Beyond Blue

Beyond Blue

Neither Blame Nor Indulge: Medication, Therapy, Mindfulness, and Rest

calm woman.jpegAndrew Solomon offers this brilliant paragraph in his classic, “The Noonday Demon” about the relationship between medication and therapy, when we should make Herculean efforts to break free from depression or rather lie listless on our beds as victims of a loathsome illness:

The conflict between psychodynamic therapy and medication is ultimately a conflict on moral grounds; we tend categorically to assume that if the problem is responsive to psychotherapeutic dialogue, it is a problem you should be able to overcome with simple rigor, while a problem responsive to the ingestion of chemicals is not your fault and requires no rigor of you. It is true both that very little depression is entirely the fault of the sufferer, and that almost all depression can be ameliorated with rigor. Antidepressants help those who help themselves. If you push yourself too hard, you will make yourself worse, but you must push hard enough if you really want to get out. Medication and therapy are tools to be used as necessary. Neither blame more indulge yourself.


I’m indebted to him for explaining it to me that way because I’ve always been confused by the relationship between meds and therapy, antidepressants and cognitive-behavioral techniques … how much I need of one versus the other, and wondering if we all need a different mixture, or if a standard Package #3 could cover most depressives.

Solomon’s words make so much sense, but given that, when clinically depressed, we have to make an assessment when the perspective of ourselves and of our disorder is jaded, it helps to have our therapist or psychiatrist tell us when we need to work it a tad more–become more aware of our negative intrusive thoughts and apply mindfulness techniques to them–and when such efforts are fruitless and perhaps even harmful.


I’ve been in this trap for a few months. Just as I think I’m ready to apply some mindfulness techniques to my very loud brain, and to help myself along in recovery, I will read a piece about how best to start and come away feeling worse, like a total failure for not being able to harness the wild animals in my limbic system.

I talked to Dr. Smith this morning about my struggle and she read aloud this paragraph from the introduction of “The Mindful Way through Depression” by Mark Williams, John Teasdale, Zindel Segal, and Jon Kabat-Zinn:

It may be wise not to undertake the entire program while in the midst of an episode of clinical depression. Current evidence suggests that it may be prudent to wait until you have gotten the necessary help in climbing out of the depths and are able to approach this new way of working with your thoughts and feelings, with your mind and spirit unburdened by the crushing weight of acute depression.


I was so relieved to read that because I have been a long fan of Jon Kabat-Zinn’s work and want to implement it into my recovery program. But lately, when I try the breathing techniques or the body scan or the other methods to tame the bastards in my head, I come away feeling even more frustrated.

I’m starting to understand that, perhaps even more important than giving me the right prescription, is Dr. Smith’s ability to tell me when I’m clinically depressed. Because sometimes I don’t even know, especially if it arrives gradually like it has in the last few months. From the form I fill out at the beginning of her session to the way in which I express myself, she can determine where I am in the cycle of depression or mania or remission.


There is a time to throw everything you have at a mood disorder. And there is a time to hold back on all the brain exercises.

For me, that time would be now.

Illustration by Anya Getter.

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  • Jarrod@ Optimistic Journey

    This makes since that Anti-Depressants work best for those who help themselves. In conjunction with therapy and a will to overcome, it’s worth using them.
    Thanks for sharing, Therese!!

  • Margaret

    Sometimes, the most Healing thing we can do for ourselves is take a nap.

  • Lisa

    I so agree with both Jarrod and Margaret. I am really learning about the “ebb and flow” of my depression. I am realizing that it really is ok to let the depression just lie, and take a nap. There are definitely times when your brain just needs to assimilate what it’s going through. Then I can practice the mindfulness when I have an upward “flow” through the depression. My daughter’s therapist says that our progress is more like a spiral that starts low and then cycles through smaller highs and lows as we progress in our way through the depression.
    The longer I live the more I realize that knowing your own mind, no matter how scary that is at times, and trusting your own instincts is the most important skill to learn in life.
    Thanks for exposing your mind to those who need it, desperately. It helps if nothing else to see that others are coming to the same conclusions as I have :)

  • Cheryl

    I’m glad to see you using the word remission. I got somewhat of a negative reaction when I decided to use the term.

