It is difficult to explain depression to those who have not suffered. I guess it’s like explaining childbirth to someone who has never had a baby. You think you understand until you are in the midst of it and realise, nothing anyone could have said would have prepared you. I have walked the road with my daughter for 15 years, so my understanding comes for the heart of a mother.
I am also a teacher and learner, so it comes also from the mind of a researcher, who has spent thousands of hours searching for understanding.
My daughter is one of over 2 million people in Australia who suffer with depression. The alarming news is that numbers are increasing in every age group, especially the young. According to the WHO depression is now the number 1 cause of human suffering and disability (above cancer and heart disease). This means that the chances are that we all know someone who is suffering. Many in silence, too ashamed or confused to ask for help. Others whose lives have fallen completely apart. Understanding depression and how you can help could be the difference between life or death for someone you know or love.
Depression is the family secret every family has.
The suffering of depression should not be underestimated. One sufferer described depression as “a slow way of being dead”. Another described it as “I couldn’t muster any emotions, and it wasn’t just some tasks that were too hard to face, it was life itself. I had no reason to live, no purpose, no sense of who I was and no future. I was a shell with no possibility of changing.”
From all my readings I would like to share with you the 10 key understandings which underpin the support I offer my daughter. These are the ‘sermon’ I preach to the ‘unconverted’ and the source of encouragement I gives to sufferers and their families in my work as an advocate and mentor. I hope they offer you some insight.
10 Understandings about Depression
1. Depression is a tragically misunderstood and misused term.
2. Depression is caused by an over activated stress response which alters the nervous system and causes a profound disruption in our chemical functioning.
3. Depression is a lifestyle disease - our bodies were not designed to live the way we do.
4. Trauma often underpins significant depression.
5. There are risk factors and protective factors that determine our level of vulnerability.
6. Drugs are part of the answer have not been a game changer.
7. Depression is not permanent, it can lift, it can be healed.
8. Healing starts with you.
9. Healing continues with someone who walks beside you.
10. Depression and physical illness are interconnected.
Let me explain each of these.
1. Depression is a tragically misunderstood and mis used term. There are several main misunderstandings or myths:
Depression is not sadness or grief. Sadness, grief, worry, confusion, fear, loneliness and even anxieties are normal human emotions. They are not depression. Using the term depression to describe them does a great injustice to depression suffers. These feelings may overwhelm us at times and even run away with us for some time. But the feelings pass. They turn themselves off before they get ‘stuck’ and throw the nervous system into constant overdrive.
Depression effects more than mood. Technically depression is considered as a mood disorder which is true but defining it as that ignores the extent of its reach. Depression reaches its tentacles into your body, your cognition, your concentration, your work, your family life, and relationship. It leaves no part of your life untouched.
Major Depressive Disorder is a clinical illness that has been normalised yet remains stigmatised. The myths proliferate and the idea that you can tell someone to ‘pull themselves together’ is still out there. It’s a bit like telling a person in a wheelchair to ‘just get up and walk’. They would if they could. You hear people speaking lightly and using the term depression out of context. It is sometimes assumed that we will all get depression. Yet conversely, people still have negative comments about suffers and call them ‘lazy’.
Traditional understandings have focussed on the biological causes of depression, firmly placing it as a malfunction in your head. Depression is not a malfunction- it is a signal telling you something. We need to listen to what our body is trying to tell us. The biological causes are only a small part of the puzzle. We need to intervene with the underlying cause and attend to the process that unfold.
We normalise something that is NOT normal.
“It is worse than a cancer diagnosis- there is an outpouring of love and support for cancer – yet depression is much more painful, more suffering. We don’t minimise the suffering of cancer, but we minimise the suffering of depression.”
2. Depression is caused by an over activated stress response which alters the nervous system and causes a profound disruption in our chemical functioning. If you ask Google to find you the causes of depression you will find thousands of articles. You will find an array of factors that influence its development and much confusion between symptoms and causes. Today the agreed understanding is that it is a combination of biological, psychological, and social drivers that trigger a depression response in a person who has the genetic disposition. Once the nervous system (including the brain) is triggered by a stressor, or multiple stressors, a cascade of biochemical changes starts which reach down to the DNA in every cell in the body. Depression is one of several illnesses that may result from this stress. Sometimes the stress gets stuck and cycles through the body, deepening the illness. The brain changes are significant and can be hard to undo as the brain is damaged when the disrupted neural circuits are left unchecked.
