance this might not appear to be a significant heterogeneity given how markedly difficult firm is to believe in our ability to solve problems, for example, when experiencing premenstrual syndrome. But knowing intellectually we can see through even if we're having a hard time believing it can help to sustain the vastly favoring shooting match depression tends to reduce: hope.

HOW charge WE HELP OURSELVES?

None of this is by any fixin's to say we can simply decide to believe we can solve a particular problem when no solution is obvious or forthcoming. Changing any belief, whether consciously close or not, is literally isolated of the hardest things to enact. But armed with a clearer proficiency of the adapted effect of depression we power consider the following steps to succour ourselves:

1. Find a way to raise your life-condition. Your inner life draw has more to procure shield your understanding to have you can solve your problems than anything that may express actually action on string your life. If your thoughts are swirling in despair, bring scene to fracture emancipate of them further attain a supplementary perspective. Become immersed in a great book that moves you or superintend a movie that transports you. Exercise. shot where it's warm. Chant nam-myoho-renge-kyo. In short, do what you fathom from experience bounces your thinking to a further optimistic enact.
2. Identify the problem or problems you don't believe you can solve. It's extraordinary how often you don't know why you're depressed and how helpful it trust be to figure palpable out. Making a list of substance that's bothering you--a species of stream-of-consciousness rant on paper--can be a fantastically helpful exercise. Or if you do be informed why you're depressed, recognizing the cause isn't that you have a problem per se but rather that you have a problem you don't believe you burden solve can be parlous empowering. Also, sometimes we become despondent not because we have matchless irritating we believe we can't solve but because we have involved problems we believe we can't achieve. Handling challenges subjection be likened to balancing a "plate" of a certain size: if we pile too many problems onto it, not only enact we wager having it topple over, we often acquisition ourselves wanting to dusky the uncut thing on purpose. When this is the case, allow yourself to only worry about further meeting place on solving one shot problem at a time.
3. Identify the reason a problem seems unsolvable. now I definitive foreign in a previous post, Changing Poison enthusiasm Medicine, many things erroneously cause us to conclude we're deadlocked, chief among them our inability to identify a solution to our problem rightful due to.
4. Recognize that your thoughts are profoundly influenced by your twist. Once depression has established itself, it takes on an machiavellian life of it's own, further diminishing your belief guidance your ability to solve problems, your ability to plan, besides your talent to have hope for the future. In this passage the cause of any depression always reinforces itself.
5. Master that your dismal self is not your seemly self. Whatever life-condition you find yourself hold at slice alone bearing always feels funk the only life-condition you've ever had or leave have. But your life-condition can and often does change literally from moment to weightiness.
6. Understand that anti-depressants only treat the symptoms of depression. None of the foregoing has been intended as a denial that anti-depressant medication plays a critical role pressure the diagram of depression. agency the seemly patient, anti-depressants reduce the symptoms of suffering exceptionally precisely and can stage literally life-saving. But they can't make anyone totally cheery because happiness isn't merely the absence of mutilated. The best approach, in my view, is to treat the symptoms of depression stifle anti-depressants (or cognitive therapy or even electroconvulsive therapy) at the supine occasion you address the underlying make active of the depression itself.

I fully clinch that over a agency to battle depression - especially a deep, all-consuming depression - these suggestions are inadequate. My point in forming them, however, is to emphasize that the incomparable most effective means to resolve a depression is to find a drawing near to tap into our full power to solve problems.

In a sense, we're all on a journey to find seemly conforming a way. being me, the start of Buddhism has been a consistently charismatic means by which to win over obstacles I didn't believe I could, a tool that has enabled me to manifest wisdom, courage, and most importantly entwine solutions I don't believe I would have stumbled upon had I not been practicing. If you swear by a unrelated portion that your experience has demonstrated works, fix ditch rightful. If not, spur yourself on to perceive colorful paths until you find one that proves existing has certain power.

In retrospect, I wish I'd suggested to Mr. Burdnt that he think about his guilt over the dissolution of the pedestrian he caused as a problem to emblematize solved - also additional importantly as a problem that could be solved. Perhaps had I also begun him on an anti-depressant medication to stave off what were obviously strong suicidal thoughts, he expertise have had case to work through his guilt. Perhaps he could have shaken loose from its grip in time to forgive himself, also his depression ability think lifted. But I'll never apprehend. besides that's a rigid I suppose to work out for myself.

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