What is depression / Definition:
The term depression is often used in everyday language. People use it to describe many different feelings or experiences. In a casual conversation, an individual might say that they’re “depressed” when they’re experiencing feelings of, loneliness, feeling down/low, overwhelmed, emotional exhaustion, or a lack of motivation. Whilst some of the aforementioned feelings or experiences are symptoms of clinical depression, it’s important to note that feeling sad, or down because of things that have happened or are happening in our lives, is an important part of the human experience and doesn’t necessarily indicate clinical depression.
Whilst using “depression” loosely in a conversation can at times trivialise the challenges of those who experience major depressive episodes or clinical depression, it may also contribute to greater awareness of mental health issues and symptoms.
According to both the DSM (Diagnostic and Statistical Manual of Mental Disorders) and the ICD (International Classification of Diseases), several depressive disorders exist, with the two most common being Major Depressive Disorder (MDD) and Persistent Depressive Disorder (Dysthymia). Some key features of a depressive episode, as outlined by the DSM and ICD, include:
Depressed mood: Feeling sad, empty or irritable, most of the day, nearly every day.
Loss of interest or pleasure: A notable decrease in enthusiasm for most activities, especially those that were previously sources of pleasure for the individual.
Fatigue or loss of energy: Feeling tired all the time or having little energy.
Insomnia or Hypersomnia: Difficulty falling asleep, staying asleep, or sleeping too much.
Diminished ability to think or concentrate: Difficulty concentrating, making decisions, and reduction in attention.
Feelings of worthlessness or excessive guilt: Ongoing and excessive feelings of guilt and or worthlessness.
Reduced self-esteem and self-confidence: Often associated with self-blame and self-criticism.
Pessimistic views about the future: Feeling stuck, lacking meaning and purpose, having a pessimistic outlook on oneself and the future and feeling hopeless.
Recurrent thoughts of death: Suicidal ideation and behaviours.
Causes of depression:
There are many theories that point to the potential causes of depression. The following is a non-exhaustive list of factors that are linked to the causes of depression.
Attachment and depression:
Early attachment experiences shape the developing brain and therefore one’s ability to regulate emotions. Inconsistent caregiving, miss-attunement or neglect by caregivers during the early attachment period may have profound effects on brain development and one’s ability to regulate their emotions as an adult.
Trauma and Adverse childhood experiences:
Trauma, abuse and neglect can impact emotional well-being and contribute to vulnerability to depression later in life. Early-life stressors or trauma can impact the neurobiological pathways associated with mood regulation, which affects a person’s susceptibility to developing depression.
Situational Stressors / Environmental factors:
Situational stressors in our lives may lead us into overwhelm which may lead to a depressive episode. Insufficient inner and outer resources to cope with stressors or an inability to effect change in challenging situations may result in depressive symptoms. Stressors encompass various factors such as the loss of a loved one, relationship challenges, financial hardship, work-related stress, health issues, trauma, abuse, major life transitions, legal problems, and social isolation. It’s crucial to recognize that what may be stressful for one person might not be so for another.
Suppressed emotions:
Suppressed emotions can lead to internal conflict which leads to psychological distress and inner turmoil. Inner turmoil often causes one to ruminate or dwell on negative thoughts and feelings without resolution. Suppressed emotions can also impact our ability to communicate in relationships thereby fostering a sense of disconnection and a feeling of not being understood by others and may also contribute to negative self-perceptions, feelings of inadequacy or a sense of being disconnected from one’s authentic self – all which are associated with depression. Furthermore, suppressed emotions can lead to maladaptive coping strategies such as avoidance, emotional eating and substance use which can contribute to the development of depression. Finally, suppressing emotions requires a lot of energy and effort. Over time this can cause the person to feel depleted, which exacerbates the feelings of apathy and lethargy.
Disconnection / Loneliness:
A lack of meaningful connections, whether in personal relationships or within communities can contribute to feelings of isolation and depression. Social connections provide emotional support, and being isolated or lonely means lacking this crucial source of comfort and understanding. The absence of emotional support can contribute to feelings of despair and loneliness. A lack of social connections can also lead to boredom and a sense of purposelessness.
Existential concerns, meaning and purpose:
Those going through an existential crisis often find themselves questioning the purpose and meaning of their lives. The absence of meaning can result in deep-seated feelings of emptiness and despair, characteristics associated with depression. Lacking meaning in life and not having something to strive towards may also lead to rumination, indecision and helplessness, all of which are features of depression. A perceived lack of purpose can lead to a sense of hopelessness and further contribute to depressive feelings. Uncertainty about the future and a perceived inability to bring about change in the face of existential concerns can evoke a sense of futility and a loss of the will to carry on.
Managing symptoms and working with underlying causes:
Therapy is beneficial for identifying, understanding, and addressing potential causes of depression. Alongside addressing these underlying factors, practical steps can be taken to alleviate symptoms and promote well-being. While these practices may seem unattainable whilst experiencing depression, they become achievable with support from family, social connections, or professionals. Below I have listed some practical steps that can reduce the symptoms of depression:
Routine: Establish a simple and achievable routine. A structured routine can create a sense of predictability and stability.
Sleep: Improving the quality of one’s sleep can assist in regulating mood, improving cognitive function, reducing stress, increasing energy levels and improving overall wellness.
Diet & Nutrition: Adopting a balanced diet and improving nutrition can bolster neurotransmitter production, fostering mood improvement and alleviating inflammation linked to depression. Additionally, proper nutrition supports a healthy gut microbiome and boosts energy levels, enhancing motivation for daily activities.
Exercise: Regular exercise stimulates the release of endorphins – the body’s natural ‘feel-good’ chemicals, which can act as mood elevators. Exercise also reduces stress, improves sleep quality and can foster a sense of accomplishment, which can positively affect self-esteem.
Social Connections: Establishing connections and support networks profoundly influences feelings of isolation, belonging, purpose, and self-esteem. Reaching out to others during depression lessens the burden, offering emotional support, comfort, and understanding during challenging times.