Nick
I do indeed have a long history with depression. In my mid-twenties I recognized the problem as a mental health issue and not simply a result of the world being depressing (it's not, it just seems that way when we're depressed). Below I share the techniques and approaches that have helped me, along with tidbits of wisdom from people I admire.
To Begin: The Definition of Depression and the Limitations of Turning to Doctors for Help
Depression takes place when the body's mood-stabilizing systems get out of whack. Depression is not just sadness. It's a loss of the ability to experience the full range of human emotions. A healthy person is like a musical instrument, capable of a wide range of emotions and resonance. A depressed person is like a musical instrument that has lost the ability to produce more than a handful of notes. Sadness is a normal part of the ups and downs of life. If there was never sadness, then how would we understand happiness?
Depression is very real, yet thinking of depression as a disease or disorder can be limiting and sometimes harmful. If you need a label, try "mental health issue," which gives you a bit more space to breathe. Many of the world's most awesome people suffered from depression, so depression is clearly just the negative expression of something we don't entirely understand yet.
Public discussion and understanding of depression has been affected by the medical and pharmaceutical industries in both helpful and harmful ways. Modern medicine has yet to provide effective treatments for depression. Doctors knowledge of treatments is biasted towards drugs. In some situations the pharmaceuitcal companies have actually withheld results from their own studies when the results were not favorable toward antidepressant efficacy. If you want to see a doctor about depression, make sure they are up to date and have investigated treatments beyond the common drugs.
If you've been through several depressions, don't despair. You can be a mentally healthy person if you learn certain skills, take certain actions, and establish appropriate support. Just consider yourself a high-maintenance instrument that requires regular tuning, and then do the tuning! Here are a few things that have worked for me:
1) Cardiovascular and Anabolic Exercise
If I start running at least 40 minutes, five times per week, I always see improvement within two or three weeks. I'm sure that any exercise which raises your heart rate enough will have the same effect. Anabolic exercise (lifting weights so that your muscles are getting stronger) also seems to help.
Both forms of exercise release hormones and endorphins into the body, which have a regulating effect on mood. But for either type of exercise you must a) get your heart rate up for at least 30 minutes (running at a good pace) or b) create a true anabolic response (i.e. strength training).
I have tried asana practice (yoga) while coping with depression, but I don't think it's anabolic enough to have the same effect. Yoga is great for mind and body, but when I'm really depressed running works better. I recommend slowly scanning the body from head to toe as you run. Doing so brings an element of mindfulness into the practice which adds greatly to its therapeutic effects.
This kind of exercise is not always easy to begin when we're depressed! That's where friends, family, professional help, or any other system of support comes in. If you can't get yourself out exercising, call somebody and ask them to be your running buddy. Do anything you need to do to get yourself exercising, and keep it up for at least a few weeks.
2) Mindfulness Meditation and Mindfulness Based Cognitive Therapy (MBCT)
Mindfulness meditation (also known as "vipassana" or "insight" meditation) has been studied as a treatment for depression by several of the world's most respected universities, particularly by Oxford University in England. Oxford basically concluded that Mindfulness Based Cognitive Therapy (which is a form of bare-bones, secular, Buddhist insight meditation) is the most effective way to treat depression ever studied, better than all other medications and therapies.
Mindfulness meditation often works something like this: Sit with a straight spine, focus on your breath for a bit, and then spend a few minutes reflecting on how you want to be happy, healthy, and at peace. Then reflect on how you want your friends and family to be happy, healthy, and at peace. Then reflect on how you want all the people in the whole world to be happy, healthy, and at peace. Then you spend the rest of the time resting your attention on your breath. Each time you realize you've drifted off into thought, you can take a quick note of where you went and then come back to the breath. The goal is to gently observe body, breath, feelings, and mind in the context of caring about the world and wanting to be happy. You are not supposed to go into a trance. You are not supposed to stop thinking. That's a different kind of meditation.
Mindfulness meditation is a specific approach to meditation. MBCT is a specific approach to mindfulness meditation. There are many approaches to MBCT. To start learning more I recommend the following resources:
A Path With Heart, by Jack Kornfield. It's a very good book on mindfulness meditation. All his books seem good.
The Mindful Way Through Depression, Freeing Yourself from Chronic Unhappiness, by Mark Williams, John Teasdale, Zindel Segal, and Jon Kabat-Zinn.
Mastering the Core Teachings of the Buddha, by Daniel Ingram. This is a free e-book. It inspired me to start meditating again. I've basically maintained my practice since I read it in June, 2010. It's a bit "far out" compared to the others, and I loved it. :)
The free resources on Dharma.org, the website of the Insight Meditation Society.
Warning: There are many religious groups who offer meditation. If you are depressed, then you may be vulnerable to manipulation, so be careful. Explore all meditation classes with your bullshit detector gently and compassionately switched to "on." The safest way to learn meditation as a treatment for depression is probably MBCT. For a broader approach to mindfulness meditation, the network of teachers and retreat centers associated with the Insight Meditation Society seem very safe and open minded. I don't particularly recommend vipassana retreats as taught by S. N. Goenka and I'll write about that another time.
3) Skillful Affirmations or Thinking Skills Practice, but ONLY if Done Certain Ways
I've benefitted from cultivating an affirmations practice, but be warned: it's possible to practice affirmations in a manner that will make you feel worse. Studies show that asking people to repeat blanket positive statements such as, "I'm a happy and vibrant person" will make happy people happier and depressed people more depressed! The reason is simple: You're not stupid enough. Telling yourself that you're happy when you're depressed will set off your aforementioned bullshit detector, which will counter the affirmation with all the contrary evidence at its disposal. Thus for every minute you spend telling yourself that you're happy, you are likely to spend five minutes refuting the claim with evidence of your depression.
My advice for practicing affirmations: Review and repeat things you know to be true and which seem to have a mood-lifting effect. That is, cultivate a list of things that will be true even when you're depressed. These can be things like this:
• I have friends who love me
• I am free and safe
• People say my dimples are cute
• I am talented with such-and-such
• I believe in the power of friendship
• I have often done the right thing, even when it was difficult
• I am an expression of the energy of the universe
• I make great popcorn
• I am willing to be witness to the truth of all things
• I carry within me a longing to be happy and to feel love, even in the darkest of times
Again, the important thing is that they are true to you. A great way to find effective affirmations is to observe your own mind when you're depressed. Notice the negative thoughts that arise, and counter them with truth. This approach is different than countering them with the opposite thought. If the thought is, "I'm the world's biggest idiot," it won't do any good to think, "I'm the world's biggest genius." You need to find something irrefutable. That thought might be, "I have enough intelligence to be a contributing member of a loving community." That's not a sensational thought, but if it resonates as deeply true then it will work. It takes practice to find the affirmations that work well.
A basic affirmation practice could look like this: Each morning you take time to cultivate your list of affirmations. Say each affirmation to yourself and then feel how it resonates. If it doesn't resonate as truth, take it off the list or play with it until it does resonate as truth. The affirmations list will evolve as you gain experience and inspiration.
Affirmations will only work if you understand the difference between things that are true and things you would like to be true. The process of affirmations should look a bit like Cognitive Behavioural Therapy, which is the most effective form of talk therapy, and is basically a process of acknowledging and correcting negative thought habits. Working with an experienced Cognitive Behavioural Therapist would be a great way to cultivate an affirmations practice.
Conclusion: Going Beyond "Managing Depression"
One reason that people relapse into depression is that they stop doing their practices the moment they feel better! If you want to stay happy, keep practicing when you're happy. When you're depressed you might call it MBCT (Mindfulness Based Cognitive Therapy) and when you're not depressed you might call it SPoAP (Super Powers of Awesomeness Practice).
I am no expert on any of this. Everything I've written here is from my own experience. I have come a long way and I still have a long way to go. Ultimately it all boils down to love, respect, and a willingness to open your heart to the present moment.
Please contact me if you have any questions,
Nick
