What is Depression? Not Just a State of Mind

There are still people today who believe depression is just a state of mind. To them, it’s just another way for overly-sensitive individuals with nothing to be depressed about to seek attention. Some think it’s simply a resolute bad attitude or a victim mentality run amuck.

What is Depression?

But what is depression, really? Clinical depression is a serious disorder that sometimes needs intensive treatment to be addressed. It will not go away with vitamins, a positive mental attitude, or even mind-over-matter.

One has only to look at how long depression has been around, how deeply it impacts the physical body, and the suicide rate across cultural lines, to gain an understanding of how persistent and serious major depression can be. Such a comprehensive view might also help us begin to understand, in addition, what depression actually is.

Depression and Mental Illness in History

From the beginning of time, depression has plagued humankind and has done so over a wide swath of different peoples and cultures. Cases can be found in early texts from civilizations as far back as Mesopotamia and Babylon. Evidence of the disorder can be found in writings from ancient Greece, Rome, China, and Egypt.

All of these societies struggled to understand why some ancients became sad, grew sadder, then despondent, and finally became self-harming or suicidal. Their efforts at trying to cure such individuals are well documented.

Depression was a persistent and serious enough problem in history that it warranted a robust study. Great minds came at it from vastly different viewpoints, and two schools of thoughts emerged over time.

The first view believed that depression (and mental conditions in general) came about by natural causes – usually physical ailments or social issues. This view supported making changes in one’s social interactions or providing medical treatment to address the problem.

The second school of thought held that mental illness was the product of evil curses, caused by malevolent spirits, or the result of demonic possession. Obviously, professions like “scientist” and “doctor” emerged from one school of thought while roles like “priest,” “shaman,” and the like, emerged from the other.

The empirical view offered remedies for depression (first known by doctors as “melancholia”) such as exercise, massage, dietary changes, and relaxation techniques to ease symptoms, not unlike some of the antidotes prescribed for depression today.

One doctor in 1621 asserted that depression, in particular, was a result of social problems, listing things like poverty, fear, isolation and other circumstances as the cause. This doctor held that “witches” (witchcraft was believed to be the culprit that invited evil spirits in the first place) were simply mentally sick individuals who needed some kind of herbal remedy or distraction, like travel and companionship.

The scientific theories of mental illness, including depression, took a back seat to the spiritual answers, however, and by the Renaissance, the idea that mental illness was not only a sign of evil spirits but a mark of angry gods was the preeminent view. The easier reconciled belief, that such an incurable condition was attributed to supernatural causes, led to flamboyant exorcisms, imprisonments, torture, and even the execution of mentally ill individuals.

While there is much written about the terrors of the spiritual solutions to mental illness in history, some of the medical remedies were just as brutal and even life-threatening. Primitive doctors inflicted unknowingly hurtful methods, and one perfect example of this is a technique called blood-letting, where leeches were attached to a person so they could suck the “bad” blood out of them.

This proved as ineffective as the beatings and torture designed to drive demons out. Needless to say, subjects with mental problems were sometimes passed back and forth between the scientific and religious models, yet their symptoms persisted. One would think that if depression were truly just a decision or bad attitude, ancients would have opted out of such harsh treatment, simply by choosing a home-remedy of “snapping out of it”, but they didn’t.

Depression and the Body

Aside from the long, documented history of “melancholia,” as well as efforts to cure it, skeptics should consider the very measurable impact depression has on the physical body and vice versa. Major depression can affect the immune and gastronomic systems, as well as other physiological systems vital to health.

Current research shows that people suffering from depression get sick more often, see doctors for physical ailments more frequently, and have higher rates of dying during recovery after major surgery. Eating and sleeping patterns are usually disrupted in depressed individuals, and the disorder often leads to weight gain or loss.

But the physiology of depression doesn’t end with how the disorder impacts the body. Major depression can both cause and be caused by physical issues. This creates a sort of “which came first the chicken or the egg” conundrum. Just as depression has an impact on our health, our physical well being has a big impact on causing or exasperating depression.

Hormones are a perfect example of how major depression can become a physical and mental feedback loop. Hormonal activity triggered by depression can actually change the physical structure and chemical behavior of the brain, creating more and worsening depression over time. The hormone most responsible for structural changes in the brain is called Cortisol.

High Cortisol levels are triggered by depression and then trigger it in return, causing a vicious physiological cycle. The part of the brain known as the hippo campus is in charge of regulating Cortisol and will release the hormone during times of stress. This facilitates the well-known physiological “fight or flight response,” a response we all have to real and perceived danger.

Cortisol levels equip us physically for whatever response is necessary to survive a dangerous situation, whatever that may be, but levels should not remain elevated for longer than necessary. In addition to the “fight and flight response,” we all have another, equally important state – the “rest and digest response.” In “rest and digest” we get much-needed rest, metabolize our food properly, restore our faculties, and think more clearly.

