There are different perspectives to explore what triggers an episode of depression. The medical lens views it as an illness caused by chemical imbalances. Psychological understandings have expanded in time from suggesting that aggression was at the root of depression to advocating that internal conflicts between impulses and a person’s conscience were the cause. Sigmund Freud connected it to a response to loss. Carl Jung distinguished depressive disorder from normal depression attributing the latter to a process of transformation in a person’s life. Subsequently subtypes of depression were identified, pertaining that a category (endogenous) of people foster their own suffering and others (reactive) was caused by a significant change in the environment.

We are now in the era of adopting a more integrated view that recognises multiple factors; genetic, mental, physical and environmental. Various disciplines such as neuroscience, psychology and psychiatry are coming together, more than ever before, to understand the causes of the very real pain suffered in different types of depression, and the possible avenues for prevention and treatment.

In my experience as a clinician I see that people want relief from the pain but most of all need to be empathised with. Unfortunately for different reasons this is not always possible to find in families, with friends, colleagues or even some professionals. Often I have heard clients say that they have not been able to reach out because they are scared to disclose the depth of how they feel, afraid to be told to cheer up because they have a lot to be grateful for or that they are causing others discomfort. Close ones might have the best intentions but these attempts can be perceived as attacks that reinforce feelings of guilt and helplessness in the sufferer.

It is important to listen to every person’s specific experience as seeking help is a huge step for people who are depressed. They often battle through self- hatred, and low energy levels, looking at the world moving around them whist they feel left behind and powerless.

Symptoms vary but usually start with a lack of desire for things that usually give pleasure but don’t anymore; thinking becomes generalised, negative and foggy, and there is a withdrawal from engaging in life accompanied with sleep disturbances. Feelings of shame, sadness and persistent irritability colour the internal emotional landscape. Often anxiety exists alongside depression creating loops of difficult feelings, thoughts and bodily memories. This ‘hijacking’ leads to using coping mechanisms that may be uplifting or soothing at first but become self-defeating in time. However it can also lead to finding a therapist that can offer support and some light at the end of the tunnel.

Various treatment modalities including medication are considered effective however I have found that the most profound tool for successful outcomes is the relationship with the therapist itself. Finding someone who you connect with, who is non-judgemental and genuinely interested in your state of mind promotes good feelings about how you see yourself and how you can be seen by another person. This experience can be powerful and facilitates positive change.

To help an individual find relief and a sustainable way forward I adopt a holistic approach drawing from different therapeutic models.

In practice, we have conversations firstly to get a sense of the ‘shape of the depression’, its foundation and purpose, and we think together about ways forward. It is a process that fosters collaboration and openness, which can lead to a feeling of not being alone anymore. We then identify if there are some more deeply rooted causes that need exploring; we also reflect on recent life events that triggered the episode of depression and we gradually develop internal and external resources to increase a sense of hope and resilience. The ending of therapy is a very important part of the work and is usually negotiated between both parties. It can be decided at the beginning by agreeing on a number of sessions or gradually as the course unfolds. There are often some indicators that suggest that it could be time, when the person feels more energised and confident, has learnt to recognise triggers and patterns that may lead to depressive episodes and they know they can reach out to others when they struggle. How many of the objectives are met in the course of therapy depends on factors such as length and modality of therapy.

If this article resonates with you or if someone you know is experiencing depressive symptoms, contact a GP or a therapist as soon as possible.


Author: Diane Metta, Psychotherapist at InsideOut