depression

The Mind and Life conference

Marissa Kimsky, Emory Wheel: While scientists are searching for a cure-all pill for mental disorders, new research shows that the cure may not be in a bottle, but could rather be found in Tibetan meditation.

Hundreds gathered in the Woodruff Physical Education Center to hear discussions on this pioneering research on meditation and mental disorders. This research was presented in a dialog in the 15th Mind and Life conference: Mindfulness, Compassion and the Treatment of Depression.

Mind and Life was organized by a scientist and an entrepreneur in 1987 to establish a dialog between Buddhist philosophers and scientists. It has proven to be extremely successful, encouraged countless studies on the benefits of meditation. The organization has inspired an initiative to teach Buddhist monks science, and it encourages a common goal between researchers and Buddhists to improve minds, lives, societies and the world.

Emory, one of the leading institutions for meditation research in the country, hosted the conference for the first time on Saturday, prior to the installation the Dalai Lama as a presidential distinguished professor on Monday.

His Holiness the Dalai Lama entered the room and immediately showered the crowed with affection. He lowered into a bow and clasped his hands together, blessing the audience.

The Dalai Lama was an extremely active participant throughout the conference, asking several scientifically in-depth questions and suggesting new directions for future research projects.

Co-founder of Mind and Life Adam Engel reflected as he opened this conference.

Twenty years ago, when the conference series began, the Dalai Lama had a request of the scientists.

“First investigate the positive effects of meditation,” the Dalai Lama said. “If you find it successful, please teach it to your society in a purely secular manner in order to benefit everyone.”

This has been the goal of the researchers for the past 20 years. Researchers Richard Davidson, Helen Mayberg, Charles Nemeroff, Charles Raison and Zindel Segal presented findings from multiple successful neuroscience projects geared towards improving the mind and mental balance. Buddhist scholars at the conference, including the Dalai Lama, John Dunne and Geshe Lobsang Tenzin Negi, connected these studies to Buddhist philosophy.

This was not necessarily an easy task for the Buddhist scholars.

“Speaking to the Dalai Lama on Buddhism is like speaking to Jesus on Christianity,” Dunne said.

Throughout the conference, both Buddhist scholars and scientists agreed that depression could be characterized by the sufferer’s inward focus.

Buddhism strives to accomplish the opposite — to turn one’s perspective outwards through compassion and mindfulness meditations.

Both of these forms of meditation were investigated by scientists in their experiments. Psychological and physical evidence showed that individuals suffering from depression were able to overcome the symptoms through compassion meditation.

Davidson used samatha, a Tibetan Buddhist form of mindful meditation, in his studies and found that it improves concentration. The functional MRI brain scans taken during this practice showed more activation in the frontal-parietal areas, regions of the brain designated to higher cognition.

Raison foresees using meditation to prevent more than just depression. He also thinks it can help prevent diseases associated with stress, such as depression, anxiety, heart failure, high cholesterol, cancer and diabetes. “Our interest is in looking at meditation as a potential strategy to protect against the emotional and medical diseases that arise from stress,” he said.

Dean Robert Paul and University President James W. Wagner also spoke at the event. Paul said he sees Emory’s research moving towards developing meditation as a prescription within preventative psychiatry, the medical practice of preventing mental disorders.

Mind and Life is also working to facilitate inter-religious dialog. Currently centering prayer, a contemplative Catholic tradition is also being investigated by other Mind and Life researchers and the conference strives to integrate various other contemplative traditions into the studies as well. Dunne believes that the research benefits not only neuroscience but an enormous array of disciplines.

“Mind and Life research also helps build a greater research network on contemplative based interventions,” Dunne said.

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Zen and the art of lawyering

San Francisco Chronicle: Mary Mocine, a 63-year-old Zen priest and former litigator, teaches meditation to burned-out attorneys at weekend retreats at Tassajara in Big Sur and Green Gulch Farm at Muir Beach.

