Depression Treatment Options

However the client should be aware of the treatment options so that he /she can discuss with the consultant. Broadly speaking, the treatment of depression rests on two factors Medication, and Psychotherapy or Counselling.

  • Medication is required for moderate and severe depressive disorder cases.
  • Counseling and psychotherapy serves as an edge in treating depression and need to be started simultaneously along with medicines.
  • You should continue the full course of psychotherapy even if you are feeling better to prevent a relapse.
  • Suddenly stopping antidepressants can precipitate a relapse. Medication needs be tapered gradually under your doctor’s supervision.



‘The Holy Shadow’ ~ A Sufi story as told by Osho

There once lived a saint so good that the angels came from heaven to see how a man could be so godly. This saint went about his daily life diffusing virtue as the stars diffuse light and the flowers scent, without being aware of it. His day could be summed up by two words — he gave, he forgave — yet these words never passed his lips. They were expressed in his ready smile, his kindness, forbearance, and charity.

The angels said to God, “Lord, grant him the gift of miracles.”

God replied, “Ask what it is that he wishes.”

They said to the saint, “Would you like the touch of your hands to heal the sick?”
“No,” answered the saint. “I would rather God do that.”

“Would you like to convert guilty souls and bring back wandering hearts to the right path?”
“No, that is the angels’ mission. It is not for me to convert.”

“Would you like to become a model of patience, attracting men by the luster of your virtues, and thus glorifying God?”
“No,” replied the saint. “If men should be attracted to me, they would become estranged from God.”

“What is it that you desire, then?” asked the angels.
“What can I wish for?” asked the saint smiling. “That God gives me his grace; with that would I not have everything?”

The angels said, “You must ask for a miracle, or one will be forced upon you.”
“Very well,” said the saint. “That I may do a great deal of good without ever knowing it.”

The angels were perplexed. They took counsel and resolved upon the following plan: every time the saint’s shadow fell behind him or to either side, so that he could not see it, it would have the power to cure disease, soothe pain, and comfort sorrow.

When the saint walked along, his shadow, thrown on the ground on either side or behind him, made arid paths green, caused withered plants to bloom, gave clear water to dried-up brooks, fresh color to pale children, and joy to unhappy men and women.

The saint simply went about his daily life diffusing virtue as the stars diffuse light and the flowers scent, without being aware of it. The people, respecting his humility, followed him silently, never speaking to him about his miracles. Soon they even forgot his name, and called him “The Holy Shadow.”

This is the ultimate: one has to become the holy shadow, just a shadow of God. This is the greatest revolution that can happen to a human being: the transfer of the center. You are no longer your own center; God becomes your center. You live like his shadow. You are not powerful, because you don’t have any center to be powerful.

You are not virtuous; you don’t have any center to be virtuous. You are not even religious; you don’t have any center to be religious.

You are simply not, a tremendous emptiness, with no barriers and blocks, so the divine can flow through you unhindered, uninterpreted, untouched — so the divine can flow through you as he is, not as you would like him to be. He does not pass through your center — there is none. The center is lost.

Finally you have to sacrifice your center so you cannot think in terms of the ego again, you cannot utter “I,” to annihilate yourself utterly, to erase yourself utterly. Nothing belongs to you; on the contrary, you belong to God. You become a holy shadow.

