Many people have an inner reluctance to trying antidepressant medication. Often this is especially so for those who practice mind-body disciplines such as yoga and meditation, as well as those who view themselves as on a "spiritual path."

Signs of Subtle Depression

What is this reluctance about? It often starts with a sense of doubt as to whether one is actually "depressed" or not. It's a myth that you have to feel suicidal or be unable to get out of bed in order to be depressed. One may be able to go through the motions of work and tending to family, and yet be suffering from a pervasive joylessness -- an enduring low-level depression that is just as debilitating in its own way as a major depressive episode.

Some people are not depressed all the time, but only during the season of cold and darkness. Over the years they may find their seasonal depressions getting more severe.

Chronic irritability, pervasive sadness, excessive worry, constant negative and critical thoughts, discouragement, fatigue, unexplained aches and pains, excessive anxiety and self-doubt, constant self-criticism and self-denigration, preoccupation with death and decay, preoccupation with accidents and misfortunes, sleep problems, loss of interest or zest for previously valued activities may all be indicators of chronic, low level depression that robs life of its joy.

It is easy to minimize or normalize these feelings, if they have become chronic. One can't remember any alternate state of being. And it is easy to find others who share and validate one's mood and viewpoint. In a sense, much of "talk radio" is a validation and reinforcement for an angry, depressive view of life.

Some will realize that something is wrong and will search for a solution. They may try vacationing, buying a new house, or finding a new lover. Or they may look for an inner solution: journaling, introspection, psychotherapeutic couseling, alternative medicine. Some may recognize depression as a spiritual issue, and seek a spiritual path. Still, they may continue to struggle with recurrent depression, discouragement and inner pain.

The Analogy to Physical Illness

Is it "acceptable" to mix antidepressants, or other psychiatric medication, with the practice of yoga and meditation? For many people there is a reluctance to try antidepressants, as they believe they should be able to overcome depression through the power of their mind, I do not agree with this view and will explain why. Let me begin by making an analogy to the treatment of physical ailments.

Although yoga and meditation can confer health benefits they don't create immunity from physical illness. I remember in my youth being surprised that some well known Indian yogis had diabetes. That was naive of me. Genetic factors, dietary factors, and lack of sufficient physical activity were no doubt the contributory factors. There was no reason to think that yoga by itself could provide immunity to diabetes any more than it would prevent tooth decay or cause one's muscles to increase. Prevention of tooth decay requires proper diet and oral hygiene. Building muscles requires proper exercise and adequate protein intake.

I would be concerned if a meditation teacher told a student not to take insulin or heart medicine, saying that "yoga heals all ills." Yoga and meditation should be considered complementary treatments, not the sole legitimate prescription . It is possible that meditation might help reduce a person's blood pressure to the point that the person would no longer need to take prescription meditation,or could take a lower dose. If so, wonderful; if not, that shouldn't be regarded as a failure.

All of us are going to die eventually. No amount of yoga and meditation will prevent that. Therefore the realistic goal of yoga and meditation is to help us learn to appreciate our life, and to cope with the inevitable facts of aging, illness, and death.

The Artificial Split Between Mind and Body

If it is reasonable to seek medical treatment for physical illnesses, and not to rely solely upon meditation as the cure. So, wouldn't it also make sense to seek medical treatment for chronic or recurrent depression? Because of our Western heritage of Cartesian dualism, we have been conditioned to regard body and mind as radically different domains. There is a conditioned resistance to medicating something that is believed to be "mental." Whereas physical problems can be treated with a physical treatment (such as a pill), "mental" problems should be treated with a "mental" treatment, whether it be meditation, or something like positive thinking. That's how the reasoning goes.

But, the fact is that what we call "body" and what we call "mind" are intimately connected, and one shades into the other in ways that are difficult to grasp. Depression is not purely a "mental" problem. It has physical correlates in the body, including such brain structures as the limbic system. Susceptibility to depression can be genetically inherited, like susceptibility to diabetes or heart disease. Traumatic experiences can become encoded in the "mind" as memories and in the "body" as dysfunctional changes to physical structures in the limbic system. (A convincing and thorough description of this can be found in Dr. Peter Kramer's book, Against Depression)

Furthermore, meditation is not purely a "mental" activity. The entire body is involved in meditation. Although initially it appears that meditation is concerned with the movement of thought, it becomes clear over time that one of the deeper aspects of meditation is to become in touch with the energies of the body -- what is called the pranas in classical Indian terminology. One of the keys to tuning into the energies of the body is working with the breath, known as pranayama. Notice that the word "prana" is incorporated into the term "pranayama," because of the intimate connection between prana and the breath. And breathing, of course, is a physical activity. And subtle changes in the breathing are connected with changes in mental experience.

If depression has a physical aspect, and meditation has a physical aspect, then why can't meditation cure depression, you may ask. But, as mentioned above, no one expects meditation to fill a dental cavity, to make a scar disappear, or to cause a wound to heal instantaneously. The adage "mind over matter" is inaccurate. Mind and body is a partnership. They must work together. Moving with the current of life allows us to influence it.

The Fable of the Elephant

An old fable tells of a yogi being warned that a rampaging elephant is coming. Several men run past him shouting, "Get out of the way! The elephant is coming!" The yogi does not take heed. He continues walking calmly, thinking, "I am a great yogi. God will protect me." As he is thinking this the elephant emerges onto his path and tramples him nearly to death. When he asks, "Why did God not protect me?" the answer he gets is, "You were protected. The men came to warn you. But you ignored them and did not get out of the way!"

Meditation has its domain, but also works with complementary methods. Meditation and yoga may assist with depression, but in cases of chronic, recurrent and refractory depression, one should seriously consider trying antidepressant medication.

Just as meditation does not cure all ills, but can help us learn how to live with them, so too prescription medication doesn't cure all ills. Some people with chronic depression try antidepressant medication and find it incredibly helpful. Others don't feel any benefit, or are bothered by side effects that cause them to quit taking the medication.

However, unless you try it, you will never find out which category you fall into.

Even when antidepressant medication is effective, it still is not the sole solution. Just as a diabetic or heart patient needs to eat properly, remain active, and keep a positive attitude in order to maximize the benefits of whatever medicine they are taking, so too a person with a history of depression is most likely to achieve long-term relief if antidepressant medication is combined with exercise, proper nutrition, adequate sleep, loving and supportive relationships, and mind-body disciplines such as yoga and meditation. In many cases individual or group psychotherapy can be helpful as well.

Meditators and yogis who find themselves battling recurrent depression should seriously consider antidepressant medication and counseling. Likewise, those taking antidepressant medication who are not practicing a mind-body discipline, should consider taking up meditation.

Further information on depression and antidepressants (other people's sites)

http://pages.cs.wisc.edu/~caitlin/papers/Prozac/

http://against-depression.blogspot.com/

Further information on meditation and mind-body disciplines (my sites)

www.leominster-mediation.com

www.subtle-energy-exchange.com