Myth: “I’m not crying all the time and I’m not really all that sad.  I therefore can’t possibly be depressed.”

Reality: Depression is an illness that comes in many different disguises.  You don’t have to be crying all the time or even to feel sad to suffer from depression.  Other emotional experiences that you may have are a sense of emptiness or fuzziness. “I have cobwebs in my brain”, is what one patient declared in describing her depression.  Intense anxiety and obsessive and unwanted worry can also be a part of depression.  And, even if mainly sad and tearful, moments of joy can breakthrough even the worst storms of depression.

Myth:  “How can I be considered depressed when I can’t even sit still.  It’s not like I’m spending all my time in bed or anything.”

Reality: Decrease in your level of motivation and energy – the desire to get up and hit the ground running – is one of the hallmarks of depression.  Many people encounter this when depressed.  However, a minority of people become agitated when suffering from depression. They get the jitters, can’t sit still, and feel like they want to jump out of their skins.  Yet others push through their lowered energy level and motivation to continue to go about their day business as usual.

While depression saps the energy and life-force of many people, not everyone experiences this.

Myth:  “I’m not depressed.  I have a stomach ache and my muscles ache.  There’s nothing wrong with me emotionally.”

Reality: Depression is the Great Trickster and can manifest in our bodies in so many ways, including what feels like physical illness.  Sometimes it is only the physical pain that we feel.  Emotionally and subjectively we may feel okay.  While it is counterintuitive to conclude that this is depression, it nevertheless may be so.

With any illness or onset of symptoms, the best first step is to see your doctor for an evaluation.  Your physician may want to get lab work done and do other diagnostic procedures to isolate what’s going on.

Emotional distress may also trigger or exacerbate other diseases.  This is yet another compelling argument to see your doctor right away even if you don’t want to consider medication as an option.

Myth:  “I’ve gained weight.  Does this have anything to do with my depression?”

Reality:  Yes, it very well may.  Either a decrease or an increase of appetite is a common symptom of depression.  However, again, some people do not experience this.  Appetite is emotionally as well as physiologically driven – as is many of our bodily processes.

Myth:  “If I take anti-depressant medications I’ll become addicted to them.”

Reality:  While for some antidepressant medications the body acclimates to them and then has to re-acclimate when you go off them, you won’t experience “cravings” as you would street drugs. Anti-depressant medications will not get you “high” or “spaced out” if they are working the way they’re supposed to.  They should work quietly and subtly.  They should just put a floor underneath your feet, so to speak, so that you don’t bottom out emotionally.  They should help improve your level of energy, motivation, clarity of thinking, the frequency and intensity of unwanted thoughts, and stabilize appetite.  They may or may not improve sleep.

Unfortunately, behavioral medicine is in many ways still in its infancy and there are no diagnostic tests that can specify whether medications will work or which medication is most effective for your specific biochemistry.  It remains a process of (at least educated) trial and error.

Myth:  What if I don’t want to take medications.  Does this mean that my depression won’t ever go away?”

Reality: I want to clarify that I am not a medication prescriber nor am I a doctor.  Having said that, my personal belief is that in dealing with depression you should have as many cards stacked on your side of the table as possible.  Depression so intimately and negatively impacts one’s sense of wellbeing and one’s ability to function.  The more tools one can avail themselves of to move through and beyond it, the better.

However, the decision to take medication or not is unique to each person.  It is your body, your psyche, and ultimately your choice.  I respect this.  You should, too.

Just like with heart disease or diabetes, lifestyle changes and psychotherapy can pack a huge wallop.  Exercise is statistically as effective as medication in combating depression.  Other helpful tools include healthy eating, reaching out to loved ones, treating yourself with compassion, structuring your daytime schedule, getting out of the house, pursuing hobbies and talking honestly and in a heartfelt way about your feelings.

What makes healing depression extra tricky is that the activities that are so helpful are often the precise things that, while in depression’s throes, you just don’t feel like doing.  For example, one hallmark symptom of depression is feeling terribly about your self worth and wanting to hide from the world.  And yet, reaching out to others and rejoining the flow of life aids significantly in recovery.  This is an instance in which medication can be helpful in pushing you in this direction.  Enlisting your support team to keep you ‘on task’ is also beneficial (even though, again, it may be the last thing you want to do).

