Coping with Depression

Coping with Depression

Posted by Dan Gottlieb on May 13, 2015 2:41 pm

Studies have shown that nearly 25% of people living with paralysis have major depression. No studies that I aware of have looked at loved ones, but I am confident their numbers are very high also.

Depression is not having a bad day or even "having the blues"-even if it lasts 6 months.

Depression is something that is a debilitating illness that affects how we sleep, how we eat, even how we think about ourselves and the future. Exercise is a great way to maintain physical and mental health, but depression eliminates our motivation and enthusiasm for exercise. For that matter depression diminishes our enthusiasm for almost everything including work, hobbies, even love.

I see depression as being similar to cancer. Sometimes it's curable and sometimes it's chronic and needs ongoing treatment. Sometimes it's relapsing. And sometimes it's fatal.

When I heard my first episode of major depression after my accident, I didn't even realize I was depressed. All I knew was that I felt crazy and was fearful of speaking up in meetings for fear that people would realize there was something wrong with me. I was scared, but I had no idea it was depression. And then one evening I was sitting in my office treating a patient and the thought went through my mind: "I wonder if I'll drive off a bridge on my way home tonight." In hindsight, it just felt like idle speculation. But it was enough to help me realize I had depression and to do something about it quickly.

I made an appointment with a psychiatrist for medication and a psychologist for psychotherapy. I had a terrible time with all medications because I had unusual side effects. These side effects included increased spasms to a point where I had difficulty functioning. So much for medication with this particular quadriplegic.

I turned to therapy and developed a relationship with my therapist in which I felt safe enough to talk about all of the bizarre thoughts inside my head. Then we talked about my fears. And then we talked about my losses and my grief. And the more we talked, the more I look forward to seeing him. For the first time in years I began to feel comfortable inside my skin.

I was still depressed so I went back to my psychiatrist and we tried again-this time with a different family of medication. This time I was able to tolerate a tiny dose. But between my therapy, the medication, staying in close contact with people who love to me, and tincture of time, my depression improved.

And then a few years later, like herpes or a cousin you hate, the depression returned. But this time, I knew early on that this nightmare was returning so I got on medication quickly and began talking about what was happening-this time with friends and colleagues just to make sure I wouldn't get it all blocked up because of shame. The depression wasn't as intense and didn't last as long.

Since then, I've experience early feelings of depression, but I knew what to do and I didn't need medication, I just practiced my meditation and especially my self compassion exercises.

Because of my genetics, my history and my trauma, I am at risk. But because of my self compassion, I am confident I will take care of this body/brain with lovingkindness and that I will be okay.

I would like very much to hear your experience and your questions about depression.

Re: Coping with Depression

Posted by Chris on May 13, 2015 10:16 pm

Dear Dr. Dan,

I am not SCI but I am fully disabled in a wheelchair with a paralyzed left leg and assorted other ortho/systemic troubles. It all happend very suddenly at age 42 - about a dozen years ago. After a couple of years of coma, surgeries, rehab, more surgeries and new infections and much more rehab, I was astonished when I came home and discovered just how hot the 10-Alarm Fire was inside my self/psyche/spirit ... my soul. I knew it would be tough but I didn't know it would devastate me so profoundly. Far more than just Major Depression, I was sick at heart. I was always a "fixer" and a "troubleshooter" for problems big and small but I couldn't "fix" what was the root cause of this lame condition or the effect it had on others - everything was burning down all at once. Even though I was very much loved and supported by my wife and mostly grown kids, I still felt terribly alone and very much unworthy (unworthy of their love as I was no longer the provider and protector of the family).

During these early days, I listened to so many others talk about "embracing their disability" (um ... why?) along with those that said "Everything's the same, it's just that now you're in a chair - that's all."  It seemed that the media had just two basic images of the disabled; HAPPY HERO (joyfully skiing down Everest on just half a leg and one index finger) or BITTER BUM (drowing in a bottle of gin or needles-full of heroin and angry as all hell at the world). There were ZERO images of someone like me ... someone who WOULD gladly trade back everything they'd "gained" from their disability to be ABLE-BODIED again ... someone trying like hell to live again but struggling with the all uphill journey constructed on a path made of thorn bushes, poison ivy and angry bees. This reality made me feel even lonelier.

The fact is stereotypes do matter - and they do hurt the individual and the community. We are nothing if not completely informed by the media in 2015 - and it will only get more complete as time passes. I make this statement for all those who believe that stereotyping is only harmful if you let it be harmful - that's not true - and, besides, not everyone is as strong as the person who might blow through the "ICE" of stereotypes.

NOTE: THE FOLLOWING IS THE MAIN POINT OF MY RESPONSE THOUGH IT DOES NOT APPLY TO EVERYONE "TRANSITIONING" FROM ABLE-BODIED TO DIS-ABLED (but I believe it is far more common and usual than one might believe regardless if the disability happened suddenly or if it happened progressively over time).

