It is estimated that one in eight individuals struggle with depression. This broad spectrum is made of many different hues - both in terms of unique lived experiences and of different depressive disorders. Each person's experience of depression varies, depending on its severity, underlying causes, and one’s circumstances. While the experience of depression may look bleak, understanding its nature and course can help us gain invaluable insight into managing this potentially overwhelming experience. In this post, we will explore the various forms of depression, examine its impacts on people's lives, and consider a psychodynamic approach to treating depression. Despite how it might seem, a diagnosis need not silence hope; there are options available that have been successful in alleviating depression over time.
Depressive disorders come in several subtypes and represent a spectrum of severity for those affected. They can range from a single episode to lasting virtually a lifetime. In either case, depression can impact a person’s life in major ways, from difficulty functioning on a daily basis, to causing pain in interpersonal relationships, to making it hard to perform at work. It is important to be aware of the various signs and symptoms of depression so that if you or someone you care about experiences it, they have access to the necessary help and support. Therapy can be an excellent resource in navigating feelings of hopelessness and building feelings of self-worth. Even if nothing materially changes in one’s circumstances, experiencing another person being ‘in it’ with you–hearing your story, being a compassionate, understanding presence–can make a significant difference.
Types of Depressive Disorders
Depressive disorders are more than just feeling blue or down in the dumps, they can be severe and long-lasting, pulling the joy and color out of life. Examples of depressive disorders include Major Depressive Disorder, Persistent Depressive Disorder (also known as Dysthymia), Disruptive Mood Dysregulation Disorder, and Premenstrual Dysphoric Disorder. Bipolar Disorder involves periods of depression as well. What differs among them are issues of duration, timing, or presumed cause.
Common to all depressive disorders is the presence of sad, empty, or irritable mood, along with physical and cognitive changes that significantly impact the individual’s capacity to function. Major Depressive Disorder is characterized by persistent feelings of sadness, low energy levels, and loss of motivation, among other symptoms. People with Persistent Depressive Disorder have similar symptoms, but have endured them for longer than two years. Disruptive Mood Dysregulation Disorder is diagnosed only in children and affects their emotions severely for most days for at least one year; it is diagnosed when a child experiences episodes of extreme irritability or anger. Premenstrual Dysphoric Disorder markedly impacts mood and functioning following ovulation and remitting within a few days of menses. Those with Bipolar Disorder experience at least a single episode of mania prior to or following a depressive episode. For some people these depression symptoms can become unbearable and prevent them from doing everyday activities that bring joy like socializing or taking part in hobbies. Therapy can help them understand and navigate these emotions, and how best to manage them so that a fulfilling life can be lived despite the challenges of depression.
Major Depressive Disorder
Major Depressive Disorder is a common but serious type of depression that affects an individual's ability to function in everyday life. Major Depressive Disorder specifically refers to experiencing symptoms of depression for at least one ‘episode’ of two weeks at a time. The symptoms include both physical and emotional experiences such as difficulty sleeping, persistent sadness or fatigue, changes in appetite, difficulty concentrating, and feelings of helplessness or hopelessness. It is often characterized by a single depressive episode lasting two weeks or more, although it can also be recurrent with multiple episodes within a certain time period. As for the severity of the illness, it can range from mild to severe, and have long-term effects on an individual's physical health and relationships with friends and family. With proper treatment, people living with Major Depressive Disorder can experience reduced suffering and lead improved lives.
Persistent Depressive Disorder
Persistent Depressive Disorder (PDD) is a form of depression that encompasses both major depressive disorder and dysthymia. The symptoms for PDD are the same as for depression, but less symptoms are required to meet the threshold for the diagnosis. This low-level depression is also experienced for an extended period—at least two years — though it may encompass episodes of major depression that are intensified experiences of depressive symptoms. The duration and severity of individual episodes can vary in intensity from one episode to the next, making recurrent depressive disorder especially difficult to differentiate from other forms of depression. Those who experience PDD know all too well the impact depression can have on life’s routines and relationships, and how incredibly overwhelming it can be. Therapy can offer vital support so that they can live a more fulfilling life.
