Notes on Depression
Depression is a severe and prolonged state of mind in which normal sadness grows into a painful state of hopelessness, listlessness, lack of motivation, and fatigue. Depression can vary from mild to severe. When depression is mild, you find yourself brooding on your own negative aspects or those of others. You may feel resentful, irritable or angry much of the time. You might regularly feel sorry for yourself or like you need constant reassurance from someone. You may suffer various physical complaints that do not seem to be caused by any physical illness.

As depression worsens, feelings of extreme sadness and hopelessness combine with low self-esteem, guilt, and memory and concentration difficulties to bring about a severely painful state of mind. You may begin to experience changes in basic bodily functions and daily rhythms. You can't sleep, or you sleep too much. You can't eat, or you eat too much. Others may notice that you are agitated or slowed down, and you may find that your energy for activities you used to enjoy has hit “rock bottom.” You may even feel that life is not worth living, and begin to think that you'd be better off dead.

How is depression commonly treated?
The most commonly used treatment for major depression is antidepressant medication. These medications are relatively cheap, and they are easy for family practitioners to prescribe. However, once the episode of depression has passed and a patient stops taking the antidepressants, depression tends to return. At least 50% of those experiencing their first episode of depression find that depression comes back, despite appearing to have made a “full recovery.” After a second or third episode, the likelihood of recurrence rises to between 80 and 90%. Those who first became depressed before 20 years of age are likely to suffer a higher risk of relapse and recurrence.

The main method for preventing this recurrence is the continuation of antidepressant medication, but many people do not want to stay on medication for indefinite periods. People are increasingly looking for other ways to stay well after episodes of depression have passed. To see what is most helpful, we need to understand why you remain at risk for depression even after you've recovered.

Why do people remain vulnerable to depression?
New research shows that during any episode of depression, negative moods occur alongside negative thinking (e.g. feelings of failure and inadequacy) and bodily sensations of sluggishness and fatigue. When the episode has passed and the mood has returned to normal, and the negative thinking and fatigue tend to disappear as well. During the episode, however, a connection has formed between the negative moods and the negative thinking patterns.

When negative moods inevitably reoccur (for any reason), they can reactivate the old thinking pattern and physical sensations. Even a small amount of the negative mood can serve as a trigger. People find themselves returning to the idea that they have failed or that they are inadequate even if these thoughts are not relevant to the current situation. People who believed they had recovered may find themselves feeling “back to square one.” They end up inside a rumination loop that constantly asks “Why is this happening to me again?” and “Where will it all end?” Such rumination feels as if it ought to lead to an answer, but it only succeeds in prolonging and deepening the mood spiral. When this happens, the old habits of negative thinking will start up again and a full-blown episode of depression may be the result.

The discovery that the link between negative moods and negative thoughts remains ready to be re-activated, even when people feel well, is of enormous importance. The persistence of this link means that sustaining recovery from such depression depends on learning new ways to keep mild states of depression from spiraling out of control.

How will mindfulness practice help me?
It will help you understand what depression is.

It will help you discover what makes you vulnerable to downward mood spirals, and why you get stuck at the bottom of the spiral.

It will help you see the connection between downward spirals and:
High standards that leave us feeling that we are “not good enough”

Ways we put pressure on ourselves or make ourselves miserable with overwork

Ways we lose touch with what makes life worth living