~ Osho


Question: I have been married for the past 26 years. We applied for divorce 3 months ago, after our younger daughter got married, a mere formality which was on our agenda for many years. Both of us are strong headed and disagreed on almost every thing from the beginning of our marriage. We lived our own separate lives cordially living under the same roof for the sake of our 2 daughters for the past 18 years. Although we are not best of friends we are neither bitter with each other. Socially, emotionally as well as financially I have been independent in my marriage and had been looking forward to the divorce. So when it finally when we filed I was very relieved. But off late I am finding myself on edge, irritable and depressed. I don’t see any reason for the same. My business is doing better than ever before and I have done all the things I have longed to do for so many years but couldn’t do. Last evening, I was at a close friends place to celebrate her promotion and I suddenly broke down into tears seeing how her entire family was there to celebrate with her. I experienced deep loneliness and sadness. I was really shocked about the way I felt. I don’t understand why the pain when I am so looking forward to the divorce. Please help.
Mrs Dixit
Answer: Divorce is not only ending a marriage technically but also of all the wishes of having a happy family and an eternal need of being connected deeply to someone special for ever. This loss exists at an emotional plane irrespective of whether you are logically justified in taking divorce or not. Along with this loss, come all other similar losses of the past thereby making it appear out of proportion. You are bound to feel lonely, depressed and angry as it is not only the loss of the marriage but a cumulative loss of your life time wish to be happily married ever, a companion with whom you have deep connection, of being loved unconditionally, the house that you’ve been living in, the social status of a married woman and the loss of your family after the marriage of your younger daughter that you are dealing with and may be many more losses of the childhood. It is natural to mourn all these losses and you need to give your self time to heal. Denying these emotions will only lead to further such unpredicted outbursts till you are ready to face them. Having someone, a close friend or family to listen to you will also help. If these persist for over a year and half, or they get worse do consider taking professional help.
Following article provides information on the emotions and its stages during divorce which generally people go through:
1. Grief and Sorrow
Being sad when a marriage ends is natural. Although it’s painful, grief is a healthy emotional response to the loss of an important relationship. We are hardwired to feel it, and it wouldn’t be reasonable to expect otherwise. While sorrow and grief can be very hard to handle, most people do understand and accept the inevitability of these feelings.
We know from research, theoretical writings, and personal experience with thousands of people going through divorces that though the emotional impact of a divorce is as severe as that of a death in the immediate family, the grief and recovery process does have a beginning, middle, and end. Though they may seem endless, the pain and confusion surrounding separation and divorce do gradually lighten and finally go away — for most people over a period of eighteen months to three or four years following the marital separation, though recovery can be quicker or slower.
• Denial: “This is not happening to me. It’s all a misunderstanding. It’s just a midlife crisis. We can work it out.”
• Anger and resentment: “How can he [she] do this to me? What did I ever do to deserve this? This is not fair!”
• Bargaining: “If you’ll stay, I’ll change” or “If I agree to do it [money, childrearing, sex, whatever] your way, can we get back together?”
• Depression: “This is really happening, I can’t do anything about it, and I don’t think I can bear it.”
• Acceptance: “Okay, this is how it is, and I’d rather accept it and move on than wallow in the past.”
Understanding these stages can be very helpful when it comes to talking about divorce and decision making. It’s important to know that when you are in the early stages of this grief and recovery process, it can be challenging to think clearly or to make decisions at all, much less to make them well. Identifying your present stage of grief and being aware of it is an important step toward ensuring that you will make the best choices you can.
2. Guilt and Shame
Experiencing guilt and shame is also a normal reaction to the end of a marriage. These feelings arise when we feel a sense of failure — of not having fulfilled our own or our community’s expectations. In the case of divorce, people often feel guilt and/or shame because they have failed to stay married for life. That’s partly a matter of personal expectations — not fulfilling the promises made to a spouse — and also partly a matter of not fulfilling what our culture seems to expect from us. If our culture’s expectations about marriage and divorce are reasonable — if they fit well with how people actually behave in that culture — and we don’t measure up, the guilt and shame felt at the time of divorce may be appropriate. If the culture’s expectations don’t match well with the reality of marriage and divorce as people actually live it, the guilt and shame can be much more problematic — difficult to see clearly, difficult to acknowledge, difficult to manage in a divorce. In addition, there are some marriages in which one or both partners have engaged in extremes of betrayal, deceit, or even criminal behavior that almost always involve feelings of guilt and shame.
Regardless of whether the feelings arise from not having met one’s own or the culture’s ideals or from actual wrongdoing, we know that for many individuals, guilt and shame can be so painful that they change very quickly into other, more tolerable feelings, such as anger or depression — often without the person’s even knowing that the guilt and shame are there. This is why it is so common in divorce for each partner to blame the other and why it can be so difficult for divorcing partners to accept responsibility for their own part in a failed marriage.
We’ve encountered few divorcing people who find it easy to see or accept their own feelings of guilt and shame. These powerfully negative feelings often remain under the radar, hidden and invisible, where they do the most harm. Strong feelings of guilt or shame can make it difficult or impossible to take in more balanced information, to maintain your perspective, and to consider realistically your best alternatives for how to resolve problems.
Guilt can cause spouses to feel they have no right to ask for what they need in a divorce, causing them to negotiate unbalanced, unrealistic settlements they later regret. Family lawyers have a saying that “guilt has a short half-life,” and because guilt is such an uncomfortable feeling, it can easily transform into anger. We often see people who have negotiated guilt-driven agreements having second thoughts and going back to court to try to set aside imprudent settlements.
Similarly, shame often transforms into blame, anger, or rage directed at the spouse. Bitter fights over children or property can be propelled by feelings like these, which needs to go somewhere, goes into fights over matters that courts are permitted to make orders about.
3. Fear and Anxiety
Fear and anxiety are common because of our hardwired “fight-or-flight” instinct. Our bodies react to stresses (such as an angry phone call from a spouse) by using physical alarm mechanisms that haven’t changed since our ancestors had to react instantly to avoid being eaten by saber-toothed tigers. You react to stress physiologically in the following ways:
Your heart speeds up, and adrenaline pours into your bloodstream Your adrenaline makes your heart contract more forcefully and may cause you to feel a pounding sensation in your head You may feel hot flashes of energy Your attention homes in on the event that triggered the strong feelings, limiting your ability to take in new information When people are under chronic and severe stress, they may have anxiety attacks, in which they tremble and their heart pounds. Or they may be paralyzed by almost overwhelming feelings of fear that seem to come out of nowhere. We work with many people who experience these feelings as their marriages end. People who feel overwhelmed or confused in this way tend to fall back upon old habits of thought and action rather than looking intelligently at the facts of their situation and weighing the best choices for the future.
4. Old Arguments Die Hard
As marriages become troubled, couples often rely on old habits of dealing with differences that lead to fights rather than solutions. If those old habits didn’t lead to constructive solutions during the marriage, they will surely yield no better results during the divorce. In addition, people feeling anxious and fearful may resist pressure to move forward and resolve divorce-related issues because of feeling unready, while their spouses may be impatient, seeing no reason why the divorce wasn’t over months ago. Bitter fights in the divorce courts often stem from differences such as these.
Unfortunately, both our court system and our culture at large encourage us to take action in divorces based on how we feel when we are at the bottom of the emotional roller coaster, when we are most gripped by anxiety, fear, grief, guilt, and shame. After all, that’s when most people are moved to make the first call to a divorce lawyer. As a result, people are encouraged to make shortsighted choices based on emotional reactions that do not take into account anyone’s long-term best interests. The resulting “bad divorces” harm everyone and serve no one well. They are very costly; they fail to plan intelligently for the future; and they inflict psychological scars on both the adults and the children. This can be avoided by consciously working on the divorce keeping ones personal prejudices away.


