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Depression: Medicate, Meditate or both?


The World Health Organization estimates that by 2020, depression will be the second largest issue in ill health worldwide. Clinical depression is defined as a persistent depressed mood or loss of interest or pleasure for at least two weeks along with a number of other physical and psychological symptoms.

14 thoughts on “Depression: Medicate, Meditate or both?

  • April 8, 2009 at 1:26 am

    I read “Mindfulness and Depression” by the MBCT folks that you mentioned in this post. I was in the midst of my first relapse, and just starting to face that depression might a lifelong struggle for me. The book introduced me to mindfulness, which has led to lots of reading on the subject and eventually to this blog.

    In the book, it’s recommended that one go through a structured program if at all possible. Do you have any resources on how to find such a program, especially on the East coast?

    Thanks so much for your blog, Dr. Goldstein. I look forward to each new post.

    Reply
  • April 8, 2009 at 7:20 am

    The experience described is a result of practicing the Transcendental Meditation technique. Look at http://www.tm.org, http://www.DoctorsOnTM.org.

    Awakening of enlightenment–the experience.doc

    “Less than two weeks after I entered the halfway house, my life changed completely. What follows is a very approximate account.

    One morning I woke up. I had been sleeping on the floor as usual. Nothing special had happened the night before; I just opened my eyes. But I was seeing without concepts, without thoughts or an internal story. There was no me. It was as if something else had woken up. It opened its eyes. It was looking through Katie’s eyes. And it was crisp, it was clear, it was new, it had never been here before. Everything was unrecognizable. And it was so delighted! Laughter welled up from the depths and just poured out. It breathed and was ecstasy. It was intoxicated with joy: totally greedy for everything. There was nothing separate, nothing unacceptable to it. Everything was its very own self. For the first time I — it — experienced the love of its own life. I — it —was amazed!

    In trying to be as accurate as possible, I am using the word “it” for this delighted, loving awareness, in which there was no me or world, and in which everything was included. There just isn’t another way to say how completely new and fresh the awareness was. There was no I observing the “it.” There was nothing but the “it.” And even the realization of an “it” came later.

    Let me say this in a different way. A foot appeared; there was a cockroach crawling over it. It opened its eyes, and there was something on the foot; or there was something on the foot, and then it opened its eyes — I don’t know the sequence, because there was no time in any of this. So, to put it in slow motion: it opened its eyes, looked down at the foot, a cockroach was crawling across the ankle, and … it was awake! It was born. And from then on, it’s been observing. But there wasn’t a subject or an object. It was — is — everything it saw. There’s no separation in it, anywhere.

    All my rage, all the thoughts that had been troubling me, my whole world, the whole world, was gone. The only thing that existed was awareness. The foot and the cockroach weren’t outside me; there was no outside or inside. It was all me. And I felt delight — absolute delight! There was nothing, and there was a whole world: walls and floor and ceiling and light and body, everything, in such fullness. But only what it could see: no more, no less.

    Then it stood up, and that was amazing. There was no thinking, no plan. It just stood up and walked to the bathroom. It walked straight to a mirror, and it locked onto the eyes of its own reflection, and it understood. And that was even deeper than the delight it had known before. It fell in love with that being in the mirror. It was as if the woman and the awareness of the woman had permanently merged. There were only the eyes, and a sense of absolute vastness, with no knowledge in it. It was as if I — she — had been shot through with electricity. It was like God giving itself life through the body of the woman — God so loving and bright, so vast — and yet she knew that it was herself. It made such a deep connection with her eyes. There was no meaning to it, just a nameless recognition that consumed her.

    Love is the best word I can find for it. It had been split apart, and now it was joined. There was it moving, and then it in the mirror, and then it joined as quickly as it had separated — it was all eyes. The eyes in the mirror were the eyes of it. And it gave itself back again , as it met again. And that gave it its identity, which I call love. As it looked in the mirror, the eyes — the depth of them— were all that was real, all that existed — prior to that, nothing. No eyes, no anything; even standing there, there was nothing. And then the eyes come out to give it what it is. People name things a wall, a ceiling, a foot, a hand. But it had no name for these things, because it’s indivisible. And it’s invisible. Until the eyes. Until the eyes. I remember tears of gratitude pouring down the cheeks as it looked at its own reflection. It stood there staring for I don’t know how long.

