Men ought to know that from the brain, and from the brain only, arise our pleasures, joy, laughter and jests, as well as our sorrows, pains, grieves and tears.

Hippocrates (about 400 B.C)


Preface

On one sunny day, in 1990, depression “walked” into my life as a real thing and not an abstract disease from a medical text book.

I was standing at the JFK airport waiting to meet my aunt and uncle. They had just arrived from Italy where they had spent several months after leaving the former Soviet Union. As they cleared customs, I saw my aunt walking in the hall clutching her husband’s arm. Her appearance struck me! She had a slow, crippled gait, bent posture and particularly sad eyes.

I always knew my aunt as a very active person who was an avid traveler, had a wealth of friends and loved life.Her home was always filled with people.

At work she was a leader, head of an outpatient clinic, supervising several physicians, nurses and physician assistants.With a medical career that spanned more than 40 years, she saved the lives of thousands of children.

We found out that she was struck with illness as soon as she applied for an immigration visa. Uncertainty about the future, losing her financial stability, social status, an apartment and friends took a toll on her health. Maybe she recalled the traumatic event in her life, when the entire family ran away from Nazi troops in July of 1941. On their way to Tashkent, the family left everything at home and spent several months living in a cattle car train.

It was only my guess, because I never talked with her about the war. When she was preparing herself and family for emigration, she became physically ill (unstable blood pressure and other problems), lost sleep and was anxious and fearful about leaving the country. When they came to Italy, the depression started to develop. By the time they arrived in the United States, the depression dominated all the rest of her diseases.
Here, in the USA, her treatment included medications and several courses of shock therapy; she had brief periods of improvement.

Today, looking back on her symptoms, I am confident that her depression was in a moderate stage, and it would nothavebeenanimpossiblefeattostabilizehercondition and prevent further deterioration. Unfortunately, at that time in 1990, I did not know about depression, aside from reading textbooks and case-studies. I had just started my first year of psychiatric residency. My experience was not enough to offer any input into her treatment. I was only seeing her briefly and talking to her psychiatrist.

The treatment of her depression was not sufficient: brief periods of improvement alternated with periods of depression. I thought about factors that would prevent her from feeling better. In all likeliness, multiple stresses and cardiac problems had resulted in the decrease of blood circulation in the brain, which somehow contributed to the development of persistent depression and poor response to medications.

Along with her depression, the medical illnesses blossomed. She developed problems walking because of pain in her leg. The work up showed poor peripheral artery circulation. She had to have two femoral artery bypasses. Then she fell at night, fractured her hip and underwent another surgery with anesthesia. The finalhospitalization was for a heart attack. Cardiac arrest put her in a coma. After being comatose for six months, she died peacefully.

Her official death certificate had no mention of it,but I am confident that her real killer was depression. Depression slowly and surely robbed her well-being. The memory of my aunt and her battle with depression are forever in my heart.

Nowadays, there are two views on depression:presumably it is either a “brain” or a “whole body” disease. There are many places inside the brain and other bodily organs, which are affected by depression. I am a big believer that depression is a whole body disease. Every organ and system in the body has its “own depression,” and we will discuss this topic in Chapters 2 and 3.

There are measurable changes in the functions of the brain and other bodily organs in people who are depressed. Given these data, the treatment of depression has to target not only the brain, but also the entire body.

For the last thirteen years, I have been working with depressed, cognitively impaired geriatric patients at the Stress Relief and Memory Training Center (SRMTC),which I founded in 1994 and have headed ever since. During this work, I developed the Brain Activation Program which is used for the treatment of depression, anxiety, memory and concentration problems.

This program was described in my previously published book, How to Activate your Brain, which contains practical exercises for enhancing brain activities and coordination. I am very excited to present this book about depression. It is a logical continuation of my ongoing work toward restoration of brain functions in depression and dementia.

Many principles of brain activation are fully applicable for people suffering from depression. This book contains practical information for people suffering from depression along with newly developed techniques to successfully overcome illness. More importantly, this workbook was designed to provide sufferers of depression with knowledge about depression as a serious, debilitating disease. Most exercises are presented in this book for the first time. Some exercises came from previous works.

At our center, the treatment for depression is both active and aggressive. What does it mean in real life? It means that the patients are my partners in the treatment process. They are responsible for launching an authentic battle to defeat depression on the first day of the treatment, versus passively waiting for three to six weeks for medications to be in full effect.

The battle continues everyday. For several weeks ahead,treatment entails:

Our experience shows that the more physical activities the patient undertakes, the faster the recovery process. I am always mindful about the remote possibility of medication failure, and I share this with my patients. It’s a seriously flawed plan for a depressed individual to rely on medication treatment only. Being a strong believer in the body’s natural healing capacity, I recommend using everything possible to increase the body’s natural restoration power and reserves. To win the fight against depression, both the brain and the body should be in sync, fully mobilized. I call this integrative treatment of depression “the battle for life”.

This book consists of six chapters:

Chapter 1 outlines a number of clinical symptoms of depression in the elderly.
Chapters 2 and 3 focus on brain and organ functions in people who are depressed.
Chapter 4 discusses our working model to treat depression.
Chapters 5 and 6 explain the restoration of brain and body functions in people suffering from depression.