Healing Depression Safely
September 2002, published in Wellbeing magazine
New research shows that most treatments for depression, including cognitive behavioral therapy, diet and antidepressants aren't enough. The only lasting solution is the oldest of all: a supportive "band" of relationships.
One of the things we find most affecting in our program for people with depression is how incredibly relieved people are to have a non-judgmental forum in which to discuss the ongoing pain of this devastating illness. They feel there’s something wrong with them for not being able to get out of bed easily--and sometimes not at all--in the morning, or for bursting into tears at work. Most believe that somehow it’s their failure that none of the prescribed treatments have worked; that they haven’t “gotten over it”. They are often afraid to “burden” friends and family with their anguish. They scarcely dare hope that there really is an answer for them.
Yet the truth is they are not alone. Also that the illness has even deeper causes than we once thought. They are not “weak” or “lazy” or “hopeless”. They are merely misinformed and isolated. Depression is not a life sentence. There is a way out.
According to government statistics, everyone is affected by depression. You are either one of three women, one in six men, or are close to someone who is clinically depressed . Yet new research shows that the most common treatments, antidepressants and cognitive behavioral therapy, are not long-term solutions  .
The problem is probably even greater than these figures indicate, since depression can take the form of anxiety, rage and many physical problems such as chronic fatigue, chronic pain and even more serious physical illnesses. Up to 80 per cent of people who go to physicians suffer from an underlying depression . Although it’s been long known that depression is “involved” in numerous diseases, ranging from alcoholism to osteoporosis, researchers are now citing it as the “cause” of heart attacks, loss of vision, certain forms of cancer and diabetes  .
Antidepressants were hailed in the 80s and 90s as the cure-all for this rapidly growing problem, particularly after the best-selling book Listening to Prozac. Yet they don’t work for 47% of the population [latest figures now cite the failure of antidepressants as high as 70% -- Ed, April 2004.] . have sometimes intolerable side-effects, and may lose their effectiveness over time . In fact, the US Food and Drug Association (FDA) recommends taking most antidepressants for no more than a short time . To make matters worse, researchers have now discovered that the real culprit in depression is probably not just insufficient levels of serotonin in the brain, which the antidepressants target, but a surfeit of the stress-related hormone, cortisol  .
We now also know that the brains of depressed people are not only out of balance chemically, they also tend to have a smaller hippocampus, which controls emotions and memory, and a less active frontal cortex, the command-and-decision making center . The good news is that we can “grow” new brain cells in those areas, through a process called neurogenesis . The bad news is that as of yet there is no pill to help this process along.
One wonders, actually, why so many people do say that antidepressants help, at least initially. It may be that the results reported for antidepressants in the first place were due to the placebo effect . Several studies have now shown that antidepressants work no better than placebos, and that both relied for their effect on the relationship the patient had with the prescribing physician . Since these studies were published, overviews of other medications, such as the so-called wonder drug interferon (which was going to cure everything from MS to cancer), have shown that they did no better when compared to a sugar pill . Again, relationships seem to play a paramount role.
Natural remedies for depression, which have the advantages of fewer side effects, aren’t the answer for everyone either. St John’s Wort is only suggested for mild depression, and many other supplements and foods can only help at best, not heal.
Even drug companies are realizing that antidepressants alone aren’t enough, and are offering therapy groups for Australian consumers. However, the director of Beyond Blue, the government sponsored anti-depression initiative, says the groups are too large to be much help  .
The problem may not be just the group size. Doubt is now being cast about the basic assumptions underlying existing forms of psychotherapy for depression, including the most commonly used, cognitive behavioural therapy, or CBT . Studies show that even patients who do well with CBT in the short term tend to relapse a while afterwards  .
“Depression is a recurrent disease for a lot of people just like cancer,” said Jackie Gollan, lead author of a study by the University of Washington . “Other factors in their lives beyond their mood need to be identified if we are to help them stay well. We need to consider who people are and how they interact with others to understand how patients remain non-depressed.”
Golan’s research showed that people who were more independent and found it hard to relate to others were most at risk of depression. This confirms the many studies which show that peoples’ happiness is in relation to the number of close, supportive friendships that they have.
A recent study by Canadian researchers links loneliness to both depression and alcoholism . And there is no question amongst health professionals that good relationships are vital for physical health. For example, studies link arguments with a spouse with physical illness, and traumatic childhood relationships to adult illnesses  .
