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Depression, Situation or Chemical?

An ongoing series of informational entries

Depression

March 5, 2017

What does it look like?

     Depression can look really different from person to person. Two people who are both depressed might have zero symptoms in common. Robin, for example, might feel really low, have terrible insomnia, be unable to eat more than a few bites at each meal, struggle with concentration, and be so miserable she's considering ending her own life. Terry, on the other hand, doesn't feel noticeably down but has no interest in anything, even activities he used to enjoy. He's sleeping 12 hours a day but is still terribly fatigued and physically slowed, and feels completely worthless. As different as these two examples are, they both are consistent with major depressive disorder. The severity of depression can vary a lot, too, from being completely unable to function to still being able to take care of one's responsibilities and even find occasional enjoyment. We're less likely to see milder forms of depression for what they are.

How does it happen?

     Depression tends to have develop gradually. The development of each symptom of depression can be like hair growing, with no noticeable change day to day or even week to week. Since we're never not with ourselves, we may not have a good sense of small changes over time as our mood, energy, and view of ourselves dip. And then one day we might finally look at ourselves and barely recognize the person we see, as the cumulative changes become obvious.

     In a related way, the various symptoms of depression often develop at different times. Depression often has an insidious onset—we develop a symptom here, a symptom there. We might not have as much energy as before, and a few weeks later we notice that we're often crankier than usual. We might not suspect that both experiences are connected to the same underlying condition. If several depression symptoms landed in your life all at once, it would be much more obvious that they were part of a syndrome.

Is it Situational?

     There may be an obvious reason for feeling down. When we're facing major challenges like health problems, a painful divorce, or job loss, we expect to feel poorly. It would be strange, in fact, if our moods weren't affected to some extent. Thus we might not call our reaction "depression" because it seems so understandable. However, these kinds of losses are one of the most consistent predictors of depression, as we lose reliable sources of reward, engagement, and support.

Is it a Chemical Imbalance?

     There may be no obvious “reason” to be depressed. On the other hand, our moods can tank without any cause that we can identify. It could be that we have a genetic predisposition to depression, or we're sensitive to seasonal shifts. There could also be identifiable changes in our lives that could account for our low mood, but we don't make the connection. For example, we may have gotten a better job, which we expect would improve our mood; however, we also left behind a solid group of friends at our old job, and now have a stressful commute in the car whereas before we could take the train. Without an obvious trigger for our depression, we’re less likely to see it when it comes.

But I'm Not Always Sad!

     Some symptoms might not seem like depression. We often think that a person who's depressed is really sad, and yet depression doesn't have to include sadness. Many individuals with depression feel more numb than sad, or may have lost interest in things they used to enjoy without having an obvious shift in their emotional state. It can also be easy to attribute depression symptoms to other factors, since depression is one of several possible explanations. For example, we might blame stress for our increased appetite and sleep problems, and think our trouble concentrating is driven by the poor sleep.

     We don’t want to see ourselves as "depressed." Despite progress over the past few decades, there is still a lot of stigma against depression. We may have internalized that stigma, seeing depression as a "weakness" or a "personal failure." As a result we might not want to recognize our own depression. Maybe we prided ourselves on our strength and resilience, and depression just doesn’t square with our identity. We may therefore look for any alternative explanation for the way we're feeling.

How Does Recognizing Depression Help?

     Coming to see our depression for what it is can be tremendously helpful, even life changing, in at least two ways. First, depression can affect all areas of our life, making us feel like everything is falling apart: We're not sleeping well, we're irritable, our motivation is gone, nothing is fun anymore, and so forth. By putting these many struggles under a single umbrella, they become much more manageable. Rather than having 15 problems, we have one, and obviously it's easier to tackle a single problem than 15.

     Second, once we've named it we know how to treat it. Several "talk therapies" have strong research evidence for alleviating depression. For example, a few weeks of cognitive behavioral therapy (CBT) generally has a big effect on depression symptoms. There are also medications that are used to treat depression, some of which can even be as effective as the best psychotherapies.

Do I Need a Therapist?

     For many people, depression can be managed without professional assistance, especially if the depression falls in the mild to moderate range, and if there's a low risk for self-harm. I was able to manage my own depression through a combination of self-help, strong support from the people closest to me, and getting involved in triathlon.There are also self-directed books that can be very helpful. The Association for Behavioral and Cognitive Therapies maintains a list of books that have their "seal of merit."

     If you or a loved one has been struggling lately and some of your symptoms could reflect depression, it may be a good idea to schedule an appointment with your primary care doctor or a mental health professional. However we combat depression, we don’t have to suffer—help is available. And like anything else, knowing what we’re dealing with is half the battle.