“I speak two kinds of language — law practice and Zen practice,” said the sunny, linen-clad founder of the Vallejo Zen Center.

Her work couldn’t be more timely. Recent studies reinforce the results of a 1990 Johns Hopkins University report showing that lawyers suffer higher rates of depression than those in other professions.

Depression is often preceded by chronic stress, and with work hours escalating and public perception of lawyers in a nosedive, some members of the hyper-rational legal profession are looking East for relief. Meditation, yoga and other stress-reduction workshops are now offered by law firms across the country, and employees can earn continuing education credits for participating.

And top American law schools, including UC Berkeley and Harvard, are sponsoring seminars in “mindfulness meditation,” also known as Zen meditation.

Fifteen million Americans say they practice some kind of meditation, according to the National Institutes of Health — and most HMOs now cover alternative treatments such as acupuncture. Increasingly, “mindfulness” — a synonym for living in the moment, without judgment — is recommended for everything from improving your tennis game to coping with long commutes.

A Zen approach to the law emerged in 1999, when Professor Leonard Riskin of the University of Missouri at Columbia School of Law began discussing mindfulness meditation in his law classes.

“I believe that mindfulness can help mediators and other dispute resolution professionals (including lawyers) feel better, get more satisfaction out of their work, and do a better job for their clients,” Riskin said in a 2005 interview with www.mediate.com, an online legal magazine…

His work has had a domino effect. After the Harvard Negotiation Law Review published his 2002 article — “The Contemplative Lawyer: On the Potential Contributions of Mindfulness Meditation to Law Students, Lawyers and Their Clients” — the review hosted a forum of more than 150 lawyers and law students at Harvard that spring to discuss the article. Soon afterward, several prestigious Boston law firms, include Hale & Dorr, put Riskin’s ideas into practice, offering on-site classes in mindfulness meditation.

The path to mindfulness was a winding one for Mocine, who graduated from UC’s Hastings College of the Law in 1968.

“It was such an inspiring time,” she said. “I wanted to bring social activism to criminal defense work.”

After doing legal aid work in Alaska and Alameda County, she represented the United Farm Workers, then co-founded a labor law firm in Berkeley. But six-day workweeks and a divorce took their toll. In the 1980s, she contracted the Epstein-Barr virus.

“I had to slow way down,” she said. “I had to take a look at my life.” A visit to Green Gulch Farm Zen Center in Muir Beach allowed her to do just that. “I fell in love with it,” she said. “It spoke to me in some visceral way.”

Because her parents had practiced Theosophy — a nontheistic philosophy based on the “love of truth” — Mocine had an affinity for some of its precepts, including karma and reincarnation.

“For me, Buddhism and Zen were easy to enter,” she said. “It didn’t seem unfamiliar.”

Zen couldn’t have been less familiar to Farley Tolpen, 51, a lawyer in private practice for 23 years in San Francisco and Marin.

“I was a scorched-earth litigator,” said Tolpen, who has done mostly personal injury cases. “My way was the right way. There was no negotiation.”

But by 1999, his life was unraveling. Overwhelmed by business problems and a painful divorce, he knew he needed to change. Then a benevolent friend invited him to a Monday night meditation group at Spirit Rock Meditation Center in Woodacre.

“It was magical,” he said. “It slowed me down, made me stop and listen.” Soon he was practicing mindfulness meditation twice a week.

Jan Lecklikner, a San Francisco public defender, had a similar experience with meditation.

“In my first five years of practice in the criminal justice system, I was the angry, hate-everybody kind of practitioner,” said Lecklikner, 58. “It finally got through to me that I wasn’t going to last long in that frame of mind.”

A serious bout of pneumonia put her to the test. To strengthen her immune system, she began studying qi gong, a Chinese breathing and movement discipline that put her back in touch with Zen meditation, which she had attempted in the past. Her first lawyers meditation retreat was revelatory: “Both in meditation and in group discussions, so many things came up about dynamics in the office and dynamics in court.”

