Although people may use the word lightly in their everyday speech – “I’m so depressed, there were no peaches at the market today” – there is nothing light about being depressed. The words people use to describe this bleak emotional state frequently invoke heaviness, weight, and darkness. In the extreme, depression may cause such profound suffering that suicide seems to provide the only relief.
Depression occurs along a continuum. At a minimum, it is characterized by an inability to experience pleasure; lethargy, sadness, lack of motivation; feeling unengaged in life, disconnected, and uninterested in being involved with others. A depressed person may grapple with a general sense of meaninglessness, and perhaps despair. This emotional state may be mild, and even occasional. At the other extreme, the experience of depression can be deep and pervasive. Your body feels heavy, getting from one moment to the next feels burdened. Colors may not appear bright or distinct, and in severe cases, colors may not even be noticed. The world feels and looks gray. The future is not bright, but only contains more of the same unremittingly sad experience. Deep depression is a profoundly lonely state; nothing brings pleasure, the experiences that once may have produced pleasure are bled dry and now only remind you that nothing helps, that nothing matters. You watch other people living, and you feel even more isolated. You may trudge through your daily routine, managing to fulfill your obligations, or you may not be able to get out of bed. You may sleep all the time, or you may be unable to sleep. You may eat and eat and eat, or you may be unable to eat. The world simultaneously feels like too much, and not nearly enough. Some despair over the emptiness and meaningless of everything—life, experience, themselves, the world—and others no longer even have the ability to think about whether there is any meaning.
Depression can be a chronic state, beginning at a young age and lasting across the course of a lifetime. People sometimes say, when their depression is finally addressed, that they must always have been depressed, because they do not recall ever feeling relief. Some people live with mild depression for years, in a state just painful enough to affect their experience of life but not so painful that they withdraw from living. Others may develop depression and experience an ongoing increase in suffering leading to deep despair and thoughts of suicide. However pervasive depression may be for an individual, having people tell them to “snap out of it” or “just go out and do something fun” can indicate a lack of understanding, and often reflects the sense of helplessness and discomfort of the one offering the advice.
The bleak landscape of depression has been part of the human condition for centuries. The ancient Greeks believed that depression (which they called melancholia, or ‘black bile’) was due to an imbalance of one of the basic bodily fluids. By the 18th century, depression was believed to be caused by electrical and circulatory imbalances in one’s body. Some believed it was due to soul sickness. Psychologists in the 20th century developed theories relating it to deep mourning, to a kind of neurosis, and to existential emptiness. By the mid-20th century, theories of depression returned to the beginning, in a way, ascribing depression to an imbalance in bodily fluids/chemicals: this time, neurotransmitters. Today, some psychologists think depression is due to habits of thought.
Beliefs about the causes of depression are important, because they inform the way we think about helping people who suffer with depression. If the cause is seen as a chemical imbalance, the treatment is rebalancing those chemicals. If the cause is seen as unresolved mourning, the treatment must address those feelings of grief and loss. If the cause is seen as a sense of meaningless and emptiness, then addressing the way the person makes meaning of his or her life is essential. Chemical causes need chemical treatment. Faulty habits of thought are relieved by training new ways of thinking. A sense of isolation is addressed by feeling a connection.
A recent study that compared the usefulness and long-term effects of psychodynamic psychotherapy (which focuses on self-reflection and self-examination to get at the root of suffering), antidepressant medication, and Cognitive Behavioral Therapy for depression found that psychotherapy is as effective as CBT but considerably more long-lasting, and that psychotherapy is about three times as effective as medication in producing relief from depression.
From my perspective, one must always start from an understanding of the depressed person’s experience. Beginning the process by training you to think differently does not typically address the underlying issues that bring you to needing help. Beginning the process by prescribing an antidepressant medication may be useful for some and produce relief of your symptoms, and may help you enough to reemerge from the bleakest places, but medication alone is unlikely to address the factors that led you to such a state of suffering. Issues of loss, and pain, and meaning, cannot usually be resolved so simply. Finding a meaningful way of understanding your experiences may provide comfort even if the “causes” are ongoing, and therapy can help you understand your personal history and yourself, so you can develop your own sense of meaning within the context of your life.