BUDDHISM AND DEPRESSION
In previous articles I’ve compared the cultural differences between the time of the Buddha and our time of life. The
issue of depression as we understand it would be very difficult for someone in the time of the Buddha to comprehence.
That’s not to say that individuals couldn’t suffer from depression—the condition wouldn’t be perceived in terms we
could recognize. In our attempt to understand the teachings, it’s important to acknowledge this difference. What are
the symptoms of clinical depression that are currently understood? Here is a basic list of depressive symptoms:
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Persistent sadness and/or tearfulness.
Intrusive, negative self-talk
Loss if interest in normal activities, often accompanied by isolation
Either loss of appetite or increased appetite
Sleep disturbance—restlessness, mid-sleep waking, not wanting to get up in the morning
Agitated/irritable or lethargic
Unreasonable self-doubt, guilt or worthlessness
Distracted, forgetful
Morbid thoughts
There are two different categories of depression: major depression and persistent depressive disorder
(which used to be termed dysthymia). The difference between the two is related to how severely a person’s
functioning is affected (more so with major depression), and how long the condition has persisted (about two years for
persistent depressive disorder). These are found in the larger category of mood disorders, including manic/depressive
disorder. Someone who has experienced a major depressive disorder or persistent depressive disorder is prone to
relapse. This means that the person will cycle in and out of depressive episodes over the course of a lifetime. Manic
depressive disorder is primarily driven by neurochemical imbalances that are genetically based, and won’t be included in
this article.
As with anxiety, depression is epidemic in this culture: about 18.7 million, that is, around 5.4% percent of
Americans have suffered from depression.
In the context of Buddhist concepts, it might be useful to think of depression as a highly developed attachment to a
particular belief or expectation. The over-valuing of a particular thought, reaction or attitude toward an event that
arises due to craving and clinging creates the belief that the thought, reaction or attitude is a self, and this identification
is projected universally to “This is who I am and always will be!”
The core view of Buddhism is that of impermanence, non-self and the distress that arises from clinging to the
mistaken notion that the self is enduring and that change can or should be controllable. Of course, this is not the case;
often, events are uncontrollable. The normal, non-depressive response to being unable to control change is to grieve
the loss and adapt to new circumstances, when possible. It seems that when a person is depressed, there’s a
preoccupation with certain beliefs, a holding pattern that creates a disruption in the normally adaptive grieving
processes. The results of this dysfunction show up as chronic stress, accompanied by intrusive, maladaptive thoughts
and feelings of hopeless inadequacy.
When I was in grad school in the 1980’s, I was exposed to Cognitive Behavioral Therapy (CBT), and it has become the
standard clinical approach to alleviating depression. The assumption is that the perceptions and attributions that
emerge from our memories of past events are distorted, and that these cognitive distortions are to be recognized and
discounted. Examples would include:
 Expanding the meaning of a singular experience as proof of failure--either “all-good” or “all-bad”. Any
evidence to the contrary is discounted or minimized. There’s a tendency to “mind read” another’s
intentions or attitudes inaccurately, or to predict failure regarding outcomes.
 Misreading an unpleasant feeling as rational thinking, for example, “I feel like I’m a failure”.
 Taking another person’s opinion or comment personally, in a negative way. This could show up as “I’m a
failure because you are mad at me!”
Back then, I had been practicing mindfulness meditation for several years, and it seemed to me that the therapy I
was taught to apply was missing something. I found mindfulness meditation to be a powerful way for me to resolve my
post-divorce depression, and a primary part of the training was to pay attention to the powerful feelings that arose
when I was reflecting on the failed marriage. The feelings “made me a failure”—actually, I was grieving the loss of
relationship and confused about my role in it. As time passed, and I continued to practice mindfulness, I realized that I
was clinging to thoughts and beliefs about myself and the marriage that just were not viable any more. That helped me
to heal. I began to apply it therapeutically as a psychotherapist.
Some time after that, I read about Mindfulness Based Stress Reduction (MBSR), a treatment for patients with
chronic, stress reactive diseases. It had been developed in a hospital in 1979 by Jon Kabat-Zinn as a rigorously defined
and applied training over the course of 8 weeks, emphasizing mindfulness to reduce stress and reactivity to pain.
Because MBSR is so rigorously applied, it’s suitable for research, and some researchers trying to understand depressive
relapse took a course and realized that this could be very helpful for research into preventing depressive relapse. Since
then there have been many books and hundreds of research papers published on the benefits of mindfulness in a variety
of diseases and conditions.
