Counselling · Psychotherapy · CBT · Art Therapy · Mindfulness · Compassion
Carbury, Co. Kildare · Tels: 0873977828 / 0862272917
Depression - Sadness Itself is not the Problem
"Depression … is the absence of being able to envisage that you will ever be cheerful again. The absence of hope. That very deadened feeling, which is so very different from feeling sad. Sad hurts but it's a healthy feeling. It is a necessary thing to feel. Depression is very different"
J. K. Rowling
It can be very difficult for somebody who has never had an episode of depression to understand what it is really like for the person who experiences it. Here are some of the things that people who have experienced depression have told us: that they often feel misunderstood and isolated, that others will look at them with either judgement or pity if they find out, that they are too ashamed to share what really happens to them with others as they feel this is their fault, that they feel completely powerless to get better. They have also told us that they are afraid of being told (even when this is said kindly and with the intention to help) things like to try and take more exercise or eat more healthily or think more positively, because they know this alone does not help. If a loved one is depressed, it can be very frustrating to watch and very hard to understand. All of this can increase the sense of isolation, guilt and hopelessness for the person. In our experience, a lot of people with depression already judge themselves pretty harshly for being depressed and for not being able to get out of it themselves, as if the depression was, somehow, their own fault ("I should be able to shake this off", "why can't I just feel better?", etc.). In their website, Aware tell us that 450 thousand people in Ireland experience depression (that is one in ten), and still there seems to be stigma around this in the country.
Depression is not just sadness. The feeling of sadness, when dealt with, is something that passes eventually. It is a feeling that we all experience and that is a necessary part of life. In depression though, sadness gets stuck and can be coupled with anxiety. Other symptoms might include hopelessness, extreme fatigue, and low negative and self-critical thinking. When you are depressed you might not be able to sleep or, on the other hand, you might not be able to stop sleeping, waking up tired and fatigued. You might have changes in your appetite, or drink as a way to cope...
If it's not sadness, what causes depression then?
The latest research into depression is showing some very interesting facts about why depression happens and what makes it re-ocurr, and it can be very useful to understand what happens:
Initially, there might be a trigger (perhaps a loss of some kind, like a job, relationship, etc. or a difficult event, or perhaps something happened where you feel you did not do very well). This can cause very normal and appropriate feelings of sadness or tiredness. In depression though, the problem starts with how the person reacts to this sadness/tiredness. The person who is depressed react by using thinking, which does seem like a good idea, as this is normally what helps us solve problems: so, we want the sadness/tiredness to go away, try to find ways to fix it, try to push the sadness/tiredness away, and ultimately we believe we are to blame and that we are worthless or useless when we can't solve these feelings. We go into our heads and try to find a solution: we go into problem-fixing mode. So, this type of reaction might happen the first time you feel depressed.
Then, if you have another episode of depression, this reactive pattern actually gets more entrenched, because when we repeat something our brain get more used to doing it; and if then you have more episodes, the reactive pattern becomes something that is completely habitual and outside of your conscious choice: we feel a bit sad/tired as a very natural and appropriate response to something, and the reaction is immediate: we go into our heads into problem-fixing to try and fix the sadness/tiredness. This comes with what is called experiential avoidance (a not wanting to feel the sensations and feelings of sadness and fatigue in the body, so the attention goes away from physical experience and into thinking in our heads).
So what is wrong with that? No one likes to experience unpleasant feelings...
Yes, it does seem like a very rational thing to do if you are experiencing something unpleasant to want to fix it, get rid of it, or make it go away. The problem is that feelings and emotions don't quite work in that way. We are trying to apply a mental and rational solution to an emotional/experiential problem, which it turns out does not work. In fact, research shows it only makes things worse. What the most recent clinical research into recurring depression has found is that this reactive way of thinking (this problem-fixing) is precisely what makes depression return. The problem is that, by now, this way of dealing with it is so very entrenched in the mind, that it is very hard to do anything different. It is not your fault that you do this, it is just the way your brain has become used to responding, thanks to a lot of practice.
Another discovery from he research is that when a person is in a depressed mode, very negative thoughts (about him/herself, or about other people or about the world in general) are actually very believable, as if they were completely true. And when that same person gets over that episode of depression and is feeling better, those same negative thoughts just don't have as much power. That means that, while depressed, the thoughts: "I am no good", "this is all my fault", "I am totally worthless" seem a reality, and when not depressed, that very same person might have those fleeting thoughts but not give them much weight. That is another important thing to understand: while in the midst of an episode of depression, the thinking is not only very negative and self-critical, it is also very believable, and that is not your fault either. That, too, has become entrenched.
Therefore, what happens is that when a person who has a history of depression experiences a normal life difficulty, the very natural response of sadness and tiredness (that anyone would experience!) triggers a chain of reactions of thinking that is beyond their control. This cannot be emphasized enough. If you are reading this and you struggle with depression, or if there is someone in your life that struggles with depression, please remember that this chain of reactions is a) not the person's fault, and b) not something that can simply be "switched off". Also, it is important to remember that, faced with a difficult enough adversity, this is something that could happen to anyone.
So what helps?
Some people find that medication helps, whilst others are not really open to it. Either way, a good place to start is to see your GP and see what your options are. Whereas medication has been proven to be relatively effective, the World Health Organisation states that we should be aware of the possible adverse effects associated with antidepressants, and also recommends interpersonal therapy and CBT. NICE (the UK's National Institute for Health and Care Excellence), apart from medication, CBT and interpersonal therapy, also recommends MBCT. The results of clinical trials all seem to show that these therapies are equally effective to medication (but without the side effects). Which one you choose really depends on your preference and what works best for you. Medication can sometimes have a very immediate effect, but does not address the root causes. The other options recommended do require some time commitment and a certain amount of effort on your part, or even a financial commitment if you can't access free services. However, if they are successful, they can give you life-long tools to manage your depression, and there are no side effects. Really, it is up to the person. You can still try the other approaches even if you are on medication, and we find that sometimes people come to us because they have been on their meds for a while and want an alternative for when they come of them.
Here in the practice, we offer interpersonal therapy, CBT and MBCT. You can read more about any of these by clicking the tabs on the right. Or you can contact us (through any of our contact details above) if you have any questions.