When the Mind Goes Dark

When depression hits, can meditating help you work through it? Maybe, but not always. Psychologists weigh in on when mindfulness therapies can (and can’t) help to ease depression.

Illustrations by Maggie Chiang

As nearly 10,000 freshmen and transfers arrived on campus at the University of California, Los Angeles, last fall, they were invited to try something never before offered during student orientation: depression screening.

The hope, administrators explained, is that by identifying their risk for depression, students can get the support they need before they face the rigors of academia and the disorienting experience of living away at college. There’s reason for the concern. In 2016, a record high of almost 12% of UCLA freshman reported “frequently” feeling depressed in the past year. And a report from Penn State, drawing data from 139 university and college mental health services, found that in the 2015–2016 year, use of these services increased by 30%, although enrollment grew by just 5%. This included “a persistent increase in ‘threat-to-self’ characteristics such as nonsuicidal self-injury and suicidal ideation.”

The screening initiative—which will be extended to the entire student body eventually—is part of the UCLA Depression Grand Challenge, a landmark effort to understand one of the most pervasive and debilitating health conditions in the world, one that affects an estimated 350 million people and contributes to the suicides of 800,000 people, including 40,000 Americans, every year.

The university launched the challenge in 2015 as a multiyear, interdisciplinary study to develop better methods of understanding the genetic and environmental causes of depression and to improve detection, evaluation, and treatment. The goal is ambitious: to cut the global depression rate in half by 2030.

This comes at a time when public health officials around the world struggle to get their hands around what is considered the leading cause of disability among adults, costing some $210 billion in medical and long-term care and lost productivity hours each year.

“That depression has not been identified as our number-one health issue astounds me,” UCLA Chancellor Gene Block said in announcing the campus-screening program in September 2017.

Unpacking the blues

While mental health experts are cautious about calling depression an “epidemic”—citing better screening and greater understanding and acceptance of the condition as possible reasons for increased diagnosis—the numbers are still startling: 350 million sufferers worldwide. According to UCLA, if you haven’t experienced depression yourself, you know someone who has.

It is also now recognized as being at the core of numerous mental health conditions, from bipolar disorder (powerful swings between high and low mood) to postpartum depression, just to name a few.

Many of the symptoms of depression are familiar: persistent low mood, exhaustion, loss of appetite and sex drive, an inability to enjoy life or cope with everyday activities—like socializing or even getting out of bed. But some may not be as obvious, such as disordered and distorted thinking, agitation, physical aches and pains, and insomnia.

Yet despite how much we now know about what depression is, we still don’t really know what causes it. What we do know is that a variety of wide-ranging factors seem to influence a person’s risk of developing depression, including childhood adversity; genetic make-up; chemical changes in the brain and body; certain unhelpful styles of thinking and relating; and social, economic, and cultural deprivation.

The truth is, there are likely myriad interrelating causes involved in each case. “We’re all vulnerable in a sense because we all have factors that contribute to that vulnerability,” says Zindel Segal, a professor of psychology at the University of Toronto who specializes in depression.

Further complicating matters, depression doesn’t always act the same way from individual to individual, or from episode to episode, which can range from mild to severe. An episode can last from a few days to weeks, months, or even years.

All of these factors make treatment difficult, because each sufferer will need something different. Indeed, treatment for depression is a bit of a guessing game, with only a 50% success rate with the first intervention tried. Antidepressants work sometimes, but not always. Talk therapies help some people, but not others. Someone may feel better with increased social contact, a change in relationships, or a new job. For others, becoming less busy or starting an exercise regime is what makes the difference. Sometimes the passage of time is what helps. Unfortunately, because depression plays havoc with the capacity to see things accurately, it’s hard for a depressed person to know what they need.

Because depression plays havoc with the capacity to see things accurately, it’s hard for a depressed person to know what they need.

And while most people recover from a depressive episode, it’s a chronic, relapsing condition, with recurrence ever more likely each time it strikes. It’s commonly accepted that if you experience even one depressive episode, you have a 50% greater chance of experiencing another.