In Major Depressive Disorders the brain and nervous system have changed. Some or all the symptoms below may be evident depending upon the severity of the stressor. Sometimes Depression is mixed with PTSD and anxiety and there are additional symptoms:
· Intense sadness
· Emotional shut down- excluding themselves for intimacy and relationships. When we are stuck in survival mode, our energy focus is on fighting off unseen enemies. This leaves little room for nurture, care, or love. The whole world into a gathering of strangers to whom you have no connection. You are out of sync with the people around you and have a searing sense of isolation.
· Negative perspective- dark lens- can’t see it will get better, sense of impending doom, rumination (churning and churning negativity,
· Numbing- When in danger our body shuts down all stimuli that will cause us panic and fear. The result is to feel nothing- no sensations, emotions, or connections. Often the only time this numbness stops is in the moments of rage and shame.
· Altered Perceptions about the past, present, and future- When the limbic system decides that something is a question of life or death no amount of insight will silence them
· Hypervigilance- chronically scared and reactive to perceived threat, scanning
· Bursts of impulsivity and emotional dysregulation- feeling frustrated, thwarted, and misunderstood
· Lack of trust:
· Altered Motor Skills- speech- movements
· Guilt and Shame
· Loss of agency- the sense you control your life
· Fatigue
· Poor sleep wake cycles, reduced healing REM sleep, sleep is chronically disturbed
· Temperature Dysregulation; Excessive sweating, cold feet, and hands,
· Digestion Issues and Reduced Appetite: Poor blood sugar regulation, food loses its central pleasure.
· Physical illnesses: headaches, migraines, neck and back problems, asthma, skin disorders, digestive problems
· Memory and Attention Deficits- can’t focus or text and conversation
· Neuro Toxicity- an inflamed brain
· Pain- Emotional and Physical- Depression lights up the pain circuitry- it is torment, agony, torture- I hurt but I don’t know where
· Compromised Immune system
· Sensitivity to light and Sound
· Sensory overload- don’t give me too much of anything at a time
· Altered pain perception- It hurts more
· Suicidality- I million people with depression world-wide a year take their lives
3. Depression is a Lifestyle disease- Our bodies are not designed for the life we are living. Our current civilised lifestyle puts our bodies under enormous stress. We were hunters and gathers for 1.8 million years- 99% of our time on earth. During this time, we suffered violent death, death from bacteria, parasites, malnutrition, but not depression. We were genetically adapted to that lifestyle and then 200 years ago the industrial revolution caused a “Radical Environmental Mutation”. The world that was created was so removed from our past as not to be recognisable by or body. What our body was exposed to and was required to do changed but our genome didn’t.
There is a profound mis match between our bodies and our lifestyle.
The result is that our body considers our current lifestyle as dangerous. Many things that evolution has told the body it needs are missing and are replaced by things that the body considers as a threat. It naturally responds in the best way it knows. It seeks to shuts us down and isolates us to protect us. It inflames our brain. It pumps cortisol so we are ready to fight, fight or freeze.
“We were never designed for the sedentary, indoor, socially isolated, fast food laden, sleep deprived, frenzied pace of modern life” Stephen IIlardi
Depression is called a lifestyle disease because it is primarily caused by our environment. We used to believe it was the genes that determined what illnesses we got. We now know that there may be something biological underlying the disease that determines the prevalence, but basically, it’s what we expose our bodies to that matters most. It was as the links to cancer from smoking and heart disease from obesity, which forced us to consider the impact of our environment and life choices. It seems so obvious now that I sometimes wonder how me missed it! But that’s another whole discussion.
You may see illnesses called “Diseases of Civilization” as they are rare in indigenous civilisations. In 2020 the list of Lifestyle diseases described by the WHO include Diabetes, Atherosclerosis, Asthma, Allergies, Obesity, Cancer (many forms) and a newcomer to the list, Depression. If you want to read more check out the post, “7 Lifestyle disease that could be killing you”. If you have one – you have a greater chance of having another as they came from the same underlying cause- inflammation.
The inflamed brain is a depressed brain
4. Trauma often underpins the stress response
In its simplest definition, trauma is when the human fear response, which is activated when a human senses danger, is not turned off after the danger has past, but stays activated in the mind and body of the survivor, sometimes for a lifetime. The fear response is a normal and VERY necessary part of the human experience. We all experience fear in our lives as our body alerts us to a possible danger. It is an essential survival mechanism. Our primitive ancestors who survived were those that were genetically coded with an effective “alert” system, those who were not as alert were simply eaten by tigers! In most cases, the moment of fear passes when the threat is removed (the tiger runs away) and the body senses that it is safe again. All the responses that had been activated “stand down” and everything returns to normal.
Research suggests up to 80% of depression suffers have experienced trauma- some states it is 100%- depression is the result of trauma- all depression sufferers have suffered trauma.