To understand more fully why good relationships are the answer, let’s look closely at how relationships gone wrong damage healthy development. To do that, we have to take a step back and examine how we were meant to live and raise children.
The old African proverb, “it takes a village to raise a child” is just about on the money. In our hearts--or more accurately, in our genes--we are hunter-gatherers. In a hunter-gatherer band (villages came later) there were from 25 to 50 members, women shared child-rearing, and a child could always find a comforting lap. Work only took up five to ten hours a week, so no one was defined by their occupation. And there were many different “role models”--aspects of styles and personality for children to selectively adopt. Relationships were learnt easily and well in this rich, safe, non-competitive environment.
What a far cry from the way we live now! The isolated, over-stressed family simply can’t meet all the needs of its members. Many don’t get enough of the four basic needs, which are for physical safety (which relies on group inter-dependence), emotional security (knowing the rules, rituals and expectations of those around you), attention (from people you live and work with) and importance (not for what you do, but who you are). The child in such a family is primed for depression in many ways. Firstly, there is the trauma of living in such a stressful, non-human situation. Criticism, neglect, parental conflict, divorce, parental addiction to drugs, alcohol and over-work, lack of freedom to run and play in nature, narrow and inappropriate expectations, emotional, physical and sexual abuse, family secrets, poverty, violence and discrimination. the list goes on. Few escape.
This is why depression and post traumatic stress disorder (PTSD) have a lot in common. Most people still think of PTSD as the result of war or natural disasters. Yet for many of us, the family was an emotional, if not physical, “war zone” and, compared to what it should be, a “disaster”.
The child can’t physically leave home, so he or she may “zones out,” mentally takes a vacation, dissociates. The brain literally slows down to limit exposure to the painful surroundings. Later on in life, this defense mechanism will increasingly be triggered by the social environment. Movement is slow, and the depressed person has trouble getting things done and becoming motivated.
Anxiety and panic attacks, which are part of the depressive syndrome, can also be reactions to events in adulthood that mimic those of childhood, even subconsciously. Cortisol, a neurotransmitter related to stress, is over-secreted, and other chemical imbalances occur. At the same time, the very structure of the brain is compromised. As a result of extreme stress and childhood trauma, the hippocampus, for example, doesn’t develop as it should--it literally has fewer neurons. The result is difficulty in handling emotions and often a loss of short-term memory. Traumatic memories stored in the amygdala, a walnut-sized part of the central brain which stores powerful emotions, flood the undeveloped hippocampus. This part of the brain is then unable to differentiate properly between a real crisis or a minor glitch in the present, or an experience in the past. The frontal cortex, which is meant to sort out emotional transmissions and decide appropriate actions, is also damaged.
No wonder the depressed person feels overwhelmed by feelings he or she can’t control, as if hounded by internal demons or pitched into an abyss of despair. No wonder they often make matters worse through inappropriate anger or actions! Telling someone to “avoid negative thinking” is not helpful if they are in the throes of emotional overload. Cognitive techniques to put events into perspective and counteract negative thought patterns can be useful, but may not be possible. Besides, even changing thought patterns doesn’t go far enough.
In a calm, supportive, safe environment, the depressed person has a chance to heal, and to learn new cognitive patterns. But here’s the catch: the depressed adult will have sought out or recreated in their life many of the abusive or traumatic elements of childhood. This again is not their fault, or even the result of conscious decisions. Once more, the answer lies in what happened to the brain in the first decisive six years. And it happened through relationships.
When a baby is born, and the mother looks at it lovingly, a neural connection is formed between eye contact, love, safety and home. When the infant is fed, a connection is made between food, love, safety and home. (Is it any wonder that food is such a ritual part of courtship, as in the “romantic dinner for two?”) If, perhaps, Italian is spoken in the house, then the child associates that language with love, safety, and home. But let’s say the child is criticized or physically punished. The same thing happens! Criticism and abuse become “wired in” to the child as, you got it--home, safety and love.
These connections, when made in the formative years before the age of six, form the “program” that will determine all the thoughts, beliefs and actions a person has in adult life. Thus, if the child was criticized, he or she will seek out criticism, if abandoned, abandonment, if abused, then abuse. This does not make abuse his or
her fault. The “program” is not the person. It’s just something the person learned.
