What is Depression?
What is depression?
Depression is a state of lowered affect that comes over most people at some point during their lives. Depression can feel different to different people. Some people experience it as a profound and seemingly unconquerable sadness. Some experience it as a complete lack of motivation, perhaps coupled with a bottomed-out self-esteem and the feeling that everything that the person does is wrong. Some experience it as extreme guilt or a feeling of worthlessness. Depression saps all of the energy and happiness from the lives of those affected.
On the biological level, depression is marked by substantially lowered levels of serotonin, norepinephrine, and dopamine. These are neurotransmitters, or, to put it in plain language, the chemicals that the individual cells of the brain (neurons) use to communicate with one another. This means that some parts of the brain are not able to function quite as well while other parts of the brain have nothing to tell them to shut up, which is why we find ourselves fixating and ruminating on certain details while we are depressed.
What does depression look like?
How can I tell if I have depression, or how can I tell if a friend has depression? There are outward signs that should be noticeable to people who are paying careful attention. On the most practical level, pay attention to the amount and quality of work that the individual is doing. Depression saps our mental resources, expending our psychological energy. Thus, that energy cannot be applied to our work quite as easily. If your friend is suddenly and unexpectedly on the verge of being fired from her job or is receiving much poorer marks at school, it could mean that her mental resources are being otherwise taxed.
One of the most common symptoms of depression is what is called anhedonia. “An-“ is a prefix meaning “not” or “without”, and “hedonia” is derived from the Greek word “hedonic” or “hedonism” which refers to pleasure. Therefore, anhedonia means that the individual is suffering a loss of pleasure or interest in activities that he previously enjoyed. If your friend is suddenly isolating himself from the world or is losing interest in his hobbies, he may be suffering from depression. For gamers, this could manifest in very different ways. Some people bury themselves in games when they’re depressed as a way of distracting their minds from the pain that they are feeling and as a way of distancing themselves from the outside world. Others lose interest in games altogether. They may look at their entire library of games and think that every single one looks like a chore. Nothing looks entertaining at the moment.
Symptoms of depression
Sadness: Depression is often (but not always) characterized by an extreme sadness. Sometimes it can be about something in particular, such as the death of a loved one or a romantic break-up, and sometimes it can just be a non-directed sadness weighing on the individual. This can be observed through posture, gait, and the increase in sadness behaviors, such as crying.
Hopelessness: One of the most debilitating things about depression is that it takes away our hope that anything will ever get better. We feel trapped. This can stop us from seeking help. If we believe that we will always feel this terrible, we will have no motivation to receive therapy or try to pull ourselves out of it. This feeling of hopelessness leads some people to end their own lives, as their limited perspective makes death the only way out that they can see at the time.
Anhedonia: As discussed above, anhedonia is the loss of pleasure or interest in activities or rewarding biological functions, such as sleep or sex. Playing video games, practicing musical instruments, getting together with friends, and exercising all seem like hard work, and depressed individuals often don’t give these activities a chance.
Low self-esteem: When we’re depressed, we often quite unfairly look down on ourselves. We are plagued by self-dislike, criticalness, and feelings of failure. Nothing that we do is ever good enough. Especially strong in those who have suffered from abuse in the past, depressed people may believe that our feelings suit someone as dirty and deplorable as ourselves. This leads into the next symptom…
Guilt / worthlessness: When depressed, we often believe that the depression is our fault, or that we deserve the depression as a form of karmic retribution for the things that we have done. We may either feel guilt for our actions, or a sense that we aren’t worth enough to waste anyone else’s time with our problems.
Suicidal thoughts: It is unfortunately common for the tragic outcome of depression to be suicide. As has been discussed above, when suffering from depression, we often feel hopeless, like there is nothing that can be done to improve our lives. We believe the pain will go on forever. The dangerous thing about suicidal thoughts is that they are addictive. When we are deeply troubled and think about offing ourselves, we feel a slight relief, as if our brain has found an exit to a seemingly insurmountable problem. Our brain begins to crave and rely upon that relief. Like any addictive substance or behavior, though, suicidal thoughts have diminishing returns. To get that same relief, we must go even further – planning a method of suicide, acquiring a weapon, suicide rehearsal. Suicide is rarely a spontaneous decision. Rather, it is something that we work ourselves up to. It is never the right choice, though.
Rumination: Rumination is a word that literally means “to chew the cud”, as does a ruminant (think cows, buffalo, and giraffes). The cud is a part of the ruminant’s mouth that it regurgitates its food into to chew for a second time (gross, I know). In the same way, when we ruminate on a thought, we are “chewing” it for a second time. We are unable to clear the thought from our mind. Consider the classic example of the romantic break-up, and the subsequent sleepless nights staring at the ceiling and wondering “why did he leave me?”, mentally replaying through every aspect of the previous two months. When depressed, we fixate on our misery and replay every little detail, as if our brain believes that, through sheer willpower, it can fix the unfortunate events that put it there in the first place. Life is not Super Meat Boy, though. There is no perfect run. Endlessly retrying and thinking through our problems will only make us more miserable.
