With Depression, Sometimes It Pays to Be Patient

There’s such a thing as trying too hard.

Anyone who has ever suffered through a case of insomnia knows this well. The harder you try to sleep, the less rest you get. Sleep only comes if you can relax and let go.

It’s true for many other things, too.

Like garage-door controls.

The other day, I was trying to get into my neighbor’s house to walk his dog and pressed the code into the box outside the garage more than 20 times, but the garage wouldn’t lift.

“You’re pressing the buttons too hard,” my daughter told me.

She did the sequence one time, pressing the buttons effortlessly, and up the garage went.

And it definitely applies to managing your thoughts.

The Harder You Try, the More Negative Things Can Get

A study published in August 2007 in The Journal of Neuroscience showed that there was a breakdown in normal patterns of emotional processing that prevented depressed and anxious people from suppressing negative emotions. In fact, the more they tried, the more they activated the fear center of their brain — the amygdala — which fed them more negative messages.

In the study, Tom Johnstone, PhD, then of the University of Wisconsin in Madison, along with colleagues there and at Tufts University in Medford, Massachusetts, examined 21 adults diagnosed with major depressive disorder and 18 non-depressed people of comparable ages. Participants were asked to view a series of emotionally positive and negative images and then specify their reaction to each one. A few seconds after the presentation of each picture, participants were asked to either increase their emotional response, to decrease it, or simply to continue watching the image.

The results showed distinctive patterns of activity in the ventromedial prefrontal cortex (vmPFC) and the right prefrontal cortex (PFC), areas that regulate the emotional output generated from the amygdala: the almond-shaped group of nuclei located deep within the temporal lobes of the brain that play a primary role in the processing of memory, decision-making, and emotional reactions. The vmPFC is compromised in depression, possibly because of the inappropriate engagement of right PFC circuitry in depressed individuals.

It even applies to exercise.

Why Too Much Exercise Can Be Too Much

While regular and moderate exercise can boost longevity, cardiovascular health, and mood — and improve symptoms of all kinds of chronic conditions — long-term endurance exercise and working out too hard can actually harm our health, according to recent research, such as a study published in 2015 in the Canadian Journal of Cardiology that linked excessive exercise to heart rhythm issues.  Such exercise has been linked to pathological structural remodeling of the heart, enlargement of arteries, and increases in anxiety and depression.

Too much exercise can also exacerbate autoimmune disease, gut dysbiosis, and adrenal fatigue. According to Chris Kresser, an acupuncturist and leader in functional and integrative medicine, overtraining affects blood levels of important neurotransmitters like glutamine, dopamine, and 5-HTP, and can negatively impact the hypothalamic-pituitary axis, possibly causing conditions like hypothyroidism. Extreme exercise also increases levels of the stress hormone cortisol, which can cause sleep disturbances, digestive issues, depression, weight gain, and memory impairment.

I know consciously that trying too hard doesn’t always render the best results, but when I experience a depressive episode, I automatically start pedaling faster, thinking that I will escape the biochemical storm sooner if I just try harder.

When Self-Help Is No Help

I showed up recently to my psychiatrist appointment with another self-help book in my hands: Mental Health Through Will Training, by Abraham Low, MD, the late professor of psychiatry at the University of Illinois College of Medicine in Chicago who founded Recovery International, a self-help group for people with nervous, mental, and emotional problems. The book is an invaluable resource that has plenty of wisdom and insights for managing chronic depression, and I was using it as an adjunct to psychiatric care. But its provocative “push yourself as much as you can” philosophy was exactly what I shouldn’t be reading in a dangerous, mixed state of bipolar disorder.

“I think you should stay away from all self-help books right now,” my doctor told me, reminding me of all the times before when I’d been in this state of mind and looked for the answer in mental health literature or self-help groups or mindfulness techniques — as if I were missing some key cognitive behavioral strategy that would instantly deliver me to the land of sanity. Moreover, pushing too hard, she said, has typically led to setbacks in my recovery rather than helped me heal.

People often ask me how much they should push themselves when it comes to managing their depression: Should they go into work, or call in sick? Should they force themselves to socialize, or stay home and recover? Having read way too many self-help books, I can say there is research to support both perspectives. The right answer is going to be different for everyone, and will vary for the same person at different times.

For me, though, right now I’m learning the hard lesson of patience and trust and moderation.

I’m learning, once again, that more isn’t always better.

In fact, sometimes less is more.

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