According to a 2005 University of Wisconsin study of Tibetan monks, including eight of the Dalai Lama’s most accomplished practitioners, “Mental training through meditation can change the inner workings of the brain.” The monks showed an extraordinary capacity for focus, memory, learning and consciousness. Brain activity was especially high in the prefrontal cortex, which is associated with positive emotions.

More recently, a June study called “Meditation Practices for Health: State of the Research,” prepared for the U.S. Department of Health and Human Services, found that meditation reduces heart rate, blood pressure and cholesterol, while increasing verbal creativity.

Mocine believes the techniques of “active listening, communication and self-awareness” are applicable in the courtroom. “You can be fierce without being hateful,” said Mocine, who no longer practices law. “Being a Zen teacher and a temple priest is what’s important.”

Some wonder if the legal profession is too conflict-oriented by nature to adapt to any part of Zen doctrine.

“The existing legal culture is based on an adversary system,” said Peter Gabel, president of the New College of California School of Law, in San Francisco, and founder of the Project for Integrating Spirituality, Law and Politics.

“But legal culture is very important in putting forward, to a society, what is a just world,” Gabel said. “We need a legal process that can foster a sense of empathy and compassion and mutual understanding.”

Each month, Gabel leads a conference call in which lawyers from across the country discuss ways to improve the legal system. The format is simple: Twenty lawyers listen in during a 20-minute presentation, then participate in a Q & A for the next 40 minutes.

The most recent conference call featured a discussion of meditation launched by the law program director of the Center for Contemplative Mind in Society. “The debate was over whether deeper awareness, through the practice of meditation, can open the heart in a way that’s essential for social change,” Gabel said.

Lawyers who meditate say their colleagues sometimes don’t get it.

“For fast-paced lawyers thinking in terms of billable hours, the idea of sitting down and meditating seems crazy,” said Rochael Soper, 35, an intellectual property lawyer in private practice in San Carlos who is part of a monthly meditation group. “But in Zen, it’s not about results.”

Mocine is careful to make a distinction between short-term, stress-reduction workshops and a commitment to meditation practice.

“Workshops might reduce your stress, but they may not teach you anything,” she said.

Tolpen, who still goes on frequent retreats, agrees that meditation is something one must treat as a practice, like the law.

“You can still be a warrior,” he said, “but because you’re at peace with yourself and you’re centered, you’re not coming from rage or fear or anger.”

Tolpen said he still gets mad and makes mistakes, though now the experience and emotion feel different: “I’m a work in progress. It’s exciting.”

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Robert Collier: “Any thought that is passed on to the subconscious often enough and convincingly enough is finally accepted”

Robert Collier

All too often thoughts set thoughts in motion with little or no conscious intervention on our part, creating an inner avalanche of ideation. Helplessly caught up in this endless cascade, we are swept away by the stories generated by our hopes and fears.

To change the metaphor, each thought sends forth an echoing cry, like an animal calling for its mate, and this cry penetrates the heart, evoking an emotional response. The end result is suffering, stress, depression, anxiety.

Our thoughts form consistent story lines:

  • “Nobody likes me.”
  • “If only such-and-such a thing would happen, then I’d be happy.”
  • “I just know this is going to go wrong.”
  • “I bet he did that deliberately.”

As we listen, without mindfulness, to these story lines, day in and day out (and at night too, for our inner dramatic arc does not cease with conscious thought) we remain utterly convinced that these stories are truth, not imaginings.

And yet thoughts are not facts, but merely the projections of our hopes and fears. As we develop greater mindfulness we begin to recognize this, to catch ourselves in the act of indulging in a story line whose punch line is an ache in the heart. And we start to be able to let go of these story-lines, realizing that they will bring us nothing good.

