It's 9 am, you're alarm went off 2 hours ago, and you are lying there, seemingly paralyzed by fatigue despite 12 hours in bed. One voice in your head tells you that if you don't get up now, you'll be late to work for the third time this month, which will likely result in losing your job. But the depression says "I can't." "I can't muster the energy to get out of bed, much less go through all the motions required to get me out the door to work."
Lack of motivation, fatigue, and hopelessness are all symptoms that most folks could rattle off as indicators of depression, but what does that mean on a day-to-day level? Those symptoms translate into scenarios such as the one above and are a complicated mix of biological, emotional, environmental, and cognitive factors. So let's break it down:
Biological: Our brains depend upon a delicate balance of neurotransmitters to regulate our emotions, appetite, and sleep. When these chemical messengers are out of whack due to depression, our appetites may increase or slump, our sleep may become disrupted, and our emotions may take a turn to the dark side.
Emotional: Our emotional experiences aren't just the product of our chemical processes alone however, and are a driving force in depression in their own right. When we are feeling negative emotions such as sadness, grief, or hopelessness, it is actually more difficult to access positive memories and to engage in positive thinking. This creates a nasty feedback loop that makes it difficult for us to do the kinds of things that might improve our mood because we find it difficult to think or feel that anything would do any good.
Environmental: Sometimes, it's not US, it's the environment. In the example above, our friend with depression is fearful that she will lose her job if she is late. This could be a realistic appraisal of the situation and would understandably cause stress. Throw in a passive-aggressive co-worker, long commute to work, and living in an impoverished area and you've got a veritable depression soup of environmental risk factors. If we think of ourselves as goldfish and our worlds as the water we live in, it can help us gain some perspective on how important environments are to our mental health. Just as you wouldn't expect a goldfish to last long if you poured formaldehyde in his little water world, we humans can be just as impacted by the experiences we have in our larger, less watery fish bowl. Identifying environmental toxins (unhealthy relationships, exposure to violence, constant criticism, processed food, etc.) can be extremely helpful in minimizing the impact of depression.
Cognitive: This refers to the way we think, which is very different than the way we feel. While emotions and cognitions have an important impact on each other they are not the same. Depression interferes with our ability to generate positive thoughts or appraisals of situations as they happen. So where a non-depressed person may think "I've been late to work before, and my boss was understanding," the depressed person may have difficulty even accessing the memory of previous positive interactions with her boss, which may result in an assumption that things will go badly.
Recognizing the many layers of depression is an important step in effectively treating it. Addressing emotional distress by learning skills for emotion regulation, relaxation, and perspective taking can help with the often crippling negative feelings. Identifying environmental stressors gives us an opportunity to work towards changing what we can, and and accepting what we can't. It also helps us to let go of some of the shame and blame that often comes with feeling depressed when we can spot some outside influences on our mood. Cognitive change takes practice, but is possible. The more aware we become of the thoughts that cause us harm, the thoughts that help, and ultimately the transitory nature of all thoughts, the more power we have to live in the moment and not get caught up in whatever story our depression is trying to tell us.