The Economy of Melancholy and 10 Ways to Battle It

Harper'sIn the May 2007 issue of Harper’s Magazine (which should be on newsstands shortly – I am a subscriber), a fascinating cover article appears entitled “Manufacturing Depression: A Journey into the Economy of Melancholy.” Written by Gary Greenberg, a psychotherapist, the article’s main idea is that true depression is actually an extremely rare event and the prevalence of depression in America is manufactured.

So why are so many Americans “depressed,” at least in the eyes of modern medicine?

First, most of the people who are currently diagnosed as depressed are actually just melancholic, which is a normal, healthy mood. Often, people who are strongly melancholic a good deal of the time are also not depressed – they merely have other factors in their life that are contributing to a melancholic mood. I admit that I often am in a melancholic mood and have wondered if I am depressed, but often doing certain activities repeatedly will improve the mood over time, so this part of the article seems highly true to me.

Second, the tests for identifying the depressed and also measuring the progress of the depressed rely on each other for statistical validity. From the article:

The way that these researchers decide whether these tests can accurately indicate depression is by correlating responses on them to reponses on tests already known to measure depression – a good idea, unless there is no anchor on the end of the chain, in which case you may have created a self-validating semiotic monster.

In other words, the only evidence that a test for depression actually indicates depression is that another pre-existing test says so.

Third, in FDA clinical trials, antidepressants only make a very small difference in treating depression, as compared to placebos. Another quote from the article:

The advantage of antidepressants over placebos in those trials [FDA trials for Celexa] was an average of two points on the HAM-D [a very common test for registering improvement in treating depression], a result that could be achieved if the patient ate and slept better. The average improvement in antidepressant clinical trials is just over ten points, which means, according to Irving Kirsch, a University of Connecticut psychologist, that nearly 80 percent of the drug effect is actually a placebo.

Given that antidepressants can easily cost as much as $3 a pill, this is a pretty significant article worth reading for people who are suffering from clinically diagnosed depression. The questions raised by this article, written in a highly reputable and fact-checked publication, are serious enough that a person taking antidepressants should ask some serious questions about what they’re really taking – and why.

While I am the last person to claim any sort of medical expertise, I do know what it feels like to exhibit many of the symptoms of depression and my own experience showed me that making some lifestyle changes and committing myself to them enabled me to move away from a constant state of melancholy into a much happier life. The tips below are no substitute for medical advice, but if you are concerned about feeling depressed, here are ten tips for battling a melancholic mood with free or nearly free things that may help.

Ten (Frugal) Tips for Battling Melancholy

1. Have fun

Do something that can completely take you away from the feelings of your everyday routine. Turn off your cell phone for a few hours and dive into something with your whole heart. For me, this is actually the library, or else a long walk in the wilderness. Because I’m cut off from the routine and the pressures that go with it, I come back feeling genuinely reinvigorated and ready to meet the challenges of life.

2. Eat well

Make sure you’re getting enough fruits and vegetables in your diet – and, no, the lettuce on your fast food hamburger doesn’t count. If you don’t prepare food for yourself, try eating food at restaurants that prepare well-balanced meals.

3. Get some exercise

If you’re out of shape, just go for a walk around the block. Stretch yourself out a time or two a day by flexing all of your joints as far as you can. A strong exercise regimen is a big commitment for some, but anyone can take the time to stretch and go for a walk.

4. Drink lots of water

The USDA recommends eight 8 ounce glasses of water a day, not soda or beer or anything else. Turn on your tap and drink – it’s really inexpensive and one of the best things you can do for yourself.

5. Associate with people that you primarily associated with when you were happy

In other words, try to reconnect with old friends and family members. Sometimes, you’ll discover that your social crowd is sometimes responsible for your negative feelings – and if that’s the case, you need to make some changes to your social life.

6. Set small goals – and reach them

Don’t go home and sit around in a state of sadness because you can’t accomplish anything. Set a very small goal that you can reach in an hour or two, then just try to do it. When you’re able to do that, try easing into a productivity plan like GTD which anyone can use and is very effective at making you feel really productive. A sense of achievement is one of life’s greatest natural boosts.

7. Get a normal amount of sleep

For most people, a normal night of sleep is between seven and ten hours. If you’re getting significantly less or significantly more than this, try to adjust your sleep so that you’re in that range.

