On Depression: The Why, The Beginning and the Recovery

IMPORTANT: This blog is not a substitute for therapy, but provides evidenced-based education for the purposes of self-help, or to compliment the therapeutic process. ​ ​This blog is non-monetized.

By: Christina Crowe, RP

There are a lot of things that can be difficult about having a condition that isn’t seen as much as felt.  If you have suffered from depression in the past, or are living with it now, you might have questions at some point like,

  • why has this happened to me,
  • how do I get better,
  • how will I know when I’m better?

When someone breaks their leg, we all know when they are better – they are walking again.  When an asthmatic has an attack, we all know they need their puffer, and then they feel relief within minutes.  When you have a cold, you know you are better when the fog lifts and you’ve stopped sneezing or coughing.  But when you suffer from depression, what is the sign for everyone, including yourself, that it’s over?  For a lot of other conditions, there can seem to be a more finite treatment and recovery endpoint. 

Understanding how you were susceptible to depression in the first place is a good place to start, because it’s related to your recovery. 

WHY DO SOME PEOPLE SUFFER FROM DEPRESSION AND NOT OTHERS?

The ‘diathesis-stress model’ of depression suggests people have, to different degrees, vulnerabilities, or predispositions, for developing depression. The model attempts to explain how biological or genetic traits – ‘diatheses’ – interact with environmental stressors to produce depression. In other words, your genetic predispositions must be crossed with stressful life events (of a social, psychological or biological nature) in order to develop depression. And further, one person’s definition of stress, is not necessarily another’s. [1]

So, the greater genetic background, the less of a stressor it will take to trigger depression, and vice versa.

In your life, what are the stressors that triggered depression?

Turns out, life! The death of a loved one, other losses such as a job layoffs, relationship difficulties like divorce, or even ‘normal’ milestones such as puberty, marriage, or retirement. For some, it’s alcoholism or drug abuse, neurochemical and hormonal imbalances, and even infections can all be powerful enough to cause depressive symptoms in someone with a ‘diathesis’ for this condition.

​A significant loss may be enough to trigger depression in one person, while a similar loss experienced by another person might not bother them much at all.

​ARE YOU STILL DEPRESSED?

The natural course of major depression is that the average adult can potentially experience 4 to 5 more episodes after the initial one.  

A depressive episode can last anywhere from 3 to 24 months, and may varyin severity person by person.

​There are different ranges studied and cited, because there are different definitions of “recovery”. [2]

​In a very basic nutshell, you have recovered from depression when you feel better, mentally and physically. [3]

In general the question is, are you functioning again in a manner similar to a time when you can identify that you weren’t depressed?  

But it can be complicated.  

​What if things have changed in your life and not only can you not resume normal activities, but for your own health, you shouldn’t? For example, you were injured, and in the aftermath of your physical recovery, you became depressed.  In order to not re-injure yourself, you’ve been instructed to modify your physical activity, or your lifestyle in some major way.  You’re left feeling like even though your mind is in a better place (after psychotherapy and potentially medication), you still can’t do what you once did. You don’t quite feel normal again.  Treatment is the best way out. 

The best evidence for depression treatment involves psychotherapy, “talk therapy” (CBT – ‘cognitive behaviour therapy’ has the most evidence behind it) and if necessary, medication. [4]

In Ontario, one can get the medication much more easily than they can get the psychotherapy (psychotherapy is as effective and sometimes more effective that medication alone, and psychotherapy combined with medication has been shown to provide the best outcomes). 

​The main reason is that once you have experienced depression, a majority of people, even those who have had medication, will suffer a relapse if they have not had any skills training to teach them how to prevent relapse. And that is where a talk therapy like CBT comes in. 

In the scenario above, there is a new perspective (the C in CBT) that can make all the difference. There is a “new normal” to adjust to (the B in CBT).  And slowly, you begin to understand (the T in BCT) how to manage your own condition, within the new context of your own life.

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JUST LIKE AN ASTHMATIC HAS TO CONSTANTLY MONITOR THEMSELVES FOR CONSTRICTED AIRWAYS, A PERSON WHO ONCE EXPERIENCED DEPRESSION NEEDS TO REFLECT AND MONITOR THEMSELVES FOR SIGNS OF RELAPSE.

 There is a heap of self-exploration that goes along with optimal treatment for depression, and the more support you can get from your family, friends and people you trust, the better.  

The trick is, it sometimes requires you to be the one to educate people about what you are going through (even people whom you think should know), despite the fact that when you are depressed you don’t have the energy or motivation to advocate for yourself. Catch-22!

​This is why reaching out for help is critical. There are a LOT of people who don’t understand what depression is or what it feels like. And it can be hard to acknowledge even to ourselves that our depression exists, let alone have a grasp ourselves on what treatment and recovery are like.

In summary, depression is a condition that can be thought of as caused by both genetic and environmental factors, and It.Is.Not.Your.Fault. There is treatment available, support for families and caregivers, and lots of free information available online. Once you dig down deep enough, there IS a start and end point, and with the support of a properly trained mental health professional (read: those who have been specifically trained to provide psychotherapy) you can get there.

MORE RESOURCES

 For more resources, check out the links on the Resources page. 

If you think you might be a little, or a lot, depressed, here is an online screening tool. It is not a diagnosis, but can give you a little direction about whether you should seek more support. Click here.

REFERENCES

[1] Scott B Patten: Major depression epidemiology from a diathesis-stress conceptualization. BMC Psychiatry 2013 13:19.
[2] Klein, Daniel N.; Kotov, Roman. Course of depression in a 10-year prospective study: Evidence for qualitatively distinct subgroups. Journal of Abnormal Psychology, 125(3), Apr 2016, 337-348.
[3] Trujols J, Portella MJ, Pérez V. Toward a Genuinely Patient-Centered Metric of Depression RecoveryOne Step Further. JAMA Psychiatry. 2013;70(12):1375. doi:10.1001/jamapsychiatry.2013.2187
[4] Cuijpers, et al. A Meta-Analysis of Cognitive-Behavioural Therapy for Adult Depression, Alone and in Comparison with other Treatments. Can J Psychiatry July 2013 vol. 58 no. 7 376-385

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Picture of ​Christina Crowe, H.BSc. MACP, RP, (S-Cert) OAMHP (she, her)

​Christina Crowe, H.BSc. MACP, RP, (S-Cert) OAMHP (she, her)

Registered Psychotherapist, Validated Clinical Supervisor, ADHD Therapist & Coach Podcast Host The Christina Crowe Podcast Christina is a Canadian Registered Psychotherapist, a member of CADDRA's Advocacy Committee and relentless mental health advocate. Christina believes great mental health information should be available to everyone, loves creating content that makes invisible things VISIBLE and finding new ways to bring healing experiences to as many people as possible.

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