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Expert Q&A

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How can I break out of my depression, find connections?

Asked by Dominique, Detroit, Michigan

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I have been depressed my whole life, mostly because of my life as a child and because I am unable to connect with people. I have had two really close friends in my life. I am socially inept, and things just blurt out of my mouth. I want to connect with people and stop being so antisocial, but when I try, people just look at me strangely or find some other reason to avoid me. I was misdiagnosed with bipolar because I had extreme moods but that has calmed down significantly as I get older. I want to break out of this but I can't figure out how. Am I doomed to spend the rest of my life as a socially inept outcast? The ironic thing is that I'm a psychology major who wants to go into counseling. Go figure.

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Dominique:

I am sorry to hear about what must have been a rough childhood, based on your brief comment as to why you have been chronically depressed. You would be amazed how many studies have confirmed what you already know from your own experience, which is that adversity early in life programs the human organism, other things being equal, to operate in a way that predisposes toward chronic depression. Increasing evidence suggests that what we experience in childhood, programs how our genes work in ways that can persist into adulthood. At least in animal models of depression this is very clear. They've even shown chemically how mother-love activates a gene that is necessary to stay cool in the face of stress.

The theory would run something like this: Humans are born with brains that are only partly formed. Nature uses early experience as a guide for what type of world an individual is likely to live in for the rest of his or her life and shapes the brain accordingly. If all the signals suggest that life will be violent, unpredictable and dangerous, such as occurs when children are neglected and/or abused, the brain and body are set on chronic hyper-alert as a protective strategy. Areas of the brain that process danger develop a hair trigger, producing anxiety and depression in their wake. Bodily stress systems are chronically hyperactive, which leads to increased inflammation that, in turn, feeds up to the brain and amplifies feelings of anxiety, irritability and depression.

I would be willing to bet that for a life lived in constant danger, these adaptations might prove quite protective. The problem in the modern world is that most of us get a better deal than our childhood programming would lead us to believe. But if our brains and bodies are telling us that the world is a depressing, dangerous place, full of people who cannot be trusted, it's hard to feel good about things, no matter what opportunities life might offer us as adults. And sadly, people tend to create the very circumstances they are "programmed" to see, so that individuals with chronic depression arising from childhood adversity often unconsciously do things to bring the real world in line with their painful expectations.

In your case Dominique you are very fortunate to have had two close friends. If these are people who support you, love you and allow you to bare your soul, then you are ahead of the curve, despite other social struggles you've experienced. Many people don't even have two people in their lives. Studies show that if you have even one true confidant, it can be a tremendous protector against depression and can help overall health.

So the first thing I recommend is that rather than focusing on the social failures, you work to nurture your friendships as best as you can. They can be a powerful source of healing. Not unrelated to this, if you've got the means to do so, I would recommend entering psychotherapy with someone you feel good about. Even if you've tried this before, I would try it again. While antidepressant medications may be of benefit for you, a large study done in part at Emory University, where I work, found that people who were depressed as a result of early abuse/neglect improved much more with psychotherapy than with medications. If you've got a painful story to tell, you need to tell it fully to someone you trust and work through it as best as you can. That is usually the way forward.

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