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November 1981

High on Waves

Editorial

If You Want To Be Victorious First Conquer the World Within
Swami Satyananda Saraswati, Gyan Mandir Military Centre, Sagar, March 1979

Yoga Research & Therapy

Benefits of Yoga in the Psychotherapeutic Situation
Dr. Swami Shankardevananda Saraswati, MB, BS (Syd)

Who is Handicapped Anyway
Dr. Usha Sundaram (Dharma Keerthi), Bangalore

Depression
Dr. Swami Karmananda Saraswati, MB, BS (Syd)

Yoga for Unemployed Youth
Swami Swayamjyoti Saraswati

What is BSY
Ravi Marphatia, B.Sc. (Hon.), B.Sc. (Tech.), C.Eng., A.R.I.C, A.M.I., Chem.E. (London); Bombay

Yoga For a Busy Day in a Restless Town
Dr. K. Nespor, Czechoslovakia

The Reunion of Physics and Metaphysics
Daniel Hawley, Ph.D., USA

Yoga Nidra and Indian Art
Dr. D. Bhattacharya, Calcutta

Tension
Swami Amritananda Saraswati

Evolutionary Role of Karma
Swami Satyananda Saraswati



Depression

Dr. Swami Karmananda Saraswati, MB, BS (Syd)

Depression is a psychosomatic disorder which afflicts the whole physical and mental structure. The nervous system, the network of endocrine glands, the muscular system of the body, sleep patterns and appetite are all disrupted. A recent study revealed that 2 to 4% of all Americans require medical treatment for depression every year, and that 1 in 8 will suffer from severe depression at some stage in life. Studies from European countries and Australia present similar findings. Clearly, depression is one of the most common illnesses, although it sometimes remains undiagnosed for years. According to many doctors, depression, in its many physical and mental guises, is the most common problem encountered in medical practice. Nor is the impact of this disease on the sufferer alone, but it has far reaching effects on family members, friends and colleagues as well.

Presentation

Depression is equally common in both women and men. The most likely sufferers belong to two groups:

  1. Men in retirement;
  2. Women undergoing the menopause or 'change of life'. However, depression can surface at any age, often in young people, for example, college students and young housewives.

Depression may present itself in diverse ways. It may be hidden or masked, both to patient and doctor. Many people deny that they are depressed because they do not feel 'sad', but the disorder has far more diverse symptoms than a simple lowering of mood. Frequently it presents itself as a physical illness which is vague and difficult to explain on purely physical grounds.

Some of the common symptoms of depressive illness are listed below, but not all these features will be present in every depressed patient.

  1. Loneliness. The person feels that no one else can know exactly how wretched he is feeling. This persistent lowering of mood is one of the most characteristic features.
  2. Insomnia. There is always a disturbance in sleep pattern. Sometimes there is difficulty getting off to sleep; but more often the complaint is of waking in the night or early morning and being unable to go off to sleep again. Sometimes a depressed person will sleep for 12 or more hours and still wake un-refreshed.
  3. Lack of energy or overwhelming physical tiredness. Depressed persons are easily fatigued, even if just sitting in a chair all day.
  4. Loss of appetite and weight.
  5. Increased irritability. The depressed person is usually irritable. Small things annoy him. He is aware that the irritability is unjustified, but can do nothing about it.
  6. Loss of memory and concentration power.
  7. Loss of interest in life. Things are put off until tomorrow, and even simple tasks become insurmountable difficulties.
  8. Excessive worrying. There is difficulty in making decisions, even very simple ones such as what clothes to wear.
  9. Anxious and agitated behaviour often masks underlying depression. When anxiety is eliminated either by tranquillizing drugs or by yogic practices, the depression manifests itself fully.
  10. There are usually a variety of physical ailments, such as aches and pains, constipation or indigestion. It is necessary to be alert to the possibility of depression as a primary cause of diverse minor complaint's.
  11. Slowness to act, and slowness of body movements, speech, etc. This is termed psycho-motor retardation.
  12. Feelings of self-pity and hopelessness may arise as the depression deepens. The person feels that he is not appreciated and that no one really cares. The depressed person begins to think, 'They would be better off without me.' This is when thoughts of suicide begin to arise. Thoughts of dying and suicide are common.

Causes of depression

Three distinct types of depression reactions are recognized, but they frequently complicate one another.

  1. Biologically based depression
    This includes endogenous depression and manic depression. The onset of this type of depression is unrelated to external or environmental stress factors. However, it can frequently be traced to hormonal disturbances, especially imbalance of the pituitary, thyroid and reproductive hormones in the blood. Both underactive thyroid and menopause are prominent causes of depression.
    A state of depression commonly follows diseases such as influenza and hepatitis, and sometimes childbirth in women.
    Depression is also a symptom of some physical disorders such as anaemia and electrolyte imbalance.
  2. Reactive depression
    This is a state of depression which descends following some form of environmental stress in the life of the sufferer. Disappointment in life is a common precipitating factor. The particular circumstances which lead on to depression, for one person depend on his individual personality, strengths and weaknesses. Common precipitating causes may include unfulfillment in marriage, failure of business enterprise, academic under-achievement or failure, response to the pain and disability of a physical illness, etc. This form of depression is especially common following sudden and unexpected failure in life.
  3. Drug-induced depression
    This is a form of depression which is only now being widely recognized. It has become far more common in recent years as many more powerful drugs and medicines are being prescribed. A wide variety of drugs may produce depression, including:
    • Anti-hypertensive agents (prescribed for blood pressure): clonidine, guanethidine, methyl-dopa, propanolol and reserpine.
    • Sedatives and anti-anxiety drugs including barbiturates, chloral hydrate and alcohol. Depression frequently accompanies alcohol addiction.
    • Anti-psychotic drugs such as fluphenazine.
    • Stimulants and appetite suppressant drugs: amphetamines, fenfluramine, phenmetrazine.
    • Others: Indomethacin prescribed for arthritis. Co-trimethoxazole- for urinary and other infections. Sulphonamides - for dysentery and other infections. Levodopa- for Parkinson's disease. Oral contraceptives- for prevention of pregnancy. Initial treatment is to discontinue or replace the medication and see if the depression lifts.

Normal and abnormal depression

A depressive reaction is considered to be a normal event following a loss in life. It may last for 8 to 10 weeks and does not require medical treatment. When it persists beyond this, it may become a depressive illness. In the recently bereaved, who have been deprived of a close relative or family member, insomnia, sadness, despair, anger, guilt, restlessness and increased physical complaints are part of the normal grieving reaction. These persist for a few months. If symptoms continue and an aura of hopelessness and sadness continues to surround the sufferer, then abnormal depressive illness is present.

Such a depressive illness usually runs a course of between 6 and 12 months. It may become chronic and last for years.

Medical management of depression

Medical management of depression is largely symptomatic at the present time. Doctors rely on anti-depressant drugs including the tricyclic anti-depressants and the monoamine oxidase inhibitor group, to temporarily elevate the patient's mood. However, soon after these drugs are discontinued, the depression usually descends as before. Also, the drugs have troublesome side-effects which increase with time of usage.

Severe depression may be prescribed electroconvulsive shock therapy (E.C.T.) in which a short, high-voltage electrical shock is applied to the brain. This is a major procedure which profoundly alters the state of the patient's memory, recall and other capacities, at least for some days or weeks. It offers temporary relief of overwhelming depression, and is often the only remedy for severely depressed patients in whom suicide seems a real and likely possibility. It has the advantage that the depressive mood is elevated immediately, whereas anti-depressant drugs must be taken for 3 weeks before reliable blood levels are attained and elevation of depression occurs. Psychotherapy has also been utilized for some depressed patients, but with limited success. At present, medical cure of depressive illness remains elusive.

Yogic management of depression

Yogic practices effectively alleviate depression. Even the deepest depressive states and illnesses respond to yogic therapy, but this should be undertaken during a residential stay in an ashram where qualified yogic therapy is available.

Both asanas and pranayamas are taught, concentrating on those practices which build up levels of physical and vital energy.

Anti-depressant drugs are discontinued and the sufferer is engaged in karma yoga. This is the second fundamental practice learned by sufferers from depression.

According to yogic science, depression occurs when there is no objective in life and no engagement for the mind. It occurs especially after retirement, when many people do not know how to fill in the extra time because they have no social, cultural, artistic or spiritual interests. So, they just end up sitting idly, wasting time. But how long can one just keep sitting? It may go on for one or two years, but during this time, the mental faculties are undergoing a process of degeneration through disuse and the nerves themselves begin to atrophy. This is nervous depression.

If such a person comes to an ashram, practices some specific asanas and pranayamas in the morning, and karma yoga during the day, they invariably pick up and feel fine within a few days. Their symptoms go into a rapid remission. As therapy continues, the sufferer gradually learns to recognize and cope with depression, and counteracts its influence upon his daily behaviour. In the ashram, he is given a busy schedule and a lot of different tasks, according to his capacities and attributes. He is given a lot of worries and responsibilities but not of his own. It is disinterested service, performed without personal motive, without attachment. The tasks are performed with all sincerity, but. they do not affect the deeper realms of the personal emotions and spirit. In this way depression is transcended in ashram life; and physical, mental and emotional energies are awakened and restored. Karma yoga is a major part of the therapy program for depression.

Yogic program for depressive illnesses

- Asana: Pawanmuktasana parts I and II, shakti bandha series, surya namaskara, trikonasana, vajrasana, shashankasana, bhujangasana, shashank-bhujangasana, paschimottanasana, sarvangasana, halasana, utthanasana, yoga mudra, matsyasana.
- Pranayama: nadi shodhana, bhastrika with kumbhaka and maha bandha, brahmari.
- Hatha yoga: neti kriya, kunjal kriya, laghoo shankhaprakshalana, agnisar kriya, uddiyana bandha, nauli kriya.
- Mudras and bandhas: moola bandha (contraction and release of perineal body) 25 times. Maha mudra and maha bheda mudra.

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