Understanding and treating depression

By: Inês Manaças

Clinical Psychologist and Psychotherapist

OPP Professional Licence No. 15444

What is depression?

How do we know whether we are depressed? Or whether we have traits of a depressive personality?

Depression can involve different emotional experiences. There is a fundamental distinction between reactive depression—a psychological response to a life event such as the loss of a loved one, separation, or unemployment—and endogenous depression, which is characterised by deeply rooted traits that become intertwined with a person's personality and constitutional predisposition. As might be expected, the latter is generally more limiting due to its structural nature, and treatment is often longer and more complex.

Depression is commonly associated with a lack of physical and emotional energy (fatigue), feelings of low self-worth and guilt, which can distort a person's perception of reality and affect relationships with family and friends. As a result, individuals may withdraw, avoid social interaction, and appear to lose interest and motivation. This often becomes a vicious cycle, in which negative beliefs about oneself are reinforced, increasing feelings of helplessness and inadequacy.

How is depression treated?

The aim of psychotherapy is to help people understand, process, and work through the origins of these feelings of helplessness. Early experiences that were frustrating, limiting, or prevented the fulfilment of basic emotional needs can be explored and transformed into new ways of understanding oneself. Rather than being seen as a permanent condition of existence, these experiences can gradually be recognised as responses to particular circumstances, opening the way for emotional growth and lasting change.

Indeed, in more severe and prolonged cases, medication plays an essential role in reducing symptoms and enabling individuals to engage more effectively in psychotherapy. However, it should not be regarded as the only or inevitable response for someone who wishes to better understand, accept, or change their thoughts, emotions, and behaviours. While medication can alleviate or even suppress symptoms, it does not address their underlying causes. Moreover, symptoms also serve a communicative function, reflecting an attempt to express that something is not working as it should. If we merely suppress these symptoms, we may hinder the person's ability to develop a meaningful response to their difficulties. Feeling temporarily better may lead them to accept their current situation without recognising the need for change. In the long term, this may result in a greater disconnection from one's own existence, prolonging depressive tendencies and reinforcing psychological inhibition, creating a cycle of treatment that is essentially palliative rather than transformative.

Furthermore, people who are more prone to depression often share certain personality traits, including greater dependency and increased vulnerability in relation to others and their environment. Consequently, taking a substance that produces immediate positive effects can become particularly appealing, potentially leading to both psychological and physiological dependence.

For genuine and lasting change to occur, it is essential to understand the underlying internal motivations and psychological processes that shape behaviour. These patterns tend to remain consistent regardless of external circumstances or whether life is going well or poorly. It is through recognising the repetition of maladaptive and harmful behavioural patterns that the possibility for change emerges. Paradoxically, it is during the process of transformation itself that we become able to identify healthier alternatives and reinforce more adaptive ways of responding.

This psychological flexibility—much like the clay a master craftsman shapes into a work of art—is fundamental to personal growth and a positive therapeutic outcome.