THE CURE FOR DEPRESSION!

How do we know when we are depressed? We know when we are depressed because we feel it!
Unipolar depression is a condition that apparently afflicts a large number of people around the world and affects as much as 50% of the American population at some point in their lives. Depression is characterized by a decrease in mood that is below “the norm”.
I would first like to point out that there is no way that we can know what “the norm” is, that is, how the rest of the population feels. For example, it is impossible to know how much pain or how much love another person feels. There is no medical test that can assess your emotions such as the response to pain. All a Doctor can do is to ask you how much pain you are in from a scale of 1-5. How does this perception of pain relate to the population at large? It is difficult if not impossible to say. Your pain scale cannot be related to other individuals. Likewise we cannot tell how depressed someone is in comparison to the general population. And more importantly, you cannot tell if you are depressed compared to others. Therefore, if you have no idea how the population feels, how can you be sure that you feel less happy than the population? Well, you can’t. It is your perception of how you feel and of how you think the population feels that leads you to the conclusion that you are depressed.
How accurate is your assessment of your own depression? Let me first state that we are terrible at assessing our own emotional states. This is clearly evident in the numbers of rock ballads that express the notion that “we don’t know what we had until its gone”. Our emotional evaluations are much better in retrospect. We can all think of times in our lives when we were clearly wrong about our emotional states. There have been periods of our lives when we thought that our lives were NOT going well, but when we look back on those times we realize that they were fairly happy and carefree times in comparison. It seems as though we need context to understand our emotions. The perceived context that we find ourselves using when we assess our own depressed emotion is often flawed. It is flawed because we cannot make accurate assessments as to how the rest of the population feels and so we incorrectly conclude that we are not as happy as the average person. [if the majority of the population is depressed, say 51%, then this cannot be depression, but instead the norm, right?].
It is difficult to believe that we are so terrible at assessing our own emotions. When we feel our emotions we “know” that they are correct, they just are! It is also difficult to believe that we have little control of our emotions. Our emotional states are largely linked to innate drives that have evolved over many years because they provide the motivational impetus to our drive states that keep us alive. In example, we can imagine that the hungrier we get the more emotional we would get about finding food and this emotional state would temporarily trump the other drive states so that we would focus on, and provide motivation for, finding food. Once we are fed this “emotion” would disappear.
Experiments have shown that we are easily tricked into feeling what the investigator wants us to feel. This is hard to believe for some of us so think of it in this context. We are also easily fooled with regards to visual illusions. These are well documented and these reveal that even when we are shown the answers to these visual illusions we sometimes still refuse to believe that we are in fact being tricked. Our visual perceptions seem very real to us and may in fact seem more real than our emotional perceptions. After all, seeing is believing, right? It is actually fairly easy to trick humans into having visual and emotional illusions, that is, into feeling whatever the researcher wants them to feel, that is contrary to their “normal” emotional response. This is hard to grasp so let me provide an example. Let’s say that we are going to assess how good a brand of vanilla ice cream is. We would start by randomly assigning members to groups and then in the first group we would have them watch a video on how the ice cream is made that is actually quite dull and boring, and have confederates (actors) in the viewing room that declare out loud how boring the video is and what a waste of time this whole study is. In the second group we would have the same video with the exception that during the video a scary ghost jumps out at you which greatly startles you. The confederates exclaim how scary the video is and how fun and exciting this whole experience is. Even though the bland vanilla ice cream is the same in both portions of the experiment which one do you think will be rated as being better? That’s right! Our emotions were easily manipulated! We perceive the rush of norepinephrine we received from being scared, and from the actors, as being attributed to the excitement we feel for the ice cream. This is how all advertising works. Moreover, Americans are probably the most marketed to population on earth and the most persuadable with regards to emotional manipulation in order to create emotions about consumable products. All of us fall prey to these emotional illusions. Similar to visual illusions, even when we know we are being tricked, we are influenced none the less. That is because our visual system and our emotional system (limbic system) operate under innate physiological rules. I think that we have been tricked into thinking that we are always supposed to be happy and that other people are indeed always happy. I think that neither assertion is true. It is attractive to think that we should always be happy but it just simply isn’t the truth. Moreover, it is likely that our mood states are balanced and controlled in part by our bio-rhythms which ebb and flow and that we must experience great sadness if we are to know great joy as Nietzsche postulated.

