Not matter how you look at it, depression is a very, very unpleasant experience.
In this series of five posts I will be outlining my views on the nature of depression or as I prefer to call to it, chronic low mood; what is it, what causes it and how to treat it.
Some of my views may agree with your own; others may trouble you.
Please understand that my intention is not to deny your experience of depression. We all have different experiences, opinions, knowledge and ideas that we bring to our experience of depression.
If you are wondering whether to engage with me or this information on this site, understanding my philosophical viewpoint of depression might help you decide if this is a place where you are comfortable.
Of course, sometimes being uncomfortable is where the journey begins!
If you believe that you will never stop being depressed, it may be hard for you to accept that I was once where you are now and that I am no longer there.
You may believe that that shows I could never have been ‘properly’ depressed.
I can assure you that I met all the DSM criteria for both persistent depression and major depression. My low mood began in my teenage years, and I count until I first sought help in my mid-30s as the total time I was depression; 21 years.
From about 2008 onwards, I have lived without depression and it’s been amazing. My goal for this website is to share how I no longer live under the greyness that is chronic low mood and to offer you the hope that this can also be your experience.
So, I lived the life, I walked the walk, cried the tears, agonised through sleepless nights, struggled with the lack of energy, low motivation, feelings of helplessness and hopelessness.
I was just where you are now, wondering if that was going to be my forever.
What you will learn in this post is that I believe depression is not a sickness but a disorder of thinking and lifestyle. It is caused by stress and maintained by negative thinking patterns.
You can eliminate depressive symptoms by dealing with stress, changing your thinking and recognising what you want from life.
You can live without depression should you choose to, by getting informed, asking questions, gathering support and taking action.
Still with me?
Let’s keep going…
If Depression is Not a Sickness, is Depression Real?
Emotions are real and depression is caused by being hijacked by your emotions. It is maintained by unhelpful emotional responses.
Yes, depression is real.
People experience emotions every day; it would be weird if you didn’t.
Some emotions make us feel nice – happiness, pride, love, excitement, relief – while others, such as grief, sadness, anger, boredom, frustration and disappointment, regret, guilt and hopelessness, make us feel bad. I know you know this.
Some people experience the normal ups and downs of life, great joys and minor disappointments, profound sorrow and utter delight. They revel in the good times and bounce back from the bad.
Some people (perhaps you?) feel an overwhelming feeling of intense sorrow, tremendous frustration, deep dissatisfaction with life and crushing sense of despair and hopelessness.
They seem relentless, these feelings.
Day after day, you may feel you are carrying your desperation with you; it sits on your shoulders, substantial and weighty like the helmet of an old-fashioned deep-sea diving suit. Dragged behind you like a boulder.
There is no bouncing back from feelings like these.
Oh yes. Depression is real all right.
Is Depression Found in the Brain?
The brain is a very complex organ made up of interconnected regions. The brain can be roughly divided into regions responsible for ‘cognitive’ or thinking activity, and those responsible for ‘emotional’ or feeling activity. It is less effective communication between these regions which sustains depression.
Chemical signals known as neurotransmitters are passed between neurons and form what are known as ‘pathways’. This activity shows up on fMRI scans.
Depressed people’s brains have the same regions and neurotransmitters as other people’s brains. However neuroscience has begun to reveal how the interactions between the brain’s regions are affected by depression. This is a complex issue and it’s not as simple as to say ‘this part of the brain is responsible for this feeling in depression, so we just have to fix that part’; all regions of the brain work in circuits and interact with each other in different ways.
However, we can make some general statements about what’s happening in the brain when we’re depressed. Let’s have a quick look at the most distressing manifestations of depression:
‘I can’t sleep:’
Sleep and depression have both a cause and effect relationship. Let’s say you’re just not getting enough sleep because you’re needing to work late at night. Some people say they can get by on 6 hours sleep each night but for most of us, that’s just not true. Our brain performs important tasks while we are sleeping. Lack of sleep makes us feel less energetic the next day and effects our mood. Continual nights of less-than-adequate or poor quality sleep lead to chronic low mood, particularly if the reason for the lack of sleep is stress.
