The Many Faces of Depression

Psychologist Adam Blanch offers advice to someone suffering depression, and says while it feels horrible, it may not be the real problem, but rather the way our body is trying to solve it.

Dear Adam, I’m depressed. Nothing I try to do makes a difference. I’ve done therapy, antidepressants, exercise and dietary changes. I’ve been to three therapists – things get better for a little while but within a couple of months I’m back where I started. The doctor say it isn’t medical or hormonal. I keep on going, but I’m not sure why, or how long I can keep it up.

Dear defeated, I get it.  

You are one of a great many people who, in the words of a former client, “got the depression”, and can’t seem to shake it. Obviously without talking to you further I can’t give an opinion about your case, but what I can do is say that there are many different types of depression with many different causes.

Depression is not so much an illness as a state of being in which our capacities for motivation, pleasure and satisfaction are seriously diminished. Like most mental health problems, it’s on a spectrum from mild low mood to crippling hopelessness. Also, like most mental health conditions, it can have a range of causes, and often it isn’t until we understand which cause or causes is impacting us that we can do something about it.  

I’ll outline a few typical causes of depression below, but let’s start with the idea that depression isn’t so much the problem for most people as much as it is something that is alerting them to a deeper problem. In other words, depression is how your body/brain is trying to get you to change something. That might be how you are thinking, your lifestyle, your beliefs or your direction in life. It could be that you need to attend to a trauma history or take a good look at your assumptions about yourself and the world. Let’s look deeper at the typical “types” I’ve encountered over the years.

Existential and situational Depression

In simple terms, this is “my life sucks” depression, or the depression we feel when we are not meeting our needs. We all have some fundamental needs such as the need for connection, self-determination, meaning, purpose and growth. When we don’t meet these needs, we get emotional signals like sadness, shame, guilt and anger to tell us to do something about it. If we persist in not moving towards a more rewarding life we eventually fall into despair.

It’s not enough for human beings to just survive, we need to thrive as well. We need to express our talents, reach our potential, do work that feels good to us and have rewarding relationships. Speaking from my own experience of depression in my early thirties, and my clinical experience with clients, I would have to say this is probably the most common form of depression I’ve seen. Most of my clients who don’t want to get out of bed in the morning have nothing rewarding to get up for.

Dealing with this type of depression requires changing course in life, escaping the comfort zone and creating a better life. The good news is that you don’t have to have achieved it for the depression to lift, you only need to be heading in the right direction for a sense of hope and excitement to return. It’s scary, but it’s necessary, usually unavoidable, and ultimately rewarding.

Stress reactive depression

For some people depression can be a protective response to elevated levels of anxiety and stress. Prolonged stress and anxiety create an unsustainable condition of over arousal in the body, leading to fatigue and illness. Depression can be how the body fights back, firstly to make us leave the situation by robbing us of motivation and energy to continue. Secondly, it forces us to take stock of the way we are living our life and to learn to respect our limitations.

Trauma reactive depression

New research has emerged which finds that depression suffered by people with a history of child trauma is resistant to standard therapeutic and drug treatments. This certainly confirms the experience I’ve had with clients, many of whom have been to multiple therapists and multiple therapies to no avail, until we start dealing with the untreated trauma they carry.

In our modern understanding of psychological trauma, it is also logical, because trauma can cause “splitting” in the human brain where a person loses access to many of the faculties of the right hemisphere such as creativity, motivation and emotional pleasure. That’s because the unprocessed trauma memories are stuck in this part of the brain and are being repressed to survive. When we try to shut out the painful emotions, we also lose the good ones. To put that another way – repression creates depression.

Cognitively caused depression

Most depression treatments are aimed at this one. Negative cognition, ranging from negative thinking to devastating schemas of being worthless, powerless and bad. In order to meet our needs in life, we need to believe we can meet our needs. Otherwise we would be constantly anxious.

Unhelpful or “negative” thinking attacks these beliefs in several ways. One way is through a direct negation of our ability and worth, such as believing we are incapable, weak, stupid, or unloveable. Another is through unrealistic demands for perfection, achievement, performance or invulnerability, which set us up to constantly fail. Another is through self-negating roles of martyrdom, duty, caretaking, stoicism and other types of repressive social conditioning.

These thinking styles usually emerge in childhood, either in compliance with or rebellion against parental and social expectations and demands. They are a form of trauma in themselves and can create the same “splitting” in the brain that leads to an overly critical or domineering left hemisphere that is repressing and rejecting the needs, inclinations and emotions of the right hemisphere.

Cognitive depression treatments dispute the rationality of these beliefs or thoughts, in the hope that seeing their falseness will lead to the emergence of more rational and helpful thinking. This can work, but not always, particularly if there is a strong component of splitting or trauma present. So, if you have done this type of therapy without success, don’t despair (any more than you already are at least). There are other options that more directly target the trauma foundation.

Endogenous depression

The idea of endogenous depression became very popular in the 90s, but I’ve come to believe it is overused. It suggests that depression is the result of a chemical imbalance in the brain as a result of genetic and environmental variables leading to a deficiency of serotonin, dopamine, noradrenaline and other neurochemicals.

It’s indisputable that genetics can incline some people more towards depression than others, as well as a host of other mental health problems. It’s also undisputable that environmental factors such as season, weather, food intake and exposure to hardships impacts on mood in a big way. It’s also true that sudden and large shifts in hormones can cause severe mood dysregulation, particularly around menstruation, birth and menopause for women, but to a lesser extent for men also.

Similarly, nearly all illness will incline us towards a low mood. This is particularly true for chronic situations for diseases, and for people with certain personality dispositions such as disagreeableness or neuroticism. If life is hard, or boring, or stressful or painful it is hard to feel good.

However, it is also true that genetic predispositions aren’t always “expressed” or activated. It’s usually not just “nature”, but a whole bunch of “nurture” that will create the conditions for serious depression to occur. This is good news, because though we cannot control our genetic vulnerabilities, we can influence our mood with out life choices, lifestyle, thinking and behaviours.

In summary

Depression feels horrible, but it may not be the real problem, but the way our body is trying to solve it. You are probably getting by now that depression is often there to tell us that something isn’t right, and to make us switch off “autopilot” and really have a good look at our life. The truth is that most people get over depression in the end, and many people look back on it as an important pivot point in their life.

As for solutions, well, that depends on the cause. If it’s serious, seek out professional help and if that didn’t work, try another type of therapist. Life is too good to always feel bad.

I hope that helps.

If you or someone you know is experiencing issues with mental health, please contact Lifeline Australia on 13 11 14, Kids Helpline on 1800 55 1800, or headspace on 1800 650 890.

About the author: Adam Blanch is a Melbourne-based psychologist, who supports clients around Australia. He provides support for individuals and group trainings for organisations through Good-Psychology, and a specific service for men’s health and wellbeing through Mentor Psychology. He is also a member of The Xfactor Collective community.

Do you have a question for Adam? Adam Blanch writes for Pro Bono News every fortnight. He will be answering all your people and culture questions. Send your questions to news@probonoaustralia.com.au

Please note the views expressed are the opinion of Adam Blanch and do not necessarily reflect the views of Pro Bono Australia, its staff or contributors.