Myth:  “Just taking a pill can’t possibly help.”  And/or:  “Just talking about things can’t possibly help.”

Reality:  In a perfect world – and, happily, one that is within the reach of many – the combination of talk therapy and taking medication goes a long way towards treating depression.  At the end of the day, however, taking action is the decisive step in reducing depression and also is an indicator that you are recovering from it.  Once you find yourself enjoying your hobbies and the little things of life again, getting together with friends, exercising regularly, getting up to speed with work (housework and/or employment), and looking forward to tomorrow, you are well on your way.

Myth:  “I’ll never get over this depression.”

Reality:  It is so difficult to believe, when in depression’s grip, that you will ever feel better.  Feeling hopeless is fueled by the depression itself.  We often feel trapped in our depression and that there’s no way out.

The average course of the illness is nine months.  This can be speeded up through medication, psychotherapy and lifestyle changes.  And even in the darkest times before the dawn, there can be small rays of sunshine.  During a severe episode of depression there are still peaks and valleys.  When feeling as low as low can be, a lifting of mood – even if ever so slight – is bound to occur.

You can therefore genuinely reassure yourself with this self-talk:  “While it seems like I’m stuck in this dark mood, it has a beginning and an end.  I will move through this.”

Myth:  “I can’t be depressed.  I’m a strong, self-sufficient person.”

Reality:  Even strong, self-sufficient people can become depressed.  In fact, every single one of us will be touched by depressed either by suffering from it ourselves or being close to someone who does.  30% of women, and many men as well, will suffer from depression during their lifetimes.  We all have a breaking point in which the number and intensity of our challenges exceeds our ability to cope.  We all need to reach out for help from time to time.  We are not meant to, nor is it healthy to, go it all alone.

Often people who pride themselves on being self-sufficient try to just suck it up and tough it out.  They risk ignoring their bodies’ red flags and put off getting help until they are knee-deep into a depressive state.  They allow themselves to “run on empty” and to not refuel themselves through self-care activities and connecting with loved ones.  This is a risk factor and can exacerbate depression.

While the human will is an awesome force, it often is not sufficient in staving off a depressive episode.  We as human beings are complicated creatures, and the cause and cures for depression human are multi-factored.

There is one sure thing, though: having compassion for yourself and compassion for those around you can go a long way.  Being excessively self-critical by nature both triggers and perpetuates depression.  To the extent possible, try to ease up on yourself and be gentle.  Understanding the genesis of your self-criticism can help take yourself off the hook.

May you get the help you need to be able to do this.

My understanding is that, extremely broadly speaking, we have three parts to our brains, each layered over the other. As we as organisms evolved from dinosaurs (reptiles) to mammals and far later to humans our brains didn’t completely remake themselves along the way. Instead, new brain structure grew on top of the old like the rings inside tree trunks

Our brains from the reptilian phase of our evolution forms the core of our brain structure. It’s like a closed fist on top of our spinal cords. It represents the seat of our basic survival instincts – our involuntary bodily functions like breathing and the beating of our heart and our instincts to flee or to fight when threatened by a large predator. It is this part of the brain that gets activated when, in modern times, we are faced with stress. Our reptilian brain can’t tell the difference between a charging mammal aiming to sink its teeth into us and the recent argument we had with our boss. It goes into flight and flight mode, bypassing reason. It is our reptilian brain that triggers the anxiety and the exaggerated responses to stress that many of us walk around with in today’s world.

As we evolved from dinosaurs to mammals over the course of millions of years, new brain structure was added to the reptilian core. The hallmark of this new brain structure, emotionally-speaking, was that we became beings capable of nurturing our young. We no longer just laid eggs and then walked away as do, say, lizards. We, with our now warm-blooded bodies, gave birth to our young, made sure they grew healthy and strong by feeding them with our milk and sharing our kills, and protected them. We no longer ate our young. We now cared about them and would fight to the end if they were dragged away by predators.

