A Psychologist's Guide to Depression: When the Helper Needs Help

Here's the ironic part: I became a psychologist because I experienced depression and recovered from it.

 

I thought understanding it would protect me. Like knowing the mechanics of a car crash would somehow prevent you from getting into one. Spoiler: it doesn't work that way.

 

Depression came back. But the second time, I recognized the signs earlier and knew how to catch it before it became catastrophic.

 

Let me share what I've learned from both sides—as someone who studies this professionally and as someone who's lived it.

First, let's address something important that neuropsychoanalyst Mark Solms and neuroscientist Jaak Panksepp have been trying to tell us for years: depression isn't simply caused by low serotonin levels.

This matters because we've built an entire treatment approach around a biochemical story that doesn't hold up to scrutiny. SSRIs have been the main treatment since the 1980s, and their efficacy has been disappointing.

So what's actually happening?

 

Solms argues that depression is fundamentally about separation and loss—situations where we're separated from or lose something we need. The brain chemistry involved is primarily the panic/grief system, which operates through opioids, not serotonin. When we're separated from an attachment object, our brain's natural opioids (endorphins) decrease; when reunited, they increase.

 

Even more crucial: depression involves a shutdown of what Panksepp called the SEEKING system—the brain's motivation and curiosity drive. When you lose SEEKING, you can no longer live happily. Once the PANIC-Grief system activates from loss, the SEEKING system can no longer function vigorously.

 

This explains why depression feels like such profound emptiness—it's not just sadness. It's the absence of the drive that makes you want to engage with life at all.

 

Depression has meaning. It's telling us something about unmet needs, about losses we haven't processed, about attachments that have been severed.

This is the one everyone should understand because it's actually normal.

 

When something damages you—losing a job, a breakup, a scary diagnosis, betrayal, illness, death, losing a body part or income—your mind responds with a shutdown. Usually about three weeks after the shock hits.

This unfolds in predictable waves: three weeks out, three months, six months, one year. Each wave brings another layer of understanding and grief.

 

You know that image of someone lying in bed facing the wall? That's this.

 

Here's what matters: this is your healthy psyche doing grief work. You're supposed to feel this way after loss.

What's not normal? When there's no grief at all. When someone loses a loved one and acts like nothing happened. Or flips into unusual cheerfulness and hyperactivity. That's "pathological grief"—the psyche refusing to process what happened.

The other warning sign: when this depression doesn't lift after several months. Then it's time for professional help.

 

Your mind removes energy from daily life so you can focus inward. The more someone uses denial and suppression, the more likely they'll avoid this necessary sadness—and the body will eventually express it through physical illness instead.

 

Every loss deserves acknowledgment. That's the only path through grief.

This one is sneaky and dangerous. I know because I've experienced it.

 

Instead of slowing down after trauma or loss, the person speeds up. Becomes abnormally productive. Schedules fun as an obligation. Fills every single minute to avoid sitting with what's actually happening inside.

 

Picture this: a calendar with 25-30 tasks daily. Every day. For months. Not one moment to hear yourself think.

I had a client who lost both parents within a year. She looked like she'd stepped out of a magazine—perfect hair, perfect skin, running marathons, launching a business. She mentioned crying once about her childhood dog but nothing about her family.

 

Something felt off.

 

I consulted with a psychiatrist colleague. She asked me to refer the client immediately. Turns out she was developing hypertension, having visual disturbances, running on fumes. All that energy was borrowed from unprocessed grief.

When I went through my own version of this, I was taking on every project, saying yes to everything, filling my schedule until there wasn't a spare hour to think. It looked productive. It felt like I was thriving. But underneath was a massive reservoir of pain I was running from.

 

This is why agitated depression (sometimes called "smiling depression") is so dangerous. It looks like success. It feels like energy. But it's hollow.

 

For those with cyclothymia or bipolar tendencies: Many people I work with describe a specific fear—the terror of falling into a depressive state. The hypomanic or pre-manic phase feels good. Productive. Alive. Creative. So they unconsciously run from any pause, any stillness, because what if it tips them into the darkness?

 

This creates a vicious cycle: pushing harder to avoid the crash, which only makes the eventual crash worse. The high-functioning phases become a way to escape the low-functioning ones, but you can't outrun your own brain chemistry forever.

 

Learning to tolerate the in-between states—neither manic nor depressed—becomes essential work. Learning to sit with moderate energy levels without panicking that depression is coming.

This is the one I know most intimately from my first episode.

 

The key feature: apathy that grows over time.

