What is depression?
Clinical depression is a mood disorder in which there are significant changes in brain chemistry. Specifically, reduced levels of the neuro-transmitters dopamine, serotonin and noradrenalin. Common symptoms include:
- Persistent low mood
- Anhedonia (loss of pleasure in activities)
- Disturbed sleep
- Daytime lethargy
- Reduced motivation
- Poor concentration
- Racing thoughts
It is estimated that over 60% of adults diagnosed with depression and given anti-depressants in the USA, are not in fact clinically depressed. Rather, they are sad, despondent or demoralised. However, in some cases this initial state of despondency can evolve into clinical depression.
This article relates to both clinical depression and to despondency.
Sources of depression
The causes of depression do not lie in changes in brain chemistry. Rather, those are the effect rather than the cause. The deeper cause lies in complex bio-social-psychological factors that lead to learned helplessness. Adverse life circumstances combined with loss of resilience lead to people believing they are overwhelmed, stuck and powerless to change their situation. Other cases result from stagnation, as individuals either withdraw from life or settle down to a life-style with too much routine and too little fulfilment.
This, in turn, leads to a kind of shut-down, in which the body goes into a state similar to hibernation as the body reduces neurotransmitter activity.
Adverse life circumstances include: early retirement, stressful work, failing (or abusive) relationships, post-natal complications and adjustments to parenthood, financial loss, social deprivation, serious illness and bereavement.
Depressive thought patterns
As life problems evolve, individuals develop a depressive thinking style that maintains learned helplessness and keeps them trapped in the depressed state. Here are some common patterns:
- Selective focus on problems. E.g. ‘I was doing ok until that phone call.’
- Over-generalisations. E.g. ‘Nothing good happened this week.’
- Magnifying difficulties. E.g. ‘It seemed too difficult, so I gave up.’
- Negative self-judgments. E.g. ‘I am a failure.’
- Catastrophic judgments. E.g. ‘I’m going crazy.’
- Emotional reasoning. E.g. ‘I’m too depressed to do that.’
- Hopeless thoughts. E.g. ‘What’s the point?’
Do anti-depressants work?
Not only are anti-depressants such as selective serotonin reuptake inhibitors (SSRIs) over-diagnosed, but a recent, large-scale study revealed that they don’t work for the majority. Since changes in serotonin are not the cause of depression but its effect, this is hardly surprising. The true cause lies in complex bio-social-psychological factors that can only be addressed in psychotherapy.
7 keys to unravelling depression
1. Understand and identify the source of learned helplessness
In this first step for treating depression, you go back to the start of your depression and clarify how and when you developed learned helplessness. This may have been in a relationship, at work (or out of work), or in some other crisis. Pinpointing when you felt stuck, overwhelmed or mentally gave up on something. Your therapist can also help you see the connection between your past experiences, and the depressed state that was the consequence. This is the normalisation process.
You can then take a decision. If the crisis is still active, then you identify what you can do, if anything, to improve your position (thus overcoming helplessness). If the crisis is in the past, or beyond your power to do anything about it, then prepare to move on.
2. Accept the depressed state without identifying with it
On completion of the first step you are in position to see the depressed state as a temporary state of unwellness, which will fade once you recover your sense of agency and purposeful activity. Instead of giving in to the depressed state and the depressing thoughts that maintain it, you bypass them and focus instead on rebuilding your life, one day at a time.
3. Identify the thoughts that maintain depression
Go through the list of depressive thought patterns listed above, and write out those that apply to you. Also, writing down the alternative thoughts that will move you out of depression. For example: the thought that ‘nothing good ever happens to me’ can be replaced by the thought ‘I have pleasant moments, and I have bad moments – they come and go.’
4. Defuse from the thoughts that maintain your depression
When you have identified and listed your problematic thoughts, you can practice defusing from them.
5. Identify small actions to take
At the start of this process it is best to take quite small steps, such as getting up earlier each day (staying in bed worsens tiredness and lethargy), taking walks, calling on people, and completing minor tasks. Remember you may not ‘feel’ like doing anything, as that is a feature of depression. Ignore that state and do it anyway – your desire will return gradually when you do.
Your therapist can assist you to get started on the activities that restore your power to act.
Note: In my own practice I ask my clients to do 30 minutes hard exercise a day, as research shows that exercise counteracts daytime lethargy and low mood.
6. Restore personal agency.
As your self-efficacy returns through taking small steps, you can got on to look at the bigger issues. Distinguishing between the things you can’t change, and the things you can change, and focusing on the latter. The important thing is to overcome the state of helplessness by doing things that make a difference to you. Once learned helplessness is forgotten your depression will fade with it.
7. Reconnect to the world and other people
This ‘step’ really goes side-by-side with the last step. As you expand your range of activities you either go back to doing the things that gave you fulfilment prior to your depression, or you find new things to replace them. This can take time. Along the way, you reconnect to the emotions that were ‘depressed’ before, and relearn how to channel them.