I want to make one more observation that is more directly related to the person writing about their profoundly injured brother. They asked "What can the family do?"  I offer this (after much consideration). Many loving people see a person struggling with an illness or a loss and they make a conscious decision NOT to engage the sick/grieving/disabled friend or family member about the "SAD MATTER" for two reasons; 1) Distract - they want to engage the afflicted person, no matter how bad and distant their "1,000 YARD STARE" may be, in discussions about anything but what's thundering in the disabled person's mind (namely; how did this happen? why did this happen to me? what the hell am I going to do now? I hate myself so won't everyone hate me now?) and 2) they fear that if they approach and ask "What kind of terribly sad and frightening thoughts are you having today? then the agrieved family member might latch on to that "Weak Frame Of Mind" and keep it forever on the front burner when they really need a strong, healthy mind that is balanced in its thinking.

Oh, there could be a 3rd reason (a selfish reason now prevalent in our modern, efficient world) that is driven by the vast number of people out there who never bring up anything bad for their very own sake. It makes them uncomfortable (duh!) and so they just don't say a word ... even when a death has occured. I fear our youngest generation is doubly-affected as they will have a great number of bad teachers to mimic (parents who are just as uncomfortable with challenging communications) and their ability to communicate interpersonally is on the brink of extinction. I believe the day is coming when Young Millennials will be texting "I'm sorry for your loss" followed by the emoji of a crying "smiley" face and a link to a YOUTUBE clip showing the Top Ten News Anchor Fails of 2009 (you know, to break the tension).

Please, I ask anyone reading this to see the unintended visciousness of the "Don't Engage Philosophy" as it causes far more injury, pain and doubt than you ever intended. When you approach someone in such a broken state (remember, they are grieving over the death of their former selves ... what to them feels like their best self was killed off and no new diet or millionth trip to the gym or all the Zen meditation in the world is going to fix and/or revive that version of themselves, the only version, they've ever known), and by talking about the weather or NOT asking them how they're feeling, you are DIS-affirming every single feeling they're having. Thinking that holding back on good, honest questions and dialogue is going to strengthen them is just naive. NOTHING IS GOING TO STOP a developed human mind from focusing on their disability. They aren't just disabled from physical activies like the Company Softball Tournament. There's a good chance that they'll be affected in nearly EVERY SINGLE PHYSICAL ACTIVITY GOING FORWARD including lovemaking, dressing, playing with a child or a pet, cooking a meal, hugging their mother, building a snowman and even moving their bowels. Unless you're going to tell them that North Korean ICBM's are now flying en mass over the North Pole toward your hometown, there's not a thing that's going to distract a grieving, broken person. At least not now.

I lived with a fairly normal, functioning body for 40 or so years. Suddenly, that all changed. Just how long would you estimate it would take anyone to completely bury what they were ... re-orient, rebuild, restore and rejuvenate? I was told by a counselor that there was an old rule they were taught in school to assume approximately one month's time for each year the patient was able-bodied. That would put me at 40 months or about 3-1/2 years to "get straight." Is that a fair number? Who knows? Who's to say? There couldn't ever really be a hard and fast measurement for this as each of us are our own "weather system" of feelings.


There's a time for everything. I was two weeks into my very first long-term stay in Rehab when a relative of mine visited and saw that I was very sad - forlorn, you might say and without hope. After a short while he told me (all in one heart-warming visit) to "Cut the sh#t" and to "Get my sh%t together."  Fast interpersonal hardball in these early days just isn't the right time and it will cause the person you love to wonder to themselves WHAT IS WRONG WITH ME? On top of everything else that's now screwy about me, I'm obviously a big weakling ... I don't have the mental toughness to overcome this? There's people out there far worse off than me and their para-gliding over the Andes by themselves and I can't stop crying when I see commercials showing families on vacation!!!!!!!  I guarantee that what you're doing by withholding the "real talk" and this, the "right time" is only adding to the mental/emotional burden your loved one is carrying - only slowing down the ability to even begin the healing. Don't let the disability and its frightening future be THE WORLD'S BIGGEST ELEPHANT IN THE WORLD'S SMALLEST ROOM! Talk about it. Cry about it. At the right moment, laugh about it. Hug and touch ... there's a tendency to physically pullback from the newly-injured and that's the wrong move. The body and soul develop a true craving for touch ... flesh on flesh (if you were intimate before, try to touch in a way that reminds this broken-hearted, broken-body that the intimacy continues even without a sexual act of any kind. 

In closing to this very long reply, I can only say (from a personal point of view) that a person who is trying to "locate themselves" after such a profound disintegration of what they were REALLY WANTS TO FEEL SAFE ONCE AGAIN. Do and say the things that make people feel safe, particularly if they're still dancing with an incredibly traumatic issue like their DIS ABILITY. Your REASSURANCE with your words, your gaze, your gestures, your tone of voice and your warm touch is the very best medicine for LIFE.

