I was nine-years-old when I first legitimately contemplated suicide. I had a plan, thanks to my late mother who outright taught me in which direction to cut my wrists and in which area of the home I could carry out the plan to completion.
Back then, I didn’t know why I felt the way I did. I only knew that my mental and emotional state seemed to be different from other children with whom I attended school and that my body often felt so heavy that moving from place to place sometimes took considerable effort.
The effects of trauma in childhood likely influenced my condition, though may not have caused what would later in life be diagnosed as major depressive disorder (MDD), recurrent, and at times severe. I was said to experience chronic history, as well.
Explaining this mental illness condition, a psychiatrist informed me that my serotonin levels were low and psychopharmacological treatment (medicine) could help bring my chemicals into balance. Thus, I was prescribed selective serotonin reuptake inhibitors (SSRIs).
Colloquially speaking, depression relates to sorrow (sadness) – hence the namesake of this blogpost. However, this common parlance description is inadequate at encapsulating what depression actually represents. According to the American Psychiatric Association:
Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home.
Depression symptoms can vary from mild to severe and can include:
· Feeling sad or having a depressed mood
· Loss of interest or pleasure in activities once enjoyed
· Changes in appetite — weight loss or gain unrelated to dieting
· Trouble sleeping or sleeping too much
· Loss of energy or increased fatigue
· Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others)
· Feeling worthless or guilty
· Difficulty thinking, concentrating or making decisions
· Thoughts of death or suicide
It’s natural to feel sad from time to time. For instance, this healthy negative emotion may occur if someone you love suddenly dies. While not everyone will experience sorrow given this circumstance, I think it’s logical to suggest that many or even most people would.
I keep this in mind when practicing Rational Emotive Behavior Therapy (REBT) – a psychotherapeutic modality that aims to help people get better and lead healthy lives based on rationally thinking. After all, sorrow is a naturally occurring emotion and doesn’t need to be pathologized.
Nevertheless, when a person uses unfavorable assumptions about an event such as death and exacerbates the already sorrowful experience, it’s possible to needlessly suffer due to one’s irrational beliefs. This self-disturbing process occurs with MDD, as well.
According to the American Psychological Association, “Depression is the most common mental disorder.” When I was first diagnosed with this condition, I wasn’t told about how my beliefs could aggravate symptoms of depression.
Of course, my declaration in this regard isn’t meant to blame the helpful psychiatrist with whom I had a strong therapeutic alliance. She was likely doing her best to treat me given available information at the time.
My prescriber told me that scientific data supported her approach to clinical intervention on my behalf. Thus, she tried me on a number of medications – all of which had various side effects and none of which were suitably effective for my interests and goals.
Oddly, some medications caused irritability. Another produced significantly more suicidal ideation (thoughts). For example, I recall sitting in my apartment and thinking something like, “What am I going to do today? Oh, I could kill myself. It’s either that or watch a movie.”
Without my psychiatrist’s knowledge, I then inadvisably discontinued all medication and that unwise decision caused even more discomforting side effects. I had intermittent shocking sensations in my head and throughout my body.
I also bumped into walls when walking, had significant brain fog (confusion), and experienced unexplainable weepiness. It would be an understatement to assert that when my psychiatrist discovered I was med-noncompliant, she was displeased. I received stern reprimand from her.
My beliefs about why I wasn’t getting better when on meds led to a miserable condition. When on them, I gained over 100 pounds, my libido was essentially nonexistent, and I couldn’t connect emotion to experiences (numbness).
I recall around that time in my life a friend of mine confided in me during a difficult event he experienced. What was described as one of the worst days of his life was a typical day that ended in ‘Y’ for me.
Part of the reason I chose to enter the field of care for mental, emotional, and behavioral health (“mental health”) was due to my typical experience which was apparently atypical for the United States population as a whole. Later, I began working in a mental health clinic that served 21 counties.
With funding to treat schizophrenia, bipolar disorder, and chronic MDD, I provided case management for clients who received treatment form clinic psychiatrists. It was then that I realized most of the clients on my caseload with MDD had similar experiences as I.
Psychopharmacological intervention was only partially effective. Prior to that understanding, I’d internalized the poor intervention response to medication as a defect in my character. Irrationally, I believed something was wrong with me and that’s why meds weren’t working.
