Rue L. Cromwell on Depression

The following is an excerpt of an email to me from my grandfather, psychiatrist and professor of psychiatry, Rue L. Cromwell, in response to my blog post: How to Get Out of Bed in the Midst of Depression.

A first distinction to make is whether your depression is situational or is an enduring proneness to mood breakdown. If situational, then becoming financially stable, having the baby, or otherwise dealing with the preoccupation would solve the problem. Alternatively, I would consider carefully the possibility you are prone to this problem. In the future some other experience would sink your mood. Episode after episode. It is often beneficial to assume the latter view.

As a clinical psychologist, the quick answer of choice is psychotherapy and antidepressant drugs. But that answer is not enough. Psychotherapy is both time-intensive and cost-intensive.  Antidepressants are focused on specific neurotransmitters and can have annoying side effects like constipation. Let me give a short tutorial on neurotransmitters (taken from my book Being Human: Human Being (2010)) and then a word about Saint John’s Wort (SJW).

Three neurotransmitters in the brain appear to operate in a cycle to conduct our daily business of which we are aware. Epinephrine allows us to scan information about our current status. Then Dopamine allows us to carry out the thought and action to do something about this information (pertaining to what we are desiring and what we are avoiding). Then serotonin allows us to size it up and survey whether we are moving on track with the right decisions to resolve the problem and to forge ahead to the next step. And so this cycle repeats itself over and over. Scan to get the info, think and do something about it. Appraise the result, reset, and move ahead.

Some antidepressant drugs are tricyclic and bolster the epinephrine. Some are serotonin specific and give us the ability to appraise and move ahead to rewards in life.

There is a dietary supplement (SJW), sold in the drug store or health foods store that blocks the reuptake (i.e., maintains a satisfactory level of) all three of these neurotransmitters:  epinephrine, dopamine, and serotonin. In Europe SJW is called Johanneskraut, and five times as many people use it as in the United States. We think that the important action is upon serotonin. It has no side effects.

Let me give my own personal experience from my “bad periods” years ago. Forget about the term depression. Think of the moment when I wake up in the morning and I know the moment my eyes are open that is going to be a bad day and I fear bed things will happen. At that moment I am on an action dilemma: MOVE AHEAD, get out of bed, vs. remain immobile, withdraw, step back, give up. The serotonin is what affects this toggle switch to move or don’t move.

I used the first mood awareness when opening my eyes to measure my psychological state and the effect of the SJW on my psychological state. With most people it takes about two weeks to see a difference. With me it was only a day or two. When I opened my eyes I felt like charging away and getting things done.

Another thing about that critical moment of eye opening and you are in between move and don’t move. Depending upon the path you take, a series of events develop. If the serotonin is plentiful enough, you move ahead, get out of bed, and soon you will be feeling good about getting things done. If you are low on serotonin then you hesitate. You don’t act. You feel no accomplishment. You feel a failure and a loser. And the path continues. But it all starts with that one little force on the go vs. doesn’t go switch.

I have taken one SJW pill a day for decades and I have not had a down period during that time.

I hope this helps. Of course, the underlying basis of your problem may be completely different, but your comment about getting out of bed suggests that this is worth trying.

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