When you get depressed, it's easy to think you are the only person who has ever felt this bad – but anyone can become depressed, especially when they suffer a major loss such as bereavement or divorce. Depression can also be a response to feeling overwhelmed by life, when the stress or upset are just too much to bear. Even the strongest of us have our limits, so when we take on too much, or life overloads us with problems, it’s easy for our mood to dip.

When you are feeling depressed, it's easy to imagine that everything is hopeless, or that you will never get better. You may be tired all the time, unable to sleep properly, taking little interest or pleasure in the things you used to enjoy. You might feel angry or irritable about every little thing, or be fearful and anxious for no obvious reason. You may also have suicidal thoughts, which are very common when we are depressed.

It’s important to distinguish between different kinds of depression. Mental health professionals talk about mild, moderate and severe depression, which are just ways of distinguishing between how much it is affecting you, your day-to-day mood and ability to function. I think it’s also useful to recognise that some people only ever have one episode of depression – usually in response to a loss or life crisis – while others have ‘chronic’ depression, which means they experience repeated bouts of low mood for years or even throughout their life.

There is much debate about what causes depression, but in the cognitive therapy model we see depression as a result of persistent negative thinking, which may be triggered by a painful life event, but is also linked to underlying negative beliefs.

Negative beliefs are key

Aaron Beck, the founder of cognitive therapy, calls these beliefs the ‘cognitive triad’, meaning negative beliefs about yourself, your experiences and your future. These beliefs may lie dormant throughout your life, until they are triggered by a loss or crisis, when they become active and start to dominate your thinking.

People with depression use all sorts of images and metaphors to describe their experience, but commonly talk about viewing the world through dark glasses, being under a black cloud, or everything looking grey (Winston Churchill, one of many famous people who have suffered from depression, talked about the ‘black dog’ that followed him everywhere). These images reflect the overwhelmingly negative bias to your thinking when you are down, making everything seem a bit bleak, hopeless and too much to cope with.

Withdrawing from the world

When you are depressed you also stop doing the things you used to enjoy, like going to movies, spending time with friends or cooking delicious food. This is absolutely normal, and in many ways perfectly understandable, because these things no longer give you any pleasure, so why would you bother?

You may also be exhausted, so lack the energy to go out and engage with the world. More than that, you might find interacting with other people difficult or even painful, so again it makes sense to withdraw from your relationships with others.

The key point here is that, although completely normal and understandable, when you stop doing things you used to enjoy or seeing other people you get increasingly withdrawn and isolated. If you spend all day in bed, you will probably not be resting, but instead engage in ‘rumination’, with all those dark thoughts going round and round your head.

Think of it this way – who wouldn’t get depressed if they never did anything fun and spent all day thinking about everything that was wrong with them and their lives?

Re-engaging with life

So one of the first things I do with depressed clients is to help them start doing things again – very gently at first, but slowly re-engaging with life. If you are really down, this might just be doing the laundry and tidying your flat; for other people it may be doing some gentle exercise, cooking at least one healthy meal a day, or planning a trip so they have something to look forward to.

Gradually their mood lifts until they feel well enough to tackle those negative thoughts – again, slowly and steadily, but persistently examining and talking back to the thoughts that tell them they are rubbish, hopeless or a failure. Over time they realise that once they take off those dark glasses, they can see life is not so bleak, that there is hope and that – with a little help, guidance and support – they can find a way through depression.

Warm wishes,

Dan