Depression

The presence of depression on an emotional level means that the person experiences an existential emptiness, continuous sadness, unbearable loneliness, and a lack of energy to do anything. Anhedonia is intense, meaning that the person cannot derive satisfaction from activities, people, and situations that were previously enjoyable, such as professional activities, family life, and social interactions. There is no desire for anything, interest in everything is absent, and the person avoids taking initiative. There is also a pervasive sense of guilt, while actions and thoughts become a constant source of disappointment and self-reproach. The individual experiences themselves as unworthy and inadequate in areas that are important to them, such as intelligence, success, health, and strength. The image that a person with depression has of themselves is characterized by five negative states: despair, hopelessness, helplessness, powerlessness, and inadequacy.

On a mental and cognitive level, intense pessimism develops. A person with depression perceives not only themselves but also the entire world in a negative way. There is a strong belief that things have always been this way in the past and will continue to be the same in the future. What the individual sees throughout the course of their life is only emptiness and endless suffering. There is also a general tendency to distort events. Whatever happens in their life is interpreted exclusively as the result of their own failure and responsibility. The person imagines their future filled with negative expectations. They constantly ruminate on thoughts about having very little energy or motivation to do anything. However, none of these thoughts is accompanied by concrete action that could help alleviate the problem.

On a physical level, the vegetative (autonomic) functions are affected, and sleep disturbances appear. A person with depression may have difficulty falling asleep, experience interrupted sleep, or, on the contrary, sleep for many hours without feeling rested. Usually, there is a very negative mood in the morning upon waking, which improves gradually as the day passes. Changes in appetite may also occur, either in the form of “more” (bulimia/overeating) or “less” (loss of appetite/anorexia). The person can no longer enjoy life.

For the diagnosis of depression, it is necessary for all of the above characteristics to be present together. Feeling sadness, insecurity, or a general sense of pessimism does not necessarily mean that someone is suffering from depression. The term depression is often used abusively, both in public discourse and in everyday language. In most cases this misuse is not intentional, yet it can still have misleading consequences.

For this reason, the identification of depression and its therapeutic treatment are the responsibility of a qualified professional, since there is no single diagnosis and no single treatment that can provide answers for every case. The diagnostic and therapeutic role of the specialist goes beyond the often stereotypical references to “depressive mood” that we hear around us and offers the most accurate possible assessment of the severity of the problem and the appropriate therapeutic interventions.

The key to dealing with depression is not fearful withdrawal in the face of the problem, but rather entering into a therapeutic alliance, where the client and the professional work together to effectively address the problem in its true dimensions. 

Very often, the feeling of sadness is confused with depression. However, its presence alone is not enough to conclude that a person is experiencing depression. For this reason, it is important to distinguish between normal sadness associated with grief and sadness that stems from melancholy. Sigmund Freud, in his work “Mourning and Melancholia,” describes these emotional states, which may appear similar but are, in essence, quite different. Therefore, it is useful to provide a clearer description of these distinct emotional experiences in order to avoid misunderstandings.

Mourning (grief) is generally a reaction to a loss. This loss may be either real (e.g., the death of a loved one) or symbolic (e.g., separation, loss of a job, etc.). The sadness caused by loss reduces interest in usual sources of pleasure and directs attention toward what is no longer present. A grieving person often withdraws from active engagement in life and may avoid forming new emotional attachments. Their energy is focused on mourning what has been lost. They need time and space to gradually readjust to life in the presence of this loss. As mourning comes to completion, the ego becomes free again from its inhibitions, and the individual’s life slowly regains its sense of interest and engagement.

Melancholy, while sharing some characteristics with mourning, involves a crucial difference: a disturbance in self-esteem. In this case, there is deep psychological pain and indifference toward the external world, similar to mourning, but the individual is also dissatisfied with themselves, viewing themselves as morally inadequate or unworthy, and may even expect punishment. Here, sadness does not follow a natural course toward resolution, but instead keeps the person emotionally stuck. There is emotional stagnation and fixation. The individual directs their negative feelings inward, toward themselves, leading to self-criticism and self-devaluation.

Thus, both in mourning and melancholy, the person experiences intense psychological pain and a loss of interest in the world. However, there is a key difference: in mourning, self-esteem remains intact, whereas in melancholy there is a significant lowering of the ego and a sense of inner impoverishment. As it is described by Freud: “In mourning, the world has become poor and empty; in melancholy, it is the ego itself that has become impoverished.” The essential point is that in normal reactions of grief, the external world is experienced as diminished, while in depressive states, what is experienced as lost or damaged is a part of the self itself.

The causes that may lead someone to develop depression throughout their life are many. These causes may have either external or internal origins. In the first case, depression appears as a response to external life events, which can be described as important “turning points” in a person’s life.

Such events may include intense emotional disappointment, such as divorce, loss of friends, social isolation, interpersonal conflicts, or the death of a loved one. Another category involves financial difficulties, such as job loss, retirement, or financial failure. In addition, traumatic experiences can act as significant triggers for depression, such as a serious accident or the onset of a serious or chronic illness, where the individual must grieve the loss of their previous state of health or life.

However, people do not respond in the same way to these external circumstances. Some individuals manage to overcome these difficulties and adapt to new life conditions, while others struggle to recover. Their emotional pain may feel endless, leading them to sink into depression. In such cases, external events interact with deeper, more enduring aspects of the individual’s psychological structure, forming a melancholic background. These may include prolonged stress, pathological fears, low tolerance for frustration, pessimistic beliefs, obsessive thoughts, a tendency toward dependency, complicated grief, loneliness, and lack of social support.

When depression has an internal origin, it may emerge spontaneously, without the person being aware of any specific disappointment or hardship that could explain it. In this state, psychological energy seems to disappear, and there is a sense of complete mental and emotional inertia. The individual may have some awareness of what is happening, yet they cannot find anything that motivates or engages them. This condition resembles a state between sleep and wakefulness, where activity and desire are significantly diminished.

In an attempt to escape this inner inactivity, the person often becomes trapped in a rigid, moralizing attitude toward themselves. They may want to overcome this emotional discomfort, yet at the same time feel that their willpower is insufficient. This leads to feelings of inferiority and guilt, especially when they give in to this emotional withdrawal. In reality, however, nothing drains a person’s energy more quickly than a vague and unfocused sense of guilt. Frustration becomes an internal psychological process, continuously turning inward and repeating itself within the individual.

It is very important, when we want to change our emotional state, to first be able to accept it. If we feel ashamed of or deny what we are feeling, we cannot move forward. Paradoxically, depression and the negative emotions we experience can become a powerful opportunity for positive change in our lives. The uncomfortable energy of these emotions pushes us to search for ways to feel better. We can make use of this inner drive to bring about meaningful changes in ourselves and in our lives. In this sense, difficult events, situations, and emotions can become opportunities for personal growth.

However, free will alone is not enough to take advantage of these opportunities. As it has been aptly said, “I see the better and approve it, yet I do the worse.” Our free will does not automatically translate into action. In reality, we often find ourselves unable to stop sinking into negativity, despite our desire to change. At such moments, it may feel as if we have no choice, or—what amounts to the same thing—that we are unable to act according to our will.

We can also observe the following: when a new problem arises in life, for which our previous way of adapting is no longer sufficient, it is natural to feel that we lack the psychological energy to cope. It is as if “the glass is overflowing.” This may be happening because an old chapter of our experience has come to an end, and what we need for the new situation is something not yet known to us. This sense of withdrawal, however, is necessary, as it gives us the opportunity to reposition ourselves differently in life. If we interpret this withdrawal with self-blame, we may label ourselves as lazy, incapable, or weak, thereby perpetuating a cycle of negative emotions.

When we constantly feel guilty or like failures, we enter a mental state that paralyzes any possible effort. If we remain attached to this negative self-perception, we stop trying, stop learning, and deny ourselves the opportunity to grow, becoming disconnected from life. In reality, the emergence of a new problem is an invitation to reinvent ourselves, to reorganize our experience in a more constructive way, and to move toward paths we may never have imagined before.

Ultimately, this is an opportunity to enrich our very existence.

A basic characteristic of depression is that it overcomes the individual’s will to motivate themselves. As a result, there is a gradual weakening of willpower and its replacement by a sense of passivity and resignation. In such cases, the recommended approach is through psychoanalysis or psychotherapy. This is an individualized form of treatment, as there cannot be a single diagnosis that applies to all cases. The symptom is unique to each person and therefore requires individualized analysis, since it does not follow universal rules but instead creates its own specific logic, which must be recognized and studied on its own.

The purpose of this process is, through communication with a professional, for the individual to express themselves and gradually gain deeper awareness of their condition. They may discover the underlying causes of their distress, which they had not yet recognized. This awareness helps them to better respond to the present and reduce the likelihood of future depressive episodes.

It is important to emphasize that the experience of depressive symptoms does not necessarily lead to an understanding of their causes. In some cases, the intensity of the symptoms is so strong that it prevents the individual from even formulating the question of their origin. For this reason, it is necessary to move beyond the level of symptoms and begin a deeper exploration of their underlying causes. However, this process is often difficult without the help of a specialist.

Another approach proposed by psychiatry is the use of antidepressant medication. These medications act as regulators of serotonin levels, aiming to restore chemical balance in the brain. There is a wide variety of antidepressants, and they affect each individual differently. Therefore, if one medication is not effective, another may help. For this reason, they should only be prescribed by a qualified medical professional.

However, it must be emphasized that medication does not replace psychotherapy, which should continue throughout the duration of the pharmacological treatment and beyond. Medications work at the level of symptoms and provide relief, but they do not address the underlying causes, the identification and resolution of which are the responsibility of psychotherapy alone.

Some suggestions for improving your mood are the following:

• Try to accept yourself, even if you feel sad. Do not feel bad about feeling bad. Give yourself permission to feel, to be vulnerable, and to need help.

• Share what you are feeling with people you trust and feel comfortable with.

• Avoid making important decisions while you are experiencing depression.

• Avoid alcohol and drugs, as they worsen rather than improve your mood. • Try not to get discouraged if emotional distress does not pass quickly. Allow yourself to take the time you need.

• Let go of the need for things to be different from what they are.

• Do not see yourself through your shortcomings. Every person is, in essence, complete as they are. Try to see yourself from the perspective of your wholeness and begin to build on that.

• Do not become attached to future-oriented expectations that prevent you from finding satisfaction in the present.

• Transform inactivity into creativity.

• Sometimes we are so clouded by anger, pain, or low mood that we cannot see the opportunities in front of us. Focus on what you have in the present.

The difficulty with these suggestions is that it is not enough to simply read them in order to overcome depression. Even though someone may recognize them as true and helpful, they often struggle to apply them. This happens because they are experienced as “obligations” or external commands, as “categorical imperatives” which, although perceived as valid, have not yet become an inner desire. The individual needs to reconnect with the flow of their own desire and gradually integrate some of these attitudes into it. In this process, the role of psychotherapy and the psychotherapist is particularly important.