I got a new pair of glasses. Suddenly, the world is super clear. I keep looking around marveling at all I can see, the distinctness of colors and edges. Suddenly, there is focus. I didn’t realize until now how blurred my seeing used to be.
It’s kind of like depression.
Many women with whom I work struggle with depression. They often realize it after they emerge. When in a depression, the blurry fog tainting things feels like reality. Beliefs just under the surface color your experience. Beliefs like:
This is the way it is. It won’t ever change.
Why try? It won’t make a difference.
I should be better. If I just tried harder, I wouldn’t feel this way.
Other people are functioning – and thriving – so if I’m not, it must be my fault.
There are all kinds of environmental stressors that can trigger depression: work stress, losing a job, moving, divorce or marital difficulties, seasonal changes (lack of light during the winter months), having baby. Here are two surprising ones: recovery from an eating disorder and planning for a wedding. Yep. Even “positive” changes in one’s life can trigger a mood shift and/or a full-blown mood disorder.
Change is scary. Even the “good” changes! And if you have a temperament that tends toward “turtle-ness” (risk-averse, anxious, cautious, slow to warm up) then depression can emerge to “help.” Depression can help slow you down when parts of you are afraid of moving quickly. Depression can help you feel “grounded” when you feel “out of control.” Depression can mute anger or make it feel less scary. Depression can provide a source of constancy or familiarity, when it felt as if everything else is changing.
But what are the “glasses” for depression?
Just in case you think I am advocating for depression, I’m not. I am aware that depression signals something (or many things) need attention, need tending. Let’s look at some of the tools, if you are struggling with depression, that may help.
Meditation is a simple (but not always easy) tool that can assist in bringing compassion and grounding to parts of you that are afraid, angry, or overwhelmed. It can help slow down the anxious thoughts. It can help “turtles” navigate change with more ease. It can provide a tiny bit of distance away from depressive thoughts of things always being like this or things that are uncomfortable or not ok being my fault. The compassionately objective voice that can emerge in meditation might say something like:
“Huh. Have things always been like this? I can see a bigger picture…”
I can feel your struggle right now and there is nothing wrong with you.
I can see a part of you that is hurt. It might help you to tend to, and speak up for, that part.
Instead of a cutting off or lifting away from the experience of depression, meditation can assist in being with it from a larger space. It can help you not get swallowed up by it. It can be the “new pair of glasses” that brings clarity to the blurry-ness. It can help you see a bigger picture, and personalize less. It can gently place you back in the experience of being human rather than the suffering of humanity being “my fault.”
I am not a Psychiatrist. I do not prescribe antidepressants. I do know that many of the women I see are hard-working, conscientious, sensitive beings that believe they “should” be able to “just get over” depression or anxiety without medication. Shame and stigma color their vision. They believe that they should just be able to function and thrive by “eating the right food” (that is a whole other blog, but let’s just say for the record, that you are not “bad,” “dirty,” “clean,” or “good” for eating or not eating any particular food), “doing the right spiritual practice,” and working super extra hard. They compare-and-despair what they are feeling on the inside, to sleek, put-together look of other people’s outsides. They think there is something inherently wrong with them. They think they “shouldn’t” need glasses. They “should” be able to just see!
I’m here to tell you that no matter how hard I worked at being good enough, or eating the “right” food, my eyesight did not get better without glasses.
Just in case you think I am pushing antidepressant medication, I am not. Medication, like meditation, is a tool in the recovery tool box. Some people choose to use this tool and some do not. I work with women who make many different choices in this area. I am erring on the side of offering medication as a tool to – hopefully – offer a stigma free zone for people who struggle with depression to make a choice. There is no right answer for everyone. There is the right answer for you, at the right time for you. If you are considering medication, you will need to explore that question with your doctor.
Important caveat: If you are considering medication for depression, and you also have an eating disorder or are a new mom, it is wise to see a psychiatrist who specializes in those areas. There are particular needs for women recovering from eating disorders (ex awareness around how medication can affect appetite and weight, risk of seizures with certain medications if you have a history of purging) and perinatal mood disorders (ex awareness around safety of different medications during pregnancy, postpartum, and breast-feeding) that your doctor needs to have in mind.