Irritability / agitation: As we’ve already discussed, we have a certain amount of mental energy, and we use this energy to perform all of our daily actions. Thought requires energy. Going to the grocery store requires energy. Calling our grandma requires energy. Playing a round of Hearthstone requires energy. When we’re depressed, the depression itself takes up a lot of that energy, leaving very little for everything else. Usually, the first thing to be sacrificed is our patience. When depressed, we are quicker to snap at people or to act impulsively. We become more easily annoyed over little things.
Sleep disruption: When we’re depressed, our sleep patterns change. This looks different for everyone. Some people sleep very little at all, getting only two or three hours of sleep each night. This can be tied to the rumination listed above. Our mind keeps itself awake with all of its worries. On the other hand, some people sleep far more than the usually do and may spend the rest of the time that they’re not sleeping curled up in bed anyway. Disruption in sleep pattern is almost universal with depressed individuals.
Tiredness / fatigue: This goes with the previous symptom. Whether we cannot sleep at all or are sleeping for 14 hours each night, we are exhausted. Remember, our energy is being leeched away by the depression. Sometimes getting out of bed feels like a Herculean task.
Appetite disruption: Much like the disrupted sleeping patterns, those who are depressed most often have disruptions in their appetite. They’ll eat very little or will over-indulge. For that reason, unintentional weight change is one of the potential signs of depression.
Social ostracization: When suffering from depression, we often lock ourselves away from others. This is actually quite dangerous, as it decreases the level of social support that we believe ourselves to have. That can make us believe that no one cares about us (even if this is untrue), increasing our feelings of brokenness or worthlessness.
How to mitigate depressed feelings
Though no one will ever argue that it is easy to defeat, there are things that can be done to chip away at this horrible beast called depression.
First, and most importantly, seek professional help. Even though we can take steps to resolve our problems ourselves, it is important to involve a professional in the recovery process. A psychologist, counselor, or primary care doctor can give us personalized recommendations, can give us resources in times of unexpected disaster and need, and can give us someone to talk to when we feel completely isolated.
Keep a thought / mood log: Take notes on your feelings every hour of the day for a week. Mark down what you’re doing at the time. Examine it with a scientific eye at the end of the week. Do you feel worse in the night than you do in the mornings? Do you feel the worst when you haven’t eaten in a few hours? Do you feel better after walking outside to check your mail? These are all useful tidbits of information! We can restructure our lives to maximize the activities that make us feel good and minimize the things that make us feel worse.
Journaling: Much like the previous recommendation, journal your thoughts every day. Getting our thoughts down on paper can be very helpful. Writing everything down like a story forces us to work through our thoughts in a linear manner. Much of what keeps us stuck in our own heads (ruminating) is the circular and illogical nature of our thought patterns. We are skipping over details and fixating on the emotions. Writing our thoughts down takes us out of our head and puts us in the role of an objective bystander.
Behavioral activation: This is a fancy psychological way of saying “get up and do something”. Get out of the house and do anything. It might seem uncomfortable beforehand, but it will help. Much of the reason why we feel so terrible when depressed is because we’re not partaking in any enjoyable activities. Forcing ourselves to do something can help us work ourselves out of our rut.
Exercise: Our brain is very respondent to our body. When we force ourselves to frown, we begin to feel unhappy, even though we know that our frown is inauthentic. Likewise, we hold a lot of our depressed feelings and tension in our muscles, and the soreness and lack of activity reinforces the feeling of being depressed. Exercising and stretching can relieve this muscular tension, making our body not feel depressed anymore. To compound its positive effects, exercise sends rewarding chemical feedback to our brain. We feel like we are achieving something.
Give or do something for someone else: As we have discussed, when we are depressed, we are often stuck within our own minds. Volunteering or doing something nice for someone else takes us out of our head and widens our perspective. On top of all of that, it forces us out of the house and gives us the opportunity to socialize. Additionally, it’s hard to feel worthless when we see the genuine thankfulness of someone who we have helped.
On the topic of unhelpful thought patterns, Burns published a book in 1989 entitled The Feeling Good Handbook in which he detailed common patterns of twisted thinking that we find ourselves tangled in. While I won’t reproduce the entire list here, out of respect for Dr. Burns, the themes he illuminates are helpful.
On his list, he highlights our tendency to increase the salience of negative events while discounting the importance or likelihood of positive events in our lives. This is what is known as a mental filter, a concept that should be familiar to anyone who has publicly shown any artistic works. We could receive rave reviews for a game we put on Greenlight, but the three critical comments that we received are going to bother us until we conclude that we are failures.
When a pebble kicked up by a truck cracks our windshield, we think “this ALWAYS happens to me!” completely discounting the years of incident-free driving. These negative events are memorable, therefore, they remain in our mind like data points begging to have a line drawn between them. They are like the Kuribo’s Shoe in Super Mario Bros. 3 that we SWEAR was one of central mechanics of the game because it was so memorable, but, in actuality, was only in one level.
