The Depression Cycle Is Complex

Six months before I was diagnosed with bipolar disorder, I was diagnosed with depression. I was shocked at the time, but the more I learned about depression, the more I realized how little I understood my own experiences.

I’ve been fortunate that my healthcare provider takes mental health very seriously, even offering classes on most of the major disorders (e.g., depression, anxiety, PTSD) and running a year-round DBT course that patients are welcome to attend at any time.

My therapist encouraged me to attend all of them. Even though I was diagnosed with depression, I had some evident anxiety behaviors and PTSD-like reflexes, so I was signed up for those courses. He thought CBT and DBT would be helpful as well, so off I went to take those classes, too.

In combination with therapy, these classes were time well-spent. I learned a TON and held on to all my materials and notes as references for moments when I struggle. I’m glad I have them; they’re a great resource to me now.

One reference item I keep on my office wall now is what they called the Depression Cycle. Most of us think of depression as a simple experience: We get sad/depressed and stay that way until either the depression resolves or we get on an effective treatment plan.

What I learned in my class is that depression is more complicated than that. It operates as a Depression Cycle.

In the first part of the Depression Cycle, we start with the idea that depressions are triggered. They may be triggered by grief, job challenges/loss, relationship issues, or acute/chronic illnesses.

For some, depressions are also triggered by biological factors. Learning, understanding, and coming up with a plan to avoid them (or at least minimize their impact) is one of the first and easiest actions we can take to manage our chances of experiencing depression because these triggers kick off the Depression Cycle.

Once the trigger happens, we officially enter the Depression Cycle. While I’m going to list the components of the cycle linearly, please understand that each of these influence and lead to another point of the Depression Cycle. In fact, each component can lead to any other component, and a trigger can drop you in at any stage of this cycle.

Let’s start with Thoughts: In the thoughts stage, we are dealing with a lot happening inside our minds. The thoughts we have are often negative, judgmental and critical, and often extreme. Most of these thoughts are automatic. We don’t recognize that we have them, and the ones we do see we don’t question. These automatic thoughts are insidious because they seem objectively true to us.

Examples of automatic thoughts include: “I always do this to myself;” “People just don’t like me;” and, “My life will never get better.”

Next, we move on to Feelings: Talk to anyone who’s lived with depression and they will tell you they felt guilt, shame, sadness, or hopelessness – and many times, more than one of those at once. Everyone has these feelings; what’s different for those in a depression is the intensity of the emotions. When we are depressed, the depth of these feelings is such that we often don’t think that we ever can or will feel better or differently again. When a well-meaning friend or loved one reminds us that our depression is temporary, we may verbally agree while internally we instantly reject the idea.

The feelings are many times based on the thoughts that we are having. If we are thinking, “I always do this to myself,” a sense of shame is a normal accompaniment.

From Feelings, we move on to Behaviors. When we are depressed, our behaviors tend to shift. We start self-isolating and become less productive in our daily lives. From a Depression Cycle perspective, these behaviors then begin to inform our feelings and our thoughts. If we aren’t showering as much, we may develop the automatic thought, “I’m just a slob,” leading to feelings of worthlessness and hopelessness.

Often, these behaviors are self-perpetuating. When our feelings and thoughts combine with these negative behaviors, our instinct is to act in a way that keeps us in the same place. (I don’t understand *why* we do this, just that evidence shows it is true.)

For me, cleaning my house is a good example of this. In my depression, I skipped cleaning the kitchen. “I just don’t feel like it today,” I told myself. I felt drained and tired. The next day, the kitchen was still had the prior’s day mess, and added to it were all the dishes from that day. “Ugh,” I thought, “I need one more day before I get to it. Let me get some good sleep first.” On Day 3, the kitchen was a hot mess. Now, looking at it overwhelmed me, and I felt shame over letting it get that bad. I felt guilty for letting my family down by not doing it, and it was just another example of how “I am so lazy.” “I can’t even face this now,” I said to myself. “It’s too much for me.” So I let it go a few more days.

We can see how easy it is to go from this scenario to the next stage of the Depression Cycle: Physical Symptoms. Depression manifests in our bodies in pretty specific ways. Our sleep cycles change; some people suffer from insomnia, while others sleep abnormal amounts. Our appetites shift; suddenly we are consistently eating more (or less) than before our depression started. Our memories are impacted, and we have challenges concentrating.

I got terrible insomnia and gained (a lot of) weight because I started making poor food choices. I felt frustrated because I was no longer “smart” (lots of memory issues – where did I put that pen again?).

As we start to understand the different components of the Depression Cycle, we begin to see how each stage influences the others. My fatigue makes my brain work less efficiently, so I don’t think as rationally, and my feelings are amplified. Now, the thoughts in my mind are more extreme, and my emotions are intensified. Beyond that, the fatigue makes me too tired to clean up after myself, exacerbating the kitchen situation, which only makes my feelings of shame worse. Then I feel shame because I should be able to snap out of this, but I don’t even have the energy to try.

If you’ve lived it, you know what I’m talking about. You may not have seen it laid out or explained this way, but I know you get it. Here’s the awesome part: Once you’ve seen this and you get it, you’re in a position to influence it. It’s hard work, but it’s absolutely doable.

We’ll be talking about how we do that over the next few weeks, starting with a chat on the causes of depression.

A big Thank You goes out to Kaiser Permanente, who developed the materials I relied upon when composing this article.

Have you experienced a depression? Do these stages look familiar to you? Please share your thoughts in the Comments section.