Working late at night under electrical lighting plays havoc with our natural sleep cycles. We are designed to be awake when it’s light and heading for bed when the sun goes down. Forcing ourselves to remain awake long after dark interferes with the production of sleep inducing chemicals and also chemicals involved in waking us up.
‘I can’t concentrate/make decisions’ and ‘I have no motivation:’
The hardest thing for me when I was chronically distressed was getting out of bed. I’d usually slept poorly and just couldn’t summon up the strength to get myself up. If I was working that day I’d manage to drag myself into the shower, but it was always as if I was pulling a ten tonne weight behind me. I’d make plans and never follow them through. On weekends I’d flop around the house, unable to decide what to do next.
Difficulty focusing on tasks or making carefully weighed up decisions is a classic manifestation of chronic low mood. I made dreadful financial decisions when depressed; buying very expensive items on my credit card. I was also so taken up in my negative feelings I couldn’t concentrate on what I was doing. I regularly locked my keys in the car or the house, lost things or forgot to take important papers or other items with me. Reacting emotionally when things go wrong is another debilitating beahviour. For me this meant crying bitterly and occasionally throwing things around.
Scans have shown that people with depressive symptoms have less activity in the prefrontal cortex, that part of the brain which sits behind your forehead, and is responsible for thinking, analysing, making decisions. It’s known as the CEO of the brain. Evolutionarily speaking, it’s the last piece of the brain to appear. Only humans have such a well-developed prefrontal cortex.
Disrupted activity in various regions of the prefrontal cortex can lead to difficulties in making plans, thinking clearly and getting motivated.
‘I feel tense and anxious’:
When I was depressed, I found myself anxious about what the day would bring. I don’t think I felt highly anxious because quite quickly the feelings of worry would dissolve into feelings of numbness, not being able to care. But there was always a great deal of stress and worry around work.
The hypothalamus, a small organ in the feeling part of the brain, controls the body’s stress response or ‘fight or flight’ response in times of stress. In depression, the hypothalamus is constantly on high alert. Stress is both a cause of low mood and can also maintain it if we are not able to find ways to ‘switch off’ the hypothalamus’ response to situations which cause us to feel tense.
Closely connected to the hypothalamus, the amygdala is often also highly reactive in depression. It is responsible for feelings of fear, anxiety and other negative emotions.
‘I feel sad all the time. I can’t even remember a time when I felt happy’:
The hippocampus, a region in the feeling brain located close to the amygdala, is responsible for storing away memories. In depression, it’s harder to remember and relive more joyful moments but easy to recall negative or sad memories.
An article on the Harvard Medical School website notes that “Research shows that the hippocampus is smaller in some depressed people. For example, in one fMRI study published in The Journal of Neuroscience, investigators studied 24 women who had a history of depression. On average, the hippocampus was 9% to 13% smaller in depressed women compared with those who were not depressed. The more bouts of depression a woman had, the smaller the hippocampus. Stress, which plays a role in depression, may be a key factor here, since experts believe stress can suppress the production of new neurons (nerve cells) in the hippocampus”.
“I don’t enjoy anything’ and ‘I just can’t be bothered’:
The worst part of depression is thinking that you’ll always experience it, that there’s no hope. It’s the cruellest part of having chronic low mood. The sense of overwhelming sadness, grief, regret, sorrow and pain is made all the worst by the belief that it’s all hopeless. Feeling paralysed by not knowing what to do to help yourself out of it – either by going to the doctor, talking to a friend, doing some research – just feeds the worry and sense that there is no hope.
Depression saps the joy out of life. Often activities which used to fill you with happiness no longer tempt you. I abandoned the dance classes which used to make me feel very good and never went to movies or out for drinks. I literally ‘wasn’t in the mood’. I found it hard to enjoy anything much at all.
The striatum is a region of the brain involved with forming enjoyable habits. Reduced amounts of the neurotransmitter dopamine seems to be responsible for feelings of boredom, lack of motivation and not enjoying activities as you might once have.
Scans have not found the cause of depression.
If you’re interested in learning more about the brain and depression, I highly recommend The Upward Spiral Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time by Alex Korb.
Scans show differences in the brains of people with depression compared to those without depression, but they do not show us that these differences are causes, or effects of depression.
Differences found in the brains of people with chronic low mood are not necessarily causes. They are correlated to the experience of depression.
