Depression is everyone’s business. You’ve probably already seen a range of stats and percentages strewn across social media. Depending on where you get your sources, depression is commonplace throughout society and is the 4th largest cause of disability. There are some worrying recent stats from the Office of National Statistics stating that 21% of adults experienced some form of depression in the first 3 months of 2021. What the hell. 1 in 5 adults were depressed in 3 months of a year, higher in young adults. Sadly these figures make sense from all the knock effects of COVID on an already struggling population. We live in a world of uncertainty and isolation where it’s very easy to get caught up in the cycle of depression and it can be difficult to get out. It’s a disorder that can destroy someone’s sense of worth despite their worth to others. It’s a disorder that can kill you. It’s a disorder where so many are just suffering in silence often when people around them are completely unaware. It’s also a disorder that is often a bit misunderstood. Who else has exclaimed ‘I’m a bit depressed’ after a very mild inconvenience. I’m guilty of that. But sadly it’s those who are depressed that often don’t say it out loud and don’t get the support they might need. Chances are you probably know someone where depression has led to them taking their life. Let’s learn a little more about it.
So what is depression? This is a question that could generate a lot of different answers but simply put, depression is a term that applies to a number of different disorders and is a cluster of symptoms that is typically diagnosed by a professional such as a Doctor. Symptoms included are: depressed mood, suicidal thoughts, changes in sleep and appetite, loss of pleasure, loss of motivation and a reduction in functioning. These symptoms will then have a level of impact. If the impact is severe, maybe your depression is severe. If it has a mild impact, then maybe depression is mild. Depending on what diagnostic book someone is using, there can be different labels such as; persistent depressive disorder (PDD), major depressive disorder (MDD) and a whole other range of types and other mental and physical disorders where depressive symptoms can play a big part. For the purpose of this blog, I have in mind MDD and PDD as these are the most common presentations.
When I talk to clients about it, I often define it by defining the word ‘depress’; pushing something down. To me, that’s kinda what it is; you and everything about you is being pushed or turned down, your mood, your emotions, your ability to regulate emotions, your focus, concentration, your ability to think rationally and reasonably, at times your movements are turned down, your energy, your metabolism in some cases, your tolerance for stress, your motivation, your pleasure, your libido, your activity levels, sleep and appetite. Sometimes your emotions are turned down so much you just feel numb, flat or apathetic. I often hear people say; ‘it’s like a black cloud…walking through treacle…I’m just a shell…just going through the motions…I’ve really changed….I’m not what I once was…I just want my old self back’. I also often hear from guys; ‘I’m ok…I’ll snap out of this…there is nothing wrong with me’. Why you get turned down and depressed can vary from one person to the next, but often it is because life throws things your way and they make you feel low. That stress and low mood lingers, and down the line you are different from what you were before. This can be weeks/months/years. Depression can then become a downward spiral where pulling yourself up by your bootstraps or getting a grip ain’t gonna happen.
I’m feeling sad, am I depressed? Not necessarily. Do you think there are people who just feel happy all the time? Are there people who just experience joy and pleasure all the time? Certainly not. We are human, to exist is to experience all emotions. We are not built to be happy all the time. Think about it, imagine our ancient ancestors, if they were happy all the time, they’d die. They wouldn’t get stuff done and would succumb to a gruesome death. That genetic lineage is snuffed out. To be ‘mentally well’ means experiencing the range of emotions as you should. This includes feeling sad. If something sad happens to you, you will feel sad. Imagine a loss or a life change, the weeks after a broken limb or long term illness, the loss of a job opportunity or losing someone. Most people most of the time will feel sad when sad things happen. We are all different but this sadness should last an appropriate level of time for you. When well, you feel sad but recover, bounce back, make changes and will eventually be able to continue with day to day life without there being a significant impact. If this sadness is pretty relentless and thinking about it has remained there despite time and despite positives in your life, it could be depression. So sadness can play a part, but doesn’t mean you’re depressed.
