In its severe forms, depression paralyzes

all of the otherwise vital forces that make us human, leaving instead a bleak, despairing, desperate, and deadened state. . . Life is bloodless, pulseless, and yet present enough to allow a suffocating horror and pain. All bearings are lost; all things are dark and drained of feeling. The slippage into futility is first gradual, then utter. Thought, which is as pervasively affected by depression as mood, is morbid, confused, and stuporous. It is also vacillating, ruminative, indecisive, and self-castigating. The body is bone-weary; there is no will; nothing is that is not an effort, and nothing at all seems worth it. Sleep is fragmented, elusive, or all-consuming. Like an unstable, gas, an irritable exhaustion seeps into every crevice of thought and action.”
Kay Redfield Jamison

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Drugs or Therapy?

Interesting piece here by Richard A. Friedman, MD, that appeared in the New York Times in January. Uncharacteristically for a psychiatrist, Friedman looks at which kinds of depression respond more to medication v. which ones respond to talk therapy. The article is titled “To Treat Depression, Drugs or Therapy?”

Dr. Helen Mayberg, a professor of psychiatry at Emory University, recently published a study in JAMA Psychiatry that identified a potential biomarker in the brain that could predict whether a depressed patient would respond better to psychotherapy or antidepressant medication.

Using PET scans, she randomized a group of depressed patients to either 12 weeks of treatment with the S.S.R.I. antidepressant Lexapro or to cognitive behavior therapy, which teaches patients to correct their negative and distorted thinking.

Trauma is Relative

One’s person trauma can be shrugged off, perhaps with some effort, but shrugged off nevertheless. Why is that? Robert Stolorow, well known within the psychoanalytic community offers this:

It cannot be overemphasized that injurious childhood experiences in and of themselves need not be traumatic (or at least not lastingly so) or pathogenic provided that they occur within a responsive milieu. Pain is not pathology. It is the absence of adequate attunement and responsiveness to the child’s painful emotional reaction that renders them unendurable and thus a source of traumatic states and psychopathology.

So, what exactly does that mean? If someone is there for the child during or after a traumatic experience, and can demonstrate empathy and respond appropriately – then the child has a chance of processing the experience without it becoming traumatic.

Put Down the Blob, Stop Thinking — And Walk!

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photo by asher isbrucker (creative commons)

Noted in both the Washington Post and the New York Times this morning, research just out (Monday) suggests that walking in nature helps reduce rumination (brooding, obsessing over unsolvable problems). The mechanism is unclear.

Why is that important? Because solid research (see Lyuborminsky) has indicated that rumination is both a symptom and cause of depression. Non-depressed folk that ruminate are much more likely to later become depressed. Depressed folk that ruminate are much more likely to become more depressed.

The researcher, Gregory Bratman at Stanford, measured bloodflow to a part of the brain associated with rumination, the subgenual prefrontal cortex. (In research on meditation, the prefrontal cortex has also been implicated in self-referential thought, and that self-referential thought is associated with unhappiness.) Post-walk, participants showed small but significant reduction of bloodflow to that part of the brain.

The Post also noted that short micro-breaks of looking at nature have “rejuvenating effects” on the brain. And the Post also noted that research that relies on brain scans to draw conclusions remains controversial. It’s certainly true that studies that measure something in the brain seem to be hailed as irrefutable by the press (see Blobology).

Still, if you’re depressed, take a walk! Or just go outside and take in some trees. It really does make a difference.