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 had she walked 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 had a physical illness, a biochemical disorder.


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: 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 brains are different. They have undergone physical changes that make it difficult 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.

Depression can be treated

Neuroscientists have recently discovered that the brains of depressed people actually look and act differently from 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 40 to 70 percent of all cases (depending o­n whose research you read), they allow a person?s mind to shift focus more easily, so that they can o­nce again see the world in a more flexible and less threatening way.

Cognitive behavioral therapy and DBT (dialectical behavioral therapy) work by teaching depressed people how to use their conscious minds to challenge the distorted messages sent by their sick brains. In essence, these therapies teach you how to use your mind to 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 brain to focus o­n what Jon Kabat-Zinn has called the “bloom of the present moment,” and let go worries about the future and painful memories from the past.

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. There is evidence that untreated depression can cause permanent changes to the brain that make a person more vulnerable to future episodes. So getting help right away is critical.

My advice for the 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. Reach out to others. Keep looking until you’ve assembled a team of trusted others who understand depression and can guide you gently and firmly o­n the path through the darkness.

With patience and hard work, you will get better.

Betsy Sansby is a licensed marriage & family therapist, and published author whose private practice is in Minnetonka, Minnesota. She is the coauthor of seven books, and the creator of ingenious communication tools for couples and families called, including: The STOP Strategy, The Art of Conversation, and The Ouch Kit: A First-Aid Kit for Your Relationship. She also has her own relationship advice column called, “Ask Betsy.” Learn more about Betsy here.