What is clinical depression in reality, what does it look like from the outside and from the inside? When should you seek help? This and more is covered in an article by American psychologist Joseph Carver, which I have translated for those who do not read the original. Using a simple example with a car, Joseph clearly explains the complex chemistry of the brain.
Joseph M. Carver, practicing psychologist, Portsmouth, Ohio
Translation: Marina Fateeva
Depression is perhaps the most common mental health problem.
health, and affects one in four adults to some degree. Depression is a mood disorder, a feeling of sadness, depression, melancholy, or apathy. While a depressed mood is present, there is also a symptom that affects the neurochemical aspects of depression, or "brain chemistry," whereby the depressed person experiences difficulty concentrating and paying attention, loss of energy, increased anxiety, appetite/sleep disturbances, and other physical manifestations. When diagnosed, periods of depression typically involve at least five of the following symptoms:
- Depressed mood most of the day or every day;
- A marked decrease in interest in all or most activities;
- Significant loss of weight or appetite;
- Insomnia or excessive sleep;
- Psychomotor agitation or inhibition (restlessness);
- Low energy levels or chronic fatigue;
- Feelings of inadequacy, loss of self-esteem, and/or self-condemnation;
- Decreased attention, concentration, or ability to think clearly;
- Recurring thoughts of death or suicide, desire to be dead.
Causes of depression:
Depression can have many causes, but the two most common situations are:
Sudden serious loss.
A situation when a person faces a completely unexpected serious loss. This could be the death of a loved one, loss of a job, friendship, or other grief. In this case, the client clearly understands what exactly causes the depressive mood.
High levels of stress over a long period of time.
In this situation, the client is depressed but can't put their finger on the cause, the "I'm depressed but I don't know why" state. Imagine replaying a video of your life, the last 18 months. Look at the stressful situations you've been in, the responsibility, the pressure, the arguments. In clinical practice, this type of depression is more common than sudden loss. This type of depression kind of sneaks up on you. When it happens, the patient will usually say something like, "I don't know what's wrong!" Or, "I don't know what I'm feeling," or "My feelings are numb."
Brain Chemistry and Depression:
The human brain runs like a car, on fluids called neurotransmitters. Just like your car has brake fluid, antifreeze, oil, your brain runs on neurotransmitters. Some of them give you energy, like those related to adrenaline, some control your body's movements (like dopamine), and some control your mood.
A neurotransmitter that is often associated with depression is called serotonin. Serotonin is the "oil" of the brain, a fairly slow-acting neurotransmitter that interacts with sleep, appetite, energy, and mood. Using the example of a car, imagine driving on the highway at high speed for a long distance, the engine will take a long time to warm up, it will obviously use more oil. While we are filling the car with fuel, it is
child. Now let's imagine that during our trip, having used a liter of oil, we add half a liter. By the time we arrive, there will be a few liters missing, and the engine will overheat.
When stress lasts for a long time, the brain increases its consumption of its oil, serotonin. What this leads to is that the brain burns more serotonin than it can replace! And as a result, after months of stress, the brain uses serotonin faster than it can produce and replace. The neurochemical level of serotonin drops and depression sets in.
You will know that your serotonin levels are low (and depression is right there) by the following symptoms:
1. Most people with depression experience early awakening, usually around 4am. (farmers don't count). Serotonin, as you can see, controls sleep cycles.
2. Loss of concentration and attention. In this state, students and schoolchildren experience a decline in academic performance. You start putting strange objects in the refrigerator (a bowling ball is an office record!), forget why you came to the grocery store, become very forgetful and absent-minded at work and at home.
3. Physically, you lose energy. You can sleep for ten hours and wake up dead tired. You scream because of a drop on your hat, driving home, cooking, sitting at work…
4. Sexual interest, appetite, any interest in general quickly decreases. You stop answering phone calls, visiting friends, relatives, "close the curtains tightly."
5. The most dangerous thing is that your thinking speeds up. Your thinking runs at 300 km per hour. People with depression usually say, "I can't stop my thoughts!" The minute you wake up in the morning, your thoughts start. Your brain turns against you. It pulls out all the bad memories it can find - childhood grievances, broken relationships - anything that makes you feel bad and especially guilty. Your own thoughts torment you.
6. As your thinking speeds up, the garbage truck arrives. While your brain is tormenting you with the past, it is creating new ideas, thoughts, to torment you. In every case of depression, if it lasts long enough, the garbage truck arrives with the same garbage thoughts. Here they are:
- You are a burden to your family/friends;
- you let down/disappointed your family;
- nobody really cares about you;
- someone else will raise the children better;
- the family will be better off without you;
- your spouse will be better off without you;
- you are going crazy and there is no hope;
- It would be better if you weren't here;
- It would be better if you died;
- You should probably kill yourself.
When you're depressed, you ALREADY know about the garbage machine. It's nearly impossible to explain this part, and the high speed of your thoughts, to someone who has never been seriously depressed. If depression goes untreated, the constant stream of garbage completely destroys your self-confidence. No matter how hard you try, you can't control this part of the process.