I offer you the possibility of clarity. As it says in A Course In Miracles, a miracle is a shift in perception. If you are struggling with depression, may you find, and put on, your new pair of glasses. May you see that hope is possible. May you put one foot in front of the other (or tuck them into seated meditation position) and keep looking for a compassionate space inside yourself. May you find exactly the right therapist and tribe of friends that treat you with compassion when you forget. May you feel that change is possible and you are enough. It is. You are.
I will love the light for it shows me the way, yet I will endure
the darkness for it shows me the stars.
We are in a dark time of the year. There is a reason why there has always been a light-in-the-darkness time, and not just for those needing light in recovering from depression. Historically, in an agricultural society, December was a time when the harvest was done and therefore it was a time to rest, turn inward and reflect. With the days being darker, and Winter Solstice being the shortest day of the year, bringing and celebrating light is a natural response to, well, not going mad in the darkness. We need light. Not only does the vitamin D literally stave off depression, but symbolically we need to know there is light in the dark.
One theory of the origins of December 25 as the date chosen for the birth of Jesus is that it was originally the pagan festival in Rome celebrating “the birth of the unconquered sun,” celebrating the sun-god and the solstice. Hanukkah is also known as “the Festival of Lights,” Kwanzaa ritual include lighting special candle holders called kinaras, and in the December Hindu festival Pancha Ganapati, a shrine with Ganesha (the Hindu elephant god who clears away obstacles) is lit. Shabe Yaldā or Shabe Chelle, held on the Winter solstice, isan Iranian festival celebrating the victory of light and goodness over darkness and evil, and Chahar Shanbeh Sure, the Iranian “festival of Fire” celebrates light over darkness on the last Tuesday night of the year.
“People are like stained-glass windows. They sparkle and shine when the sun is out, but when the darkness sets in, their true beauty is revealed only if there is a light from within.”
-Elizabeth Kubler Ross
For recovering people, this can be particularly challenging to remember the light: the light of hope, the light of “this too, shall pass,” the light of love. It can be difficult to remember you have an inner light to which you can listen.
There is a lot to be concerned with in the world right now. So much suffering. Holding the light of hope can be hard. So many religions and cultures have this light in the darkness in their symbolism for this very reason. It is a human need; an archetypal commonality we share. Remember that you are only responsible for your light, your candle in the darkness. Light your candle. Revisit, hold onto, re-light this light. In the words of Anne Frank,
“Look at how a single candle can both defy and define the darkness.”
Light your candle. The world needs it. The world needs you.
…and recovery is always possible
My first year with the baby was dreamy, so when I started to decline, I didn’t think it was Postpartum depression (PPD). The docs had said PPD could occur anytime in the first year. They didn’t say what it was when depression occurred after that. Since my self-esteem was plummeting, which is one of the hallmarks of PPD, I concluded that my downward spiral was my own fault, due to poor management of my time and energy. It got ugly as the chemistry in my brain lost more and more balance.
What it felt like is that the sun that energizes the earth and had brightened my day was no longer available. I couldn’t feel its warmth. People often use the sun metaphor when talking about depression. When the depression lifts, they say, it is like the sun comes out again. This is very much what it was like for me. When the sun was absent, it was so frustrating because I knew what was missing – a connection to the universe – but I could not get it back. Movement, light, forward momentum – they were gone.
Usually, when you walk, you go forward.
In the dark season, your footsteps dissolve in the mighty, silent ink.
Lost, you have no choice but to sink into what you cannot see.
You reach out but your hands slide down the slick walks of despair,
This relentless, downward pitch can only be a vein of hell.
the baby sleeps through the night, you get a day off, you lie down and rest.
beats your heart. Your mind says nothing.
You feel heat again in your spine. You see orange at the corners of your eyes.