A little over a decade later, researchers suggested why the clinical intervention strategy was so ineffective. In one study, researchers conducted systematic reviews, assessed meta-analyses, and examined large data-set analyses to reach an ‘umbrella review’ conclusion:
Our comprehensive review of the major strands of research on serotonin shows there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity. Most studies found no evidence of reduced serotonin activity in people with depression compared to people without, and methods to reduce serotonin availability using tryptophan depletion do not consistently lower mood in volunteers. High quality, well-powered genetic studies effectively exclude an association between genotypes related to the serotonin system and depression, including a proposed interaction with stress.
For context, imagine that for many years the leading theory about body composition posited that people reached maximal healthiness at any given weight. Then, an astonishing report is released and which claims that obesity and being overweight contribute to type 2 diabetes.
I use this comparison with intention, because I was told for many years that SSRIs treated a serotonin deficiency, much like medicine is used to treat type 1 and 2 diabetes. However, the aforementioned study refuted the scientific evidence supporting serotonergic agents (i.e., SSRIs).
After validity of the serotonin hypothesis was questioned, another set of researchers reviewed the study and concluded that “there are some reliable abnormalities in serotonin mechanisms in depressed patients but their potential role in the causation of illness remains to be determined.”
It appears as though not all people who practice science agree with one another. A separate study was conducted to examine refutation of the serotonin hypothesis and researchers concluded:
[T]he methodology is inconsistent with an umbrella review, with substantial bias created by the authors’ chosen quality criteria, selective reporting, and interpretation of results. There is an underappreciation of the complexities of neuroscience and neuropsychopharmacology, and it is therefore impossible for the reader to draw valid or reliable conclusions […] The proven efficacy of SSRIs in a proportion of people with depression lends credibility to this position.
Science can be messy. Scientific data can be noisy. Scientists don’t always agree. While I’m inclined to favor the umbrella review study supporting my lived experience, I’m aware that motivated reasoning of this sort is predicated upon irrationality.
Setting aside bias as much as one is capable of doing, I acknowledge that there are no absolutistic or perfect answers which may satisfy questions I’ve had about my experience with MDD since childhood. As well, I appreciate how a separate set of researchers concluded:
Drawing conclusions about the specific involvement of serotonin alone in depression is difficult due to the many intertwined transmitter systems, such as dopamine and glutamate, and other cell types, such as astrocytes and microglia, that are increasingly coming into focus.
Alas, sad science carries on. Likewise, so do I. Although I may never find suitable answers to questions I have about MDD, and though I may not receive an adequate psychotherapeutic intervention, I no longer needlessly disturb myself with unhelpful beliefs about my condition.
Rather, I unconditionally accept that I am as I am. If you experience symptoms of MDD and upset yourself with unproductive beliefs about your condition, I may be able to help you learn helpful techniques to stop exacerbating the effects of mental illness.
If you’re looking for a provider who works to help you understand how thinking impacts physical, mental, emotional, and behavioral elements of your life—helping you to sharpen your critical thinking skills, I invite you to reach out today by using the contact widget on my website.
As a psychotherapist, I’m pleased to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.
At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply helping you to feel better, I want to help you get better!
Deric Hollings, LPC, LCSW
References:
American Psychiatric Association. (2020, October). What is depression? Retrieved from https://www.psychiatry.org/patients-families/depression/what-is-depression
American Psychological Association. (n.d.). Depression. Retrieved from https://www.apa.org/topics/depression
Bremshey, S., Groß, J., Renken, K., and Masseck, O. A. (2024, March 13). The role of serotonin in depression—A historical roundup and future directions. Journal of Neurochemistry. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/jnc.16097
Hollings, D. (2022, November 18). Big T, little t. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/big-t-little-t
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Hollings, D. (2022, March 24). Rational emotive behavior therapy (REBT). Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/rational-emotive-behavior-therapy-rebt
Hollings, D. (2022, November 1). Self-disturbance. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/self-disturbance
Hollings, D. (2022, October 7). Should, must, and ought. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/should-must-and-ought
Hollings, D. (2023, August 6). The science. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/the-science
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Hollings, D. (2022, July 11). Unconditional acceptance. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/unconditional-acceptance
Hollings, D. (2024, March 18). Unhealthy vs. healthy negative emotions. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/unhealthy-vs-healthy-negative-emotions
Hollings, D. (2024, April 17). Wishes, dreams, and goals. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/wishes-dreams-and-goals
Jauhar, S., Arnone, D., […] Cowen, P. J. (2023, June 16). A leaky umbrella has little value: evidence clearly indicates the serotonin system is implicated in depression. Molecular Psychiatry. Retrieved from https://www.nature.com/articles/s41380-023-02095-y
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Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., and Horowitz, M. A. (2022, July 20). The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry. Retrieved from https://www.nature.com/articles/s41380-022-01661-0
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