A Review of Some Remedies for Depression

The nice thing about homeopathy is that it is not limited by diagnostic stereotypes. As with any type of illness, homeopathy recognizes that there is great diversity in terms of types and presentations of depression.

Successful homeopathic treatment is critically dependent upon being able to identify different patterns of symptomatic expression and their oftentimes subtle differences. One could argue that there are an infinite number of types of depression, since each individual case is unique. Technically speaking, the goal of the homeopath is not to treat depression, per say, as much as it is to treat the person who suffers from depression.

The allopathic stereotype of depression is clearly delineated in the latest 5^th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). As a consequence, rather than appreciating individual patients and their struggles for who and what they are, many physicians wind up spending inordinate amounts of time and energy quibbling over whether a given patient conforms to the diagnostic criteria enough to warrant treatment and/or insurance reimbursement.

This perfunctory academic ritual is often conducted only to arrive at the obvious allopathic conclusion that the patient may benefit from a prescription of one of a variety of antidepressant medications.

This cookie-cutter approach to mental health boils down to millions of people trapped in pharmaceutical limbo, having to depend upon antidepressants for indefinite lengths of time. Many take antidepressants for years because they experience some modicum of relief.

Thus, while they continue to suffer, albeit to a lesser degree, they nevertheless continue to take antidepressants as a crutch for survival. This is the case because medical groupthink is so adamantly opposed to new ideas that alternative approaches like homeopathy are never even considered.

The woeful standard of allopathic care not withstanding, most homeopaths have witnessed the miracle of a suffering patient who has been permanently freed from the burden of his or her chronic depression. One would expect thoughtful, open-minded physicians to demonstrate curiosity when told of such case histories.

Surely, they would become inquisitive, wanting to know more. But when doubting skeptics instead demand scientific proof of such occurrences, the answer, in my opinion, should always be, “just talk to my patient.” Further proof should not be necessary.

Denial of the value of this type of firsthand clinical evidence is an indication of how lost and cynical modern medicine has become. I do not consider it my job to dissuade skeptics from their default positions of disbelief or their overreliance upon statistical certainty.

But I do encourage every homeopath faced with incredulous medical colleagues to stand firmly on the ground of experiential evidence, the kind of evidence that comes straight from the patient’s mouth.

The depression that we think of as homeopaths is not the same rigidly defined depression outlined in the DSM. It is a much broader phenomenon, one that encompasses greater diversity and subtlety. Have you ever asked a patient whether he has been depressed, only to have him hesitate for fear that you will saddle him with a diagnosis of clinical depression?

More than a few times I’ve had to reassure patients that I’m using the term as a general reference and that I’m not looking to pigeonhole them. Many patients rightly fear being stereotyped and stigmatized by a medical system that fails to hear them or understand them. More to the point, they fear being told that they will need to take antidepressants for the rest of their lives.

Fortunately, homeopathy gives us the ability to treat those who have reservations about a pharmaceutical approach to mental health. In my clinical experience of thirty-five years, homeopathy can treat most cases of depression more effectively, far more safely, in a way that affirms the personal truth of each patient, and in a way that does not require interminable treatment.

So, let’s take a look at a sampling of some of the more commonly indicated remedies for the various presentations of depression in homeopathic practice.

Aurum metallicum – This is the remedy that most closely approximates the conventional stereotype of clinical depression. Aurum tends to fit deep thinkers who take their religion and spiritual condition seriously. He may pray, meditate, and read books about spirituality.

However, when his high expectations and ambitious nature meet with obstacles, he may be thrown into a downward spiral of disappointment. When things get bad enough, he begins to see himself as a failure. Life loses its meaning, he loses his faith in humanity, and he may even begin to doubt his religious beliefs.

Words that can describe Aurum are bleak, dark, hopeless, joyless, despairing, purposeless, and meaninglessness. In its most destructive manifestation, Aurum loses the will to live. He sees no further point in living.

As he contemplates suicide, the thought of death comforts him because he sees it as a way to put an end to his suffering. The Aurum patient may descend into such a state after a business setback, the death of a loved one, disappointment in a romantic relationship, or any situation that causes him to perceive himself as a failure. Music is one of the few things that can temporarily ameliorate the existential pain of Aurum.

A note of caution here: Aurum is the type that tends to follow through on his suicidal impulses. If you suspect that you have an Aurum case, and the patient acknowledges having suicidal thoughts, it must be handled with great care.

