[wozniacki]

Without sounding insensitive, may I ask what it is - that you think - that is at the root of this stripe of depression that you seem to be well acquainted with.

I know that this sort of thing cannot be easily summed up.

However, most of us on the outside have little clue about what sets these things in motion, for various individuals, in the first place.

Broadly and typically, is it a fundamental disillusionment with (and thereby rejection of) the state of affairs of the world and the person's place in that world?

Is it a sense of (perceived) total betrayal of the social contract?

I'm sure any elaboration would help others understand this better.

[thaumaturgy]

For me, it seems to be multi-faceted. There's definitely some kind of mood swing component that seems entirely biological; regardless of whether things are going well in life or not, there are periods of between a week and sometimes as long as a month where I simply have difficulty getting up in the morning, focusing, socializing, and maintaining healthy habits like regular exercise. Usually my sugar consumption skyrockets when this happens and I keep bad hours and the cycle feeds into itself.

Then there seems to be a slightly greater sensitivity to problems. Outwardly, I can power through a lot of problems -- financial trouble, management, work, personal life stuff, whatever -- but inwardly, it kills me a little bit.

Annoyingly, other people's problems bother me a lot too, extending all the way out to sociological issues. I think this is part of what created David Foster Wallace's famous speech, "This is Water" (https://www.youtube.com/watch?v=8CrOL-ydFMI) -- he eventually committed suicide. But this can also be a strength, it's what drives me to try to make a difference.

Anyway, the real trouble begins when I'm in a biological downswing and things in life start getting really hard. In a single year, I lost most of my friends over a disagreement, my parents both had serious issues (and I was their counselor for much of it), my business was struggling, and the effort I had put into training for search and rescue all Summer got wasted when the vehicle I was driving died on the way up to the final exam. It was just a lot of stuff all at once, so when the mood problems hit, I barely functioned at all for about a month.

The only common theme that I think I've found so far among people who struggle with depression is a feeling that nobody cares about them, or that they're undervalued in some really big way. Struggling with depression is challenging; struggling with it alone is extremely difficult.

On the other hand, because of the social stigma it currently carries, few people want to make a big deal of depression when they're struggling with it.

So, if you think you know someone who's having trouble with it, it can sometimes help them a lot to just initiate contact and suggest spending just a little bit of time doing something they enjoy: a card game, going out for a bit, watching TV, whatever. It doesn't have to get heavy. It'll help them to know that somebody cares.

[mhenr18]

Man, the mood swing part rings true for me. In my case they're usually 1-2 weeks. There's some anxiety/depression on my mother's side of the family but I wouldn't say that I've got any issues with it.

Now I'm curious as to whether the mood swings are more common, or whether that's actually something I should look into. If there is an underlying issue I need to resolve then it might have been masked by my relatively good run of things.

[thaumaturgy]

It can worsen (or improve) with age or biology. If you can, it could be worth finding a doctor you trust and talking to them about it, and try to determine whether it needs to be addressed or not.

[osteele]

[I'm not the grandparent poster, but in case it's useful:]

Allie Brosh in Hyperbole and a Half puts it as well as I've seen http://hyperboleandahalf.blogspot.com/2013/05/depression-par...

One aspect is the anhedonia (joylessness); another is the pain.

I suppose you might call some of this “disillusionment”, but that makes it sound cognitive, and intellectual, and amenable to argument and reasoning. Whereas it's more an affective and emotional state, not a set of propositions or an intellectual theory about the world.

When I'm not depressed, it's not that I believe intellectually in a god or a purpose to life any more than when I am depressed. It's just that my non-depressed self generally enjoys being alive; or that when he doesn't, he knows that he can wait out a period of blah or even normal-grade sadness or grief to reach a point where he'll again experience moments of joy.

When I am depressed, the subjective experience of being alive is at best deadened and deadening (although my depressed self knows intellectually, from experience, that he'll reach the other side), and at worst so actively painful that it doesn't seem like any period of happiness at the other end could be worth suffering through the bad stretch. As though someone said we're going to torture you on the rack now, but after a month or two you can have a lollipop, so just hang in there.

Anyway, read the Hyperbole and a Half comic. I don't know how many people who have been depressed are depressed in the way that Allie Brosh was, but she nailed it for me.

[ghswa]

I'll chime in here, if you don't mind - I'm bipolar[1].

My health often deteriorates for short periods of time, perhaps a day or two, sometimes a week or so. In these situations there is often some trigger - high workload, poor sleep hygiene etc. My mood doesn't usually reach such an extreme that it causes any significant difficulty day to day.