‘OK’, I hear you say, ‘If my brain is not functioning normally, doesn’t that make depression an illness?’
No, because your brain is functioning normally.
The brain is simply functioning as it is being directed by the experiences of its organism or its body, that is, you!
The brain’s job is to process information. Sounds, sights, smells…all the physical sensations come into the brain and give us information about where we are, who we are with, what’s happening around us and how we feel about those experiences.
The brain processes the information based on what it has already processed.
If you have pleasant memories associated your beloved grandma making homemade strawberry jam, then the smell or taste of strawberry jam, when encountered as an adult, may invoke those good memories again.
You have ‘laid down’ in the very neurons of your brain, a memory that associates strawberry jam with feeling good.
To give another example of how we ‘direct’ our brains, let’s say you grew up bullied at school and with little sympathy or support from your family. Today, as an adult, being in situations which make you feel uncomfortable (work meetings with the boss, unpleasant situations with hostile neighbours, at the doctor with a cold indifferent manner) may bring up those same feelings of fear and not being listened to and being pushed around.
Your brain is associating certain situations with apprehension and worry because they are the messages you heard as a child and they have become part of your response to those uncomfortable situations. Those emotional responses are telling you to be afraid because something ‘dangerous’ is about to happy and that you need to run away.
Your brain is not malfunctioning. Your brain is doing actually what your brain is supposed to be doing.
OK, Maybe my Brain isn’t Malfunctioning, but Depression is Chemical, isn’t it?
That’s what the doctor told you, did she? That’s what he said as he wrote out the prescription for antidepressant medication? That the drugs would rebalance your brain chemicals? That you’re a bit low in serotonin and that’s what causes depression? That the drugs will top up your serotonin?
Well, she wouldn’t be the only one.
Here’s what Dr Daniel Carlat, psychiatrist, (author of Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis amazon link) admits to saying to patients:
“If a patient asks me how the medication works, I will respond with, ‘We’re not completely sure, but it has something to do with increasing levels of neurotransmitters like serotonin or norepinephrine—basically, these pills rebalance certain chemicals in the brain.”
The repetition of this message from the doctor is likely to be a reason why so many people believe it. Why wouldn’t you? Doctors have been trained in this kind of thing. They’re the experts, aren’t they?
So, is your serotonin out of balance? Not sure?
Well I understand your confusion because your doctor probably didn’t measure your serotonin. How could she? You can’t stick a needle into a living human brain, draw out brain fluid and peer at its contents. Not yet, anyway.
Did you know that there’s no evidential basis for the chemical imbalance theory of depression? There are lots of good resources online to help you understand where this theory came from and what it means. But it simply isn’t true. There’s no evidence.
No scientific research has found any evidence for the ‘serotonin imbalance’ theory.
It’s all a bit of a guessing game, diagnosing depression and offering chemical treatment.
The doctor (GP or psychiatrist) uses information provided by the American Psychiatric Association in their manual of mental illnesses, called the Diagnostic and Statistical Manual of Mental Disorders. 297 ‘mental disorders’ are contained within this manual, each with a checklist of descriptors which doctors can use against the information provided by their patients.
You see, the diagnosis is made purely on the information you give to the doctor. He doesn’t listen to your heart, order an x-ray or blood scan, measure your blood pressure or tap your knees!
No, there is no physical examination which can be done for depression.
Despite not being able to do a physical examination, most doctors use the ‘medical model’ to think about depression. The medical model views depression as a physical illness with a biological basis (though none can at present be identified), similar to Alzheimer’s Disease or diabetes.
I wonder…when did natural human feelings become sicknesses?
So There’s Nothing Wrong With My brain, But Could I Still Be Sick?
Yes, but physically, not mentally.
Inflammation as a cause of depression
Dr Kelly Brogan, doctor and author of A Mind of Your Own writes powerfully about how depressive ‘symptoms’ originate in the body and that certain substances, such as sugar, chemicals found in the environment, as well as stress, cause inflammation in the body which results in mood changes.
She writes: “In the brain, inflammation serves to shunt the use of tryptophan toward production of anxiety-provoking chemicals like quinolinate, instead of toward serotonin and melatonin”. These chemicals produce a series of behaviours sometimes known as ‘sickness behaviours’ – lethargy, loss of appetite, desire to sleep, loss of motivation to participate in activity – which are actions needed to heal the body.