A further step in some meditation traditions is to cultivate thoughts that will enhance well-being rather than diminish it. And so, in the development of lovingkindness practice we repeat phrases such as “May I be well, may I be happy,” and in mantra practice we repeat phrases that evoke enlightened qualities of insight, compassion, and energy. Even the traditional recitation of the refuges and precepts can be seen as a way of convincing the mind of the value of committing oneself wholeheartedly to the path of awareness and compassion.

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Relieving stress could be just a breath away (Ledger-Enquirer, Georgia)

Hilary E. MacGregor: New Age flute music plays softly as people file into an apartment in West Los Angeles, remove their shoes and seat themselves quietly on Oriental carpets on the floor. A picture of a bearded guru in white robes sits at the front of the room with a tiny offering of fresh flowers. There are 14 students, and they have come here to learn to breathe.

Known as the “Art of Living,” this intensive breathing course will last six days. The class has drawn people ranging in age from their 20s to their 60s. There is a builder, a businessman, a masseuse, an acupuncturist and a Jacuzzi engineer. It includes some who are seeking relief from asthma, chronic pain and depression, and others who have come because they heard about it from a friend. One man came after seeing a flier at a Whole Foods market.

Students of the program say the breathing technique can bring greater awareness, a fuller and happier life, less stress, greater mental focus, and a bevy of other health benefits. But there is scant research so far to support those claims.

Now, a handful of doctors and psychiatrists in this country are touting the benefits of the special breathing technique taught in the course to help relieve depression, post-traumatic stress disorder, insomnia and anxiety.

One of those is Dr. Richard Brown, an associate professor of clinical psychiatry at Columbia University’s College of Physicians and Surgeons. After Brown published a book in 1999 about holistic approaches to depression, people from the “Art of Living” contacted him and explained their program. Impressed with what he heard, Brown later began recommending the program to many of his patients.

“Many of them were transformed,” Brown says. “I didn’t expect that.”

Brown eventually took the course, then started teaching the program to, among others, fellow mental health professionals in New York. He’s also become the program’s main spokesman in the medical community.

Earlier this year, the national Centers for Disease Control and Prevention released a survey on Americans’ use of alternative and complementary medical therapies and found that 12 percent of adults reported that they had done some type of breathing exercises in the past year.

Studies of yoga, which places a lot of emphasis on breath, have demonstrated its effect on reducing blood pressure, relieving anxiety and boosting the immune system. Eastern exercises such as tai chi and qi gong also incorporate focused and deep abdominal breathing.

But it is difficult to design a research study that would weigh the health benefits of purposeful breathing techniques by themselves.

The Art of Living is a meditation and yoga practice started by Indian guru Sri Sri Ravi Shankar (he is no relation to Ravi Shankar, the Grammy Award-winning sitarist who rose to international fame when Beatles star George Harrison became his student). The 48-year-old Art of Living founder once studied with Maharishi Mahesh Yogi, the guru famous for teaching Transcendental Meditation. Art of Living’s Shankar says the centerpiece of his breathing program known as the Sudarshan Kriya came to him in 1982, during a 10-day period of solitary silence.

As Shankar tells it, during his time of solitude, he perceived that the different rhythms of breath had a connection with different states of mind. He came to believe that this practice could help people with their suffering, and so began to teach the breathing technique to others.

Today, the Art of Living Foundation claims that its volunteers have taught 2 million to 3 million people in 142 countries. The course includes 16 to 20 hours of instruction in a simple breathing technique that can be practiced daily at home. About 50,000 people have gone through the program in the United States, the foundation says.

John Osborne, president of the Art of Living Foundation in the U.S., believes the course has grown in popularity because it fits the needs of the times. The breathing, he says, offers a powerful way to counter stress, and the course’s spiritual lessons appeal to people who may be feeling a sense of alienation and powerlessness.

The program received a publicity boost after 9/11, when the Art of Living ran a full-page ad in the New York Times a month after the terrorist attacks, offering the course free of charge to New Yorkers. Ten teachers were flown in from around the country, and during the next several months, more than 1,000 people, including firefighters and police officers, took the course.

