"On Healing" July 2005

Posted on Mon, Jul. 25, 2005
Parents can reduce the risk of childhood depression
By Dan Gottlieb

In my last column I talked about the difference between sadness and depression. And I talked about various treatments including medication and psychotherapy.

Depression is a brain disorder, and some children are more prone to it genetically. But parents can do many things to diminish the risk. And the same techniques that reduce depression risk also help raise healthier children.

Most people instinctively divide emotions into good (happiness and pride) and bad (anger, hurt, sadness or shame). As parents, we try to protect our children from the bad ones and help them experience the good ones. But in doing so, we might not be helping our children develop the resilience they will need in life.

Psychologist Karen Reivich, co-author of The Resilience Factor, suggests that building resilience is similar to the way immunizations work - give the child a small dose of the disease and let the psychological immune system do the rest.

All children sometimes come home from school feeling rejected by schoolmates, self-critical for poor performance, or angry with the teacher. Our instinct is to try to make them feel better. So some parents will try to talk children out of their bad feelings while others might go to school and complain to a teacher about a grade.

But when we do this, we convey that the children are fragile, that their perceptions are wrong, or that they are innocent victims. Not only does this harm a child's development, this pattern will eventually close down honest dialogue.

Reivich calls this last issue the most significant risk factor for childhood depression. If children do not feel that parents will understand their emotions, they are likely to keep their feelings to themselves, and feel more alone.

Stress is another risk factor for depression. Children who live a stressful life have higher rates of many psychological disorders including depression. Children in affluent suburbs with high expectations have a much higher rate of depression, anxiety disorders, and substance abuse than the national average. Combine this stress with a child who might not be open with his or her parents, and the risk for depression increases substantially.

So what's a parent to do? Reivich suggests that when a child runs into adversity, a more helpful approach would be to listen to children's feelings and when they feel you understand them, help them use their creativity to resolve the problem: "Ask them to explore other possibilities for people's motives, or other explanations for their poor performance. If we are patient with our children, they can develop solutions for most of their problems. And if they cannot, it is important for them to learn that whatever suffering they are experiencing in the moment will not last."

Families can do many other things to cut down the risk of depression. Research shows that having family dinners three to four times a week reduces the risk of smoking, drinking, substance abuse and depressive symptoms. A University of Minnesota study showed that adolescent girls who had frequent family dinners were less likely to develop eating disorders. And even small children who attend the dinners tend to have a better vocabulary!

But even more important factors are in play here. Family dinners give children a sense of belonging, especially if everyone feels heard. Here more than anywhere else, children learn about parents' values, ethics and what it means to be part of the family.

A healthy sense of self-esteem is also critical in cutting the risk of depression. Telling children repeatedly that they are special or high performers is not necessarily healthy. But self-esteem based on a child's sense of making a positive contribution to the world will generate a healthier sense of self and can help inoculate the child against future depression.

Eat together. Listen to one another. Have faith in your children's resilience. And together do something to help others.

Posted on Mon, Jul. 11, 2005
Clinical depression is very different from sadness
By Dan Gottlieb

I recently received a letter from a woman who said she's been feeling depressed because a significant relationship ended. She felt consumed by angry and sad thoughts and felt it was time for help. But under no circumstances would she take medication.

Without seeing her, I cannot diagnose her. But the fact that she is feeling depressed does not necessarily mean she has a clinical depression. Sometimes when we feel depressed, it's a reaction to loss or trauma and we usually recover on our own. Because feeling depressed is so distressing, we always want to recover quickly. But most often, it takes time. Wounds to the body heal at a rate of one millimeter a day. Wounds to one's psyche probably heal as slowly.

Far too many people, with the help of well-meaning but misguided doctors, take medication for normal sadness. Although many report that the medication makes them feel strange, others say they feel better. This is not necessarily good because when we experience loss, we are supposed to feel pain. It's the natural healing process.

Clinical depression is another story. It is not a symptom of weakness or poor attitude. It is a very serious brain disorder. It is often genetically based and can be triggered by loss, trauma, or normal developmental issues such as puberty. Its effects are far more pervasive than normal sadness or even mild depression called dysthymia. Clinical depression can affect sleep, appetite, and intimate relationships. It's quite common for people with depression to feel hopeless, worthless and consumed with guilt.

When I experienced clinical depression, my first thought in the morning was: "how many hours before I can get back into bed tonight?" Mild depression or grief feels as if you are going through your life with sunglasses on. Clinical depression feels like carrying a 1,000-pound gorilla. Some evidence suggests that depression is a brain trauma not unlike an epileptic seizure. The longer it lasts, and the more often it happens, the more vulnerable the brain becomes to having it happen again. That's why treatment for clinical depression must not be delayed.

Those who fear medication should understand that the options have changed greatly in recent decades. In the old days, the only treatment was with powerful mood-altering drugs that could be habit-forming and ineffective.

Today, these medications are designed to recalibrate the brain chemistry. Although most antidepressants are not habit-forming, many cause uncomfortable side effects. Some of the newer medications can take a month or longer to be effective, and even then, it could take some trial and error to find the best medication and dosage. So be patient. Also, while some over-the-counter medications such as St. John's wort have shown promise with milder depression, they seem ineffective with clinical depression.

Most important, with the combination of medication and psychotherapy, most people reported significant improvement.

Whether your depression is clinical or mild, here's how to help yourself:

Set small, reasonable goals each day. Your impulse may be to withdraw or bury your feelings. Both might make you feel worse.

One should not make important decisions during clinical depression or grief.

Mild exercise and healthy diet are good for the brain.

So is social engagement. Spend time with people who care for your well-being and won't try to talk you into feeling better. And be open to their observations. A guest on my radio show once said that depression begins from the outside in - people around you will notice that you are behaving differently before you are aware of it.

Depression also heals from the outside in. Those same people will notice that you are looking and sounding better before you do.

In my next column I'll talk about some things we can do to prevent depression in ourselves and our children.

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