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Shrink Rap

Feeling blue? Hunkering down? How to make it better

By: Merrill Powers, LCSW
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Depression can be daunting. Some people feel bad for good reasons: a dead end job, or loss of a job; a bad relationship, or loss of a relationship; illness or physical injury. Older people may outlive friends and family, and can review the past with regret. Some people feel bad, even if their lives appear to be fine.
Depression has many causes, from biochemical (lack of light and nutrients; and/or genetics, as in bipolar and unipolar disorders) to a response to trauma, physical or emotional stress, loss, or a response to attachment injuries. Of course, many depressions have many overlapping causes. Regardless, the mechanism is a protective dorsal vagal response that shuts down many body/brain functions in response to a hyperaroused reaction to trauma, emotional or physical stress, or anxiety.
Depression pushes down the emotions, but it is also profoundly physical. Depressed people feel tired, drained of energy, sometimes immobilized. They may eat or sleep too much, or not enough. Moods can swing from sadness to extreme irritation and anger, from anxiety to hopelessness to flat inertia. They express beliefs like, “I’m worthless” to “the world is screwed up and always will be.” Depressed people report they no longer feel pleasure in activities they used to enjoy. They are likely to contemplate and carry out suicide.
Among white people in 2014, nine times as many people died by suicide than by homicide, according to the Center for Disease Control and Prevention. The medical community responds to mental health issues by prescribing psychiatric medications. Studies show that the drugs work only about half the time and can produce side effects such as anxiety and sleeplessness that mimic worsening symptoms. That’s like putting a Band-Aid on an infected wound.
The good news is that a person can use many easy techniques to flip the switch back to the light. The best antidepressant I know is exercise, especially if done outside in the sunlight. Taking a 30-minute walk each day can jump-start recovery. A yoga class can provide a sense of well-being and serenity.
People with Seasonal Affective Disorder (SAD) can feel better with light therapy. Omega-3 supplements and reducing the consumption of sugar carbohydrates and caffeine stabilizes moods and promotes restful sleep. That said, some people still need medication to shift their hormone balance, stabilize their moods, or change their serotonin levels to provide the energy to take advantage of therapy interventions.
A licensed therapist will take a thorough history to detect the source of the depression. Is the depression a normal response to abnormal life events or problematic relationships? The therapist can help problem-solve difficult situations in the present or heal past traumatic events that may have thrown the person out of balance.
Or has the depression been a chronic condition, present for most of the person’s life? Were there early attachments that failed to meet the needs of the developing child? Therapy can repair attachment ruptures that may be affecting the person’s ability to have healthy relationships in the present.
Successful treatment for depression helps people stop unnecessary “braking” to be able to “accelerate” at a functional pace, to be capable of social engagement, enjoyment, and normal responsive moods. EMDR is a multimodal therapy that brings together client history, the therapeutic relationship, cognitions/beliefs, emotions, and sensations in the body. EMDR can heal trauma-based depression, whether based in post-traumatic stress disorder (PTSD) or smaller, everyday traumas such as school bullying or being raised in a home with parents in perpetual conflict. It can facilitate the healing and management of biologically based depression, in conjunction with medication. Many of my clients on antidepressants were able to successfully titrate down their medication dose, and eventually stop the medication under the supervision of their doctor, during the course of treatment with EMDR therapy.
For example, Sam (fictitious name) came to me for EMDR therapy to treat his PTSD from his service in Vietnam. For 40 years he successfully avoided his combat memories by staying busy with his career, his marriage and raising a son. After retirement, while applying to the VA for increased benefits, he was required to tell about his Vietnam experiences. That’s when Sam came undone. In order to cope with reliving the trauma of combat, Sam shut down into a deep depression that left him unable to leave his house or to perform simple tasks. The medication prescribed by the VA provided some small help. EMDR therapy allowed Sam to replay his memories while being fully aware of his safety in my office 40 years later. He healed his moral injury releasing the guilt from witnessing the atrocities of war.
A year after treatment, Sam called to tell me he is exercising at a gym, driving himself to appointments and volunteer activities, and fully engaged in life again. Under the supervision of his doctor, Sam titrated down his medication and today is medication free.
Sam’s depression is a good example of how the nervous system will put the brakes on when the system is overloaded. Sometimes the brakes get stuck, and there’s no choice but to go to the repair shop.
Merrill Powers, LCSW, specializes in EMDR therapy in Auburn. Reach her at merrill@powerstherapist.com or PowersTherapist.com.