Your mind is not a cage.
It is a garden.
And it needs cultivating.
The incidence of depression is rising rapidly, at least in the western world. It has been described as the common cold of psychiatry and psychology.
Depression is a common disorder, but this does not make it either inevitable, or an acceptable part of modern life. The lifetime incidence of depression continues to show a steady rise, with each succeeding generation having a greater risk. For people born before the First World War, the lifetime risk was about 3%, for Americans currently in their midtwenties, current estimates put their lifetime risk to be approaching 25%. This rapid increase shows little sign of slowing down.
Depression is a modern pandemic, with damaging effects on the quality and duration of people’s lives, and is showing an increasing incidence across nearly all cultures. In another 15 years, depression is likely to overtake heart disease as the major cause of morbidity in the western world. It constitutes a global emergency. Depression has a major impact on mental and physical health, with a significant knock on effect on our quality of life.
Much of the research performed over the last fifty years, has concentrated on diagnosis, medication, and cognitive therapies. Although this has provided many useful answers, and has added considerably to our knowledge about depression, it has produced an even larger set of new questions. In the last few years this research has been reviewed. This reassessment casts considerable doubt on the reported results, particularly for treatment studies, and raises concerns about the ethical practices behind the publication of results.
Medication is seen by many as the mainstay for the treatment of depression, especially in view of the Serotonin Theory of antidepressant effects, (see here) however, many of the studies that produced negative results were never published. When these studies are included in the analysis of the research findings, the results are very different.
People who show the signs and symptoms of Severe Major Depressive Disorder, do show a positive response to tablets. However those with a Mild or Moderate condition, show no greater benefits from antidepressant medication than are seen with placebo. The treatment effects in the severe group seem to last only while the medication is taken, with many people having a rapid relapse in their symptoms when the medication is stopped. It is for these reasons that other approaches to treatment, and prevention, have been gaining ground both as therapies, and in the research that they generate.
There is good evidence for ECT – again in the case of severe depression, or for those who have psychotic features as part of their presentation. Novel treatments, such as Trans Cranial Electromagnetic Stimulation, are also starting to show promising results. However, most medical treatments only show a benefit for those who have a severe disorder. Less severe depression also causes significant disabilty, and has a marked impact on physical health and long term quality of life. One recent theory sees depression as a whole body, inflammatory condition, affecting all the systems in the body. This may explain the apparent effects of Omega 3 fatty acids in treatment and prevention.
Maybe one solution to depression is to stop trying to figure out what’s wrong with us, and to just experience more fully and mindfully what’s going on in our life and what’s right with us.
Mindfulness for Life.
Trauma early in life, a strong family loading, stressors – such as ill health, marital breakdown, or job loss, are all things that contribute to the development of a depressive disorder. Many aspects of our modern life style, such as drinking, smoking, taking drugs, poor diet, isolation, and sleep problems, have all been shown to contribute to this tsunami of depression. This means that there are many areas we could choose to address if we choose to try and alter out risk of depression. One area for which there is increasing evidence, particularly in preventing relapse, is the practice of mindfulness.
There are many psychological theories about depression. One feature they seem to have in common, concerns the way in which depression either changes our thoughts, or is brought about by a change in our thinking. Either way, distorted thinking is a major feature in depressed patients, and contributes to the duration and severity of the disorder. Therapies that directly challenge these thoughts are the ones that are best supported by research. Indeed, Cognitive Behavioural Therapy is the recommended first line treatemtn for depression, of any severity, according the National Institute of Clinical Excellence in the UK.
One simple thing that we can all do to protect ourselves against relapse, and which would probably reduce our risk of developing depression in the first place, is to practice mindfulness. An expanding body of research is showing that this simple practice has benefits for both our mental and physical health. Much of our response to the world around us is automatic, being managed by our unconscious mind. These automatic responses have much to do with our behaviours, particularly when we become angry, anxious or unhappy.
The conscious mind has only a narrow bandwidth for processing information, so much of this is performed by systems that have been set up to keep us alive. Our conscious mind sets up the parameters within which the survival systems react, but many of us are unaware of what these are. Mindfulness helps us to become aware of the thoughts, emotions, and behaviours that we display, both by choice and as these automatic responses. It is this mindless state that accompanies most of throughout our lives. We blame others for the problems we bring on ourselves, or project our fantasies about what we need to be happy, onto our world – usually a new relationship, more money or some material possession. Mindfulness allows us to see these automatic reactions, allowing us to gain some control over them, so that we can gradually reprogramme our unconscious systems
When we are mindful we are open to new experience. We can approach our lives with interest and gain stimulation from everything. When we allow novelty it stimulates our brain and generates a sense of wellbeing. It permits our natural creativity to thrive with positive results on our physical and mental health. Healthy individuals who include novelty in their daily lives show less depression than those who do not.
There is good evidence also to show that people who live in strong communities show less depression as well. A sense of connection to the world seems to be protective. The same weems to be true when we have a sense of disconnect between our self and our life. When we are depressed we tend to disconnect even more, withdrawing from those around us, giving up on ourselves and the world. We perceive the world as a hostile place and respond accordingly.
Mindfulness helps us to reconnect to our world and our life. We become aware of what we are feeling, what is happening around us, and how we respond. This is accompanied by the development of acceptance that this is how things are at the moment and an awareness of how things are contantly changing; nothing lasts for long – either the good bits or the bad. One benefit is thatwe tend to develop a sense of compassion and kindness towards ourselves and others, allowing a non judging approach to the world.
Moment by moment awareness of life, as we are living it rightnow, with all the additional choices that this allows us to make. This not only helps to pull ourselves out of depression, but also helps us to deal with the problems of daily life. To approach life in this way makes it easier to cope with the stresses of work, improves our relationships with others, and allows us to communicate more clearly with our self and others.
So, if we want to improve our general mental well being, there are several simple habits that we can adopt that will help.
1. Take up mindfulness. Benefits have been seen with as little as twenty minutes a day for eight weeks. Whether we wish to develop a formal mindful meditation practice, or just take a few minutes each day to practice awareness, there are considerable benefits to be gained.
2. Do something different each day. Introduce novelty into our life. It will soon become a habit that will contribute to our enjoyment of life. It can be as simple as going to a different cafe for lunch. Making new friends.
3. Look out for new things in the environment. Become aware of the small changes that are constant in our mind, our body, and the world around us.
4. Choose to live in the present. Stop fretting about past events, they are over and cannot be changed. The future is yet to come, so there is little point in worrying about specific thoughts we might have about some mistake we might (or might not) make.
5. Most of all, give more attention to our life. Both the good bits and the bad. If we can watch the constant state of flux that is around us, we can stop clining to our ideas and behaviours as if they were all we are. Instad we can change how we approach life to deal with all that it throws at us. Both good and bad.