This quiet place at the bottom where the flame always burns,
must be a chamber of heaven
that it took the darkness for you to see.
I wish that I had known sooner that what I was experiencing was a delayed onset of PPD. I would have sleep-trained the baby earlier, and arranged for more visits like the one I just had at my mom’s. A late-onset PPD diagnosis also might have prevented a lot of anger directed at myself for being such a failure at managing my life. So I say, if you have a child under two and you meet the criteria for PPD, it probably is PPD and deserves to be treated as such. At the risk of stating a cliche, you deserve the support you need to feel better.
Sheira Kahn is a recovered bulimic and Marriage and Family Therapist who practices in the East Bay and Marin County. She teaches self-esteem workshops and classes on reducing emotional eating and is co-author of The Erasing ED Treatment Manual, available on Amazon.
At the age of 50, she gave birth to Alexandria in April of 2014. Her blog can be found on www.sheirakahn.com.
The short answer? “It’s complicated.”
The longer answer: Genetics and temperament both play a strong role in the possibility of Depression or an Eating Disorder developing, but do not determine it.
The hopeful answer: Even if your child develops an Eating Disorder or Depression, it is possible to recover.
In this post, I will look at some of the risk factors that can lead to an Eating Disorder or Depression.
Eating Disorders: Are they inherited?
Eating Disorders develop as a combination of genetic vulnerability combined with temperamental traits and a facilitating environment. Some (but not all) risk factors named in Carolyn Costin and Gwen Schubert Grabb’s book 8 Keys to recovery from an Eating Disorder (W.W. Norton, 2012) that can contribute to developing an eating disorder include:
- being overweight or dieting as a child
- having a mother who diets or has an eating disorder
- early menstruation
- being bullied or teased
- engaging in sports or activities with a focus on appearance or weight (for example ballet, cheerleading, ice skating, wrestling, gymnastics, modeling)
- a history of childhood abuse
In a 2000 study in the American Journal of Psychiatry, results showed that anorexia nervosa has a heritability of 58%, but the authors were unable to rule out the contribution of environment. However, they did conclude that genetic factors influence anorexia and contribute to comorbidity of anorexia and depression.
Along with genetic links being discovered with both anorexia and binge eating, certain temperamental traits tend to foster the birth of an Eating Disorder. Ovidio Bermudez, in presenting at Eating Disorder Recovery Services conference* this past year discussed the following temperament traits as those at risk of developing an Eating Disorder:
- Anxiety, Depression, or OCD
- Low stress tolerance
- Low distress tolerance
- Sensitivity to real or perceived injury
So in other words, if you have a sensitive child who struggles with tolerating “distressing” feelings such as sadness, anger, or shame and you (or a family member) struggle with Depression, Anxiety or OCD, the ground is fertile for the seed of an Eating Disorder to sprout.
What about Depression?
At least 10% of people in the U.S. will experience Major Depressive Disorder at some point in their lives. According to statistics, two times as many women as men experience major depression. (There is a lot to be said there in terms of mis-diagnosis of symptoms, gender bias, and who reaches out for support to mental health professionals, that can affect these statistics, but that is for another blog.)
According to two Stanford doctors writing about genetics and brain function, genetics play a strong role in causing Major Depression (Levinson, Douglas F. M.D. and Nichols, Walter E. M.D., Professor in the School of Medicine Department of Psychiatry and Behavioral Sciences, Stanford, 2015). They write:
- The heritability (or percentage of the cause due to genes) is probably 40-50%, and might be higher for severe depression.
- The situation is a little different if the parent or sibling has had depression more than once (“recurrent depression”), and if the depression started relatively early in life… the siblings and children of people with this form of depression probably develop it at a rate that is 4 or 5 times greater than the average person.
What else contributes to Depression? And what about Postpartum Depression?
