Question: Can bad dreams be an early warning sign of depression? For the last few months I have started having unpleasant dreams a lot. I didn’t used to remember my dreams in the morning but now I do and they kind of taint the way my day gets started. They kind of cling to me and pull me down a bit. What could be causing this? I am not on any new medications and my routines have not changed in any significant ways?

Dr. Ari Hahn Says...:

This is a really good question. Although the research does not have a good answer, I think there might be really good answer in the practical sense. I'll try.

There is very little research on this question. The research usually has two categories of bad dreams: disturbing dreams and nightmares. Nightmares are those bad dreams that wake you up in the middle of the night. Disturbing dreams are the bad ones that you remember when you wake up after you finish sleeping. There is different data for the two types of bad dreams.

What has been generally found is that there is a correlation between nightmares and depression. But that is a correlation, and does not indicate that one is caused by the other.It does not even mean that the nightmares happened before the depression. It might be that in the people that were studied, they were depressed and then experienced nightmares. We just do not know.

If you have a history of depression or a history of abuse, there is a greater likelihood that nightmares can trigger the factors and anxiety connected to the depression or abuse and, in turn, trigger depressive symptoms. Also, if you are losing sleep because you wake up and cannot fall back asleep, you are at greater risk for all sorts of problems, but not necessarily depression (although it is possible.)

You say you are not on any new medications. That sounds like you might be on some long term medications. That need to be considered. Even though the chemicals you are putting into your body haven't changed, your body and brain are constantly changing. 

Since you do not sound like you are depressed now (only concerned about the future) you should consider doing things that can ward off depression. Look at activities that enhance a sense of well-being. If you like some sport or challenging hobby now would be a good time to reengage in that activity by dedicating two hours two or three times a week. That can include dancing or playing a musical instrument. Or you can get involved in a charity or other socially helpful organization or movement. You might be or have been active in a religious organization and rededicating yourself is another helpful tactic to lower the risk of depression. Renewing old friendships is also helpful. The involvement in such activities not only increases your resilience to depression, it enhances you sense of well-being and when you use you mind for these activities you are less likely to experience the bad dreams.

Good luck and if you need more help or information, please do not hesitate to contact me.

Question: Are there any anti depressants that increase dopamine in the brain? I have done cocaine and methamphetamine in the past and both made me feel very good. I am now struggling with what I think is depression. If anti depressant medications could give me a way to feel like I did on coke for a lasting time then I would be very interested in trying this out. I know that they mostly increase serotonin levels. If dopamine is what makes me feel good why don’t anti depressants increase dopamine?

Dr. Ari Hahn Says...:

So you want a prescription for a chemical that will make you feel like are using coke or speed? That wouldn't be a bad idea if it would work and be legal. Or safe. But that is not going to happen. There is no chemical, drug, medicine or even neurotransmitter that we understand how it works in the brain. Not one. Not even the greatest neuroscientists in the world have a real understanding. Additionally, every chemical that you will try will have unpredictable side effects.

Anti-psychotics often work on the dopamine system. You may be aware that Parkinson's disease is also connected to the dopamine system. The medications for these disorders generally promote dopamine usage in various ways because these patients don't seem to have enough. There is a strong opinion that this is the opposite of what happens in addictive behavior, where there might be too much dopamine. According to this opinion, if you added dopamine to your brain, although you might not get addicted to dopamine, you very well might have an irresistible urge to resume you addictions.

If you want to feel good you need to engage in activities that make people feel good. Get involved in helping people. Cultivate gratitude. Meditate. Get involved in a serious hobby like a sport or a creative activity. Positive activity will relieve your "depression". It will take more work than popping a pill, but it will be more efficient, healthier, and you will be happier. I promise.