8. Get regular massages

My wife and I give each other massages and it may in fact be the most consistent long-term mood elevator in my life. If you don’t have a significant other or a close friend who can give you a gentle massage, it may be worth saving up nickels and dimes to get a professional one.

9. Don’t expect dramatic mood improvement overnight

If you walk around the block, get an endorphin rush, and use that rush to do four or five things that have been nagging you, and suddenly you feel really good, don’t despair if the sadness returns. An overall mood, especially an entrenched one, doesn’t change overnight. Try doing more of the positive things that made you feel better instead.

10. Go to sleep thinking about the positive things you did today, not the negative ones

Make it a goal to do at least one positive thing in a day – walking around the block, going to work and getting your tasks done, sweeping the kitchen floor, getting through your GTD inbox, whatever it takes – and then think about that success as you go to sleep at night. It gives your mind something good to focus on as you wind down in the evening and drift off to dreamland.

If it is true that you are merely suffering from melancholy and not depression, some combination of these activities can almost assuredly lift your mood – and save you the tremendous cost of professional help and antidepressants. However, if these do not help, please seek a medical professional.

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  1. Hazzard says:

    I find that the source of my stress (which causes me to feel a bit depressed) is mostly about being a good provider and the pressures that come with it. When I find myself not liking my job but worrying that if I didn’t have it all of our finances could come tumbling down etc, I try to remember that I live in one of the most prosperous countries in the world and that the vast majority of human beings on the planet would kill to be in my place.

    It seems that if I don’t pull myself back from the day to day grind and look at the larger picture, I can easily get dragged down in to the somewhat inconsequential stresses that are more fabricated than anything.

  2. Michelle says:

    I’m going through this right now. Am I anxious and depressed because of a chronic neurological condition, or is it just that I don’t like my job and I’m not sure if any of the alternatives will work? (Long story, as they all are.)

    The funny thing is, I probably have enough slack in my current circumstances to make changes and still be okay, but I’m not sure it’s the right thing to do. Time will tell… In the meantime, thanks for the reminder that it’s not just me.

  3. Sharon says:

    I’m betting that you will be getting a lot of posts about this, but I for one agree with you. My classic example is my niece who called me about of her friend(19 yrs old) who had lost a fiancee to heart attack(congenital issue) less than a month before the wedding. My niece was very concerned about her, because her friend had cried every day in the week since he had died.
    I thought that was a very appropriate response. Why do we think we need to run to a doctor to medicate ourselves? Yes, if after a month she was still crying everyday, I might begin to be concerned. (Begin being the operative word) If in that month nothing had made her smile at least briefly, I might be concerned. But yes, you get to cry for a while…Sharon

  4. Vincent says:

    I have a healthy mistrust of the pharmaceutical industry in general, especially with things like this. I’ve been familiar with melancholy (my mom wants me to get checked for depression but I know it’s not that) for a couple of years now, and all the things you mentioned always cheer me up. Especially exercise. If I’m feeling really bad, I hop on my bike and go for a ride and by the time I’m done I feel great.

    Thanks for another great post–this actually helped me get motivated today.

  5. amanda says:

    I saw my sister dramatically improve after taking anti depressants. While I understand that a lot of people don’t really need them, they can be helpful for those who really do have some sort of chemical imbalance. But I see your point about doing “something” – I used to see a therapist and I definitely feel like sessions with my personal trainer often improve my mood far more than a therapy session ever did! Same for massage. But then again I think I was just melancholic, not like my sister who was truly depressed.

  6. Trent Hamm Trent says:

    Amanda: the point of the Harper’s article is that in most cases, people that are called depressed are actually just melancholic. Based on that premise, my advice is that before you commit to antidepressants, try some things that can naturally lift your mood as it can save a lot of money and effort.

  7. plonkee says:

    It also has to be said that if you are truly depressed, eating better, sleeping better, etc are not going to be bad for you in any case so its worth giving them a try.

  8. KMC says:

    It’s pretty apparent from the comments that none of you have ever suffered from depression. As someone who does, I find it very frustrating when people poo-poo the idea of true depression. Trent, I realize the thesis of the article is that most (not all) cases are not truly depression. This point is debatable, but I can accept the opinion. However, please don’t make the mistake of minimizing depression. Eating better, sleeping better, and ‘having fun’ are not legitimate treatment in my opinion. Someone who has never been depressed simply cannot understand the feeling.

