Magazine: Yoga Journal
Issue: November/December 1996
Author: Kristin Barendsen

Dealing with Depression

Growing up in a family with a history of depression and alcoholism-a self-described "petri dish for depression"-Nancy Levine, 35, of Oakland, California, quickly learned to pretend that everything was fine. At age 13, she suffered her first major depression. "You can't move, you can't sleep, you want to die," she recalls. "There are almost constant suicidal thoughts, like an urge, like an itch you want to scratch."

By the 10th grade, Levine discovered that smoking pot helped her cope. "It lessened my anxiety and it was restorative, at least temporarily." Use turned to abuse, however, and by age 23 Levine was subsisting on chocolate and bouncing from cocaine to Quaaludes. Her hands shook, and blood vessels in her arms and legs began to burst. "One day while I was stoned on any number of things," she recounts, "it occurred to me that if I continued in this way, I would die."

Like the young Levine, many people seek relief from depression through substance use. Alcohol, nicotine, marijuana, and the harder "street" drugs can all give a temporary lift to mood, but the high soon wears off, only to be replaced by a low far worse than the original feeling. With regular use, these and many prescription drugs can overwhelm the brain's natural hormones, causing insomnia, fatigue, loss of interest in daily activities-in short, exacerbating the condition.

What Exactly Is Depression?

Just because you feel down sometimes doesn't necessarily mean you suffer from clinical depression. Everyone feels this way at one time or another; no one is immune to occasional low moods or sadness in response to a loss. When these feelings persist, however, or when they deepen over time no matter what you try to do to change them, they may indicate a more serious imbalance. True depression is a loss of interest in nearly everything that once gave you pleasure, replaced by a pervasive feeling of emptiness or numbness. It brings a host of other physical and psychological symptoms, including disturbances in sleeping and eating patterns; overwhelming fatigue or anxiety; feelings of worthlessness, hopelessness, inappropriate guilt, regret, shame, and grief; diminished ability to think and concentrate; and recurring thoughts of death or suicide. If you experience at least five of these symptoms for longer than two weeks, you likely suffer from major depression.

Shades of gray exist, however, between low moods and major depression. Negative thinking patterns, for example, can aggravate a chronic low-grade depression called dysthymia. A minor depressive episode is an intense period of depression lasting less than two weeks. Depression manifests differently in everyone, but whatever form it takes, it should be treated with attention. It can be long-lasting and debilitating, and the risk of suicide is real. For these reasons, and because depression is often a symptom of a physical illness, it is important to seek help from a trusted professional. A thorough medical exam may help rule out other possible reasons for how you're feeling: adrenal problems; thyroid deficiency; reactions to drugs (prescription or illicit) including oral contraceptives; food allergens or poor diet; or even more serious viral or bacterial infections.

Mental or Neurological?

Psychiatry has long viewed depression as a mental illness originating from the repression of painful emotions, such as anger and grief. In recent years, however, science has begun to explore the biological connections between depression and low levels of certain neurotransmitters, or brain hormones-especially serotonin, norepinephrine, and beta-endorphins. According to Tierona Low Dog, M.D., a well-respected herbalist and physician who runs a medical clinic in New Mexico, doctors believe that if you can keep these neurotransmitters around longer by inhibiting the brain enzyme monoamine oxidase (MAO), you can lift depression. In fact, raising the levels of these chemicals in the short term appears to lift mood; balancing them over the long run seems to help people heal from chronic depression.

The search continues, then, for substances, behaviors, and activities that balance brain chemistry. Perhaps the most famous substance is Prozac, best known among the antidepressants for bringing people back to normal functioning from states of near stupor. Prozac, however, does not work for everyone. No one knows the long-term effects of the drug or even exactly why it works, and many people question whether taking such a powerful medication addresses the root causes of depression. Because so many factors contribute to depression-physical illness, toxins, nutrient deficiency, lack of exercise, chronic stress, and painful emotions, to name a few-addressing these factors can restore chemical and emotional equilibrium and make for long-lasting change. To paraphrase Annemarie Colbin in Food and Healing, mind and body can be seen as an infinity loop, or figure eight. Disease introduced anywhere in this loop travels through the rest of the system; similarly, we can intervene anywhere along the loop to begin healing.

Holistic Intervention

Nancy Levine, convinced that she was spiraling out of control, sought help in bioenergetics, a body-oriented therapy that helped her get off drugs and provided an outlet for the feelings that surfaced as a result of sobriety. But at age 32, the breakup of a relationship plunged Levine into another serious depression. This time her therapist insisted she try Prozac. Levine adamantly refused. "In my case, it would have been like shooting a football player full of cortisone so he can go back and play," she says. Instead, Levine made some major life-style shifts. She began to study what foods affected her moods. After discovering she felt better when not eating meat, sweeteners, wheat, and dairy, she eliminated these from her diet. Always a sports enthusiast, she started playing tennis every day. Depth-oriented brief therapy, in which parts of the self begin to dialogue, served as "a cornerstone." Perhaps the most important factor in her healing, however, has been her art. In a one-woman comedy performance called "Leaving Scarsdale: The Art of Coming of Age in a Family Going Mad," Levine tells the story of her childhood. "Taking something that's so painful and making it into humor-there's something immensely healing about that," she says.

