DIRT FROM THE ROOTS 11: DEPRESSION
Welcome back to DIRT FROM THE ROOTS, your monthly blog for discovering new perspectives on interesting, insightful, and obscure topics within the mental health and psychology fields. Today, we discuss perhaps the most familiar of all conditions, depression, and how our understanding of it may be continuing to develop.
TOPIC OF THE MONTH
“If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather.”
— Stephen Fry
A recent July 2022 study conducted around depression has caused a stir involving our perceptions of the condition, as the paper concluded with information that was taken as shocking by many. The findings that led to so much discussion can be summarized in one sentence: “There is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity.”
Just to be sure everyone is caught up, the reason this news can be perceived as shocking is due to long held beliefs that serotonin (the neurotransmitter responsible for regulating mood), or rather a lack of serotonin, was the chemical responsible for what we call ‘depression’. While this information is certainly groundbreaking and assuredly holds large implications about how we go forward treating the condition, my focus today will be around the idea that this also opens the door on many questions around depression which were never adequately answered in the first place.
If you or someone you have been around has experienced depression, you may have realized that common depictions or descriptions of depression are only sometimes accurate. Similarly to ADHD, the stereotypical perception of depression (sadness, withdrawal, lethargy) is absolutely correct– but overlooks the fact that this is simply the most common and media-represented portrayal of the condition, thereby creating an intersectionality of differing presentations that may go undiagnosed.
The answer to this definition is probably much more complex than is commonly assumed. But put most generally, depression can be defined by a lack of pleasure in things that an individual would usually find enjoyment out of to a degree in which the symptoms are preventing the individual from their full quality of life. This can present in a long list of ways, but generally the emotions displayed are low-energy and negative, the emotional pain will often permeate to affect many different realms of life, and typically also correspond with difficulties in eating and sleeping.
One thing that I think will be helpful to make clear at the beginning here is that depression does not function rationally. If we are feeling deeply negative emotions in response to deeply saddening situations, that would be considered grief. Depression does not just quickly go away by “looking on the bright side” or “appreciating the positive”. In fact, these statements even risk being seen as hurtful, as the very condition can be described as an inability to see things optimistically. Though these statements are true over long, intentional periods of growth, the inability to re-regulate mood around an issue is the indicator of depression, not a failure to “fix” these maladaptive moods.
THE COMPLEX TRUTH ABOUT NEUROTRANSMITTERS
To go back to the initial study: where does serotonin (or lack of) come back into play?
The truth is, things may be no less ambivalent than they already were. Our understanding of neurotransmitters is a work in progress, as we only have so far of an understanding.
We know that neurotransmitters function as chemical messengers within the brain, but we are not entirely sure exactly how. We know that neurotransmitters can affect one another, we know what each neurotransmitter is responsible for, but we do not know if this is as simple as “5 units= regulated when 4 units= not regulated”, rather just that there is an effect. The idea of taking SSRIs (selective serotonin reuptake inhibitors) is therefore not necessarily an ineffective method of treating depression, but rather highlighted as a different process than was once assumed.
While this study again has many insightful implications, it does not necessarily infer that the modern methods of treating depression are ‘wrong’ as much as it stands as progress in our understanding of the functions that SSRIs do treat.
THE MANY TYPES OF DEPRESSION
“Depression” itself is also a very umbrella term, as there are many more specific subsets of the condition that may be more helpful in understanding.
Major Depressive Disorder is the most generalized categorization. It is defined by depressive symptoms occurring for 2+ weeks with no specific reasoning to pinpoint as far as roots.
Persistent Depressive Disorder is the same criteria as MDD, but for 2+ years rather than months.
Perinatal or Postpartum Depression refers to depression that occurs during or after pregnancy in women
Seasonal Affective Disorder describes a pattern of depression that correlates with seasonal changes. Typically this is seen from fall-winter, but can be seen at any point of the year.
Depression with psychotic features includes hallucinations and delusions on top of the depressive symptoms, and bipolar disorder can often feature depressive episodes in tandem with mania.
While these roots are widely differing, presentation can look very similar.
THE MANY FACES OF DEPRESSION
To return to an initial point of sadness being the predominant emotional expression of depression, this is far from the only symptom.
In cases of complex depression, the affected individual may not even realize what is happening to them due to lack of awareness of typically presenting symptoms. An excellent example of this is seen throughout the renowned TV series The Sopranos. While the main characters do not present as classically depressed– rather as tough, hardened, angry, and violent– the show unravels to reveal that cultural, societal, and personal reservations towards accepting their struggles as depression has led to a much more maladaptive manifestation of emotions that all stem from an underlying depressive root.
The following will list some ways that depression can manifest, whether typically perceived or not.
Sadness, emptiness, pessimism, anxious feelings about the future: Depression is most commonly associated with a lack of joy or feeling discontent
Irritability, frustration, restlessness: Depression can manifest as higher energy emotion, and oftentimes anger can be perceived as either easier or more acceptable than other emotions in response to depressive feelings
Feelings of worthlessness, guilt and helplessness: there is a common belief that “depression is rage turned inward”; for some, it is easier to self-flagellate than inflict pain onto others.
Loss of interest or pleasure in activities, decreased energy, fatigue, apathy, lethargy: it is not surprising that we associate the lack of serotonin with depression, as we can quite literally lose our will to do anything in lack of proper neurotransmitter regulation. This results in a very “closed in” response.
