I’ve done quite a bit of thinking recently about depression. Partly my depression but also more generally. This all came about because a couple of weeks ago I had a fairly major down, which dropped me into both depression and panic and caused me to have to cancel a couple of important things I was supposed to be doing.
One of the things I came to realise is that there seem to be two types of depression. Or perhaps more accurately there are two types of depressive, which may reflect two types of depression as I think they may be able to co-exist. There are also essentially, it seems to me, to be two triggers for depression.
Let’s deal with the triggers first. I’ll call them “Despair” and “Overload”.
Despair
This is the classic “I feel useless and inadequate” scenario; “nobody loves me”, “I’m a mess”,” I’m useless”, “what’s the point of anything?”, “let’s end it all now”. We all get this sometimes and I’m not immune, but it generally isn’t the cause of my depression — more usually a result of me having royally cocked up something.
Overload
The alternative trigger, which is also fairly well accepted as a cause of depression, is excessive (for you) change and excessive load. Too many commitments; way far too much to do; bosses buggering everything around, etc. It’s the classic “I can’t cope with any more” scenario.

OK, so what are these types of depression/depressive?
I’ll call them “Do” and “Sit”.
Do
The standard self-help advice for depression seems to go along the lines of “get up, have a cold shower, put on some good brass band music and get on with life”. Which is fine if (a) you’re not too far in and (b) it works for you. It doesn’t work for me and never has. It broadly seems to fit with the Despair model.
Sit
To understand this let me give some background. Some years ago (like maybe 20 years) I read an article by a couple of medics in (I think) Glasgow who noticed that most people who were hospitalised with depression just wanted to sit in a corner and do nothing. This was contrary to the accepted treatment of giving them occupational therapy or psychotherapy (ie. a treatment of the Do type), which, guess what, for these people not only didn’t work but made them worse. The medics hypothesised that this was because the problem was that these people were reacting to an unreasonable (for them) level of change in their lives and that what they needed was stability. So forcing them to do things was just imposing more change, hence making them worse.
So they tested it by allowing a small number (six from memory) of people to sit in the corner as long as they wanted. And they found that they got better. As long as the occupational therapy was there, and the patient could see it was there, they would eventually come out and start joining in — but only after they’d sat in the corner stabilising for some while. Unfortunately I can’t now find the reference to this work and I don’t know if anyone has followed it up with a properly controlled study.
I realised quite a while ago that my depression was almost always of the Overload type and that making me do things didn’t work. The more I have to do, and the more things change under my feet, the more likely I am to drop into depression. So if I’m feeling fraught, I need less to do. I don’t need more to do. I am always loaded up as much as I can take (and more) so woe betide you if you insist I do more. Which is why people insisting I count calories, go to the gym, cut the grass, whatever, don’t get very far and don’t help me. This is why when I first started having hypnotherapy I told my hypnotherapist (a) I don’t count things, and (b) my obesity and my depression are inextricably linked. Nonetheless he had to learn both the hard way.
One of the other things I’ve noticed over the years is that sometimes, if I have a lot on and I’m feeling anxious, I’ll have a five minute panic. For instance, if I’m going out to yet another meeting I don’t want to, I’ll sit on the bed while getting dressed and panic; not cope; quietly go into meltdown. But after a few minutes I can come out (I usually have to as the clock is ticking on), put my shoes on and cope.
If I don’t come out I go into a proper panic attack and depression and then have to start bailing out of doing things, which is what happened a couple of weeks ago. It’s real “I can’t cope with this and this and this and that. What can I bin so I can recover?”.
Now I’m not pretending that Despair and Overload are black and white. Nor that Do and Sit are. Clearly there is a spectrum of greys here; a continuum. But I suspect that most depressives will be predominantly one way or the other. But it does seem to me that Do will tend to align with Despair, Sit with Overload. That looks logical.
I’m also not pretending any of this is necessarily new but it was an interesting voyage of discovery. I’d be very interested if any of this has actually ever been properly tested, in controlled studies.
And there remains too a necessity for appropriate drug treatment as this often provides some initial respite and a gateway to allow recovery to start.