Cleansing the Body. Depression-causing toxins come in more innocuous packages than the obvious ones like alcohol and drugs. Caffeine, chocolate, and sweetened foods trigger a rapid rise in blood sugar, followed by a "crash" a few hours later, thus fueling wide mood swings. Reactions to food allergens such as wheat and dairy, and to chemicals such as artificial colorings, preservatives, and pesticides cause similar stimulation and withdrawal symptoms. Though unlikely to single-handedly trigger clinical depression, these substances can maintain a low-grade depression or magnify an existing imbalance.

To clear toxins from the body, Elson Haas, M.D., usually advises clients with depression to embark on a cleansing diet for a period of two to three weeks. Director of the Preventive Medical Center of Marin, in San Rafael, California, Haas outlines a gentle cleansing program focusing on steamed vegetables, the right oils, and some whole grains in his book A Diet for All Seasons. Following the cleansing period, Haas recommends eating a diet free of wheat, dairy, sugar, and additives. He says that clients with depression "are often carbohydrate cravers," so he recommends a diet with fewer carbohydrates and more vegetables and protein. While carbohydrates tend to make the blood sugar level rise and fall, protein helps to rebalance it, Haas says, "making for a more stable psyche."

Supplementation. Vitamin deficiency commonly mimics clinical depression. Earlier this century in the South, over half the beds in state mental hospitals were occupied with people with pellagra, a vitamin B3 deficiency. The entire B complex is critical to mental health, as is vitamin C and essential minerals like calcium, magnesium, and potassium. Haas recommends supplementing your diet with these nutrients. He also often prescribes the amino acids L-tyrosine and L-tryptophan, precursors to the neurotransmitters norepinephrine and serotonin. However, because the interaction of amino acids is highly complex, many experts advise taking these supplements only under the eye of a medical supervisor. Tierona Low Dog agrees that B vitamins can work wonders, especially B12. Her one caveat: Don't take B12 in pill form-it doesn't work as well. Take it in nasal drops, sublingually, or by injection. When buying a B complex, do not select the synthetic variety. If there's any doubt about the quality of your B vitamins, she advises, drop a pill into apple cider vinegar; if it doesn't dissolve, don't take it.

Energizing the Liver. Herbalist and nutritional consultant Brigitte Mars of Boulder, Colorado, emphasizes the importance of treating the liver in clients with depression. The liver is the organ that breaks down hormones and toxins, and in depression is often "sluggish and blocked," she says. To help clear the liver and strengthen it, Mars recommends avoiding saturated fats and the transfatty acids found in margarine and many commercial snack foods. Seattle herbalist Karta Purkh Singh Khalsa suggests several herbs to purify and stimulate the liver: milk thistle seed and dandelion root, the Chinese herb Baical skullcap, and the ayurvedic herbs turmeric and bhumy amalaki.

Herbal Treatments. St. John's wort has a long tradition of use in Europe as an antidepressant; it acts as a mild MAO inhibitor, as do some antidepressant medications. While most MAO inhibitors cause sensitivity to dairy products and alcohol, according to Low Dog, St. John's wort does not. If a patient becomes sensitive to sunlight, however, Low Dog recommends switching from capsules to tincture or standardized extract. A typical dose of St. John's wort with at least 0.3 percent hyperacin is 300 mgs. (capsule form) three times a day. Most studies, according to Low Dog, use standardized extracts made from the fresh herb, typically 5 ml. two to three times daily.

Calming Herbs. When nervousness or acute anxiety is associated with depression, people often suffer from insomnia, have trouble shutting their minds off at night, and experience a lot of muscle tension. In a recent workshop, Low Dog recommended several herbs that help slow things down and take the edge off. Valerian, probably the most common, combines nicely with equal parts black cohosh and cramp bark. Three to 5 ml. in a tincture two to three times a day works best. Some people, however, experience adverse effects when they take too much black cohosh: piercing headaches behind the eyes, nausea, or gastric distress. Therefore, don't take more than 20 ml. per day.