  9. I take an medicine that is for both anti-anxiety and anti-depression and it has definitely worked for me. It’s hard to explain except I just don’t have as many negative thoughts and overwhelming feelings. For me, it’s definitely worth the money.

    I tried therapy and self-help books. I was active and social. But finally I got on the stuff and phew, I can’t tell you how relieved I am.

    I will say that it took awhile to feel like this. It doesn’t happen overnight, and my particular medication wouldn’t work for everyone. You have to find the one that works for you.

  10. Lala says:

    I’m going to second Amanda and KMC. Also this article was unusual in that -not as much research went into this.

    First, what is depression? It is not one or two symptoms (you feel sad, low energy) – check out the DSM IV for criteria – you need to meet several symptoms and over a certain period (and no, not after a relative died.

    Second, the info that the Harper article cites (placebo versus meds) – sadly, yes many studies have this problem because they only test patients with mild depression and exclude patients with suicide ideation, etc. I could probably test patients with mild migraines and also generate effects for the placebo.

    However, there is new data over the last year – trials that actually used patients with moderate-to-severe depression (the star*D trials) – there are several peer reviewed papers published on this topic, you can find them in pubmed.

  11. SJ says:

    Depression is real and medication can help – my father was definitely helped by medication. That said, I have cousins who have been treated with antidepressants as small children who would have benefited more from counseling.

    Another point I want to make is that, especially for women, depression can be an indication of thryoid hormone problems. 18 months ago I was depressed, and just thought I was depressed because I was tired and hated my job. Instead it turned out that my thyroid had completely stopped working. A simple blood test can diagnose these problems, and hormone replacement can fix it.

  12. Mrs L says:

    Why is there an idea that depressed people are desperate to try medication without trying other methods first? In my experience, it is quite the opposite. Most depressed people (myself, my mother, my ex-husband, several friends) resist very strongly the suggestions of the doctor or anyone else to try anti-depressants. They are afraid it will ‘change who I am’. They insist that if they try harder, they can get over it. They remind themselves of all the reasons they should be feeling better, and all the other people in the world who have much worse situations. Above all, they feel horribly guilty. They feel like failures. Telling them that ‘Oh, and you’re costing your family too much money being depressed’ is not the way to help. I don’t know a single person who agreed to take anti-depressants as anything other than a last resort.

    Depression is a real disease caused by a real chemical imbalance in the body’s neurotransmitters. Some people can manage it without medication, just as some diabetics can manage their disease without insulin. But some people need help. Please don’t make it any harder for them to ask for that help.

  13. Mitch says:

    As Plonkee noted, everything on the list is probably healthy for everyone to do. However, if you’re depressed, you may not be physically able to have fun (anhedonia is a huge problem that is hard to explain to other people), you may not be able to hear or understand the positive people in your life (and the dissonance can make you feel like a fraud), and your appetite and sleep may be pretty disturbed. If this is going on for a while, you should probably at least check on some counseling, and if you are bad enough (high anxiety, suicidal ideation, &c), it may be worth starting on meds right away (each one can take up to eight weeks to kick in, and you may have to try several to find one that works). Meds do have expenses and side effects, so they are worth it only if they are what makes it possible to live your life.

    I have two things to note. One, I do not have a Harper’s subscription, but of course the psychometric tests have to rely on each other for statistical validity. We are starting to see depressive indicators in neuroimaging and neurobiology, but this is not yet diagnostic. It is not like there are antibodies we can just check for and cross-confirm that way. The paper tests tend to have construct validity according to the psychodynamic theories. This may not be relevant to the Mr. Greenberg; one almost gets the impression that the quotation tries to deny the existence of depression altogether. It would be interesting to note (from a bias standpoint) what his therapeutic and philosophical/religious slants are.

    Two, Americans seem to adopt psychological terms for their own use, especially for insults (he’s retarded) but also descriptively (depressed instead of “blue,” crazy instead of unusual). This is confusing enough, but even clinically the words are pretty stretchy. For example, even DSM gives modifiers for mild, moderate, and severe depression along the continuum, with axes for other contributors to the problem. In short, my depression is not your depression, is not their depression. I think it’s true that pharma marketing tends to encourage thinking that medication is the first answer for everything, but it is still true that medication is part of the answer for some people, and as TSD notes above, in that case you should talk to a professional (and note that internists often do not have much training in these areas).

