Depression often is misunderstood in our society. One reason may be because it’s a variable illness. It can look different in different individuals.
There are gradients of depression. For instance, the depression may be mild — abating after making lifestyle changes — or more moderate — requiring therapy and medication. And there’s no single underlying cause. People may become depressed for a range of reasons and factors.
To clear up some of the confusion, we asked clinicians and researchers who specialize in depression to share the biggest lessons they’ve learned about the illness. Below you’ll find 10 insights on everything from what triggers depression to how it’s treated.
1. Some people with depression don’t seem depressed. According to clinical psychologist Selena C. Snow, Ph.D, some individuals with depression go to work or school and appear as though everything is fine. However, on the inside, they’re struggling greatly.
Because depression can be invisible, others may not recognize their loved one’s suffering, she said. Consequently, this makes the person with depression “feel misunderstood and alone.”
This is why Snow has found group therapy to be helpful. “[A] depressed person has an opportunity to learn that they are not the only one suffering in silence as they gain support and empathy from others who understand the depths of their pain. And they benefit from the encouragement of peers to take small steps forward.”
2. Setting unattainable goals can contribute to depression. Ironically, these goals may include wanting to be happier. People assume that “if we simply work hard at it, we can master happiness, just as we can figure out how to use new computer software, play the piano, or speak a different language,” said Jonathan Rottenberg, Ph.D, an associate professor and director of the Mood and Emotion Laboratory at the University of South Florida.However, striving for happiness is different. He likens it to “putting yourself on a treadmill that goes faster the harder you run.”
Striving for any unattainable goal may backfire. According to Rottenberg, also author of the book The Depths: The Evolutionary Origins of the Depression Epidemic:
“From early on, parents, teachers, and the media have touted the idea that children can become anything they want, so long as they’re willing to work for it. An extraordinarily deep-rooted ethos in our culture shames and discourages people from ever giving up on a goal — whether it’s an unrealistic NBA dream or a failing marriage. Many people’s default response is therefore to double down, often locking themselves into depression for weeks, months and years.”
Individuals also may become depressed because they fear they’re not rich, successful or attractive enough, he added.
3. Seeing a physician is key. “One thing I’ve learned when treating clients with depression is to recommend a medical exam right from the start of treatment,” said Lee H. Coleman, Ph.D, a clinical psychologist and author of Depression: A Guide for the Newly Diagnosed.
While your doctor probably won’t find a single cause for your depression, it’s common for people to have medical issues that exacerbate symptoms, he said. For instance, endocrine problems, such as hypothyroidism, are common. Another example is polycystic ovary syndrome (PCOS) “which can cause or worsen many of the symptoms of depression,” he added.
Seeing a physician is also important because it helps you see yourself as actively managing and treating your symptoms, Coleman said.
4. The “brain fog” of depression can be overwhelming. Another critical lesson Coleman has learned is that depression can wreak more havoc on a person’s thinking than the mood symptoms.”My depressed clients often feel frustrated or angry at themselves for feeling indecisive, forgetful, and unable to do their best work.” He emphasized that the cognitive issues — the “brain fog” — aren’t a weakness or permanent condition but a treatable symptom of depression.
5. Sticking to treatment is really hard. “The biggest lesson I’ve learned is to be patient with the process and to help my clients move through … inconsistent moments with compassion and gentle persistence,” said Deborah Serani, PsyD, a clinical psychologist who’s treated people with mood disorders for 25 years.
That’s because the symptoms of depression make it difficult to follow a treatment plan. For instance, the acute fatigue makes it hard to attend therapy sessions or go to the pharmacy for medication, she said. The negative thinking convinces you that both aren’t even helping, so you might miss sessions or skip medication doses, or stop treatment altogether.
It also leads people to “minimize any successes or positive changes and feel a pervasive sense of helplessness and inability to get better or change their situations,” said Melanie Greenberg, Ph.D, a clinical psychologist who specializes in managing stress, mood and relationships in Marin County, Calif.
6. It’s important not to wait to feel motivated. Act first. Snow’s clients often tell her that they don’t want to get out of bed. (Which is common for people with depression, because it siphons your energy and motivation.) They’ll do so once they start feeling better. “However, we know that behavioral activation is a key component to overcoming depression and that the behavior must precede the mood change rather than waiting for the mood to somehow improve on its own.”
As she added, “Lying in bed feeling depressed will lead to more lying in bed and feeling depressed.”
7. Depression isn’t solely a mental health problem. “Depression is a mind-body-relationship issue,” and the causes are complicated, Greenberg said. They might include a person’s biology, a history of trauma, relationship losses, maladaptive coping strategies, loneliness, an unhealthy lifestyle and toxic relationships. (And, as mentioned above, medical conditions may contribute.)
“To provide the best treatment, it’s important to consider these different factors, decide which are most important, and include them in the treatment plan, referring to other health professionals as necessary.”
Greenberg shared this example: If vitamin D deficiency or inflammation is affecting your depression, you might take vitamin D and Omega-3 supplements, and exercise outside or practice yoga.
8. Small changes can be powerful.
“I have found that patients are often surprised to discover that simple therapeutic interventions can be very effective and improve their mood,” said Snow, who has a private practice in Rockville, Md. For instance, she teaches clients relaxation strategies, such as deep breathing, to help them tolerate distress and manage their mood.
9. Sharing your own experiences can help. Another pivotal lesson Serani has learned is to share her personal experiences with depression with her clients. This is counter to what most therapists are taught: to never reveal information about themselves in session.
“I’ve learned that sharing my unique perspective of knowing depression personally and professionally can help individuals feel less alone; show them that I truly understand their struggles because I’ve been there myself; and offer them tried-and-true interventions that conquer depression,” said Serani, also author of two books on depression.
10. Patience is paramount. “It’s important to meet a depressed person where they are, not where you want them to be,” said Coleman, also an assistant director and director of training at the California Institute of Technology’s student counseling center. “This applies to people we know who may be depressed, and it applies even more so to ourselves.”
In other words, try not to add to your pain by expecting to be further along in your recovery than you actually are, he said. Having high expectations is common. Coleman has this conversation with lots of people, who worry that being patient is akin to giving themselves permission to be lazy and unproductive.
However, having patience is “being realistic and compassionate when we’re already carrying a heavy load,” he said. Because depression is a heavy load.
Thankfully, with treatment, it’s a load that gets lighter and lighter.