In a broad sense there are two types of depression: clinical and non-clinical. Clinical depression is an episodic illness where episodes can last from weeks to about a year. Clinical depression gets better on its own without treatment, similar to other illnesses. It’s caused by a neurochemistry imbalance that the body usually recalibrates back to normal over time. Characterized by sadness, low energy. Medications usually aim to reduce the episode duration or severity of it. Non-clinical, congruent depression is usually more encompassing, constant for years. It’s not something antidepressants can fix, it where people are genuinely stuck in life.
Neuroscience of Depression
Default mode network or DMN is the circuit in the brain that grants capacity for self-awareness. Depression is when the DMN becomes hyperactive and gets one stuck in a loop of thinking about themselves. Some drugs like ketamine actually inhibit DMN and sort of turns off this self reflection and as a byproduct it also turns off depression - this is actually researched as treatment for depression.
Studies have shown that meditation (Dr K’s Guide - Meditation) can shut down or make the DMN less active. A nice parallel is how yogis have been saying that one of the goals is Vairagya or detachment from ourselves. Meditation is training the mind to detach thoughts from ourselves. This detachment is the ability to take a step back and look at the bigger picture.
General Differential Diagnosis
Depression is a symptom or manifestation, not necessarily a diagnosis. Depression can be caused by all manner of things – and understanding the cause of your depression is crucial to overcoming it.
The most common cause of depressive episodes is a group of diagnoses called mood disorders. Mood disorders are when a condition alters the general mood for a period of time.
- Major depressive disorder aka unipolar depression, it’s a period of sadness lasting from weeks to about a year that usually returns to normal after the period on its own. Unipolarity is described as this one directional mood alteration to the depressive side.
- Bipolar disorder is described as this two directional mood alteration swings with periods of abnormally elevated moods in addition to depressive periods.
- Dysthymia is a persistent low mood with almost no treatments.
Other cause of depressive episodes are personality disorders which tend to be more episodic than mood disorder and as such harder to treat. Even further than that, personality disorders may not even be related to any neurochemistry, it comes down to how one is wired so to say. That’s not to say that it is not possible to rewire, quite the opposite:
- Borderline personality disorder is when people don’t have a good internal sense of the self. As we can have an internal sense, what we think of ourselves, and we can have an external self, what other think about ourselves. With borderline personality, how one feels about themselves is determined by others. And the moods swing according to how people react to them as well.
Mood Disorders
Mood disorders are when a condition alters the general mood for a period of time.
Bipolar Disorder
Bipolar disorder is described as this two directional mood alteration swings with periods of abnormally elevated moods in addition to depressive periods. About 1% of the population is affected by bipolar disorder, it is not very common.
Important to note that bipolarity is often mixed up with mood lability - rapid fluctuations of mood - which is not a diagnosis itself but a symptom of mood and personality disorders. In bipolar disorder, mood lability is not really involved, the fluctuations are usually a lot longer.
There are more specific diagnoses within the bipolar spectrum:
- Bipolar Type I - same depressive episodes as major depressive disorder, but there are periods of mania. Mania is a period of 1-4 days of elevated mood, with drastically decreased need for sleep.
- Bipolar Type II - same depressive episodes as major depressive disorder, but there are periods of hypomania. Hypomania are kind of like mania, but toned down and longer in length.
- Cyclothymia - rapidly cycling mood, not as rapid as lability, but in periods of a couple days.
Clinical Depression
Diagnosed causes of depression are varied:
- Major depressive disorder - affects 1:3 adults, usually starts in puberty, women are two times as likely to experience it. Symptoms include sadness for at least two weeks, low mood, decreased interest or lack of enjoyment, negative self attitude, suicidal thinking, low concentration, low energy, increased appetite, sleeping too much or too little.
Treatment for clinical depression is aimed at managing depression not curing it. Medications usually aim to reduce the episode duration or severity of depression.
- Selective serotonin reuptake inhibitor or SSRI - first-line antidepressant treatment work by increasing serotonin in the synaptic left boosting serotonin signal. It takes up to a couple of weeks to start working and a couple of months to see full effectiveness as they result in creation of new cellular machinery. The results happen slowly, but side effects are usually fast, so that can discourage a lot of patients. Activating SSRIs can give more energy and combat sluggishness, other types can be more relaxing in effect.
- Serotonin norepinephrine reuptake inhibitors or SNRI - work on norepinephrine as well as serotonin.
Congruent Depression
Congruent depression that is appropriate for our circumstances as opposed to a malfunction of the mind. Sometimes, our depression is caused by a genuine lack of purpose or feeling like our life is missing something important. Clinical depression requires treatment, whereas congruent depression involves making a genuine change in your life.
Congruent depression is like a message from the body and mind to tell you that something is missing from your life. It’s kind of like hunger, the body is creating this unpleasant feelings to nudge us to do something that we need to do. Depression is telling us to satisfy this kind of mental hunger for purpose and meaning. And interestingly unlike abundance of food which satisfies hunger very well, an abundance of meaning can actually paralyze the mind and make the hunger even worse.