As mammals our brains allowed us to become attached to our young. Anyone who has a dog knows the no-holds-barred love dogs have for their human caretaker. A dog leashed to a lamppost while his/her human caretaker is inside a store shopping, leaps for joy at the first sight of his owner. They don’t respond that joyously for just anyone that happens by: they have eyes only for their special love object.

This capacity to attach is quintessentially human. It, however, originates from our mammalian selves.

The earliest experiences that we as babies and as small children have with our caretakers become encoded in the mammalian part of our brains. We carry a template about what love is – and love is defined by our relationships with our parents while growing up.

This in part explains why we, as humans, end up in adulthood with partners who aren’t good for us – and keep on selecting bad partners in spite of our higher reasoning faculties telling ourselves not to. Our mammalian brains drive us to search for love objects matching our earliest experiences of love. Our hearts are held sway by our mammalian desires. While our intellect says “walk, don’t run. This guy is no good and will only hurt you in the end”, our mammalian brain gives us the green light. Our choices in love, when ruled by our mammalian selves, defy our logic and capacity for rational thinking. As many of us know all too well.

The outer stratum of our brain is the cortex, an outgrowth of our evolution from mammals to humans. This is the region of the brain responsible for our powers of higher reasoning, our capacity to weigh different options, to be conscious of our own mortality, and to think in abstract terms. We employ our cortex to guide us in our choices regarding mates and friends, hoping to rein in the influence of our mammalian brain.

In the best of scenarios, our cortex and mammalian brains work in concert.

However, we often find they are at odds. Our hearts and mind strain against one another.

Psychotherapy offers a way to bring our hearts and intellect more into alignment. In psychotherapy we tap into all three regions of the brain to better understand our choices in love and where to go from here.

We, as humans, are enormously complicated creatures. What I’ve just described is vastly oversimplified. As a psychotherapist I work with you in all of your complexity and uniqueness. Together we look at your own personal riddles regarding love.

I just read in an online news bulletin that women who are lonely have an 80% increase in the risk of developing heart disease – and that this risk is unique to woman. This statistic is a close second cousin to the finding that while being married is in and of itself a protective factor for men in regards to heart disease, this is not so for women. For a woman, it is the quality of the marital relationship, and not just being married per se, that counts. A woman who feels lonely and maltreated in her marriage also is more at risk for heart disease.

This news item is just the latest evidence that body and mind are intimately connected. Emotional wellbeing is entwined with physical wellbeing, and vise versa.

Emotional heartache can lead to cardiac complications. Cardiac complications can trigger emotional heartache.

Often people will ask me whether a physical pain or symptom is “real” or is it “all in my head?” While I am not a physician and am not qualified to diagnose physical ailments, often the answer is both: it is a real bodily symptom and also a manifestation of emotional distress. Stress has a systemic impact on our bodies and on our psyches. We are both of body and mind.

It pays for us to hold both our physical and emotional pain with compassion, free of judgment, self-criticism, and “shoulds.” If we allow ourselves to just pause for a moment and sit with our emotional pain, we find that it takes up residence in our body. It may be felt as a fist around in the center of our chest or as a hand around our throat. It may be experienced as lower back pain or neck and shoulder pain. Conversely, if we simply sit with our bodily pain – just allowing it to be while suspending judgment – we find that our emotions and feelings are just around the corner.

The distinction that we’ve traditionally made between our pain being “just in our heads” versus a “real” disease is not as hard and fast as we once assumed. We should recognize that all of our distress signals – physical and emotional, body and mind – are valid and are worth attending to.

A woman who is lonely even in a house jammed with family owes it to herself to take her distress seriously. She may long to deepen her relationships and feel more understood and truly known by her loved ones. She may feel taken for granted or only seen as the on-call 24/7 family chef, family chauffer and expert-at-putting-things-away. She may dismiss these feelings as being “all in her head” and tell herself that she just has to “suck it up “. In ignoring her distress she is doing herself and her heart a big disservice. She deserves to take care of herself and take action. In so doing she will be living a “heart-healthy lifestyle”, strengthening her emotional heart and her blood-and-tissue heart.

We should all – men, women, married, single – live life knowing that the state of our hearts (the organ) and our hearts’ desires matter. We matter.