5. There are risk factors and protective factors that determine our level of vulnerability
Why do some people develop depression and not others? Why are some people more resilient than others? What are the mechanisms that allow some people to survive?
Risk factors are the things you have in your life that increase the likelihood of getting depression. While the list below is like a checklist, the more risk factors you have the more vulnerable you are, not all the items on the list carry the same weight. The other catch is that it’s not really what happens to you- it’s how you interpret it that makes the biggest difference. What meaning you attach to the events? We have an ‘attributional style’ how we unconsciously interpret events.
I will mention here that some recent work states emphatically that if we believe all depression comes from a stress response, logically all risk factors are related to something that puts the body under stress. The body can be placed under physical, psychological stress or social stress.
It is also important to note that risk factors are often related to experiences in our childhood, as these experiences are processed and stored very differently.
These risk factors are:
1. Abuse: Physical, sexual, emotional – this includes bullying
2. Neglect: Physical and emotional
3. Witnessing violence: Witnessing a mother’s abuse, murder
4. Cultural and Familial influences: divorce, separation, confinement, living with a family member who is addicted to alcohol or other drugs, is depressed, has other mental illnesses or who is imprisoned, family conflict and dysfunction
5. Lack of Agency and uncertainty about the future
6. Chronic Illness - accident
7. Physical Restrictions: Lack of physical exercise, movement
8. Systemic inflammation- Other Inflammation diseases already evident
9. Cognitive distortions- media, misinformation, propaganda, extremists, negative and fearful images
10. Social Inequalities: Injustice, poverty, lack of environmental and social rewards, homelessness, unemployment, financial vulnerability or crisis, discrimination
People who have multiple risk factors (as little as 4) have a 700% increased risk of alcoholism, a 1200% increased risk of suicide attempts and a 100% increased risk of heart disease and cancer. People with high scores, have more marriages, more broken bones, more depression, more prescription drug use, and higher levels of obesity.
Remember: Genetics- If someone else in the family has depression (especially if it is a parent and a grandparent), you have a pre-disposition. I think we probably all do! But you will only develop depression if this disposition is activated.
Why do some people experience devastating trauma and yet not become depressed? There are patterns of behaviour or skills that protect us- some people have these, and some do not. These are called protective factors.
The top things that people who do not suffer depression have in common are hardly surprising as they are the opposite to the risk factors.
1. Secure attachment to parents
2. Good physical health and healthy behaviours
3. Healthy diet
4. We have a positive ‘attributional style’ (how we unconsciously interpret events)
5. Quality social support networks and strong inclusion
6. Sense of Identity, pride and belonging- sexual, cultural
7. One significant person
6. Drugs are part of the answer have not been a game changer
In the beginning the pharmacological approach offered so much promise. But several things went wrong. Whilst it encourages some brain growth, we discovered that a medicine approach at the best reaches the part of the illness that has biologically origins so that the sufferer is well enough to manage the symptoms while they attend to the real underlying causes. For many people it makes no long-term difference. Even if there is initial success, once the medication is stopped, symptoms return and are often more severe. So, you can never stop. Medication has failed to alter neuro- transmitters as promised. Expectations were for a quick fix and the result is that many sufferers feel like they are not ‘trying hard enough’ when medication fails. Sadly medication sold the idea of a broken brain and a damaged person to be “fixed” which is one of its greatest weaknesses.
I am not anti-medication, but we must remember the harsh reality that modern medicine is a money-making business. There is little doubt that in most cases interest is directed into profit-making interventions. We must also remember that what we do to one part of the body will impact on another. Medication has significant side effects that can alter the body permanently. They are designed for short term use and to relieve symptoms- but you can’t find the underlying cause, we stay on them for too long. There is no one size fits all, so generic medications have their limitations. We all have unique connections with infinite possibilities. We do have to find what works for us personally.
This is a wicked illness, and we must throw everything we have at it, try every possible approach because what works for one person may not work for another. My caution is not to believe the spin or feel you have failed if it does not work for you. Let’s be honest, if the medication worked and healed you, there would not be a 300% increase and 280 million people still taking anti-depressants.
We need to talk less about chemical imbalances but more about the imbalances in the way we live.
7. Depression is not permanent, it can lift, it can be healed.
My daughter would tell me she could see she was in depressions grip but couldn’t do a thing about it. It is said to be a sensation of being afraid all the time but not knowing what you are afraid of. But you get through if you have someone waiting for you, walking with you, pushing, accepting and believing and if you have access to good treatment. The treatment we have is limited but we must remember that 50 years ago there was nothing! I guess in 50 years will ask us why we did the things we did. We are learning.
