Depression is many things: a mood disorder, a mental illness, a crippling hindrance to your social and professional life, a real mood killer in the bedroom. But is depression a choice?
From the outside, it can seem like some people really do choose — or at least accept — depression. Whether you’ve experienced such feelings yourself or have seen others simply give in to and live in their sadness and emptiness, everyone can think of someone who seems to be choosing their depression as a lifestyle, rather than fighting it.
But depression isn’t a lifestyle. It isn’t a preference, it isn’t a personality trait and it isn’t a choice.
If you’re worried that someone in your life (or you yourself) may be “choosing depression,” there are several things you need to understand. You need to know why depression happens, you need to understand what really causes depression and you definitely need to understand what the symptoms of depression typically look like.
Perhaps most importantly, you need to know how depression is ultimately treated.
Choosing a decision isn’t what you think — the best way to explain this is to start with the most important thing about depression: people don’t “decide” to have it.
A person with a depressive disorder can expect it to affect their happiness, their sexual function, their digestive system, their weight, their memory, their productivity and their ability to work and socialize with friends, family and partners.
It’s a serious mood disorder, and many of the various forms of depression can lead to more serious mental and physical problems over time. That includes heart issues, increased risk of neurodegenerative diseases and the big one: increased risk of suicide.
Nobody wants to be suicidal, but suicidal thoughts, suicidal ideation and suicide attempts are a serious and unpredictable symptom of clinical depression (also known as major depression) and other depressive disorders.
If you’ve had thoughts like that yourself recently or are having them right now, you can skip the rest of this article. You don’t need to worry about whether someone thinks you’ve chosen to be here. It’s time to talk to someone.
If, on the other hand, you’re just experiencing some milder symptoms of depression or you’re seeing a friend or loved one struggle with them, there’s another major reason depression isn’t a choice: the ways you can get a depressive disorder aren’t really something you can control for yourself.
Depression doesn’t come with a sign-up sheet. You don’t apply for it like TSA PreCheck®, nor do you save up codes from Sprite® bottles until you have enough points for a free case of depression.
Depression doesn’t really have a singular cause or source — it’s commonly understood that a variety of factors can contribute to your individual risk of depression, and these factors represent a wide swath of potential dangers.
Maybe your family history shows numerous examples of depression: parents, siblings, extended relatives with a history of depression.
Maybe your adolescence was plagued with stress and a lack of security.
Maybe as an adult, your social circles are limited and unreliable, leaving you feeling isolated on a regular basis.
Any of this could potentially be a risk for depression.
Depression in adults and children alike can come from other sources as well. Traumatic events, injuries, accidents, illness, deaths in the family, intense stress at work or chronic stress generally can all increase the chances that you’re going to wake up one morning with a depressive disorder.
Or none of the above can affect you. Instead, things like your diet, the changing of seasons or the state of your community could all be at play in your mental health.
That’s because we haven’t isolated a singular cause of depression — and we likely never will. Researchers instead have settled, for the time being, at least, on the biopsychosocial model of depression, which concludes that depression can come from a variety of biological, psychological and social/environmental factors.
With so many factors involved in your risk assessment, it may feel that not only are you not choosing to get depression willingly, but you might not even be capable of keeping track of all the ways depression can happen in the first place.
And it turns out that in the case of depression, something you don’t choose to have is also something you can’t choose to no longer have.
If you’re a person with depression, you’ve probably been asked this very patronizing question before: “can’t you just, like, say no to depression?” We cringe just thinking about it.
Depression is a mood disorder — not laziness. It affects your brain’s chemical balance, it clouds your thoughts and it causes brain fog. It can literally sap the will to live from people if left untreated. You can’t just, like, try harder.
In fact, it’s dangerous to “choose” to ignore or deny that you have depression, because refusing to treat it can just make it worse.
Depression is a leak in the hull of your mental health. Pretending you don’t see the water flowing in isn’t going to stop you from sinking.
Instead, you have to do something about it — manage, treat and cope.
Read our blog on explaining your depression to someone for more help.
Coping with depression is about making choices with the professional support of a healthcare provider. They will help you identify the best mental health treatment options for depression in your unique circumstances.
There are many ways to treat the symptoms of depression and properly cope with your issues. Here are a few your provider may suggest:
Many people find that therapy (and, particularly, cognitive behavioral therapy) is an effective way to manage depression.
CBT is a system where you can learn to resist and reduce your negative thoughts and emotions throughout the day, which in turn will reduce the number of hours, days and weeks lost to giving those hopeless and sad thoughts space in your mind.
And it works. A 2020 meta-analysis on the efficacy of CBT in the treatment of depression looked at 115 comprehensive studies on the topic and found that CBT was an effective treatment strategy for depression — both in terms of relieved symptoms and reduced rates of relapse.
Likewise, antidepressant medication can be a great daily element of depression management.
There are many forms of antidepressants, but healthcare providers will most likely prescribe selective serotonin reuptake inhibitors or SSRIs first, because they’re considered first-line medications.
SSRIs are safe, effective, and have the lowest risk and intensity of side effects currently on the market, so the average person will typically find them to be the best option.
A healthcare professional or mental health professional might also suggest lifestyle changes to manage your depression better. Diet, exercise and good sleep habits can all help you reduce your risk of depression, and if you already have depression, getting these elements of your life into healthy ranges can help reduce your symptoms.
Your healthcare provider will likely suggest one — or, more likely, a combination — of the above treatments.
We’re going to speak to the person with depression for the last few lines, because while the loved ones are important, they don’t need the same honesty as someone battling a mood disorder.
There are some hard truths that we have to accept when we get depressed. One of them is that, regardless of what you or anyone else says, you are not in control of whether you have depression.
Not having control is hard, but it’s also affirming. You can’t control getting depression, but you can control how you face it. Make the choice to get help.
A healthcare professional in your corner means access to medication and many other treatment and management options for your depression. It also means that you have guidance as you try out those options to find the right solution for your personal needs.
Looking for a therapy professional? Our online therapy platform is a great place to connect conveniently with a stable of professionals and find the right match for you.
But you don’t need to work with us to manage your depression — you can start anywhere. It’s your choice, and regardless, starting now is the right choice to make.
Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.
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