    These were the first moments after I was born as it, or it as me. There was nothing left of Katie. There was literally not even a shred of memory of her — no past, no future, not even a present. And in that openness, such joy. “There’s nothing sweeter than this,” I felt; “there is nothing but this. If you loved yourself more than anything you could imagine, you would give yourself this. A face. A hand. Breath. But that’s not enough. A wall. A ceiling. A window. A bed. Light bulbs. Ooh! And this too! And this too! And this too!”

    All this took place beyond time. But when I put it into language, I have to backtrack and fill in. While I was lying on the floor, I understood that when I was asleep, prior to cockroach or foot, prior to any thoughts, prior to any world, there is nothing. In that instant, the four questions of The Work were born. I understood that no thought is true. The whole of inquiry was already present in that understanding. It was like closing a gate and hearing it click shut. It wasn’t I who woke up: inquiry woke up. The two polarities, the left and right of things, the something/nothing of it all, woke up. Both sides were equal. I understood this in that first instant of no-time .

    So to say it again: As I was lying there in the awareness, as the awareness, the thought arose: It’s a foot. And immediately I saw that it wasn’t true, and that was the delight of it. I saw that it was all backward. It’s not a foot; it’s not a cockroach. It wasn’t true, and yet there was a foot, there was a cockroach. It opened its eyes and saw a foot, and a cockroach crawling over the foot. But there was no name for these things. There were no separate words for foot or cockroach or wall or any of it. So it was looking at its entire body, looking at itself, with no name. Nothing was separate from it, nothing was outside it, it was all pulsing with life and delight, and it was all one unbroken experience. To separate that wholeness and see anything as outside itself, wasn’t true. The foot existed, yet it wasn’t a separate thing, and to call it a “foot,” or an anything, felt like a lie. It was absurd. And the laughter kept pouring out of me. I saw that cockroach and foot are names for joy, that there are no names for what appears as real now. This was the birth of awareness: thought reflecting back as itself, seeing itself as everything, surrounded by the vast sea of its own laughter.

    When I try to explain how The Work was born in that instant of realization, I can analyze the instant, slow it down, and tell it so that it takes on time. But this is giving time to an instant that wasn’t even an instant. In that no-time, everything was known and seen as nothing. It saw a foot, and it knew that it wasn’t a foot, and it loved that it was. The first and second of the four questions is like the slow-motion mechanics of the experience. “It’s a foot” — is that true? Can I absolutely know that it’s true? No. What was it like before the thought of “foot” appeared, before there was the world of “foot”? Nothing.

    Then the third question: How do I react when I believe the thought? I was aware that there’s always a contraction, that when I believe any thought I create a world separate from myself, an object that is apparently “out there,” and that the contraction is a form of suffering. And the fourth: Who would I be without that thought? I would be prior to thought, I would be — I am — peace, absolute joy. Then the turnaround: It’s a foot / it’s not a foot. Actually, all four questions were present in the first — Is it true? — and everything was already released in the instant that the first question was asked. The second, third, and fourth questions were embedded in the inquiry that was there in the experience. There were no words for any of the questions — they were not explicit, not thought, not experienced in time, but present as possibilities when I looked at my experience later and tried to make it available for people. With the fourth question the circle is complete. And then the turnaround is the grounding, the re-entry. There’s nothing / there’s something. And in that way people can be held without the terror of being nothing, without identity. The turnaround holds them until it’s a comfortable place. And they realize that nowhere to go is really where they already are.

    Reply
  • April 8, 2009 at 8:06 am

    Synthetic drugs currently available to treat depression are only a few of the medications possible to discover, and by no means the best, we can surmise. One very promising source for developing effective, safe drugs is plant secondary metabolites. Unfortunately, NIH has done a scandalously poor job of funding research and development of drugs for depression and anxiety derived from plant metabolites, not to speak of its minimal funding for research on herbal remedies themselves. For an example of what could be done with proper funding, see http://www.scientiapress.com/findings/ahmad.htm.

