My advice for anyone suffering from depression is this: Hit it hard. Hit it fast. And treat it aggressively from all four directions: biochemical, behavioral, spiritual, and emotional.

Dear Betsy,

I think my husband is depressed, but because he won't admit it and I am afraid to raise the issue, nothing's changing. He's negative, cranky, and short with everyone, and now he's even refusing to go to work. I've had it. He says he feels sick, he can't sleep, he hurts all over. But there's nothing physically wrong with him. I think if he'd just stop being so negative his physical symptoms would go away. He says he's trying, but I don't see it. What do you think?

Signed,
Fed up with excuses

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Dear Fed Up,

Yesterday I saw a woman who was referred to me by her doctor because although her medical tests had come back negative, she was clearly suffering from some kind of physical illness, an illness her doctor had diagnosed as depression. She couldn't sleep. She couldn't eat. Her arms and legs ached. Her throat was tight. Her chest was a hive of bees. Suddenly, this vibrant woman who was used to springing out of bed each morning to catch the first few rays of sunlight could barely lift a toothbrush to her mouth. Within a few short months, she had gone from feeling great to utter despair.

No sooner did she walk into my office than she began to cry. "Something's wrong with me. My body hurts and I can't eat. I've lost 20 pounds in four weeks, and I'm afraid to leave the house. Last night I went to Target and had a panic attack in the check-out line. What's happening to me? The doctor says I'm depressed, but there's something wrong with my body!" Of course, she was right. And her doctor was right. This woman has a physical illness, a biochemical disorder that wreaks havoc with every system of the body: Depression.

What most people don't understand is that depression isn't simply a matter of stinkin' thinkin,' although that is o­ne symptom of the illness. And the people who get depressed aren't lazy people or people who choose to be miserable. Depression is a devastating illness that strikes o­ne in ten Americans at some point in their lives: happy o­nes, sad o­nes, optimists, pessimists, rich people, poor people, good people, bad people.

To a non-depressed person depression may look like a choice. That's because a non-depressed person's brain chemistry allows them see most situations in a fairly balanced way. What the uninitiated don't understand is that depressed people's no longer function like normal brains do. They have undergone physical changes that make it difficult if not impossible for them to see the world in a balanced way.

Expecting a person struggling with depression to think positively is like asking a person who's is high o­n cocaine to chill out. In each case, the person's brain chemistry largely determines how they will experience the world.

Neuroscientists have discovered that the brains of depressed people actually look and process information differently than the brains of non-depressed people. Medications used to treat depression do so by increasing the availability of certain neurotransmitters in the brain that regulate our moods. When these medications are effective, as they are in only about fifty percent of all cases, they allow a person to shift out of the negative thought loops that characterize a depressed person's thinking process. Examples of these include: endless worrying, chronic fearfulness, jumping to worst possible case scenarios with little or no evidence to support them. When the medications are helpful, they are once again able see the world in a more flexible and less threatening way.

Cognitive behavioral therapy and DBT (dialectical behavioral therapy), and work by teaching depressed people how to use their conscious minds to challenge the distorted messages sent by their sick brains. In essence, all these therapies teach you how to use your mind to actually heal your brain. Over time and with practice, most depressed people can learn how to pull themselves out of the whirlpools of negative thinking and retrain their brain to think in a more fluid and balanced way.

Meditation and other Mindfulness practices have also been effective in reducing depressive symptoms, especially when a person also suffers from anxiety. The brain scans of accomplished meditators show increased activity in the left frontal cortex of the brain, the area associated with happy feelings. With regular practice, meditation can retrain the mind and reshape the brain so that both are less reactive to thoughts and sensations. And when the mind and brain are less reactive, people are able to observe and experience even the most painful and challenging situations without making them worse by amplifying or perpetuating them.

The main thing to remember is that depression is an illness. It is not an attitude, and it most certainly is not a choice. The good news is that almost everyone who suffers from depression gets better, but healing takes time, and getting the right kind of help is very important. Research shows over and over again that the more active a role a person takes in their own treatment, the better their chances for a full recovery.

You can help those who are suffering from depression by taking their complaints seriously and by encouraging them to seek help as soon as possible. All the research on depression has shown that untreated depression can cause permanent changes to the brain that make a person more vulnerable to future episodes. So getting help right away-- before the brain gets good at learning how to be depressed--is very important.

My advice for anyone suffering from depression is this: Hit it hard. Hit it fast. And treat it aggressively from all four directions: biochemical, behavioral, spiritual, and emotional.

I encourage you to reach out to others. Keep looking until you've helped your husband assemble a team of trusted others who understand depression and can guide you both gently and firmly on the path through the darkness. With enough patience and hard work, your husband will get better. Let him know you believe he will get better and that you won't give up on him.

And if at any point your husband threatens suicidal, you should treat this threat as a medical emergency. Get him in to see a professional immediately, no matter how hard he may protest. And until you get him in, get rid of any firearms or medications that are in the house. And do not leave him alone.

Hang in there. Depression is a terrible illness. Almost everyone gets over it in time.

Betsy