Melancholy, Sadness and Depression
We live in a culture with unrealistic and harmful ideas that we should be perpetually happy. This is not just unrealistic, it is harmful. Life is all about the ups and the downs. No person can experience great joy and ecstasy who has not also been deeply sad, or experienced grief. Still…. Our culture offers quick fixes (addictions, really) to all negative feelings. Eat this. Watch this. Do this. Buy this. Read this. Drink this. Take this. All of these behaviors, as innocent as a cup of coffee or as problematic as shooting heroin, are intended to numb and mask our negative emotions: anger, anxiety, and especially sadness, shame and grief.
The ”cure” for overwhelming feelings of sadness, is ultimately being able to feel the feelings and make some sense of them. To “mother” oneself and walk the path through the pain to healing and integration.
However, there are times for all of us, when the pain of sadness, depression and shame is so overwhelming that we cannot make the positive decisions we need to pull ourselves through the pain. And these are the times we need help to “raise the bottom” of our emotional swings. Here are the tools I use in my practice to support my patients with significant sadness or depression.
Exercise: Believe it or not, aerobic exercise (think walking, running, swimming, cycling, aerobic classes, or active games), when done for 30-45 minutes 5 days a week, works as well as Zoloft. And the anti-depressive effect lasts longer than Zoloft.
Sharing: Talking about what is happening with a trusted friend or family member or therapist can make a world of difference.
Regular sleep: Depression disrupts sleep and restoring sleep can be life-changing. See my blog Sweet Dreams for help with sleep strategies.
Stop doing the things that you know are making it worse, if at all possible….leave the destructive relationship, don’t see unhelpful friends, find a new job, stop the addiction, get out of the house, get off of social media (it increases depression).
Eat fruits and vegetables—you need the nutrients to power your happiness.
Love. Laughter, hugs, affection, and sex all have remarkably positive effects on your mood.
Create. In whatever way feels right to you. Do art. Play an instrument or just make a playlist. Dance in your kitchen. Write in your journal or for others. Expressing what is inside will free you.
These are the basics of maintaining positive mood. When these are not working… I suggest supplements.
For depression that cause low energy and motivation and is not anxious, I like SAM-e (S-adenyl methionine) 100-800 mg in the morning. It is an element of intracellular mitochondrial energy and is motivating and works quickly. It can exacerbate anxiety and insomnia, so be careful with the dose.
For depression with anxiety (and especially if there is an element of PMS for a woman) I like 5-HTP (5 hydroxy-tryptophan), which is the precursor of serotonin. Increasing serotonin is the target of most anti-depressants and this has a mild effect like that. I start with 100 mg before bed and increase to 200 mg. It can also help with sleep. And the dose can be increased to 200 mg twice a day. This will interact with other medications that affect serotonin so avoid this if you are on antidepressants unless your doctor is aware.
St. John’s Wort has been used for a century for depression. It is typically tested at 300 mg 3 times daily, but I usually start with 450 mg in the a.m. and then increase slowly to 450 mg twice daily. It interacts with MANY medications, including birth control pills and hormones, so consult with your physician before starting if you are on medication.
In some people taking relatively high dose B vitamins that are pre-methylated (e.g. methylcobalamin or methyl B12 and methyl folic acid) can have an anti-depressant effect. I would start with a B complex that contains these.
And if things are really challenging, I prescribe anti-depressants. This should always be done in consultation with your doctor.
Sending blessings for peace and possibility in your future,
Rachel