Every human being wishes to be eternally connected with a person. This connection is established or expected to be fulfilled in a love / marital relationship. Infidelity in the relationship causes severing of this connection and also the hope of it in future. Too often, the numbness and confusion, the pain and anger of uncovering the infidelity is intensified by the myths and half-truths about affairs and inability to share the wound, that makes surviving infidelity that much more draining and difficult – both mentally and emotionally.
Emotions in infidelity mimic that of death of a person, only more difficult to deal with because it is not an actual physical death. The partner is not only mourning the loss of the relationship but also the eternal wish to be connected with a human being. It stirs up deep infantile feelings of insecurity and leaves the person feeling unloved and abandoned.
Compounding the issue, infidelity is often kept under wraps as it is shrouded by societal humiliation, shame, guilt and lowered self worth. The partner goes through various stages such as denial/ disbelief, anger, apathy and then grief. This mourning can last up to a year, or even more. Each occasion/ incident is mourned individually till the person is ready to let go and forgive. Often, during this phase of grieving the wounded person, although aware of the practical approach to deal with the situation, is unable to do so due to intense emotions. Family and friends out of their concern and not wanting them to be in pain provide with logical/ practical solutions and try to cover the wound quickly. This only further complicates the problem and the person further withdraws into his/ her shell. Now, not only he /s he is wounded but is also expected to wear a smile on his/ her face and move on in life. To forgive, and forget. But the wound festers within, causing more damage.
Each affair is unique. Each different type of affair serves a unique purpose to the cheating husband or wife. Here are areas of knowledge that, once studied, generate tremendous relief and hope.
There are different TYPES of INFIDELITY.
I came up with 7 types of affairs in my work with couples over the last 15 years:
1. My Marriage Made Me Do It
2. I Can’t Say No
3. I Don’t Want to Say No
4. I Fell Out of Love…and just love being in love
5. I Want to Get Back at Him/Her
6. I Need to Prove my Desirability
7. I Want to be Close to Someone…but can’t stand Intimacy
The reasons behind the varying types of affairs are distinctive. One may be motivated by compulsion, another by strong personal needs for excitement, another for revenge, another to maintain distance in all relationships, and another to project blame onto someone or something else.
These motives derive not from the marital relationship or the wounded spouse, but from the personal coping patterns of the cheating spouse. Additionally, these characteristics, motives, and patterns were already set well before the marital couple even met. At some level, it was necessary for the cheating spouse to “play out” these patterns. Unsurprisingly, most of this acting out (if not all of it), or at least the motivation behind the acting out, are well outside the consciousness of the cheating wife or husband.
Once the wounded spouse becomes aware of these patterns, the complexity of the infidelity and the motives for the cheating spouse – and other person as well – a flood of relief flows. The more one can make distinctions in a situation, the more refined those distinctions become, the less power that situation has to control the feelings and behavior of a person. Knowledge is power because it comes with options.
Overcoming infidelity requires a lot of space for the hurt and anger to be vented out. It is important that this venting out is listened to without any evaluation. This process along with challenging the beliefs about marriage and extramarital affairs helps the individual to cope with infidelity in an appropriate manner. It is difficult for the near and dear ones to do so because of their emotional attachment and involvement and often requires professional psychotherapeutic help for healing the individual/ s and their relationship. Working on these beliefs will provide the grieving person with clarity of thought and thereby the ability to choose his /her future actions. Knowledge about infidelity and self awareness becomes power with which one can heal oneself.
Look at the following false beliefs for example:
1. LOVE IS MAGICAL & SACRED: Coping with infidelity for the wounded spouse may mean dealing with the seeming fact that s/he is no longer “loved” and in reality that “love,” which was so sacred, is given to someone else and one has no control over it/ the ability to regain it. And, honestly, what is more emotionally devastating than to feel unloved?

