Depression is a classic example of whatās referred to today as an invisible illness. When youāre depressed, you may find yourself expending precious energy just so you can appear to the world as if nothing at all is troubling you.Ā
This āitās-work-to-seem-fineā coping mechanism illustrates just one way in which depression complicates your life. Not only are you exhausting yourself pretending to be OK, you may find it hard to rally support from friends, family, and coworkers who only see how well you seem to be functioning.Ā
While there is rapidly growing recognition of the very real difficulty and damage caused by depression, the stigma of past decades and centuries lingers. We often still hear the familiar notion that you can just āpull yourself together and get on with it,ā as though keeping a āstiff upper lipā should be enough to defeat depression. But strong neurochemical, social, and environmental factors contribute to this very real, physical illness, and successful treatment requires more than maintaining an āupbeat attitude.ā
Depression Is a ChameleonĀ
Our ability to recognize and effectively treat depressionāwhich 1 in 14 people will experience in their lifetimeāis complicated by the fact that it manifests differently in everyone affected, according to the National Institutes of Health. Anythingāyour age, your gender, or the stage of your depressionācan change what the illness looks like for you, meaning itās not necessarily simple to get a diagnosis, or even recognize symptoms of depression, whether in yourself or in other people.
For women, depression is more likely to appear as sadness, worthlessness, and guilt. Hormonal and life cycle-related changes, as in postpartum depression, can make women more susceptible to developing the illness. In fact, women are statistically more likely than men to experience depression.Ā
For men, depression often looks like exhaustion, irritability, and sleeping problems. They also lose interest in things they once enjoyed. Men are also more likely to turn to drugs and alcohol, experiment with reckless activity, or become intensely devoted to work in order to distract themselves from their illness. Ā
For teens and tweens, depression can look like extended and severe periods of sulking, getting into trouble at school, prolonged irritability, and an intense feeling of being misunderstood.Ā
These are by no means the only ways depression can appear. Some people experience short, intense periods of depression, while others feel it as an unmoving cloud over their awareness; for some, itās linked to difficult life events, while for others it doesnāt go away even when their outward circumstances seem fine.Ā
Should You Try Mindfulness for Depression?
Various treatment options for depression exist, including drug regimens and talk therapies. However, the jury continues to be out on how effective antidepressants are for treating depression. A comprehensive 2018 study conducted by an international research team examined 522 studies, including 116,477 patients, to learn about the effectiveness of 21 antidepressant medications. The researchers discovered that, although nearly all of the drugs were more effective than placebos, their effects were still āmodestā in most cases.
Complicating treatment is the fact that depression is often a chronic condition that tends to relapse, even with medication and talk therapy. According to research, relapse rates range from 50% to as high as 80%.
Interestingly, when mindfulness is added to the standard depression treatment protocols, relapse rates decline. But itās unlikely that simply practicing basic mindfulness meditation will ease your depression symptoms. In fact, such an attempt could be supremely unhelpful, notes Julienne Bower, PhD, professor of health psychology at UCLA.
She tells us that the research showing that mindfulness meditation improves symptoms of depression is, at best, vague. She also notes that itās really hard to meditate on your own when youāre depressed.
Zindel Segal,Ā PhD, concurs. The Distinguished Professor of Psychology in Mood Disorders at the University of Toronto, Dr. Segal has pioneered the use of mindfulness meditation for promoting wellness in the area of mood disorders. He was also one of the team who developed Mindfulness-Based Cognitive Therapy (MBCT), a research-backed mindfulness protocol for depressive disorders.
Chronic Unhappiness?
āWhen we talk about depression, and where mindfulness is strong and less strong as a treatment, we have to know what type of depression you have,ā says Segal.
āDonāt consider mindfulness a treatment when youāre dealing with acute depression,ā he advises. Depression āshuts down your concentration and disrupts your executive network ability,ā which makes practicing mindfulness difficult, says Dr. Segal. Instead, for acute depression, consider seeing a mental health professional for treatment with antidepressants, cognitive behavior therapy, or both. Mindfulness can bolster those treatments, but not replace them.
Mindfulness-Based Cognitive Therapy, however, was specifically designed to help people who are depressed or chronically unhappy. MBCT is a therapeutic protocol that combines cognitive therapy, which helps people interrupt the disturbing behavior or thought patterns that interfere with their lives, with mindfulness practices that help you learn to develop a healthier relationship to unhelpful thought patterns.
āOur research looked at specific ways that MBCT helps people work with rumination and worry in ways that are more generous and compassionate,ā says Dr. Segal. āThis therapy helps you learn to āde-centerā and allows you to see your thoughts unfold moment to moment. It helps you to not listen to the messages that depression is sending you.ā
How MBCT Helps
The goal of MBCT is to help you become familiar with the ways your mind and your thinking patterns contribute to depression, which helps you to develop a new relationship to your depression.
According to Dr. Segal, many people describe leaving the MBCT training with these two major insights:
1) Thoughts are not facts.
2) Depression is not me.
At first, these points may seem overly simplisticābut when we pay attention to how we are thinking and feeling, over time we become better at spotting the buildup of difficult emotions and thoughts. In that way, we can deal with them more skillfully, instead of just reacting in ways that might not be good for us.
āMindfulness practicesāfocusing on the breath and body, as well as mindful movement and developing greater mindful attention to everyday activitiesāhelp us learn to recognize the feelings and patterns of thinking that cause unhappiness,ā says Willem Kuyken, PhD, the Ritblat Professor of Mindfulness and Psychological Science at the University of Oxford.Ā āWe learn that thoughts are just thoughts. They are not facts, and we can choose whether to give them power over our minds and hearts. In time they can even help us savor and enjoy all the things that give us pleasure and a sense of accomplishment,ā adds Kuyken.
When it comes to depression that relapses after treatment, he suggests that MBCT has proven to be particularly helpful, if you adhere to the program. The program consists of eight weeks of classes, as well as at-home practices you do on your own for about an hour a day. āMany people [with depression] are trying to turn around very long-standing and ingrained habits of thinking and behaving, and that will take time and effort,ā says Dr. Kuyken. He notes that a recent study by Dr. Segal showed that the more a person practices MBCT over time, the greater the benefits for easing depression.
To find a therapist who has been trained and certified in practicing MBCT, visit accessmbct.com
If You Need Help
If you or someone you care for is having suicidal thoughts, these helplines in the US, Canada, and UK offer free, confidential prevention, crisis resources, and support 24/7/365.
US: Dial 988 to reach the Suicide & Crisis Lifeline.
988lifeline.org
Canada: Dial 988 to reach the Suicide Crisis Helpline.
988.ca
UK: Dial 116-123 to reach Samaritans.
samaritans.org
This article was first published in the April 2020 issue of Mindful magazine.
The Ultimate Guide to Mindfulness for SleepĀ
Sufficient sleep heals our bodies and minds, but for many reasons sleep doesnāt always come easily. Mindfulness practices and habits can help us fall asleep and stay asleep. Consult our guide to find tips for meditation, movement, and mindfulness practices to ease into sleep. Read MoreĀ
This article was made by www.mindful.org by Sara Altshul
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