stress

Reblogging: The Many Origins of Depression by Dr. Kelly Brogan

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Kelly Brogan is a psychiatrist practicing in New York city who approaches depression in a holistic fashion. Not only does she listen to your symptoms, but she takes a wide-angle view of a patient’s life to help each person find the appropriate treatments. I have done a lot of reading on the causes of depression, and based on what I’ve learned, I completely reject the notion of brain-based chemical imbalances. Depression, from all that I have learned, is a much more complex reaction to life-situations than a simple chemical imbalance. I agree with what Kelly says near the end of this article,”…taking a one-size-fits-all antidepressant is like turning off the smoke alarm and ignoring the fire.”  Read on to discover the myriad of causes for the fires inside.

What Is Depression?

Is depression a flat mood, an inability to participate in ‘normal life activities,’ or unexplained bouts of sadness? In spite of its singular clinical classification, depression looks different for each person. Like Leo Tolstoy noted in his famous novel Anna Karenina, “All happy families are alike; each unhappy family is unhappy in its own way.”

While all happy families aren’t necessarily alike, this adage speaks truth in terms of depression. Each person’s depressive symptoms – remember, depression is a symptom, not a disease – depend on their unique circumstances, bodily health, emotional history, and held beliefs. As the serotonin model of depression continues to lose its hold on mainstream psychiatry, a theory of depression as evolutionary mismatch has emerged. In this theory, depression is the result of modern living; we did not evolve in the context of environmental toxins, isolated living, and near-constant stress. Some argue that depression is a response to this mismatch, also called paleo-deficit disorder, and depression is simply a message from our bodies trying to protect us from the madness of the modern world.

However, even the evolutionary mismatch theory of depression relies on the dangerous assumption that all depression is the same: that depression is one disease, with one origin and a universal set of symptoms. Anyone who has been affected by depression will challenge this assumption. Depression can be caused by a constellation of factors that cause chronic inflammation – inflammatory foods, medications like the birth control pill, reduced sunlight exposure, and loneliness, to name a few – and manifest differently in different people. Some of the symptoms that qualify a person for a diagnosis of depression seem downright paradoxical: increased and decreased appetite, insomnia or fatigue, motor agitation or impairment. Even in one person, different depressive symptoms can appear at different times.

A recent scientific review article entitled ‘Depression subtyping based on evolutionary psychiatry: Proximate mechanisms and ultimate functions’ attempts to re-classify depression into twelve subtypes.1 For each of these subtypes, researchers propose different causes for depressive symptoms, as well as potential reasons that these subtypes evolved and purposes they serve. In this framework, depression may be (1) an beneficial adaptation that effectively addresses a specific problem (2) an adaptation that does not solve the problem (3) a byproduct of other adaptations or (4) a general pathological state that serves no purpose and is harmful.

The proposed twelve subtypes of depression

Twelve Causes of Depression, Explained by Scientists

In infection-induced depression, symptoms result from underlying inflammation. This classification is supported by studies showing that anti-inflammatory agents reduce symptoms of depression.2 Further, the ‘sickness behavior’ of chronic inflammation, including social withdrawal, might worsen depression.

Long-term stress activates the immune system, leading to chronic inflammation that creates depressive symptoms. Why would stress activate the immune system? For a good reason, actually – in our evolutionary history, stress meant a higher chance of being wounded, and our immune systems ramped up to protect from infections that could result from those wounds. But nowadays, stress is rarely caused by true danger. Instead, stress comes from working long hours (against circadian rhythms), feeling pressured to meet deadlines, and financial worries.3 The response of inflammation to stress seems to be an evolutionary mismatch; the immune response that served us for centuries is no longer beneficial.

In the ancestral world, loneliness literally meant death. If you were separated from the tribe, you were vulnerable to predators and other forces of nature. Loneliness is a powerful and protective message that impels us to seek the company of others, which was crucial to survival for many generations. While loneliness is admittedly less dangerous now, this fear remains imprinted on us and leads to loneliness-induced depression.

People who have experienced significantly traumatic events are more likely to be diagnosed with depression, which researchers call trauma-induced depression. In fact, one study of almost 700 randomly-selected patients with depression found that 36% of them were also diagnosed with post-traumatic stress disorder (PTSD),4 and a large meta-analysis of 57 studies revealed that the comorbidity of depression and PTSD was 52%.5 Like those suffering from loneliness, people with PTSD show elevated levels of pro-inflammatory markers.6

Depressive symptoms can result from conflicts in modern hierarchies, such as the workplace, social groups, and families. Humans and social animals establish hierarchies, and those at the top enjoy many benefits. Therefore, we all want to be at a comfortable hierarchical position to meet our needs. If we don’t reach our desired place in the hierarchy, our self-esteem suffers.

Hierarchy conflicts, such as unemployment,7 bullying,8 and striving for unreachable career goals9 are all associated with depression.

Grief is a common driver of depression diagnoses. Up to 20% of people who lose a loved one and are grieving are saddled with the label of depression. Even in animals, losing a mate, sibling, or offspring leads to depressive symptoms. 10

Similarly, romantic rejection can cause depressive symptoms. Researchers found that after two months, 40% of people who had been left by their romantic partners showed symptoms of clinical depression.11 The sadness following a breakup may indicate true love and disappointment, and these feelings might also help make more aligned choices in future romantic relationships.

Six months after childbirth, 10-15% of women are diagnosed with postpartum depression. Symptoms of postpartum depression include crying, hopelessness, anger, and loss of interest in the new baby. Many studies indicate that mothers who feel that they are receiving inadequate childcare support from the father or her family are more likely to be diagnosed with postpartum depression.12 That is, a mother’s feelings of overwhelm, tiredness, and depletion are often categorized as postpartum depression. It has been hypothesized that the symptoms of postpartum depression may serve as a signal that the mother requires more support.

Seasonal Affective Disorder (SAD), also called seasonal depression, is a mood disorder that strikes a person at the same time each year, usually in the winter. A person diagnosed with SAD exhibits general fatigue, decreased libido, and increased appetite for starchy foods. SAD is more frequent in people with evening chronotypes, and light therapy can help resolve the symptoms.

Chemically-induced depression is a subtype of depression that results from substance abuse, such as alcohol or cocaine, or a side effect of medications like benzodiazepines. Yes, a side effect of anti-anxiety and antidepressant medications may be more depression. This type of depression appears to resolve when people stop ingesting the drugs or alcohol.13 Furthermore, as many people who feel sad self-medicate with alcohol, alcohol abuse may confound other drivers of depressive symptoms.

Interestingly, evidence is piling up that environmental toxicants, such as heavy metals, neurotoxic compounds, plastics, and pesticides may cause depressive symptoms.14 15

Being diagnosed with a disease like Alzheimer’s, migraine, and cancer increases the risk of also being diagnosed with depression. In fact, almost two-thirds of women who suffer from breast cancer are also diagnosed with depression.16 Of course, the diagnosis of cancer is traumatic and causes many types of anxieties, ranging from financial to emotional, and cancer treatments may cause further injury that adds to the stress burden.

Overall, depression is a meaningless label until you find its personal meaning.

This peer-reviewed article presents 12 research-backed possibilities that could be root cause drivers of depressive symptoms – and there are likely more than twelve. Scientific evidence continues to show that depression is a sign of imbalance, not an inherited genetic condition that you are powerless to change. Imbalances can be caused by inflammatory foods, toxins, medications, life events like trauma, and stress – and taking a one-size-fits-all antidepressant is like turning off the smoke alarm and ignoring the fire. Release the fear and move into curiosity. Commit to lean into your symptoms, realizing that they’re only messages, reduce your toxic exposures, turn down the noise, and explore the root cause of these symptoms for true healing.

References:

  • 1 https://www.ncbi.nlm.nih.gov/pubmed/29051086
  • 2 https://www.ncbi.nlm.nih.gov/pubmed/18073775
  • 3 http://europepmc.org/abstract/med/12821012
  • 4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219856/
  • 5 https://www.ncbi.nlm.nih.gov/pubmed/23696449
  • 6 https://www.ncbi.nlm.nih.gov/pubmed/19780999
  • 7 https://www.ncbi.nlm.nih.gov/pubmed/28359031
  • 8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926772/
  • 9 http://onlinelibrary.wiley.com/doi/10.1111/j.2044-8341.1970.tb02109.x/full
  • 10 http://press.uchicago.edu/ucp/books/book/chicago/H/bo12233936.html
  • 11 https://www.ncbi.nlm.nih.gov/pubmed/2016673
  • 12 http://www.sciencedirect.com/science/article/pii/S1090513899000161?via%3Dihub
  • 13 https://www.ncbi.nlm.nih.gov/pubmed/16930163
  • 14 https://www.ncbi.nlm.nih.gov/pubmed/18621076
  • 15 https://www.ncbi.nlm.nih.gov/pubmed/26987761
  • 16 http://www.europsy-journal.com/article/S0924-9338(07)01398-3/abstract

Holding on, and Letting Go: Mindy Abbott on Joy and Pain

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I’d like to welcome Mindy Abbott to my blog. Mindy and I met a few years ago at Howard Community College’s Blackbird Poetry Festival, the college’s annual celebration of poetry held every April.  More recently, Mindy and I have worked together in an informal critique group, punctuated by homemade meals shared across our kitchen tables.  Mindy brings a wealth of experience as a counselor, teacher, writer, and of course, a wonderful friend. Welcome, Mindy!