2. POOR MARRIAGE LEADS TO INFEDILITY: Another common misconception is that someone jumped into the arms of someone else because the marriage was awful. Quite often, this means that the sex was awful, or even nonexistent. The wounded spouse is left lamenting the arguments and the points of differences with his/her spouse as if those differences tainted the marriage or relationship or worse what could they have done to avoid the infidelity.

3. Everybody is unfaithful; it is normal, expectable behavior: Seeking solace in commonality of the problem can bring about temporary relief, but along with it it brings about disillusionment and hopelessness about life in general and relationships in particular.

4. Affairs are good for you; an affair may even revive a dull marriage: Back at the height of the sexual revolution. This is an ineffective way to pacify oneself as jt leads to further damage in a relationship and more so to ones own self esteem.

5. People have affairs because they are oversexed: Affairs are about secrets. The infidelity is not necessarily in the sex, but in the dishonesty.

6. People have affairs because they aren’t in love with their marriage partner: On closer examination it routinely turns out that the marriage was fine before the affair happened, and the decision that they were not in love with their marriage partner was an effort to explain and justify the affair. Being in love does not protect people from lust. Infidelity with your loved one is not a very loving thing to do, and it may be downright hostile. If people are experiencing a deficiency in their ability to love their partner, it is not clear how something so hateful as betraying him or her would restore it.

7. TIME WILL HEAL THE WOUNDS: The wounded person is wounded because he/ she was unconsciously attracted to a person with particular traits. If these motives are not uncovered, he / she is likely to fall into a similar trap once again. So in a way they are responsible, albeit unconsciously. If these wounds are not opened, aired and well looked at, they are likely to remain infested and the infection likely to reappear at a later date, and often more damaging. Hence often we find the person saying that my partners often have uncannily similar personalities. Time does not help in protecting oneself in the future. One needs to work not only with ones emotions but also take professional psychotherapeutic help to figure out what about them drew them to such a person.
Such knowledge about infidelity brings great relief, quite often right then and there. Knowledge about infidelity gives options to act, feel and think differently, which gives one a tremendous feeling of personal power. The “wounded spouse” moves beyond playing the victim, and now recognizes that he or she is not at fault for the affair taking place. S/he is not defective. She or he can confront him or her with a basic educated guess as to the end result of that confrontation. There is nothing s/he could have done to avoid infidelity in the spouse. It also brings in awareness about ones own mental makeup protecting the person from future hurts.


