Relationship Break-up and Emotional Breakdown

Lost love. It's difficult to think of great literature without this enduring theme. Would, for example, Emily Bronte's Heathcliff and his passion for Cathy have captured our imaginations if they had lived happily ever after in Wuthering Heights? And would Romeo and Juliet have been as memorable if they had quietly married with the blessing of their families?

Unfortunately, what makes for great reading doesn't play out well in real life. As in recovering from a grave physical injury, healing a broken heart takes time and care. If time doesn't ease your grief, or it interferes with your work or your ability to connect with friends and relatives, you probably need professional help: You may be battling a case of severe depression.

What feelings are normal after the breakup of a relationship?

The rupture of an intimate bond between two people spells crisis in most people's lives, and grief and even anger are normal, healthy responses to this overwhelming loss. In a breakup, not only are you losing the person you love, but your existence as part of that couple. For most of us that means the loss of the way we led our lives and much of what we held dear -- love and intimacy, the social activities we care about, shared friendships, and a secure home. Small wonder, then, that the end of a relationship can feel as though life has ended as well.

Certainly, the pain associated with losing a loved one is not confined to married couples. Some studies indicate that as many as one out of five teenagers suffers depression because of a romantic breakup. Teenagers who've gone through a romantic breakup, in fact, are more likely to experience the onset of a major depression while still in adolescence, according to a study published in the Journal of Abnormal Psychology. If the phrase "love is a drug" has any basis in fact, its sudden loss can be likened to going through drug withdrawal, and often involves the same harrowing set of symptoms: real physical pain, sleeplessness, anxiety, depression, hopelessness, loss of motivation, and thoughts of suicide. If you have constant thoughts of suicide, it's important that you talk to a doctor or call a crisis line immediately.

After 16 years, Dona Blanchard* still recalls the sleepless night she spent after her first painful breakup at age 24. The end of the relationship came during the holidays, and instead of celebrating with friends, she spent Christmas at home weeping. Instead of commiserating with her, some friends were impatient for her to get over the loss of her three-year relationship and enjoy the holidays with them.

"I cried the whole holiday season. I wanted to kill myself. It was really like I was losing an arm," she says. "But a lot of my friends didn't know how deep the relationship was. It seemed like people really didn't care that much. They said to me, 'That's okay. You'll get over it.' "

Others interviewed echoed her experience, adding that recently divorced people are often treated with more understanding and compassion by their friends. "I remember so clearly the breakup of my deepest relationship," says one woman. "We had been in love for five years, and I was so depressed I felt suicidal. Yet in the first week of the breakup, friends were already inviting me to come to parties and 'meet some cute guy.' I felt like I was in an insane asylum. I truly believe that if my sweetheart and I had been married, people would have taken my feelings more seriously."

People who are depressed not only feel sad, they are usually contending with a persistent sense of hopelessness and lethargy. The ability to concentrate and make decisions wanes, along with interest in eating or going out with friends. When emotional exhaustion sets in, even thinking of activities that might distract them is beyond the scope of most people suffering from depression.

When Jack Anderson* moved to California from Ohio to be with a woman he'd been with since college, he thought they'd be together forever. But when she revealed she was seeing someone else, he was devastated. It was like his body shut down. He couldn't sleep well and felt so unmotivated and lethargic that his dinners soon consisted of beans eaten straight from a can. "That's all I had the energy to do," he says.

What can I do to break out of my depression?

If, after two months, you feel as rotten as you did the first week you broke up, or if your mood is affecting your work or making it difficult to take care of yourself or your family, it's a sign you may be suffering from a clinical depression. In this case, you should consider consulting a psychologist, marriage and family therapist, or psychiatrist who can help you determine if you have a mood disorder that can be treated with therapy and/or antidepressant medications.

Talking to your doctor or a counselor can also help speed the healing process. Depression is a serious disease that can be treated with a variety of drugs, but you might find the best help comes from combining them with some type of individual or group therapy that can help you cope with your feelings.

Cognitive behavioral therapy and interpersonal therapy are two types of therapy that have been shown to help people recover from depression; others may find regular psychotherapy helpful. In part, cognitive behavioral therapy consists of changing negative ways of thinking: Healing from a breakup, in part, requires that you not give into obsessive thoughts about the loved one, and that you not rehearse over and over again what went wrong in the relationship. Some therapists also suggest relaxation techniques or other behavior modification tools that may help you overcome symptoms of distress.

Therapists may also suggest you see a physician who can prescribe antidepressants, while some may suggest herbal supplements. The effectiveness of herbal remedies is still a matter of debate, however. Although a review of 23 German studies concluded that St. John's wort, long considered useful in maintaining emotional health, can combat minor bouts of depression as successfully as some antidepressants, a major study published by the National Center for Complementary and Alternative Medicine, the Office of Dietary Supplements, and the National Institute of Mental Health found it to be no more effective than a placebo. Always consult with your doctor before taking herbal supplements because they can interact adversely with other medications, including antidepressants. (Note: never combine herbal antidepressants with antidepressant drugs; the combination can be extremely dangerous. Also, don't take St. John's wort if you're using HIV drugs or organ transplant medications.)

Though the temptation to brood may be overwhelming, try not to let yourself sink into apathy and a lethargic state of mind. It can undermine your self-esteem and exacerbate a downward emotional spiral. Keeping to a schedule of seeing friends or exercising will help fill your time while your heart heals.

As you begin to heal, you may also want to consider the following strategies. They can help you pick yourself up and dust yourself off, even if you're not ready to start all over again.

•Find time to exercise. Studies have shown that getting at least 30 minutes of exercise at least three times a week can lift your mood as much as taking certain antidepressants. Exercise raises the levels of serotonin, the brain chemical that boosts feelings of well-being. (For more information, see Exercise and Depression.) Joining a group of hikers or tennis players will also get you out of the home, where you're more likely to brood.
•Reach out. Isolation can exacerbate depression. Whether it's your family, a formal support group for those going through a breakup or divorce, an informal network of sympathetic friends, a church or synagogue, reaching out to others is crucial in rebuilding your life. Schedule plenty of coffees and lunches with your supportive friends. If you haven't made a new friend in a while, you can use the gym or your local bookstore to find companions.
•Watch what you eat and drink. If you're the type of person who doesn't eat or binges when you're depressed, you shouldn't use this time to embark on a diet or go overboard eating chocolate for dinner. Your body as well as your mind will need healing. Try to keep up with vitamins and supplements that you normally take. Eat the foods that maintain your energy, including fruits and vegetables.

Several natural remedies are thought to boost serotonin levels in the brain and help stabilize your mood, including omega-3 essential fatty acids. According to Harvard psychopharmacologist Andrew Stoll, omega-3 fatty acids, which are found naturally in fatty fishes like salmon, play a significant role in healthy brain function and seem to have a preventative or mitigating effect on both depression and bipolar disorder. You can also get your omega-3 fatty acids courtesy of seafood, but you need to eat fish several times a week to get the full benefit. Taking fish oil or flaxseed oil supplements containing omega-3s is another option.

Although you might be tempted to dull the pain of losing someone with alcohol, consider the effect it will have on your energy level, mental state, and antidepressants you may be taking. It might be healthy to drink moderately (up to two drinks a day for men, up to one drink a day for women), but try not to overdo it. Since alcohol is a depressant, too much of it may depress you further. And remember that with some medications, you shouldn't drink at all. When in doubt, ask your physician.

•If you're healed up enough to venture out of your routine, consider taking a class or otherwise nurturing your creativity. A major life change is an opportunity for reevaluation. If there's something you've always wanted to learn how to do now is the perfect time to try. Universities, dance studios, and community colleges are good places to find literature, painting, language, sports, writing, and music classes.

Creative activities can be outlets for emotions that we don't know how to express in other ways. Some researchers also believe that brain patterns change and serotonin levels may increase when you're painting, playing music, or engaging in other types of art. Writing in a journal can be not only creative, it can help you get feelings of anger and hurt out. Keeping them inside only adds to depression.

•Volunteer. Many people forget about giving to the larger community when they're in a relationship. But community services that involve interacting with others or creating a product that helps others is a good way to restore your faith in humanity. They're also a good way to find new friends.
•Consider a change of scene. Never underestimate the power of an adventurous vacation. Traveling, whether it's to a town just a few hours away or to a different continent, can help you focus on your immediate surroundings and less on the past.

But because traveling alone can sometimes reinforce feelings of isolation, especially if you're in a country where the language is strange to you, you might want to travel in a group or book a vacation that involves activities with other people.

It's probably not a good idea to make any major life changes at this time. This is not the time to suddenly change your job, or move to another city or state. Give yourself some time to adjust to this new state of being before embarking on another big change in your life.

In other words, take care of yourself.

A year after he broke up with his girlfriend, Anderson found a new job and returned to Ohio. And although he and his girlfriend continued to talk by telephone after his return, he was able to concentrate on his new surroundings and resolve his feelings. "There's still a strong sadness," he says. "I still question the things that led up to the breakup, but I don't question the breakup itself."

For Blanchard, it has taken years for the pain to go away. She coped by developing her career as a writer and eventually, she married someone else. Even though she still thinks of her former boyfriend occasionally, she now believes the relationship would never have worked. "I still love him," she says. "But it's a long mourning process. It just has to run its course."

-- Melanie Haiken, M.A., is the former health editor of Parenting magazine. An independent journalist specializing in health, business, and parenting issues, she has served as managing editor of BabyCenter and the San Francisco magazine and executive editor of an Industry Standard magazine, and has written for Time Inc. Health, The Washington Post, and many other publications.

•These names have been changed.
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