Depression is a complex psychological condition with biological underpinnings. It affects motivation, emotions, cognition, behavior, and biological processes. Major depression is quite common, affecting around 5-17% of people at some point in their lives, with women experiencing it at about twice the rate of men. While depression is highly debilitating for those experiencing it, some researchers have hypothesized that it may have evolved to serve an adaptive purpose, such as facilitating rumination or protecting individuals during times of stress. Early life experiences, particularly insecure attachments, are strongly linked to increased vulnerability to depression. Developing compassion for oneself rather than engaging in self-attacking can help prevent and overcome depressive symptoms.

1. Depression – some psychological
thoughts…
Martin Liebenberg C.Psychol.
Addenbrookes – 21 February 2013

2. ‘That’s the thing about depression: a human being can
survive almost anything, as long as s/he sees the end in
sight. But depression is so insidious and it compounds
daily, that it’s impossible to ever see the end. The fog is
like a cage without a key.’
Elizabeth Wurtzel, Prozac Nation

3. How can we tell?
• Motivation Apathy, loss of energy and interest: things seem
pointless, hopeless
• Emotional Low mood, emptiness, anger or resentment, anxiety,
shame, guilt
• Cognitive Poor concentration, negative ideas about the self, the
world and the future.
• Behaviour Lowered activity, social withdrawal, agitation or
retardation.
• Biological Sleep disturbance, loss of appetite, loss of weight,
changes in circadian rhythms, hormones and brain chemicals.

4. Diagnosis of Depression
• Diagnosis requires presence of 5 of the following for at least 2
weeks:
- Sad, depressed daily mood
- Loss of interest in usual activities
- Difficulties in sleeping
- Poor appetite and weight loss
- Loss of energy, great fatigue
- Negative self-concept
- Recurrent thoughts of suicide or death

5. Depression Issues
• Depression exists on a continuum
• Major depression is quite common
- Lifetime prevalence rates range from 5.2% to 17.1%
- Women are twice as likely to develop depression as are men
- Higher rates in young adults and among individuals in lower
socioeconomic groups.
- Depression prevalence varies across cultures
• Prevalence of depression has been increasing over the last 50
years

6. Does depression have a purpose?
The mystery of depression is not that it exists - the mind,
like the flesh, is prone to malfunction. Instead, the paradox
of depression has long been its prevalence. While most
mental illnesses are extremely rare - schizophrenia, for
example, is seen in less than 1% of the population -
depression is everywhere, as inescapable as the common
cold.
Obsessed with our pain, we will retreat from everything. We
will stop eating, unless we start eating too much. Sex will
lose its appeal; sleep will become a frustrating pursuit. We
will always be tired, even though we will do less and less.
We will think a lot about death.

7. Darwin had some thoughts…
If depression was a disorder, then evolution had made a tragic
mistake, allowing an illness that impedes reproduction - it
leads people to stop having sex and consider suicide - to
spread throughout the population. For some unknown reason,
the modern human mind is tilted toward sadness and, as we’ve
now come to think, needs drugs to rescue itself.
The alternative, of course, is that depression has a secret
purpose and our medical interventions are making a bad
situation even worse. Like a fever that helps the immune
system fight off infection - increased body temperature sends
white blood cells into overdrive - depression might be an
unpleasant yet adaptive response to affliction. Maybe Darwin
was right. We suffer - we suffer terribly - but we don’t suffer in
vain

8. Is it therefore possible?
Depressed affect makes people think better – does
rumination teach us something?
“Do you not see how necessary a World of Pains and
troubles is to school an intelligence and make it a soul?”
– Keats
Depression plays a protective role
Sadness, like happiness, has many functions.
Important note: To say that depression has a purpose or that sadness makes us
smarter says nothing about its awfulness.

9. A comment on pharmacology?
“I remember one patient who came in and said she needed to reduce her
dosage,” he says. “I asked her if the antidepressants were working, and she said
something I’ll never forget. ‘Yes, they’re working great,’ she told me. ‘I feel so
much better. But I’m still married to the same alcoholic son of a bitch. It’s just
now he’s tolerable.’ ”
The point is the woman was depressed for a reason; her pain was about
something. While the drugs made her feel better, no real progress was ever
made.
For some, medication is a life saver…

10. Is there a key?

11. Early relationships…
Provide protection from external danger
Provide needed resources – food, warmth
Stimulate (positive) affect systems
Emotional regulation
Guide self-other evaluative systems
Threats: low protection, low positive affect, neglect, trauma/abuse
Depression highly linked to poor early attachments
Reduced risk of depression in the context of high care even if there
is a genetic vulnerability

12. Feeling safe in the minds of others…
Creating positive feelings and thoughts in the minds of others, about
oneself, makes the world safe
safe and will not be rejected or attacked
likely to be available in time of need
co-create advantageous relationships (e.g., sexual, co-operative)
physiologically regulating (e.g. oxytocin, cortisol)
stimulates positive feelings for self and other
lay down emotional memories of warmth
Creating negative feelings (contempt, anger, ridicule) in the minds of
others leading to attack, rejection or ‘un-included’ makes the world
unsafe
major threat --- generating defensive behaviours such as
fight/flight/submit
Paul Gilbert

13. Do I feel shame? (Gilbert & Allen)
Social comparison
Compared to others I generally feel:
Inferior 1 2 3 4 5 6 7 8 9 10 Superior
Submissive behaviour
I agree that I am wrong even though I know I’m not
I do what is expected of me even when I don’t want to
External shame
I think that other people look down on me
Other people see me as small and insignificant

14. Self correction vs Self attacking (Paul Gilbert)
Compassionate Self-Correction is focused
on:
•The desire to improve
•Growth and enhancement
•Forward-looking
•Given with encouragement, support and
kindness
•Building on positives (e.g. seeing what one
did well and then considering learning
points)
•Focuses on attributes and specific
qualities of self
•Focus and hope for success
•Increases the chances of engagement
Shame Based Self Attacking is focused on:
•The desire to condemn and punish
•Punishing, past errors
•Backward-looking
•Given with anger, frustration, contempt
and disappointment
•Focuses on deficits and fear of exposure
•Focuses on a global sense of self
•Focuses on a high fear of failure
•Increases chances of avoidance and
withdrawal

15. Is SHAME a cage and
compassion a KEY?

16. Some helpful dos… (not said much about treatment)
Sunbathing in the Rain (Gwyneth Lewis)
Remember that depression can’t harm you
It’s not people who get depressed who go mad, it’s
those who don’t
Listen to what depression is telling you, and change your
life accordingly
Get what depression is stopping you doing…

17. However much you blame others, depression will you back to
yourself
Learn to distinguish between your rubbish and what is true
Depression teaches you that the only permanent way out is
by finding and accepting the truths you have been avoiding, even if
you thought you’d already faced them.