Depression Treatment in Baltimore
Psychotherapy for Depression
“In depression, the meaninglessness of every enterprise and every emotion, the meaninglessness of life itself, becomes self-evident,” my friend Andrew Solomon wrote in his memoir of depression, The Noonday Demon.
In psychiatric terms, the symptoms of depression include:
- Feeling sad or having a depressed mood
- Loss of interest or pleasure in activities once enjoyed, including sex
- social withdrawal and feelings of isolation
- Feeling pessimistic, hopeless and helpless
- Changes in appetite — weight loss or gain unrelated to dieting
- Trouble sleeping or sleeping too much
- Loss of energy, increased fatigue, feeling of being slowed down
- Irritability, agitation, anxiety, emptiness or flat numbed affect
- Feeling worthless or guilty
- Difficulty thinking, concentrating or making decisions
- Unexplainable physical symptoms such as headaches or body aches
- Thoughts of death or suicide
Treatment of Depression
From research and clinical experience we know there are a variety of therapeutic and somatic treatments, often times in combination, that can be effective with depression. Part of the art of treatment is to draw freely on all these approaches.
Most recently, we have found a third tool: meditation.
I have found that combining meditation with more traditional therapies has made my work far more effective
We now know that meditation reduces activity in a part of the brain called “the default mode network” that is overactive in depressed people. That voice in your head that ruminates and repetitively criticizes you is a symptom of an overactive default mode network. Meditation helps quiet that voice.
While it never goes away (nor should it), meditation changes your relationship to that critical voice.
Instead of regarding it as the ultimate authority, you can take it with a huge grain of salt. Meditation helps you take what Buddhists call “the great step backward,” If you think of the stream of consciousness as a literal stream, one can feel like they are drowning in that stream, especially if they are depressed. Meditation allows a part of us to take a step back and stand on the calm stable bank and observe the stream from the outside. From that perspective everything looks different and we are able to observe what that voice is saying without believing it.
As Buddhist psychologist Jack Kornfield explained, before we learn to meditate, it’s like we are people at a movie theater with our noses pressed to the screen who think what is happening in the movie is real. When we meditate, it’s like we move to the tenth row and realize “Oh, this is just a movie.” This is just what my mind is projecting onto the screen.
Earlier models of cognitive therapy for depression emphasized replacing negative thoughts with positive thoughts. But that can be a frustrating undertaking, since the truth is, we don’t control our thoughts. Mediation allows us to take a step back and observe our thoughts from the bank of the stream with calm dispassionate objectivity, and helps us release the distorted depressive thoughts and let them float downstream, rather than rehearsing them over and over again in our heads.
Depressed patients also have to be helped to see there are almost always alternatives they haven’t considered, and we are rarely as trapped as we think. Meditation helps gives us a wide-angle lens that allows us to see alternatives, listen to our own intuition, and open our eyes to novel ideas.
“’Meditation helps everybody, because it addresses a problem that everybody has,’ says Gartner. ‘We all have an omniscient narrator in our head who is harsh and negatively commenting on our life. Having a voice constantly urging us to do better undoubtedly has some survival value—but it can make us miserable. Meditation reduces the power the voice has over us.’”
–Hara Estroff Marano, “The Omnibus Cure,” Psychology Today, 6/10/16
Depression Treatment
I offer my depression patients an informed treatment approach which is both tough (when needed) and compassionate in the context of a committed long term relationship. Experience and research shows this kind of therapeutic relationship combined with meditation has a high rate of success.