When You Are Depressed, How Do You Feel and Think?

When you go down into significant depression, the world becomes a dark place. What was bright, beautiful and exciting becomes flat, ugly and even sinister. Being depressed, you believe your spouse and children are better off without you. Nothing seems comforting, pleasurable, or worth living for. You feel that there is no hope for things ever improving. As you think about past events, your memories are rewritten and you experience them as confirming that everything has always been miserable, is meaningless and always will be full of hurt.

When you become depressed, there are real changes in how your memory works - you can only remember events, thoughts and feelings when you were similarly depressed: happy memories are physically out of your reach. What you believe seems absolutely real: anything that you think, hear or see that conflicts with your current beliefs becomes as unbelievable as a memory or message telling you that the sky is purple or people walk on the ceiling.

You are unable to feel love for a spouse, and if they remind you that you used to feel that love, you may firmly believe that were pretending - even though at the time you truly felt it. In your depression, you cannot remember feeling love, affection, enjoyment, excitement or any positive emotion, you cannot feel it now and so you conclude that you never felt it. In fact the more friends and loved ones tell you that you used to be happy, and will feel happy again, the more misunderstood and isolated you feel because you are convinced that it is not true and cannot be true.

As the depression descends, no one seems loving or lovable, everything irritates you, your work becomes boring and unbearable. Activities that take the slightest effort, feel as if you are wading through mud: what was challenging feels overwhelming; what was sad feels unbearable; what felt joyful feels pleasureless; and you seem to be swimming in an ocean of pain.

When you are depressed, the levels of some neurotransmitters (such Serotonin, Norepinephrine and Epinephrinein and their precursor Dopamine) can become abnormal in your brain and neural pathways causing you to feel intense pain that cannot be identified in any particular part of the body. Normally pleasant and comforting touch and embraces can feel painful to the point of tears. People seem remote on the other side of a glass bubble, no one seems to understand you nor care how you feel. From your isolation, people seem insincere to you, and everything seems meaningless.

So what I can do to help people escape depression when they come for counselling?

The answer is different for each person: however there are commonalities in the escape plan that we can build together. For some people, medication works well and I encourage them to see their doctor to be prescribed an SSRI (selective Serotonin reuptake inhibitor), SSNRI (Serotonin and Nor epinephrine reuptake inhibitor), TCA (Tricyclic antidepressant) or MAOI (Monoamine Oxidase inhibitor): there are quite a range of drugs currently on offer and it may take several attempts for you and your doctor to find what works for you.

Acupuncture, acupressure therapies and other energy centred approaches suit some people.

I have experience of offering talk therapy and Cognitive Behavioural therapy, on their own or with one of these other treatments.

Commonly we address five aspects of my client's personality: bodily presence, thoughts, emotions, behaviours and external factors.

• In exploring their experience of their body, we look at improvements in Nutrition, at using exercise and activity to improve health, at elimination or management of pain, and achieving physical comfort and enjoyment.


• As we address my client's thoughts, we will discover that our thoughts often interpret what we sense: how we interpret half a cup of coffee is up to us - is it half empty or half full? We may find patterns of thought that persistent and imprisoning and which we need to break. And we can notice that ruminating on the past can prevent us from thinking new and fresh thoughts about the present and future.


• Emotions are another area where changes can be fruitful. Accurately recognising which emotion they are currently in can be significant, and clients can be surprised when they link each emotion to what they sense in their body, what thoughts they can think and the memories and images they can access. My client may find they are stuck in one or two emotions (and actively avoiding other emotions): learning how to move into, through and out of each emotion into a different emotion is a key life skill.


• Mapping a client's regular behaviours is different for each person. There are ways of being that we learn in our early life from our families and sometimes the behaviour that we model is not good for us. There are also behaviours that we have learnt as a response to events in our lives but which lose their effectiveness with time so we need to adjust and redesign them to match today's needs. Some behaviours may have been left out of our education in the school of life: how to affirm ourselves, how to recognise what we enjoy, how to accept other people's love for us, and how to assert our needs and desires. Often the changes in behaviour that my client needs to make will support and empower the changes they need to make in their body, thoughts and emotions.


• The remaining aspect we consider are the external factors in my client's life. When bad things happen to good people, it is natural for them to feel low. Anyone who is the victim of violence, abuse, job loss, bereavement, redundancy - as well as warfare, disease, flood and famine - they can expect the jarring in their reality to depress them sooner or later. Of course we cannot necessarily cure the effects of these external factors so often the only relief available is in talking about and understanding these external factors.

I think everyone I meet who is depressed has a different experiences yet there are significant areas of commonality between depressions. This gives me hope that as I work with each new client, my past experience of counselling will be relevant as we build an escape plan that will suit this particular person.

So let me turn to the hard part of this article: if you recognise that you are depressed in how you think and feel, please do not just suffer in isolation, please act and reach out for help - find a counsellor who can accompany you as you escape from depression.

Adrian Pepper counsels people with personal difficulties and life issues - such as depression, anxiety, stress and anger management. You can contact him through Help 4 You Ltd, through his website at http://www.help4you.ltd.uk or by phone +44-7773-380133.

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