A New Understanding of How Depression Operates
A Little Something for World Mental Health Day
I think I am in the majority who stares at their calendar in disbelief, wondering whether I budgeted enough money for Hallmark cards to celebrate National Pancake Day (September 26), Sibling Day (April 10), and National Shower with a Friend Day (seriously - February 5).
Which brings us to a bonus issue for today - World Mental Health Day [here].
In a prior issue [here], I highlighted the staggering number of ways a person can suffer from clinical depression. Depression can present in 11,242,766,620,167,150 distinct ways. That's eleven quadrillion, two hundred forty-two trillion, seven hundred sixty-six billion, six hundred twenty million, one hundred sixty-seven thousand, one hundred fifty different combinations of symptoms. This numbers demand an approach that is neither simplistic nor superficial.
Two questions interest me:
Which symptoms are at the core of this condition? There is work suggesting it might be Anhedonia [here] - where a person loses interest or pleasure in activities once enjoyed. It's when things that used to offer vitality no longer do, leaving you feeling emotionally flat or numb.
What is the sequence of how symptoms influence each other? There is work suggesting that feeling lonely and helpless are the biggest drivers of what depression symptoms you feel tomorrow [here]
There is a new, mega mother study with 4,361 people studied four times, every two months to better answer these questions. To understand what these scientists discovered, let’s dissect this single image of the results:
This network of symptoms shows you internal problems today that predict what is experienced later. The color of the lines between symptoms represents the type of influence (blue means a positive correlation, red means a negative correlation). Line thickness indicates correlation strength.
A Summary of Interesting Findings
Notice that depressed mood (orange circle in the middle) predicted later concentration problems, which, in turn, predicted anhedonia.
Use of drugs as a coping mechanism led to more depressed mood which in turn, led to more loneliness which made people want to control their emotions.
Excessive monitoring for threat led to more suicidal thoughts. Feeling suicidal in turn, interfered with sleep and made people feel more worthless - only intensifying an already scary situation.
Holding dangerous beliefs (“worry is harmful” and “strong emotions are dangerous”) led to more anhedonia which in turn, led to the use of drugs to cope with these painful thoughts and a desire to control emotions.
Why This Matters
If you are one of the 280 million people living with depression, know that your experience might differ from everyone else you know who suffered from this condition.
During a depressive episode, individuals experience a persistently low mood or loss of interest in activities for most of the day, nearly every day, for at least two weeks. This is often accompanied by symptoms such as poor concentration, excessive guilt, low self-worth, hopelessness, suicidal thoughts, disrupted sleep, appetite changes, and low energy. What increases the risk of suicide for a particular person depends on a personalized understanding of what are the big drivers. In recent research presented, there is no simple model where feeling depressed or sad increases the risk of suicide - even though this is claimed by the World Health Organization.
Do see a therapist who will ask questions and formulate a model of what is and is not working for you - including the biggest influences requiring heightened attention. Each person has an individualized network model like the one above. It is time to abandon one-size-fits-all assessments.
Depression can feel overwhelming, but it's important to remember that effective treatments are available. Evidence-based therapies, such as Cognitive Behavioral Therapy (CBT), have been shown to help many people manage and overcome depression. These therapies work by helping individuals change the negative thought patterns and behaviors detailed in that figure above, leading to improved mood and well-being.
For more on depression treatments and their effectiveness, read this short article from the National Institute of Health - HERE
With the right support, recovery is possible, and a brighter future is within reach.
As a psychologist who studies emotional disorders, addressing depression is of paramount importance. Do leave comments and ask for references or anything else.
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Todd B. Kashdan is an author of several books including The Upside of Your Dark Side (Penguin) and The Art of Insubordination: How to Dissent and Defy Effectively (Avery/Penguin) and Professor of Psychology and Leader of The Well-Being Laboratory at George Mason University.
Thanks for this, Todd. It’s perfect for Mental Health Awareness Day.
I’d like to point out that many different therapeutic approaches have been shown to have similar positive effects in treating depression. I get a bit uneasy when posts seem to promote CBT as the go-to just because it’s labeled 'evidence-based.' There are plenty of studies showing other approaches—like emotion-focused therapy, psychodynamic therapy, and even Gestalt therapy—are also effective for treating conditions like depression. While CBT is often favored by psychologists (for a variety of reasons), I think it’s important to give people more options when seeking support and not overlook other approaches that can be just as helpful.
At one point, Freud wrote a paper titled "Mourning and Melancholia" (melancholia being the word for depression).
His theory was that when someone experiences a significant loss, they unconsciously internalize aspects of the lost "love object," leading to self-criticism and negative feelings directed towards themselves. So in essence, loss feelings turned inward.
The "love object" could be a person, a job, a sense of identity, a life goal, etc.
While I don't normally look to Freud's theories, this makes so much sense to me as an explanation for depression. It also explains why so many people go through it... because loss is inherent to the human experience. 😔
Depression should be so normalized at this point. In an ideal world, taking time off work to recover from depression would be as common as taking maternity/paternity leave. Just my two cents.
Thank you for this piece. Sharing!