- One of the neurobiological underpinnings of depression is the impaired action of dopamine in the reward pathway of the brain.
- Low energy leads to low-self esteem and shame, which leads to more low energy.
- Ways to break the self-reinforcing cycle of low energy include knowing that depression is not one's fault and getting encouragement from others.
Lately, I have had several conversations with people suffering from depression in which the topic of shame has come up. They discuss feeling shame over not doing what they should do, want to do, and even what they need to do. Their depression is taking a big toll with its accompanying low energy that causes people to stop doing those things that would make them feel accomplished.
The lethargy of depression directly induces shame as people stop living in accordance with their own values (e.g., to be reliable or productive) or their images of themselves (e.g., as people who do what needs to be done or who finish their work). It does not matter your age or your occupation. People, whether employees, homemakers, managers, or students, can feel weighted down by depression. The energy necessary to get up and do something is outweighed by the inertia of the depression. The motivation to defy the pull of lethargy and move is minimal.
The lethargy of depression is like a gravitational pull to slow down and by itself is the major block to getting things done. The lawn does not get mowed, the bills are not paid, the homework is not completed, the report remains unfinished on the computer. Undone work is the hallmark of depression when lethargy is the dominant symptom. And people feel ashamed of not fulfilling their obligations. They judge themselves as weak and try to stay under the radar about what they are not doing because when the tasks of life go undone the risk of being judged by others goes up. For students, the judgment may be a bad grade. For an employee, it may be the risk of a performance improvement plan being started (or failed). And for a homemaker, the knowledge that the family is living in a mess or not eating well adds to the self-disparagement so common to those with depression.
It is not just the loss of energy that interferes with accomplishment, however. The low self-esteem that plagues depressed individuals leads them to fear more rejection or failure. So even if they contemplate trying to do something: trying to finish the paper for school, apply to the college, put their name in for a promotion, they hold back because they fear that they won't do it well or get what they try for. The very possibility of finishing and then being judged negatively is worse than the shame of not doing the task at all. And anticipating that if they start a task and they won't finish it raises anxiety. Anxiety about failure just makes it that much harder to start. As one client of mine stated, "It is easier to just avoid the task, telling myself I will do it later than to face the stress of trying knowing I might fail anyway."
Low energy and low self-esteem are further complicated by the difficulty of finding excitement or even just satisfaction in completed tasks. "Checking off items on a to-do list should be meaningful and satisfying," reported JK, one of my clients, "but I just don't feel all that excited when I get something done." He is reflecting the emotional experience of one of the neurobiological underpinnings of depression: impaired action of dopamine in the reward pathway of the brain. Many theories about the neurotransmitters connected to depression offer glimpses into causes, such as studies that indicate lower levels of serotonin impair the sensation of satisfaction. The reality is, if you do not feel reward when you get a job done, it makes it darned hard to put out extra energy even for a possible good outcome.
There is even more to the story of how brain function and structure contribute to depression and lack of achievement because most people with depression feel some degree of accomplishment. But in addition to limited feelings of reward, depression both causes and is an outcome of difficulty noticing and holding on to positive sensations. Even when work is completed, the modest degree of satisfaction can be fleeting. Depressed brains do not give enough attention to positive experiences, and that bias toward noticing negatives mires people in the muck of depression.
Escaping that negativity is like trying to escape quicksand. By not noticing or remembering positives, future motivation is impaired. If you cannot recall how good it felt to get something done, then the missing sense of accomplishment impairs motivation to act when feeling depression's downward pull. Not wanting to act becomes a shameful secret. The more shame people feel, the less likely they are to discuss their depression and get some help for it.
There is a way out of the self-reinforcing cycle of low-energy > low self-esteem > loss of accomplishment > shame > low energy. How does a person deal with what seems like an inevitable failure of motivation and activity?
Here are some thoughts to help break into the cycle:
1. Believe that depression is not your fault.
Believe that depression is a medical condition (not your fault or a sign of your weakness) in which you have thoughts and feelings that are not true. Just because you don't see positives in your life does not mean there are no positives. Not every belief you have is true. Try believing that depression clouds your vision of who you are and what you are worth and it impairs your ability to see what is good about you.
2. Start thinking.
To enhance your ability to get moving, start with just thinking. Think about the benefits of completing a task and then think about the costs of not completing it. If you can logically decide it is important to get something done, you may be more inclined to fight your low energy. You might even write down your reasons and read them several times to strengthen your resolve.
3. Take one step at a time.
Break any task into small steps and list them out. You will see it does not take so much energy to complete one at a time, and you only need to expect yourself to complete one step at a time. And yes, cross each step off the list as you do it. Seeing movement toward your goal may be just the extra boost of reward that helps you pull up from your depression.
4. Get encouragement from others.
Left to your own devices, you are probably talking yourself out of trying, discounting the importance of small steps, or telling yourself that you will only be worthwhile when you can make giant leaps of improvement. There is ample evidence that the praise and encouragement of other people can boost motivation. Getting encouragement means telling someone what your goals are. The goals should be concrete and the completion of the goal should be observable. "I am going to go back to school and finish my degree," is too big, too far away, and too vague for another person to cheer you on. Telling a friend or family member that you are going to a) identify three university programs to apply to and b) gather information about the application deadlines are specific and complete-able goals so that a supporter can ask if it is done and help you feel positive about achieving a stated goal. You can then create other goals or action steps in the same way, small, measurable steps that you and others can see you have achieved.
The shame of not getting things done is your judgment on yourself that does not recognize depression's strong gravitational pull to stop moving. Shame does not help you find a way out of depression. Try putting shame away and finding the small steps that get you moving again. Just like a long, heavy train does not go from 0-60 in a matter of seconds, so in depression, you can only pull away from the low energy by moving in small increments.
Next: some concrete ideas to help you get that train moving.