Before beginning the class in West Los Angeles, all students pay $250, commit to completing the course and sign a non-disclosure statement, promising not to reveal the contents of the course.

The technique “is simple,” Osborne says. He adds somewhat cryptically: “But if done wrong, people might try it at home and they might hurt themselves.”

The teachers, Josette Wermuth, an instructor at Los Angeles High School, and Phylis LeBourgeouis, a lab technician at the University of California, Los Angeles, tell the class to avoid alcohol for the duration of the course and to stick to a vegetarian diet.

There is a strong touchy-feely aspect to the course. The teachers seem to glow with happiness, and they never stop smiling. We begin by walking around the room, looking into one another’s eyes and saying, “I belong to you.” Over the next six days, we sit in small groups and talk about expectations, responsibility, happiness. The intimate philosophical discussions initially make some students uncomfortable.

On the first two days, we learn the “pranayams” three positions of sectional breathing. All three positions hands on hips; thumbs in the armpits, elbows folded out; arms folded above our heads involve inhaling, holding and slowly releasing the breath. Then we do a fourth breath work, called ‘bellows breath,’ in which we shoot our arms overhead to move energy through the body. The deep breathing of the “pranayams,” as well as the bellows breath, is based on ancient yogic techniques.

It is not until the four-hour weekend sessions that we learn the Sudarshan Kriya, the active breathing technique that is the heart of the course and is, according to the Art of Living Foundation, unique.

Before we begin, our teachers tell us our hands might grow numb, our body temperatures might drop. It is the middle of a stifling heat wave, sticky by 10 a.m. Someone opens the windows. Shankar, we are told, has decreed that the Kriya must always be done with fresh air.

With that, Wermuth slips in a cassette tape of the guru. From far away, Shankar begins to guide us through the breathing in his melodic voice. We breathe in cycles, slow, faster, fast, until it feels like controlled hyperventilation.

“The rhythm of the breath is linked to emotions,” Wermuth tells us. “There is a specific rhythm for every shade of emotion.”

At the end, we lie on our backs.

The second day, we do the Kriya, the effect is more dramatic. A few people cry. One man says his hand became immobile; another says he felt temporarily paralyzed from the waist down. Our teachers don’t explain much about why this might be happening. But clearly, something seems to be going on.

Shankar recommends students carry on the breathing practice for at least six months. The daily regimen takes about 30 minutes.

By the end of the six-day course in West Los Angeles, some students already were reporting changes.

Rasik Raniga, a hotel manager who took the course hoping for relief from asthma, claimed he already was able to cut down on the use of his inhaler. Michael Miller, a home builder who said he had been feeling depressed, found himself feeling better after three days. Analilia Silva, a businesswoman who came to the course at the suggestion of a friend, described the change as subtle: “It’s like when you start exercising,” she said. “And you suddenly feel better but you don’t know why.”

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Buddha Lessons (Newsweek)

Claudia Kalb, Newsweek International: A technique called ‘mindfulness’ teaches how to step back from pain and the worries of life.

At the age of 39, Janet Clarke discovered that she had a benign spinal tumor, which caused her unremitting back pain. Painkillers helped, but it wasn’t until she took a meditation course in Lytham that Clarke discovered a powerful weapon inside her own body: her mind. Using a practice called Mindfulness-Based Stress Reduction (MBSR), Clarke learned to acknowledge the aching, rather than fight it. “It was about getting in touch with your body, rather than your head,” she says. “Mindfulness gives you something painkillers can’t—an attitude for living your life.”

