Depression is the most common mental health affliction, described as the common cold of psychiatry. I work among the mentally ill every week, and most of my patients are depressed, some severely so. They move slowly, they sigh a lot, their facial expressions are grim, their words few and negative, their thought process inward and despairing. Some have tried to kill themselves. Many are thinking of doing so, something called “suicidal ideation.” Some of these eventually succeed.
Here are some grim and little understood facets of depression.
1. Both body and mind slow down. People become constipated. They talk slowly. They report that it’s difficult to think because thoughts come slowly, if at all.
2. Many abandon social media. This phenomenon is so reliable that psychiatrists have proposed monitoring social media posts as a way to diagnose depression.
3. Sleep becomes poor. Some cease dreaming. Others run a fever at night. Most toss and turn. Some can’t sleep at all, while other sleep away the day.
4. For many, all color drains from the world, as if they now see in black and white. Food loses its taste. Sex becomes uninteresting. Smells are muted. Beauty is obscured. God goes behind a Great Wall.
5. Regrets take hold. Even those usually not prone to ruminating about the past now obsess about it, becoming convinced that their current doomed lives are the results of choices they now wish could be altered. Sometimes a regret is just a regret. But depression magnifies them to an inordinate degree.
6. Relationships becomes less important. Making new connection is nearly impossible due to low energy levels. Maintaining current ones is a strain. Most people with depression withdraw from their social networks and even their families.
7. Pain is more painful. Aches are more achey. Uncomfortable stretches become more uncomfortable. Even random painful stimuli like a stubbed toe or a paper cut are magnified.
Given the many and varied afflictions of depression, why would Mother Nature let this happen to her children? Depression is a phenomena of withdrawal and shutdown. Based on this some believe it’s an adaption to tragedy, loss or social humiliation. Depression encourages the sufferer to slow down, reflect and reconsider while also protecting one from further harm. While this has plausibility, the extreme forms depression are hardly adaptive. Severe depression can render people completely disabled, unable to work or interact with society. Some become bed bound. Others kill themselves. The standard theory for this is due to a biochemical imbalance. Certain forms of depression such as manic depression show these kinds of changes, with large swings in dopamine driving equal large swings in mood and behavior. The question is whether biochemical changes cause depression or are caused by it.
What’s clear is that depression is an illness, one that can be treated effectively with medication and talk therapy. New therapies are coming online: magnetic stimulation of the brain, ketamine, and psychedelics. There is no need to endure months of affliction.
The mysteries of depression persist. Most of the depressive signs I described are not understood. Plenty of research lies ahead. In the meantime, I can reassure the suffering that they are not at fault, and that treatments exist to ameliorate and asometimes cure their affliction.
— E D Nelson