There are other factors at work, too. As hunter-gatherers, which we remain despite our technological advances, we are genetically driven to “idealize” other members of the band so that we feel secure. If a natural disaster wiped out the rest of the group, each individual could recreate the rituals and ways of the tribe. Through idealization, the brain has taken on this information. Growing up we may idealize parents who have themselves inherited faulty coping mechanisms. We try to make them right, in order to feel safe and in control of life, and in doing so we may set ourselves up for failure. This is the reason we usually marry Mum or Dad or both. We seek out those characteristics which our parents (or older significant people in early life) exhibited.
Making the ideal right can create even more problems. What if Dad said you were “stupid and lazy, just like your Mum?” What will you become? Stupid and lazy, of course! (At least in the eyes of others.) What if Mum said you were never going to find a mate? It will be very difficult to relate to a potential partner with that sentence hanging over your head!
If one or both parents were depressed, we take on the beliefs, characteristics and even (probably in the womb) the chemistry of the depressive. Experiences in the womb do not doom us. If, for example, a depressed mother recovers from her depression, so will her infant.
But if we are born into such a family, we will have to do more than repeat positive affirmations or attempt to counter our faulty belief systems to recover from depression.
We also learn dysfunctional coping mechanisms if we are brought up in a difficult family situation. If our parents don’t have enough one-on-one time for us, we may fall ill to get the attention we so desperately need, a strategy that can carry on through adulthood. We may be the “bad” child who acts out in class and takes risks with the law as an adult. Or we may be the “goody-goody” who helps everyone but ourselves, falls prey to stress, and is so busy looking after others we can’t take care of themselves.
How do you counteract this legacy of the battered nuclear family and a society that lost the plot somewhere between five and ten thousand years ago? Since we can’t all go back to hunting the woolly mammoth and living a traditional hunter-gatherer lifestyle, how do we heal ourselves of the dysfunction of our present way of life? Of the depressive cycle, the injured brain, the feeling that we don’t belong, the agony of depression?
We may not be able to copy the free and natural lifestyle of our ancestors, but we can recreate the most important aspects of their lives: the close and supportive circle of friends, or “band.”
As we bring functional, lasting relationships into our lives, at work, at home and even at spiritual gatherings, we heal the brain. What is a “functional relationship?” One that meets our genetic, ancient needs as humans. We find that most people haven’t a clue as to what these are. After all, if we are to believe the ads on TV, all we need is the biggest house, the best beer, the silkiest shampoo, and the fastest car!
Even more damaging than the consumer culture is the use of generalities. When we initially ask people what they need from other people, we usually get vague answers: “I need respect,” “space,” “love,” “to be understood.” Yet what do these really mean? These generalities act as barriers to relationships. We expect the other person to second-guess what we really want. And they can’t! Others will filter these words or phrases through their own childhood experiences, and they will mean different things than they do to us.
If we want our relationship needs to be met, they must be specific and concrete. For example, “I need you to listen to me, and by that I mean, look me in the eyes, wait until I’m finished talking, and then ask me questions to make sure you understood what I just said.” Now that’s specific. The other person may not want, or be able to, meet that need, but there can’t be any misunderstanding.
And if they are not willing to do that, what are they saying about the importance of the relationship to them? Is this someone you really want to be involved with? Are they reinforcing your dysfunctional program and beliefs (such as unworthiness) if they criticize or refuse to listen? The answer is probably yes. Are they part of the solution, or part of the problem of your depression?
We find that most people, if they really understand your needs, will try to meet them. As you learn to state your needs clearly, you will probably find that you gain the respect of many people in your life. You will begin to feel safe and cherished. This is a positive environment, one which does not constantly re-trigger the past, one in which your brain can heal. Without constant re-traumatization, the brain can begin to grow new cells in pivotal areas.
As you create a safe, secure relationship environment, you also undo the programming of the past. If you were programmed to seek out criticism, you require of those in your life that they do not try to control you through criticism. New connections are made in the brain: I don’t deserve to be put down, I am competent, I am worthy of being loved. If you lacked attention, you tell people in your life, for example, how often you want them to call and to be with you. If you lacked safety, figure out what would make you feel safe and make sure everyone in your life complies by those instructions.
This needs process also creates chemical changes in the brain. According to some researchers, for every concrete need you give, you receive a dose of dopamine, the “feel good” chemical. Every time a need is met, you get an increase in your brain’s uptake of serotonin, the neurochemical that helps the overall function of the brain.
Is there room for negotiation in this process, or do you go around brandishing your list of needs as if they were ultimatums, written in blood? Of course! In our courses, articles, audio-workbooks and books we let people know how to decide which needs are most important and which allow the most compromise. We also teach how to clearly communicate what you need and why. Finding out the other person’s needs of you, whether that person is your boss, child, best friend or lover, is an important part of the process.