With its roots in ancient Buddhist traditions, mindfulness is now gaining ground as an antidote for everything from type-A stress to depression. At the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts, where MBSR was developed by Jon Kabat-Zinn, 15,000 people have taken an eight-week course in the practice; hundreds more have signed up at medical clinics across the United States. Now scientists are using brain imaging and blood tests to study the biological effects of meditation. The research is capturing interest at the highest levels: the Dalai Lama is so intrigued he has joined forces with the Mind & Life Institute in Boulder, Colorado, which supports research on meditation and the mind. Next month, scientists will meet with the Dalai Lama in Dharamsala, India, for a major conference on the neuroplasticity of the brain. “People used to think that this was a lot of mystical mumbo jumbo,” says psychologist Ruth Baer, of the University of Kentucky. “Now they’re saying, ‘Hey, we should start paying attention’.”

Paying attention is the very essence of mindfulness. In 45-minute meditations, participants learn to observe the whirring thoughts of the mind and the physical sensations in the body. The guiding principle is to be present moment to moment, to be aware of what’s happening, but without critique or judgment. It is not easy. Our “monkey mind,” as Buddhists call the internal chaos, keeps us swinging from past regrets to future worries, leaving little time for the here and now. First attempts may provoke frustration (“I’ll never be able to do this”), impatience (“When will this be over?”) and even banal mental sparks (“What am I going to make for dinner?”). The goal, however, is not to reach nirvana, but to observe the cacophony in a compassionate way, to accept it as transient, “like bubbles forming in a pot of water or weather patterns in the sky,” says Kabat-Zinn.

The keystone of mindfulness is daily meditation, but the practice is intended to become a way of life. At Stanford University, Philippe Goldin encourages patients battling social-anxiety disorder to take “meaningful pauses” throughout the day as a way to monitor and take charge of their fears and self-doubts. Inner control can be a potent tool in the fight against all sorts of chronic conditions. In a pilot study of 18 obese women, Jean Kristeller, director of the Center for the Study of Health, Religion and Spirituality at Indiana State University, found that mindfulness meditation, augmented with special eating meditations (slowly savoring the flavor of a piece of cheese, say), helped reduce binges from an average of four per week to one and a half.

Mindfulness takes you out of the same old patterns. You’re no longer battling your mind in the boxer’s ring—you’re watching, with interest, from the stands. The detachment doesn’t lead to passivity, but to new ways of thinking. This is especially helpful in depression, which plagues sufferers with relentless ruminations. University of Toronto psychiatry professor Zindel Segal, along with British colleagues John Teasdale at Oxford and Mark Williams at Cambridge, combines mindfulness with conventional cognitive behavioral therapy, teaching patients to observe sadness or unhappiness without judgment. In a study of patients who had recovered from a depressive episode, Segal and colleagues found that 66 percent of those who learned mindfulness remained stable (no relapse) over a year, compared with 34 percent in a control group.

The biological impact of mindfulness is the next frontier in scientific research. In a study published several years ago, Kabat-Zinn found that when patients with psoriasis listened to meditation tapes during ultraviolet-light therapy, they healed about four times faster than a control group. More recently, Kabat-Zinn and neuroscientist Richard Davidson, of the University of Wisconsin, found that after eight weeks of MBSR, a group of biotech employees showed a greater increase in activity in the left prefrontal cortex—the region of the brain associated with a happier state of mind—than colleagues who received no meditation training. Those with the greatest left-brain activation also mounted the most vigorous antibody assault against a flu vaccine.

There’s more in the pipeline. Stanford’s Goldin is taking brain images to see if mindfulness affects emotional trigger points, like the amygdala, which processes fear. And at the University of Maryland, Dr. Brian Berman is tracking inflammation levels in rheumatoid arthritis patients who study mindfulness. One of them, Dalia Isicoff, says the payoff is already clear: “I’m at peace,” she says. Mind and body, together.

With Clint Witchalls in London

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Exercising the demons

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The Observer (UK): For millions of Britons suffering from depression, therapy and pills are a first-stop solution. But when conventional treatment failed him, Dan Roberts chose to play and pray.

As anyone who has experienced severe depression knows, it is a hellish state. Your confidence, self-esteem and energy are eviscerated by anxiety, self-doubt and a darkness from which there appears no respite. Symptoms commonly include insomnia, acute anxiety, loss of appetite, libido and energy, with even the most minuscule task taking on Herculean dimensions. In its severest form, depression is crippling, rendering the sufferer unable to lead a normal existence.

