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Dr. Gaudet: Undoing Depression

I looked at my clinic schedule one day recently and was happy to see Megan's name. She was vital and engaging, and spending time with her always energized me. When I asked her how she was, she smiled and said she was doing well, but her voice was flat and the room felt strangely empty. "Really?" I asked, putting down her chart. Her lip quivered -- and then she just sobbed. "I'm sorry," she said. "I can't seem to dig myself out of the hole I'm in. Practically all I've done for six months is cry. I can't sleep, and I don't have the energy to take care of my family. I feel like I'm sinking."

For even the most vibrant, life-loving women, depression can fly in like a dragon and scorch the whole landscape. Simply doing everyday activities -- let alone enjoying them -- feels impossible; the very essence of who you are seems lost. While it may be surprising, this dismal state touches virtually all the women I see in some way, at some time. Either they struggle with depression themselves (or have in the past), or someone they love does -- a spouse, friend, or family member.

A true mind-body condition, depression not only wreaks havoc on your mood but also significantly increases your risk for heart disease, Parkinson's, and other conditions. (In a recent study, women with depression were shown to have a 41 percent increased risk of heart attack.) Effectively treating it, then, is essential -- not just because of the immediate suffering but to protect your physical health as well.

While the conventional medical model focuses a great deal on chemical causes and chemical cures, I've found a holistic approach, one that takes into account how you live and who you are, to be far more powerful.

Why Are Women at Risk?
As with men, genetics, family history, lifestyle choices, and traumatic events can increase a woman's risk. But simply living in a female body poses its own risks; women suffer from depression at twice the rate as men do. Some of it comes down to pure chemistry. We know that hormones affect moods in myriad ways and that some women are more sensitive to hormonal shifts than others. Birth-control pills can also contribute to depression, so I always recommend that women taking the pill monitor their mood -- and if it drops, consider a trial off the pill.

Beyond sheer chemistry, I suspect that the way many women live their lives is itself a risk factor. We often have an incredible number of demands that drain our energy -- running the household, managing the kids' schedules, working -- and they're not always counterbalanced by activities and people that really fuel us. Over time, this energy deficit can lead to emotional and spiritual emptiness that sets the stage for depression. Many women I see with depression have been running on empty for months, even years.

Our basic emotional framework can also make us vulnerable. I often think of emotional boundaries in terms of big brick walls versus big glass windows. On the whole (yes, I'm generalizing here), men are more likely to have walls. These keep them safe in all kinds of emotional weather, but tend to buffer them from life's happiness and can lead to greater isolation. Many women, on the other hand, have big glass windows, which allow them to see and feel a lot more beauty and joy in the world, but also experience more pain. When you're depressed, its as if the glass itself is gone, leaving no barrier between you and the elements. What's more, someone is out there shoveling in mud, and you don't have any tools to shovel it back out.

A Whole-Person Toolkit
If you're experiencing depression -- or suspect you might be -- talk to your health-care provider or a mental-health professional about your symptoms. Depression causes changes in brain chemistry and can feed on itself, and the sooner you start treating it, the better. Regardless of whether you take antidepressants (or, in milder forms of depression, St. John's wort and other supplements), taking steps in the following areas can help.

Diet and Exercise
What you eat can affect your mood dramatically. Be sure to get at least three weekly servings of omega-3-rich foods -- fatty fish like salmon or black cod -- and beware of foods and beverages that can trigger energy swings (anything with high sugar content or caffeine). Alcoholic drinks, while they may initially seem to help your mood, are actually a strong depressant. Alcohol affects women much more dramatically than it does men and has the additional problem of disturbing your sleep, which can compound depression. (Many women who drink alcohol in the evening awake approximately four hours or so after they have gone to sleep.)

Be disciplined about exercise, especially aerobic activity; in a 2007 study of 202 adults, it proved as effective as antidepressants for major depression. All forms of movement can help: dancing in your apartment, swimming laps, riding a bicycle, yoga. If you can't muster the energy, try a passive approach in which you're being moved instead, like sailing, horseback riding, or a water therapy called watsu.

Support and Perspective
Depression can be a very lonely place, so you'll need to reach out to the people who love you -- and also to get the professional support you need. Work with a psychologist to treat the depression, and if you're having trouble getting motivated, consider a life coach.

While you need to talk about your feelings, know that sometimes what your mind really needs is a break. To that end, spend time with friends who can recognize when you're staring into the eyes of the dragon called depression and turn your head 90 degrees. Be intentional about listening to music that lifts your spirits, going to movies that make you laugh, spending time in nature or a church, walking a labyrinth, anything that takes you outside your head for a little while.

And if you're tormenting yourself about something that happened, like the end of a relationship or getting fired from a job, try sitting with the possibility that "everything is as it should be" or, as a friend of mine says, "What if nothing is wrong?" I've seen patients try this and feel a great sense of freedom and levity.

Loving Touch
All kinds of touch heal. Libido often goes by the wayside when you're depressed (rest assured, it comes back!), but that doesn't mean you can't still feed your sense of touch by cuddling with your partner. Expand your opportunities for touch by getting a massage or curling up more often with your pet. The latter approach might sound silly, but having a pet has been shown to help ease depression

Focus on Small Successes
When you're depressed, making healthy changes is far from easy, so I encourage people to acknowledge the little triumphs. One patient with depression says she knows it's coming on when her house becomes increasingly messy. Over the years, she recognized a pattern: Not emptying out the dishwasher leads her to put dirty dishes in the sink, then on the countertops. With no clean dishes, she starts ordering out pizza or Chinese takeout instead of cooking (which she normally loves to do). Eating poorly as a result, her depression worsens, and the mess spreads into the living areas and bedroom. Her one small yet meaningful step? Always put away the clean dishes. That success helps break the pattern, making space for other successes; eventually she builds momentum and energy for bigger steps.

Staying Conscious
People with depression often ignore their risk factors and deny their symptoms, which can be maddening to the people around them. But it's possible to work against this tendency. If you get more conscious of both the circumstances that lead to depression and your particular symptoms, you can intervene at the first signs.

Staying conscious can also help you tune into the strategies and practices that improve your depression. I strongly recommend writing in a journal, even if it's just a few words a day, to keep track of how you're feeling, both when you're up and down.

And keep in mind that overcoming depression doesn't mean that all your days will be "up." As I often tell my patients, living life fully isn't about cutting out the sorrow or pain; it's about embracing the full spectrum of joys and sorrows and loving yourself through it all. With a solid "window" and the right tools, this is possible.

Text by Dr. Tracy Gaudet

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