My emotions are everywhere; I’m angry, I’m numb, I’m irritable, what is going on? Depression could be any emotion. Think about someone experiencing the symptoms of depression; sleep/diet is all over the place, metabolism is faltering, concentration off, focus off, mood is low and chances are they are thinking a bit more negatively and all the chemical processes and biology going on might be off too. They’ve probably got or had some stressors or life events adding to difficulties. What is it like to be this person? Lets just say their child is delaying getting dressed for school. Are they more or less likely to get frustrated or snappy? There is a leak in their kitchen, how will they react? Something really joyous happens, will they feel pure unadulterated joy about it? Chances are you thought they’d be a bit more snappy, anxious, stressed and a little more emotional or apathetic. In itself depression isn’t an emotion, but can contain a range of emotions where joy, contentment and happiness are fleeting and often absent, whereas apathy, sadness, shame and guilt bubble to the surface more often than not. Furthermore depression can play a part in almost every other mental health disorder and will often run alongside many physical health problems.
Why the hell am I depressed? You may never know this answer with absolute certainty, however you can make some reasonable assumptions. The causes of depression are so multifaceted and broad. I don’t think I’ve ever spoken to or provided an intervention to someone where the cause of depression is just 1 thing. Causes can range, sometimes sad things just happen and for whatever reason you get caught up in the spiral, this spiral often looks like this; life happens, feel sad, do less, lose out, feel sad, do less, lose out and so on. For others a cause can be really negative beliefs about oneself that formed very early on in life. Other causes could be the impact of trauma, perhaps a a very poor diet just denying your body the building blocks of all the good stuff, perhaps its insomnia, could be a lack of meaningful connections with others, doing nothing to be proud of, not having any fun for long periods of time, a disconnect from the world or a reduction in doing stuff you love that makes you you. At the very bottom of the list, there may be a bit of a hereditary predisposition/genes or chemicals playing a bit of a part, however I don’t think this is ever a cause, just a risk factor. The problem with these causes is that for some they lead to and maintain problematic thinking and beliefs that become a bit of a habit: ‘I’m not good enough…I’m useless…what’s the point…I’m lazy…others got their shit together…I’m stupid…better off if I was gone’. Depression then becomes a bit of a grey filter; imagine you wear a pair of glasses that makes everything grey. All the good stuff just bounces off the lens or is turned grey. It’s really easy then to see how these thoughts begin to stick and influence your whole being.
I just want to snap out of it. Maybe you tell yourself this, may someone else tells you this. If you’re depressed, it is not that easy. Sure some mild bouts naturally resolve with time perhaps due to more positive changes in life or the relief of a stressor. However, a lot of the time you get stuck and there ain’t no quick fix or magic wand. Just telling yourself ‘I need to snap out of it’ is thinking that just backs you into a corner. It’s black and white and not very realistic. Depression can lead to very unhelpful thinking; catastrophizing, stewing in the past and being very self critical to name just a few. So when a twitter guru tells you to walk 10,000 steps, lift weights, get early morning sun, eat offal, take an ice bath and meditate for an hour each day you may find it hard. Firstly, very few people have the time or means to do this. Secondly, this is because depressed thinking takes over. If you’re telling yourself ‘I’m worthless’, are you going to find the discipline and motivation to do a fraction of this stuff? No. Then that worthlessness now has won, and you think you’re a little more worthless. Fundamentally, doing really hard stuff that’s uncomfortable like jumping in an ice bath or hitting the gym at 6am is easier when you like yourself and your mind and body is in good working order to start with. You can still do these things of course when depressed, but you have to acknowledge that when depressed you might be fighting back against the result of a lifetime of rigid beliefs and patterns of behaviour that don’t just change overnight. This means, like a lot of things in life, if you try something really really hard that you aren’t ready for, there’s a chance you set expectations too high and fail at it. This will just feed the doubts you had about yourself in the first place. The trick is to have a big goal, but with little steps along the way and just appreciating that doing a step is great in itself, especially if you are depressed. You might also be really tempted to click links like; ‘3 ways to banish depression for good’, but I’m afraid chances are there isn’t a quick fix. But many people through their own self help and support adapt and grow and can break the cycle of depression.
