managing depression

Many people suffer from depression at some stage in their lives. Some is short-term while others suffer in the medium to long-term.

There are different types of treatment and these will depend on how severe the depression is in the first place. Mild to moderate depression can be effectively treated with talking therapies, such as cognitive behaviour therapy (CBT) or psychotherapy. Antidepressants (such as selective serotonin reuptake inhibitor SSRI, and serotonin norepinephrine reuptake inhibitor SNRI) leave more serotonin available, rather than reabsorption into cells in the brain; serotonin is a neurotransmitter that carries signals between brain cells and these strengthen brain circuits that regulate mood. These can be an effective form of treatment for moderate to severe depression. Sometimes different antidepressant medications need to be tried before finding the one that works best for the individual.

A combination of medication and psychotherapy has been associated with significantly higher rates of improvement in more severe, chronic, and complex presentations of depression. It is the author’s opinion that there is an over-reliance on medication and that the health-care industry are not entirely to blame. Nowadays, in our fast-paced society, people demand a quick-fix and do not appear to have the patience to work on alternative treatments which may take longer but be more effective in the long-term. However, it is recognised that some of these alternatives, such as psychotherapy, can be more expensive than medication.

Learning to replace negative thoughts with more positive ones is a key element in recovery from depression. This negative thinking is the primary symptom of depression and if it can be eliminated, the other symptoms, such as intense sadness, sleep disturbances and loss of interest in activities, will abate. One of the most critical stages in cognitive behaviour therapy involves the client keeping a record of the conditions under which these negative automatic thoughts occur so that they can be eliminated.

Other treatment and care modalities include:

·       Self-management: these are methods, skills and strategies people use to manage themselves.

·       Peer support interventions: this is where support is mutually offered and reciprocal.

·       Digital technologies; includes the use of the internet for self-help and computerised CBT for mild to moderate depression.

·       Apps and wearables: healthcare and mobile apps are being used to access information about and monitor nutrition. 31% of people surveyed were open to this idea for mental health.

·       Mindfulness: this approach uses techniques that draw on meditation, breathing and yoga. Mindfulness-based cognitive therapy has been recommended as a preventive measure for people with recurrent depression.

·       Medication: this can be effective in the short-term but is not a long-term solution except for very severe cases.

·     Exercise: this has been proven to be effective for depression and anxiety. Exercising resulted in improved mood and enjoyment alongside reduced symptoms of depression. Brain changes occur including the release of positive neurochemicals such as serotonin (which increases  motivation and willpower), noradrenaline (which enhances thinking, focus and dealing with stress) and dopamine (which controls aspects of pleasure, decision-making and focus). It is both the serotonin and noradrenaline systems that are mostly targeted by antidepressants. Exercising also helps to reduce stress hormones such as cortisol and adrenaline.

·       Nutrition: healthy eating has been found to be associated with better emotional health compared to unhealthy eating. Patients with depression can sometimes be divided according to their gut microbiome. There are potential benefits of using probiotics in the treatment of mood disorders.

·       The arts: these include various forms such as the visual arts, dance and music therapy. Art therapy can be very successful in treating mental health symptoms.

·       Setting goals & making decisions: making decisions (not necessarily the best, but good enough) includes creating intentions and setting goals. All three of these are part of the same neural circuitry and engage the prefrontal cortex in a positive way, thereby reducing worry and anxiety. This helps to rebalance the dysfunctional frontal-limbic circuitry found in depression. Indecisiveness is part of the downward spiral of depression because it enhances the feeling of being out of control; the amount one feels in control of a situation lowers one’s stress level. Once a decision has been made the prefrontal cortex organises one’s actions to achieve the goals and changes the way the rest of the brain perceives the world. This decision-making (which is a high-level brain process) positively affects the lower-level sensory processes. Decisiveness in one part of one’s life improves decisiveness in other parts.

One way to start this process is to think about what your values are and to then link your goals to the values and purpose in life. In “Man’s Search for Meaning”, Viktor E. Frankl says “Those who have a ‘why’ to live, can bear with almost any ‘how’” and similarly, in his book, “A New Earth” (p257), Tolle says that “There is no substitute for finding true purpose.”