Question: Does marijuana have any impact on depression? I have been a smoker for about 11 years and it is something that I enjoy. Nowadays it is one of the few things I look forward to. I don’t smoke everyday but I Probably smoke 4 or 5 times per week, or whenever I have an evening to myself without work commitments. I think I have some mild depression. My doctor has recommended Zoloft but I am trying to hold off on the medication and I am seeing if my new exercise routine might help. So far it is not really making me feel much better but after a few weeks of exercise I have managed to lose like 5 pounds, so at least that’s something. So long story short, my girlfriend is bugging me to stop smoking pot because she thinks that it is not helping with my depression. I do not know if she is right or not, although it has never before caused me to feel depressed and I have been using it for a long time. However, because it is truly one of the few things in my life right now that brings me any pleasure at all I really don’t want to give that away. At least it gets me out of my head for a while and lets me zone out into a movie or some video games. Given that I have used marijuana for a long time without problems, is my occasional marijuana use likely playing any role in the depression I am feeling right now?

Dr. Ari Hahn Says...:

Depression is a very difficult subject to properly address in a posting. There are probably many types of depression - more than we have diagnoses. Many people who have depression can get other diagnoses and others who are not depressed will get diagnosed with depression. So my answer will be general, but I hope helpful.

I have not heard anything indicating that marijuana causes depression. I would not be surprised if it did in some people, but from what you are saying, I do not think it caused you to be depressed. You surely have other factors in your life, other stressors, important relationships and responsibilities that can effect your mood. It sounds like your main symptom is that you have lost interest in previously enjoyable activities. If this is true, then there are two avenues to begin to effect a change. One is to change your body chemistry. The doctor does this by prescribing medication. If you persist with the exercise for at least three times a week for at least 12 weeks you are very likely to achieve the same change in body chemistry as two weeks of anti-depressants. Whatever you do, keep it up for at least a year.

But there is a psychological factor also. For that you need to engage in positive interactions with other people. You should be able to do more of that as the effects of the exercise or medication kick in. However, here is where marijuana can be detrimental. Smoking is not a positive social interaction. Even when you do it with friends, it gives a pleasure independent of being with the company or not. They become your friends because you are experiencing a parallel internal experience. That is not an real relationship. Friends share external experiences. As long as your major form of recreation is drug related you will be vulnerable to depressions. And although it sounds like you think you are a light or occasional user, heavy users are defined by smoking more than three times a week.

So if you want to cure and avoid depression I would strongly suggest that you cut back your pot use in a major way and learn the pleasure of sharing positive and negative emotions with your loved ones.

Question: My wife is a wonderful person who worries about things too much. While I sleep like a baby she lies away at night worrying about even the slightest problems in our life. I think the fundamental problem that she has is that she looks at the world in negative way, expecting that the worst will happen and I look at the world sort expecting that things will basically always work out…and if they ever don’t we’ll more than likely be able to deal with what comes in any case. I am always telling her not to worry but of course that doesn’t really help her much! How can I help her to look at the world with a more positive outlook? I really believe that much of the unhappiness in her life is of her own making and that if she could just change her outlook a bit she could be freed from such a lot of worry each day.

Dr. Ari Hahn Says...:

First of all, I am sorry it took so long to answer.

This is a very common problem, although not usually to the extreme that you describe. There are very good reasons for many men to believe that their wives worry too much. Since I do not know you or your wife I cannot judge if it is really "too much" and if it is "too much" is it "too much" for you or for her? I can explain how this happens, and what you can do to help her and yourself.

There is some basic differences between the male brain and the female brain. There are basic differences in male hormones and female hormones (besides the obvious sexual differences.) These differences are the biological basis for different ways of thinking, feeling and relating to people. (Please realize that these are general differences and you can always find many exceptions to what I describe.)  There are two differences that are relevant to this situation. The female brain is more adept at multi-tasking, while the male brain is better at in depth understanding. As a result many women tend to ruminate, that is, to think about a topic and consider all of the possible outcomes which invariably are mostly negative. That is a major cause of insomnia by many women. In other words, the tendency to worry is a natural one and probably has more positive potential than negative potential. If it is causing problems, the goal is to moderate and direct the rumination. A blunt way of saying that is that her "problem" is not that she worries too much, but she does not know how to worry! 

The greatest and most fundamental paradox in helping people change is that the most efficient way of helping people change is by accepting them as they are. People listen better when they feel accepted. The more you tell your wife that she worries too much and she can make herself happy by not worrying the less likely she will listen to your suggestions. Even if she knows that you are saying it from your great love.