7. As part of the "garbage truck", the mind will try to create maximum discomfort for you. You may be filled with thoughts of violence (directed towards you and others), thinking that you are rejected by God, or that you deserve such conditions for some reason. Your garbage will also tell you that if you seek professional help (a therapist, psychologist, psychiatrist), you will have to go there constantly.
8. When you are depressed, your brain starts to play a mental "video tape" of your worst defeats. If you are married, the movie plays the worst events day after day. If a child or young person is depressed, he or she suddenly becomes preoccupied with thoughts about upbringing, about the best sneakers that were bought for another, beloved child, about the car that was not given to you... Frequent, if not constant, thoughts and preoccupations with past problems and affairs are a common sign of depression.
In short, depression is a neurochemical response to severe and prolonged stress, either suddenly onset or creeping up on you over many months. Treating this dark cloud is easier than you think.
Modern therapy for depression:
Treatment for depression often consists of two programs, one that uses antidepressant medication and one that repairs the damage caused by months of junk thinking. Current research confirms that the best results come from using both methods.
Medication: You remember from the car example about the severe lack of oil after driving for a long time with an overheated engine. Depression is treated with medication in a similar way - we add oil until the oil level (in our case serotonin) reaches the normal level. When we are depressed, we use antidepressants to "add" oil to the brain, in most cases serotonin. Antidepressant treatment slowly increases the level of serotonin in the brain. Prozac, Zoloft, and the newest Paxil are antidepressants specially made for this purpose. They form their own class of antidepressants (SSRIs).
Like a car, once the oil level has risen, the symptoms ease. Most antidepressants take four to six weeks for serotonin levels to rise, although you will notice an improvement after the first week. Treatment with antidepressants such as SSRIs often stops the garbage truck in five to 10 days.
Psychotherapy: Psychologists, psychotherapists work with you to "repair" the damage done by the "garbage machine." They help you eliminate what your brain has been pestering you with for the past few months. Many people think that going to a psychologist, psychotherapist means lying on the couch and telling you how you were potty trained as a child - nonsense! Modern psychologists understand not only brain chemistry, but also how to repair mental damage and rebuild, reconstruct your confidence. A combination of medication and psychotherapy is very effective.
Usually successful therapy for serious depression includes medications and psychotherapy. In this case, normal sleep returns first, the speed at which thoughts appear slows down, the "garbage truck" leaves.
Some general thoughts about depression:
1. Depression is the most common problem faced by modern psychologists and psychiatrists. In most cases, hospitalization is not necessary unless there were persistent suicidal thoughts.
2. If you are depressed, your brain is filled with mental garbage - be prepared for this! During this period, it is best not to make important life-changing decisions, but to wait until the garbage truck leaves.
3. Depression has been studied by physiologists, psychologists, psychiatrists... Listen to the advice of experts - not your neighbor or Aunt Glasha. If you are prescribed a drug, they may say "don't take this medicine!" Remember, there is no garbage truck driving 200 kilometers per hour behind the people who give this advice! Stick to the point of view of professionals. Depression is a chemical problem, not associated with demons, the devil, bad eating habits, the new moon and other nonsense.
4. There may be other symptoms such as severe anxiety, overexcitement (pacing, total lack of sleep, etc.). This means that other neurochemistry has intervened. In this case, the psychiatrist will select medications that are suitable for depression and overexcitement.
5. When you are depressed, those who love you become a real pain in the ass. They are constantly "pestering" you, trying to cheer you up, giving advice ("buck up" or "stop it" are the most common), and trying to be there. Children shadow their depressed mother, practically protecting their mother. Be prepared for this.
6. Remember that memory hunts for bad memories, looks for old memories to torment you. Be prepared to relive old grievances, guilt, shame, worries. Your brain can constantly play a video tape (a "tape of the most terrible defeats") in life. You will feel guilty for something you did in childhood, mistakes from ten years ago, etc. As long as depression is with you, you will live in the past. Interestingly, when the serotonin level rises, the "past" will return to the past not as a tormentor, but as a memory.
7. Because your brain is tyrannizing you, you may "lock away" horrible thoughts. You may feel like you have a fatal disease. You may be consumed by guns, evil thoughts, etc. Often people feel that they are somehow "infected" with murder and are afraid that they will pass the disease on to their family. One husband brought his wife to therapy when she started making breakfast wearing a surgical mask and rubber gloves!
In other depressive situations, people become obsessed with other things, almost always the "road not taken." It often happens that, going through a midlife crisis, a businessman of strict rules suddenly wants a Harley and tattoos, while another suddenly starts thinking about an old lover. In almost all such situations, the person acts differently than usual.
8. All people with depression seek escape from reality. Common methods are alcohol, drugs, sexual relations, changing jobs, etc. Many good marriages are destroyed when the partner hears from the depressed spouse "I need more space", "I have to leave to find myself". Such escapes do not work. Such methods only complicate depression and recovery. The best way out is not to make decisions about changes, just contact a professional.
9. Most people think of emotion-altering medications as "nerve pills." This is far from the truth. Psychiatrists have medications for severe anxiety/hyperexcitability (Valium, Ativan, Xanax) and for depression (Elavil, Prozac, Zoloft, Sinequan). There are different formulations for each condition, and many people make the grave mistake of taking a "nerve pill" thinking they are treating depression - this is a mistake! You will feel calmer, but you will still be depressed. It's like drinking six beers when you have a broken arm - the pain will be significantly reduced, but your arm will still be broken. Your psychiatrist will choose the best medication for you.
10. If you are prescribed medication, do not expect immediate recovery. Taking antidepressants is like pouring oil into the engine, 100 grams per day. As you continue taking the medication, your mood will slowly improve, because the level of serotonin in the brain increases. In depression, every day is terrible and full of mental garbage. As you continue taking the medication, you will have a bad day, then a good day. When the serotonin level rises, you will have a bad morning, and then three good days. In short, it is bad and good at first, and then, as a result, good days with routine difficulties. There are no absolutely, eternally happy people. Constantly happy people are in medical institutions, because this is not normal. "Norm" is a good mood with normal reactions to the stresses of everyday life.
11. When choosing a therapist or consultant, everyone is very different - different personalities, styles, attitudes towards the client. Choose someone who is in your style and, most importantly, someone whose words make sense. If someone says, "I don't believe in drugs," leave them. This specialist is about thirty years behind the modern approach. Sometimes you have to look for a specialist who is right for you.
I want to warn you that many inexperienced professionals with little practice may miss the fact that you are depressed. You may come to see a psychologist to sort out something from your childhood that happened 20 years ago. You may fool your family doctor with numerous complaints, because when serotonin is low, all the body's systems seem to go haywire. An experienced psychologist will ask you not only about your life and growing up, but also about physical aspects - sleep, sexual interests, concentration and other indicators of stress or low serotonin. An inexperienced psychologist may focus on "garbage thoughts" and miss the bigger picture of the presence of depression. If you have clinical depression, discussing your past weekly, as the "garbage truck" suggests, will only prolong and possibly make your depression more intense. When in doubt, consult with your doctor about the situation, because most general practitioners are able to recognize depression with low serotonin. If you suspect that depression is part of the problem, ask your doctor to refer you to a psychiatrist and/or psychologist.
12. Depression does not only affect the person who is depressed, it is also a problem for family and friends. If a husband or wife is depressed, s/he will constantly talk about the marriage and the relationship. Remember, the "garbage truck" is driving through your head, thinking about everything bad that was said or done. The spouse is usually faced with hundreds of accusations and thoughts long after the fact. The spouse of a depressed person may suddenly find out that his/her partner never liked his/her hairstyle, mother, choice of car, or the price of the house. The spouse of a depressed person will hear many things that happened years ago and were never voiced. He/she may be awakened in the middle of the night with accusations and complaints that can last for hours. The spouse of a depressed person will feel responsible for all the unspoken desires and will be helpless when the depressed person lists the mistakes and misunderstandings that took place during the marriage, relationship. Even if they were already discussed at the time, the spouse of a depressed person will be judged for past events.
If your son or daughter is depressed, they may suddenly withdraw from the family or become hostile. Because of their age, most of their life experiences are tied to their family; these memories make up 70 percent of their mental video tape. The "garbage truck" will then bring back every parenting mistake. The parents will be saddled with everything that was done wrong in raising the child, feelings that were never discussed, attitudes toward siblings. When self-esteem is low due to stress and depression, the son or daughter may be intensely rejecting because they feel they must reject the parents before the parents have a chance to reject them. The anger and hostility are often so intense that the parents are too busy blaming and being hostile to notice the depressed mood.
An adult son or daughter may begin to apologize for their childhood behavior, asking for forgiveness - despite the fact that they themselves are already parents. Parents may be shocked to learn that a married son/daughter, being depressed, suddenly thinks about divorce, like a bolt from the blue.
If a friend is depressed, he/she suddenly stops supporting your friendship. Stops calling, visiting or writing. If your depressed best friend suddenly gives away something very dear to him/her, or includes in his/her will that his/her children be looked after - be on guard! Such behavior is often part of a suicidal plan, when a depressed person wants to "settle his/her affairs" before leaving this earth. In such a case, a heart-to-heart talk is needed, perhaps even accompanying the friend to the office of professionals for help. Many depressed clients are brought to specialists by their parents, friends, colleagues.
Conclusions:
Depression affects every adult to some degree. Most depressions are short-lived, and as the stress subsides, serotonin gradually returns. But when depression comes and stays, you may need comprehensive professional treatment to recover. If you think you may be depressed, consult a professional. A professional will be able to suggest you seek psychotherapy and/or possible medication. Depression is no longer a mystery and is quite easy to treat with modern methods. Treatment is usually short-lived, and usually does not involve lying in a hospital bed.
Joseph M. Carver, practicing psychologist, Portsmouth, Ohio
First published on Joseph M. Carver, Ph.D. Website