Clients come into my office on a regular basis and express they’re depressed, but have no awareness as to why. They say things such as, “I’m depressed, but I have no reason to be.” My first thought is, “Apparently there is because you are.” With all kidding aside, I understand what they’re attempting to share is they can’t understand why they’re experiencing what I refer to as depressive symptoms. 

In addition, they may state, “Other people have it so much worse,” or, “I SHOULD be more happy or grateful.” This line of thought frequently leads to them feeling guilt and shame for being depressed, which only serves to make them more depressed. Perhaps, they went to their physician who diagnosed them with depression and prescribed them an antidepressant, such as Prozac, Lexapro, Zoloft, Wellbutrin, etc. 

The Myth of The Chemical Imbalance Theory

This may have resulted in a temporary diminishment of their symptoms, but all too commonly they end up back where they started within a period of time. This approach to treating depression is founded on the ‘chemical imbalance’ model. This view asserts you have a chemical imbalance in neurotransmitters, such as serotonin or dopamine, and if you take an antidepressant to address the insufficient levels of these neurotransmitters you will feel better. 

I would argue against this model as being too simplistic and reductionistic. Let me state that last sentence in a more direct manner, “I believe it is dead wrong.” Even in the most mentally ill individuals I have worked with, such as those suffering with schizophrenia or bipolar disorder, I have never found this to be exclusively the case. Our biology and our interaction with our external environment are much more complex than this. 

Not a Disorder but a Disordered System

I have come to see depression not as a disorder but as a set of symptoms unique to each individual that are informing one that something is disordered in their system. I refer to what my client reports to me as depressive symptoms, rather than some global disorder or disease referred to as DEPRESSION. To obtain the right assistance or treatment requires identifying the correct cause of the symptoms. To view depression as a disorder or chemical imbalance dismisses approximately over ninety percent of the origins of an individual’s depressive symptoms. 

I would like to clarify at this point I am not against medication and for numerous individuals it has been beneficial to achieving stabilization and a decrease of their distress. Furthermore, I would in no way want anyone to feel a sense of guilt, shame, or inadequacy for taking medication. In some cases, it is a very necessary part of a person’s treatment and can be literally a life-saver. The majority of my clients enter therapy expressing they either don’t want to take medication or desire to get off of the medications they are currently prescribed. 

Symptom Resolution vs. Symptom Management

I inform them this is definitely possible once we have identified the specific causes of their depressive symptoms. I also instruct them this needs to be done with the guidance of their attending physician. Moreover, there is also an ever-increasing research-based, holistic interventions for treating depressive symptoms. Although, there are many well-meaning individuals in the mental health community, the majority of the approaches in the field are focused primarily on symptom management, rather than symptom resolution. 

Another factor in the treatment of depressive symptoms is associated with culture. With the advent of technology and innovation, we are conditioned to assess things through the lens of speed and convenience. This is great in numerous contexts, such as Amazon, smartphones, concierge services, etc. However, when we it comes to the treatment of depressive or anxiety symptoms, people often will opt for the pill over the work of addressing their issues on a deep level or making necessary lifestyle changes. 

Resistance to Discomfort

I get it. This is human nature. I am not immune to taking the easy way out, and have done so on many occasions. But although getting to the root cause takes longer, it lasts. If you build your castle on sand, it is sure to crash. Again, there are many great things about our current culture, and I believe overall it is the best time in the history of humanity to be alive. However, as a generalization we have become resistant to things that cause us distress. 

This has resulted in an over labeling of things that are just normal aspects of human experience as depression. An example of this are things such as grief and loneliness. If you lose someone or something important to you, you will be sad. This form of sadness is what we refer to as grief. Grief is not depression. But because we have become so averse to discomfort, we label it as depression and believe something is wrong and we need medication. 

Emotions As a Resource

If we block or numb these feelings, we are robbing ourselves of what the emotion is designed to do for us. Each of our core emotions has evolved over human history for adaptive reasons. Grief informs us of what really matters in life and that everything is finite. Therefore, pay close attention to what is most valuable, such as people, purpose, and meaning so you don’t end up getting distracted on things of lesser value and end up in regret and despair. 

Loneliness is another form of sadness. It alerts me to the fact I desire more connection. Developing and maintaining connection takes work. Work I do not always have the energy to do. Or, perhaps you fear rejection, and this causes you to avoid attempting the risk of asking someone to get together or engage in some activity. The discomfort of the feeling of loneliness can push you through this fear or lack of energy to do the behavior it takes to create relationships. Then once you have connection, the feeling of loneliness goes away. 

Emotions are in the most simplistic terms energy and information. The word emotion stems from a Latin term that means ‘to move’. They move us towards or away from things for reasons of survival or to attain important needs. If we block or numb this energy, it will disrupt our ability to meet some of our most important needs. I hope this is making sense and provides some motivation for you as to why we would want to feel these emotions that are at times painful. Always remember they are internal resources for creating the life we desire, and mastering them is the key to getting your most important needs met. 

Multiple Contributing Factors

Returning to the topic of depression, the first step in overcoming your depressive symptoms is to identify the causes. I use the plural term due to the fact that most often these symptoms are generated by more than one source. To begin resolving depressive symptoms, we must identify each contributing factor. Below is a list of some of the most common causative origins I see in my clinical practice that contribute to individual’s depressive symptoms:

• Unprocessed grief
• Relationship distress
• Shame
• Overwhelming sadness
• Dissociative shutdown
• Numbing activities to avoid pain
• Unprocessed trauma
• Lack of purpose and meaning
• Burnout
• Cortisol imbalance or depletion
• Hormonal imbalances
• Anhedonia – Inability to feel pleasure often generated by chronic substance use or compulsive behaviors
• Nutritional deficiencies
• Gut issues
• Lack of self-care correlated with feelings of worthlessness
• Lack of boundaries in relationships
• Medical conditions, treatment side-effects, medical trauma
• Difficulties in acculturation
• Lack of social support
• Career dissatisfaction – Over 80% of people globally dislike or hate what they do
• Comorbid mental health conditions

Although this list is not exhaustive, it does outline the majority of the primary sources of depressive symptoms I have identified with thousands of clients over the last fifteen years. Furthermore, many of these root causes can be correlated with each other and bidirectional. 

The Interaction of Multiple Causes

For example, if a person is overextended at their current employment this may result in experiencing a burnout syndrome that can also contributed to relationship distress due to their lack of physical and emotional availability to their partner. They may then experience cortisol and neurotransmitter depletion leading to low energy, anxiety symptoms, and a lack of ability to feel pleasure in their life. 

This can further cause them to encounter a lack of purpose and meaning in their life and begin to self-medicate with food, substances, or spending, which causes more stress and feelings of shame and unworthiness. As a result, their nervous system shuts down to conserve energy due to believing nothing they do is going to make any real difference in their present situation – learned helplessness. 

I hope this provides an example of the complexity of the numerous contributing factors that can generate an individual’s depressive symptoms. Just taking an antidepressant will not address any of the underlying origins of the person’s depressive symptoms. I will concede the fact that doing so necessitates much more effort than taking a pill to address the myth of the ‘chemical balance.’ However, doing so will actually produce the long-term outcome you are attempting to achieve. 

Developing Interventions

Once you have identified the underlying contributors to your depressive symptoms, you can move to the next step of developing interventions for each source. In the above example, I would create a treatment plan based on these factors. I may have the client arrange to meet with a functional medicine specialist to holistically balance their cortisol levels, address nutritional deficits, begin amino acid treatments to raise their neurotransmitter levels, or potentially assess gut issues that can also lead to decreased levels of neurotransmitters, such as dopamine and serotonin. 

We could also identify the factors leading to burnout, such as a toxic work environment, work that is unfulfilling or aversive, attempting to compensate for feelings of inadequacy through achievement, or fear of scarcity that prevents an individual from creating and maintaining a balanced schedule. Couple’s therapy may be needed to address how these dysfunctional work patterns have negatively affected the relationship, as well as teaching how to effectively use the relationship as a source of support and security. 

If the client has been self-medicating with substances or compulsive behaviors, they may need treatment to terminate these behaviors. In addition, a plan may need to be generated to provide hope their actions can lead to a positive outcome in order to break free from the learned helplessness that has developed. Again, it is my hope this example can illustrate how your specific symptoms developed, how to create interventions to address them, and dispel the myth of the ‘chemical imbalance’ so you can fully resolve your depressive symptoms. 

If you would like additional information related to this topic or to speak with us directly, please contact us at www.hawkinscounselingcenter.com