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Recently, I've begun to prefer the old-fashioned term "melancholia" for the condition I've experienced since I was a child, rather than "depression" because, though I am actually currently on Wellbutrin, I work as a self-help book editor, and I co-authored a book on depression with a well-respected psychiatrist, I no longer believe I have a physical disease. My "credentials", as it were, include a lifetime of struggling with chronic sadness and dissatisfaction, having had therapists off and on since I was a child, and having been on two courses of antidepressants in the last five years. At this point, my own prescription notwithstanding, I believe in meditation rather than in medication, and I believe I know what happens when we - or at least, I - get depressed.
The CBT therapists are right when they say that depressed people tend to choose thoughts that make them unhappy. In this, CBT, which has worked somewhat for me, can be useful in helping us melancholics gain some distance from our ruminations. Saying we choose these thoughts is not to say that we don't want to feel better, although I know for myself that I do tend to have resistance to letting go of my ruminations. They comfort me, and in the moment, they ease the pain a little bit, even if in the long term they bring my mood down. I'll talk more about this in the next section. So I believe that, Number One, depression is about a tendency to think thoughts and ruminate on thoughts that make us feel bad, even when we know that it's not helpful to us.
At the recent ABCT conference in San Francisco, Michelle Newman presented her theories that people with anxiety ruminate not to avoid uncomfortable emotions, but to avoid the sudden onset of difficult emotions such as pain, anger or sadness. It's the contrast between being okay and feeling bad that is so uncomfortable to us, and we may prefer chronic discomfort to that horrible feeling of suddenly being confronted with a difficult emotion. This is exactly what feels true for me in my depression (which I believe is closely linked to anxiety). Dr. Newman also posited that people with anxiety are more sensitive to these difficult emotions; that the emotions are more uncomfortable to them than to people without anxiety. Judging from the reactions I've had from others when I've described my experience, I think this is true. So, Number Two, I believe that people with depression are physiologically more sensitive to difficult emotions than the general population.
The research on depression medications is mixed. Some say that meds are really no more - sometimes less - effective than a placebo, while others see much improvement in people on medications. This leads me to my next point, which I believe clears up this little quandary. I believe that the mild but measurable positive effects of meds are true (obviously there are individual differences here), but I also believe that what the depressed person does with these effects is what matters. So my third point is this: if the person on meds uses that slight uptick in mood (even if it's a placebo effect!) to make substantive changes that we know help with depression, such as socializing when she wants to isolate herself, getting exercise when she wants to continue sleeping, and eating better when she wants to stop eating at all, this is what causes her to feel better and, if this is even possible, "recover" from depression. If, however, she expects the pills to work miracles and cure her without any further effort on her part, they won't work, or not for very long. When I've gone on meds, it's been to boost myself just enough to be able to function so that I could deal with the issues I had to deal with. They were never a long-term solution.
Above, I imply that there may be no real way to "recover" from depression, so let me explain further. I believe that depressed people are temperamentally and physiologically primed towards feeling difficulty and pain more intensely than others. I believe that we tend to ruminate and overthink about this pain more than is healthy, and I believe that medications can help if we are willing to use the slight lessening of pain to become healthier in other ways. But my fourth point is this: I also believe that people with depression will always need to be vigilant about their own thoughts, the way most diabetics will always need to be vigilant about monitoring their blood sugar. For most people with depression, and there are always exceptions, I believe that we were born with personalities and brains that tend us towards a certain way of experiencing the world, and that, in order to feel better, we need to recognize this and practice being able to step back from the pain and discomfort that we will probably always be sensitive to. Which is why I think that meditation and a practice of self-compassion, and to some extent, exposure and desensitization practices, are the best way for people with depression to feel better in the long term.
For those of you with depression, I say find the treatments that work for you, whether meds, therapy, exercise, meditation, or, most likely, a combination of these. But I would caution against thinking that anything out there is a cure, rather than a proactive way to lessen your natural tendency to react sensitively to pain. By cultivating a respect for ourselves and our experiences, and by getting to know our own reactions, triggers, and problematic thought patterns, I believe that people with depression can both feel better and put our inherent strengths -- such as deep empathy, the ability to feel emotions strongly and to be self-reflective -- to good use in the world. I don't believe that depression is a disease; it's a personality type that can also have positive aspects, if people with that personality type are brave enough to get to know themselves very, very well. If we think of it this way, we can ease some of the self-stigma and shame of having a tendency towards low mood, which can help increase our positive mood!
