The many faces of depression

“I never realized you were depressed; you always had a smile on your face,” or “I didn’t know they were suicidal because they always turned up for work and got the job done.” Depression is hard to spot, so that’s why a psychotherapist will work hard to get to know each individual client, so they know what depression looks like for them.
 
The beast of depression is a multifaceted creature. For some, it shows itself as anger and frustration whereas for others it is tears or disconnection. That can make it tricky for you to recognize it in yourself and your loved ones.
 
I always explain to clients that you know yourself and you know your loved ones. So, in your eyes, are there significant changes? Is someone who is usually peaceful and reserved acting in an explosive and hostile way? Is someone who is usually sporty and outgoing giving up on friends and activities?
 
I also like to point to excess as a key identifier for depression: Is someone working excessively, eating excessively, or are they excessively explosive? From a Polyvagal perspective, this is when someone is in the sympathetic fight-or-flight state. The nervous system detects cues of danger, and we respond by fighting or fleeing in an attempt to establish safety.
 
Excess can show itself in other ways. Is someone excessively scrolling through social media, staring into space, or becoming forgetful? From a Polyvagal perspective, this is when someone is in the dorsal vagal (shutdown) state. The nervous system detects cues of danger, and we respond by shutting down or numbing out because it feels like there is no hope of escape.
 
Faced with depression, our first goal is to recognize when we are in these states where we sense danger (sympathetic fight-or-flight state, or dorsal vagal shutdown state). Compassionate is a crucial approach to depression, so we need to be curious about what state we are in, and why this might be happening.
 
The second goal with depression is to identify when we are in a ventral vagal state; in other words, when we feel safe and calm. These might be few and far between, but if we can identify one or two, we can build on those and try and replicate them as much as possible. For example, we might feel safe and calm when we think of a beach or see the color purple, or when we are around a particularly supportive friend or family member.
 
The more flexible we become, recognizing that there is a state of safety and calm, not just the fight-or-flight and shutdown states, the easier we will ride the ups and downs of life. As Dr Gabor Mate once wrote, “it’s not about feeling better. It’s about getting better at feeling.”
 
Chris Warren-Dickins
Psychotherapist & Author
Counseling & Psychotherapy in Ridgewood, New Jersey