A second difference between men and women is that women have a hormonal makeup that makes them less aggressive in solving problems on their own and easier for them to reach out to others, seek help, and seek and give comfort. Again, this is a basic biological difference. It is difficult for men to understand this since we tend to try to buckle down and solve problems on our own. When men and women get together, she is reaching out and he is feeling, "why can't she just focus on finding a solution?"

Let's put those three threads together. You cannot change your wife's natural tendencies. She is looking for support. The best way to help a person change is by acceptance of who they are. Let's throw into the mix the old adage that you cannot control anything except your own behavior. So what can you do?

1. Find time to listen to her concerns and learn to validate them even if you do not agree. (Validation and agreement are very different.) If you can do this before sleep it would be best (for more reasons than one.)
2. Encourage her to find solutions to the issues after she feels validated (like the next day.)
3. She might be looking for your suggestions at this point, but you will need to know your wife's style (ie: if she asks, hints, or just expects you to suggest.)

You will not be able to "make her happy" with these suggestions, but you will definitely ease her heart. If and when it works she might be a very happy person because you might just "become" that partner she always dreamed of!

These are all new skills and require time, practice and often coaching type feedback. If I can help you, please contact me.

Question: I am really having a hard time with depression. I don’t really want to tell people at the office about my diagnosis. I am now on a daily 60 mg of Cymbalta but only a week or so in and not feeling any better yet. I just wish everyone at work would leave me alone. I just can’t bear to talk to anyone these days and It is hard enough for to get my job done without having to spend the energy needed to socialize and I just really can’t be bothered to care about anyone right now. I know that sounds terrible but it is true. I am thinking about applying to work in a remote capacity. My work can be done online and I have the clout to pull the move. My wife, who is the only one who knows I am dealing with this, thinks that this is a bad idea. She is worried that I will become very isolated and this will make my depression worse. She does not know how hard it is for me to walk down that corridor every morning and exchange greetings with people… Would reducing my contact with others have a negative effect on my mood? I feel like taking away anything that is making my life harder right not is the right thing to do, but I am not sure I am able to concentrate enough to really make solid rational decisions either.

Dr. Ari Hahn Says...:

The quick and dirty answer is that you should not make any changes in your work or social life that has any modicum of permanence. If you were to stay away from the office for a limited period of time (say 2-4 weeks) and engage in a vigorous program to revitalize yourself, that might be a good plan. That type of plan needs strong coaching to keep you on track, and it can include many factors. I will try to explain further on.

Depression is a very difficult condition, and unfortunately extremely common. It is called "the common cold of mental health." There are many reasons for it being so common, the main one is that it is probably a name for many different clinical pictures.

But first, I must tell you that anti-depressant medications take at least two weeks before you feel the effects. Even if medication can completely solve your problem, it will take time. I strongly suggest that you keep it up for a few more weeks, if there are no problematic side effects. If there are, then you need to go back to your physician and try a different medicine.

Although medication is helpful, it rarely is a complete answer. The scientific community recognizes that depression is a catch all diagnosis for symptoms that come from many different causes. Most therapists do not work differentially according to different types of depression, and the medical/pharmaceutical  community is interested in calling it one disease in order to sell more pharmaceuticals. If your depression is caused only by accumulated stress (with no trauma, social or biological causes) then there is a reasonable chance that your serotonin (a brain chemical) is depleted and antidepressants might be the key (although there is evidence that in some cases adding serotonin can increase depression.) 

Even if the medication will solve the depression, it can only make you feel "undepressed." If you have been suffering for any length of time it is possible that you have gotten out of the habits and behaviors that enhance positive emotions. All doctors and most therapists follow the medical model of ridding a person from the "pathogen" or whatever is making the person feel bad, and expect the patient to be "all better." That works for medical issues, but not for emotional ones. Being "undepressed" does not make a person flourish. For that he or she needs to build personal strengths. There are a growing number of therapists that work with people to develop the parts of your personality that can make you feel good. This might be along the lines of creativity or better relationships, or helping behaviors, or many other things that fit one's particular personality. If this is accomplished then medication is less likely to be needed in the long run.

If you have enough control over your circumstances I would suggest the following. First give another week to see if the medication is having a positive effect. If yes, continue and stay on the job. If not, consider working at home for four weeks, with a commitment to go back to the office at the end of four weeks. 

