About Mind/Body Consultant Services & Protocols
Protocols: Depression Self-Care Recommendations
The following is a general outline of some of the interventions which our office has found helpful in resolving problems with depression. It is estimated that one third of all individuals experience an episode of depression in their lifetime resulting in a national cost of 40 billion dollars. In essence depression can be either a "depression" of normal feelings, needs, and spontaneous enthusiasm for living and, or a biochemical imbalance of primary or secondary origin. Symptoms of depression include: changes in appetite (especially for sweets and carbohydrates) or weight, difficulty with concentration or decision making, loss of confidence or self-esteem, racing thoughts, indigestion or bowel changes, difficulties sleeping (especially early morning wakening), fatigue, feelings of worthlessness or guilt, frequent tearfulness, feelings of shame, thoughts of self-abuse or suicide, substance abuse and other forms of self-medication.
Depression can be secondary to a primary physical condition such as: diabetes, Wilson's Syndrome, food allergies, digestive problems, hormonal imbalances, sleep disturbance, excessive cortisol production, and thyroid dysfunction. Seasonal depression is also medically distinct condition. If you are experiencing major depression is would be well to see your physician and rule out these and other conditions that may be at the root of the depression.
While many individuals become depressed at some point during their lifespan, major depression is a different experience in it's strength and magnitude. People who have experienced what is known as general "dysthymia" and also "major depression" report huge differences. In major depression the entire world looks bleak and hopeless, feelings of aliveness and enjoyment seem like they will never return, and even simple life tasks like making the bed may seem overwhelming. Most often, but the time an individual is in major depression there are physical changes that have gone on in the body that need to be addressed along with the cognitive and emotional changes that may be more obvious.
There are many different methods of recovering depression and individuals will respond differently to different strategies. Generally, we find it helpful to build a "toolkit" of several different strategies and procedures - perhaps choosing several from each of the below categories. This can be done on your own if you have dysthymia, but you should always seek professional assistance when experiencing major depression. Although effective antidepressant prescription medications which alter the brain serotonin levels are in wide-spread use today, research such as that summarized in Prozac Backlash by Harvard psychiatrist Joseph Glenmullen, M.D., is now showing that there are hidden side-effects which can be serious and sometimes permanent. While synthetic medication may be necessary at times, this should be viewed as a last, not first, option for treating psychological difficulties. If nothing else, working through depression can often be an important part of our personal and spiritual growth and development as human beings. To deprive ourselves of this opportunity reduces our life - a milder form of abortion.
In addition to working through items listed below during counseling meetings and at home we recommend that you order the corresponding TherapyWorks workbook Overcoming Depression. (To order: 800-211-8378 ext. 95780) Another excellent resource is Feeling Good: The New Mood Therapy by David Burns, M.D. There is also a Feeling Good Workbook that goes along with the text.
Most importantly, when we are depressed there is a tendency towards inertia. This symptom of depression prevents us from taking steps to relieve our depression - driving us deeper into a depressive state. Do not wait until you feel like taking action. You won't feel like it until you have taken the action which will gradually start to improve your outlook! Likewise, do not wait to figure out the deep meaning behind your depression or for some great psychological insight. Even if there is a deeply hidden psychological conflict at work, the end result of unearthing it will invariably lead you right back to the need to take good care of your self today! Like the commercial says, "Just do it!"
- Self-Care - Self care is essential in depression recovery. At the end of each day we can take a few minutes to examine our schedule for the next day terms of limiting negative and stressful circumstances and including as many self-care activities as possible in each of the following areas: Mental, physical, social, spiritual, emotional. Self-care may mean taking regular breaks at work to just enjoy the view out our window, having a relaxing bath at the end of the day, or taking time to go for a walk or do a little gardening each night after dinner.
- Processing Feelings - Feelings come in two general varieties, "carried" feelings from our past and the more immediate feelings generated in our present life. Regarding the former, it is helpful to work toward discharging carried feelings as these tend to accumulate and result in depression when repressed. "Psychodrama" exercise, Eye-Movement Desensitization and Reprocessing and other techniques can be helpful in this task. Regarding the latter, it is healthy to work to find ways of preventing negative feelings arising from our daily life and activities. For example, we might set boundaries with a family member so that resentments would not build up.
- Cognitive Therapy - See our individual protocol in this area.
- Affirmations and Daily Meditation - Affirmations can have a powerful uplifting effect on many depressive conditions. Various affirmation books are available and it is also helpful to write one's own specific affirmations - carrying them in a place where they can be accessed throughout the day.
- Family of Origin Issues and Patterns - Working with a trained psychotherapy to identify old messages and patterns which "program" us towards depression is a sometimes time-consuming but essential process. For example, if one was trained as a child to believe that one can never be "good enough" depression is certain to eventually result.
- Identifying Self-Destructive Messages - Essentially we need to make the shift from negative to positive in both how we treat ourselves and how we look at life. Just making this shift can begin the cycle of recovery from depression. Begin by noticing how much of the time you spend giving yourself negative messages, or even simply carrying with you a vague feeling that you are "bad" or have done something "wrong" and then shift these self-directed messages to the positive.
- Eye Movement Desensitization and Reprocessing (EMDR)
- Developing Self-Esteem - Awareness of our value as human beings leads to appreciation for our life and greater enjoyment of our circumstances, whatever they may be.
- Developing Self-Confidence and Awareness of Personal Strengths - Research has demonstrated a correlation between depression and lack of assertiveness. When we are not appropriately assertive about our needs we naturally depress them and this results in more general, systemic depression.
- Establish A List of Personal Warning Signs For Depression - When you find your warning signs showing up in your life it is time to take preventive measures to ward off depression. We are never totally depressed, or totally happy. We are always somewhere on a continuum between ecstasy and suicide. When we find pay attention to our depression warning signs we are in a better position to increase our anti-depressant self-care measures.
- Identifying Awareness of Life Goals - Our goals in life can be both long and short term. When we ignore our goals we increase our depression. This is most evident where a goal has been directly blocked, such as when an individual loses a job or relationship. If we fail to find a way around these block and, or express our grief about the loss depression can be the result.
- Identifying and Practicing Recreational Activities - Recreation is essential to maintaining balance in life. Each individual needs to have at least one or two recreational activities which serve to reenergize us.
- Developing an "Emergency Plan" - What would we do if depression hit us hard? This plan can be written down for best results. Most depression emergency pans should include contact with another person who can serve as a "reality check" and, or coach.
- Stress Management Training - See our individual protocol.
- Music - Music has obvious positive effects on our mood. Sometimes even just listening to music which allows us to grieve can unlock our emotional energies which have been depressed within us.
- Engram Therapy - Engrams are associations to positive or negative life experiences and usually focus on one of our five senses. For example, if one finds being at the beach relaxing and uplifting - putting a little suntan lotion on our body where we can smell it might bring back those good feelings.
- Meditation - See our individual protocol in this area.
- Guided Imagery - There are various guided imagery tapes available on the Internet and in bookstores and catalogs which focus on relief from depression. These can also be made by a psychotherapist or even at home using a script from a book or your own ideas. The more important thing is to use the guided imagery tape on a regular basis - daily if possible.
- Environmental Changes - Empowering ourselves to change something in our environment (rearrange furniture, take a different path to work, buy a new CD to listen to) can lift depression.
- Thought Field Therapy - TFT is a specialized form of psychotherapy which can very rapidly target and alleviate cognitive blocks and restore a balance to our mental and emotional energies. Based on acupuncture energy meridians this technique can even be learned and applied without professional assistance. (See Instant Emotional Healing by Drs. Peter Lambrou and George Pratt)
- Allopathic Medication - Avoid antihistamines, hypnotics, nonsteroidal anti-inflammatory drugs, beta-blockers, over the counter and prescription sleep medications, calcium antagonists or calcium channel blocking agents, steroids, and tranquilizers.
- Herbal and Homeopathic Medication - See our individual protocols for: St. John's Wort; 5-hydroxy-L-tryptophan, SAMe, Ginko Biloba, Inositol, DHEA (May lower cortisol levels.), Coenzyme Q10, L-Tyrosine, Melatonin, Phenylalanine as DLPA, Rosavin, Colostrum. See our individual protocols on these drugs for further information. Do not take herbal or enzymatic products without the advice and supervision of a physician, naturopathic physician, or trained complementary healthcare consultant. In combination some of these products can be dangerous and a diagnostic assessment is needed to determine which medication will be helpful for your condition and lifestyle. There are also various homeopathic remedies for depression which can be found in health food stores. These are without side effects, so there is little to discourage their use. It is best to seek the guidance of a trained homeopath to determine which remedy is best for your individual constitution.
