Depression is Real — and Not All Depression is the Same
This article was co-authored by Andre Burey, MD, and Amanda Craig, PhD, LMFT.
Depression… the cloud of sadness over life. Sometimes the clouds lightly shadow the joys of life, but they still shine through. It’s a mild discomfort, but you’ve learned to live with it. And even when the sun is out, you know another sad day is coming.
Sometimes depression appears as dark, angry clouds. Have you ever known someone who is easily angered or frustrated at the drop of a hat? That can also be an expression of depression. We often think depression is always sadness, but sometimes it shows up as anger—especially in men.
For others, the clouds move in, and the sunshine disappears altogether. The world is colored by thoughts and feelings of pain or deep numbness. The hurt may come in waves or linger for days or weeks at a time. Sometimes it feels unbearable to survive. It becomes hard to see any sunshine at all.
Depression isn’t the same for everyone. But you might experience:
· Feeling weighted down, like you’re in cement blocks
· Trouble getting out of bed and often feeling like taking a nap
· Feeling hungry, but nothing sounds good to eat
· Eating brings comfort
· People are talking too fast
· The world is moving too fast
· Feeling “blah”
· Feeling an emptiness you can’t explain
· Aches and pains in the body — literal physical discomfort from emotional hurt
· Irritation that leads you to fly off the handle in ways you can’t control
What happens in the brain during depression:
Historically, research suggested that depression was caused by low levels of individual neurotransmitters—serotonin, dopamine, norepinephrine, and/or histamine—in the brain. However, we now understand that depression is caused by a complex interplay of genetics, dysfunctional brain circuits, temperament/personality traits, and environmental stressors.
In the brain, MRI scans commonly show bright spots in the basal ganglia and the thalamus, as well as reduced sizes in the hippocampus and caudate nucleus. These are deeper, more primitive regions of the brain with essential functions preserved across mammalian species. PET scans of depressed individuals often show decreased activity in the frontal brain regions—areas responsible for attention, memory, concentration, mood regulation, and other higher-level functions that make humans uniquely vulnerable to depression.
Is depression environmental or genetic?
Sometimes a life event can cause grief, loss, disappointment, or mild depression. Some people have a genetic predisposition to depression, which means that when life gets hard, they may be more likely to experience symptoms than someone without that genetic link. When there is a genetic link, you may notice similar feelings or symptoms in other family members.
All medications are not created equal
First-line antidepressants are selective serotonin reuptake inhibitors (SSRIs) such as escitalopram (Lexapro) or fluoxetine (Prozac). These have shown the most benefit in studies comparing their effectiveness to placebos.
Second-line antidepressants include serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor) and norepinephrine-dopamine reuptake inhibitors like bupropion (Wellbutrin).
The right medication depends on the specific symptoms being treated and the side effect profile of the medication.
For individuals whose depression persists despite therapy and standard medication, psychiatrists may combine medications from different classes to improve effectiveness.
Tips to Climb Out:
Keep it simple. When we expect too much from ourselves during depression, we feel worse when we can’t meet those expectations. Baby steps build to big ones.
Know your early signs. If you have a history of depression, knowing your first symptoms can help you catch it early and feel better faster.
Stick to the basics. Eating well, sleeping enough, and moving your body are foundational. When you’re rested and nourished, you have more strength to fight depression. A little goes a long way.
Practice good sleep hygiene. Understand your sleep patterns and find ways to manage them. Some people can’t sleep; others are always tired. Know your symptoms so you can respond with the right habits.
Challenge negative thoughts. Negative thoughts can worsen sadness. Remind yourself daily: You matter to your family and friends. You bring value to the world. Be specific—how do you make others smile? Why do you matter? Find even the small things.
Reframe. When you catch a negative thought, try to shift it to something more positive or neutral. Left unchecked, negative thoughts spiral.
Surround yourself with support. Spend time with people who uplift you, and create distance from those who hurt you.
Speak up. Sharing your pain helps. Keeping it hidden gives it oxygen to grow.
Seek help. Therapy and psychiatry can provide the support and strategies you need to feel better and make life changes.
Do what brings you joy. Make time for things you love. You deserve that time—for yourself, and for the people who rely on you.
Take others seriously. If someone you know is struggling with depression, remind them why they matter. Help them find a therapist or psychiatrist. If you’re concerned about their safety, don’t hesitate to call 911 for a wellness check.
Have you noticed any of these signs of depression in yourself or someone you care about?
Which description of depression felt most relatable to you?
What’s one small step you can take today to support your mental health?
This article was co-authored by Andre Burey, MD, and Amanda Craig, PhD, LMFT.
Dr. Burey is a psychiatrist double board-certified by the American Board of Psychiatry and Neurology (ABPN) in Adult Psychiatry and Child & Adolescent Psychiatry. He is a staff psychiatrist at Silver Hill Hospital in New Canaan and has a private practice in Darien, CT.
Dr. Craig is an American Association for Marriage and Family Therapy (AAMFT) board-approved supervisor and a licensed marriage and family therapist (LMFT) with a doctorate in family psychology. She works primarily with couples and parents of tweens. She has a group practice in NYC and a private practice in Darien, CT.