Depression Explained
What it is, why it happens and what to do about it
Depression is extremely common, but still barely understood — by society, by sufferers and even by psychiatrists. Is it genetic or circumstantial? Is it a disease or a mindset? Is it necessarily chronic, or is recovery possible? Why does it happen to some people and not others? And when someone we love is suffering from it, how can we help them?
Over the past decade I’ve spent a lot of time thinking about all of these questions. And I believe I’ve found some useful answers.
When I first fell into depression, at 25 and after a happy and stable life so far, I didn’t know what had hit me. Over the next five years I was struck down by winter lows so bad that I was unable to function.
It was as if my body was an empty shell, the personality that had inhabited it had died, and all that remained was a shadow of who I used to be.
But I wasn’t going down without a fight. I set out on an odyssey of recovery, a quest to understand what had got me to that point and how I could get out. Along the way I tried pretty much everything that touts itself as a depression remedy. I read dozens of books on mental health and happiness. I kept going, until eventually I found my way out. Here’s what I learned.
What is depression?
Depression is your body’s way of telling you, in the most extreme way possible, that the way you are living is not good for you.
Now that’s my definition, not a clinical definition (eg the American Psychiatric Association defines it as “a common and serious medical illness that negatively affects how you feel, the way you think and how you act”).
The reason I define it that way is because I wholeheartedly believe that depression is grounded in the reality of someone’s lived experience — it’s not an illness or disorder that manifests out of nowhere.
I’ve never come across anyone who’s been depressed who couldn’t identify some real life circumstances that contributed to getting them there.
My own depression first arose out of a chain of events that started with a job that I hated but felt trapped in. The way I was living — staying in a job that was causing me major unhappiness — was not good for me. My mind thought I could cope with the strain. But my body knew otherwise.
Being desperately unhappy in a job is a pretty obvious example of living in a way that’s not good for you. But the factors causing depression aren’t always so clear. Sometimes it’s linked to unresolved past trauma or repressed unhappiness. And of course much is made of the possibility of genetic predisposition to depression (and other mental illnesses) — though the evidence is far from decisive.
From the evidence I’ve seen, I don’t think anyone genuinely happy and fulfilled in their lives — anyone living in a way that is truly good for them — would become depressed.
Unhappiness vs depression
Depression tends to develop out of a situation that someone finds stressful, distressing or otherwise unhappy. But how do we go from a ‘normal’ level of unhappiness to a full-blown depressive episode?
Here’s my theory about how we spiral into depression:
- Initially you begin to feel anxious over the issue that’s distressing you. This anxiety disturbs your sleep pattern — by impacting the quality of your sleep or making you lose sleep altogether.
- Because your body becomes sleep deprived, you find it more difficult to function to the same levels you’re accustomed to. You may have less energy for your established exercise routine, or for activities you’re used to enjoying. You do less → you enjoy less.
- Sleep deprivation can mean you begin to find tasks considerably more difficult. This is exacerbated by the loss of headspace brought on by the anxiety you’re feeling. Once you start finding normal activities harder to carry out, your distress will worsen. This in turn will cause you to lose more sleep, and so you become more distressed, and so on. This is the start of a downwards spiral — and illustrates how worries about falling into a depression become a self-fulfilling prophecy.
- By now your body is putting all of its limited energy into maintaining vital functions, namely sleeping, eating and moving around. Less vital functions, like sex drive, cognitive ability and coordination, begin to shut down, Your ability to carry out regular tasks, like work or driving, is even more diminished.
- Once you become conscious of your inability to do things you once did with ease, thoughts of “I’m stupid”, “I’m worthless”, “I’m a failure” clock in. You lose your confidence and can find yourself paralysed, unable to make even seemingly innocuous decisions (what sandwich to get) let alone big choices (should you leave your job).
Characteristics of a full-blown depressive episode
- Extreme lack of energy, tiredness, loss of appetite, drive, sexual drive, enthusiasm, enjoyment and motivation.
- An inability to function as you once did in social situations — “not having anything to say” or feeling boring.
