The goal of this brief commentary is to provide you with a slightly different understanding of depression, a perspective that you may not necessarily find in your usual internet search. It is important to put my bias up front, I am a trained psychoanalyst, so the perspective I take is solely psychodynamic and is built upon my educational background and years of clinical experience.

What is Depression?

Depression is a condition that causes extreme feelings of sadness and emptiness. You may experience yourself as being unlovable, worthless and inadequate. Consequently, self-esteem is lacking and vulnerability becomes excessive and pervasive. People who suffer from depression may lose interest in activities they once enjoyed and experience a constant feeling of hopelessness on a daily basis. Severe depression can interfere with a person’s ability to work, sleep, eat, interact with others or enjoy life. With the correct treatment, however, depression can become a manageable condition. In order to get the correct treatment, one first has to understand that which is driving the depression.

What Causes Depression?

This is a very complicated question with many answers, I will outline just a few below. In my practice, a careful assessment will usually reveal a long history of mood swings, frequent periods of despair, depressive like symptoms and a sense of hopelessness and futility. Depression, also known as clinical or major depression, may be triggered by certain events or occur along with other chronic illnesses. It is very important to discern that which causes depression before designing a treatment approach. Here are just a few common pathways to depression which ultimately lead to different types of depression.

Are there Different Types of Depression?

Different types of depression go hand and hand with different causes of depression.  I will address this further in a later commentary, but here are just a few common causes of depression:

  1. Depression can be driven by an underlying masochistic personality disorder. Stated differently, some people, without realizing it, sacrifice all of their interests for someone who does not reciprocate. They can brush aside an entire part of life in pursuit of the idealized but unavailable love “object” while neglecting all others for what becomes total self-involvement for the one .. person, thing, feeling, relationship, accomplishment, etc.
  2. From what I have observed in my practice a ‘narcissistic crisis’ in depression is often times quietly and unconsciously at work, behind the scenes, but powerfully playing a significant role in the depression. When there is a disappointment, a frustration, or some kind of let down the image one has of oneself collapses, and depression may be a response.
  3. Anger and aggression can cause depression. When one devalues, judges, or criticizes, for instance, a colleague, an intimate partner, or anything of value, such as an accomplishment, that has severe consequences.  That devaluation, the attack, either overt or in one’s mind, leads to an inner world devoid of valued, rewarding and stimulating experiences.

How Is Depression Treated?

Depression is a serious condition that can severely affect individuals and their families. Left untreated, depression may lead to anxiety, isolation, difficulties at work or school, relational problems, alcohol or substance abuse, and in extreme cases, suicide.

Depression can be treated with a combination of psychotherapy and antidepressant medication. Psychotherapy, and in some cases psychoanalysis, aims to treat depression by helping the individual first and foremost begin to understand what is causing the depression.  I will say more about this in later post, but an important piece of the work that I do with my patients is thinking. I help patients distinguish between thoughts and thinking and develop a capacity for thinking instead of simply being persecuted by painful thoughts. New ways of thinking oftentimes leads to new ways of behaving, and this in turn has a positive impact on how one feels about oneself, thus enhancing self-esteem and therefore reducing depression.

The most important part of the treatment approach, from my perspective, is to address the very issues which are causing the depression.  If you are looking for long term relief, addressing the factors of causation is a necessary part of the work. If you or someone you know is struggling to manage their depression it may be helpful to contact and talk with a qualified mental health professional.  If you have any questions about this commentary or if you would like to set up a consultation to talk about your emotional state feel free to reach out.

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