  14. Paula says:

    Mrs. L is absolutely right. Aside from the idea that the drugs will change you (and for those of us with major depression, it does…for the better), there are side effects, which can cause all kinds of problems, including making the depression worse. I have run the complete gamut from melancholy to major chronic depression, and “melancholy” is a problem IF it lasts for more than 2 weeks without a letup, and you have tried all of the suggestions from the article.

  15. I can confirm the thesis through personal experience. A few months into talk therapy, my therapist despaired of being able to provide significant help w/o me being on anti-depressants.

    Schooled from a young age to medicate as a last resort rather than a matter of course, I educated myself on the symptoms of depression and the possible ways of alleviating those symptoms naturally. I implemented many of the suggestions you list here, and fortunately, they did *enough* of the trick that talk therapy could do the rest.

    The one thing you don’t explicitly mention which I think is a must is reducing dependence on chemical stimulants and depressants. I dramatically cut back on my caffeine and alcohol consumption, both of which had crept up (and it makes sense that they crept up hand in hand). Drinking a lot of water helps, but cutting out the crap is integral for those of us who have grown dependent.

  16. lorax says:

    I agree that anti-depressants are overprescribed (actually my opinion doesn’t count, but Nortin Hadler MD’s does). They shouldn’t be handed out like candy.

    On the other hand, I have seen the drugs make a huge difference in those with clinical depression. I hope the article draws a distinction between those who are well and those who need the drugs because they are ill.

  17. Rebecca says:

    I wanted to underscore the point made earlier by Mitch. Frequently, when you are depressed, these healthy activities that we should try in response to melancholy or depression–positive interactions, socializing, eating and sleeping better–are difficult to impossible for someone who is depressed. As someone who has struggled with depression for years, when I’m not on medication, no matter how much I know these activities will make me feel better, I have an extraordinarily difficult time doing them. Its only when I’m on an appropriate medication that I have the motivation and desire to do them.

    What I’ve discovered is that antidepressants don’t replace “melancholy me” with a strange, twitchy “un-me”. I’m still melancholy, I still have negative emotions. The medication simply helps me respond more appropriately, as well as allowing me to live my life with all it’s ups and downs.

  18. Ernst says:

    1. There is real factual depression, but it never ever effects the 20 % of the population now taking some sort of mood enhancer
    2. Life is up and down and down and up. There can be no light without shadow and no shadow without light. Feeling depressed and dejected are totally normal conditions. At least if they are temporal.
    3. I´ve had my share of depressions. Fortunately I did the same things like Simple Dollar. Patience is very important. If you´re down the past and the future looks black. If you´re up it´s vice versa. Always remember, life is not meant to be one long rosy patch. The corporations want to sell us this crap so we consume more. Life is hard and the best things come from exertion. It´s very hard to get up if you´re down and go for a walk or a ride on a bike. But it helps. Guaranteed!!!!!!
    My beloved sister died in a state of deep depression. It was accident cum suicide. She took loads of medication. Now we know that some of the medication has in some patients the exact opposite effect………
    One last word: There´s clinical depression allright and you need to treat it with any means available. But it´s ridiculous what people nowadays regard as such. The drug dealers i.e. big pharma is laughing all the way to the bank.
    Finally the profits are really staggering. So much so that they pay advocacy groups supposedly consisting of patients….
    One last advice: Do get the next “Harpers”

  19. Jennifer says:

    I am excited to see a blog that questions some common assumptions of our current state of pharmacuetical relations in this country. (I would probably enjoy the article in Harpers as well). I agree with the other comments regarding TRUE, clinical depression – it exists and there is a need/necessity for medication to treat it. What frustrates me is a society that assumes we must be feeling happy/social/all is well or something is wrong.

    For example a friend I knew had marital problems. She and her husband went to marriage counseling. Within the 1st 2 counseling appointment, my friend was advised to go on Prozac because she was “depressed”. She and her husband changed counselors and as of this writing (5 years later and no prozac) they are happily still married.

    I am convinced that Television and advertising have a great deal to do with our society’s rejection of melancholy seasons inour lives. Celebrate Turn off the TV week by doing some of the things suggested on the article!!!

    One additional thing I have done to help me out of my melancholy days — I write a success journal… a book where I can write anything, as long as it is a success. No analyzing or rationalizing about how it might not be a true sucess by some other measure is not allowed. It’s great to be able to go back and read through it (and I’ve only been keeping it for about 2 months)

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