Understanding Depression

People who have never experienced depression sometimes seem to view it as a sort of intense or prolonged sadness, but I think this is a misconception.  Having been depressed myself, and talked to and read the accounts of numerous others, I feel very firmly that the two are not as closley related as people sometimes believe.  Sadness is an emotion, a feeling, and depression is much more than a feeling, more of an all-encompassing state of being.

A depressed person can feel a wide range of emotions, or lack thereof.  Some people can be depressed and still feel good or happy some of the time.  In some cases, the happy feelings can feel distant or blunted, even if they show outwardly on a person's face.  In other cases, a person may feel genuinely happy, quite often, but then later on, shuts out the memories of the earlier happy feelings.

Depression sometimes involves feelings of sadness, as well as other feelings like frustration, anger, shame, guilt, stagnation, agitation, annoyance, hostility, stress, or other feelings that aren't exactly the same as sadness.  But when depression becomes very severe, often the feelings vanish entirely, and all that is left is a numbness, a lack of feeling.

I've heard people describe that, when in this state of numbness, even the most bitter emotional pain can feel intensely liberating.  Imagine being unable to cry, and then feeling the release when you can actually cry.  This may explain why some people find behavior like self-injury offers a release from depression.  In my own experience, sadness, even intense sadness, is a much more positive feeling or experience than my most troubled moments that I've experienced during depression.

These things all point to how sadness and depression are two very different things.

Rather than thinking of depression as an emotional state, I prefer thinking of it as a holistic state of a person and their life.  Depression involves many different aspects of life:

• Mood / emotions - A depressed person will usually feel more negative emotions and fewer positive emotions, or will focus on the experience of negative emotions and distance themselves from or shut out memories or experiences of the positive emotions.  Depressed people may also feel a numbness or lack of emotion, or a sense that all their emotions seem distant.
• Thoughts - A depressed person nearly always exhibits certain distortions of thought patterns, including a selective focus on negative interpretations of events, and a lack of focus on positive things, often finding ways to "explain away" positive events or ideas, magnifying negative aspects of things, or minimizing positive aspects.
• Habits and actions - When depressed, people tend to become withdrawn and take less initiative in many, most, or all aspects of their life.  They reach out to people less, and may spend a lot of time sleeping or sitting around, often doing less in total.  They may even physically move slower as they go through their day, and they become likely to get less exercise as a result.
• Social relationships - Depression strains and weakens social relationships.  When depressed, a person may withdraw or close off from others.  They may seem so gloomy that others push them away, or they may deliberately push others away, in some cases even saying negative things that alienate the people close to them, or believing that others dislike or hate them, or have betrayed or abandoned them.
• Beliefs - Depression influences and skews a person's belief system.  They will begin to believe more negative things about themselves, about society, about human nature, and most centrally of all, about their potential to have the things that they want in life.
• Diet and Appetite - When depressed, people often experience changes in appetite relative to their normal state.  For some people, this can be eating less or feeling less hungry, whereas for others it can be eating more.  In most cases, the resulting dietary choices a person makes are less healthy, not fully nourishing them, and in many ways feeding back into the unhealthy mental state that they are in.
• Physiology - People experience a wide range of physiological changes during depression.  Depression can have negative impacts on many aspects of health, and when it continues long-term, can increase risk of chronic diseases like heart disease.  People who are depressed will often have less energy.

The theories behind Cognitive Behavioral Therapy, one of the most scientifically-established treatments for depression, explain that people who are depressed exhibit 10 common distortions of thought:

