Demystifying Depression/The Buildup to a Depression
At this stage you are in possession of all the ingredients necessary to understand how depression develops. The negative effect of the stress hormones on the maximum normal capacity is the key to comprehend the buildup process that makes a depression feed on itself, like a positive feedback mechanism.
Let us go back to Figure 4. Imagine that you would chronically go over your limits, thus forcing your body to constantly rely on the stress hormones to compensate for the lack of serotonin. On the long term, your maximum capacity would therefore be reduced, making it much more likely that you would have to resort to the stress system to compensate. And thus the feedback begins: your maximum capacity is diminished, forcing you to use the stress system all the time; and because of all the stress hormones flowing through your veins, your brain has no chance of recovering, and your maximum capacity diminishes even further.
This may sound very mechanical, but I would say that it is the key element that leads to the development of a full-blown clinical depression. Alas, it is also something that most doctors fail to realise. And if you are still clinging to "psychological" notions about the illness, it is time you put them into perspective. Psychology plays a role in the factors that lead to the initial dip of your work capacity, but after a certain stage the problem just feeds on itself, and it is crucial to understand that to avoid falling prey of this downward spiral.
Even though the graphs might give the impression that this is a phenomenon that happens very quickly, in reality the process typically takes many years to develop. Moreover, the progressive increase of the levels of stress hormones in your body provide a very good advance warning, if only you know how to read them. I will now provide a basic description of what to expect (and what to do!) at each stage of the process. Beware that different people have different symptoms, so your mileage may vary.
In the very early stages, a depression will not feel like a depression at all. The small amounts of stress hormones could in theory be measured—your blood pressure would be slightly higher than otherwise—but in practise it would be difficult "to extract the signal from the noise". Subjectively, you might feel a bit down and tired, especially during those periods when you are crashing down from the adrenaline, but most people would still not say that they feel depressed. Also, you would start sleeping a bit less than usual, and not feeling quite as fresh when you wake up.
The problem is not very serious yet, and I think that most people could recover on their own if they were to simply take a long holiday and to make sure that they sleep well. There is some evidence that if done properly moderate amounts of aerobic exercise might help at this stage. However, be sure to read The Role of Sports section before you decide to embark on any exercise routine. In fact, I would rather advise people not to begin exercising than to risk having them over do it and making their condition worse. I know this flies against some commonly held beliefs, but sports alone can worsen a depression. If you do not believe now, read carefully both installments of this document and you might understand what I mean.
Elevated stress hormones
As the amount of stress hormones increases, you will start feeling some of their nasty side-effects. This is largely person-dependent, but most people start having problems with their digestive system, headaches, and having more frequent nightmares. Since stress depresses the immune system, people also tend to fall sick with infections more often . Only a minority of people suffer from sleep paralysis , but it is also a good indicator of elevated stress hormones. An objective measure such as blood pressure should be controlled: it will definitely be higher than normal, and a good doctor would not fail to recognise it. At this stage you are very clearly sleeping less than normal, waking up early in the morning, feeling tired and "lazy" about getting up. Subjectively, you should notice that you do not feel things quite as intensively as you used to: you feel empty, morose, and definitely "depressed" most of the time. Other subjective indicators include loss of appetite and sex-drive, feelings of guilt, lowered self-esteem, and detachment from hobbies or friends .
At this stage you should not be complacent about the problem. The best thing you can do is to go see your doctor. Take also into consideration that you have been putting too much pressure on your brain. Really do give it a rest: take a long holiday, make sure you sleep well, and be careful not to get any extra responsibilities. Antidepressants are very effective at this stage, especially if combined with minor lifestyle changes. (And yet another reason why you should see your doctor!)
As the buildup towards a depression continues, you get to the point where it is impossible not to notice that there is something definitely wrong. At this point, most people start having serious problems with anxiety, stress, panic attacks, hyperventilation, bouts of psychosis, etc. Your sleep will definitely be a mess, your blood pressure will be high, and your ability to focus at work seriously compromised.
One should definitely seek professional help at this stage. In particular, do not make the assumption that your GP will be qualified to treat you. They may, or they may not. Unfortunately, many doctors still do not quite understand what is going on. My experience in this area was quite bad: I spent more than one year jumping from doctor to doctor, with the problem constantly aggravating, and getting all kinds of bad advice. In short, you need to stop. Your maximum capacity will probably be so low that you cannot even work full time. Also, specifically ask your doctor for antidepressants. In the country where I live, the Netherlands, this is bit of a taboo subject, so depending on where you live, you might need to convince your doctor not to be stingy and stubborn. Should they suggest that you start exercising, just ignore that advice. It is a very good indicator that they do not have a clue of what is going on. Also, you will need to make changes to your lifestyle. The Recovery Guide section describes one author's personal experience in that regard.
In the last stages, the maximum capacity is practically nil, and the level of stress hormones so high that people cease to be able to function. The stage of a clinical depression is very difficult to describe in words, but I will do my best. The anxiety transforms itself into a "fire" which constantly burns inside your head; you will feel desperate, much more than you ever felt in your life, as if you could never be happy again; and you will definitely be suicidal, to the point of actually planning suicide or even attempting it (with success in many cases, tragically). During this stage, people can barely sleep, if at all.
To an outsider, the fact that a clinically depressed person is pretty much confined to bed is often misinterpreted. People often think that a clinical depression is a simply a state of apathy. Quite on the contrary: remember that the blood pressure and heart rate of a depressed person are extremely high. Rather than apathy, depression is an overwhelming fire which will not subside and burns you from the inside.
Unfortunately, it is only at this stage that many people finally concede that they need professional help to treat them. Needless to say, you will need to make drastic changes to your lifestyle if you want to recover. You should also be very patient: it will take a long time before things go back to normal. Most important of all, a clinical psychiatrist is the proper specialist to accompany you during this period.