Just like when a wound when cleaned causes more pain, so does talking about your hurt does. Talking about the problems brings about catharsis and a release of emotions. This can be perceived as threatening initially but is an essential step in healing.

Wounds when left unattended to are likely to form abscess and increase the pain. Similarly emotional wounds do not disappear over time. They need to be addressed carefully to avoid further problems or even amputation in worse case scenario.

Dragging along with negative emotions actually leads to further damage to the relationship. Emotional content of one incident adds on the next and carries on till it becomes unbearable.

People listen and trust non verbal or body language more than verbal messages. It is of no surprise that 80% of our communication is non verbal. Family and friends, if they are closely bounded, therefore will already have some idea about the problems. Keeping it hidden from them not only isolates you, but causes greater anxiety and even conveys a message to them that you do not trust them. In effect your efforts to keep them from being in pain actually cause more damage to your relationship with them and ultimately greater pain to both. Sharing pain with the family gets each other closer.

This is self induced pain and helplessness. This belief is the language of a victim who at an unconscious level prefers to remain as a victim. There is no basis to this belief.

Marriage is a relationship between two dynamic individuals. Changes in one lead to changes in the other. It has a ripple effect on the other. It is also a well known fact that one can only bring out changes in oneself and any attempt to change another is a foolish act. In my 10 years of practice I have worked with numerous marital conflicts and more often than not only one person consults for therapy as the other is either unwilling to come for therapy. Relationship has been resurrected despite only one member being present.

Blaming fate is an unconscious unwillingness on our part to bring about changes in our self. Change in any aspect is perceived and experienced as stressful and therefore unwelcome. However we verbally say that we are willing to work on the marriage, there is a resistance to change in a similar manner and its outward manifestations are in the form of helplessness to fate or blame on our partner. Our age old saying “taali ek haath se nahin bajti” goes a long way to explain this phenomenon.

Taking on the responsibility of change in your self is the first step to healing a marriage. Any attempts to change the other is seen as an evaluative, judgmental and a corrective act and therefore sabotaged at the first chance. I have more often than not worked with only one individual with equally effective results and in as much time.

The basis of this is negative thinking and the focus on what is not there. We can spend our time on focusing on how there is a speck on the drawing sheet or paint something so beautiful that the speck although there does not catch our attention. How we view things, a glass half full or a glass half empty is the premise of our belief in working out a marriage.

This is a powerful and omnipotent belief that love is magical. Therefore one can not really work on it or create it. It is either there or not there. If damaged, one can not create it. The fact is marriage or any relationship is not magical. We all need to work on it and resurrect it from time to time. Communication is therefore a crucial element in its survival. Even the purest form of unconditional love of a mother and child needs efforts to keep it alive. There is nothing magical about it. Any mother will tell you how she struggled with her child and that only conscious effort and good communication helped.

Many clients feel that going to a counselor will spoil things for them yes, many have experienced this too. Counseling is good; unethical practice in the name of counseling can have devastating effects. You need to be careful in choosing the type of marital counseling you are opting for.
Also, one may be aware that the marriage is not working out and may fear discovering that during the counseling. Some clients opt not to go for counseling as their fear of discovering this is higher than their pain. Some realize this in the middle of therapy and tend to push the blame onto the counseling sessions. Remember it is always your choice what you want. There is nothing right or wrong about it.
To avoid disappointments check out these basic premise of counseling before you enter therapy sessions:
• Consult a person who is non judgmental and non directive in his approach. We do not want it to be a verbal court battle in the counselors room where the counselor decides who is right and who is wrong.
• Another crucial element of counseling is confidentiality and therefore for any marriage counselor to take counseling sessions together with both the clients can actually do more harm than good. It actually turns out to be the power experienced by the counselor himself when he sits on a judgment on who is right and who is wrong.
• The counselor needs to empathize and work with you as an individual. If he is able to take you to a different level working with you, things automatically improve. The interest of the client is at the forefront in a session.
• Explore how comfortable are you with the changes in your life and decide for yourself what are your comfort zone. A good counselor can help you work on this.


