Karlphoto.2Introduction:
This is the second in a series of articles to help bring depression “out of the closet,” to demystify it, remove the sense of shame or defect for having depression and provide some accurate information about what depression really is and ways to learn to “dance” with it rather than fight it.In the last article depression was presented from a first hand account from having experienced it. This article will focus on what depression is, and what can cause it.
What is Depression?
There are many opinions about depression – what it is and isn’t, how you get it and what to do about it. The following explanation is based upon my personal experience as an individual who has lived with depression since childhood, as a client who has received therapy and medication for depression, as a mental health investigator and examiner who has evaluated people with depression in court commitment hearings, as a clinician providing counseling for people with depression and as a speaker, trainer and consultant who has explored alternative explanations for, and approaches to, understanding and transforming depression.
There are many kinds of depression. In the “old days” depression used to be categorized as exogenous and endogenous with endogenous being believed to be more a function of hereditary disposition and exogenous or “reactive” being more of a result of life circumstances. It was also believed that endogenous depression exhibited certain vegetative symptoms such as sleep and appetite disturbances, loss of pleasure and energy.
Today it is recognized that depression cannot be so neatly categorized and that there are many forms of depression. There is also much debate about the causes of depression, how much is hereditary and how much is environmental and how effective antidepressant medication actually is in treating depression. There is also lively discussion about the role trauma and traumatic stress plays and how re-exposure to another person’s suffering can trigger our own (unresolved) pain.
In very general terms, depression can be seen as a mental and emotional response to internal and/or external stressors or triggers that can result in a mild to severe sadness, depressed mood and/or loss of pleasure that can last for days, weeks, months, even years. It can be a one time occurrence, “single episode,” or it can be recurring. It is usually assessed as a “major depressive disorder” if it lasts more than two weeks. It is very often precipitated by an external loss or other event that can trigger the emotion but not always. It is often accompanied by changes in sleep, appetite, energy level, crying spells, difficulty concentrating and sometimes a desire to isolate yourself. In acute or severe depression there may be suicidal thoughts and impulses.
What Causes Depression? 
While the exact cause(s) of depression is still unclear, the development of depression can be seen as a combination of genetic factors, personal history, family dynamics, social and cultural influences and life circumstance. There are also numerous medical conditions that can present as depression and a medical screening is always warranted especially in the development of sudden and severe depression in someone with no history or family history of depression and no clear precipitating event. Depression can also be part of other emotional and mental conditions and enduring personality traits.
In my personal experience as a client and as a therapist, depression is most often precipitated by a sudden loss such as the death of a loved one or an important relationship, loss of a job, finances, of position/prestige or some other significant injury to one’s sense of self. The precipitating external event often initiates or re-engages an internal process of emotional pain often accompanied by self-depreciating thoughts that can become intertwined and mutually reinforcing. Painful emotions can lead to self-depreciating thoughts that can trigger more painful emotions. While there is still much debate about which comes first, the thought or the emotion, I personally don’t think it matters. To me they seem like heads and tails of the same coin.
When depression is a result of the activation and intensification of an internal process that becomes self-perpetuating and self-reinforcing, there are often unresolved emotional issues at play; past personal trauma being one of the most common. The relationship between Post Traumatic Stress Disorder and depression is well known. When past trauma is re-activated by current loss and/or traumatic stress, sudden and intense feelings of depression, hopelessness and helplessness are often activated.Unraveling the tentacles of trauma that are wrapped around depression can be complex and challenging and will be discussed in more depth in the next article.
In most cases, depression is “caused” by a triggering event that is personally painful, even overwhelming to the person experiencing it. The event usually triggers thoughts of worthlessness and self-depreciation and feelings of hurt and loss. In more severe cases previous trauma, old memories and self-defeating mental schemas are activated that can trigger intense feelings of hopelessness and helplessness and a downward spiral is set into motion. Left untreated this kind of depression can become severe and require intervention.
Next article will examine severe depression often associated with trauma, suicidal thoughts and impulses.