- Immense lack of concentration (which is why people who are depressed are not recommended to drive).
What to do about depression
As I write this, I’m aware that everyone’s circumstances and means are different. So while some people may be able to afford private therapy or even inpatient healthcare (and I’m one of these people), these are by no means an option for everyone. But happily (!) in my experience the most effective remedies for depression are affordable or even free. Here they are:
1) Hang tight
All of the books, studies and doctors agree: depression does not last forever. When you’re in it, it feels like there’s no end in sight — no matter how many people try to reassure you otherwise. But once you’re out of it, the experience gradually recedes into a distant nightmare. It takes immense personal strength to find the will to keep pushing through it, day by day. But like climbing any strenuous mountain, the view from the top is worth the effort. You’ve just got to keep focusing on putting one step in front of the other. The world will keep on turning and everything will be waiting for you to rebuild on the other side, when you’re ready. I know all this because I’ve been there, many times.
2) Find some sort of purpose
If you’re unable to carry out your normal work, find something you can do — and make yourself do it. You will feel better for it. I was lucky because I found staying at home unbearable anyway — some people can’t bear to get out of bed, but it’s worth it. The best thing I found to do was volunteering in a charity shop / thrift store, which are busy during the day so offer contact with people, but where the tasks are sufficiently menial, and the atmosphere positive (this last bit is important). You could also do a short course in something you’ve not done before that doesn’t require cognitive ability (eg pottery).
3) Force yourself to exercise
Exercise produces endorphins, which make you feel good: it’s as simple as that. Unfortunately, exercise may be one of the last things you feel like doing if you’re depressed. So it’s just another one of those things you need to force yourself to do, even if it’s just a walk (preferably somewhere green). But the best thing you can do is get your heart rate going, as regularly as possible — you’ll notice the difference immediately.
4) Get therapy if possible
But at the right time and with the right person. They say that therapy like CBT (cognitive behavioural therapy) is less effective when you’re in a full-blown depressive episode — but even then it’s still good to have the supportive ear of a therapist you connect with and respect. It’s particularly helpful when you’re recovering and looking to make changes to prevent depression happening again. If you can’t afford private therapy, see if there’s any online or free therapy you can do (eg through the NHS in the UK, or a charity).
5) Improve your sleep
Bedtime was my favourite time when I was depressed — the chance for some respite and escape from the world for a few hours. But sleep disturbance is a key feature of depressive episodes, so do everything you can to help aid it. I listened to sleep hypnosis and meditations on youtube to get off to sleep and found them comforting and helpful.
6) Consider medication
This is a difficult one. I’ve taken many different antidepressants over the past few years — enough to strongly recommend proceeding with caution. They can be very effective (after starting on one particular drug, I felt almost fully better within three days) but also dangerous (I believe that same drug tipped me into a manic episode a few months later). Other side-effects are common and grim, including the inability to go to the toilet, sexual dysfunction and much else besides. It’s a personal choice — one which is easy to make when you’re feeling desperate in depression, and one which can help give you a boost out of it. But it’s not a solution to be pursued in isolation of making the other changes listed here. And if you do take medication, make sure you’re monitored and supervised by a doctor, and taper off slowly when you want to stop.
7) Look after your gut
It’s recently come to light that gut health and mental health are closely linked. So if you are feeling depressed, look into probiotics, glutamine or other health supplements that may make a big difference in helping you to feel better.
8) Cling on to whatever — and whoever — makes you feel good
Wherever you find enjoyment when you’re depressed, pursue and savour it. Spend time with friends and family who love you without judgement. They will carry you through this. Sit in companionable silence watching escapist films. Don’t beat yourself up about eating chocolate or smoking cigarettes. In my view, it’s such a miserable time you deserve any precious small relief!
Finally, please remember: depression is not your fault. It is your body’s way of telling you, in the most extreme way possible, that the way you have been living is not good for you, and that something needs to change. It will pass.
I hope that this has been helpful, even if for just one person.
