David Baxter PhD
Late Founder
The Slide Into Depression: Untold Stories
by Jonathan Rottenberg, Ph.D.
March 19, 2011
Musings on the scientific and human aspects of the slide into depression
An Illustration of the Typical Phases of Depression
Increasingly, our epidemiology demonstrates that depression has several phases, each with distinct characteristics. Acknowledging these phases, depicted in the figure above, yields insights, but also points to new research and clinical challenges.
A first insight is that it's rare for serious depression to come on all of the sudden. It does happen, just not very often. Usually, deep depression is preceded by an onset phase of low mood. This onset phase might last weeks or months, or even years, in which a person drags around with moods that are sad and heavy as well as moods that are anxious and foreboding.
These low moods of the onset phase are often the harbingers of serious depression to come. The mood states are unpleasant but they are also familiar. Everyone has had times when they felt pessimistic, found fault with nearly everyone and everything, and felt unmotivated to pursue new ventures.
The next phase, however, involves a slide into more serious depression. In this phase, ordinary sad mood is transformed and transmuted into something strange and terrible. It's a netherzone where the depressed person is exiting the world of common experience and entering their own intensely private zone of pain.
It strikes me that if we are to better contain depression we need to zero into exactly what happens during this phase of worsening. We need a stronger scientific and humanistic accounting of what happens during the slide. Here I ofter a few thoughts about the human part of the equation, how people respond to the acute worsening of low mood. The diversity of people and of depression never ceases to amaze me, and there's no reason to think that our literary and scientific accounts of the slide will be unified. I suspect that when the dust clears, there will be three main themes or patterns.
For a first group, the slide is freakish and terrifying. Sensations during the slide can involve perceptions of physical weakness and/or pain and/or moods that leave the normal realm of language to the realm of the indescribably bad. The slide can also involve dramatic new symptoms that are noticeable to others, as when a person stops eating and drops 15 pounds. For this group, the slide sends a clear alarm signal that something is seriously wrong. This alarm can be enough in and of itself to drive the person into seeking treatment.
Of course we know that in the US most people who go through an episode of depression do not seek treatment and even when treatment is sought, it is sought after the slide, when the person has hit bottom, or even is delayed by years, until the next episode. What this implies is that for a second group of people, the slide into the strange world of serious depression is accompanied by denial. These are the brave who often try to heroically conceal that they are depressed and will tell stories to themselves and others to dispel the bogey of depression (i.e., I must have mono). Make no mistake, the stigma of depression still stalks the land, a close ally of denial. There will be danger when denial collapses and turns to desperation. At this moment, the person might seek drugs or alcohol to ward off plunging low moods or even fantasize about suicide to impose an endpoint.
However, for still others, the slide will be a return, a return of something strange. Depression is a recurrent condition. And the majority of episodes of depressions are recurrences not first onsets. The moment of return can be a double-edged sword. On one edge, the slide can be met with a resignation that borders on acceptance. For those who have experienced many episodes of depression, this resignation can be fortified with resolve. If you've already been to the bottom and back, you know in your bones that recovery is more than a theoretical possibility. Cutting the other way, if you've slid down before, you know there's a good chance that depression may get worse, before it gets better. Although, the slide offers no easy resting place for anyone, this may be especially true for those who have been depressed before.
Jonathan Rottenberg is an Associate Professor of Psychology at the University of South Florida, where he directs the Mood and Emotion Laboratory:
by Jonathan Rottenberg, Ph.D.
March 19, 2011
Musings on the scientific and human aspects of the slide into depression
An Illustration of the Typical Phases of Depression
Increasingly, our epidemiology demonstrates that depression has several phases, each with distinct characteristics. Acknowledging these phases, depicted in the figure above, yields insights, but also points to new research and clinical challenges.
A first insight is that it's rare for serious depression to come on all of the sudden. It does happen, just not very often. Usually, deep depression is preceded by an onset phase of low mood. This onset phase might last weeks or months, or even years, in which a person drags around with moods that are sad and heavy as well as moods that are anxious and foreboding.
These low moods of the onset phase are often the harbingers of serious depression to come. The mood states are unpleasant but they are also familiar. Everyone has had times when they felt pessimistic, found fault with nearly everyone and everything, and felt unmotivated to pursue new ventures.
The next phase, however, involves a slide into more serious depression. In this phase, ordinary sad mood is transformed and transmuted into something strange and terrible. It's a netherzone where the depressed person is exiting the world of common experience and entering their own intensely private zone of pain.
It strikes me that if we are to better contain depression we need to zero into exactly what happens during this phase of worsening. We need a stronger scientific and humanistic accounting of what happens during the slide. Here I ofter a few thoughts about the human part of the equation, how people respond to the acute worsening of low mood. The diversity of people and of depression never ceases to amaze me, and there's no reason to think that our literary and scientific accounts of the slide will be unified. I suspect that when the dust clears, there will be three main themes or patterns.
For a first group, the slide is freakish and terrifying. Sensations during the slide can involve perceptions of physical weakness and/or pain and/or moods that leave the normal realm of language to the realm of the indescribably bad. The slide can also involve dramatic new symptoms that are noticeable to others, as when a person stops eating and drops 15 pounds. For this group, the slide sends a clear alarm signal that something is seriously wrong. This alarm can be enough in and of itself to drive the person into seeking treatment.
Of course we know that in the US most people who go through an episode of depression do not seek treatment and even when treatment is sought, it is sought after the slide, when the person has hit bottom, or even is delayed by years, until the next episode. What this implies is that for a second group of people, the slide into the strange world of serious depression is accompanied by denial. These are the brave who often try to heroically conceal that they are depressed and will tell stories to themselves and others to dispel the bogey of depression (i.e., I must have mono). Make no mistake, the stigma of depression still stalks the land, a close ally of denial. There will be danger when denial collapses and turns to desperation. At this moment, the person might seek drugs or alcohol to ward off plunging low moods or even fantasize about suicide to impose an endpoint.
However, for still others, the slide will be a return, a return of something strange. Depression is a recurrent condition. And the majority of episodes of depressions are recurrences not first onsets. The moment of return can be a double-edged sword. On one edge, the slide can be met with a resignation that borders on acceptance. For those who have experienced many episodes of depression, this resignation can be fortified with resolve. If you've already been to the bottom and back, you know in your bones that recovery is more than a theoretical possibility. Cutting the other way, if you've slid down before, you know there's a good chance that depression may get worse, before it gets better. Although, the slide offers no easy resting place for anyone, this may be especially true for those who have been depressed before.
Jonathan Rottenberg is an Associate Professor of Psychology at the University of South Florida, where he directs the Mood and Emotion Laboratory:
"I am interested in hearing your story of your slide into depression. If you are comfortable sharing your story via email and/or are interested in being interviewed for my book, please email me at chartingthedepths@gmail.com."