Rahul was 12 years old when he was referred for bed wetting (enuresis) and passing stools (encopresis). He was referred by the family doctor who found a non medication approach to his bedwetting and encopresis a better solution, especially considering the long term side effects of the medicines and the fact that there were no physiological causes to his problem.
His problem had escalated soon after they had shifted into this new house. Parents didn’t think that shifting house could have been the reason for the same as he always wanted to shift back to this house. In fact he had many friends here and would initially quickly finish off his homework to go down to play. But soon he started wetting his bed in the night more often and the ‘accidents’ at school too increased.
By the time he started with play therapy, he was regularly wetting his bed in the night and the soiling his pants at least once a month. Rahul was so unsure of his own bowel movements that he refused to go for school trips or for a sleep over at his friends or cousins house. Off late he was fearful of going to school too, as he was now teased for being a sissy boy. At home too, he would play with his play station for hours on end and would be generally. His parents had tried every thing from making him visit the toilet at bed time and before going to school to more frequent visits when outside, but to no vain. Normally an active boy was now unsure and irritated most of the times.
During the case history on enquiring about any traumatic history the parents recalled that just before they had shifted the house he lost his grand mother and around that time the van in which the school children traveled had met with an accident. Although no one was injured Rahul had recounted the incident in great detail. They found it difficult to believe that these could again be the reasons as it was not the first time he was dealing with a loss of a grand parent or meeting with an accident. In fact he had lost his grand father the previous year, to whom he was more attached. Since his grandmother suffered from Alzheimer he hardly ever interacted with her over the years.
Bedwetting is considered to be problematic for children only above 6 years of age. Till about 5 it is considered normal if the child occasionally wets the bed. Usually children have considerable bowel control by the age of 4 and do not soil their clothes. Enuresis can be primary (the child did not grow out of using diapers) or secondary (child stopped wetting beds but suddenly after a period of time started wetting them again, as in Rahul’s case).
It is often connected to psychological issues of emotional stress / anxiety. Often the causes remain unknown to both the child and the therapist. Therefore using cognitive or reasoning approach is difficult with these children and it is not in their awareness or consciousness. Also emotions of shame and guilt are quite complex for the children to express verbally. This coupled with threats or punishment from parents (who feel an extreme sense of concern and frustration dealing with this problem) can become quite traumatic for the child. Play therapy, being dynamic, non directive and symbolic allows the child to reenact and work out his emotional issues leading to the problem in a safe and trusting environment without having to get into verbal communication. This is further supported by some parenting sessions where parents are usually asked to bring about certain changes in the child’s routine to support the sessions proves extremely effective.
The following are some of the changes that parents are requested to introduce:
• Having liquids at least 4 – 5 hours before the bed time.
• Setting up alarms at regular intervals and encouraging Rahul to visit the toilet.
• Keeping an extra pair of clothes and bed sheets so that Rahul need not wake his parents every time he had an accident.
• Not humiliating / threatening / asking too many questions to the child to rectify his behaviours .

Rahul began his play sessions. Initially he found it quite boring to play with toys that were around and often asked if he could carry his video games or whether there was access to computers. But slowly as the sessions progressed he started playing with animals, clay and balls. The therapist noticed that in most of his sessions he would give instructions to the therapist to follow. He would make loud noises and fight with the wild animals. With the clay he would often make snakes and then turn them into turbans which the therapist was instructed to wear and become the care taker of the animals. Some times he used the ball to knock down the animals. After many such sessions, he moved on to drawing. He initially drew only symmetric drawings but soon moved on to draw themes. Most of the themes again reflected anger, punishment and morality issues.
Around the 8th session, the mother mentioned that Rahul had wetted his bed only once and had soon woken up to change his clothes and the bedsheet. The therapist had given a list of instructions to the parents to follow. Soon after that Rahul showed greater interest in his play and also in the sessions.
After his summer break when he returned for the first session, he sent a message containing smiley face and to inform the therapist that they were on their way to the clinic. He seemed to have settled down with not a single mishap of soiling his clothes or wetting the bed. He had returned to his original confident self and seemed less tentative about things. Although he was apprehensive on the first day of school, he settled into his new routine pretty soon. On the follow up terminating sessions, the bedwetting and soiling behaviours had consistently shown improvement with no further accidents. His academic marks also returned to their earlier levels.