Understanding Depression

Recent data from the CDC indicates in the United States, 20 to 26 percent of women and 8 to 12 percent of men will experience an episode of clinical depression at some point in their lives. What's more, there are an estimated 40,000 annual suicide deaths attributable to it (that's more than traffic deaths and more than twice the number of homicides). In fact, according to the CDC's National Center for Health Statistics, suicide is the tenth leading cause of death—and depression is a major cause of suicide.

Depression is very hard to explain to someone who has no personal experience with it. It is an ineffable state of being that simply can't be adequately described. Much like other phenomenological experiences that defy description, depression, too, simply cannot be put into words.

For example, how would one describe the taste of chocolate, or any food, to someone who has never tasted it and, therefore, has no experiential frame of reference for the feelings and sensations it produces? Or, how does one thoroughly convey the experience of deep, romantic love to someone who has never felt it?

Of course, most people understand the psychological experience of sadness. But to liken clinical depression to mere "sadness" (or feeling "blue,” "down," or "unhappy") is to liken life-threatening pneumonia to a case of the sniffles.

When someone is depressed, his or her mind and body are in a state of tremendous imbalance. Brain physiology is altered, stress hormones are constantly surging, and almost all bodily systems are affected. This is why the symptoms of depression usually disrupt a person’s regular rhythms of mind and body. For instance, disturbances in appetite, sexual functioning, energy, concentration, memory, and sleep can occur; loss of interest and pleasure, sobbing and/or anger outbursts, feelings of guilt, loss of self-esteem, pessimism, and hopelessness are also some of the more common symptoms of clinical depression (or what is technically called major depression).

Indeed, major depression is being increasingly understood and characterized as an arrhythmia of the brain (e.g., Llinas, R. R., et al. 1999). The brain is an amazingly complex and intricate bioelectrical organ that has various rhythms and cycles. Some are moment-to-moment (e.g., mood, energy, and concentration), while others are hourly (e.g., hunger), daily (e.g., sleep) and monthly (e.g., menstruation).

Another bioelectric organ is the heart. It depends on an electrophysiological process to beat normally. But sometimes the heart’s rhythm becomes chaotic such as during atrial fibrillation (when the top chambers of the heart quiver instead of beat rhythmically) or some forms of tachycardia (when the heart beats abnormally fast). In many cases, these cardiac dysrhythmias can be corrected by shocking the heart with an electric current (usually delivered with a defibrillator). Similarly, in some cases, the brain’s natural rhythms can be restored by applying an electrical stimulus to it such as when ECT or “shock therapy” is performed.

While most people have some awareness that true depression affects thoughts, emotions, and actions, what very few people understand is the profound sensory component that is also a common feature of the illness. Yes, depression is an actual illness; it’s not a weakness, character flaw or personal failing.

Thus, in addition to cognitive, affective, and behavioral features, depression has many unpleasant sensations associated with it, too.

Gut churning; chest tightening; jaw clenching; inner shakiness; head pressure; crushing fatigue; and/or visceral, live wire agitation. These are some of the descriptors that people use when trying to convey the sensations they often experience during an episode of depression. These feelings and sensations can feel so awful that some people will do anything to end the pain. Yes, pain. True, deep psychic pain that is sometimes associated with various bodily pains, too.

In fact, recent research suggests that some of the same brain regions that mediate nocioception (i.e. the perception of physical pain) are also involved in the experience of emotional or psychic pain (e.g., Kulkarni, et al. 2007).

So if someone you know is suffering from clinical depression, try to understand that it's not just a passing blue mood or a state of sadness. Rather it is a potentially debilitating, sometimes lethal condition that can ravage people's souls and lead them to feel "broken," "hollow," “empty,” “hopeless,” and "worthless," as well as in genuine pain and horrible sensory discomfort.

The good news is there is help. In fact, the vast majority of depression sufferers can be helped with either medication, other somatic therapies (e.g., ECT or Transcranial Magnetic Stimulation, TMS), and/or with proper psychological therapy. For mild to moderate depression, CBT seems to be the treatment of choice. For more severe depression, a combination of medication and CBT is often the best approach. And, as suggested above, ECT can be an amazingly effective treatment, too, as can others.

Depression Essential Reads

Exercise as an Antidepressant for Teens

The Overlooked Burden of Treatment-Resistant Depression

Remember: Think well, Act well, Feel well, Be well!

Copyright Clifford N. Lazarus, Ph.D., 2017. This post is for informational purposes only. It is not intended to be a substitute for professional assistance or personal mental health treatment by a qualified clinician.

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