First of all, depression, like any other disease, has a biological component, and more particularly has a lifestyle/nutrition component. See this article for information on how depression is caused in part by inflammation.
I tell clients the biological part, or how hard the depression hits when it does, is like the ammunition in a gun. You can have a rocket, a shotgun shell, a BB, whatever. This is the biological (and yes, to a small degree genetic) influence on depression.
But the fact is that, unless you're so incredibly malnourished (as many Americans are), whether this means not enough Omega-3s or inflammation in general, you simply cannot have this ammunition fired in your life without a trigger. That's how guns work. The ammo is useless without the engineering of a trigger. What is the trigger?
Cognition, or how you think about things, and especially the beliefs you have. According to a long theoretical and research history with depression and the cognitive tradition, depression is ultimately propped up and maintained by core beliefs or schemas (although these are technically different terms, I'll be using "schema" to stand for both). What are schemas? They're broad interpretations you have for your life, whether toward yourself, other people, and/or the world.
A clinical psychologist and researcher named Jeffrey Young has a list of 18 schemas. These schemas can basically explain almost all psychological illness, including depression, anxiety, anger, etc. Each disorder has its own "preferred" schemas.
What wins the cake with depression? Defectiveness, the schema that involves the belief that a person is somehow flawed in terms of their character. Shame is a landmark symptom of defectiveness: you think there's something inherently wrong with you. Not with what you do, which is a different schema sometimes associated with depression: inadequacy, or failure to achieve (this is more popular with anxiety as well). Other linked schemas might apply, such as emotional deprivation, and especially unrelenting standards. With the latter a person might feel naturally defective, but if they try really hard they can attain a momentary state of achievement, which kills the sense of defectiveness. I'm worth it because I did X...for a while.
But schemas aren't always activated; you're not always thinking about how you're a failure, or defective, or no good, etc. Turns out we all go into "modes" in our daily life when our schemas are activated. Say I'm taking a test and suddenly realize I don't know half of the material. I go from feeling a little adaptively anxious to feeling very sad and depressed, because I'm thinking, "I'm such an idiot, everything I do is a failure," which is my inadequacy or defectiveness schemas getting activated. I'd challenge everyone to simply write down what they're thinking the next time they're depressed, paying close attention to how they think of themselves and their futures.
Still, in my case as a therapist, every single case of depression that isn't accounted for by environment or general stress (and this is pretty rare for diagnosable depression) goes back to the defectiveness schema. The next big question with schemas is investigating how they were learned, and that (very importantly) they're just ideas and not truths at all. As clients learn to explore the historical bases (always when they're children or early adolescents) of schemas, they realize that they weren't the ones who put these ideas there. Nobody wakes up one morning completely fine and says, "you know what? I'm going to make myself depressed for the rest of my life." With schema therapy, you learn to externalize your depression by putting it into the bounds of a schema, which you can realize is "talking" throughout the day by activating that familiar critical voice, which might say things like, "you're a failure," "nobody loves you," "you're hopeless," etc.
But that isn't all. The next important step is changing this schema. I'd be happy to answer questions on how this goes, but for the sake of time I'd just highly recommend Young and Klosko's incredible Reinventing Your Life, which I always use with clients when doing schema work with them. It even has useful self-assessments to see which schemas might apply, including defectiveness.
Now, not all depression is reducible to defectiveness, but I'd say that the depression that seems to come back again and again is almost certainly reducible to this and other linked schemas. Depression is most fundamentally about hopelessness, and we're naturally people who look to the future; that's what it means to be human. But there are definite barriers that prevent us from looking hopefully to the future, such as having an incredibly stressful environment which would make anyone feel adaptively depressed. But the nonadaptive depression we're talking about here, which probably almost every person on this subforum is experiencing, is due to some combination of malnutrition, inflammation, lack of exercise, social isolation, lack of sunlight exposure, and/or most importantly schemas, particularly defectiveness. (For other non-psychological bases of depression, see Ilardi's The Depression Cure.)
As an epilogue, I'd point out that hormones most definitely play a role in depression, and whether we're talking about thyroid for males and females, or testosterone for males or other hormones, we're much more prone to imbalances in this domain which can definitely have an effect on mood. Vitamin D is another hormone that's way underplayed these days because of our sedentary lifestyle. And actually, when researchers compared moderate exercise three times a week for thirty minutes at a time to a commonly used antidepressant, guess which condition won out in terms of reducing depression?