We live in the right time- even if it doesn’t always feel like it.
Depression is a symptom of an altered brain. It is not a condition with an unknown cause. We now know that we can change the brain and undo what has been altered. That is amazing, ground-breaking and life changing news! There is hope. So, much of the healing is about changing the nervous system including the brain.
We also must remember that depression is an illness about how you feel. So, if you feel better, you are better. If you have cancer and stand on your head every day and say you feel better, you still have cancer. If you have depression and stand on your head every day and say you feel better. Then you feel better. So, if it works. It works- even if we don’t understand why and even if it works for one person- it works.
You also must have the perseverance and optimism to reach out for one more treatment- even when many have failed. You are looking for your own personal way into your nervous system, into your stress, into your personality and life experiences. No treatments will be the same.
Change your lifestyle so you remove the stress on your body
and
help the body heal from past stress
There is growing evidence that each of the things listed below change our neural chemistry and protect us from the stress of our lives. Each one in some way contributes to turning off the stress response that is altering our chemistry and resulting in many maladaptive responses, including depression. If you would like to know more about these in detail, check out the post Top 10 natural ways to fight depression. As a brief summary here are the top 10:
1. Movement: Exercise is Medicine. It signals Dopamine and Serotonin. It is more powerful than any pill you could take.
2. Sleep: One of the biggest risk factors for depression is sleep deprivation.
3. Food: Reduce inflammation by eating whole food, avoid sugar
4. Brain Growth: Challenge your brain with learning, Omega 3 supplements
5. Connection to nature: Sunlight and sounds.
6. Connection to others: We are born to connect and be part of a tribe- Just belonging to the group send a powerful signal to the brain that we belong and we matter.
7. Connection to self: Listen to your emotions and thoughts, challenge them, manage the ruminations, breath
8. Shifting your Mindset: Imagine a future with possibilities, purpose, hope and less suffering.
9. Shifting your relationship with depression: Shutting out the depression strengthens it/when you hide from it, it grows- tolerate it- listen to what it is teaching you.
10. Shifting your patterns of Behaviour; Identify what patterns keep you stuck, find new routines, stop the rumination
You are onto the road to recovery, and you just don’t know it.
It is possible- there is hope.
8. Healing starts with you- all of you- all of us
We have all heard that you must want to get better and put in the effort and as hard as it is to hear that is no different in the case of depression. The difficulty is that your motivation, energy, and thinking are all compromised so the normal logical things you could do if it was a physical illness- are just not functioning as they should be. The depressed state did not happen by accident. It is your body’s way of protecting you. It does not want you out exercising and socialising. It wants you safe in bed. That’s why it is so easy to get stuck on the treadmill. Sometimes you have to go so low that you have nowhere else to go. Sometimes it takes loved one dragging you up kicking and screaming, when you wish they would leave you alone.
My daughter had to be willing to confront the trauma that had caused her depression and that takes great courage. But the whole family, everyone that loved her had to confront how her illness had impacted upon us all. We had our own demons. As a mother watching her suffer and being unable to do anything but lift her when she fell was agonising. I had to wait until she was ready. So, I did and in time, there was a transformation in both of us.
Through the years I have seen my child’s dignity stripped from her and her life decimated. I witnessed systems that failed us all her and ignorance that seemed insurmountable. I had seen my family in pain beyond description, and yet somehow, we had finally come to a new place. Ever so gradually, I noticed that we had begun to accept the tragedy that had overcome my family. We had begun to shift our thinking. To change our language. To re-frame. To challenge our assumptions. To ask new questions. To live with uncertainty. To have realistic expectations. To forgive. To let go. We had all stopped trying to control what we cannot control. I had stopped trying to protect what I cannot protect. I have stopped trying to restore what had been lost. We had stopped fighting and blaming the world. We had stopped looking for reasons. And most of all I had stopped blaming myself that I had caused my daughters illness and I could not make my child well. I had to make this change, I had no choice, I had run out of options. When I changed, my daughter changed too.
I began to place my energies into finding a peace and acceptance that I would have once thought impossible. This change has not come easily and, I would be dishonest to suggest that I don’t have a moment’s when my very thin and fragile layer of acceptance and assurance is torn apart by the latest crisis or trauma. Or that this has not required massive changes from within me. I have learnt so much about myself in this journey. I am a work in progress and a part of the acceptance is just that- I am learning to be better at life and by default will be a better mother. Through time, soul-searching and maybe some sort of wisdom that comes from having to face the unimaginable, I am now living and slowly learning to breathe again.
Here are a few of the top things we both learned in this journey:
Awareness of our Body
Where did I hold my emotions?
How could I slow my mind?