• All-or-Nothing Thinking - Also called "black and white" thinking, forcing something into either/or categories, that really exists in shades of gray.  Examples would be: saying "I completely screwed this up." if making a mistake on something, or: "He obviously doesn't support my idea." if someone voices an objection to a small part of the idea.
• Magnification or Minimization - Finding ways to make positive things, accomplishments, assets, or strengths seem smaller, and problems, negative events, or weaknesses seem larger.
• Mental Filter - Selectively focusing on negative things that happened, or negative interpretations to events, and mentally filtering out positive ones.
• Negative Labelling - Attaching a negative noun or adjective to someone, usually to themselves, such as calling themselves a "loser" or a "failure".
• Overgeneralizing - Seeing one event or a few events as indicators of a global pattern.  For example, if someone gets turned down on a date, they might say: "No one finds me attractive." or if someone fails a math test, they might say: "I'm no good at math."
• Discounting the Positive - Finding ways to insist that positive things "don't count".  For example, if a person gets an A+ on an exam, they might say: "Oh, well that exam was easy." or if a person asks someone on a date and the person says yes, a depressed person might say: "Oh, well he he just said that so as to not hurt my feelings."
• Jumping to Conclusions - Drawing conclusions, usually negative ones, about something, when we don't have enough evidence to conclude this.  Usually this takes the form of making negative predictions of the future: "I can tell something is going to go terribly wrong." or assuming negative things about what someone else is thinking: "She doesn't care about me."
• Should Statements - Beating yourself up (or others) with the word "should", like: "I shouldn't have said that." or "I should have known better than to do that."  People can also use the word "should" in ways that promote frustration, annoyance, or other negative feelings, like: "It shouldn't be this way." or "She shouldn't be treating me this way." instead of accepting the world, or people, as-is.
• Emotional Reasoning - Insisting that something is true because it feels true.  For example: "I feel like a loser, therefore I am a loser." or "I feel like no one cares about me, so it must be true that no one cares about me."  This reasoning is flawed both because in depression, a person's feelings are out-of-whack and divorced from reality, and also because the ideas expressed, like "no one cares about me" are actually thoughts, not feelings.
• Blame (Usually Self-Blame) - People who are depressed typically blame themselves for things that go wrong ("It's all my fault."), but they can also blame other people and poison their relationships or push people away.
• Personalization - Assuming that things that other people say or do are about them, especially when the interpretation is negative.  For example, if a person cancels an appointment, the other person might think: "He really didn't want to see me." instead of thinking about the many other possibilities that the person cancelled the appointment.

A person's thoughts flow from one to the next, and also flow into feelings and actions.  The distortions above can explain why people suffering from depression exhibit the symptoms and problems that they do: thoughts like "I'm a loser." or "No one cares about me." lead people to feel bad, and also lead them to withdraw from their relationships or activities.

The empowering realization that CBT has to offer is that by changing how we think, we are often able to change how we feel and thus help lift ourselves out of depression.

People often talk about depression as if it is "caused" by major negative life events, things like the death of a loved one, chronic disease, or a breakup or divorce.  These events are more accurately described as the trigger of a depressive episode, rather than a true cause.  The true causes of depression are actually much deeper, and often exist long before the depression manifests.

Just as depression has many different manifestations (in thoughts, behaviors, physiology, etc.) discussed above, it also has many different causes or contributing factors.  These factors are very diverse:

• Beliefs and culture - Since depression manifests in thinking, and thinking is shaped by cultural beliefs and learned and taught beliefs, beliefs that people pick up from their culture can influence depression.  Cultural ideals of success are a major culprit, when people constantly compare themselves to others, or to an unattainable ideal, and don't feel like they add up.
• Social Relationships - People are more likely to become depressed when other people close to them become depressed, and similarly, are more likely to recover when people close to them recover.  Abusive and negative relationships in a person's life can also increase the person's risk of depression, including years later.  Social isolation can also contribute to depression.
• Genetics - There is significant evidence that depression has a large genetic component, in that some people inherent genes that make them at greater risk of becoming depressed.  The ways in which this happens are likely very complex, and probably interact with the other factors.
• Diet - Dietary deficiencies in a variety of different micronutrients can manifest as depressive symptoms.  Important nutrients for which this is the case include the essential Omega 3 fatty acids, Vitamin D, and magnesium.  Omega 3 deficiency is common in the U.S. due to a scarcity of these fats in our food supply; Vitamin D deficiency is common in winter in climates that get little sun.  Magnesium deficiency can be common in alcoholics.  Less commonly, other nutrient deficiencies can have a similar effect, such as B vitamins, iron, zinc, iodine, or protein or calorie deficiency in people who are chronically malnourished.
• Lifestyle - A sedentary lifestyle, with little aerobic exercise, can make it much more likely that a person will become depressed.  This can be influenced by environmental factors, for example, people who live and work in car-oriented areas will tend to exercise less than people for whom it is easy to walk to work.

In the United States there are many factors in the culture and structure of society that contribute to increased risk of depression.  This includes car-oriented design of cities and communities, which makes it more difficult for people to get exercise in the course of their daily life, a diet often deficient in certain micronutrients (Omega 3 fats are a big one in the U.S.), and negative aspects of our culture, often passed through social networks by non-constructive criticism or negative comments people make about each other.

Becoming aware of these factors is important both for protecting ourselves from them, and rooting them out from society.

Because depression is complex and can have so many different causes, I think it is most effectively overcome if you tackle it from different angles at once.  I also think that approaches that work well for one person may not necessarily work for another person.

Some of the most effective and realistic methods for overcoming depression include:

• Exercise - I list this as the #1 treatment for depression because it has solid evidence of working, and is accessible to most people, and inexpensive.  Something as simple as walking more can help.  Also, being more active during small moments in daily life, like standing up more often while at a desk, or pacing while talking on the phone, or even just fidgeting and bouncing around more, can help too.
• Diet - Diet is most effective at treating depression in people with specific nutritional deficiencies that can be easily addressed by small additions to the diet.  Ideally, if you can do so, getting tested by a nutritionist can help identify if you have any nutritional deficiencies (or possibly a thyroid condition) which could be causing your depression.
• Therapy or Counseling - Therapy can be helpful for many people to overcome depression, but I want to emphasize that just seeing a counselor isn't necessarily an instant fix.  Some counselors are more effective than others, and for some people, it can be hard to locate and schedule (or pay for) counseling.
• Self-help Books or Bibliotherapy - Below is a very popular (and scientifically tested) book for helping people to overcome depression.  I personally found it very helpful; it outlines many of the key methods of Cognitive Behavioral Therapy

I did not choose to list medication (prescription or herbal) on this list.  For a small number of people who are experiencing severe depression, medication can be temporarily helpful to get them to function long enough to seek out and carry out other forms of treatment.  However, medication can be dangerous and, in my opinion, is often over-prescribed, even aggressively pushed by some psychiatrists.  Antidepressants can sometimes increase the risk of suicide.

There is no scientific evidence that medication provides any long-term benefit for treating depression; at  best, they only treat the depression while the person is taking the drug, and if the person does not also implement other changes in their life or follow other treatments, their depression will return once they stop taking the drug.

Since I don't think of depression as strictly an individual problem, but also one that has cultural causes, I think it is important to not just work to help individuals, but to also look at the systemic factors in our society that increase the risk of depression, and address these as well.

Some of the things I think we could do to reduce depression on a broad scale include:

• Promote Walkable Communities - If we designed our physical environment so as to be more oriented towards walking, bicycling, and public transit, it could help people to get more exercise more easily, as they go through their daily lives, without having to set aside special time for it.
• Embrace a Healthy Food Culture - Mainstream American food culture doesn't promote the best diet for fighting or preventing depression.  Processed food, refined carbs, factory-farmed meats, and a diet low in fruit and vegetables is a prescription for disaster.  When we help promote a more diverse culinary culture, supporting traditional foods from cultures around the world with healthier, more diverse diets, we can help to promote both physical and mental health across the board.
• Be Positive and Root Out The Negativity - Even if we're not suffering from depression ourselves, we may inadvertently pass on some of the cultural ideas that contribute to depression when we make negative statements or criticize others, whether it's in public, or more privately, in our family or friend group.  Two rules of thumb that I like to use are to criticize people's actions but not the people themselves (i.e. no personal attacks), and to only bring up a problem or concern if I want to propose or ask for solutions, or ask for emotional support.  This way I follow any negative statement with a positive one, contributing to a brighter mood in society as a whole.