I tell clients the biological part, or how hard the depression hits when it does, is like the ammunition in a gun. You can have a rocket, a shotgun shell, a BB, whatever. This is the biological (and yes, to a small degree genetic) influence on depression.
But the fact is that, unless you're so incredibly malnourished (as many Americans are), whether this means not enough Omega-3s or inflammation in general, you simply cannot have this ammunition fired in your life without a trigger. That's how guns work. The ammo is useless without the engineering of a trigger. What is the trigger?
Cognition, or how you think about things, and especially the beliefs you have. According to a long theoretical and research history with depression and the cognitive tradition, depression is ultimately propped up and maintained by core beliefs or schemas (although these are technically different terms, I'll be using "schema" to stand for both). What are schemas? They're broad interpretations you have for your life, whether toward yourself, other people, and/or the world.
A clinical psychologist and researcher named Jeffrey Young has a list of 18 schemas. These schemas can basically explain almost all psychological illness, including depression, anxiety, anger, etc. Each disorder has its own "preferred" schemas.
What wins the cake with depression? Defectiveness, the schema that involves the belief that a person is somehow flawed in terms of their character. Shame is a landmark symptom of defectiveness: you think there's something inherently wrong with you. Not with what you do, which is a different schema sometimes associated with depression: inadequacy, or failure to achieve (this is more popular with anxiety as well). Other linked schemas might apply, such as emotional deprivation, and especially unrelenting standards. With the latter a person might feel naturally defective, but if they try really hard they can attain a momentary state of achievement, which kills the sense of defectiveness. I'm worth it because I did X...for a while.
But schemas aren't always activated; you're not always thinking about how you're a failure, or defective, or no good, etc. Turns out we all go into "modes" in our daily life when our schemas are activated. Say I'm taking a test and suddenly realize I don't know half of the material. I go from feeling a little adaptively anxious to feeling very sad and depressed, because I'm thinking, "I'm such an idiot, everything I do is a failure," which is my inadequacy or defectiveness schemas getting activated. I'd challenge everyone to simply write down what they're thinking the next time they're depressed, paying close attention to how they think of themselves and their futures.
Still, in my case as a therapist, every single case of depression that isn't accounted for by environment or general stress (and this is pretty rare for diagnosable depression) goes back to the defectiveness schema. The next big question with schemas is investigating how they were learned, and that (very importantly) they're just ideas and not truths at all. As clients learn to explore the historical bases (always when they're children or early adolescents) of schemas, they realize that they weren't the ones who put these ideas there. Nobody wakes up one morning completely fine and says, "you know what? I'm going to make myself depressed for the rest of my life." With schema therapy, you learn to externalize your depression by putting it into the bounds of a schema, which you can realize is "talking" throughout the day by activating that familiar critical voice, which might say things like, "you're a failure," "nobody loves you," "you're hopeless," etc.
But that isn't all. The next important step is changing this schema. I'd be happy to answer questions on how this goes, but for the sake of time I'd just highly recommend Young and Klosko's incredible Reinventing Your Life, which I always use with clients when doing schema work with them. It even has useful self-assessments to see which schemas might apply, including defectiveness.
Now, not all depression is reducible to defectiveness, but I'd say that the depression that seems to come back again and again is almost certainly reducible to this and other linked schemas. Depression is most fundamentally about hopelessness, and we're naturally people who look to the future; that's what it means to be human. But there are definite barriers that prevent us from looking hopefully to the future, such as having an incredibly stressful environment which would make anyone feel adaptively depressed. But the nonadaptive depression we're talking about here, which probably almost every person on this subforum is experiencing, is due to some combination of malnutrition, inflammation, lack of exercise, social isolation, lack of sunlight exposure, and/or most importantly schemas, particularly defectiveness. (For other non-psychological bases of depression, see Ilardi's The Depression Cure.)
As an epilogue, I'd point out that hormones most definitely play a role in depression, and whether we're talking about thyroid for males and females, or testosterone for males or other hormones, we're much more prone to imbalances in this domain which can definitely have an effect on mood. Vitamin D is another hormone that's way underplayed these days because of our sedentary lifestyle. And actually, when researchers compared moderate exercise three times a week for thirty minutes at a time to a commonly used antidepressant, guess which condition won out in terms of reducing depression?
Last edited: