It starts as a heavy feeling somewhere around my heart. Warm and fuzzy but in an unpleasant way, hazy and kind of empty. My facial expressions quickly become less responsive, a heaviness around my cheeks and mouth make smiling an effortful and unnatural task. Fear quickly emerges; while my brain encourages me to keep going, keep living like normal, let go of the negativity, my heart is trembling with fear of drowning in the depression as it has so many times before.
Having lived with depression all my adult life I’ve come to know well how it manifests in me. I wonder often whether it’s something I can heal from or if it’s just a part of me. And if it is a natural part of me is it possible that I can live along side it without the help of medication. I have fazed out my medication (SSRI) many times over the years and been successfully without for months at a time, but had to take them up again eventually. And when I say ‘had to’ I mean that I spiralled so deep into negativity that life was unmanageable and I was not functioning, at times not wanting to live. After a while I realise I am not pulling myself up but going further down and at this point I decide, reluctantly, to start the medication again.
There are many theories about the causes of depression which is what I want to discuss in this article. I have not got the answer, and the answer might be different for different people, but here goes – from the chemical to the spiritual:
The western medical theory is that depression is caused by a deficiency in a neurotransmitter substance in the brain called serotonin. The most popular type of antidepressant medication are a group called ‘Selective Serotonin Re-uptake Inhibitors’ (SSRI). These work by inhibiting the re-uptake of serotonin in the brain, so the serotonin that is released in the brain does not all get reabsorbed and stored again but instead circulates in the brain longer. There are studies that suggest SSRI medication is no better than placebo. My experience however is that they most certainly do work. But I understand that many people with depression do not find relief from the pills.
But why would some people have a serotonin deficiency?
It is sometimes suggested that it is hereditary, some people are born with a deficiency just like some are born with an insulin deficiency and are diabetics. If this is true then of course a medication to top up on the deficiency sounds sensible and any idea of trying to ‘heal’ from it psychologically would be futile since it is a problem on the chemical, physical level.
The next theory is coming from the level of behaviourists. Here it’s taken into account that seretonin levels in the brain vary over the course of the day. Just like adrenaline in the body is released in larger or smaller quantities depending on the situation, serotonin also responds to circumstances thought the day. So when we have low serotonin we feel depressed, but also negative and depressed thinking reduces the amount of serotonin released, less serotonin, more depression, more depression less serotonin. A negative spiral, and like the chicken and egg, who knows which one comes first.
But being devils advocate – I know close friends and family who complain and dwell on negative things in a similar way to me and do not get depressed (and with depression Im not talking about feeling down, low or sad, I mean clinical depression). But then again we never really know the workings of someone else mind do we.
As we come into the negativity of depression another theory and downward spiral emerges. Negative thoughts cause stress, they are often worries about the future or past. Our stress response is designed to have a completion, what I mean by that is that if you see a tiger running towards you, your body will go into a stress response, release a lot of adrenaline into the system, you will then respond by running away from the tiger thus burning off the adrenaline in your body. But when an imagined scenario plays out in your mind, for example worrying about a future event, the body will react just like with the tiger scenario with a release of adrenaline, but this time there is no completion to the stress response. So when you go to bed that night the mind tries to ‘complete’ the cycle then in the dream state. In sleeping more time is therefore taken up by dream sleep and less time spent on the restorative deep sleep. So thats why depression can often leave us feeling unrefreshed and tired on waking. So now we are not only depressed but also tired, which of course leads to an exacerbation in symptoms.
Moving on to the more psychological theories. Depression can described as anger turned inwards. Often when someone overwhelmingly reacts to situations with sadness this can be a disguise for anger (the converse tends also to be true). To be healthy we need to have access to the whole range of our emotions. Sometimes due to a whole host of different reasons we develop mechanisms to cope, those mechanisms become so hardwired that they are difficult to break away from. So we can also consider what other pain the depression is hiding. You might think depression is an odd kind of coping mechanism since it causes so many problems. I equate it with the ‘freeze’ or ‘play dead’ stress response, it sidesteps what ever pain we cant deal with and paralysis us.
Stepping now to a higher dimension perhaps depression is trying to tell us something bigger. Perhaps it is a very sane response to a crazy world, telling us that all is not well. We live in a society that has travelled far away from nature, has demands over and above what our bodies or minds are meant for. Perhaps it is a message to tell us to realign, readjust, to reinvent, to rest. Many agree that our society is spiralling out of control, the structures we have in place are unsustainable, for the individual and for the environment.
Here is a lovely article discussing just this higher purpose of depression:
There are many articles describing these ideas separately. I hope seeing them all discussed in the same place helps in understanding depression in a more balanced and nuanced way. This means we have many doors in by which we can treat, understand or lessen depression.
Perhaps, like many things in this complicated, nuanced life we live in all of the above theories play their part.
So next time you feel the black dog descending send out an enquiry to the universe: what is the black dog here to tell me this time?
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