Either way, contract with a therapist that can work with you on building your positive strengths. (I can help you, if you want.) Expect to work with that therapist for at least three months in order to have your innate flourishing skills blossom and take root. If you need to be working from home, expect to dedicate a serious amount of effort on a daily basis to the things that will make you feel good. If you go on at the office, then, while you still need to work on building positive, your focus will be less intense.

Without actually getting to know you I cannot be anymore specific. But I hope this is helpful. Again, if you want to talk about it, Choose Help has my profile, and I would love to talk to you.

Question: My father has pancreatic cancer and his prognosis is not good. My wife and I are his primary caregivers and he lives with us. Since his diagnosis 2 months ago he seems to have become quite depressed but he won’t admit to it and he gets quite irate when I bring up his talking to someone about his mental health. He may not have much longer than a year left with us and I want to see him get as much life and joy as he can out of what time he has left but how can I cheer him up when doesn’t want to get any help, and when, to be honest, he has a very good reason to be feeling down?

Dr. Ari Hahn Says...:

I'm sorry I haven't answered sooner. I was unable to write since I celebrate the Jewish New Year.

Of course your father is "down" but I would not called him "depressed." He needs to mourn. He is losing more than he ever imagined and that requires a mourning period that, during the first stages, looks like depression. While there is no way of knowing how much any particular person needs to mourn his own life (or life stye, since there is really no way of knowing how long he will actually live) he does need to be allowed to mourn in the way that he feels right, and for as long as he needs to. Letting that happen will actually make that period shorter.

He feels ill and "not right." He does not not want to hear anybody tell him that he has mental health issues on top of his other health issues. He does not need a mental health professional, rather a quality of life professional. When I work with people in this situation I find that often the family also needs to be involved in order to help the patient work through the issues, and because they are actually working through many of the same issues.

Focusing on quality of life can be looking at the loved one's life and appreciating all with good that the family has gained from having him around and what the loved one want to make sure is left before he goes on. Once those positive outlooks find a foothold, more positive experiences can be built up and appreciated.  

You are right about wanting him to have as much joy in life that he can. The positive attitude can increase his resilience and chances to live longer. But it can only be achieved by allowing him to start where his is mentally and find and build on the positive joyful moments that he can find now.

Question: I've had frequent bouts of depression during the winter months. Are there particular reasons for and strategies against winter depression in particular? I am getting really anxious now that the next winter approaches... I even considered relocating to Florida (sadly, it is impracticable as I am the CEO of a company here in the north).

Dr. Ari Hahn Says...:

Yes there is something that is winter depression. It is called Seasonal Affective Disorder (SAD). It is caused by the lack of sunlght, and cure by adding light. You can look for a commercial "Light Box" and sit in front of the light for a few hours a day and avoid the depression.

(And yes, there is less SAD in Florida and more in Alaska.)

Question: I have an undergraduate psych degree but have never used it for much of anything, but the study of the mind has always interested me. Having lived in a number of Buddhist countries it seems to me that depression is much less of a problem in these countries than it is here back home. I see that mindfulness is now a recommended method for dealing with mental health problems. Is there any research that suggests that certain cultures are better protected against mental illness due to their underlying world-view and philosophy of life?

Dr. Ari Hahn Says...:

Quite a good question. The answer depends on your perspective. One of the earliest sociological studies was by Emile Durheim in the 19th century that showed that suicide (which correlates very highly with depression) is strongly influenced by culture, although he only looked at various European cultures.

If you were to use the psychological perspective it becomes more complicated. Diagnosis is hard to compare from culture to culture because psychiatric diagnosis is according to symptoms and they can be perceived differently in different cultures. While depression is extremely common in the USA, most of it is not major depression. Major depression seems to be relatively equal across cultures, but the type of depression (dysthymia) that is less serious might not be. I do not know of good research linking this to meditative practices even though meditation is helpful for this type of depression.

There are various other positive exercises besides mindfulness that increase resilience to depression (gratitude, commitment to a greater cause, etc) that would be confounding factors in such research. I suspect that the science of positive psychology needs another 10-20 years to be able to adequately begin to address your question.