First of all, this isn’t a ‘how to get over depression’ guide. It’s something of a response to quite a few blog posts and articles on depression I’ve been reading lately and some concerns about what I’ve read. Many of the blog posts I’ve been reading seem to automatically define depression in medical terms and then go on to speak of brain chemical imbalances, staying active and making your bed in the morning, followed by general CBT advice. And whilst some of that is fine and well-intentioned, it really assumes far too much about the cause of your mental state before going on to make more assumptions about the right treatment.
Depression as Illness in Itself
Yes, some people appear to become depressed with no obvious life event or build up to it. They may have a disease. I haven’t met any of those people, but I’m sure they exist. After some discussion most people usually begin to identify something that precipitated their becoming depressed. There may well also be some people who have some neurological cause to their depressed mood, such as the much-suggested brain chemical imbalance, but that’s for a neurologist to assess, not anyone online. Then there is port-partum depression, for example, and depressive states that are the result of chronic insomnia, over-work or fatigue from discreet physical illnesses that deplete our energies. In other words, we can experience depression for many reasons.
The brain chemical imbalance hypothesis is actually a theory based on dissection and studies done on rat brains in laboratories. Our human brain chemistry changes all the time in response to our thoughts, body processes and external stimuli, and at the time of writing there exists no evidence to my knowledge that a brain chemical imbalance is the cause of depression. So unless someone has come up with a test to measure our overall individual chemistry as a specific cause of depressed mood, then it remains a theory that, yes, many people seek to address with drugs that a doctor can prescribe.
Also, if you think about it, if a doctor said to you that he thinks you may have a thyroid hormone imbalance, you’d expect to have your blood tested before he or she prescribed you medication, wouldn’t you? But for some reason, we assume that it’s ok to start taking pills for a hypothesised brain chemical deficiency without knowing for sure that’s the cause. We’re expected to try it and see what happens. And that’s the advice I’m reading online all over the place. However, many of those particular psychotropic drugs can also increase suicidal ideation as a ‘side effect’ when you first start taking them! So if you decide to start taking them it’s very important to read the little leaflet that comes with the drug and have a close friend or family member help you monitor your mood for any changes, good or bad.
Depression as a symptom of physical illness
Taking psychotropic medications for depression that alter your brain chemistry isn’t necessarily the right or best course of action. It can sometimes be helpful for establishing some mood stability, when for example, you’ve let your depression go unaddressed for a very long period of time and you’ve ended up feeling hopeless and that life has no meaning. Many people do let themselves get into this state – I’ve done it myself. But ideally, beginning to do something to address your feelings of depression sooner is better, rather than letting yourself slip deeper and deeper into it. If there might be some clear medical cause then it’s important to have that addressed medically in the first instance. In any case, if you’ve let yourself get a long way down the depression road then being assessed medically is not a bad starting point in order to check for causes and gain access to support. If it’s caused by some disease process, hormonal imbalance due to endocrine system problems, menstrual cycle, inflammation or associated cholesterol imbalances, nutrition and diet, insomnia, exhaustion, digestive tract problems, seasonal light changes, alcohol or substance misuse, or physical and mental exhaustion for example, then that’s where you start identifying the cause and looking at relevant solutions. Otherwise it’s premature to assume that your depressed mood is automatically a medical or mental illness.
Depression as a symptom of lifestyle
If your depression isn’t caused by some underlying physical process, alcohol or substance misuse, then it would then make sense to explore other possible causes, such as your lifestyle and your ways of managing yourself, your feelings and relationships. If this is the stage you’re at after being cleared medically then it makes sense to do this exploring with a trusted friend or family member, or a trusted therapist. There are people out there who will continue, even at this stage, to refer to depression as an illness or a disease. This in my view is not necessarily a helpful way to look at depression that doesn’t appear to have a medical point of origin or co-morbidity. We generally seek a doctor’s expertise to treat diseases and illnesses, and so thinking of depression as a disease when there isn’t an obvious pathological process involved can put us into a medical patient mindset. This mindset is one in which we expect an external agent, or expert – a doctor for example – to do something to fix us. It is a psychologically passive state. However, depression that is the result of the way we have been living or responding to life is only truly fixable by changing the way we are living, not by having an expert do something to us. Depression in this form is the result of active patterns of choices we make and habits we have formed. As such it is we, rather than someone outsode of ourselves, who have to do the ‘doing’ part, and this requires us to be in a state where we are ready to accept responsibility for starting to make the necessary changes to the way we go about life, with of course, the support of that trusted friend or therapist.
If you come to an educated and informed conclusion that your depression may be the result of a life event, like a bereavement or the way you were raised as a child or something happening at work, then it may be worth finding a psychotherapist who can do a thorough assessment with you. Psychotherapists are like everyone else, there are some you will feel confidence in and others you won’t. Choose one who you feel some degree of confidence in and if he or she knows what they are doing then part of their assessment process will be first to check for any signs that your depression could be medical in origin and referring you to your doctor if you haven’t seen one already. Gathering a lot of detailed information on your lifestyle, history, support network, habits and significant life events should be a part of that assessment process. The more detailed and in-depth the better in my view. When you and your therapist have established a clear picture of what may be producing your depression, with an assessment of any risk you might pose to yourself or others (and a risk managment plan if necessary) then you would discuss what might be involved in your recovery. Therapy may or may not play a part in that recovery.
Depression: negative thoughts or bad circumstances?
Even at this stage, it still isn’t helpful to assume that your depression is the result of ‘negative thinking patterns’ as much online advice seems to suggest. This is part of the CBT legacy – Cognitive Behavioural Therapy – that is still doing the rounds on the internet. So-called ‘negative’ thoughts may well be accurate thoughts in response to painful circumstances and toxic relationships, for example. It might then make more sense to change the circumstances or the relationship rather than assume there’s something wrong going on in your head. Depression isn’t necessarily ‘your problem’, or fault or the consequence of faulty thinking: sometimes it’s a perfectly sane response to perfectly insane life events, people, situations, and it may be those external things that have to be changed.
Having suffered from depression and being a psychotherapist, I have a pretty good idea of what has been helpful to me and what hasn’t. A good, thorough assessment with a clear problem formulation (an explanation of what appears to be causing your problems) followed by a clear support plan is, I would suggest, a better way to proceed with your recovery than ‘let’s talk about it for a few weeks and see how it goes’. Whilst this latter approach may be helpful for some people with a mildly depressed mood, it’s not necessarily helpful for anything more serious because, apart from anything else, all it’s doing is facing you with a few more weeks or months of uncertainty and the unknown, which isn’t necessarily going to be very helpful to you in a depressed, anxious or hopeless state.
Whilst this post isn’t of the type that says ‘here are ten ways to cope with depression’ it is, I hope, a starting point that helps us avoid wasting time or making assumptions about what depression is or isn’t and what you should or shouldn’t do about it. Depression has many causes and thus different solutions and approaches to recovery.
In summary, here are the two simple steps described above to start you on your way to that recovery:
- Get yourself checked medically to rule out or identify any possible physical causes
- Get yourself assessed by a competent psychotherapist who will
- do a comprehensive assessment
- assess your risk
- provide a clear problem formulation
- provide a clear support plan or strategy