I hope this is helpful in some small way.
Chris Traynor
LIONHEART Disability Transition
"Awareness & Healing For Disability's Deepest Hurt"

Re: Coping with Depression

Posted by Dan Gottlieb on May 20, 2015 2:29 pm

hi Chris,
thanks so much for your thoughtful reply. Like most of us, you have one hell of a story to tell. Almost all of us, whether we are disabled or have a loved one they are caring for, has been to hell. I often say at lectures that the good news about going to hell is that hot weather is not scary!
It does give us perspective. Unfortunately, for whatever reason, many have difficulty getting out of that very dark space.

Those need a helping hand. A literal hand to put around their shoulders, to listen, to answer questions and to share experience when it's appropriate. Like you said Chris, you felt alone in the world. Almost all of us have. And there have been few things in my life more painful than when I felt alone-less than human.

And now I know my body is broken, I am occasionally anxious and insecure, and yet I am fully human. In many respects, because I have been to hell I have a deeper understanding of what it means to be human. Painful painful lessons.

Thank you so much for your contribution Chris


Re: Coping with Depression

Posted by REAPER on May 21, 2015 4:51 pm

I deal with depression on a daily basis but I believe it is because I miss my family as well as the fact that I'm bored out of my mind and need a job and I don't have any means of transportation of my own and I miss the independence I had when I could walk

Re: Coping with Depression

Posted by Dan Gottlieb on Jun 17, 2015 4:29 pm


I must tell you I am not comfortable with your promoting a company overseas that uses stem cells exclusively. I have looked over the website which indicates you have used stem cells on a large number of disorders for which there is no acceptable research. This includes autism and traumatic brain injury to mention a few.

Stem cell treatment has great promise and has already saved many lives. But to promote it for disorders it cannot help diminishes the value of this product.

Re: Coping with Depression

Posted by Dan Gottlieb on Jan 25, 2018 5:53 pm

Abba, you have made it very clear about why depression must be treated and fairly quickly. Longer it lasts, the harder it is to treat. And it affects not just our minds and our bodies, it affects our loved ones.
So depression, like quadriplegia, is a family problem.
Medication can be helpful for moderate to severe depressions. The kind that makes it difficult to get out of bed or leave the house. The kind where you feel unable to love or unworthy to be loved, where you have no vision of a better future.
Psychotherapies tend to last longer than medications. There are many therapies out there and many are effective depending on the person who is being treated. There is mindfulness-based cognitive behavioral therapy, EMDR, interpersonal therapy, and many more.
But there are additional things that are important parts of treatment. Moving one's body through exercise, yoga or just taking a 10 minute walk every day.
And one more thing…
Years ago, I had a patient with a depression that was unresponsive to medication. And although we had a good working relationship, the depression did not seem to be improving. It was beginning to interfere with her work and asked if I would agree to her taking a leave of absence. I didn't want her to risk her job, but I know having nothing to do makes depression much worse.
So I told her I would sign the paper if she made a commitment to spend 20 hours a week helping sentient beings. Not raising funds, but actually making eye contact. It didn't matter if she was an animal walker, a reader at a preschool or spending time in a nursing, home talking to people.
After a few weeks her depression improved. And then she became responsive to medication. And the more she worked, the more her depression lifted.
Sometimes we can only find out who we are when we devote our time caring for others.

Re: Coping with Depression

Posted by Dan Gottlieb on Feb 1, 2018 1:52 pm

Depression is awful. When it hits, it consumes our entire being; our thoughts, our emotions, and even our body as we are increase risk as depression compromises our immune system.

But there are many things we can do on our own:

since most of our thoughts are about regrets or resentment about the past or worry about the future, we would be much better off spending more time in the present. So meditation per se may or may not be effective, but yoga and/or aerobic exercise could be great. It is important that we get connected to our bodies. In addition, aerobic exercise increases our endorphins which make us feel better.

And speaking of feeling better, too many of us spend too much time worrying about the cause of our depression. And although that's valuable, we need to begin to retrain our brains by engaging in activities that are the opposite of depression. It's important to bring joy into your life. So increase your time spent doing things you enjoy.

And finally, depression forces us to live inside of our heads and focus narrowly on ourselves. This makes depression worse. In my professional experience, people who go out and volunteer in a hands on way, tend to improve more rapidly. No matter what kind of sentient beings  you choose to work with, make sure you have direct contact with them.

And most important… Relationships. Spend more time with people you like/love and trust.

Re: Coping with Depression

Posted by CaptainPike on Jul 11, 2018 10:35 pm

Dan Gottlieb said:
taking a 10 minute walk every day.

This statement THREW ME for a loop, being an actual quadriplegic. I stopped reading here – sometimes we have to guard against depression, voting with the mouse!

Re: Coping with Depression

Posted by Dan Gottlieb on Jul 16, 2018 5:03 pm

I'm sorry that comment upset you. It was taken out of context as I was likely trying to tell someone some non-medical interventions to help with depression. Of course, I would never suggest that to anyone on these pages. Nevertheless, if you can get out in nature and watch the leaves move in the highest trees or count the shades of green or see if the air feels differently than it does in the house or listen to the sounds of nature, that too could contribute to diminishing depression.

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