Because of its complexity, a full understanding of depression has been elusive.
The most common understanding of depression has been to label it as an illness that starts in the mind as distorted ways of thinking, which then leads to psychosomatic symptoms. It’s an interpretation that makes sense, as depression is known to cause suffering and even death. In recent years however, researchers have been questioning this definition of depression and many now believe depression is an adaptive response to adversity rather than a mental disorder; as well as beliefs that it’s an important part of our biological defense system against stress, meant to help us survive.
What is Depression?
The common way to understand depression:
Depressive disorder, or depression, is a common mental health condition that can happen to anyone. It is characterized by a low mood, loss of pleasure or interest in activities for long periods of time. This is different from regular mood changes and feelings about everyday life. Depressive episodes last most of the day, nearly every day, for at least two weeks.
Understanding depression through Polyvagal Theory (By neuroscientist Stephen Porges):
Our daily experiences are based around the autonomic nervous system (ANS) – when the ANS feels safe, we experience a sense of well-being, calm, social connection, as well as feeling connected to ourselves. Our ANS is constantly scanning our internal and external environment, looking for signs of danger. If it detects a threat, it’s first strategy is to go into a fight or flight response which we often identify as anxiety. If a threat lasts for a very long time or is even too overwhelming for our ANS, it decides to use its second strategy which is “immobilization”.
To preface, there is no single known cause of depression. One way to understand the cause of depression is through Polyvagal theory. People often compare and judge why one person may find work too stressful while another manages just fine. What people aren’t understanding is that it’s not about the triggers or the actual experience that generates a defensive response. It’s the way that the ANS in our bodies perceives threats and whether it utilizes fight/flight or immobilization. This happens at a pre-conscious point, meaning before we even have the chance to think about it or try and choose a response, it’s already happening.
By studying anxiety and the fight/flight response, researchers now know that many modern-day experiences can trigger a defensive response.
- E.g., low rumbling noises during construction can sound like the growl of a large predator to our nervous system. Feeling like your being evaluated at work or school can remove our sense of safety causing a fight/flight response (anxiety).
If these experiences last long enough, our ANS might start to feel like it can’t get away and will initiate the immobilization response to defend us. However, if this response lasts too long, it can create symptoms of depression. These symptoms represent a good biological system that is trying to help an individual survive.
Other popular theories of causes of depression:
- Brain chemistry: Chemicals in your brain called neurotransmitters play a part in your mood. When you have depression, it could be because these chemicals aren’t working the way they should. However, according to newer research, changes or abnormalities in neurotransmitters may rather reflect experiences, rather than being the primary cause of them.
- Hormones: Your hormone levels change because of pregnancy, postpartum issues, thyroid problems, menopause, or other reasons. This can set off symptoms of depression.
- Genetics: Researchers haven’t yet found the genes that might be responsible for depression, but you’re more likely to have depression if someone you’re related to has it.
- Trauma: Many negative experiences like trauma, loss of a loved one, a difficult relationship, or any stressful situation that overwhelms our ANS may trigger a depressive episode.
- There’s been increased research and hypotheses on the gut-brain connection (diet) as well as on how inflammation in the body can contribute to symptoms of depression.
Symptoms of depression may include:
- Feelings of sadness, emptiness or hopelessness
- Angry outbursts, irritability or frustration – sometimes seemingly over small matters
- Loss of interest or pleasure in activities you once enjoyed
- Sleep disturbances, including insomnia or sleeping too much
- Decreased energy or increased tiredness or fatigue – even small tasks may take effort
- Change in appetite and weight (increase or decrease)
- Feelings of worthlessness or guilt
- Difficulty thinking, concentrating, or making decisions
- Slowed movements or speech that are severe enough to be observable by others
- Frequent or recurrent thoughts of death or suicide
- Unexplained physical problems, such as back pain or headaches
Types of Depression:
- Major depressive disorder: Also called clinical depression, this type of depression includes symptoms like depressed mood or loss of interest that interfere with daily activities for at least two weeks.
- Seasonal depression also named “Seasonal affective disorder (SAD): People with SAD experience mood changes and symptoms similar to depression. The symptoms usually occur during the fall and winter months when there is less sunlight and usually improve with the arrival of spring. SAD is more than just “winter blues.” The symptoms can be distressing and overwhelming and can interfere with daily functioning.
- Perinatal depression: refers to depression occurring during pregnancy or after childbirth.
- Persistent depressive disorder (or dysthymia): A person with persistent depressive disorder has a depressed mood for most of the day, for more days than not, for at least two years. In children and adolescents, the mood can be irritable or depressed, and must continue for at least one year.
- Premenstrual dysphoric disorder (PMDD): A woman with PMDD has severe symptoms of depression, irritability, and tension about a week before menstruation begins
If you’re interested in receiving an assessment to know whether you meet diagnostic criteria for depression, in Ontario you can meet with a psychologist, your family physician or ask for a referral to see a psychiatrist. Registered Psychotherapists are not legally allowed to provide diagnoses in Ontario.
Treatments for depression:
- Psychotherapy. Talk therapy is one of the most common forms of treatment for depression; somatic types of therapy are increasingly becoming more popular as well. In Ontario, psychotherapy can be provided by a trained professional who can be a physician, nurse, psychologist, social worker, psychotherapist or occupational therapist. Psychotherapy can help you learn new perspectives and coping tools for depression. Your therapist may even guide you through various psychotherapeutic approaches that have been shown to help reduce depression such as Somatic Experiencing, EMDR, emotion focused therapy, and more.
- Medication. Antidepressant medications can also be useful in treating depression and can be prescribed by your family physician or a psychiatrist. However, it is important to keep in mind that adverse effects are possible with medication. Sometimes it takes various rounds of collaboration with your physician to determine the right brand and dosage of medication that is right for you. In addition, medication may take up to 6-8 weeks before desired change is observed.
- Social connection: According to Stephen Porges, it isn’t enough to just remove stressors from our lives to help us get out of a defensive response – we instead need to help our ANS recognise signals of safety. The best way to do that? through social connection.
