Although depression is all around us and has probably been in existence as long as there has been a human race, we still labor under many misconceptions about it. Even mental health professionals, doctors and scientists have a long way to go before we can truly say we understand it fully. In this article I will focus on some of the most common misunderstandings I hear about depression.

#1. “HAPPINESS IS A CHOICE”

Talk about blaming the victim. This is one of the worst, most hurtful, misconceptions. Really, who on earth would choose to be depressed? If merely choosing to not be depressed worked, I’d have to find another job! I think in part people say this because we all like to feel in control. The rational part of our mind is often trying to maintain control over the emotional self. When we tell ourselves or others that we can choose not to be depressed we feel safe and in control. I have seen innumerable instances where people’s rational side overestimates its power over the emotional side. Often the result is that the feelings persist, leaving the person with a sense of being a failure.

#2. “DEPRESSION IS A WEAKNESS”

Similarly, many people with depression blame themselves. They may feel like they are weak for “letting” themselves get depressed. The truth is that depression is an equal opportunity illness. It strikes people from all walks of life, from all backgrounds; it strikes people with great physical strength and force of will, as well as those with less.

#3. “WHAT DO YOU HAVE TO BE DEPRESSED ABOUT?”

The missing consideration here is that biology (more on this later) often plays a big role in determining who does or doesn’t get depressed. That role can be so powerful that people who truly do have everything going for them can find themselves depressed. Or conversely, people who are living very difficult lives can be spared from depression. External stresses and events clearly can be part of the picture, but they are only one factor of many.

#4. “DEPRESSION AND SADNESS ARE THE SAME THING”

While being sad and having major depression share some similarities in terms of sad mood, major depression is much more than that. First of all, depression goes on and on, day after day,  for weeks, months or even longer. Also it is associated with alterations in sleep and appetite (either too much or too little). Depressed people tend to lose interest in pleasurable activities, find it difficult to motivate themselves to do the things they have to do, feel tired and run down, find it hard to enjoy themselves and avoid socializing. Memory, concentration and libido (sex drive) are often diminished. And most concerning of all, they may have thoughts of suicide or even try to end their lives.

#5. “ANTIDEPRESSANTS WORK FOR EVERYBODY”

Although antidepressants have helped countless people and saved many lives, they do not help everyone who takes them. Only about ⅔ of people taking a given medication get substantially better and only about ⅓ get full remission from their medication. If you then allow for switching medications and adding boosters to them, you can get better statistics. Even then, however, there always are some people who just don’t seem to respond to medications. This is where TMS can be particularly helpful, because it is a completely different approach. Most people who have already tried and failed several different medications do see meaningful improvement with TMS. 

#6. “JUST EAT RIGHT AND EXERCISE”

A healthy diet and regular exercise are important parts of wellness. Often, for levels of depression that don’t qualify as “major” or clinical depression, these can be all you need. But the more severe a depression gets, the less likely it is that these will be sufficient. But folks are still well advised to keep exercising and eating right! There is evidence that certain supplements including l-methyl folate, l-threonine, n-acetylcysteine and vitamin D are useful, particularly in a supporting role, but they are probably not as effective as antidepressants or TMS for serious depression. 

#7. “DEPRESSION IS A CHEMICAL IMBALANCE”

Doctors are largely responsible for this one. In an attempt to destigmatize depression, and probably because we saw how effective chemicals were at relieving depression, we oversimplified things. Although adding manmade chemicals raises the levels of internal chemicals like serotonin, norepinephrine and dopamine, when we go looking for low levels of these in depressed people we don’t often find it. Just like a headache is not an ibuprofen deficiency, depression is not simply a serotonin deficit. We do see that for many, raising the levels of one or more of these neurotransmitters relieves symptoms of depression. Another argument against the “it’s all chemical” theory is that non-chemical treatments like TMS or ECT work quite well at treating depression and are not thought to produce their effect via chemical means. TMS increases the activity level of one node in a network of brain regions. We are only now learning the importance of these networks and their wiring diagram. Another area of active research is epigenetics. We are learning there is a complex, elaborate system of controllers that regulate the activity levels of genes. This seems to also be very important in the development of depression. 

#8. “DEPRESSION IS THE RESULT OF STRESS”

Stress is a very important factor, but is only one of many. Genetics, psychological makeup and early life experiences also usually pay a part. It seems depression is a complicated combination of many factors coming together in different ways in different people.