Depression is probably the most common psychiatric problem, impacting easily 20% of the population at some point in their life (16.9% officially in the United States). Depression has a role in normal human development, especially as a reaction to events that require cognitive restructuring. Depression is nothing to be ashamed about, and yet existing social stigma prevents the affected from properly communicating and learning about the condition beyond ads from pharmaceutical companies.
1. You can’t just decide to be depressed or to stop being depressed
No one decides to be depressed, nor can someone simply “decide” to stop being depressed. Average levels of different neurotransmitters and neuron activity have an effect on mood and even emotional stability, but these cannot be changed purely by will. Although determination to change your emotional state can help clear up depression, it is not simply a binary switch. Expecting yourself or others to simply “stop being depressed” from one day to the next is not helpful or productive.
2. Depression reduces brain activity in some areas and increases it in others
Depression can reduce specific types of brain activity, but it can also increase other types of brain activity. Depression is often connected with “ruminations” about negative thoughts, past life situations, and even about the future (or a lack thereof). Depressive states carry different patterns of brain activity than normal, so it should be no surprise that a depressed person may not show the same type of cognitive performance as they otherwise would. This reduction in the performance of specific tasks does not make the depressed person stupid but instead implies an altered state of perception that is suited to different types of tasks.
3. Depression can have different causes, and they cannot all be fixed by the same type of therapy.
Not every depression is the same: different causes, different genetics, and different perspectives can all lead to different types of depression. A genetic predisposition towards depression can make returning to a healthy emotional state more difficult than if the depression is purely based on experience and cognitive structures, but both situations can be overcome. The future of psychiatric medicine will see more “personalized” treatment aimed at identifying the type of depression and the most effective type of therapy.
4. Depression, like psychosis, normally does not last forever… even with no medication.
A depressive phase is not that uncommon, and affects every 8th American at some point in their life (16.9%). Whereas some depression can be linked to seasonal changes and exposure to light and can be best treated through light therapy, other depressions stem from repetitive thoughts or chronic past abuse. The idea that a temporary psychological condition calls for lifelong medication is a relatively new one and is not grounded in established scientific evidence. Understanding that we go through phases as humans and that current suffering is not permanent, is knowledge that can itself help people overcome and take control over temporary depression.
5. Depression, although not a decision, can be influenced by you.
The ratio of positive experience and thoughts to negative experiences and thoughts has an effect on the average levels of neurotransmitters and subjective experience of mood (see Barbara Frederickson, 2013). Cognitive habits can trigger or sustain depression, and medication can not necessarily cure a depression driven by these cognitive structures. At the same time, we contribute to the positive and negative experiences of our friends, family, and acquaintances: showing empathy, understanding, and sharing our joy and support can have a meaningful effect on the mood and psychic well-being of ourselves and other humans.
6. Some “antidepressants” can actually worsen depression and create a chemical dependence
In the same way that not every depression is the same, not all depressions will react the same even to the same medication. Some antidepressants have been even shown to exaggerate depressive and self-destructive symptoms and increase the odds of suicide versus a placebo, which is what a recent review of the drug paroxetine (Aropax, Paxil, Seroxat) revealed. Antidepressants have a place and can useful for many people, but it isn’t useful for everyone or in treating every depression.
7. There is no “one size fits all” solution to depression, and you can best help depressed friends by trying to understand and empathize.
Again: not every depression is the same. Many depressions appear connected to the proportion of positive experience to negative experience and the effectiveness of coping strategies, and are likely the average levels of different neurotransmitters. Whatever the cause, telling someone to “get over” their depression is almost certainly a negative experience, and thus likely to worsen instead of improve someone’s depressive episode.
Showing empathy and support while trying to create positive experiences for the depressed is a lot more meaningful, and helpful, than any insistence that they simply “snap out of it.” Personalized treatment may provide the ultimate answer, but the least we can do is refuse to contribute to the problem.