What can I do about it? It’s a really boring but (I hope) an empowering answer; some stuff might be in your control and take small gentle steps. Initially it is about taking an active interest in your overall health and wellbeing and it’s the little things that make a huge difference. Work on your sleep (read my blog on sleep here), find a healthy way of eating that works for you, take an active role in your health, remove or resolve stressors (read more on stress here), cut down on booze and drugs, engage in hobbies and interests, do fun things with people whose company you enjoy, move more, establish a simple routine that you can stick to and be in nature more often. Imagine a compassionate, less depressed version of yourself. Nothing absurd or out there; ‘a nobel peace prize, 5 times lottery winner and love island heart throb’. Just a version of you that you’d like to be. What is that version of you doing in an average week? Can you add in gentle small steps to get a little closer to this version of you? If this is impossible to imagine, maybe talk to someone about what you’re going through.
Another little mantra that I’ve pinched from the ancient stoics is the principle of ‘more often than not’. More often they practised one of the stoic virtues and would try to do the right thing. I think ‘more often than not’ works well with depression. Do what’s good for you more often than not. This can apply to lots of daily tasks, it’s gentle, realistic and it’s just a way to win a probability game. It could be something simple like; ‘I will do something that is helpful once a day’. This could be going to the gym, having a walk, texting a friend or doing a bit of housework, more often than not. Fast forward a few months, and whatever rut you are in will look alot better. Furthermore, you’ll probably find that you’ve fallen into a bit of a routine and will simply find doing things a bit easier.
With all the will in the world if you are really depressed making changes can be very, very hard. If you’re that person who believes wholeheartedly they are useless and bad and aren’t able to see themselves for their true worth, just making a small change could be impossible. If you find making changes too hard and/or are feeling like crap despite changes, seeing your GP is a good call. If you want to know what happens next then please see my blog on demystifying the journey of depression here.
There is so much out there; helplines, self help modules online, self help books, a range of support groups, charities and organisations, therapy groups, gym referrals, counselling interventions, cognitive behavioural therapy groups and 1:1’s specifically for depression, behavioural activation, mindfulness based cognitive therapy, compassion focussed therapy, acceptance and commitment therapy, solution focussed interpersonal therapy and even medication. Accessing help for any mental health difficulty may feel really hard and lonely, but is common. You’re not alone and whoever you see isn’t going to be surprised by anything you say. Whether it’s a GP, mental health professional or a worker at a local charity, they’ll do what they can to help. Whatever recommendation is given, there is no one size fits all, however sometimes trying to find the best fit just means speaking with someone who knows a bit more. Rather than trying to find answers alone in your head, it really helps to speak to someone who can help you plan the next steps of your journey out of depression. If you are struggling with depression please seek support. Contact your mental health worker at your surgery, speak with your GP or contact local services such as MIND.
Thank you for reading, maybe next time I’ll write more about the do and don’ts of depression.
If you want to learn a little more, some books that I have found helpful myself and have recommended to many people over the years are; Overcoming: Depression, Mind Over Mood and Lost Connections. Also, if you want to take a bit of a deep dive check out the Huberman Lab podcast on depression. For some more reading recommendations check out reading well book suggestions. Also feel free to like, share and subscribe to our podcast.
About the author
I have been working as a mental health nurse since 2016 and have been around the block working in a lot of different areas. At present I work in a service where I assess people and provide interventions. I love my job, I love learning and talking to people about mental health and wellbeing. This article represents my personal opinion and is certainly not medical advice. If you have concerns about your mental health please speak with a GP or health professional.
The CALL helpline – 0800 132 737 or text HELP to 81066. Sometimes reaching out for support whether it is a friend, family member or GP is the hardest thing to do, but a good way to do this is by talking to someone through a confidential and impartial service. CALL Offers emotional support, a confidential listening service and information/literature on Mental Health and related matters to the people of Wales and their relatives/friends.