It is essential to reach an agreement with the patient such that he guarantees his safety. He must agree to contact you or some other support person in the event that he believes he may do something to harm himself.

Out of an abundance of caution, and because the patient’s state of mind could be exacerbated before relief sets in, I prefer to make sure that the patient will not be alone during the first 24-48 hours after taking the first dose of the remedy.

On a more positive note, a well-indicated and timely dose of Aurum can lift the dark burden of depression from a suffering patient, thus restoring his will to live. It can be nothing short of miraculous and transformational.

I once had the opportunity to help a very unhappy boy in his early adolescent years. Although it was clear that he was quite intelligent, he had become pretty disdainful of both his social life and his schoolwork. During one of our conversations, he attempted to sum up his prevailing mindset for my benefit. He said, “I’m a nihilist.”

Naturally, this got my attention, and so I asked a few more questions. He admitted to having occasional suicidal thoughts. After a few doses of Aurum over the course of several months, he was like a new person, and his parents were thrilled.

Sepia – This is a commonly indicated remedy for hormonally related depression. I suspect this is because so many women are prescribed hormonally active drugs, mostly for birth control reasons, but also as treatment for a variety of female health problems, especially irregular menstrual cycles. Unfortunately, the net effect can often be the irritable state of indifference that Sepia so perfectly embodies.

The Sepia depression, which can range from mild to severe, is a state of neutrality in which the normal range of emotional highs and lows becomes dulled or blunted. She may complain that she doesn’t feel emotion like she used to. She feels blah, numb, detached.

The resultant narrower range of emotional responses commonly presents as a flattened expressionless affect. The one emotion that Sepia does experience is irritability, and she usually directs that irritation at her husband or her children. She also has a tendency to weep, especially when talking about her troubles.

This emotional state may correspond to an actual state of hormonal neutrality whereby the feminine qualities are diminished while masculine attributes are accentuated. Thus, we see the classic Sepia aversion to family, aversion to children, aversion to husband, and a general distaste for anything that represents domestic responsibility.

On the physical level, this state of neutrality frequently presents as a lack of libido and, in more advanced cases, an outright aversion to sex. Sepia keeps her husband at a distance and does not encourage his affection.

In order to overcome her depression, Sepia seeks to escape from her family, her home, and her marriage. She prefers to be out in the world, preferably the working world. Sepia may present as the career woman who lacks interest in being married or having children.

Physical exercise is one of the few things that can help Sepia cope with her depression. Just as some people need coffee to survive, Sepia may depend upon a regular exercise routine to lift her out of the blasé apathy that plagues her.

The need for Sepia can usually be confirmed by tracing the change of mental status to a corresponding change in hormonal status. Hormonal events such as puberty, pregnancy, miscarriage, abortion, birth control pills, fertility treatment, IUD placement, hysterectomy, or menopause often create the conditions necessary for the development of a Sepia type depression.

The good news is that Sepia has the power to reverse this common type of hormonal depression. I have witnessed more than a few marriages saved by a few doses of this wonderful remedy.

Phosphoricum acidum (Ph-ac) – Here we have a completely different kind of depression, one that is strongly associated with fatigue. Ph-ac may present like Sepia, looking flat and lifeless, but it usually has nothing to do with hormones.

The Ph-ac depression is a state of unmotivated fatigue brought on by having struggled with adversity. Ph-ac is worn down, burnt out, drained, and simply has no energy left to care anymore. This unique combination of low energy and indifference may be brought about by a difficult illness, a prolonged emotional ordeal, or a failed romantic relationship. It can take the form of a lack of physical energy or a lack of emotional energy, or both.

The picture is that of a person who sleeps late in the morning, and has to drag himself out of bed. In spite of having slept all night long, and extra hours until noon, he still feels unrefreshed on waking.

He gets out of bed and plunks himself on the couch where he is likely to remain, unable to rouse himself to do anything. This couch potato state is the result of a mix of apathy and fatigue. His friend calls and invites him to do something. He tells his friend, “Nah, I’m good. You go on without me.” Instead he sits on the couch and watches TV all day. He just isn’t motivated to do anything.

Now, you may recognize this state as rather common among teenagers—and you would be right. Ph-ac is particularly indicated for the tall thin adolescent who has just endured a growth spurt. The physiological strain of having grown several inches in height in a matter of months can take its toll on the vital force. When we see the teenager with growing pains, who can’t get out of bed on time for school, and who has sunk into an apathetic fatigued funk, we know we have a case of Phosphoricum acidum.

One can categorize this state as a type of depression or something akin to chronic fatigue syndrome. It may be either, or a combination of the two. Regardless, it often looks like depression.

One little helpful telltale sign is that there may be a desire for carbonated drinks. The refreshing nature of such drinks can serve to momentarily rouse the Ph-ac patient from his exhaustion. Thankfully, a few doses of Ph-ac can provide a much-needed burst of energy and can restore the vital force to its former healthy state.

Natrum sulphuricum (Nat-s) – The type of depression associated with Nat-s is frequently accompanied by suicidal ideation, but it is said that he restrains himself due to his sense of responsibility. And this appears to be true. A Nat-s depression does not seem to be nearly as grave as an Aurum depression, however, that doesn’t mean that it should not be handled with caution.

Although not always true, in my experience most Nat-s depressions can be traced to a head or spinal injury. Since the connection between the two may not be apparent to the patient, he or she may fail to report it as such, which is why, when presented with a case involving suicidal thinking, it is incumbent upon the practitioner to always ask questions about the history and timing of events like head injuries, concussions, spine injuries, sports injuries, motor vehicle accidents, and so on.

This type of post-traumatic depression resulting from trauma to the brain or spine is a very common occurrence. In some cases, the progression of depression may be slow and insidious, thus making it harder to discern the link between the two. Nevertheless, whenever we see a patient with a history of head injury with subsequent development of depression or suicidal thinking, Nat-s is by far the number one choice of remedy.

It is worth noting that Nat-s is a remedy that has both sodium (Natrum) and sulphur as its constituent elements. Correspondingly, I have found that many Nat-s patients tend to exhibit similarities to the remedies, Natrum muriaticum and Sulphur. Hence, for example, the Nat-m sense of responsibility toward others that compels Nat-s to not act on his suicidal ideation.

Natrum sulphuricum along with Thuja and Medorrhinum are the three most prominent representatives of the sycotic miasm. Thus, we may also see symptomatic clues associated with these remedies sprinkled throughout a Nat-s case.

We also tend to find characteristics associated with the sycotic miasm, such as aggravation from damp or humid weather. One helpful clue is that a good number of Nat-s patients will acknowledge a fondness for tart or sour apples. Although this is not listed as such in most repertories, I have confirmed it multiple times in practice.

There is no better evidence of the healing power of homeopathy than when a Nat-s patient experiences dramatic relief from his or her depression, in spite of the fact that the trauma that triggered the depression occurred not weeks or months ago, but years ago.

Ignatia amara – Although Ignatia has a reputation as a “grief” remedy, the depth and intensity of Ignatia’s dramatic suffering can sometimes qualify as a form of depression. The high expectations and high ideals of Ignatia make her particularly susceptible to hurt and disappointment. When relationships don’t work out, Ignatia can be easily thrown into a vortex of powerful emotion.

Ignatia is the most commonly indicated remedy for “hysteria”, which means that her emotional states are intense, ever changing, and unpredictable. In her woundedness, Ignatia feels alternatingly distraught, angry, humiliated, defensive, insulted, anxious, hopeful, and then distraught again. Such spasms of emotion may be triggered by discord in romantic relationships, friendships, or family relationships. Most commonly, it can result from the death of a loved one.

In her grief, Ignatia can go to extremes. She may cry uncontrollably for hours or even days on end. On the flip side, she may exert tremendous effort to control those powerful emotions. She can go for long periods without shedding a tear, but then eventually breaks down into an explosion of spasmodic sobbing.

When she successfully represses her emotions, she may pay the price in the form of physical spasms that can manifest as muscle tension, muscle cramps, internal cramps, twitches, or tremors. Emotional spasms may even alternate with physical spasms. Some keynote clues include dramatic sighing, and globus hystericus, which is a sensation of a lump in the throat. We see this when unprocessed emotion becomes somaticized, trapped in the body.

Natrum muriaticum (Nat-m) –This remedy is also primarily a grief remedy, and is closely related to Ignatia. Although the two can be sometimes hard to tell apart, the Nat-m patient is usually more adept at concealing his suffering. His emotions are usually not as dramatic or tumultuous. In his pain and grief, Nat-m withdraws into a protective shell of silence, often preferring to be alone to lick his wounds.

He may hold onto his grief for long periods to time, even years. His capacity for silently carrying his internalized pain and sadness can create the conditions that make him susceptible to depression. So don’t be fooled.

To the world, to his closest friends, and even to the practitioner, he may appear to be just fine. He shows no sign of distress because he prefers to keep his troubles to himself, and he is very good at doing that. In fact, to reveal his true feelings would be mortifying. Nat-m has no greater fear than to be exposed, to be vulnerable, because that would create the opportunity for someone to dismiss him, to reject him.

If we suspect Nat-m, it is important to question thoroughly without getting the patient on the defensive. He has to know that you can be trusted before he will open up to reveal himself.

Two simple questions that I like to ask are, “Do you like or need to have alone time?” And, “Do you like to talk about your feelings or do you prefer to keep them private?” The answers to these questions can sometimes open the door to further questioning.

Nat-m is often the type who rarely if ever cries. He may say that he never cries, or doesn’t like to cry, or feels like crying but can’t cry, or will only let himself cry when he is alone.

A few doses of the remedy will sometimes open the floodgates, allowing him to purge himself of the internalized burden that he has been carrying for so long, thus allowing the healing process to begin.

It’s also worth noting that Nat-m and Sepia are frequently indicated in sequence. Thus, it may be necessary to prescribe one and then the other in order to adequately address a case of depression.

Sulphur – With this remedy we tend to see a garden-variety type of depression. The Sulphur depression isn’t deep like an Aurum type of depression, but it is enough to make him miserable.

The Sulphur patient tends to be irritable, argumentative, disorganized, and disheveled. He is blunt, talks loud, demonstrates his knowledge of various topics, and doesn’t hesitate to say what he really thinks.

His ego is big enough to make him question the knowledge of the practitioner and his ability to do the job. He likes to engage in debate, not because he’s trying to be difficult—although he often is—but for the sheer sport of it.

Although not all Sulphur patients are sloppy—some can actually be fastidious—he does tend to let his physical surroundings fall into disarray. He sometimes downplays the disorder, arguing that he has his own system that allows him to find things amidst the chaos. He procrastinates and lacks motivation to take care of daily responsibilities, but he finds the energy for his special interests and the things he likes to do.

He is often preoccupied with his own thoughts, too busy mentally to attend to physical reality. He may neglect his hygiene to the point where it becomes noticeable. In time, his failure to attend to the important things in his life may accumulate to the extent that he can no longer keep up, thus exacerbating his depression.

One sure sign that a Sulphur prescription is working is when the patient reports back that he decided to finally tackle all the junk that had been piling up for years in his garage. He threw some of it away and organized the rest. And don’t be surprised when he tells you that he did it all of his own accord, no thanks to any remedy.

Thuja occidentalis – The Thuja depression is characterized by feelings of worthlessness and low self-esteem. She wants to be liked and so projects different personas to different groups depending on what she thinks will make her acceptable to each group. But all the while she carries inside herself a feeling that something is wrong with her, that she is different from everyone else, and that she is tainted in some way. She is hard on herself, and may have feelings of self-loathing.

The reasons for her secret shame can vary, but it often has to do with sex or sexuality. She may have been sexually abused. Perhaps she had an abortion, or was once diagnosed with a sexually transmitted disease. Maybe her father was an alcoholic. She may be simply carrying the secret that she is gay and is afraid to come out to her family, or to society.

A Thuja patient once told me that she grew up on the poor side of town and, even as an adult, she still didn’t want anyone to know about it. A lot of Thuja patients suffer from dysfunctional body image issues. I once saw a patient who had band-aids on her fingers. I asked her why. She said she used them to cover up her warts, which she thought were dirty and disgusting.

Regardless of the specific nature of the thing that makes Thuja feel unlovable or unacceptable, it is a heavy burden to carry and conceal. It can be exhausting to cover up one’s tracks, making sure that your secret remains a secret.

So in a certain sense, Thuja can be a person who leads a double life. She dreads being outed, because if the world ever discovered her secret, what would people think? Fortunately, a timely dose or two of Thuja can make a person forget that she ever worried about such concerns.

Psorinum – This remedy shares a lot of characteristics with Sulphur. However, while the Psorinum patient may be similarly disorganized, slovenly, and unmotivated, there are some distinct differences.

Aside from the fact that most Sulphur cases are warm-blooded while most Psorinum cases are quite chilly, Psorinum tends to have a different feel. I tend to think of Psorinum as a sad pathetic Sulphur who has lost his confidence. It’s almost the polar opposite to Sulphur’s egotism.

The Psorinum patient tends to be rather fatalistic. He seems to expect failure. He knows that things will not go well for him. His life is this way and it will always be this way.

His lack of success is a given, and so he prepares himself for more of the same. Rather than rail against his fate, he sinks into a passive type of depression, one that he accepts with a sense of resignation.

The Psorinum theme has been compared to the cliché of the starving artist. In order to make great art, the starving artist believes that he must live in poverty with the expectation that his true greatness will likely never be recognized, at least until well after he is gone from this earth.

To be an artist, he must know pain and suffering and poverty. While Psorinum assumes the same fate, he also lives in fear of failure and in fear of poverty. He fears for his future and he fears for his health.

After all, it is his fate in life to meet with adversity. In more advanced cases, Psorinum feels forsaken and will despair of his fate as he sinks into depression and considers suicide.

I once gave a patient a couple doses of Psor 30c. He had been living in a dirty old apartment. When he returned, the first thing he told me was that he decided to splurge. He had taken the rare step of dipping into his closely guarded savings. He had gone out and bought himself a brand new bed!

Pulsatilla – This is a well-known remedy and, like Sepia, it can be useful in hormonally related depressions. The presentation, however, is quite different. In fact, it’s almost the opposite. While Sepia is averse to company, Pulsatilla desires company. Pulsatilla does not want to be alone. She wants someone to be with her, to comfort her, to give her affection, to sit with her and make her feel better.

Although both remedy types can be weepy, Sepia is more irritable and standoffish, while Pulsatilla gives off a sad ‘woe is me’ vibe as if to say, please help me. She tends to cry at the drop of a hat but is easily consoled. But don’t be fooled because her moods are changeable and she is quite capable of being irritable, too.

The Pulsatilla patient often feels abandoned and forsaken. She is soft, easy going, and dependent upon others. She is easily influenced and can be taken advantage of by a stronger person. Her fear of being abandoned and alone makes her overly loyal to a partner, even if that partner treats her badly. She is the type who will keep going back to an abusive relationship.

Incidentally, I have chosen to describe each of these depression remedies in terms of ‘he’ or ‘she’ for the sake of convenience and consistency in my writing, not because one remedy is only indicated for men or another for women.

For example, Sepia may be needed for men and Sulphur can be indicated for women. I say this because Pulsatilla has a particularly strong reputation as being a women’s remedy. Don’t believe that for a second.

It’s a common trap to be overly influenced by the stereotypical descriptions of remedies. It is quite possible, and not unusual, for a man to exhibit feminine characteristics or qualities that point to the need for Pulsatilla.

A bank manager once consulted me for help with his depression. He was a large but gentle, sharply dressed man. He was feeling discouraged by having to endure repeated visits by supervisors from corporate headquarters.

He knew he was doing a good job but he felt emasculated by their constant oversight. He was considering leaving the job. A few doses of Pulsatilla lifted his depression and provided the fortitude that he needed. He weathered the scrutiny and recommitted to his job with renewed vigor.

Helleborus – In psychiatric terms, the keynote feature of this depression remedy is psychomotor slowing or psychomotor retardation. The patient who needs Helleborus struggles mightily to think and may even struggle to move his body in a coordinated manner. Helleborus has weakness of memory and great difficulty thinking.

The Helleborus mind is slowed to a crawl, as if paralyzed. It’s as if his stupefied mind has gone blank. His facial expressions and speech are correspondingly slow. It’s as if we can see the patient thinking in slow motion. There is a noticeable delay between when a question is asked and when the patient responds.

Helleborus is the main remedy in the Mind section of most repertories under, “Answers slowly.” This type of mental molasses is the key identifying feature of Helleborus.

The mind is confused, but not because he has multiple thoughts swirling through his head. The Helleborus confusion occurs without thoughts, as if he is not thinking, or can’t think. This inability to function is a source of great distress and can contribute to the Helleborus depression, even to the point of suicidal ideation.

His inability to concentrate can affect his ability to perform physical tasks. Without a concentrated effort, his body may forget what his mind is telling it to do. His hands may lack coordination or he may be ataxic.

We tend to see this type of symptomatology in cases of depression associated with neurologic insults, such as meningitis, encephalitis, dementia, and especially traumatic brain injury.

A long-standing patient once consulted me after having been in a car accident. It was evident that she could barely think. Having previously known her, I was shocked to see her in this state. I prescribed a couple of doses of Helleborus 30c. When she returned a few weeks later, it was as if nothing had happened. She was her normal, clear-thinking self.

Nitric acidum (Nit-ac) – With the Nit-ac depression, we tend to see a mix of pessimistic negativity and hypochondriacal anxiety. Nit-ac’s cynicism tends to dominate his perspective. He always thinks in terms of the worst possible outcome.

It’s like the cliché of the Negative Nancy in which Suzie says, “It’s supposed to be sunny today,” but Nancy says, “Yeah, well I heard it’s gonna rain tomorrow.”

Nit-ac is consumed by thoughts of his own problems. He stubbornly clings to his predominantly fatalistic outlook. His negativity may cause him to be angry and irritable. Nit-ac is prone to holding grudges and, as the repertory rubric suggests, he may be “unmoved by apologies.” He has a propensity for swearing, he can be vindictive, and he tends to blame others for his problems.

Nit-ac is famous for its intractable anxiety about health. He may be convinced that he has cancer or some fatal condition. When one doctor definitively asserts that he does not have cancer, he seeks the consultation of another doctor.

All attempts to reassure him tend to fall on deaf ears. After repeated visits to the doctor with a varying array of complaints, it is easy to see why he would eventually wind up with a prescription for an antidepressant.

When treating a Nit-ac case, it’s important to realize that progress is likely to be slow and incremental. The depth of his syphilitic destructiveness and the obstinacy of his hypochondriasis are not going to vanish overnight.

It is important, therefore, to be cognizant of small signs of improvement, even when the patient doesn’t acknowledge those improvements. Otherwise, one can be easily tempted to abandon the remedy in the hope of finding a more effective one.

Conium – Here, as with Phosphoricum acidum, Sepia, and Helleborus, we have another remedy that can present with a blunted affect. In this case, however, the depression of Conium is the net result of a slowly progressive neurologic decline.

It may develop so slowly that the patient himself is not aware of it, at least at first. But in time the patient begins to notice weakening of his memory, numbing of his emotions, and confusion of mind. Of course, Conium is a remedy made from hemlock, the very same poison that Socrates was sentenced to drink for teaching heretical ideas.

Conium pathology has been described as a slowly developing “induration” of the mind. This mental state may be accompanied by other neurologic symptoms. It is as if a slowly creeping paralytic weakness gradually takes over the life force. This paralytic or numbing phenomenon may have a tendency to work its way upwards, from the lower extremities to other parts of the body.

At the root of the problem, there may be a history of suppression or lack of fulfillment of the sexual life of the patient, as in the case of an unhappy marriage, or a celibate clergyman.

Alternately, Conium pathology may be associated with sexual excesses. Sometimes the Conium symptom picture may simply present as a manifestation of dementia attendant upon old age.

I recently treated a middle-aged woman who complained of emotional numbness and memory difficulties. After taking Conium, she improved quite dramatically. Only after taking the remedy did she realize in retrospect that over the course of many years her toes had become numb and her motor control over them had diminished. The interesting thing is that she now reported the sensation as if her toes were “coming back to life.”

CONCLUSION

Now let’s review these remedies in terms of their basic features:
In patients who represent a serious suicidal threat, think Aurum.
When we see a hormonally related depression with flattened affect, think Sepia.

Depression combined with apathy and fatigue points to Phosphoricum acidum. In the case of head injury plus suicidal ideation, think Natrum sulphuricum.

If a depression is accompanied by dramatic and unpredictable changes of mood, consider Ignatia. When depression is carried as a silent burden, think about Natrum muriaticum.

Depression, procrastination, and disorganization should make us consider Sulphur. When depression is associated with a shameful secret, Thuja is the likely choice. When we see depression with a fatalistic expectation of failure and poverty, remember Psorinum.

When we see depression in a person who seeks consolation and company, think Pulsatilla. When we see head injury resulting in psychomotor slowing, think Helleborus.  Any combination of depression, negativity, and hypochondriasis should lead us to consider Nitricum acidum. And when we see depression and psychomotor slowing that have developed slowly over a long period of time, think Conium.