Difficulty with sleeping and eating: whether too much or too little in both cases, depression can also create issues with appetite and insomnia/oversleeping
Difficulty with concentration and focus: if I have conveyed one message clearly throughout this blog series, I would hope that it would be that emotional dysregulation will disrupt almost all cognitive processes in the brain.
Increased thoughts of suicide and self harm: while this is a common association, I believe it is more important to highlight that it is also normal for those without depression to consider suicide, and that the intention of self harm is almost always for release rather than ideation. If thoughts have increased to a specific individual, that would be more telling than simply having thoughts
Physical symptoms: aches, pains, headaches, and digestive problems can all be symptoms of depression, especially if they are not eased by treatment.
So while we can see common themes– most prominently just a plethora of negative emotions that inhibit functioning– it is clear that depression goes far beyond the idea of someone crying alone in an isolated area.
THE MANY ROOTS OF DEPRESSION
The best way to answer “what causes depression?” is that this question has no single answer.
Surely, we will all face difficult life events. While the emotional level of response has everything to do with context, we must be aware of how our reactions are affecting our life more so than what reactions are happening. Going back to grief, it is again crucial to remember that everyone grieves differently, and therefore a long lasting response to a grief event may not necessarily be depression, while suppression of grief may end up leading to depression far (or not so far) down the line. While we can typically say that yes, large life stressors are a trigger for depression, it is more complex than simply leaving this statement as is.
Secondly, genetics do seem to play a part in depression. Certain brain chemistry does seem to be more or less prone to depressive episodes, though much like many conditions, it is hard to separate genetic dispositions from environmental influence in the case of being raised by a depressed parent.
Substance use can lead to depressive spirals, although it is far more likely that these chemicals exacerbate a preexisting depressive condition than cause them specifically. Loneliness and illness can also be seen in this same category, with exception to the case of certain illnesses which may affect brain chemistry and the idea of a terminal illness being very difficult to cope with.
Finally, giving birth also seems to spark depressive episodes, though this is likely intertwined with the drastic life changes that cooccur within having a child.
While the roots of depression are varied and unclear, the understanding is still developing and, just like the rest of mental health, is an extremely complex issue.
Another perspective on depression, which I happen to feel most strongly on, takes an entirely different approach in depressive realism.
Depressive realism is a view on the condition that posits depression is actually the baseline human condition, and due to this, all humans are prone to depression and views the main root not as a chemical imbalance, but rather a signal that someone is in an unsustainable environment. This theory essentially gives the metaphor that a polar bear is obviously going to struggle and fail to thrive when living in a desert, despite being an apex predator in its natural polar landscape. Depression is a mechanism of the body to indicate that things need to change, and much like a fever rises to prevent sickness, the function is for self-preservation.
The implications of this theory also suggest that those who are depressed are actually seeing the world with less delusion or influence, as the studies conducted in the formation of the theory showed that depressed individuals gave more accurate self-assessment than non-depressed individuals.
DEPRESSION AND RELATIONSHIPS
An additional consideration when looking at depression is how it can affect relationships with others. Despite how we may be perceiving things from the outside, it is potentially not in line with what that person could be feeling internally, creating breakdowns in communication. Depression in the form of anger may become displaced on others, and depression in the form of withdrawal may be difficult to recognize should the affected individual withhold the information or not feel comfortable expressing their feelings. The very miscommunication between the misunderstanding of what is happening can create many of the issues that prevent best treatment.
If you are interacting with someone with depression, it is important to remember that it may be difficult or even impossible for them to communicate their full feelings, and it may be detrimental to try and “pull it out” or suggest people “just go out and do things”. Again, just sitting with a person and allowing them to process the feelings is likely our best option, and understanding that depression requires patience and acceptance may be good replacements activities than trying to “fix” the situation.
DEPRESSION AND HEALING
Depression’s complexity requires first a full understanding of the root, as the initial treatment consideration should include focus on which area that the affected individual is most inhibited by symptoms. While some depression requires simple time and processing, SSRIs and other antidepressants have also shown to help individuals cope with more chronic negative feelings.
In the case of environmental factors, it is also important to remember that changing the environment will not necessarily “end” the depression, but will rather be a powerful influence in reframing maladaptive or negative thought patterns. And finally, therapy has shown to be more helpful with depression than most conditions, particularly in combination with additional treatment measures.
While it is very easy and with good intent to consider ways that we have felt better about ourselves and suggest them to others, depression is better seen as a head cold to wait out rather than an itch that needs to be scratched. While we surely would appreciate a solution that would just fix things, the frustration and isolation that can come from hearing many outsiders make suggestions that the affected individual has surely attempted and failed before can sometimes create a cyclical feeling of hopelessness or self-doubt that is more likely to prolong or exacerbate the condition. It may be more comforting to hear validation that these feelings are not enjoyable and appreciating the connection of another person that is willing to sit with them through the feelings rather than try to “fix” them.
While depression can be seen as one of the most daunting, lonely, and isolating condition, it is also one of the most common as well as one with solid evidence of healing. While we may view this condition as something scary and dangerous, it is not without a few benefits and primally-beneficial logic as well.
WHAT’S COOKING FOR NEXT MONTH
Next month, Nick will discuss depression’s close relative in anxiety, and the many ways that this may manifest differently than we may expect as well.
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