    Reply
  • April 8, 2009 at 8:38 am

    People struggling to just survive, and hoping they can keep food on the table and a roof over their heads have good reason to be depressed. But someone living in a million dollar house, driving a fifty-thousand dollar car and never worrying about doctor’s bills or braces for their kid’s teeth elicts little sympathy from me. Maybe they need cognitive therapy to realize the destructive exspectations they have for what will make them happy. Of course it helps to have the money or the insurance to get that support.

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  • April 11, 2009 at 10:53 pm

    Hi Meghan,

    The best I can offer at this point until they have a more structured way of finding MBCT programs is to search for MBCT and your area. Otherwise, you can go to http://www.umassmed.edu/cfm/mbsr/ to find an MBSR (Mindfulness-based Stress Reduction)program in your area.

    Reply
  • April 12, 2009 at 1:51 pm

    Thanks for the article – anything that helps people to get over, around or through episodes of depression – or anxiety, or any similar challenges, is to the good.
    And activities that help someone from relapsing should be promoted, taught, etc… just as long as the depression itself gets sufficient attention and treatment.

    For myself – well, i am one of perhaps many who had read and tried everything out there to deal with recurrent slides into depression from my teens on. Therapists with different approaches,a cognitive approach, meditation (which I find a good practice, just not effective against depression), herbs, exercise and diet changes. Oh and TM – though not specifically for depression (and I still meditate, altho’ somewhat differently). It was a long time ago, but I do remember what I felt when none of these approaches worked – hopelessly anticipating the next down cycle, and wondering
    what else was wrong with me, since I obviously couldn’t do these “right” either.

    I was reluctant to use anti-depressants… but finally, in my mid-forties,I did try Prozac — and in about 5-6 weeks, people were asking me what had changed in my life. It helped me -Then a return to a therapist to deal with some past issues,and a tendency – born of depression- to behaviors that weren’t supportive of a more rewarding life.

    Post medication therapy was immensely helpful – and I am certain that my ability to benefit from it rested on the fact that the underlying depression was alleviated, leaving more energy to deal with “issues.” The old black dog (the Churchill term for his depression)still visits, but knowing it can be tamed makes it far less overwhelming.

    So – My take is -there are a lot of ways to deal with depression and its associated symptoms and miseries … but knowing I would have been among the lost if I had never had a successful chemical intervention makes me leery of approaches promising change if ONLY the individual does X (say mindfulness meditation) or Y (e.g.,walking every day and cutting out all sugar).
    Coaching folks prone to depression in adapting more rewarding behaviors may help them to become more resilient –and maybe it will change some brain structure for the better. But – I can’t help but worry that someone may be given a message that IF ONLY he just does meditation the right way,depression will be held at bay.( And if s/he doesn’t, its his/her fault).
    So its important that people get help for the depression, as well as opportunities to learn behaviors that will help them stay in the world.

    Reply
  • April 17, 2009 at 6:20 am

    Mr. Don DeLong,

    After reading your response, I couldn’t help but comment back (I never write comments). It is important to remember that money does not buy happiness. Just because someone has money does not mean their lives are perfect. Just because one group has more economic trouble does not mean they are allowed to be depressed while the group that is well off financially should never be upset with anything. Bad things can happen to anyone no matter how much money they have. For example, what if a rich person lost their parents in a car accident and in the aftermath grew more and more depressed.

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  • April 17, 2009 at 1:28 pm

    In my experience, suffering is indiscriminant on class. Some of the poorest people on this planet, Masaai tribe in east Africa for example, who live in huts made out of dung,with no running water or electricity, are reportedly equally as happy as the top 400 in Forbes richest Americans. With that said, having access to proper mental health care and support resources can give someone a leg up in actively taking care of their physical and mental health. This piece needs more support in our society.

    Reply
  • June 17, 2009 at 7:09 am

    Mr. Don DeLong, I have come to realize, that many more people than not believe exactly the same as you. Obviously, you have never had the misfortune to be rich, because it really sucks, you know. It’s very depressing, in fact.

    for once, it’s like being a beautiful woman, the wish that makes many women believe would bring them happiness, like fame, and money. But, you know, a beautiful woman, just like a very rich man, they will never know if they are being loved for their beauty or for themselves? (and, that is just one tiny point)

    I appreciate your commenting, Mat, especially if you are not used to it.

