Depression: What it is and how to treat it.

Meh.

It isn’t really an emotional state or a feeling, more of an utterance.  An utterance that can sum up a lot of what depression feels like.  It just makes life feel, well, pretty “meh”.  Getting out of bed: “meh”.  Going to work: “meh”. Should I go out with my friends or hang on the couch?: “meh, I’ll just stay on the couch”.  Should I go for that run?: “meh, what’s on Netflix”.

What is depression?

Depression is more than an emotion or a state of mind, it is really a process.  It is a combination of thoughts, emotions, and behaviors.  They act in concert with one another, not necessarily in a way where any one causes the others.  The pervasive sense of sadness that is often labeled as depression is certainly a hallmark feature, but is never the only symptom of depression.  That sadness typically comes with a series of thoughts.  Exactly how they sound varies from person to person, but general themes are often self criticism, harsh criticisms of others, and pessimistic views of the world.  They can play off of each other.  You wake up feeling miserable and your mind tells you “it will be like this forever”, which leaves you feeling a little more miserable than you did a moment ago.  That misery compels you to inaction.  Compels you to stay in bed a little longer, to not do that thing that needs doing, or that activity that you love.  The longer you stay in bed the worse it feels and the guiltier those thoughts get.  The whole process compounds.  It is often described as feeling like being in a cold, dark, hole.  Being in that hole can feel listless.  

Depression can be sneaky and insidious.  Actor and comedian Patton Oswalt described depression as “seductive” when discussing the grief that came with the death of his wife.  He referenced Batman and how his origin story is bullshit in terms of sadness.  Depression doesn’t really push you go get fit and change the world.  It seduces you back to where things are “comfortable”.  Comfortable being a relative term of course because you're not exactly fully relaxed on the couch under the weight of that depression, just that pain is better than the expected pain of doing anything else. 

That comfort digs the hole deeper, and the deeper it gets the harder it can feel and be to get out of it.  The deeper the hole gets, the more regrets there are about the past, and the more dread there is about the future.  As depression progresses your world gets smaller.  The more those thoughts and feelings, and the pain they inflict, keep you away from the things you value the colder and darker that hole gets.  That hole is a place of polarities.  You can binge on food (usually not the healthy stuff) or you may skip meals, barely eating at all.  You’re always tired and sleep the day away, or it doesn’t matter how tired you are you just can’t turn your mind off and get to sleep, so instead you fill time with junk TV, video games (nothing against them, play them myself), or any other distractions that are readily available.  One consistent is that misery follows wherever you are.  Your mind is creative in that hole, always finding new and creative ways to criticize you.  New and creative ways to point out how you aren’t measuring up.  If things are deep and dark enough it can literally be life threatening.  The range of what depression looks like can be wide.  From complete isolation and suicide, to going about the majority of your day like nothing is wrong, but really just going through the motions with a gray pallor over everything.

So how can you treat depression?

That is the big question if you are considering therapy, right?  What can we do about it?  Therapy is also a process.  Simply put it is a process to learn and apply various skills to interrupt the patterns of depression and get back to living your life.  Let’s go back to the three areas that depression affects: thoughts, emotions and behavior.  We can only change and influence our thoughts to a certain degree.  It would be nice if there was a way to permanently silence that inner critic we all have, but that simply isn’t possible.  We are even more limited in our ability to alter how we feel.  If we could will our way into a different emotional state I likely wouldn’t be writing this right now, you would not be reading it, and depression would’t be a problem here or anywhere else in the world.  Instead, according to the NIMH, in 2017 depression affected roughly 17 million Americans, or about 7% of the US population.  Keep in mind those figures account for individuals who have been diagnosed with major depressive disorder, they do not include individuals who suffer nonetheless but don’t meet clinical criteria.  That number only grows if you include varying levels of sub-clinical symptoms that adversely affect your life even if they don’t meet clinical criteria. 

So, we can only do so much about our thoughts and can’t do much at all about our emotions.  That depressed part of your mind may even be stepping in right now to say “see, told you it was hopeless”.  What we are left with is behavior, which, technically speaking, is 100% under our control.  Unfortunately that doesn’t make any of this easy.  Simple in a sense of the word, but not at all easy.  Behavior here doesn’t just mean things that we do that are observable to others, it also includes our internal experience that only we are aware of.  When that self critic pipes up how do you respond?  Do you agree?  Do you argue with it?  The initial thought is the part that is out of our control, how we respond is a behavior that is within our control.  

This is an important part of the process of therapy, and where we can start to move the needle when it comes to depression.  In a way we work towards building skills that change our relationship with our thoughts and emotions.  Therapy helps to interact with them differently so that they have less power over us, and less power over our lives.  Depression makes our lives progressively smaller and smaller.  Depression is a liar.  It tries to convince us some things are true even when our experience doesn’t sync up.  The question “why am I depressed?” often comes up in therapy, and there is usually some value to exploring it.  However, I think a much more important question for treating depression is “how do I make my life bigger?”. 

Similar to emotions we can’t effectively “will” ourselves into behaving differently.  Willpower is a perfectly fine trait to value, but it alone won’t get the job done here.  If willpower alone was sufficient depression likely wouldn’t exist.  Everyone would be able to power through it, and again, I wouldn’t be writing this, you wouldn’t be reading it, and suicide rates wouldn’t be at their highest levels in decades (which they are at the time I am typing this).  A hard truth is that doing something about depression is hard work.  Going back to the insidious nature of depression when you start taking steps to make life bigger that self critic can get louder, the emotional pain can get worse.  A metaphor I often use with clients is that it is like being in a swamp.  You’re stuck in a swamp right now and it’s a really uncomfortable place to be.  No one can blame you for not wanting to spend another second in that swamp, or for not wanting to move further into it.  However, at the edges of that swamp are the things that make life bigger, make life enjoyable.  Maybe it’s getting back to things that feel purposeful, that you used to be passionate about.  Perhaps it’s finding a new sense of meaning and purpose.  Is it worth traversing the muck and the mire to get to those things?  

A simple word for the things that make life bigger is values.  Values here being things that you freely choose as being important and making life meaningful for you.  Not what social media would have you value, or what your family would have you value, but what you choose to value.  Hell, chasing values you find on social media or living in line with values thrust upon us by our family can be major catalysts for depression right there.  Science can’t tell us what to value or how to value it.  The population of the planet at any given time is probably the number of value sets there are out there.  Certainly there are some matches and lots of overlap, but equally as certain no two are exactly identical.  What science does tell us is that have some clarity around what you value, and living in line with those values consistently increases life satisfaction.  Improved life satisfaction is essentially the antithesis of life draining depression.  The closer you get to the edges of that swamp, to the things that matter in life, the less shitty it feels, and the easier it gets to keep moving through it. 

Depression is extremely treatable, even if it is hard work and your mind tries to convince you otherwise.  There is no linear path that can be followed to beat depression, more a combination of skills and clarifying values to get back to living the life you want.  Most therapy, and especially the way I practice, is about building these skills in a custom tailored way that suits you and your life.  Have you ever met someone that loves self help books but only owns one?  I haven’t.  There simply isn’t a “one size fits all” approach.  In therapy we work to build a sustainable, workable approach to get out of the hole of depression, removing the pallor, and doing more than just going through the motions.  If you need help getting out of depression, reach out and let’s get to work.