Depression vs. Dark Night of the Soul

“If it looks like a duck, walks like a duck, and talks like a duck . . . it's probably a duck.” This may be good advice for duck hunters, but not so good for millions of us who visit doctors because we feel low, sad, blue, depressed, out-of-sorts, exhausted, or are having an existential crisis. In spite of all the shades of blue and gray of human emotion, doctors jump to a diagnosis of Clinical Depression very quickly. Before you know it, you're walking out of the office with a prescription for Paxil. You looked like a duck and were treated like one, even if you are an eagle, dolphin, or wolf.

In my last article in The Light Connection, I wrote about “How Doctors Diagnose,” how they/we are trained in the process of “differential diagnosis,” a process by which a doctor makes a list of the numerous reasons or illnesses that could explain the variety of symptoms you have. Depression is one area in which differential diagnosis has become indifferent diagnosis. Because 99 percent of us will experience some degree of depression in our life, it is important to know what the possibilities might be for why we feel sad, blue, or depressed.

Clinical Depression

Clinical Depression is a “real” illness that has a strong genetic component. People with Clinical Depression may be happy, normal functioning folks with little or no mental/emotional problems. In Clinical Depression there is a profound plunge in the neurotransmitter norepinephrine, serotonin or both. These people are not only profoundly depressed, they can't sleep. They walk, talk, and think more slowly. Their motivation drops precipitously. Their memory and concentration are usually impaired. Their self-esteem is in the gutter and they lose all perspective on the reality of their life. They over-generalize, seeing everything as bleak and hopeless. While they may have been successful in whatever their work is, during a depressive episode, they may feel like complete failures. At the extreme, they are at risk of suicide. Anti-depressant medication is a good treatment choice for Clinical Depression, and these people generally respond well. When people with the diagnosis of Clinical Depression are not experiencing an episode of depression, they are usually totally normal.


While anti-depressant medication is valuable in the treatment of Clinical Depression, it is important to remember what makes our neurotransmitters. The amino acid L-tyrosine is converted into norepinephrine in the brain, while the amino acid L-tryptophan is converted into serotonin in the brain. I have never treated a depressed person who did not have a significant deficiency of L-tyrosine, L-tryptophan or both.

There are two nutritional tests that map out brain chemistry. Amino Acid Analysis will tell you if you have an amino acid deficiency. You can think of amino acids as the “input” side to the manufacturing of neurotransmitters. A urine test called The Metabolic Analysis Profile examines organic acids, which are the breakdown products of a number of biochemical reactions, including the breakdown products of serotonin, norepinephrine, and dopamine. From this test, one can determine if serotonin, norepinephrine, or dopamine are problems. Between the two tests, we can zero in on which neurotransmitter system is out of balance and which amino acids would help treat the depression, when taken as supplements. In addition, these two tests examine a number of co-factors that are essential for the conversion of L-tyrosine and L-tryptophan into their respective neurotransmitters. Some of those co-factors are SAMe, pyridoxal-5-phosphate (the active form of Vitamin B-6), copper, Vitamin C, magnesium, iron, and other B Vitamins. One can treat depression by taking the appropriate deficient amino acid along with the co-factors. Or, if one chooses to take an anti-depressant, Amino Acid Analysis and the Metabolic Analysis Profile will tell you if your depression is due to serotonin deficiency (in which case drugs like Paxil and Zoloft are most appropriate) or to a norepinephrine deficiency (in which case Wellbutrin is your best medication). Without this kind of testing, treatment of depression with medication is a shot in the dark.

Medical Conditions That Cause Depression

A variety of medical problems can produce depression or masquerade as depression. If you treat these illnesses with anti-depressants but fail to identify and treat the underlying cause, the consequences can be dangerous. Some conditions associated with depression are: hypothyroidism, hypoglycemia, fibromyalgia, candidiasis, chronic fatigue syndrome, Lyme Disease, adrenal dysfunction, pituitary tumors, heavy metals, food allergies, PMS, sleep disorders, heart disease, multiple sclerosis, chronic pain, head injury, Parkinson's Disease, chronic inflammation, temporal lobe epilepsy, stroke, brain tumors, and liver disease. In addition, a host of viruses, including all of the herpes viruses (Herpes Simplex I and II, Epstein-Barr Virus, Cytomegalovirus, Human Herpes Virus-6), hepatitis, and HIV can all produce depression.

In addition, a variety of medications can cause depression as a side effect. These include: tranquilizers and sedatives, antipsychotic drugs, antihistamines, beta-blockers, high blood pressure medications, birth control pills, anti-inflammatory agents, corticosteroids, cimetidine, and indomethacin. This is an abbreviated list.

Many great saints throughout history would have been classified as “depressives” today. St. Teresa of Avila suffered from temporal lobe epilepsy and resultant mood problems. If she had been “treated appropriately,” her religious visions and spiritual ecstatic states would have stopped. We must be careful in sorting out our miracles from our madness.

Riding Out the Blues

All of us experience low periods, the blues, disappointment, and sadness. Sometimes we know why we are feeling down and sometimes we don't. Generally, if we examine our lives carefully, we can pick up the patterns or events that preceded feeling “down.” You might feel trapped in a job or a marriage. That is depressing. You may be someone who has a difficult time with anger, in which case, when you are in a situation that makes you angry, you quickly bury the anger. Before you know it, you're feeling depressed. For people who swallow their anger, expression of that anger in an appropriate way can relieve the depression. In this instance, Sigmund Freud was right. He believed that depression was anger turned inward. This is not why all people get depressed, but it is why some people do.

Simply being in a situation in which you feel trapped and as if you have no control to change anything will make most people depressed. Now, the fact is that we can all make decisions about how we respond to any particular situation. Even in the Nazi concentration camps, there was quite a spectrum of human emotion, best written about by Bruno Bettleheim. He noted that “religious fanatics” (his words), did the best and somehow managed to maintain hope and a positive attitude. So, there really is no situation that is intrinsically a trap. Only thinking makes it so. If you are experiencing anything like what you've just read, technically we call that an “Adjustment Reaction with Depression.” I don't treat that with medication. I use mental imagery and a host of other psycho-spiritual techniques and strategies to help people experience and work through this kind of depression or the blues. While anti-depressants may help these “situational depressions,” I do not see the need to treat life as a disease.

Dysphoria: Moods Without Names

Most of us can relate to times when we feel crummy, or out-of-sorts. We don't feel right and our mood is unpleasant, although it is hard to define what our mood is. “Dysphoria” means, “an unpleasant mood or mental state.” Maybe you've come home from a long, stressful day at work and you just feel dysphoric. You feel “blah,” negative, worn out, negative, crummy, crappy. You can't really put your finger on what is wrong and you can't give a name to the mental state. Maybe your biorhythms are not working in your favor that day. Maybe if you check your astrological chart (a real astrological chart), it will warn you that, “Today is not your day. You feel crummy. Rest today.” Unfortunately, some of these words will sound like Clinical Depression to a psychiatrist or other prescribing physician, and you can be put on anti-depressants because you are dysphoric, when, in fact, dysphoria has nothing to do with Clinical Depression.


Grief and depression are often confused. When you suffer great loss, such as death of a loved one, you go through great pain. If you are lucky, you will “be” with the pain and not push it away. You will let the tears pour, and will accept the support of family and friends. Frequently, doctors will offer anti-anxiety medication and sleeping pills for people in grief. It is a bad form of treatment, for it can interfere with the grief process running its course.

The more emotional baggage you carry from childhood and from accumulated, unresolved conflict, the more likely you are to move away from the pain of grief as quickly as possible. Many of us move into anger and blame, which allows us to distance ourselves from the raw pain. But, the long-term consequences can take a toll. Un-experienced grief will turn into depression…or physical illness.

A friend of mine recently had three close relatives die within one week…all unexpectedly. She cried for several days and fully felt the pain of the grief. But each tear released some of the pain, and a week later she had completely moved through the grief. She shared her experience with me, partially in e-mail, one of which said, “I believe tears are one of the most beautiful things in the world. Tears just go so deep. I think tears are the language of the heart. In the last week I have cried a lot, when talking to my relatives on the phone, and just being by myself at home. Do you know something? After crying I have felt tremendously alive and extremely blissful.” As a psychiatrist, I can say that she is not in denial. The fact is that people can move through grief, through the tears, and feel not only relief and release . . . but even bliss. The key is to accept and embrace the pain of grief. By so doing, pain is transformed.

Adult Survivors of Adult Abuse

Those who grew up with severe abuse or neglect have a lifetime of inner work to do before they feel whole, healed, and complete. Child abuse/neglect causes a state that I call “The Void,” which is a giant emptiness inside. When I ask adult survivors of abuse to visualize themselves at the edge of an abyss, they will see and experience a bottomless pit that is as wide as the Grand Canyon. Out of the void arises addiction, feelings of emptiness, a feeling as if one is never living on solid ground, and a profound depression that can provoke suicidal thoughts and acts.

These people suffer tremendously emotionally. Over the years, psychiatrists will treat them with every category of psychiatric medication. Medications rarely work, and when they do, the effect is usually short-lived. It would take too long to explain the biology of this, but it is easy to explain the symbolism. If you throw a pill of Paxil into the Grand Canyon, what is the impact on the Grand Canyon going to be? Nothing. When we treat adult survivors of abuse with anti-depressants, we are essentially trying to heal the great abyss with a tiny pill. It does not work.

Dark Night of the Soul

St. John of the Cross was the first to write about the Dark Night of the Soul. While the term is used in a variety of ways, its general meaning, as it relates to conscious spiritual practice, is a lengthy and profound absence of light, hope, and connection to God. One feels profoundly alone and cut off from Self, others, and God in the Dark Night.

The Dark Night is to be expected for spiritual seekers, many of whom will experience a number of Dark Nights as part of the journey. Frequently, the Dark Night will occur before a major spiritual breakthrough. Regardless of what you call your spiritual path, all paths lead to the same mountaintop, namely the individual Soul merging with God, Love, or Light. Until there is complete merging, there is separation, and the pain of separation. At times, the longing for spiritual union is exquisitely painful. The great Indian Saint Parahamsa Ramakrishna went through a period in which his longing for a vision of the goddess Mother Kali was so great that he was ready to take his life. In his darkest night, Kali appeared to him, resolving the crisis. If it can happen to Ramakrishna, it can happen to you and me.

Not all of us are aware that we are on a spiritual journey. Some of us are conscious of the journey and others are not, but we are all on the same journey. For some, the Dark Night of the Soul may manifest as an existential crisis, a period in which one questions everything in life. One questions the meaning in one's life and whether there is any meaning at all. These people need the help of a skilled psycho-spiritual or pastoral counselor to help them find meaning in their meaninglessness, or to discover their true passion or bliss, and then move in a new direction.

Whether you are questioning the meaning in life, having an existential crisis, or a Dark Night of the Soul, your experience should not be confused with Clinical Depression. You do not want to short-circuit this process with medication any more than you want to abort the grief process with medication. In both situations, medication will ultimately lead to genuine depression, the exact thing it is intended to treat. You cannot treat “meaning” with a drug. Nor can you accelerate your expansion of consciousness, your spiritual awareness, with medication. Of course, I have worked with many people who were unsuccessfully treated for “meaning disorders,” “Dark Night Disorders,” and “existential crises” with anti-depressants.

I regret to say that psychiatry has a limited vocabulary with which to understand the full spectrum of human experience. If you sound like a duck, walk and talk like a duck, your psychiatrist is going to assume you are a duck. If any of your words sound like depression, chances are that you will be treated for “Clinical Depression” with anti-depressant medication.

It is up to you and your doctor to understand the depth and breadth of depression, grief, emptiness, exhaustion, emotional pain, dysphoria, sadness and related emotional states. It is up to your doctor to make sure that you do not have a serious medical problem that is causing depression. A classic example is pancreatic cancer, which can first manifest as mental depression.

Before you can find the light at the end of the tunnel, you must first determine which tunnel you are walking through.

David Gersten, M.D. practices nutritional medicine and psy-chiatry out of his Encinitas office and can be reached at 760-633-3063. Please feel free to access 1,000 on-line pages about holistic health, amino acids, and nutritional therapy at


Dear Louise

Dear Louise,

I really need your help. I hope you hear my prayer and reply to me. I usually find your affirmations very useful, but I'm currently in such a depressed state of mind that my thoughts keep turning negative. I try to say affirmations, but they ring hollow because I'm having a difficult time believing in any good or positive thoughts these days. Is there anything I can do to help myself believe the positive words and thoughts again, or is repetition the only answer? Second, much of my current situation has to do with a lack of money. Are there any specific affirmations that attract money and a positive cash flow?

S.B., Chicago, IL

Dear S.B.,

We sure make a big god of money. If we don't have some, many of us choose to make ourselves miserable by our choice of thoughts. The more miserable our thoughts, the more depressed we get and the more that money stays away from us. And I bet you're choosing to eat junk foods with lots of sugar, which only depresses you further. If this is true for you, find the best diet plan for your particular body by seeking out a good nutritionist in your area.

Meanwhile, affirmations for prosperity can be: The Universe is my supply. I release all resistance to attracting money. The Universe finds unique ways to increase my prosperity. Money is my friend. I open the doors to accepting money. I let it come in expected and unexpected ways. I am a channel for all good, including money. I breathe deeply and know that I am blessed, I am worthy of a positive cash flow. I smile often, knowing that I am moving into a new way of thinking that will allow abundance to flow to me.

And remember: All is well!

Dear Louise,

Although I've worked with your books for some years now, there's still one thing I don't understand: When I don't like something about a person, why is that a reflection of me—or why does it say that I don't like something about myself? For instance, my husband is very stubborn. I don't like that at all. But I'm not stubborn myself. I'd be happy if you could explain the concept behind it again. Maybe there's an aspect that I've overlooked so far.

T.C., Montreal, Canada

Dear T.C.,

Being stubborn, of course, means being unwilling to yield to something or someone. And it also can mean “not responding to treatment.” You're unyielding in your dislike of your husband's behavior, as you've relayed it here in your letter. What I don't know is what he thinks about you and your behavior. I'm only hearing one side of the story. First, his behavior has nothing to do with you. Second, if you sit in quiet meditation you might find many little places in your life where you're quite stubborn. We all hide from ourselves.

If you don't believe that people really are mirrors of your feelings, then you have nothing to worry about! Just take care of you. People in our lives may behave in ways that trigger uncomfortable responses in us. However, they didn't get into our minds and create the buttons that have been pushed. Taking responsibility for our own feelings and reactions is mastering our “ability to respond.” In other words, we learn to consciously choose rather than simply react.

Choose these aspects of yourself when you're interacting with others and they'll come back to you many times over: Forgiveness. Kindness. Love. Joy. Respect.

All is well!

Dear Louise,

My husband and I have been very close, and on a spiritual journey for many years. Although we've been through our ups and downs, we've always been together in our search. Now, it's as if we're parting ways. What does one do for oneself during this time?

D. J., Atlanta, GA

Dear D.J.,

The best answer I can give you is to love yourself as much as you can. See this as a bump in the road. Sometimes relationships last longer than they're supposed to. In spite of the words society has put into the marriage vows, not all marriages are meant to last forever. It's wonderful that your marriage has a spiritual element to it. However, just as we all change over time, so do our spiritual journeys. None of us are the same people we were 10, 20, 30, or 40 or more years ago! We often change in different directions. Bless your husband with love and shower yourself with lots of tender love, too. You never know with Life; you may come together closer than ever.

Affirm: I place this relationship in the hands of the Universe and know that it will be resolved for the highest good of all of us. I am at peace.

If you would like Louise to answer your letter in this publication, please send it to: Dear Louise Column, c/o Hay House, Inc., P.O. Box 5100, Carlsbad, CA 92018-5100, or e-mail your letter to: (letters used in this column may be edited for length and clarity). Please visit Louise's website at: or the Hay House website at: