Cures for the Depression Epidemic
By Bob Murray, PhD
Feeling down, blue, depressed even? You are not alone. The World Health Organization says that the incidence depression is doubling every ten years and will be, by 2020, the most pervasive illness in the world (it is currently second to heart disease) and the second major cause of death. The good news is that, with help, you can beat it.
In the US and Australia, and throughout the western world, a pall of stigma and secrecy still surrounds this experience. And a pervasive ignorance. For example depression is seen as largely a disease of women. In fact, although no one can agree on just how many people in Australia suffer from it, the received wisdom is that women are hit twice as often as men. No man wants to admit to having a woman's illness, or to be out of control of his emotions, which are the province of women. Yet the most recent studies indicate that men suffer depression in almost equal numbers as women even post natal depression, according to a recent UK study! and the male suicide rate is skyrocketing (there are 30,000 suicides in the US compared to a total of 20,000 homicides). Male depressive symptoms can include aggressiveness, isolation marriage to a computer for example, or web-surfing and drinking more than he should.
And depression, far from being confined to the 'mind' or to the emotions, is a major contributory factor, according to the latest research, in so-called 'physical' ailments such as osteoporosis and heart disease. In fact one US study found that 80 percent of all people who visit physicians suffer from depression.
Yet at a major international conference in Britain on depression held last year it was revealed that less than half of all GPs recognize symptoms of depression. The European director of the WHO even went so far as to say "There is no country that knows what it is doing in this area of healthcare. Doctors, psychiatrists and other healthcare professionals are working blindfolded." Even the most optimistic expressed skepticism about there ever being a cure.
One of the many nasty things about depression is that it is an insidious illness that often disguises itself as something else, hiding in physical symptoms from stomachaches and headaches to nearly crippling muscle pain. Fatigue, broken sleep, weight loss and gain and inability to enjoy the pleasures of life are all part of the price many accept for our modern lifestyle. Forgetfulness, inability to concentrate... happens to us all after 30 doesn't it? Isolated?... who has time to socialize? Helpless and hopeless?... you try balancing work and toddlers! Or deciding between them!
Tell that to the numbers of my clients who are now free from a lifetime of depression!
There are currently four approaches to treating depression: the antidepressants produced by the major drug companies, herbal remedies such as St. John's Wort, alternative medical-like treatments such as acupuncture, and psychotherapy. Which works and which doesn't?
There are three major classes of antidepressants: tricyclics such as Norpramin, SSRIs (selective serotonin reuptake inhibitors) such as Prozac and Zoloft, and MAOIs ( monoamine oxidase inhibitors) such as Nardil. Contrary to the information in that peon of praise to pharmacology "Listening to Prozac" by and large the drug-approach has a pretty poor success record. In fact studies completed about a year ago at the University of Connecticut and the University of London showed conclusively that in reality the drugs were little better than placebos. Further all antidepressants have side effects, ranging from a loss of libido (in up to 70 percent of users) to long term memory loss, and in the US they are not cleared for use for more than 12 months, although most doctors encourage their patients to stay on much longer often for life There can also be very distressing withdrawal symptoms associated with coming off many of these drugs.
The herbal remedy, St. Johns' Wort has been shown to be as effective as antidepressants in trials in Germany and elsewhere, with no major side effects. However it is only recommended for mild depression. Further, St. John's Wort, like more conventional antidepressants often tends to make depression somatize, that is find expression in physical problems such as illness rather than emotional ones.
The problem with the drug approach is that antidepressants work on altering brain chemistry and do nothing to deal with the underlying cause of the problem (nor, for that matter do the medical-like 'alternative' approaches such as acupuncture).
Depression can be "wired in" through connections between brain cells made as a result of childhood traumas such as abuse, neglect, criticism or impossibly high expectations. Also in childhood, the brain begins to "learn" poor responses to stress, so that in later life even small stresses may trigger a depressive episode. To combat this you need to understand your behavioral and emotional patterns and begin to change them. These patterns were formed in the brain before the age of six and form part of our operating program. However, much like a computer, the brain can be reprogramed.
This is the aim of psychotherapy. Most research has shown that traditional psychotherapeutic approaches are about as effective as antidepressants. The most popular approach is cognitive-behavioral therapy (CBT). In essence (and I am being very general) it attempts to break the depressive disorder down into its component behavioral and cognitive (belief and thought patterns) parts and, through a system of subtle rewards encourage the client to change these patterns of thought and behavior. This form of psychotherapy has, according to the most recent studies, a short-term success rate of about 47%. However the long term relapse rate is distressingly high.
A more sophisticated and, I believe more successful approach combines the new findings from genetic and anthropological science, a thorough understanding of neurobiology and somatics (the study of movement physiology). This last is important because depression is also lodged in the body. The aches, the slowness, the strong lack of desire to get out and exercise, are obvious symptoms. You must address your physical as well as emotional self to break to the chains of the disease. As part of our therapy we have developed special neuromuscular movements based on the Feldenkrais method (Repatterning Movements) which can actually cause the brain to open to new learning and rewire itself.
The most important thing about this new approach is its emphasis on relationships. We human beings are relationship-forming animals and wellness whether physical, emotional or spiritual can only really be achieved within the context of a nexus of supportive people around you. This is particularly important with depression. Long term depression can be seen as a reaction to dysfunctional and traumatic relationships in a person's early years. These relationship patterns are solidified in the cellular make-up of the depressed person's brain and are unwittingly recreated in subsequent associations. We emphasize the importance of the client learning to get his or her functional needs met within every relationship particularly those needs which were not met in childhood. Our techniques are geared to helping the individual enhance their capacity to form functional supportive networks of relationships within their communities. Such relationships have proven to be powerful antidotes to depression and anxiety, helping to prevent relapse of depressive symptoms. Indeed the Uplift Program has been demonstrated by patients' self-reports to have a long-term success rate of up to 94% in dealing with mild to moderate depression and relationship issues.
We also use other tools particularly in our Uplift Intensive such as ritual and story-telling to help create a supportive 'tribe' within the group of attendees.
Depression is a social disease, exacerbated by the increasing stressors of modern life, and ultimately the cure will come from a change in our society. In the meantime it can be treated effectively without the use of drugs.
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About the Author
Dr Bob Murray is a widely published psychologist and expert on emotional health and optimal relationships. Together with his wife and long-term collaborator Alicia Fortinberry, he is founder of the highly successful Uplift Program, and author of Raising an Optimistic Child (McGraw-Hill, 2006) and Creating Optimism (McGraw-Hill, 2004).
Disclaimer: The diagnosis and treatment of medical or psychiatric disorders requires trained professionals. The information provided in this article is for educational purposes only. It should NOT be used as a substitute for seeking professional help.
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