Lastly, when we are depressed, we make a lot of assumptions. Of the things that make us upset, I think we’ll be surprised to find just how many are unfair or untrue assumptions. We assume that the store clerk was giving us an awkward eye, even though she didn’t say anything to indicate that she didn’t like us. We assume that we are going to fail the test, even though it hasn’t happened yet and it could go either way. Challenging our assumptions and rooting our expectations in hopeful positivity will increase the likelihood of positive things happening and having a positive attitude with which to experience them.
Finding the small victories in life. Achievement hunting!
Evolutionarily, humans are achievement hunters (Xbox players will already be familiar with this notion). We are rewarded on a brain-chemistry level for overcoming challenges and figuring things out. This is why video games feel so good. We feel like we are achieving great things – overturning Templar plots and rescuing princesses from fire-breathing turtles. Every small victory and step in the right direction is rewarded by pleasurable neurotransmitters being released in our brains.
When we are depressed, we often feel worthless – sometimes even guilty for our lack of positive contribution to the world. Part of what keeps us depressed is the feeling of failing at everything that we attempt. Failing everyday.
We need to build more “achievements” into our own lives. We must structure our lives as a series of small challenges, and reward ourselves for each progressive step in the right direction. When we are depressed, it can be a seemingly insurmountable chore to get out of bed, and cooking ourselves a healthy meal may as well be a Soul Level 1 run. If we can create a reward structure or set daily challenges (small stuff) to complete everyday, we can begin to see trackable results. Better yet, have some accountability with a friend who will check in and see how your “achievement hunting” is going.
It is important to fill our lives with small accomplishments. Strive to achieve something unique and meaningful every day, whether it is cooking a new recipe, starting a new game from your Steam backlog, putting out a job application, or going somewhere you’ve never been before. These goals should be accomplishable in the space of a day.
How to prepare for times of depression while you are not depressed.
I want to highlight one of the most important pieces of advice that I can give. While this article is primarily aimed at those who are seeking to work their ways out of a depressive episode, but I also wanted to acknowledge those who are not currently depressed.
Depression happens to everyone. Prepare for times of depression when you are not depressed. It should come as no surprise that, when depressed, you are not able to think and plan quite as clearly and effectively as when you are not depressed, so use that to your advantage. In the same way that you don’t want to wait until your house is on fire to create a fire escape plan, don’t wait until you are hurting to make a depression contingency plan.
Look at past episodes that you have had. Study your vulnerabilities. Make notes of your potential triggers. Talk about your warning signs with friends and family. You can make depression more manageable with some careful consideration while still sober-minded.
Games that can help with depression
This list is intended to highlight games that can be helpful tools for overcoming depression. These are not games about depression, as there are many lists of those already.
- First of all, go outside, do some physical activity, and get some sunshine on your skin (where possible). Everyone is affected, to some degree, by a lack of sunlight, and gamers may find themselves falling victim to this more often than most. Move your muscles and absorb some of that tasty vitamin D.
- Animal Crossing: We tend to isolate when we are depressed, and that cuts us off from support and gives us the false impression that no one cares about us. Nintendo’s Animal Crossing series, available for just about every console that they have produced since the Japanese N64, gives us a safe and non-intimidating space in which we can socialize, to a small degree. It also invests us in aspects of self-care, improvement of our own space and the world around us, and in going outside and being active. Even a simulation of these activities can help put our mind in the right place.
- Persona 4: This entry in the long-running Shin Megami Tensei series is an excellent representation of mental health issues – our problems are both a part of ourselves, but also separate from ourselves, and should be viewed and conceptualized as a separate entity. We can both accept that our “shadows” are a part of ourselves, but also separate and able to be defeated. This game also doubles down on Animal Crossing’s lovely socialization mechanics.
- The Jackbox Party Pack: The PhDs, pharmicists, and researchers of the world have created some terrific depression treatments, but few have the lasting potency and immediacy of effect of a good belly laugh. The Jackbox Party Pack, an extension of the You Don’t Know Jack series of quiz games, is genuinely funny and surprising. It’s hard to not smile while playing it. Also, it encourages playing with other people in the same physical space. Couch multiplayer can go a long way to rebuilding those essential support networks.
- Wii Fit / Dance Central: As has been mentioned before, it is important to exercise and be physically active. This will wake our bodies up and get some good, natural reward chemicals flowing through our brains.
- Rhythm games / shoot-‘em-ups (Rock Band, Rhythm Heaven, Super Hexagon, Luxuria Superbia / Geometry Wars, Crimzon Clover, Pixel Galaxy): These types of games require the full attention of the player and can tap into that naturally rewarding flow state. It is hard to think about anything else while playing games so fully engrossing.
- Journey / Flower: The particular emotional arc of these games mirror that of a depressive episode, and the cathartic, triumphant bits at the end of both might help inspire or give hope to someone in their time of darkness.