Depressed mind has some identifiable features. Dwells in the past, filled with regret - usually with certain rigidness where there is no doubt in the way the conceptualize the past. If anxiety is described as this uncertainty about the future then depression is described as hopelessness towards the future. As if the hopeless future is 100% certain. Negative self attitude - worthlessness, powerlessness, hopelessness. Depressed mind makes a rigid connection between mistakes in the past and the person in the present as if these mistakes were not lessons to be learned from but proof of failure. Past failure becomes present identity. Low motivation and energy - the orbital frontal cortex and anterior cingulate cortex calculate whether something is worth doing. It is calculating energy needed vs likelihood of success. If a person sees the future as hopeless and themselves as powerless then their calculated likelihood of success is very low. Lack of motivation is more of a consequence of the last two points and is usually not the point to fixing depression as its not one of the root causes.
Depression through Panchakosha theory
Also discussed in Dr K’s Guide - Meditation.
Panchakosha theory (pancha being Sanskrit for five, kosha a sheath) aka the five layer theory describes humans as having 5 layers:
- Annamaya kosha - physical layer
- Pranamaya kosha - energetic layer (Eastern theory of chi/prana, the vital life energy)
- Manomaya kosha - emotional layer
- Vijnanamaya kosha - intellectual layer, thoughts, analysis, the ego
- Anandamaya kosha - bliss layer, the soul, the you-ness that trancends the other parts of self, the observing self
To take care of these layers:
- Physical - Surya namaskara yoga, sunlight exposure, exercise, balanced diet
- Energetic - Pranayama and qi gong breathing exercises, yoga, Tai Chi
- Emotional - Psychotherapy, counseling, spending time in nature, journaling, self-reflective processes, meditation
- Intellectual - Pratyhara practice, controlling the senses/indriyas, reading, stimulating curiosity, learning new things
- Soul - Meditation, mindful self observance, find dharma/purpose/meaning
- For all of the above - Shuddhi practices, cleansing yoga
Neurochemical imbalance is in the physical layer. Usually people describe low energy in depression, decreased prana or chi, so that’s in the energetic layer. Since depression affects our mood fluctuations and emotions then it also affects the emotional layer. In the intellectual layer there is the sense of self and ego, this is where the negative self-attitude comes from. A lack of meaning is depression in the the soul layer. To really work on depression all layers have to be taken care of.
Sources of Depression
Falling Behind
Very common feeling is the persistent feeling of falling behind. That everyone is moving on with their lives, but they are stuck unable to catch up.
It can come from the minds tendency to create this perfect Frankenstein of other people and only pick the best part of each from the people who are better than you. Even worse that the mind does not really think about all the other things, it only wants to focus on the parts that are better than you. And even worse than that the concept of catching up really does not have an end. There is always the next thing or person to catch up on. It is important to realize that this concept does not matter, it is a mental construction. Focus on action not the outcome as explained in Dr K’s Guide - Meditation.
Inability to Forgive
A lot of people suffering from depression have a lot of blame against themselves. Depression can be thought of as anger against the self. Usually blame comes from how we were conditioned to blame ourselves or from this wish of blaming ourselves to protect other people. It can also go the other way where blame is put onto others to protect the self. Blaming ourselves can come from strict parents, teachers. Protecting others comes from this difficulty of blaming people we love for wronging us. It might feel guilty or ungrateful for bringing these things up. In protecting ourselves there is also this lack of forgiveness to ourselves. Shifting the blame can seem like a strategy but in reality the negative energy is still in the unconscious.
Protective Hopelessness
Some people have lost hope, lack motivation, or feel stuck. These people often look for ways to increase motivation or get unstuck. Despite trying different techniques, reading different books, and exploring productivity methods, they still stay stuck. Dr K says usually after tunneling into the whys of their lack of motivation it comes down to “there is no point because nothing is going to succeed.”
Hopelessness is a shield to rejection and failure. No hope > no trying > no failure. Usually it comes from some failures in the past where a huge leap was met with failure where hopes got smashed. Interestingly even success might feel like a failure to those with protective hopelessness: success may make them feel that they have to live up to the success. It’s like the mind is saying “great job, but this is only step one, and we’ve got an endless number of steps remaining.”
Conditional Love
For some people, the nature of their depression is a feeling of internal worthlessness. They hold the idea that their worth is dependent on their performance. If they stumble, they start to think poorly about themselves. As they think of themselves as incapable, they start to perform worse, which in turn makes them feel even more incapable.
Confitional love almost always starts from childhood where parents (un)intentionally teach their child that their worth is conditional on their performance. Like other samaskaras from they childhood this is also usually very deep rooted as behavioral reinforcement is more effective the younger the person.
This is a hard one to fix by the one suffering from conditional love samaskara because each failure is a hit to their confidence and faith in themselves. Failure to fix becomes a failure in itself and so on. It is really important to look for intrinsic value and to really catch these thought loops and patterns. It is important to consider upbringing and treatment from parents.
The Fantasy Trap
Our mind actually uses negative emotion to motivate us to change. However, our mind has a coping mechanism – fantasy – that protects us from negative emotion. Unfortunately, getting caught up in fantasy can lead us to be trapped in a false world – where we dream and dream, and never make change.
Hopelessness can come from this feeling that what happened in the past is definitive and also paved the way for the present and future with no hope of changing it. Regret about the past can become fantasy: all the woulda, shoulda, couldas. It is really easy to get into these thoughts about “how life would be if I had done X, Y, Z” and the mind can really get a sense of truimph from these fantasies.
This is quite dangerous as the brain actually learns from negative emotions. Negative emotions spur and lead change, but fantasy can kind of drain all the negative emotion away.