Dealing with the cause of inflammation in the body is likely to reduce the unpleasant ‘symptoms’ of depression. This means changing your diet, eliminating toxins and pathogens from the environment and incorporating relaxation techniques such as meditation or mindfulness into your daily routine.
Talk to your doctor about having a range of tests done to eliminate physical causes of your chronic low mood.
Am I Stuck With Depression Forever?
When you read the online discussion forums and Facebook groups for people with chronic low mood, a common view is that depression is a biological illness which needs medication to be treated. There are lengthy discussions between members about experiences with medications, which have been effective and which have unbearable side-effects, dosage, combinations and so on.
Some people see depression as something outside of themselves. Something which ‘descends upon them’ at different times, which they feel ‘coming on’. They feel it’s going to be a ‘bad day’ and hope that tomorrow will be better.
Many people who contribute to online forums seem to believe that depression is something you’ll have forever, all you can do is manage the symptoms – this leads to medication, lots of ideas about keeping your mood up day by day, some hints about lifestyle change (go for a walk, eat more salad).
It’s as if they have no control over their emotions or moods. And if you’ve been struggling with a low mood for years, it might indeed seem as if your moods are something external that has a hold over you.
Nonetheless some forum contributors do suggest daily tips for keeping your mood up, so there must be some belief that the things you choose to do can help. Leaving aside the obvious question (why aren’t the medications doing this?), it is true that doing certain activities each day or regularly through the week will help you feel better.
The next obvious question is, why not do these things more, if you know they make you feel better?
The medical model of depression is widely accepted in both the medical profession and broader community. The idea that depression is a lifelong battle with which the person will be locked in combat forever is well-entrenched.
Mental health advocates believe depression is a sickness and describe people who talk about their depression as brave. They ‘fight the disease’, ‘will not give in’, are ‘not ashamed of their illness’ and that ‘tomorrow will be better if we all just keep battling depression’. They are heroes.
All this war-like language. All this drama.
Mental health bloggers who have built businesses, selling their story in their memoirs or creating personal glory through their websites and hashtags need to maintain the narrative of depression as an illness because if they recovered, what then?
Who would they be?
- Has ‘depression’ become part of your identity?
- Do you believe it is something that you will experience forever, holding you back from your dreams and goals?
- Preventing you from having a rewarding, enjoyable life with full repertoire of emotions, both sad and happy?
I believe it is a crime that the over-diagnosis of depression as a mental ‘illness’, a biological disease, that there’s something inherently wrong with you and there always will be has left so many without hope.
It has created in people a sense of disempowerment, that living with chronic low mood is a life sentence and that all you can do is ‘manage your symptoms’.
You can do way more than that.
You can learn to control stress and regulate your emotions so that you don’t need to plummet into chronically low mood.
Life is not about hoping to feel a little bit better tomorrow.
Life is about intending to feel much better and know that you can, for every tomorrow for the rest of your life. Life is about experiencing the whole range of human emotions – joy, grief, bliss and distress – without thinking there is something wrong with you.
You are worthy of a rewarding, pleasurable, contented life, full of moments of happiness, satisfying challenge, and delightful memories.
You can live as global as you want, travelling the world, building a career, changing the course of history, or as local as you want, contributing to your community and local environment, living sustainably, leaving a light footprint on the planet.
Or something in between!
There are no limits once you decide that you can learn how to handle stress and regulate your moods, rather than the other way round, rather than letting stress and emotions restrict you!
Come, share yourself with the world, or with your neighbours. We need you.
But do it for yourself first.
 Carlat, D, 2010, Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis, Free Press.
 Hickey, P, Exploiting The Placebo Effect: Deceiving People For Their Own Good? https://www.madinamerica.com/2016/02/exploiting-the-placebo-effect-deceiving-people-for-their-own-good/ viewed April 2017
 If you’d like to read more about the development of the chemical imbalance theory of depression, try these resources… Whittaker, R, 2010 Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Crown; Lynch, T, 2015, Depression Delusion, Volume One: The Myth of the Brain Chemical Imbalance (Volume 1), Mental Health Publishing.
 Brogan, K, 2016, A Mind of Your Own, Harper Thorsons.