Disruptive Mood Dysregulation Disorder
Disruptive Mood Dysregulation disorder is a diagnosis for children, ages 6 to 10 years old. Central to this disorder is chronic, severe, and persistent irritability. This can be seen in frequent temper outbursts, usually in response to frustration. Outbursts can be verbal or behavioral, must occur frequently (on average three or more times per week), and take place for over a year in at least two settings. Chronic irritability will also manifest as a persistently foul or angry mood between the more severe outbursts which is noticeable by others. This diagnostic category was created in response to the overdiagnosis of bipolar disorder among children. Children with these symptoms often experience marked disruption in family and friend relationships, as well as in school performance.
For a child to receive this diagnosis, the onset of disruptive mood must be before the age of 10 years. Children under 6 years old and those over 18 years old cannot be diagnosed with Disruptive Mood Dysregulation Disorder, and instead likely fit criteria for one of the other mood disorders discussed in this article.
Premenstrual Dysphoric Disorder
Central to Premenstrual Dysphoric Disorder is rapidly shifting mood, irritability, dysphoria (low mood), and anxiety symptoms that occur repeatedly during the premenstrual phase of the cycle and remit near the onset of menses or soon thereafter. These symptoms may occur in the context of behavioral or physical symptoms, e.g. hypersomnia or insomnia, marked change in appetite, breast tenderness or swelling, joint or muscle pain, or weight gain. These experiences must have taken place during most menstrual cycles during the last year, and have had a negative impact on work or social functioning.
Bipolar Disorder is characterized by extreme variations in mood, energy, and behavior. Episodes of significant ‘highs’ (known as mania) and ‘lows’ (known as depression), either of which can last up to a few weeks, are the hallmark symptoms of Bipolar Disorder. A manic episode involves abnormally persistent elevated, expansive, or irritable mood and persistently increased energy and activity, present for most of the day, nearly every day for at least a week. These episodes can vary significantly in terms of their severity and frequency—some may experience a few mild episodes each year while others may go through several intense episodes in a much shorter amount of time. The experience and intensity of these manic and depressive episodes differ significantly.
A close friend described their experience of living with depression:
I remember my dad reflecting that I seemed depressed when I was nine years old. I remember feeling very sad almost all of the time, and it ebbed and flowed for years. As I got older, I had more language to put to my feelings. I became more isolated. By the time I was an adult, I was managing suicidal ideation. I imagined what it would be like to sleep and not wake up. The one thing that kept me going was the idea of how devastating it would be to my parents if I were to die by suicide. I somehow managed to keep a friend or two. Even my pets kept me going.
In hindsight, my family life was dysfunctional; my parents’ own attachment styles were not healthy. I’d been through some traumatic experiences that had overwhelmed my abilities to cope. There were genetic vulnerabilities, too: depression ran in my family. My siblings–out of their own challenges–took a lot of my parents’ attention. Very often I felt like I did not exist within my own family, that I was on my own. Growing up this way, I came to feel worthless. I felt like a ghost that people did not see. People would look at me, and see through me.
I didn’t relate to my family. I felt like the black sheep: the loner, the outsider, the one who did not belong. I didn’t feel as if I was a part of the family, or even that I deserved to be a part of them. I felt mistrusting, as if I didn’t quite believe that they could be helpful or reach me. I felt alone, and sad.
My relationship with myself became, at its worst, a sense of hatred. I didn't want to be left alone. To be alone with myself meant that I would be with this appalling thing that was me–and that was terrifying. My mind, my body, my being was waging war against me, and I was just trying to keep going. There was no aspect of self-compassion. That wasn’t even a concept I was aware of. If it was, I wouldn’t have believed I was worth the practice.
What was lethal about depression was how it sapped my energy and made it hard to experience pleasure in doing anything at all, and how in spite of that I needed to force myself to get up and do all these things that seemed completely pointless. In hindsight, I think doing just that kept me alive, even though the act of getting out of bed would feel impossible.
The friendships that remained in my life were with other depressed people. That could at times be unhelpful, because we were not well placed to help each other, even if we could understand each other. My connections with “healthy" people slipped away, because I was embarrassed to be seen or known this way. I was like a walking zombie. Having any friendship was significant in defending against depression, but the depression itself played games with my mind. There was a lot of mistrust. In hindsight, it was likely pretty challenging to be friends with me in that state, which made the whole situation harder.
