Depression and Hopelessness: When the Flatness Won’t Lift

Depression is one of the most common reasons that people come to therapy. It tends to be described in terms of sadness, indicating that the primary experience is one of visible distress. For many people, depression is something quite different: a flatness, a withdrawal of colour and meaning from the things that usually matter, a type of heaviness that makes ordinary life feel effortful in a way that is very difficult to explain to someone who has not experienced it.

For a significant number of people, depression is also something that exists in the context of a functioning life. When we are depressed, we are not always the people who cannot get out of bed. We are often the people who get out of bed, go to work, meet our responsibilities, and return home to a private experience that nobody around us can see.

What depression actually involves

Depression is a sustained shift in mood, energy, and the capacity to experience pleasure or meaning. It tends to involve a persistent low mood or emotional flatness, a loss of interest in things that were previously enjoyable, changes in sleep and appetite, difficulty concentrating, a slowing of thoughts and movement, and a deep rooted feeling that things will not improve. The hopelessness that accompanies depression is a symptom of depression, rather than pessimism or negativity.

Depression also has a physical dimension to it. The fatigue of depression is not ordinary tiredness. The physical heaviness, the sense of moving through resistance. These are real bodily experiences and understanding depression as something that lives in the body as well as the mind tends to change how we approach it.

For some people, depression reaches a point where thoughts of suicide or not wanting to be alive begin to surface. These thoughts are a symptom of the condition - a signal of how much is being carried internally. They are more common in experiences of depression than is often acknowledged.

Functioning depression

Many of the people who come to therapy with depression have been managing it privately for some time, sometimes for months or years. You may have developed the capacity to perform ordinary life while carrying something significant beneath the surface. This is sometimes referred to ‘high-functioning depression’. Though it isn't a clinical diagnosis, what it describes is the gap between how someone appears to others and how they actually feel on the inside. That gap can be exhausting to maintain and tends to widen over time as the effort of concealment adds to the weight of what you may be experiencing.

The particular difficulty of functioning depression is that it can be very hard to feel justified in asking for help. Your life continues beside it, other people may not necessarily have noticed or expressed concern. Your internal experience may feel disproportionate to the external circumstances. And so you continue to try to manage privately, until managing no longer feels sufficient.

What makes it harder to address

Depression can be self-reinforcing. The withdrawal from activities and relationships that tends to accompany it, removes the very things that might provide relief. The negative thinking that depression produces (about the self, the future, and the possibility of change) makes it harder to take the steps that might help. The hopelessness that coexists with depression can feel like a rational conclusion, which is part of what makes depression so difficult to shift from the inside.

A delay between the onset of depression and seeking support can occur because of the stigma that remains present around mental health difficulties. Difficulty asking for help may also link to the belief that seeking support won't make a difference. The delay can also be due to the fact that our thresholds, for acknowledging that something is wrong, are set very high.

What therapy can offer

Therapy for depression offers a space to understand how your low mood has developed over time. It van help you to manage your symptoms and make sense of the internal and external conditions that have contributed to your depression. Therapy can help you to gain clarity around which factors maintain your depression and which lift it.

Therapy also offers a consistent, reliable relationship with someone whose attention is entirely directed toward understanding your experience. If your depression is connected to your relational history (to early experiences of not being seen or valued) the quality of that relationship itself can be part of how change happens.

If you have been living with low mood, depression, or hopelessness, and something resonates with you here, therapy might be a helpful option to explore.

If you are struggling with thoughts of suicide or feel you may be in crisis, you do not have to manage this alone:

• Call 999 if you require immediate assistance

• Contact your GP and ask for an urgent same-day appointment

• Samaritans: call or text 116 123, free, 24 hours a day, if you need to talk

• SHOUT crisis text line: text SHOUT to 85258

• NHS urgent support: call 111 and select the mental health option

Dr Erin Reid is a counselling psychologist offering online therapy to individuals, couples, adolescents, and families across the UK and internationally, and Walk and Talk' therapy in Northwest London green spaces. Visit drerinreid.com to find out more.