“It seems only yesterday I used to believe
there was nothing under my skin but light.
If you cut me I could shine.
But now when I fall upon the sidewalks of life,
I skin my knees. I bleed.”
Billy Collins ~ On Turning Ten

Mindy Abbott, Montepulciano, Italy
Mindy Abbott, Montepulciano, Italy

In my earliest memory I am sitting in cool, soft grass on a hot day, peaceful in a big, white tent. Big kids’ voices sing. I am too young to know all the words, but these I remember: “Yes, Jesus loves me…” I am safe, part of a community, and loved.

My educator parents, adorable younger siblings, and extended family made my young life beautiful. Mom created my hand-smocked dresses. Both my father and grandfather cuddled me while reading books of rhymes and fairy tales. I lived my life with my senses, playing among lilies of the valley, inhaling their scent, exploring their tiny white bells and surprisingly sturdy little stems. I stretched out with my dad on the beach of a Maine lake, naming the constellations and seeing, for the first time, the dancing pink and green aurora borealis – the northern lights. Life was magical. Our family was not fancy, but was rich in things that really mattered. We gave thanks.

As I grew, life became more, well, life. That freckled kid down the street stole my hat and threw it in the highest branches of a maple. I learned to climb tall trees. Sometimes my mother’s body was present while her mind traveled circular paths, but the reading she modeled let me instead travel by tesseract, feel the sting of paint from Michelangelo’s ceiling in my eye. Later, when a real big, bad wolf waited for me on a path one night, I discovered ferocity, and a strong, loving man who would be there for me. So how is it that, when I married and started my own family, I somehow believed that I could keep us all in the big white tent?

“Life is brutiful. The brutal and the beautiful cannot be separated, we must embrace both or neither.”
~ Glennon Doyle Melton, Momastery, 12-23-2011.

I laugh a lot. I thrive in nature, literally stopping to “smell the roses”. That’s the way I was as a young mom. But I believed myths: bad things wouldn’t happen if I were good enough; if I experienced pain, I should “tough it out”; and the big one, that I was in charge. Ha! I picture God laughing at this, saying “Isn’t she just the cutest?” I thought that diligence would protect me and my little family. But, of course, life came along, not as I had pictured it, but the way it really is: surgeries, loss, heartbreak, being transferred by employers from the people and places we loved. I tried to foresee and prevent pain for myself and my family, but it still snuck in, no matter how hard I worked or sincerely I prayed. I tended to react with “well, could be worse!” That was true but, finally, constantly discounting stress and pain wasn’t working for me. Nor, actually the people I loved. Some pain is too important to be cheered up. It needs to be heard, held gently, and honored. There had to be a better balance. I couldn’t control life.

“The wound is the place where the Light enters you.”
~ Rumi

As a sailor, I know that I do not control the winds, nor the waves; I can only adjust my sails. I was introduced to mindfulness meditation as a pain and stress management technique. As a teacher, the science of mindfulness results appealed to me. The formula “pain x resistance = suffering” made sense. For example, the first sensation when I lifted a stubborn rental car headrest and heard something in my shoulder pop was pain! But why add worries about future activities that might be affected, images of a year with a non-functioning arm, or self-blame? It just makes things worse. Applying self-compassion to the shoulder, then doing a meditation on the rest of the body parts that were doing just fine, helped me keep my physical pain in perspective, reduce my blood pressure, and relax.

Mindfulness turbocharged my religious beliefs with deeper awareness, and a stillness that lets me better hear the holy guidance that sometimes comes in a whisper or a nudge. Mindfulness helped me learn patience, acceptance, and peace.

I have retained my childhood sense of awe, adventure, gratitude, unconditional love, and the seemingly paradoxical senses of belonging and independence. I still laugh, bury my nose in roses, and draw on nature the way that deep roots draw nourishment from the earth. But pain has helped me grow. I found and released my myths. I no longer expect prayer to “fix” things, but feel the Holy Spirit with me through the most difficult moments. I listen more intently. I am more sensitive to the way that my energy affects others. My prayers now include a blessing:

May we all be free of suffering;
may we remember that we are truly known and deeply loved;
may we give and receive compassion and respect;
may we laugh; and
may we be at peace, come what may.

If you’d like to explore mindfulness meditation, try these talks by Tara Brach http://www.tarabrach.com/talks-for-beginners/ , guided meditation by Elisha Goldstein https://www.youtube.com/watch?v=wvbm4ITpAR0, an MBSR course or mindfulness group, or visit the Insight Meditation Community of Washington.

Melinda “Mindy” Abbott, BSW, M.Ed., worked in adult and pediatric long-term care before teaching public school in three states. An award-winning teacher in Maryland, she later co-taught mindfulness for children, trained in Mindfulness-Based Stress Reduction (MBSR) in Mind-Body Medicine, and published poems as Melinda Bennington. Her heart resides in family, friends, and nature.