Selection from Carver, Joseph, PhD. “Depression: Causes, Symptoms and Treatment.”

Causes of Depression

Sudden Severe Loss
In this situation, the individual has experienced a sudden, perhaps surprising severe loss. This loss may be the death of a loved one, loss of a job, loss of friendship, or other grief process. In this type of depression, the patient can clearly identify what is creating the depressed mood.

Long-term High Stress Level
In this situation, the patient is depressed but can't quite put their finger on the cause, the "I'm depressed but I don't know why" condition. Imagine running a video tape of your life, reviewing the past 18 months. Look at the stress you've been under, the amount of responsibility, the number of pressures, and the number of hassles. In actual clinical practice, this cause of depression is seen more often than sudden loss. This type of depression creeps up on you. When this type of depression is experienced, the patient offers comments such as: "I don't know what's wrong!" "I don't know how I feel." "My feelings are numb."

Brain Chemistry and Depression

During long-term high stress, the brain burns its oil, serotonin, at a higher rate. The bottom line in depression and stress: The brain burns up more serotonin than it can replace! In the end, after many months of severe stress, the brain is using serotonin faster than it can create/replace it. Your neurochemical level of serotonin drops and you become depressed.

You'll know your serotonin level is low (and depression is here) by the following symptoms:

1. Most depressed folks experience early morning awakening, usually around 4:00 am.  Serotonin, you see, controls our sleep cycle.

2. Concentration and attention will drop. Depressed children/students will experience a drop in grades. You'll start putting odd things in the refrigerator (a bowling ball is the office record!), forget why you went to the grocery, and become very forgetful and scatterbrained at work/home.

3. You'll lose physical energy. You can sleep for ten hours and you'll still be bone tired. You will cry at the drop of a hat - driving down the highway, doing dishes, sitting at work, etc.

4. Sexual interest, appetite, and general interest will rapidly drop. You will stop answering the phone, stop visiting friends/relatives, and pull the blinds.

5. Most dangerous - your mind speed will increase. Your mind will race at what seems like 200 miles per hour. Depressed people often tell their doctor "I can't get my mind to stop!" The minute you wake up in the morning - it will start up. Your brain will then turn against you. It will reach in your memory and pull out every bad memory it can find - abuse as a child, failed relationships, etc. - anything to make you feel bad and especially guilty. You will be tortured by your own thoughts.

6. As your mind speed picks up, the "garbage truck" will arrive. While the brain is already torturing you with the past, it will create/invent new ideas/thoughts to torture you. In every case of depression, if the depression stays long enough, you will receive the same "garbage" thoughts from your mind.

You will be told:
- you are a burden to your family/friends
- you have failed/disappointed your family
- no one really cares about you
- your children would be better raised by someone else
- your family would be better off without you
- your spouse would be better off without you
- you are going crazy and there's no hope
- it would be better if you weren't around
- you would be better off dead
- you should probably kill yourself

 If you're depressed then you already know about the garbage truck. It's almost impossible to explain this part and the excessive mind speed to someone who has never been seriously depressed. If your depression goes untreated, this constant "garbage" will totally destroy your self-confidence. Try as you may, you will be unable to control this part of depression.

7. As part of the "garbage truck," your mind will try to make you as uncomfortable as possible. You may be flooded with thoughts of violence against yourself and others, you'll think you are condemned by God, or you'll think you deserve this condition for some reason. Your garbage will also tell you that if you seek professional help (physician, psychologist, psychiatrist, etc.) that you'll be committed to an institution forever.

8. When depressed, your brain begins running a mental "video tape" of your worst experiences. If married, a mental tape of the marriage is played daily, only focusing on the worst experiences. Frequent if not constant thoughts and preoccupations about past problems and issues is a common sign of depression.

In short, depression is a neurochemical reaction to severe and prolonged stress, either suddenly surfacing or gradually creeping up on you over a period of many months. The treatment for this dark cloud is much easier than you think.

Some General Thoughts:
If you are depressed, expect your brain to be filled with mental garbage - get ready for it! During this time, do not take action on those garbage thoughts and make no major changes in your life. It's best to wait until the garbage truck leaves before making decisions that will or may change your life.

You may have other symptoms with your depression, such as severe anxiety or agitation (pacing, no sleep at all, "hyper", etc.). That only means another neurochemical has kicked in. In these cases, a psychiatrist can best select the medication for the combination of anxiety and depression.

When you are depressed, those who love you will become a pain-in-the-butt. They will "bug" you constantly, trying to cheer you up, giving you advice and trying to be by your side. Be prepared for this.

During depression, remember that your brain goes on a bad-memory hunt, looking for old memories to torture you. Be prepared to relive or re-feel old hurts, old doubts, old guilt, and old sorrows. Be curious about what memory files the brain selects rather than focus on those memories. You can expect your brain to constantly replay the video tape (your "worst hits" tape) of your life. You'll feel guilty for things you did as a child, mistakes you made ten years ago, etc. You'll live in the past as long as the depression remains. It may interest you to know that as the serotonin level increases, the "past" returns to the past as a memory - not a torture.

In other depressed situations, people become obsessed with other issues, almost always "the road not taken". Often viewed as mid-life crisis, a straight-laced businessman now wants a Harley and a tattoo while another individual begins suddenly thinking about a past sweetheart. In almost all of these situations, the individual acts totally out of character.

All depressed folks look for escapes. Common methods of trying to escape depression are excessive alcohol use, drugs, sexual relationships, changing jobs, etc. A lot of good marriages are lost during these times as the spouse of the depressed partner hears "I've got to have space" or "I've got to get away and find myself!" You'll find these escapes don't work. These methods only complicate your depression and your recovery. Best bet - don't make changes, just get to a professional.

Depression affects more than the individual with the depression - it's a family-and-friends problem as well. If your spouse is depressed, he or she may be constantly talking about the history of the marriage and relationship. Remember, the "garbage truck" is running in their brain, thinking of every bad thing that has been done, said, or not done. The spouse that isn't depressed is frequently "dumped on" with hundreds of accusations and thoughts that are long after-the-fact and totally beyond correction at this point. The non-depressed spouse may suddenly learn that their partner never did like their hairstyle, their mother, their choice of automobile, or the price of the house. The non-depressed spouse will hear many "thoughts" that were present at the time of marital decisions, often years ago, but were never mentioned. The non-depressed spouse may be awakened at night with accusations and complaints that may last for hours. The non-depressed spouse will be made to feel responsible for these unspoken wishes and will be helpless as the depressed spouse lists mistakes and misunderstandings that have taken place during the entire marriage/relationship. Even though they might have been discussed at the time, the non-depressed spouse will receive much blame for past events.

If a friend is depressed, they will suddenly have no interest in maintaining your friendship. They'll stop calling, visiting, or writing. If your depressed best friend suddenly gives you their most prized possession or asks you to be included in their will to take care of their children - be on the alert! Such behaviors are often part of a suicide plan in which the depressed friend wants to "take care of business" before they leave this earth. At that point, a heart-to-heart talk is needed, perhaps offering to accompany them to a professional's office for help. Many depressed individuals are brought to the office by their parents, friends, or work supervisors.