Stressful life events (trauma, loss of a loved one, moving/loss of support, having a baby) can lead to depression in and of themselves. When combined with a genetic risk, there is a stronger possibility of developing depression. And having one (or more) episode of depression increases the risk of having future episodes. (Kendler, Thornton, and Gardner, 2001)
While many women experience some mild mood change or “the blues” during or after the birth of a child, 1 in 7 women (and some recent research says 1 in 5) experience more significant symptoms of depression or anxiety. 1 in 10 Dads become depressed during the first year. (Postpartum Support International)
Risk factors for Postpartum Depression
Some women are more likely than others to develop Postpartum depression. The following factors put you at an increased risk:
- Previous history of depression
- History of severe PMS or premenstrual dysphoric disorder
- Medical complications for you or your baby
- Lack of support from family or friends
- A family history of depression or another mental illness
- Anxiety or negative feelings about the pregnancy
- Problems with a previous pregnancy or birth
- Marriage, Relationship, or money problems
- Stressful life events
- Substance abuse
How does Postpartum Depression impact children?
Postpartum Depression and other Perinatal Disorders (Anxiety, OCD, Psychosis) can affect children in the following ways:
- Behavioral Problems
- Delays in Cognitive Development
- Emotional Problems and/or Depression
According to Zero To Three, a research-based resource for federal and state policymakers and advocates on the unique developmental needs of infants and toddlers, untreated Depression can have detrimental effects on children’s functioning and future outcomes (2009).
The mental health of parents can affect young children… infants of clinically depressed mothers often withdraw from caregivers, which ultimately affects their language skills, as well as their physical and cognitive development. Older children of depressed mothers show poor self-control, aggression, poor peer relationships, and difficulty in school.
Unlike adults, babies and toddlers have a fairly limited repertoire of responses to stress and trauma. Mental health disorders in infants and toddlers might be reflected in physical symptoms (poor weight gain, slow growth, and constipation), overall delayed development, inconsolable crying, sleep problems, or aggressive or impulsive behavior and paralyzing fears. Early attachment disorders predict subsequent aggressive behavior. Some early mental health disorders have lasting effects and may appear to be precursors of mental health problems in later life, including withdrawal, sleeplessness, or lack of appetite due to depression, anxiety, and traumatic stress reactions.
So, if you have had or are currently suffering with and through (because it is possible to recover and get through it) an Eating Disorder or Depression, your child does have risk. But that does not mean they are doomed. It means, even more important than ever, that you get treatment and recovery yourself! When I attended Postpartum Support International’s training on Perinatal Mood Disorders, the message that they gave was: There is Hope and You are not alone. It is possible to recover and in recovering yourself, you help build a more protected base from which your child can thrive and grow.
Wade, Tracey D, Ph.D., Cynthia M. Bulik, Ph.D., Michael Neale, Ph.D., and Kenneth S. Kendler, M.D., “Genetic and Environmental Risk Factors Anorexia Nervosa and Major Depression: Shared Risk Factors,” Am J Psychiatry 2000; 157:469–471.
Eating Disorder Recovery Services The mission of EDRS (Eating Disorder Recovery Support), Inc. is to promote recovery and wellness for those impacted by eating disorders by providing support, information, and education to individuals, families, professionals, and the community at large regarding eating disorders and recovery resources. EDRS.net
Ovidio Bermudez, MD Dr. Bermudez has lectured nationally and internationally on eating pathology across the lifespan, obesity and other topics related to pediatric and adult healthcare, and has been repeatedly recognized for his dedication and advocacy in the field of eating disorders. eatingrecoverycenter.com
“Major Depression and Genetics” Douglas F. Levinson, M.D. and Walter E. Nichols, M.D., Professor in the School of Medicine
Department of Psychiatry and Behavioral Sciences (2015) Depression and Genetics
Zero To Three The Zero To Three policy Center is a nonpartisan, research-based resource for federal and state policymakers and advocates on the unique developmental needs of infants and toddlers. zerotothree.org
Link to Depression during and after Pregnancy Fact Sheet
Link to study on teaching sleep with infants to prevent Postpartum Depression:
Link to study on effects of Lexipro on treatment of Postpartum Depression: