"It's Like A Dark Cloud That Wont Go Away"
People struggling with depression are insanely beautiful human beings. Underneath the depressive surface they are typically sensitive, hopeful, empathic, and have utopian ideals for themselves and the world. They are sensitive to suffering, pain, impermanence, and loss. They can be in touch with reality in a way that others aren’t. They are acutely aware of the difference between the desired world and the world we currently inhabit.
It is important not to mistake sorrow for depression, they are not the same. In ordinary grief, the external world is experienced as diminished in some important way (e.g. it has lost a valuable person), whereas in depression, what feels lost or damaged is a part of the self. Grief comes in waves, depression is relentless. Interestingly, those who tend to mourn or grieve well do not tend to get depressed. In our experience, grief or sadness is far different than depression and a sign of a health person. In fact, it can often be a precondition or optimality towards healing and growth. The old model for doing life often isn’t working anymore and people experience grief associated with that. Moving into these feelings, allowing, exploring, and working through them are the path to transforming sadness into enlightenment.
Sometimes the line between renewal and self-destruction is thin.
Don’t get caught up in the neurobiological explanation for depression, it’s not all genes. Low serotonin levels, dopamine deficiencies, etc. but these are often the chicken and not the egg. These levels respond to our psychosocial lives, not cause them. Focusing on regulating these levels without addressing the underlying psychological dynamics often proves a futile approach. Therapy and medications can work well in tandem, but no expert ever recommends medication alone. In some cases, working depression back to front with the use of medication can be a helpful tool. For some, it temporarily props them up enough to begin the work on the psychological side so it can be a useful too for more severe cases. In summary, you have to address the underlying psychosocial, emotional causes for real relief. We know how to do this.
Depression is an unconscious defense with a big cost. To depress literally means to “push something down.” When you have experienced big, life changing, painful or overwhelming events, particularly when young, and spend much of your life avoiding processing these experiences a depressed state is often the outcome. Research shows that those who experience a major loss at a young age are exponentially more likely to suffer from depression as an adult.
Those who are depressed typically struggle with anger in that they turn it towards themselves (Freud called it “anger turned inward”) and they tend to view themselves or the world as depleted or deficient in some major way. Depressed adults often weren’t given age appropriate explanations for the major events during their childhoods, they tend to grow up in repressed or emotionally unavailable family cultures (particularly where mourning is discouraged) that are also highly critical. They are the adults who as children played the emotional middle man in the family or grew up with a parent that modeled depressive responses and therefore came to believe that their needs drain and exhaust others.
In some sense, depression is a defense. As a child, it was likely your emotions were not appropriately attended to maybe because there wasn’t a place for them. Depressed adults often report that they could sense no one would be able to hear it or that they were afraid their issues were going to be too much because they didn’t want to overwhelm the people they love and depended upon. Like any fear, the longer you avoid the more dangerous it appears. Over time, every future or anticipated form of pain or loss seems insurmountable. Depression is premature resignation to the call of living fully in the world. It is a self that needs to be reclaimed, validated, understood, and experienced with another person.
Some common childhood themes of depressed adults are:
As a defense, depression helps you quit before it starts. It says, “I will stifle my hope and protect myself from experiencing life fully, in the moment as I once did, so that I never have to experience that kind of loss/grief/terror/vulerability/etc. ever again. I will not let my hope be my poison once more.” One of my patients once said, “Im just afraid to get hopelash again.” When this goes on too long what was once a problem becomes a personality and a personality into a life. You don’t have to stay there, we want to help you emerge from under it and risk living again.
Depression is one of the most challenging, yet one of the most common psychiatric disorders. Different from popular belief, it is not prolonged sadness. Sadness is a normal and expected part of being alive and human, depression is not. Depression, in fact, is not an emotion, it is a state of mind in which emotions are being suppressed. To “depress” something literally means to push something down.
Underneath the surface of “depression” there is often internalized anger, helplessness, regret, disappointment, self-criticism, unworthiness, meaninglessness, fear, or fatigue from prolonged anxiety. We have also noticed that depression occurs when people are disconnected or not meaningfully connected to others. When depression is more relational, interpersonal patterns and habits need to be worked on. It also helps to understand and attend to one’s early relational templates. Depression is not a discrete disorder in and of itself, it is not simply a biological event, but a signal on the dashboard of your life. It’s time to talk to someone.
In terms of the signs on the dashboard here’s what to look for. Although unique to each person, there are some common experiences to depression. One of the most prominent symptoms is called “Anhedonia” or the inability to experience pleasure. Things you once enjoyed just seem dull and bland, your motivation is zapped, and you find yourself wanting to isolate or be alone. Those who seek help for depression often report feeling “like a black cloud is always hovering over me” and are burdened by excessive guilt.
Changes in appetite and sleep are often common too. In fact, difficulty falling asleep and/or waking up early in the morning without being able to fall back asleep are common early symptoms of a depressive episode. Excessive fatigue, irritability, feelings of emptiness, and difficulty concentrating are other common complaints. Those suffering from depression often notice that it has become a habit of mind to ruminate on the past and find it incredibly difficult to remain present.