Episodes of illness that have a significant detrimental impact on day to day life seem to build up slowly. They start out like the episodes described above but they just keep on going until my mood is so extreme that day to day life becomes very difficult to deal with.

My most recent episode of this nature was probably caused by the stress of a couple of deaths in the family, a daughter who doesn't want to sleep, a wife commuting across country to work, a high workload myself and (frustratingly) mental health services not providing care when I could see my health was deteriorating.

It's been around 6 years between my last two episodes of that nature.

Poor sleep hygiene is by far the biggest risk for me and it becomes a vicious cycle if I'm in a manic phase. Other than that, continued high levels of stress are a problem but only really if I'm dealing with multiple stressors.

[1] http://en.wikipedia.org/wiki/Bipolar_disorder

[patrickdavey]

Do you keep a sleep diary? Are you aware of when your patterns are changing?

One thing that I find helps is a 'mental contract' with my partner.. if she thinks I'm getting elevated etc. then she has a contract which she can enforce and basically frog march me off to the doctors to get a strong sleeping pill for a week or whatever it'll take. Note, she's never had to use it, but having it has given both she and I peace of mind.

7 years and counting here.

And, while I was going to post this on a throwaway account, whatever, my own trigger for bipolar was a 10 day vipassana meditation course. There's audio etc. detailing why I went on the course, what it was like to be manic, sectioned under the mental health act, Depression (with a capital D), and getting better again... at : http://livingvipassana.blogspot.com

Now, 7 years clear, doing very well, and, while I'd not repeat the experience, I feel like I learned a heck of a lot about what humans can go through.

And trying to walk on water was fun ;) (didn't work)

[peterkelly]

Clinical depression is often a result not of one's external environment or social situation, but a chemical imbalance in the brain (Serotonin in particular). I'm certainly no expert on the topic, but from what I know science still doesn't have a definitive answer to what brings such an imbalance about. Also it is sometimes hereditary.

External factors (financial/relationship problems and the other various pressures of life) can contribute to the problem and either be a trigger for or worsen the symptoms. But there are many instances in which someone who is otherwise successful and happy with things in general (as it sounds like this man was) can suffer from it. Everything can be going fantastic in your life, but the "black dog" comes visiting nonetheless.

[Mz]

I cannot answer for Rob, but there can be significant bio-medical factors. I am not really prone to depression. If I am depressed for more than a short period of time, you can bet I am anemic, not sleeping well enough, etc. But I have a serious medical condition and have lived with quite a lot of crazy-making stress over the years. If my brain chemistry is wonky enough, I can be suicidal, in spite of not being the depressive type.

I know a fair amount about such things. I suspect bio-medical/brain chemistry issues are much more common than is generally recognized. I manage a lot of my issues in part with diet. I think a lot more can be done. But I don't know how to get the word out.

[mikeash]

Mental illness is a physical disease, not something to do with "disillusionment" or anything like that.

Depressed people can be disillusioned, of course, but that is a symptom, not a cause. The cause is still somewhat mysterious, but it's biological, physical, not an attitude thing.

[dreamdu5t]

According to what? You assert that the cause is "still somewhat mysterious" (you mean completely?) in the same sentence you claim the cause is biological. That's pretty contradictory.

[mikeash]

No it's not. You can have an idea of the general area where the cause lies without knowing precisely what it is.

For example, there are clear genetic factors in mental illness, which can be seen in the same way that genetic factors for any disease are studies. This doesn't tell you which genes cause it, let alone how they cause it, but it still tells you that it's a biological thing.

[dreamdu5t]

There are not. There are no conclusive genes or genetic markers for depression. All that is required for someone to be depressed is to self-report as depressed and experiencing those symptoms.

[mikeash]

Just because the specific gene hasn't been identified doesn't mean it isn't known to have genetic factors:

http://en.wikipedia.org/wiki/Major_depressive_disorder#Cause...

"In addition, a Swedish study estimated the heritability of depression—the degree to which individual differences in occurrence are associated with genetic differences—to be around 40% for women and 30% for men...."

You seem to think that we must either know the exact cause, or we know nothing about the cause. That is simply not true.

[dreamdu5t]

No, I think psychology has medicalized a range of normal emotions and behaviors, like sadness and anger for example, and that there is not necessarily any such disease as depression. I know that's not PC and some may find that shocking, but it's pretty plausible when you look at the history of psychology.

Since I've already crossed the PC/shocking line... It's amazing the similarities between SSRI's and lobotomy. The mechanism of action isn't fully understood, yet some people are improved, and some people are made worse, and everyone has side effects. It was considered a breakthrough at first, then followed by controversy as people began to question the mechanism of action, the ethics of forced surgery (forced drugging) etc.