Depression was the focus of the latest in a series of conversations between Tenzin Gyatso, the Dalai Lama of Tibet, and neuroscientists. During a daylong conference on Oct. 20, 2007, at Emory University in Atlanta, researchers described depression's effect on the body and its persistence throughout life. They also presented findings that suggest that some forms of meditation may offer protection from or treatment of the illness.
"It is becoming clear there is truly a beneficial effect" to meditation, the Dalai Lama said.
Nearly 10 percent of people in the United States—21 million—have a mood disorder, according to the National Institute of Mental Health, and it is the leading cause of disability among people ages 15-44. But depression is a range of illnesses, from the short-term low mood to a persistent lack of all emotion, said Charles Nemeroff, chairman of the department of psychiatry and behavioral sciences at Emory. And what works to treat one person may not help another.
"One size doesn't fit all," Nemeroff said. "In other disease states, we can measure things and we can predict what treatment" to use. "In this disease, there are no predictors."
There are risk factors for depression, though, Nemeroff said. Two-thirds of the risk is due to environmental factors, one-third to genetic factors, he said. "Genes mediate risk as well as resistance," he said, citing his research with people who experienced severe trauma as children.
In most cases, people who were severely stressed as children (by sex abuse in this study) have higher rates of depression as adults. They also have consistently higher-than-average rates of CRF, a hormone that is activated by stress, and consistently lower rates of oxytocin, a hormone that aids in improving relationships and feeling close to people.
But Nemeroff also found some protective variants of the gene that triggered release of CRF. A child who was abused and had the variant did not show abnormal levels of the hormones in her brain, "but if you had another form of the gene, you were extremely vulnerable," he said.
If children were tested for this genetic factor at birth, he said, "you could know who is vulnerable and who is protected against child abuse." Such an approach has never been taken before, he said: "It would be practicing preventive psychiatry."
Emory researchers Lobsang Tenzin Negi and Charles Raison are testing another potential form of prevention by giving first-year college students short courses in meditation or in group-talk therapy. After six weeks of sessions, the researchers put the students through a stressful experience (such as giving a lecture). Overall, the meditators showed less response physiologically (measured by heart rate and inflammatory response) and described themselves as under less stress than those who had the talk therapy; those who meditated regularly showed less of a stress response than those who meditated only occasionally, Raison said. Those who merely listened to the lectures on meditation but did not practice scored the same as the talk-therapy group.
These results are preliminary, Raison cautioned. It might be that those who chose to meditate more are the sort of people who would benefit from meditation while those who did not would not—or some other factors could be at work. But one thing was true across all groups, he said: "Some of these kids were shocked by the idea that thoughts could have an effect.”
Adding to the mix
Cognitive therapies, in which people learn to recognize and counteract unhelpful patterns in their thinking, are effective in treating some forms of depression. These therapies' attention to people's schemas, or how they represent the world, and the tendency to turn inward and focus excessively on their problems, are mirrored in Buddhist practice, said John Dunne, an assistant professor in the department of religion at Emory.
In mindfulness meditation, people concentrate on observing their thoughts with interest but not emotion. In compassion meditation, people concentrate on the emotion of compassion for self, for others, and for all beings.
Using mindfulness practice, depressed people may be able to see beyond the circle of rumination and negative thoughts in which they sometimes get trapped, Dunne said. Using compassion meditation, they may step out of the circle of introspection and self-absorption and reconnect to family and society.
These forms of meditation are currently being studied and used in treatment, but as adjuncts and not in any formal way, he said. Were these practices formally in place, cognitive therapy would be even more effective, Dunne said.
Zindel Segal of the University of Toronto agreed. Studies have shown that the best form of depression prevention for patients in cognitive therapy lies in efforts to reduce their reactivity to strong emotional triggers, such as a sad movie, he said. But that benefit is "a consequence of current treatment, not a direct goal."
"There is a need for a greater diversity in the type of treatments," Dunne said, including implementing certain methods according to a person's special needs. "Perhaps we can use Buddhist science and Buddhist philosophy in secular ways."
Not yet Nirvana
Meditation is not meant to completely eliminate all negative emotion, the Dalai Lama told the nearly 4,000 people seated on bleachers and chairs in the main gym of the Woodruff Physical Education Center on the campus of Emory University. In its pure form, meditation practice is designed for an individual to attain enlightenment, something that he believes occurs over generations of practice. Using it in a "secularized" form, though, it may well help people find ways to cope better.
"Your work is a hopeful sign," the Dalai Lama said. "For the next few centuries, I think, your experiments may bring some piece of understanding."