Depression is a subject I've been avoiding for a while; it is deeply complex and for those suffering, a deeply personal and seemingly insurmountable thing to deal with. It is fraught with both self induced guilt and also an air of 'there must be something wrong with me'. It is debilitating and soul destroying.
It is not a simple as a chemical imbalance, and certainly not a lack of 'Prozac, Nortriptyline, Sertraline or Citalopram'.
And each person that experiences depression will experience it in their own individual way. For some it is the 'black cloud' that just won't shift, leaving one feeling soulless, amotivated, blank, empty and down. For some it's a insipid and insidious, for others it is a deep despair and or a deep loathing. It's the feeling that there is 'nothing' - no emotions whatsoever that can be more devastating than feeling deeply sad.
The causes can be many fold, but after working in the industry for a number of years I would say there are three main contributors. These are interrelated and can not be seen as separate from the other. Unfortunately, if you visit your GP - they are more likely to prescribe you with anti-depressants than to do a complete review of your nutritional/lifestyle/physical status and prescribe you a series of vitamins, supplements and lifestyle changes as a first line approach.
I'm going to start at the Soul - if you diet is good, your nutrition is perfectly profound it may be that it is your soul that is restless and wanting. If you are stuck in a dead end job/relationship and are being untrue to yourself, the consequence will be restlessness, unease, dissatisfaction. If you are carrying a deep sense of guilt, shame, remorse - this must be dealt with, unearth and aired - preferably with a psychologist to support you on your journey. One can not carry on 'as if it never happened' - these things have a way of coming back to you until you deal with them.
The Mind is a tricky beast. Programmed to see the 'faults, dangers and potential foes' you can easily see how your mind may be stuck in negative thought patterns. It's constantly looking out for you - for potential dangers, mental and physical as a form of protection - however this can be unhelpful and anxiety provoking when all you want to is pop out to a friends dinner party. The potential 'whatif's' can be overwhelming as your mind seeks to protect you from every possible mishap - including the potential for embarrassment. This can lead to an anxiety mixed with depression picture. If you stop and observe that little voice in your head: What are the repeated negative thoughts going on in you head? Are you constantly berating yourself? Does your mind need a shift? Do you need to enhance compassion toward yourself? Once again - a psychologist will help you examine this pattern and help you to change negative thought patterns with Cognitive Behavioural Therapy and other useful tools which you can use on a daily basis to 'rewire' your brain.
The third component is related to your Body. Nutrition is essential for good mental and physical health. However most people are not meeting daily recommended (minimum) requirements let alone at high levels enough to give you optimum health and well-being. Add to this poor nutrition choices that lead to chronic inflammation and that take nutrients away from you (alcohol, 'junk food') - getting the right nutrients can be challenging. Many foods grown commercially are grown for size - not for nutritional content. Food can be days old before it even gets to you - and vitamins like vitamin C are often significantly decreased by the time we get to eat it.
In New Zealand 27% of us are below the recommended blood level of vitamin D. New Zealand soils are deficient in; selenium, boron, iodine - therefore New Zealanders are also regularly deficient in iodine and selenium as well as zinc. These nutritional deficiencies can have not only an impact on your mental health - but a huge impact on other areas of your health and well-being. A low selenium status is associated with an increased risk of mortality, poor immune function and cognitive decline, according to a recent review in the Lancet. Iodine and selenium are also essential for adequate thyroid function. The last National Nutrition survey found about 11% of New Zealand women had low iron stores, iron deficiency or iron deficiency anemia with a higher prevalence among Maori. A 2001 study found that 45 per cent of adolescent women were at risk of low dietary intakes or iron and that up to 13 per cent of women aged 15-49 years had sub-optimal iron levels. (See more: here.) Low iron can cause poor sleep, extreme fatigue and poor cellular function. Folate deficiency is common in those suffering from depression. Magnesium and Zinc deficiencies and lack of the B complex vitamins can contribute to a low mood.
Add to this our modern day lifestyle, with infrequent exercise, pollution (noise, air, toxins in our food and water supply) and stress of a physical or mental nature, we can end up with poor absorption of food, poor cellular function, constipated bowels (or the opposite), worn out adrenal glands, a dysfunctional HPA (hypothalamus, pituitary, adrenal) axis, a sluggish thyroid and disrupted hormones often causing a vicious cycle of low energy, low mood, poor eating habits and sedentary lifestyle.
how to heal
If you are depressed, there are a few places to look for solutions. One in to get a full assessment from your GP: full thyroid function, full iron studies, full bloods and cortisol levels. A vitamin D test would also be helpful. If these are 'normal' - remember that what might be considered 'normal' for the population many not be right to you. Borderline measures can still signify huge problems in the intake, absorption or use of minerals and vitamins in the body. I personally would advise starting on a very good high strength multivitamin - to cover all bases, ensuring that all B groups are covered as well as magnesium, zinc and selenium.
If lack of sleep is your problem - get something to assist with this (herbal or magnesium can help) and start a good bedtime routine. Bed by 10pm, up around eight. Bring in relaxation exercises to help. See here for more tips on sleeping. If you are suffering from total exhaustion mixed with depression - you may need more sleep - up to 10 hours per night. It is imperative that you give yourself this time to rest and recover - while working on other strategies (diet, nutrition, counseling, therapy, supplementation) to get your health back.
Then there are the things to exclude. Caffeine, alcohol, energy draining people. poor nutrient foods, refined carbs. Eat as many vegetables as you can possibly get your hands on, and good lean protein.
Counseling helps. Talking helps. Seek out a psychologist, counselor or other elder that you trust and start getting the help you deserve.
It might be the last thing you feel like doing - but exercise in some studies has been shown to be as effective as an antidepressant. Phone a friend, ask for support, tell them you want to get an exercise regime 4-5 times per week. Personally I recommend walking, preferably outside. It's cheap, easy, requires no extra equipment and you can gently build yourself up.
Yoga is a wonderful way of connecting with your body and soul, as are other mind-body practices like Tai Chi, Chi Quong and other martial arts.
As depression has more recently been linked with inflammation it's important to eat as well as you possible can. Eat vegetables, the green and leafy ones, simple grass feed meats, avoid all omega 6 oils, focus on omega threes (nuts, fish, seeds) and whole foods. Cut out sugar, cut our gluten, cut out processed, deep fried low quality food - give your body the best chance of recovery.
Getting outside and being in nature - many studies show that being in 'green' spaces has a positive effect on well-being. Having good dental hygiene helps and having good gut bacteria can help reduce body inflammation and improve general health. I have written about other strategies to help the recovery process here.
Treating depression is a many pronged approach. There is not one cure all, antidepressants are great and life saving in the short term when necessary - but don't believe that a tablet will make everything better. You also need to make the changes necessary to support your body, soul and mind in the healing process.
Most importantly - get help - and keep searching for answers. You should never have to suffer from this alone. You are worthy and deserve to be happy. It's a basic human right.