    I also want to thank you, Lawrence, for sharing your personal experience like you did. Some people may read your post and not even listen, thinking you are a nut case. I don’t and it takes a lot of courage to share something like this and which I believe must be quite vulnerable stuff to say, and it doesn’t feel great to be ignored?

    Elisha, this article I can much better relate to than an earlier one you wrote about preventing relapse of depression. So, thanks.

    The thing with antidepressants is, that if you have taken them for 3 years, you may as well take them forever, or have to take them forever, because your brain chemistry has changed, and although every doctor may try to convince you that you are still depressed after getting off them, the case is both ‘YES’ and ‘NO’. You are very depressed but it’s from the medicine and much less likely due to any other reason.

    I appreciate your commenting, Mat.

    Reply
  • June 24, 2009 at 9:22 pm

    No, money does not equal happiness, but…

    given the choice between being

    depressed and broke

    or

    depressed and rich

    i’ll choose the latter 11 times out of 10.

    No, money can not buy happiness, but it sure can eliminate the pain of poverty and take the sting out of anything else life cares to throw our way.

    And as for the mud hut people being happy…just cuz they live in mud huts does not mean they can be equated with poor people. Just that the material things they value are vastly different than what we value. Take a closer look at those mud hut dwellers and I’ll bet u the chief with his 10 wives, animal skins and sturdy spears is a much happier man than the poor bastard relegated to cleaning up after him.

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  • June 28, 2009 at 3:43 pm

    Medication was not meant to be a permanent solution to mental health issues

    What about people who are chronically depressed? Bipolar people? Schizophrenic people?

    This is an attitude I’m ashamed to see on this site.

    Reply
  • June 29, 2009 at 12:06 pm

    Hi Erika,
    I can understand that sentence seeming a bit strange when it is not included with the sentences that make up the entire point. Here is the whole paragraph stating the point that medication can be a support the ability to cultivate skills to incline us toward mental health. It is commonly understood that medication + skills is better than medication alone.

    Here is the entire paragraph:
    “Medication was not meant to be a permanent solution to mental health issues because they don’t target the supposed causes of the episode itself, but more to help relieve symptoms for a period of time so people who are suffering could cultivate the stability and skills to support themselves moving forward. Medication can be a wonderful support; however, it’s important to also cultivate the skills to work with the potential relapse of depression moving forward. This is a more effective long term strategy.”

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  • July 1, 2009 at 9:56 am

    I agree w/the person who said that without medication she would not have been able to benefit from therapy. I was the same way (have been diagnosed w/bipolar disorder, as my mother was; she ended up committing suicide when I was a teenager & I have had several suicide attempts myself). I had a lot of “therapy” since I had my first attempt at 15, but it wasn’t until I was medicated w/medicine used to treat bipolar was I able to start learning & applying things I’m learning in therapy.

    I have found Dialectical Behavioral Therapy to be instrumental in my ability to discontinue several medications–an anti-psychotic, anti-anxiety, & sleeping medication. Plus I’ve been able to cut my dosage of another medication by 1/2 & I hope eventually to be able to discontinue it as well.

    DBT is a group that is more like a class in that we have homework to do & learn new coping skills; how to reduce out-of-control emotions that lead to destructive behaviors; effective communication tools; how to employ mindfulness to help ease symptoms of disordered thinking & depression & anxiety, etc. It uses the cognitive behavioral therapy techniques, but adds more specific skills. We have a manual that we work from & I am so excited to be improving my mental health w/the tools I am learning.

    I’m now 55 years old & I tell you, living w/the depressions that lead to the suicide attempts was an incredibly horrible quality of life.

    Both my children had bad bouts w/depression. One in high school & the other in college. My daughter had to take a medical leave from college to get treatment which consisted of taking an anti-depressant & therapy. My son also took medication & had therapy. Both of them were on the anti-depressants for one year.

    The doctor explained that they could probably change their attitudes & thinking that was causing the depression without medication after a year. My son is now 30 & has never had a reoccurrence. My daughter is 33 & has had more bouts that have become quite severe, but she is a lawyer & is leery of getting any mental health care due to the stigma involved.

    Reply
  • July 22, 2009 at 5:09 pm

    Thanks for the post!

    Reply
 

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