·       Giving your brain a rest: poor sleep is one of the most common symptoms of depression, as well as one of the biggest contributors to developing depression and staying depressed. Poor sleep is not only getting insufficient sleep but also getting low-quality sleep. Poor sleep negatively affects one’s mood, lowers the pain threshold, and interferes with learning and memory. It also alters the functions of the positive neurochemicals. Sleep quality is best when one’s sleep is synchronised with their circadian rhythms (the brain’s internal clock which controls a variety of hormones and neurotransmitters on a daily basis) and is continuous. After the sun sets the circadian rhythms tell the brain that it is nighttime and that it should start getting ready for sleep. Good practice for sleeping includes using your bedroom for sleeping and not work, creating a routine for preparing for sleep, avoid caffeine near bedtime, eat and drink in moderation prior to sleep, and exercise but not too close to bedtime.

·       Developing positive habits: habits are created by repetition. Repetition causes wiring  in the dorsal striatum which is an ancient processing centre deep in the brain. The striatum, unlike the prefrontal cortex, is not rational and does not distinguish good from bad; it will just continue on with bad habits, if created, with no regard to the long-term consequences. Studies have shown that thinking about one’s positive qualities makes it easier to change one’s habits. Positive self-reflection enhances  serotonin activity which is essential for proper functioning of the prefrontal cortex; this self-affirmation helps the thinking prefrontal cortex override the habitual stratium to great results. Other ways to increase serotonin is to get sufficient sunlight, massage, exercise (especially aerobic), and remembering happy memories. Stress biases the brain toward old habits over intentional actions so it is important to reduce the stress levels.

 ·       There is a powerful force that directly combats negativity. It’s called gratitude. Gratitude improves mood and reduces the likelihood of suicidal thoughts. Gratitude also reduces anxiety. Developing the gratitude circuit in the brain increases activity in the cingulate cortex of the brain that sits at the intersection between the emotional limbic system and the rational prefrontal cortex and helps modulate communication between those. Remembering things in the past that one is happy or grateful for increases the production of the neurotransmitter serotonin.

·       Power of others: social interactions change the activity of numerous brain circuits and neurotransmitter systems. Talking, physical contact or just being near other people can decrease stress, pain, anxiety, and depressive symptoms, while increasing calmness and happiness. It can be easier to absorb feelings of happiness from others than to generate them in yourself. Also, in depression, the “love hormone”, oxytocin is out of sorts. Ways of increasing oxytocin include hugs, handshakes, massage, interacting with friends and having a pet.

·       A single-session of Havening (a psychosensory psychotherapy) intervention can result in improved scores for depression and these improvements can be sustained over time. Havening intervention is a useful and cost-effective intervention for common mental disorders.

·       Biofeedback: the brain changes its activity based on what the body is doing because it constantly receives signals from the rest of the body. So, here are some examples which help with depression:

Ø  A sudden splash of cold water on your face slows down the heart rate so if one is feeling overwhelmed, stressed or anxious, it is good to fill your hands with cold water and splash it on your face.

Ø  Music engages most of the limbic system which is why it can be motivating and enjoyable and can help regulate the emotions.

Ø  Smiling and laughing can make us feel happy. It basically tells the brain we are happy. It increases positive feelings.

Ø  A confident posture may not automatically make you happier, but it does modulate your brain’s response to your thoughts. Changes in posture are reflected by changes in neurohormone levels. So if you’re feeling doubtful, keep your chin up, stand up straight and stick out your chest, which reminds me of the  lyrics of the song by Val Doonican,

Walk tall, walk straight and look the world right in the eye
That's what my mama told me when I was about knee high
She said son, be a proud man and hold your head up high
Walk tall, walk straight and look the world right in the eye.

Ø Calm your face and your brain thinks you’re happy. In a similar way, if the face is flexed the brain thinks you’re upset or worried.

Ø Changing your breathing is one of the quickest ways to change your emotional state. When anxious or overwhelmed, slow breathing can help. Breathe in slowly through your nose while counting slowly to six, pause for a couple of seconds and then exhale slowly through the nose for the same count.

Ø Relax the muscles, particularly the facial ones as these have the most influence on emotions. To help the brain with this, sometimes it’s helpful to clench them first. Take a deep breath in, flex a tight muscle for a few seconds, then exhale with a sigh and relax.

It seems that there is no one big solution to depression. But there are dozens of small solutions which can kick-start the brain and that add up to more than the sum of their parts because in complex systems like the brain, a little shift can change the resonance of the whole system. It is important with all of the above to allow time for the brain to rewire.

If you would like some help with any of the above please do not hesitate to contact us at www.holisticcounsellingireland.com. We are here to work with you.