Low Dog's patients also respond well to passionflower, also a mild MAO inhibitor, which can calm those anxious feelings without making a person drowsy. Blend equal parts of passionflower with chamomile to calm nerves and nervous digestion. Lemon balm (Melissa), the "gladdening" herb, uplifts the spirits and calms digestion. It's best prepared as a tea with equal parts skullcap and oatstraw (2 teaspoons of the blended herbs with one cup boiling water, steeped 10 to 15 minutes). Two to three cups a day works well. The skullcap in the tea works as a tonic-lifting the spirits up when someone is low, and lowering them if she's hyper. The oatstraw soothes the nervous system and has a calming but spirited effect. For a person who is overcome with sadness, who cannot stop crying, or who suffers from nervous headaches, Low Dog recommends a tincture of pulsatilla made from the dried herb (5 drops two to three times a day) may help. This does not benefit the person who has a great deal of fear surrounding her depression, however.

Other Helpful Remedies. Mars recommends several other treatments for depression. Gingko biloba helps the brain utilize oxygen, nettles serve as a kidney tonic, and hawthorne "strengthens the heart," according to Mars. Licorice, which regulates blood sugar, can help with mood swings. Mars also suggests that depressed clients add a few drops of the pure essential oils jasmine or lavender to the water for a hot bath. She says that the uplifting scent "makes you remember to breathe more deeply," delivering more oxygen to the brain.

Mars also talks about the importance of sunlight in maintaining happiness. Light affects the pineal gland, stimulating production of melatonin, a hormone that regulates sleep and mood. During the winter months, when sunlight is scarce, many people experience a low-grade depression called seasonal affective disorder (SAD). For this condition, Mars suggests spending 20 minutes a day outside without UV-blocking contacts or sunglasses (never looking directly at the sun). She also suggests replacing incandescent bulbs with full-spectrum lighting in the home or office. Homeopathic Relief. Homeopathic remedies also hold promise in treating depression. Dana Ullman, M.P.H., homeopathic educator and author of The Consumer's Guide to Homeopathy, explains that homeopaths view depression not as a mental illness but as a syndrome of physical and emotional symptoms unique to each person. Because the homeopath tailors each remedy to the client's unique pattern of symptoms, there are "literally hundreds" of possible remedies for depression, Ullman says. He cautions that while "one can learn to treat oneself for acute grief states," treating deep, long-lasting, or recurrent depression requires the attention of a professional. Remedies for acute grief include Natrum Mur, Ignatia, and Staphysagria.

Ayurvedic Understanding. Depression, according to ancient ayurvedic principles, reflects an overall imbalance between the body, mind, and spirit. Many factors that contribute to depression relate to an imbalance in kapha-the dosha, or fundamental principle, in the mind and body that governs structure and lubrication. According to Robert Hensley of Maharishi Ayur-Ved, kapha slows digestion when out of balance, allowing impurities to form and accumulate in the system. These impurities block the micro-circulatory channels that deliver nutrients to the cells and deprive the cells of energy and vitality, slowing the body's continual process of cell regeneration. When the old tired cells outnumber the fresh vital ones, you feel fatigued, sluggish, and sad. When brain cells become sluggish, your mind feels cloudy, small problems become huge, and you feel less satisfied with life.

Kapha also operates directly on the emotions, Hensley explains, giving a person a sense of steadiness and an even temperament. Out of balance, however, it can create heaviness, a lack of enthusiasm, and sluggish emotions.

An ayurvedic formula would have to address all the factors leading to such an imbalance in order to be successful. For that reason, formulas can contain as many as 20 herbs. The main ingredient in one such formula is arjuna myrobalans, a large tree famous for its effects on the heart as a muscle and on the emotions as well. Some other ingredients include: winter cherry (ashwagandha) and holy basil (tulasi), both powerful adaptogens that increase the body's natural resistance to stress; Ailanthus excelsa and arjuna myrobalans to promote cellular regeneration, hastening the replacement of dead or tired cells with fresh, vital ones; long pepper (pippali) and Indian gooseberry (amalaki) to enhance longevity and improve digestion; and ginger as a digestive aid that prevents the accumulation of impurities. Long pepper also increases bioavailability of the herbs and speeds the benefit of the whole combination.

Additional ayurvedic guidelines, says Hensley, include meditating daily to reduce stress and balance the emotions; avoiding stressful situations until you can handle them without strain; favoring foods that are light, dry, warm, pungent (spicy), bitter, or astringent while reducing foods that are heavy, oily, sweet, sour, or salty, which aggravate kapha and are difficult to digest. Hensley also recommends decreasing cold foods, such as ice cream, which put out digestive fires; avoiding cold damp weather; getting plenty of exercise and plenty of rest.

Traditional Chinese Medicine. Oriental medicine views depression as a complex of physical and emotional symptoms. Barbara Custer, L.Ac., O.M.D., of Mill Valley, California, explains that in Oriental medicine, physical and emotional states are represented by the interaction of five elements: fire, earth, water, metal, and wood. In depression, Custer says, the fire element is often very diminished, so the body feels fatigued and the heart has no joy. The water element, which rules the function of the brain, might also be diminished, leading to slower brain functioning. Wood, associated with the liver, can also be imbalanced because of repressed anger or the overuse of drugs that could congest liver functioning.