- Aerobic Exercise - has been shown to improve mood. Exercise must be strenuous enough to increase respiration and cardiac rate and be done 5 to 7 days per week. For individuals who experience morning depression, exercising in the morning can help to break this cycle. (30 min. 5 day per week)
- Dietary changes - Add to your diet a multivitamin with 100 mcg of selenium, 500 mg of Folic Acid and at least some Zinc, a "B-100 Complex", 500 mg of Vitamin C, 1-4 grams of Omega-3 Essential Fatty Acids (Product should contain only small amounts of Omega-6.), 500 mg of Chelated Magnesium with 500 mg of Calcium. Drink plenty of water daily. Choose foods such as: Oats, sweet corn, ginger, tomatoes, bananas, barley, avocados, pineapples, eggplant, walnuts, cheese, yogurt, sour cream, chocolate, broadbeans, chicken livers, pickled herring, Spirulina, soy products, cottage cheese, pumpkin seeds, chicken, tofu, and watermelon seeds. All of these are high in serotonin, tryptophane or melatonin which tend to mitigate against depression. Avoid: Sugar, caffine, all fats except monounsaturated and EFAs, alcohol and tobacco which tend to contribute to depression.
- Breathing Exercises (See individual protocol)
- Energy Therapy - Tai Chi and Qigong are tradition Chinese regimens involving movements and breathing techniques with a view to balancing the body's flow of energy. Some studies have found these exercises helpful in reducing depression and anxiety. An excellent Qigong training video
- Relaxation Response Training - Harvard physician Herbert Benson coined this term which refers to the stimulation of the parasympathetic nervous system through various form of relaxation. Sympathetic nervous system over-arousal has been correlated with states of agitated depression. Thus, it is helpful to train the body to initiate a relaxation response - rebalancing the sympathetic and parasympathetic autonomic nervous systems. Methods for doing this include breathing exercises, meditation, imagining oneself in a relaxing setting, alternating tension and relaxation of muscle groups throughout the body, an autogenic training. Carrying an attitude of relaxation throughout the day gradually reduces depression.
- Sleep Hygiene - See our individual protocol in this area.
- Hydrotherapy - Anything from hot baths to special hydrotherapy massages.
- Negative Ion Therapy - See our individual protocol in this area.
- Phototherapy - See our individual protocol in this area.
- Aromatherapy - Various books and Internet resources can provide detailed information on specific aromas that might have an antidepressant effect. The best researched is lavender.
- Massage - A wide range of well-designed research studies have found massage to be highly beneficial in alleviating depression.
- Acupuncture - Although research is just emerging, acupuncture has been used in oriental cultures for centuries to treat depressive conditions. Finding a qualified practitioner is the most difficult task. Sometimes it is necessary to visit several before settling on one who has good needling technique and a high level of professional skill. Doctor of Oriental Medicine are generally the best trained. Some M.D.s also have acupuncture training.
- Stress Management - See our individual protocol in this area.
- Transcranial Magnetic Stimulation - Research studies have shown that magnetic stimulation of the brain through the use of externally applied magnetic fields can alleviate depression and some forms of anxiety. While most research has been done with expensive electromagnetic equipment known as rTMS, some studies indicate that stationary magnetic fields generated by direct current magnets may be effective to a degree. See our individual protocol in this area.
III. SOCIAL CONTACT
All of the following types and levels of social contact have been shown in research studies to correlate with reduced levels of depression. Choose contacts that fit your personality. Make sure to use proactive "I statements" in communication and try and be as "real" and congruent with your emotions and thoughts as possible. Setting boundaries and practicing self-ownership is also essential to making social relationships work for you.
- Support Groups
- Peer relationships
- Marriage and family relationships
- Church groups
- Psychotherapy and mentor relationships
- Relationships in which you can contributing to others
IV. CAREER / FINANCIAL
- Finding Satisfying Work
- Mastering Resources - Financial stress is one of the leading contributors to depression in our culture. Being good "stewards" of our time, energy and finances can help us to feel safe and confident. Additionally, we then have the resources needed to take time off work, or see a therapist when we are feeling depressed.
- Prayer and Meditation
- Letting God do the work
- Church attendance
- Scripture reading
- Connecting with nature
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