JB: Support and unconditional love definitely play a major part. While depression can be overwhelming for all involved, actually, there are other actions that help. It's been shown, for instance, that regular cardiovascular exercise releases chemicals that mitigate against depression; getting enough sleep (but not sleeping the day away) also makes a difference. What else?
AS: The first thing to do in depression is to regularize these externals: to take exercise even if the condition has made you feel it's the last thing you'd want to do; to balance your diet; to limit your intake of caffeine and alcohol (caffeine boost anxiety; alcohol boosts depression). Try to regulate your sleep: go to sleep at the same time every day and get up at the same time. Don't let yourself spend the day in bed. Of course, try talk therapies. Some people are helped by mindfulness training, by yoga, by exposure to sunlight or to a lightbox that recreates some of the sun's full range. Limit whatever stressors are in your control; don't do unnecessary things that are painful and difficult. But keep doing as many of the necessary things as you can. And most of all: surround yourself as much as you can with people who understand what you are enduring and will help you through it--be they family, doctors, or friends.
JB: All sound advice. As you mentioned before, depression has no cure but it does have many treatments. In your lecture, you mentioned that it's crucial to catch depression before long because otherwise it can go deeper and last longer. Also, it's more likely to recur. Why is that?
JB: Depression is in most cases a cyclical illness. There are some people who have a single episode occasioned by a particular experience and then don't hear from the condition again, but most people who get depressed once will get depressed repeatedly. These recurrences may reflect in part a biological process; it's as though the depression carves a pathway into the brain, and so the transition into depression may become more frequent. They may in part simply reflect a depressive personality, triggered repeatedly. They may over time become more and more detached from external circumstances. So your first depression may be initiated by a terrible trauma or loss; by your tenth, it may just come like a change in the weather.
If you can break this cycle before it sets in, you can keep that carving of the brain from going so deep. Some people seem to think there's courage in not treating their depression, and they heroically sit out their worst episodes. But those episodes are toxic; each one inscribes the illness more profoundly in the grey matter. If you had a heart condition, you wouldn't keep going off your medication and having another heart attack; you'd recognize that a person who has had thirty heart attacks is likely to be much more damaged than someone who has had only one and then has managed to control the situation. Think of the depressions like that; they are awful unto themselves, but they are also cumulative--biologically and also experientially, because depressions wear you out, and by the time you've lived through thirty of them, you are a different person than you were going in.
There are lots of good treatments and to sit it out without making use of them is a greater madness than the depression itself. Some people need therapy, and some need drugs, and some can get by on prayer or mindfulness. There are a million approaches. Find the one that can work for you.
JB: How do we support our loved ones in handling the intermittent nature of this condition? You've gone through this yourself. It must be so dispiriting to feel those dreadful symptoms returning. How do you face that reality without coming undone?
AS:There's a certain circularity in your question, because what you're really asking is how one faces the reality of coming undone repeatedly without being undone by it.
JB: That's exactly right.
AS: Depression is inherently chaotic, and to some degree, as you escalate into depression, you feel that control slipping away from you. Over time, however, one learns that one has the ability to get through; the possibility of recovery becomes more familiar. You may feel as a symptom that your condition is permanent, but you know intellectually that it is not. So, while repeated episodes are taxing and destructive, they do carry the possibility of achieving a new level of resilience.
JB: Nice reframing. Who couldn't use more resilience? Thanks so much for talking with me, Andrew. Depression is all around us; it affects all of us indirectly, if not more closely. When we understand what it looks like and how to deal with it, we're all better off.
***
from Andrew's website: "Andrew Solomon is a writer and lecturer on psychology, politics, and the arts; winner of the National Book Award; and an activist in LGBT rights, mental health, and the arts."
His epic work on depression, 2001: The Noonday Demon: An Atlas of Depression
(Note: You can view every article as one long page if you sign up as an Advocate Member, or higher).
3
3
1