To summarize, depression is formed by painful or lacking relationships in early life. It is not your fault, even if you can’t seem to get the various treatments that may have been suggested to you to work. You can’t rid yourself of this pervasive and increasingly common illness alone, or even with the occasional help of a health professional. Ultimately, only by creating lasting, supportive relationships will you finally heal your brain, emotions and body. If you do so, you go far beyond depression, to a happy and purposive life. If your childhood programming says you can’t have these kinds of close connections, or that you’re not worthy of them, it’s lying. You can do this.
This article was published in Wellbeing. September, 2002, entitled "Coming Together: Techniques That Heal Depression."
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 “National Health Priority Areas Mental Health: A Report Focusing on Depression from the Australian Institute of Health and Welfare”, 1998.
 Jacobson/Gollan report of study findings presented at Association For the Advancement of Behavior Therapy, December 1999.
 Prof Steven Dubovsky, Mind Body Deceptions. pub. Norton & Co, 1997.
 For diabetes. “Depression in Adults With Diabetes” by Patrick J Lustman, PhD, and Ryan Anderson, Psychiatric Times. Vol. XIX Issue 1 January 2002; for vision loss. see article in Ophthalmology by Stuart I Brown MD, chairman of UCSD's Department of Ophthalmology; for heart disease. many, eg “Treating the Patient as a Whole Person” by Elizabeth Fried Ellen, LICSW, Psychiatric Times. June 2001 Vol. XVII Issue 6; also Prof Michael Frenneaux University of Wales College of Medicine study for the British Heart Foundation; for breast cancer. study by Johns Hopkins School of Public Health reported in Cancer Causes and Control. September 2000.
 “Rumble in Reno: The Psychosocial Perspective on Depression” by David Antonuccio, PhD, David Burns, MD, William Danton, PhD, and William O'Donohue, PhD, Psychiatric Times. August 2000. Also findings of study by Royal College of Psychiatrists, quoted in The Guardian newspaper, February 13, 2002.
 For side effects. see many FDA warnings about individual medications but also eg British Journal of Cancer, January 2002; for loss of effectiveness. see also RCP statement quoted above, also Overcoming the Dangers of Prozac, Zoloft, Paxil and Other Antidepressants with Safe, Effective Alternatives by Joseph Glenmullen, MD, Simon & Schuster, 2000).
 Virtually all antidepressants have had recommended time limits placed upon them by the FDA after which they say that they do not condone their continuance, eg Zoloft warning on extended use, August 1996--recommended 9 weeks; Paxil, in Australia called Aropax, August 2001--8 weeks; Venafaxine, October 1997--recommended 4-6 weeks; Anafranil, April 2001--10 weeks. See also UK & German studies, esp. into Prozac, some reported in The Guardian newspaper, October 1, 1999, others reported by Glenmullen above.
 Many recent articles, eg “Role of Cortisol in Development of Human Psychopathology”, British Journal of Psychiatry. Vol 179, 2001.
 For example Daniel Amen, MD, “Why Don’t Psychiatrists Look at the Brain”, Neuropsychiatry Review, 2001.
 Numerous recent studies, eg study by Prof Fred Gage, Salk Institute, reported in Nature. March 2002.
 Many recent studies eg Irving Kirsch et al reported in Prevention & Treatment. July 1998.
 See Kirsch above.
 Numerous recent studies eg study by Jon Stoessl and colleagues at the University of British Columbia in Vancouver reported in Science magazine, September 2001.
 Prof Ian Hickie quoted in The Sydney Morning Herald. February 17, 2002.
 Jacobson/Gollan report cited above, December 1999.
 Study by Donald McCreary, PhD et al reported in Psychology of Addictive Behaviors. June 2001.
 Many studies but eg The Sickening Mind by Paul Martin pub. Harper Collins 1997, and “Childhood Trauma, CRF Hypersecretion and Depression” by Deborah Lott, Psychiatric Times. October 1999 Vol. XVI Issue 10.
About the Authors
Dr Bob Murray is a widely published psychologist and expert on emotional health and optimal relationships. Alicia Fortinberry is a psychotherapist, health writer and executive coach. Together they are the founders of the highly successful Uplift Program. and authors of Raising an Optimistic Child (McGraw-Hill, 2006) and Creating Optimism (McGraw-Hill, 2004).