Dodging the wrecking ball

At this point you might be thinking, “Now you’re going to tell me that this is where mindfulness fits in.” After all, doesn’t the practice of paying attention to the present moment enhance our ability to see clearly, stabilize the mind, and be freed from unskillful patterns of thinking and behavior? Doesn’t it have salutary effects on the mind, brain, and body?

Well, yes. But, also, no.

Psychologists widely agree that mindfulness has an important role to play in managing the condition—as a self-care practice, and by helping us to tune in to the natural ebbs and flows of energy and mood.

In fact, having a regular mindfulness practice may help someone who struggles with depression to notice when they’re at risk, allowing them to take appropriate action, if not to avoid an episode, then to at least minimize its impact.

Having a regular mindfulness practice may help someone who struggles with depression to notice when they’re at risk, allowing them to take appropriate action, if not to avoid an episode, then to at least minimize its impact.

“I think somebody who has a mindfulness practice and a history of depression will know themselves whether they need rest, or whether it would be better to walk the dog or go to work,” says Willem Kuyken, a professor of clinical psychology at the University of Oxford, and director of the Oxford Mindfulness Centre, which has pioneered mindfulness-based treatments for depression. “What’s so beautiful and transformative about mindfulness is that it places the wisdom in the person and their own practice. They have a sense of ‘what’s happening with my mind and body at the moment?’ and how to shift from automatic pilot to more of an experiential present-moment mode. From that place they can judge what feels skillful and discerning.”

One model in particular, Mindfulness-Based Cognitive Therapy (MBCT), which offers mindfulness training in conjunction with cognitive-behavioral therapy, appears to be particularly effective. “We’ve got 10 randomized controlled trials suggesting that for people with a long history of depression, MBCT does much better than usual care,” Kuyken says.

He explains that depression makes someone more likely to react to life’s setbacks with negative, judgmental thinking, which can lower their mood and trigger a new episode. Mindfulness helps create mental space around these thoughts, enabling people at risk to observe, with kindness, the patterns of the mind that might otherwise drag them down.

He shared the example of a former client. “She was a young mother who was pushing her toddler son on a swing. It was a happy moment, but then a thought popped into her head: ‘I don’t deserve to be happy, and this happiness won’t last.’ We all have thoughts like this, but for someone who’s vulnerable to depression those shards of negative thinking can quickly spiral into a whole bunch of other negative thoughts, associated emotions, and behaviors.”

For this woman, he says, the thoughts came in the form of “I’m a rubbish mother” and the internal thrashing that typically followed. Prior to MBCT, he says, going down that path “might have led her to do a ‘duvet dive’ and hide away from the world,” resulting in more rumination and furthering the downward spiral. Instead, she was able to recognize the destructive pattern forming—what she called “wrecking-ball thoughts”— and take a sideways step, allowing the thought to pass through her mind without being knocked over by it.

Zindel Segal, one of the creators of MBCT, agrees. “Qualitative analyses show the core takeaway from MBCT is I am not my depression. That the self is bigger than that.

“That’s a source of liberation, because they can choose how they want to act, rather than running to the first solutions that the mind offers, which can often be reactive,” he adds. “Their symptoms may not reduce to zero, but their well-being and resilience increases as they develop a different relationship to them.”

There’s a time and place for mindfulness

For the great success mindfulness, and MBCT in particular, has shown for helping people with a history of depression to avoid or lessen the impact of those depressive dips, there are equally strong caveats against using the practice when you’re in the throes of an episode.

“It’s very hard to sit and do formal meditation practices when you’re depressed,” Segal says. “The executive control networks of the brain are often compromised when you’re in an episode of depression, and it’s di cult to engage.” In other words, when the world goes dim and life feels bleak, your brain might not have the bandwidth to be a kind, nonjudgmental observer to its own thoughts, or to grasp the bigger picture.

Susan Woods, a psychotherapist and mindfulness teacher in Vermont, goes further: “If somebody is in a major depression episode, mindfulness is useless. There’s just no energy there, no ability to concentrate for any length of time.”

Even if a person with depression is able to engage with meditation, there is a risk that heightened exposure to the unpleasant symptoms of their illness, experienced while paying mindful attention, could actually increase their fear and aversion, triggering a reactive spiral of deepening low mood. “There is some evidence that vulnerable people exposed to mindfulness can have