Telling someone who is depressed "just snap out of it" or "it could be worse" is not helpful

These types of phrases are common with family and friends to those suffering with depression. They are often made with kindness and with the intention of being helpful. Sometimes they come out of exasperation or from the pain and hurt one feels from seeing a loved one feeling depressed. However, these types of statements rarely seem to be helpful. Many with depression actually say that these types of statements make them feel worse and culpable - that they are counterproductive.

The neuroscience today provides a better understanding of why. Family, friends, and colleagues should be encouraged to look for alternative ways and measures to help an individual dealing with depression.

Depression, a state of, but not only, sadness

It is difficult for someone who is not dealing with depression to be able to place themself in the shoes, or understand the feelings, of someone who is. When we try to do it, the thoughts that naturally occur are those of sadness. However, depression is much more than just sadness... it can include the feelings of anxiety, hopelessness, fatigue... a lack of interest, psychological suffering, and low morale.

The negative effects and thoughts are often the most visible part of depression and probably the most "understandable" for society. In the same way people try and sympathize with those that suffer from a physical injury, people often try and sympathize with loved ones who suffer psychological pain, even when they do not understand the cause.

But depression is not only reflected in this excess of so-called negative effects. It also manifests itself in another aspect, which is equally frequent and serious: the lack of positive affects. Psychiatrists have a varied jargon to describe the different symptoms: anhedonia or the inability to experience pleasure, aboulia or the abolition of the will, and the inability to act or a feeling of numbness.

A feeling of low spirits is temporary, but not depression

When people often think of depression and its symptoms, it is common for people to think and remember when they felt a feeling of "low spirits" and periods of discouragement. These types of feelings can be a result from an overload of stress or painful news; however, fortunately, these symptoms, generally, turn out to be temporary.

In fact, when a few days of rest are not enough to get out of this state, loved ones are there to shake and push us to act or change our ideas. But during depression, ideas do not change on demand, as a result of a simple distraction or direction... nor do they change spontaneously. The term rumination, one of the symptoms of depression, precisely defines this inability to "change ideas," this propensity to concentrate on the same negative thoughts again and again, to blame oneself for the same bad things. Very often, a person with depression is fully aware of their condition... that they are suffering from it, yet they are unable to change their mindset or outlook.

This second component of depression, the lack of positive affects, is not necessarily well treated by current therapies. Conventional antidepressants (including selective inhibitors of serotonin reuptake) appear to be more effective in most patients for treating the excess of negative effects, the first component, according to scientific literature.

A disease that affects the brain networks involved in motivation

The latest research in neuroscience suggests that depression is a also disease involving motivation, that is, it affects the brain networks involved in motivation. This suggests that telling someone who is suffering with depression to "make an effort" or "be more motivated" is just as absurd as telling someone with diabetes for his/her pancrease to "make an effort" or for someone who has broken his/her leg to "feel less pain." 

There are several ways in which a researcher can approach the mechanisms of motivation. Thus, it is possible to ask about its determinants related to genetics or the environment, its neurobiological foundations (at the microscopic level of a cell, its neuroreceptors, neurotransmitters), its cerebral bases (visible through imaging studies, at the cerebral area) or its cognitive mechanisms (related to the functioning of thought).

The team of Cognitive Neuroscience, Brain Motivation, and Behavior at the French Brain and Spine Institue (ICM) is studying this in patients. They use functional magnetic resonance or electrophysiology, taking into account prescription medications.

In this focus, motivation can be defined as the set of factors that determine the behavior of an individual, in terms of direction: choosing one action before another (e.g. preparing dinner instead of ordering a pizza) or in intensity: determining the amount of resources one assigns to an action (the amount of effort or time one devotes to an action).

A comparison between benefits and costs

When we have to choose between several actions and options, our decision is based on a confrontation between two opposing elements: on the one hand, the benefits (the rewards we can obtain) and the losses (those that we can avoid) and on the other hand, the costs (the energy and effort expended or required)

In this context, the notion of a reward can refer to a material good (an object, food, and even money) and to an intangible good (e.g. the pleasure of immersing oneself in a book or self-esteem from compliments). In the same way, costs can refer to both physical and mental costs.

This division into two categories of the determinants of our actions is probably reductive, even simplistic. But it allows for it to point out the origin of a disorder of motivation as part of one of these two main axes: either a decrease in sensitivity to rewards or losses or an increase in sensitivity to effort. These two mechanisms can likely coexist in an individual dealing with depression, in different degrees.

Take the example of a person who faces the action of going out to meet his friends in a restaurant. An individual suffering from depression may be unable to do so either because the prospect of reward is removed (the pleasure of being with loved ones), or because of the increasing cost of each of the actions required to meet his friends (the effort associated with making decisions, getting dressed, styling his hair, and traveling to the restaurant).

Each decision becomes a mountain to climb

Many individuals with depression express their difficulties in these similar terms: the slightest decision, the slightest action, become large mountains to climb. In fact, every time it is asked upon someone with depression to "try harder" or to do something that seems minimal, it is actually a large undertaking to them. Even if they do the action that seems minimal to us, like "just going to eat a restaurant," it is such a huge effort for them that they won't even be able to enjoy the accomplishment.

In recent years, several teams around the world have tried to measure these two aspects of motivation, in the general population or in individuals with a motivational disorder, such as depression.

What is at stake is so important that a series of arguments seem to indicate that the cerebral and chemical bases of each are different. When we calculate the value of the reward or the cost of effort, it is not the same brain regions, and probably not the same neurotransmitters, that are being exercised.

However, currently there is no validated way for psychiatrists to measure the weight of these two mechanisms in a patient in their daily practice. For the time being, these evaluations are limited to patients who have followed a research protocol and are only valid at the group level.

However, there is a strong possibility that these two main mechanisms of motivational disorders (such as depression) may require different therapeutic interventions, whether medications; brain stimulation, such as transcranial magnetic stimulation or electroconvulsive therapy; or psychotherapy. In the future, it will probably be possible to distinguish, in a loved one suffering from depression, which of the two mechanisms is involved.... until then, we should refrain from overwhelming those with depression with phrases aforementioned.

Have you ever been told phrases that did not help with your depression (or mental aspect of dealing with a condition)? How did it make you feel?

What would you recommend to others to say if they want to give you encouragement or try to make you feel better and help?