Diet Can Help With Depression
In recent columns we have explored a side of motherhood that is rarely discussed seriously: the weariness, irritability, low mood, and health problems that can develop when the hard work and stresses of mothering are not balanced by lots of replenishing resources. A physical state of depletion often results in which important building blocks of the body have been drained and key systems have been dysregulated.
In this and future columns, we will describe how mothers and fathers can preserve and restore their health and well-being while being highly nurturing to their children. We will begin with lifting one's mood, since our sense of happiness or sadness is an immediate, all-pervading experience that colors every moment we are awake.
When it's hard to be happy
Much of the time, parenting is a very happy experience, full of joy and deep love. But there are also moments when any parent feels dismayed, sad, or "down."
When these feelings become common, often in the background of whatever it is that we are focusing on, sometimes gone but always returning, then it is possible that a depressive quality is developing in one's mood. The word "depression" covers a lot of ground. Related feelings include sorrow, irritability, demoralization, hopelessness, helplessness, anxiety, emotional numbing or indifference, and mental confusion. At its worst, depression is utterly disabling, a black nightmare in which it is enormously difficult to think clearly, move briskly, or even get out of bed.
At the other end of the spectrum, a depressive mood is a kind of mental smog that colors everything with a haze of emotional gray; this mood may lift for a while during especially wonderful moments, but then return.
Within the classification system generally used by mental health professionals, depressive mood is described within two principal diagnoses: clinical depression and dysthymic disorder. Clinical depression refers to a serious condition, lasting at least two weeks, in which the individual experiences at least five of the following symptoms:
Parents sing the blues
The chances that a woman will suffer from clinical depression at some point in her lifetime are about 22 percent, and those of a man are about 13 percent. The chances of dysthymic disorder for women in general are about 8 percent and for men are about 5 percent.
How about for parents? Clearly, having children exposes an individual to demands and stresses that often lower one's mood. Most of the research on depressive feelings among parents has been done on mothers. A woman's likelihood of having clinical depression rises with the number of children she has, as does the likelihood that she will suffer from at least some depressive feelings while not fulfilling the full criteria for dysthymic disorder.
Depressive mood among mothers is due to a variety of causes. First, thyroid dysfunction following the hormonal disruptions of pregnancy and childbirth can lead to depression. Second, chronic stress can alter brain chemistry, creating a biochemical highway to depression. Third, the combination of wanting desperately to have the best for her children while simultaneously having little control over many important influences on their lives -- such as child health problems, mean kids in the neighborhood, inept teachers, or fathers who parent quite differently or do not share the load fully -- can cause a mother to develop "learned helplessness" and other negative views of herself that can lead to depression.
Fourth, motherhood can lower one's sense of personal worth. Individuals with depleted energy reserves -- such as mothers -- have a harder time warding off drains on their self-esteem. These nicks on self-worth can have an external source, such as the raised eyebrows or overt criticism of others (ie. mothers in a playgroup, children who say "Bad mommy!," strangers in the supermarket, one's mother-in-law). And they can originate from the inside. In a 1997 survey of American women by the Pew Research Center for the People and the Press, 56 percent of the mothers thought they were doing a worse job of parenting than their own mother, 33 percent said they were doing about as well, and only 11 percent thought they were doing a better job.
Maternal depression can, in turn, lead to other negative consequences.
Physically, the risk of heart attack up to 20 years later increases if a
person has had a single major depressive episode. Psychologically, a
depressed mother is prone to feeling that she has failed in a fundamental
role, especially if she herself has come from a dysfunctional familybackground. Socially, depressed mothers are more likely to have children
with significant academic, social, or behavioral problems.
The ubiquity of depressed mood is why some have referred to it as "the common cold of mental health" -- but most depressed people would gladly swap their mood for the worst cold they ever had!
A spectrum of care for depressive mood
Depressive mood is due to physical, psychological, or interpersonal factors. It can have physical, psychological or interpersonal symptoms; for example, a physical symptom could be fatigue, a psychological symptom could be unhappiness, and an interpersonal symptom could be withdrawal from others. And depressive mood can be cared for through physical, psychological orinterpersonal methods.
Like most professionals, we look at depressive mood in an integrative way, and we particularly encourage that it be cared for comprehensively, through physical, psychological and interpersonal means. Before going any further, we need to make an important point: depressive mood may be the result of a physical health problem. If you feel at all depressed, you should immediately speak with your physician and rule out any possible organic conditions. Our columns are no substitute for medical advice, and we urge you to err on the side of caution in the care of your own health and that of everyone in your family.
You are probably aware of the physical method most commonly used for depressed mood: anti-depressant medications, such as Prozac, Zoloft or Serazone. You may also know about psychological treatments such as psychotherapy, or interpersonal methods such as support groups. Generally speaking, research has established that medication and psychotherapy are about equally effective for the average person; if there must be a choice between the two, medication often gets the nod when the depression has a substantial physical component, and psychotherapy is more effective at preventing relapse; in practice, both medication and psychotherapy are often used for clinical depression.
Of course, the idea of the "average person" is a fiction used in research, and the most effective treatment strategy is one that is tailored to each individual's unique needs. Additionally, exercise, increased sleep, greater social support, and the removal or diminution of major stressors can all help lift one's mood.
Anti-depressants are best prescribed, in our opinion, by psychiatrists who have extensive experience with the subtleties and potential side effects of these powerful medicines; unfortunately, some studies have shown that anti-depressants are most often prescribed by physicians other than psychiatrists based on an average of six minutes of conversation with the patient.
A potential alternative to anti-depressants
Since anti-depressant medications and psychotherapy are widely available, we will focus on a class of methods for lifting one's mood that are not as well-known, although they are getting increasing attention from sources ranging from the National Institute of Health to Larry King, whom you may have heard on the radio pitching a product that combines St. John's Wort and ginseng. These methods involve giving the body naturally occurring substances known as "natural remedies" -- such as St. John's Wort or 5-hydroxytryptophan (5-HTP) -- that are generally gentler and easier to adjust to than pharmaceutical anti-depressants.
Anti-depressant medications have been one of the great medical success stories in this century, and millions have used them to good effect; one anti-depressant has even been approved for use by dogs. As a very general statement that will not apply in all cases, anti-depressants are stronger and more likely to succeed with severe depression yet they more commonly have significant side effects, while natural remedies are milder yet easier for the body to de-toxify.
An increasingly common strategy is to start with a natural remedy, and if that is not powerful enough, perhaps move on to an anti-depressant. And whatever the physical intervention may be, we always recommend pursuing psychological and interpersonal methods as well.
A person's situation may direct him or her in one direction or another. Pregnant or breastfeeding mothers, for instance, need to be particularly careful about the use of anti-depressants. And people with severe depression may not be able to take the time to try natural remedies. These are personal choices that should be considered with a physician or other licensed health professional.