Depending on the client's constitution and which organ systems are out of balance, Custer treats depression with herb formulas like Siler, Platycodon, and Major Bupleureum for a sluggish liver; Rehmannia 8 for kidney/adrenal insufficiency; and dong quai and peony for the hormonal fluctuations experienced by paramenopausal women. She also will use ginseng to raise the level of fire, as it "tonifies the whole body and spirit." Acupuncture points are chosen along the meridians of imbalanced systems; in addition, points at the top of the head are commonly used to stimulate the flow of chi into the brain.

This flow of chi to the brain is crucial. The brain requires oxygen and glucose in a steady supply; when supplies are low, fatigue, unclear thinking, and depression can result.

Exercise and Yoga. An excellent way to deepen the breath and keep the blood flowing, daily exercise clears toxins from the tissues, stimulates endorphin production, and raises serotonin levels, bringing a sense of well-being. It is recommended by allopaths and naturopaths alike. As psychiatrist Mark Gold remarks, "It's impossible to be depressed when you're actively exercising."

Yoga combines these benefits of exercise with many others that are helpful in lifting depression. Yoga can help regulate the endocrine (hormone) system and other organ systems; it leads the mind toward peace and equanimity; and it provides insight into where tensions and blockages are held in the physical, emotional, and energetic body.

In one yogic view of depression, a blockage of energy in and around the heart chakra causes constriction in the chest area, leading to slumped shoulders and a sunken chest-often the posture a depressed person adopts. To open the heart chakra, yoga teacher Barbara Kaplan of Oakland, California, suggests practicing chest openers and backward bending poses such as Cobra, Locust, Camel, and the full backbend. Kaplan, a Phoenix Rising Yoga therapist, also recommends inversions such as Headstand and Shoulderstand. These poses "are a marvelous aid to sleep, and they stimulate concentration as they bring blood to the brain," Kaplan says, noting that backbends and inversions are best learned under the guidance of a skilled teacher.

For someone who is having a hard time getting to a yoga class because of depression, Kaplan recommends a session with a yoga therapist. "Yoga therapy can be an easy transition from the do-nothing period to a safe environment for movement," Kaplan says. The yoga therapist brings the client into supported poses and invites the client to explore sensations or emotions that surface-either verbally or just by going deeper into the feeling. Kaplan says that specific asanas can help the client explore certain emotions: Child's Pose supported with bolsters might help one express grief; chest openers can awaken the possibility of giving and receiving love; Warrior Pose or quick Sun Salutations with jumping can help one express anger or open to personal power.

Yoga therapy is just one way among many to get in touch with painful emotions, an important step in healing. Psychotherapy, bioenergetics, cognitive therapy, and hypnotherapy are others.

Depression as Spiritual Practice

Becoming aware of patterns of thought and behavior that lead to depression can help us to change them. "When I realize I'm feeling depressed, I ask, 'What am I depressing?'" says Cheri Huber, author of The Depression Book: Depression as an Opportunity for Spiritual Practice. Huber describes depression as a process of rejecting painful emotions, feeling depressed, then rejecting the depression and rejecting ourselves for not being able to "snap out of it."

This vicious circle can be broken, however, if we can learn to "sit still with that feeling . . . embrace it," Huber says. "Ask yourself, 'How can I take care of myself when I'm feeling this way?' Treat yourself as you would treat someone you love." She suggests throwing a "depression party": "Bake yourself a little black cake. Don't put anything in it that would make it rise. . . . Paint a big, dark depression picture." Letting go of resistance to feelings helps one step outside of them and gain perspective, Huber says.

"Any of these things in life that are considered 'real drags' can actually be gifts," Huber continues. She compares her experiences with depression to her chronic back pain. "I can't just walk away and leave myself behind. I have to be present. And I consider that a tremendous gift, because I want to be present. Spiritually, there's no greater friend."

Author D. Patrick Miller also explores the spiritual meaning of depression. "Though depression is widely regarded as a psychological or biochemical disorder, I have come to understand it also as a form of spiritual crisis," he writes in The Book of Practical Faith. "Depression is, according to its degree, the relative absence of faith." Miller offers four strategies to "recognize the negative mysticism of depression": "Turn to nature. . . . Activate the body, preferably in a playful way. . . . Confront guilt and other negative convictions. . . . Ask God for help." Tierona Low Dog recommends walks in the garden, watching the sun set, or seeing a baby smile. Find support in the everyday things you do, and don't be afraid to let yourself cry.

Kristin Barendsen is a freelance writer whose cover story on Caroline Myss appeared in our September/October issue.

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