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.

Yes, that is a serious question!
Average life expectancy has roughly doubled in the last 150 years. Whereas life expectancy at birth 150 years ago was around 35-40 years it is now around 80 years. (See Why are you not dead yet? which is an interesting read.) Well OK they’re figures for the US, but the UK and rest of the developed world isn’t much different. According to Wikipedia medieval life expectancy in the UK was 30 years, and was still only 31 years in the early 20th century. Indeed (according to World Bank data, via Google Public Data) UK life expectancy has risen 10 years in the last 50!

Forget airplanes, cars, nuclear weapons and the internet. This increase in life expectancy is probably the most important difference between our modern world and life 150 years ago.
Before the advent of modern medicine — and a lot of that has happened since World War 2 — infant and child mortality was incredibly high. And many of those who survived into adulthood were killed by accidents or disease which would be easily vanquished today. Just as an example, one of Noreen’s relatives about 100 years ago died in his mid-30s of erysipelas (St Anthony’s Fire), a bacterial skin infection which today would be quickly cured by antibiotics.
Remember that just because your direct ancestors lived into their 50s, 60s or even 80s, there were many children who died before puberty and hence are no-one’s direct ancestors. In the 19th century families of 10 or 12 children, with only one or two reaching adulthood, are not uncommon. And it was a lucky family which didn’t lose a single child even well into the 20th century.
In fact there is a good chance that you — yes, you reading this! — are already on your second or third life. And that is almost certainly down to either modern medicine or modern safety (think things like seat belts and air-bags).
In my late 20s I had appendicitis. It grumbled for a year or more until the medics decided what it was and removed the offending organ before it blew up. Without that medical intervention I would likely have died of peritonitis within a year or two. Noreen has similar stories — blood poisoning from an infected toe injury; a shattered left elbow (which would have been at least disabling). And we have both been extremely lucky with our health!
We all forget how common such diseases and injuries are and how much we have come to take for granted that they can be fixed. We also forget all those illnesses (smallpox, polio, whooping cough (aka. pertussis), measles) which we never or seldom see because of vaccination.
So tell me, please, why are you not dead yet? Without modern medicine what would have killed you? I’m curious to know.