How do you sit?
What is my body telling me?
Awareness of Self- Emotions- Thoughts- Limiting beliefs- Mindset
What is the story I am telling myself?
Why was this so hard to shift- what was holding me there?
What are my limiting beliefs?
Why do I attach to others the way I do- what is that telling me about myself?
What triggers me?
I am susceptible to my thinking and my emotions- they are not me- they pass.
Everything leads me to be the person I am meant to be.
Pain comes from my belief- as soon as I question it starts to move.
Talk to yourself.
Be open to the possibility…..
Ask why you resist- why you are stuck- what are your gaining from remaining as you are?
Hurt people hurt people-Don’t take it personally
If the thinking that has bought me this far hasn’t worked- it’s crazy to keep doing it
If there is no enemy within the enemy outside is not the problem
Stop resisting the fact that bad staff has happened, is happening and will happen again
Perfection does not exist
We do not control ANYTHING
Don’t try to plan anything- know you will know what to do when the time is right
Be still- listen- breath- act.
All things pass- they REALLY do- I promise.
Life is not about waiting for the storm to pass but about learning to dance in the rain.
9. Healing continues when someone walks with you- It is much harder do it on our own.
In the beginning I dragged my daughter on a merry-go- round of experts in search of the Messiah. I discovered they did not exist, and the result was disillusionment and a loss of trust in others to help. It became us against the world which was unhealthy for us both. I discovered that we were asking too much of some people and that we just had to keep looking until we found the right people to walk with us. And until then, if it was just us- well she wasn’t on her own, and she knew I would never, ever under any circumstances leave her.
Depression turns off the circuits in the brain which initiate a change
You can do it- but can’t initiate it. So, I dragged and pushed. I cajoled, bribed, and negotiated. I researched and organised. I cleaned up messes, at times begged for help and carried the load when she needed me to, always mindful of the dangerous road of enmeshment and co-dependency. And in the background, I raged, I wept and held my fear close to my chest.
Slowly, she began to pick up the reins and I could step in and out. Accountability makes a BIG difference. I could not do it for her, but I could do it with her. I knew she had to have someone- I knew 100% that she had a better chance of beating this if someone was with her. If it wasn’t me, it could be a friend, a partner or a professional. Someone to push when she needed it, remind her she could do this, shut down the negative ruminations, keep her moving and eating, carry the load at times, celebrate her success and love her for the beautiful young woman she is.
And ultimately, if the source of your depression is a significant trauma as it is in the case of my daughter, you will also need professional help from a skilled practitioner. That is hard for me to say after so many failures, and my daughter is still not ready to trust, but my research tells me that healers do exist- we just have to find the right one at the right time.
We know what we need to do but we don’t live by it- we are in a machine that is designed to make us neglect what is important in life.
10. Depression and physical illness are related
Our physical body and psychological body are designed to work together and to respond to each other in a delicate “dance”. There is a ripple, or tsunami effect on other parts of our body when one part is unwell. It seems unthinkable that we would consider mental health and physical health as two separate disconnected bodies, but that is exactly how the current medical system works. The immune system of depression sufferers is compromised. It is focused on putting all its energy into fighting the perceived threat. As a result, many illnesses, specifically autoimmune illnesses can occur. These illnesses appear statistically above the average, for no logical reason and are difficult to resolve.
When my daughter became unwell with depression the physical illnesses were not far behind. They were not “in her mind”. Appendicitis, loose shoulder joints, kidney stones and a bladder condition, cannot be fabricated for attention (which was implied by one doctor). The longer the mental illness goes on the more the physical symptoms increase and eventually the auto immune system shuts down and there is a cascade of seemingly unrelated issues.
Today, millions of dollars go into physical medical treatments for depression suffers. Many doctors are more comfortable treating the physical symptom that fall within their specific field of expertise then having the underlying triggers identified and treated first. The initial response to physical symptoms is most likely to treat them with medication or surgery. The best you can hope for in many cases is some short-term symptomatic relief.
Those with mental health issues have 3x the rate of hospital admissions, 4x the cancer diagnosis and die on average 5 years earlier than those without. The tragedy is that it is VERY hard for patients with a mental health issue to receive quality medical care even when the issue IS predominantly physical in origin.
So, there it is, the ramblings of a mother who has walked a long and difficult path, to finally be at a place of acceptance and healing. You may also be interested in Inside the Walled City a post I wrote after a dream in a very difficult period of my daughters’ illness. I think it captures the desperation of a mother……
Good luck and remember to keep your eye on the light at the end of the tunnel. And if you can’t see the light, get up and turn it on! Look for the small lights along the edge of the path.
Annie
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