Several years ago, I became aware of publications describing Mindfulness Based Cognitive Therapy (MBCT), a
therapeutic approach that I had been practicing on my own since grad school. It combines CBT with mindfulness and a
focus on learning how to tolerate unpleasant feelings as just feelings, rather than the feelings being self-defining. MBCT
emerged out of the research on MBSR, with the same rigorous definition and application protocols. Since then, several
alternative therapies have emerged from research, such as Acceptance and Commitment Therapy (ACT) and Dialectical
Behavior Therapy (DBT).
MBCT emphasizes mindfully recognizing dysfunctional beliefs, such as those described above, and replacing them
with more adaptive beliefs. ACT emphasizes determining the most appropriate goal or valued option in a situation, and
using mindful acceptance of the feelings that might interfere with achieving the goal while making choices that realize
the valued option. DBT also emphasizes developing the ability to tolerate surges of emotion with mindfulness, while
interrupting disturbing and distorted thoughts and replacing them with more adaptive thoughts. All these modalities
emphasize the importance of mindful awareness of emerging thoughts and the ability to tolerate urgent feelings, either
pleasant or unpleasant, as transient phenomena that aren’t self defining.
HOW DO MINDFULNESS AND LOVINGKINDNESS MEDITATION BRING RELIEF FROM DEPRESSION?
As mentioned previously, one of the functions of mindfulness is to be presently aware of how thoughts, moods,
expectations and behaviors are forming in the mind. This is best achieved when the mind is relatively settled and not
complicated by strongly held beliefs. This quality of attention is what I call samadhi/passadhi, that is, stability of
attention accompanied by calmness and tranquility.
This ability to observe in a calm way how the mind is shaping this moment of “selfing” is followed by the ability to be
able to disregard negative thoughts and urgently unpleasant emotions and moods is the next stage of liberation from
depression. This includes what can be termed thought replacement, that is, the substitution of more wholesome selftalk in place of the depressive internal narrative. This is when the lovingkindness mantra can be helpful: “May I be safe,
may I be happy, may I be healthy, may I be content; may I love myself sincerely and with gently patient kindness, just
as I am now, no matter what happens.”
The ability to replace unwholesome thoughts with more wholesome thoughts requires the ability to mindfully note
that the strong negative emotional processes that accompany the unwholesome thoughts. Actually, the emotions are
the drivers of depression, not the thoughts! What I suggest is to acknowledge the depressive thoughts and troubled
emotions as constructs of the mind that are conditional, not truly accurate descriptions of oneself or of life. I often
suggest to folks that depression is like a psychological fever, and that fevers are conditions that will subside when one
takes care of oneself. Who is to blame for having a fever?! Just acknowledge the unpleasant conditions and take action
to provide relief.
Mindfulness and lovingkindness are not “magic bullets” that will wipe out depression, but they are important tools.
Other ways to “reduce the fever” include becoming physically active, such as walking, going to the gym, gardening, etc.
it’s also valuable to intentionally do things that are upbeat and involve social contact. Having been depressed, I know
that the “fever” doesn’t feel like exercising or being around people, and it seems that nothing can be upbeat.
This is where the mindfulness training can be useful. The resistance to exercise involves a story line and a feeling of
resistance, and being mindful of that phenomena and deciding to disregard the resistance and exercise anyway can be
cultivated with mindfulness meditation practice. The same principle applies to social involvement and intentionally
doing upbeat things.
When a person is seriously depressed, to the extent that they can’t function due to feelings of hopelessness or total
inertia, it is probably a sign that consulting a physician for antidepressant medication is indicated. There is no shame in
taking antidepressants; I compare this to wearing glasses so I can see. It’s not my fault that I’m depressed, just like it’s
not my fault that I need glasses. Antidepressant medication is not always going to work right away, but it’s worth
persisting with treatment until the situation improves.
The research on mindfulness suggests that mindfulness practices are useful for preventing depressive relapse, not
necessarily for easing serious depression (although it can be effective for mild depression, and diminish the severity of
major depression).
RECOMMENDED READING ON MINDFULNESS AND DEPRESSION
THE DEPRESSION BOOK by Cheri Huber
THE MINDFUL WAY THROUGH DEPRESSION by Mark Williams, et al.
THE ZEN PATH THROUGH DEPRESSION by Philip Martin
PEACEFUL MIND by John McQuaid
LEARNED OPTIMISM by Martin Seligman