Persistently high Cortisol levels will literally shrink the prefrontal cortex, which is the center of the brain responsible for regulating emotions and facilitating decision-making. Over time, high Cortisol levels will also enlarge the amygdala, the part of the brain responsible for emotions, leading to the disturbances in sleep and motivation that we see in depressed individuals.

Because of the important mind-body connection when it comes to depression, mental health professionals will provide therapy in collaboration with medical treatment. Counseling for depression generally starts with the therapist recommending a physical exam, and since depression can often be relieved pharmaceutically, it can reduce therapy time dramatically.

Another reason for a doctor to manage medications, while treatment for depression takes place, is that prescription drugs can contribute to and even cause major depression.

It follows that illegal drugs can have the same impact, causing and exasperating depression symptoms. Because of this, substance abuse must be ruled out by therapists before effective treatment can begin, and good therapy is done in conjunction with chemical dependency treatment, the latter being a necessary first step.

People who abuse substances are more likely to suffer from depression, and likewise, those who suffer from depression are more likely to abuse substances. When depressed individuals also have substance abuse issues it is known as a co-occurring disorder. Therapists cannot fully address depression until the fire-feeding-fire effect of both conditions is neutralized.

Because depression is so interactive with physiological systems, physical markers can actually help therapists predict and even prevent depression in the first place. Like anxiety, depression is hardwired into some people. Physical markers predictive of depression include genetics, biochemical reactions, and hormonal activity, especially in women during menopause or while pregnant or nursing.

All of these markers can be measured, and they often play a part in diagnosing clinical depression. So Clearly, major depression can impact the body and the body impacts depression, so when we engage with individuals suffering from depression it’s important to understand that it isn’t just in their head; it’s in their body too.

Depression and Suicide

If the long history and the measurable physical signs and symptoms of clinical and debilitating depression are not enough to convince some of us that depression is a very serious condition, we need to look no further than the current death-rate for more conclusive proof. Sadly, depression can take the loss of a life before loved-ones realize just how profound and final the disorder can be.

Suicide is not only a serious issue for families but for society as a whole. It is, in fact, one of the most persistent social issues of our day. For every successful suicide, there are numerous attempts that can result in hospitalization or intense inpatient treatment that requires constant supervision until an individual is able to tolerate and cope with depression symptoms on their own.

lWith all the assessments and indicators of depression, it is the prolonged and intense emotional pain of the disorder that best indicates when someone is at risk for suicide. Therapists are duty-bound to monitor clients with clinical depression when they have thoughts of wanting to die. Such thoughts are not static and are commonly referred to as “suicidal ideation.”

Ruminations are initially fleeting but predictably progressive. They evolve, sometimes outside the client’s active awareness, into a dangerous, self-harming mindset. A clinically depressed client often doesn’t see the harm in these contemplations and may tell their therapist they aren’t really serious about killing themselves.

Instead, they might explain, they find their mind wandering as they long to “disappear” or just “not exist anymore,” but without intervention this becomes problematic. Desires to stop the pain can develop into a growing belief that one is better off dead, which then graduates into obsessive thinking and planning.

When depressed individuals begin to withdraw from once enjoyed activities, isolate from others, and find themselves alone with their increasingly toxic thoughts, they experience emotional flooding, feelings of confusion, emptiness, and especially loneliness. Under such circumstances, suicidal ideation graduates into the planning phase.

The planning phase involves actual preparations for killing oneself, working out the logistics (time, place, and means) and making final decisions about them. It is especially dangerous when the means (prescription medications or a family-owned firearm for example) are readily available and easily accessible. This is why therapists generally encourage the family to keep such items under lock and key until suicidal thinking is under control.

Suicide is so prevalent that therapists are legally mandated to report to authorities when their clients are preparing for or planning a suicide attempt. With first responders across the country, arriving on the scene every day in response to suicidal threats and attempts, the seriousness of major depression is compelling. In the face of overwhelming suicide statistics, it is difficult to see how anyone could believe depression is simply a matter of willpower, but many do.

Depression is a physically measurable, persistent condition that has historical significance, real interactions with our physical health, and can lead to the unnecessary loss of life if ignored for too long. While depression cannot be shaken off or muscled through, it is extremely treatable with modern medicine and therapeutic treatment.

When taken seriously, family members can get help and measures can be put in place that dramatically improve a person’s quality of life and reduce their painful symptoms. Clinical depression has to be distinguished from the occasional bad mood or “the blues” that we all experience from time to time.

Life-threatening suicidal thinking must be identified, ferreted out, and addressed during the initial stages of treatment to keep people safe. Today’s treatments for depression are so effective that risk factors and symptoms can sometimes be resolved in a matter of months.

Treatment involves medical visits, sometimes medication, and talk therapy of one form or another. Once stabilized, a client can learn better self-talk and coping skills to best manage ongoing symptoms and continue healing with less and less professional support. So the next time you hear that depression is just a state of mind, think again.