Good news is, it is easily treatable! This is a process that works. We have helped many face their depression and the issues underpinning the symptoms. Many report a sense of regaining their old vitality (or finding it for the first time). Don’t wait until it takes over your life, the earlier you seek help, the better off you will be and the more likely you will be able to avoid depressive episodes in the future. The research is consistent on this. Reach out to a depression psychologist today via the “our team” link above.
Although people with depression share a common symptom pattern the “course of illness” you could say varies. Recovery is based on individual factors as well as obtaining quality care. This is well documented in the literature; certain clinicians are more effective than others in treating the disorder.
Each person’s recovery is different and unique to the person as well as the severity of the depression. Many recover within a few weeks to months and yet in a smaller percentage, estimated around 20% (NIMH, 2020) of people the symptoms don’t entirely go away. For those, learning how to identify early warning signs, manage depressive episodes, and become more skillful in navigating depressive states is crucial. Additionally, reducing the intensity and duration of depressive episodes is totally realistic and achievable. There is a better life waiting.
According to the American Psychological Association (APA) 80% of people who have engaged in psychotherapy for depression reported that it “significantly helped.” The odds are that you will get better and stay better when you begin therapy for depression.
Effective treatment modalities for depression include Cognitive Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT), Psychodynamic Therapy, Acceptance and Commitment Therapy (ACT), Insight Oriented Psychotherapy, Logotherpay, Neurolinguistics and Humanistic/Existential.
Our team uses an eclectic approach, pulling from all of the major evidence-based practices. We find that treating depression is most effective when you utilize the key elements of the most beneficial methods and apply them uniquely with each patient. Last, but not least, we approach treatment holistically and honor the role of health, diet, exercise, social, and stress factors involved in your recovery.
Being sad and being depressed are very different things. Sadness is a normal response to events in life, lasts a brief amount of time, and is actually healthy to experience. It is a common misunderstanding that depression is prolonged sadness. Rather, depression is a condition that some are vulnerable to and involves a combination of genetics and early environmental influences.
The subjective experience of depression is one in which people feel a sense of sedation about life, a sense that even sunny days feel cloudy. The depressed mood typically lasts every day for at least 2 weeks and includes feelings of emptiness, hopelessness, and fatigue. People report totally losing interest in activities they once enjoyed. Others symptoms include weight loss or gain, low self-esteem, sleeping too little or too much, lethargy or edginess and feelings of worthlessness. Some experience excessive guilt or preoccupation with the past and mistakes, difficulty concentrating or indecisiveness, and suicidal thinking.
Major Depressive Disorder (MDD) and other depressive conditions are best diagnosed by a clinical psychologist. Your therapist will spend some time in the beginning of therapy really getting to know you and your unique story – we know what questions to ask to help understand what may be going on. In doing this, we want to obtain a thorough personal history, identify symptoms, and explain to you directly your diagnosis and the key elements to address in treatment as a part of your personal recovery plan. At times, we will provide additional psychological assessment measures if things seem unclear. Our systems allow you to complete these measures at home, at your convenience, and we can discuss the results in the following session.
There are four main types of Depression. First, and the most common, is Major Depressive Disorder also known as MDD described in the “symptoms” question above. Dysthymia or Persistent Depressive Disorder, is another type of depression and far less common. As stated in the name, it is chronic and ongoing. The depression seems to always be present to a milder degree, however, within that disorder, people can still experience depressive episodes as a part of the illness. In order to be diagnosed with Dysthymia the symptoms must be present for at least 2 years (only 1 year for teens). Also unique to teens, the symptoms tend to present more as ongoing irritability as compared to adults where the most prominent feature is the depressed mood.
The last two depressive disorders are subtypes. Unique to women, there is a specific type called Premenstrual Dysphoric Disorder (PMDD). In PMDD, depression tends to set in during the final week before the onset of menses and becomes minimal or absent in the weeks post menses. In addition to the core features of depression, those with PMDD also experience anxiety, mood swings, and irritability.
Lastly, Seasonal Affective Disorder, ironically acronymed SAD is a seasonal depressive condition in which people only experience depressive episodes that correlate with certain times of the year. It is most often seen during the fall but it is not uncommon for it to set in during early summer months too. Psychotherapy is the standard treatment, however, many find it helpful to also include light- therapy in their approach.
Risk factors for depression include a family history, chronic stress, history of trauma, gender (females typically more), poor nutrition, substance use/abuse, and certain personality traits. One study found that certain people who experienced depression without other causes scored high in neuroticism and harm avoidance and low in self-directedness and cooperativeness. Another study found that this same subgroup was more introverted and reported feeling more vulnerable/insecure, got stressed easily, were less organized, impulsive, and procrastinating.
Lastly, it was recently found that those who experienced early loss in the first few years of life were exponentially more likely to be diagnosed with depression as an adult. It is well known that some types of depression stem from loss and grief called “complicated” or “unresolved” grief. Healing the major wounds of loss and grief can be vital to recovery in some. Grief is not always about losing a loved one, it can also be about losing one’s own capacities or sense of future.
If you are reading this and think you might have depression please reach out for help. There are lots of qualified providers who can help you get back on your feet. You don’t need to continue to suffer in this way. Please know that there is hope and people who care out there. We are a group of those people. We have seen so many beat this disorder and get back to living a life they enjoy. Call or text anytime, day or night, and we would be glad to get to know what you are going through and help you schedule a session with us.