Thursday, April 20, 2006

From depression to freedom - By Paul Douglas

Mild depression can lead to brooding on negative aspects of self or others, feeling aggrieved, irritable or upset much of the time, feeling sorry for oneself, and requiring constant reassurance from someone. It can also lead to various physical problems that are not caused by any physical disease.

As depression intensifies, feelings of extreme sorrow and hopelessness blend with low self-esteem, guilt, memory loss, and concentration problems to bring about a critically painful state of mind. To make things worse, there may appear a change in body functioning. The usual daily rhythms seem to go wrong: you have sleepless nights, or sleep too much, you can’t eat, or eat too much. You lose enthusiasm for activities you used to enjoy. Sometimes, you even have a feeling that life is not worth living and suicidal thoughts occur.

Antidepressants are the most commonly used treatments for clinical depression. It is quite cheap, and it is easy for family GPs to prescribe. And this is they who treat the majority of people with depression. But when the episode has passed, and medication ceases, depression usually returns, and minimum 50% of people who experienced an initial episode of depression find that depression is back, despite appearing to have made a full recovery.

After a second or third episode, the risk of recurrence increases to 80-90%. Early onset depression (before 20 years of age) is particularly related to a considerably greater risk of relapse and recurrence. For people having been suicidal in the past, any depressed can lead to a return of suicidal thinking.

The very serious problem with viewing antidepressants as the main method for preventing recurrence of depression is that most patients are not willing to stay on drugs for long-lasting periods, and when the medication stops, the risk of becoming depressed again comes back. Finding new ways of helping people stay well after depression requires an understanding of why depression keeps returning.

During crisis in which a person becomes depressed and suicidal, an association is learned between the various symptoms (low mood, physical pain, suicidal tendencies, and so on). This means that when the negative mood returns, for any reason, it will tend to trigger all the other symptoms - a process called "cognitive reactivity").

It is a very relevant discovery that the connection between negative moods and thoughts remains ready to be reactivated even when patients begin to feel better: this means that preventing prospective crises depends on the ability to control mild upsets from turning into serious conditions. The study has revealed that combining the ancient practice of meditation with modern psychotherapies can help people achieve this.

Mindfulness-based Cognitive Therapy blends contemporary cognitive behavioral therapy with meditation practices in order to help patients become more aware of the present moment, including communicating with moment-to-moment changes in the mind and body (see This therapy is based on Jon Kabat Zinn’s Stress Reduction program at the University of Massachusetts Medical Center.

Participants of the therapy learn the practice of mindfulness meditation in weekly classes and by listening to CD’s or tapes at home during the weekdays. Participants are also educated about our moods, and they are shown the connections between thinking and feeling. They are taught how they can best take care of themselves when a crisis threatens them.

The MBCT approach helps participants in the classes to recognize when their mood is starting to sink. It helps break the normal connection between negative mood and negative thinking. They develop the ability to allow distressing moods, thoughts, and sensations to come and go, without having to struggle with them.

Participants discover that they can stay in touch with the present moment without the need of ruminating about the past or worrying about the future. Consequently, they see more clearly how to approach moment-by-moment experience skillfully, taking more pleasure in the good things that often pass unnoticed or underestimated while handling more efficiently with the problems that they encounter.

Two controlled clinical studies have shown that MBCT can decrease the probability of deterioration by about 40-50% in people who have suffered 3 or more previous episodes of depression. Due to such findings, MBCT has recently been included in the British government’s national guidelines for treating recurrent major depression.

But this suggests a redefinition of treatment itself. As our understanding of depression increases and we see that it is a repetivtive problem, the emphasis is shifting from cure to prevention. Mindfulness-based approaches have already proven that they will play an incredibly relevant role in this.

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Paul Douglas This article was reprinted from health blog.

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