Can my chemical imbalance, and my depression, be cured by antidepressant medication?
I most likely don’t need to inform you that antidepressant medication is not a cure for depression. These medications are powerful and very effective, but mainly treat the symptoms of depression. I have no idea what is really meant by the term “chemical imbalance”. I think a Psychiatrist probably first coined this saying as a metaphor for explaining the actions of neurotransmitters at the synapse and that it became used in a much too literal sense. If you understand Psychopharmacology, or have read my chapter on Psychopharmacology, you know that the quantity of neurotransmitter at the synapse is in constant fluctuation. Once the neurotransmitter is released it is quickly removed from the synapse (around 1msec) either through enzymatic degradation, re-uptake, or diffusion. Moreover, the most important factor with regard to how the synapse relates to the release of neurotransmitters is the type and quantity of post-synaptic receptors on the receiving neuron and not the level of neurotransmitter present. If in fact you have too much (or too little) neurotransmitter at the synapse, the post-synaptic cell will down-regulate (or up-regulate) the number of post-synaptic receptors in order to maintain homeostasis at the synapse. This is why drug tolerance happens. Furthermore, the most important fact in the field of Neuroscience is that the brain is plastic, which is to say that the synapses within your brain are continually changing. Therefore, the term chemical imbalance really has no meaning. Medications such as Prozac are perhaps best thought of as a cast for your break in emotion and is similar to when you cast a broken bone, at some point the cast needs to come off (preferably when the fracture has healed). I concede that mental fractures seem to take a much longer time to heal than do your bones, but the point is that you will need to discontinue the medication eventually. The cast will need to come off.
Psychotherapy can be very effective at relieving the symptoms of depression. Studies have shown that therapy can be as effective as medication. The best treatment appears to be when the depressed individual is treated with medication and psychotherapy. Because the brain is plastic you will cause physical changes in your brain as a result of changing your thought processes as a result of psychotherapy. These physical changes in your synapses will cause you to think differently about different stimuli. This is the path to the alleviation of depression. It is an upward spiral that you could liken to building up a muscle. It will take both work and time to build up this mental muscle, but it will be much stronger in the end.

Whether we use medications or psychotherapy to help us to overcome our depression at some point we must cease treatment. We simply cannot continue antidepressant medication forever and the goal of psychotherapy is not life-long treatment. So, at the end of the day, what has really changed when you finally defeat your depression? Neither medication, nor therapy, is a cure for depression. In the end, when the depression is gone and you no longer are on therapy or medication, what you are left with is your new  interpretation of your own mood states that are created by the workings of your very own human brain.
A friend of mine once told me that one of the tenets of the Buddhist religion is that life is supposed to suck! Once I knew this life seemed much better for me! I thought yes, of course, life is a struggle, that way you learn and appreciate it much more. In fact, in some ways the more you struggle the more you learn. It is the hard times in your life and in your business that teaches you the most about yourself. When you expect life to suck you really appreciate it when things go well! If you always expect things to go perfectly, you will live your life in disappointment and depression.

Don’t be fooled into thinking you know your own feelings. What you experience is your interpretation of your feelings. Don’t fall into the trap of thinking that the majority of people feel better than you do. That is an illusion. When you change your beliefs about your expectations and your interpretations of your emotions you will truly cure your own depression. Medication and psychotherapy can speed you to this change in interpretation, but at the end of the day when you are no longer on medication or are undergoing therapy it is this change in interpretation that will light your way.

~ by hbfarmstrong on November 8, 2008.