 

In reactive depression, you eventually start wanting to live again. In apathetic depression, you want less and less, week by week.

 

Your world shrinks. Social life disappears. Movement stops. You can't shower—there's no energy even for that.

 

I've worked with several clients through this:

• One couldn't handle basic administrative tasks for over a year
• Another spent months in bed, only getting up for work, until eventually "going down the subway stairs became impossible"
• A third stopped leaving their apartment entirely. Only enough energy for scrolling online.

The cruelest part: in this state, you have no energy to seek help. None. Every decision becomes impossible. Standing up is a decision. Texting someone is a decision.

 

How it's different from reactive depression:

 

Reactive: You lie down, you rest, and after some weeks, you start wanting things again. Food. Laughter. Connection. The fog lifts.

Apathetic: Each week you're capable of less than the week before. The fog thickens.

 

When I went through this, I stopped leaving my apartment. Then I stopped being able to do basic tasks. The washing felt insurmountable. Making food became impossible. I wasn't sure why I needed to leave my bed.

 

Thankfully, I had a partner who took care of me when I couldn't take care of myself. After months of constant suicidal thoughts—not active plans, but that persistent "wouldn't it be easier to just not exist"—I decided to try antidepressants.

I was terrified of medication. But I was more terrified of where my mind was heading.

 

Signs you're recovering:

Tears. You can cry again. During apathetic depression, crying feels pointless—it takes energy, and for what? Everything feels empty anyway.

Anger. I had a client who, after months of apathy, suddenly got furious at a store clerk and filed a complaint. Her psychiatrist was delighted: "She's getting better."

This is crucial and often overlooked.

 

Before or alongside medication, check:

• Vitamin D levels
• Ferritin (iron stores)
• B12
• Thyroid function
• Sleep quality and patterns
• Eating regularity (not even "well," just "regularly")

You cannot build recovery on a broken foundation. Get bloodwork. Fix deficiencies. Establish basic sleep hygiene and eating patterns. Then add other interventions.

Antidepressants work better when your body isn't already depleted.

 

The strict rule for apathetic depression:

Tell people. Tell as many as you can manage.

"I can't get out of bed. I can't leave the house. I can't work. I can't make food. I can't answer messages. I can't talk."

Tell people who can do something: come over, bring food, connect you with a doctor, sit with you.

Understanding the neuropsychoanalytic perspective gives us a different lens on recovery. If depression involves a shutdown of the SEEKING system—that fundamental drive for curiosity, exploration, and engagement with life—then recovery isn't just about fixing brain chemistry. It's about reigniting that system.

 

The SEEKING system is activated when we imagine a goal and see it as really possible. When the SEEKING system and the mental image of a goal join together, we find motivation, energy, focus, and optimism.

 

When the SEEKING system loses activation, we experience loss of energy, hope, optimism, and capability—in other words, depression. What turns it off? Anticipating failure. Running into brick walls. When goals feel unreachable, pleasurable anticipation melts into hopelessness.

 

So how do you restart a system that's been shut down?

 

Small, achievable novelty. The SEEKING system responds to novelty and exploration. Novel stimuli activate dopamine neurons and the brain regions involved in motivation. But here's the key: when you're depressed, "novelty" doesn't mean skydiving or radical life changes. It means:

• A different route on your walk
• A new flavor of tea
• Rearranging one shelf
• Trying one new recipe
• Listening to music from a genre you've never explored

The goal isn't excitement. The goal is gently reminding your brain that exploring feels safe. That seeking can lead somewhere.

 

Curiosity over achievement. The pleasure is in the anticipation and seeking, not just the reward itself. Depression often makes us fixate on outcomes—"what's the point if I can't do it perfectly?" But the SEEKING system activates through the process of exploration.

 

Ask yourself small questions:

• "I wonder what would happen if..."
• "I'm curious whether..."
• "What does this taste/feel/sound like?"

Curiosity predicts reduction in anxiety and depression symptoms and improved emotional mood. Not dramatic curiosity. Just... noticing things.

 

Tolerate the in-between. For those prone to cycling between highs and lows, the SEEKING system can lose its functional autonomy and become narrowly fixated on specific activities or completely shut down. Part of recovery is learning that the SEEKING system can operate at moderate levels—you don't need to be hypomanic to feel alive, and you don't have to shut down completely when you pause.

 

This is uncomfortable at first. Moderate engagement feels wrong when you're used to extremes. But maintaining the functional autonomy of the SEEKING system means allowing it to activate spontaneously, not just in response to immediate rewards or pressures.

 

Professional support matters.