Depression is becoming the affliction of our time – one in four people in the UK suffer from it at some point in their lives. For the past 11 years I have been among that 25 per cent, laid low by bouts that can last for weeks and which have ranged from mild to severe.

Depression runs in my family. We are all hugely driven, highly motivated people, prone to often scathing self-criticism. We feel deeply, but vent our emotions poorly, especially anger. As in any good Jewish family, guilt is second nature and (one of the key components in any depressive personality) we expect a great deal – from life, love, the world. When our experience fails to match our lofty dreams we fume, often turning that indignation in on ourselves.

My own cycle of emotional boom and bust began with the untimely death of my father in 1992, when I was 25. I was travelling and hadn’t seen him for two years, so I never got to say goodbye – it was as if he just vanished from my life…

I returned to England and eventually entered counselling to help with the bereavement. I spent the next five years in individual and group therapy, but with hindsight, I believe this examined every dark corner of the past too minutely. Having become disenchanted with therapy in 1997, I spent a year battling my demons alone and, after an especially brutal episode (in which, for the first and last time, I came close to suicide) I visited my GP. She recommended Prozac, but I did not trust antidepressants – I felt it was like taking aspirin to cure a broken leg. A year later, I again bottomed out and was referred to the Tavistock Clinic, where an old-school psychiatrist assessed me and frostily recommended analysis – four times a week. I was working full-time and had a young son, so it was out of the question. Once again, my GP suggested Prozac. Again I refused, and in light of the increasing evidence about the potentially harmful side-effects of SSRIs (selective serotonin re-uptake inhibitors) such as Prozac and Seroxat, I’m glad I did.

Eventually, like millions of others, I discovered Dorothy Rowe. Her book, Depression: The Way Out of Your Prison, spoke with greater simplicity and truth about the causes of depression than any therapy session. Her assertion that depression is a choice made at a very young age, and that we construct the ‘prison’ of depression through rigidly held belief systems, struck a profound chord with me. If, however unconsciously, we choose to be depressed, we can also choose not to be.

Rowe also asserts that regular exercise is a key tool in combating depression. I recently contacted her to seek clarification. ‘Exercise is very helpful,’ she said, ‘because the depressed person is doing something to benefit himself, instead of constantly punishing himself. The decision to do something for yourself, even if it is the tiniest thing, can be the starting point of change and coming to value yourself.’

The precise physiological reasons are not yet clear, but exercise is believed to alter neurotransmitters such as norepinephrine in the brain; the changes are similar to those produced by antidepressants. Better documented is the release of endorphins during and after working out, which provide a natural high.

Whether the effect is mental or physiological, it works. I exercise almost daily; running, swimming, playing tennis and kickboxing. In the weeks where I let my regime slip, my self-image worsens, I feel sluggish and lethargic, and often end up depressed.

The other key component of my anti-depressive programme is meditation. As Rowe says: ‘The depressed person might appear to an outsider to be inactive, but inside, the person’s thoughts are churning around. Meditation, or just learning to centre yourself and relax, can quieten these thoughts.’

This is an oft-ignored aspect of depression – the anxiety and whirling clouds of noxious, self-destructive thoughts that precede and/or accompany it. I meditate daily and find it provides an invaluable aid in my battle with the blues. Meditation taps into a hugely powerful resource – that of an inner calm, strength and resolve which survive any external assault. Depression and psychological turmoil are nothing new, and people have been self-regulating their psyches for millennia through prayer and meditation.

I am not claiming that my approach will work for everyone, but it works for me. I have come to accept that depression will probably be a lifelong, though unwelcome, companion; but never again will I consider suicide. Never again will it suffocate me for weeks on end.

I have learnt how to live with and manage my depression. Perhaps one day I may even free myself from its shackles for good.

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