It was definitely hard–impossible at times–to experience joy or pleasure. There were times I was convinced that I would never feel joy again. It felt like running a marathon with no prior training. You just come up against these mental battles without preparation, and it crushes you. Things that I remembered having loved from earlier wouldn’t even bring a smile to my face. The part of me that knew I used to love and feel joy felt impossibly distant.
Now when I look back, the colors of my life from those years seem mute, like sepia tones. It was an entirely different way of existing. Everything–any little thing–felt difficult. It seemed like I’d never get out of it, and the joke’s on me: this is simply how I’ll exist for the rest of my days. And it felt like a life-or-death battle. Every day was hard.
Therapy was the most significant factor in saving my life. I explored the roots behind why my depression manifested. It helped me to actually process my feelings and better understand myself. In the therapeutic relationship, I developed empathy with myself, and how to become proud of myself for the strength that I had in fighting the battle. I felt my esteem coming back. Talking and feeling through my experience helped me slowly become more optimistic, more hopeful. I know that while difficulties will come up in life, I’m more confident in my ability to handle those hard times. I learned to trust myself, in my own strength.
Per the roots of my depression–I learned that it made sense. There had been experiences throughout my childhood and adulthood that were genuinely difficult, and these had impacted me more than I knew. Taking the time to sort through them and creating a coherent sense of how it impacted me and why, I gained more conscious control and autonomy in deciding what patterns I wanted to continue or to adjust.
I owe my life to my experience in therapy. It was incredible. I’d felt unseen, unlovable, and worthless for most of my life. I found a space where the therapist made me feel that I truly mattered, that my feelings mattered–what I went though and felt was validated. I felt worthwhile and had a reason to live. This was where it got turned around for me. It’s there for you, too.
Psychodynamic Therapy for Depression
When it comes to engaging therapy for depression, psychodynamic treatment can be powerful. The psychodynamic approach allows for an exploration of your past experiences, memories, relationships, and feelings, and exploration of how those affect your present. Using the relationship between yourself and your therapist, you will gain greater insight into non-conscious parts of your being. By making these parts of yourself conscious, greater richness, freedom, and choice are often the result. In relationally-oriented dynamic therapy, this takes place by mining the therapeutic relationship. The interactions you have with your therapist are seen as a thumbnail sketch of relational dynamics that likely carry over into the rest of your life. Thus, the therapeutic relationship acts as both a window into your emotional world, and as the crucible of change. Less directive than other modalities, you can expect the freedom and encouragement to explore anything that crosses your mind. Psychodynamic therapy is less oriented toward attempting immediate behavioral change and symptom reduction, and more toward depth. This approach is focused on finding new ways of being–with yourself, with others, and with your circumstances.
Exploring depression in psychodynamic therapy might involve sorting through the reciprocal impact of your treatment of yourself (for example, seeing yourself as worthless, flawed, or incompetent) and your relationships. It is common to feel numbness, frustration, or disgust with oneself when depressed. You might imagine that the critical way you feel about yourself is shared with others. Convinced of this–perhaps expecting rejection or dismissal–it can be easy to withdraw from friendships and relationships. Now isolated from others who would otherwise support you, depression can deepen. This cycle can be especially pronounced if you have a past marked by rejection, shaming, or neglect in early childhood. Our earliest experiences of being met (or not) by our caregivers–usually parents and close family–strongly impacts our sense of self and how we learn to relate to others. Learning to hold these feelings rather than pushing them away can help stop fueling problematic patterns of relating that prolong and deepen depression. Other people struggling with depression may come to learn that feeling bad does not mean that they are bad people; that others’ poor treatment of them is not a barometer of their worth. Being met with a therapist able to compassionately validate your suffering can be transformative. You can begin to feel that you do in fact have an impact on others, that your emotional experience matters, that your pain is not grounds for dismissal, but a burden that can be cared about together–even shared. In psychodynamic therapy, the hope is that not only will your suffering diminish, but your capacity to bear it to grow.
If you think seeking professional help could benefit you, don’t hesitate to reach out and schedule a consultation with one of our highly experienced therapists today.