Here's a refined version:

Professional support matters. I'm not a medical doctor, so I can't prescribe or advise on specific medications. What I can say from professional and personal experience: different approaches work for different people. Some find therapy alone sufficient. Some need medication. Some need both, plus lifestyle changes, plus time.

 

However, during severe stages of depression—when everything feels impossible and pointless, when getting out of bed is insurmountable—antidepressants can be essential to create enough movement for any other intervention to work. You can't do therapy effectively when you can't think. You can't implement lifestyle changes when you can't get to the kitchen.

I highly recommend working with both a psychiatrist and a psychologist to find the right combination. For some people, this means 6-8 months of medication alongside therapy, then tapering off and maintaining recovery through other means. For others, longer-term or even lifelong medication creates the foundation for a good quality of life.

 

My personal advice: if you're feeling off for two weeks, don't wait for it to get worse. See a psychologist. Early intervention is so much easier than trying to climb out of a deep hole. I caught my second episode earlier precisely because I knew what the warning signs looked like, and it made an enormous difference in recovery time.

 

The earlier you address it, the more options you have. Don't wait until you can't get out of bed to ask for help.

Endogenous Depression: No trigger. Just brain chemistry. Relatively rare. Requires ongoing medication, which can make life completely manageable and good.

Dry Depression vs Tearful Depression: Can't cry despite having reasons (dry) or crying at everything (tearful). Both can last years. Often variants of reactive depression, linked to hormonal responses to stress.

Somatized Depression: Depression disguised as physical illness. Doctors treat the pain, the symptoms, search for causes—find nothing. This often happens to people who "push through" everything.

 

I met my colleague's client, who had chronic back pain and limping for two years. After months of medical tests showing nothing, her doctor asked about recent losses. She'd lost a parent eighteen months prior and "didn't have time to grieve." Therapy plus addressing her vitamin deficiencies, and the pain started lifting.

 

Masked Depression: Multiple physical symptoms that move around. Headaches one week, stomach issues the next, then muscle pain. All real. All connected to unprocessed emotional pain.

 

What Requires Professional Diagnosis

 

PTSD: Doesn't respond well to standard antidepressants. Treated effectively with EMDR therapy. Can look like depression but has distinct trauma-response patterns.

Bipolar II: Alternates between highly functional phases and extremely low-functioning ones. Antidepressants alone can make things worse—can trigger manic episodes.

Generalized Anxiety Disorder: Tons of energy consumed by managing anxiety. Makes basic tasks feel impossibly complex. Often coexists with depression.

Depression is a state disorder, not a personality disorder. It's biochemical. Neurophysiological. Your neurotransmitters—particularly in the SEEKING and PANIC/GRIEF systems—got exhausted and stopped delivering the right messages.

 

Any of these symptoms—even one—can signal something's wrong:

• Waking up multiple times per night
• Insomnia or sleeping too much
• Appetite changes (eating too much or too little)
• Forgetting words, losing short-term memory
• Passive suicidal thoughts ("wouldn't it be easier to just not exist")
• Feeling separated from everyone by invisible glass
• Derealization (everything feels dreamlike or unreal)
• Depersonalization (feeling like you're watching yourself from outside)
• Nothing brings joy as before

This isn't about your personality or your strength. It's about tired brain chemistry. And it's treatable.

 

I'm a psychologist. I know the field, I know the warning signs, I have access to excellent colleagues.

 

And yet:

I didn't recognize my own first episode initially—I thought I was just tired.

 

Don't stop at the first provider if something feels off. This is your brain health. It's worth the search.

 

Being a psychologist didn't make me immune. Understanding depression academically didn't prevent me from experiencing it. But it did help me recognize the warning signs earlier the second time, and it gave me the language to ask for help.

Sometimes knowledge isn't a shield. Sometimes it's just a map that helps you navigate the darkness a little better.

Final Thoughts

 

Depression removes the fake energy and shows you exactly where you are: "I have this much capacity right now. I can't pretend anymore. I need help."

 

That's not defeat. That's honesty. And sometimes honesty is the first step toward actual recovery.

 

The neuropsychoanalytic perspective reminds us that depression isn't meaningless brain chemistry gone wrong. It's your psyche responding to loss, to separation, to unmet attachment needs. The feelings associated with depression are motivated—they're trying to tell you something.

 

Listen to them. Honor them. And get the support you need to process what they're revealing.

If you're reading this and recognizing yourself: please tell someone. A friend, a doctor, a crisis line, anyone. The hardest part of depression is that it makes asking for help feel impossible.

 

But you deserve help. Your brain deserves support. This is treatable.