  • Bill White

    Damn, you write well, Therese. I really enjoyed this piece, as I typically do most anything you write. I’ve been discussing much the same philosophy. I simply refer to it as making it a mission “not to lose the forest for the trees.” We can become so focused upon the minutia of strategies and techniques that we lose perspective on the big picture – as you said, to the point where we become somewhat egosyntonic re our situation – we don’t even know we’re depressed, manic, obsessing, behaving compulsively, etc. I continue to think about you and wish you well as you endure and conquer your current shtuff.

  • Ana

    Sometimes things overwhelm me where I need to just take a nap to “escape”. Othertimes, I do push a bit to keep going because it is necessary as a MOM. I cannot totally indulge myself so finding a moderate level of meds and therapy and action seems to work. I keep wondering when is it going to be my turn (I am dealing with a husband and a child dealing with issues too). But that is the selfish thoughts that fly through my brain at times of weakness. Then I get going again and try again. I worry about today, just making it through today. When I wake up tomorrow is soon enough to worry about tomorrow. :)

  • Judy

    Dear Therese,
    Thank you for sharing so generously and bravely. You have put words to my own experience. My own roller coaster ride with depression is so frustrating. I will read or hear of something that seems as though it would be helpful but if I try it at the wrong time, it’s like doing a 40 yard dash in a 30 yard gym…it doesn’t end very well. My prayers are with you and all of us on this very strange ride.

  • Lisa

    It’s all about balance. Thanks for such a simple reminder. Sometimes we need to just step back and say I need a nap. Or I need to stop trying so hard. Then when I feel rested I’ll work on it some more. Get your blood iron levels tested and your thyroid too. I found both mine were flat as a pancake but put off being tested thinking it was just the depression. There is always something you can do to feel better. Sometimes less is more. And sometimes you need to push through the pain.

  • LH

    I am in the middle of reading your book “Beyond Blue”. You are a great writer and you book is awesome. I can relate so well to most of what you write .. Catholic girl from Dayton, Kick Line (at chs), and in the midst of being dx with bipolar disorder, along with the depression and anxiety. I am also a proud memeber of a twelve step program. Thank you Therese for letting us know we are not alone.

  • D

    Hat’s off to you! You have put into words what I have been living for sometime now. It is truely sad that “depression” is so misunderstood. I deal with a co-worker, who can be so supportive, but feels that I don’t try hard enough or I should throw myself into my work; and if I don’t follow the advise given then I should just shutup and deal with it.
    I find it easier to just “shut down” and not talk rather than it caught in my own loop going over the same thing over and over.
    I have found that I can come to this site and find something to read and uplift myself.
    Thank you for the wonderful articles as they seem to give me the “lift” I need until I can get with my “support team that I have built”!!

  • Miriam

    Here’s a possibly useful thought:
    The term used for depicting depression is often ‘riding a roller-coaster’.
    The problem with this term is that it evokes a passive image; we are helplessly riding the ups and downs of mood.
    Instead, using with the analogy of ‘surfing the waves’ offers some useful lessons.
    First is that the ride through depression is interactive between the person and the condition – we are not passive. The condition affects us, and we affect the condition. This is true even when we are purposefully practicing ‘non-doing’.
    The second lesson is that just as one would never try to barrel through a large wave, so it makes practical sense when one is riding a wave of mood to relax and coast on it as it rises and paddle purposefully when it subsides.
    Thanks for sharing your experiences.

  • Rachel Shuki

    So truthful. I think certain (expected or unexpected)life events even when we handle them well are draining and we need to regenerate more than most. However, being able to go out at night sometimes is worth the energy drain for it’s very own uplift. I have a hard time judging when and what are worthwhile and delinating the others that are a waste of time and effort.

  • Wendy Love

    I like this approach to depression recovery…the idea that sometimes you are not even well enough to apply the strategies that usually work. I like the idea that antidepressants only help those who help themselves. I am concerned for those who come away from their doctor with a prescription and no other help at all. This illness is so complicated that it behooves us to collect as many strategies as we can. But I like your advice to make sure you get a little bit better first before applying ‘rigor’ to your recovery attempts. It is kind of like the song “The Gambler”…”you’ve got to know when to hold em, know when to fold em, know when to walk away and know when to run”.

  • mcljackson4

    As with any medication, there are often risks and benefits of its use. The best way to learn of these is to speak with a physician, ask about any potential side effects and completely disclose your current medical condition and any medications that you are currently taking. In some instances, medications may negatively react with one another and this can be very dangerous to the patient. Acne medicine is no different and the patient should have a complete understanding of how it operates before using is very benifitial .for humans……

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