Depression isn’t something you just wake up with one morning and it doesn’t always present itself as you imagine it should – depression can and does subtly advance, until before you know it, you feel utterly engulfed every day, and ‘just functioning’ becomes an act of survival.

Depression can wear lots of faces

Whilst having prolonged periods of feeling down, little interest or pleasure in doing things, lacking in energy and trouble concentrating are all classic symptoms of depression that are widely referred to and assessed in the PHQ9 (Patient Health Questionnaire), over the years in therapy I’ve heard it (and seen it) described as so much more, and it’s these more subtle signs of depression that you really shouldn’t ignore.

Depression can make you feel hopeless. Those things that used to give you joy, no longer even touch the sides, and it’s not something you can ‘think yourself happy’ or ‘snap out of’, it is a genuine sense of hopelessness.

Getting out of bed in the morning becomes a major feat in itself, a battle of wills, because no matter how much sleep you’ve had, it never feels enough, and whilst sleep may have once been your ‘go to’ for a serotonin brain bath, when you are depressed no amount of sleep ever feels enough to feel energised enough to take on the day.

The point (your purpose) becomes lost in a fog induced haze. Even knowing who you are can begin to feel like a distant memory, and those daily acts of self-care and personal hygiene tasks get harder to maintain, it is energy you simply do not have. Depression hits motivation hard.

Anger, frustration, and limited patience can become a part of daily life. It’s often these subtle changes in the people we love that give us the biggest clues that they are suffering.

And sadness, the kind you can feel in your bones envelopes you. For some, that sadness makes them tearful, and it can mean withdrawing and disconnecting from the very things that they need, because the effort to appear ‘OK’ becomes too much.

As well as:

  • Self-medicating.
  • The pursuit of perfection.
  • Extreme feelings of Guilt.
  • Feeling worthless.
  • Thoughts that you/others would be better off with you not here.
  • Changes to your appetite.

We all have a limit and a tipping point

Life throws massive curveballs at us, and sometimes those curveballs are just so big, or they come in such rapid succession that they knock us to the ground. They hit us all, and we don’t get to choose how, or when, or the intensity – and depression is often the first sign that we’ve breached that tipping point.

We know that depression is associated with stressful life events, and that major depressive disorder (MDD) is associated with chronic life stress. We also know that people with a history of childhood trauma are twice as likely to develop MDD (Heim & Binder, 2012) and that in utero stress also increases the risk of MDD in later life (Stein et al., 2014).

There is a current drive in Psychology to look at the specific types of stress that are most associated with MDD, and there is a body of research looking at the role of the 5-HTT gene and how polymorphisms in the 5-HTT gene appear to moderate the impact of early negative childhood experiences on susceptibility to stress related depression in later adulthood.

We all differ in terms of what we perceive to be stressors (the stimuli or situations that we believe to be adverse or threatening) which are ultimately influenced by how well we believe we can cope.

Stress in itself is a pattern of psychological, biological and behavioural responses caused by those stressors.

When our stress response is triggered, it activates the hypothalamus, which in turn activates our SNS (sympathetic nervous system) which then stimulates the release of the hormones adrenaline and noradrenaline from the adrenal gland into our bloodstream – often referred to as our ‘fight or flight’.

The very same stress response also activates our HPA (hypothalamus pituitary adrenal) axis response and it drops a corticotrophin hormone into the pituitary gland which in turn secretes cortisol and the combination of these two key responses becoming activated releases 3 key stress hormones into the circulation.

Our stress response serves a catabolic function

It mobilises our body and brain for ‘fight or flight’ and it’s highly adaptive, it has evolved to enable us to deal with acute (short lived) environmental threats requiring physical action. But todays stressors, are often “more psychological vs physical and are maintained by worry and are longer lasting” (Sapolsky, 2004).

During chronic stress there is frequent and prolonged activation of the HPA system which leads to damage and disruption of our biological systems – depression is associated with chronic life stress, and when those curveballs keep on coming they activate the stress response on a more long term basis, it can feel like there is no ‘off switch’ and the stress response becomes more damaging than the stressor itself. In Psychology, we refer to this as the ‘allostasis and allostatic load’.

Allostasis is a stress response which allows our body to deal with stressors by changing our biological systems, and these allostatic changes are adaptive in the short term.

Whereas the allostatic load is a frequent or prolonged activation, and it can have a negative impact on our health and trigger stress related illness. In fact there is a whole school of knowledge known as ‘Psychoneuroimmunology’ or ‘PNI’ for short which explores the stress vs immune system relationship.

Chronic stress impacts our immune system, and can lead to problems in both our physical health and our cognitive health.

High levels of cortisol can lead to changes in brain function at a cellular level, we know that BDNF (Brain derived neurotrophic factor) is a really important chemical in neurogenesis and that this chemical is significantly lower in people who have depression.

Imagine a world where there is no shame in mental health/mental illness.

Where people could talk openly about their struggles and thoughts without judgement. Without the label of ‘attention seeking’ and without feeling that they have failed, or they are weak, or that people will see them in a different light for ‘not coping’ or ‘falling down’.

People only see a very small part, or the current load of the load others carry, and have very often been carrying their entire life.


Conversely, when it comes to our physical health, people don’t hold back, yet our brains are a physical part of who we are. Our brains are a physical structure – they produce our mind and behaviour – but our behaviour and experiences also have the ability to modify the structures in our brains. The interactions between our brain and behaviour are in fact reciprocal.

You could argue that our brains are our most formidable organ, because collectively over time they have produced the entire universe of knowledge we have as humans and with 86 billion neurons and 10 trillion synapses in each and every human brain, it’s no wonder that our mental health might have periods of both good and bad throughout our lifetime.

We are not machines

We are human beings responding to the world around us, and each of us experiences the world in a different way – there is still so much of the human mind and our level of consciousness that even neuroscientists and psychologists don’t understand. Just as we are a work in progress, our brains too are evolving and changing over time to keep up with us.

So be kind to yourself and be kind to each other, and most importantly, talk about your mental health as openly as you would any other aspect of your health.

Reach out for help if you are feeling depressed, and be really aware of the allostatic load you’ve been under/or are under, because those sophisticated ways you’ve adopted and adapted over time to enable you to cope with the stuff in your head and the trauma you have experienced have a shelf life too.

Sharing the load in your head is not a sign of weakness

Talking about the stuff in your head does not make you a burden to others.

You are not a failure for reaching out and asking for help.

What you are feeling is wholly relative to your life and your experiences. Please don’t compare your load with the next persons’ load. It is your load, and only you have experienced carrying it.

A mental health crisis is often the point where the outside world and the people you love realise just how long you have been holding it all together literally by a thread. It’s a massive call to action to yourself and to the people around you.

If you’re experiencing any symptoms of depression, including the more subtle ones, reach out and talk to someone before you get to crisis point. Whilst there’s no magic treatment for depression, there are treatments that do work.

It’s about finding the right one for you.


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