People suggesting exercise, avoiding negative thoughts, and going out and trying new things need to understand that their advice is sound - you need to make changes in your life situation to rise out of the depressed state. However, you have got to realize that depression is a disease of the brain. Forget your Cartesian mind/body duality - the "mind" is the result of complex electrical and chemical signalling in the brain. To grossly oversimplify, getting up off the couch to go outside involves activation of the prefrontal cortex, where planning occurs. Information is passed to to the premotor complex, which has a role in planning movement and sending signals to the trunk muscles. The motor cortex has to be activated to execute voluntary movements. You have activation of the hippocampus to orient yourself in space and remember what you were getting up to do. The rest of the limbic system is involved in your motivation and emotional state.
In depression, you can have problems with the signalling in any of these regions, and the propagation of signals between the different brain regions. To understand what this can look like, think about
Parkinson's disease. The Parkinsonian patient has lost key dopaminergic inputs to brain regions responsible for voluntary movement (dopamine does all sorts of things in the brain - most neurotransmitters have diverse functions, varying with the timing and location of their release. Dopamine is involved in voluntary movement, paralyzing your body when you sleep so you don't act out your dreams, reward conditioning [a dopaminergic pathway is a common final pathway in drug addictions] among other things). Despite the will to movet= the body, the Parkinsonian patient displays rigidity, slowed movement (bradykinesia), tremor, and impaired balance. The patient wants to make smooth voluntary movements, but lacks the chemical messengers the brain uses to carry out this function.
It helps to think of depression the same way. There are defects in the chemical messengers and neural circuits involved in mood, motivation, memory, appetite, anxiety, sleep, energy/lethargy, irritability, and the impulse to harm of even kill oneself. The specific changes vary between patients and can have genetic, developmental, and acute etiologies.
It's easy to say to the depressed patient, "just get up and do something! Think positive thoughts!" However, the brain of the depressed patient may lack the chemical messengers, pathways, connections, etc. to actually accomplish a simple act like getting motivated to get out of bed, get ready to leave the house, and engage in a relatively simple task. Think of asking a diabetic to "just make more insulin!" It's a little more complicated than that, because the brain is so incredibly complex and there are so many signals and connections, but the analogy is still helpful in understanding why depressed people seem locked into negative thoughts, are seemingly unable to engage in seemingly simple beneficial activities, and may be obsessed with feelings of worthlessness and suicidality. Your brain needs proper signalling to occur for you to carry on the activities of your life. Screw up that signalling and you can get mental illness. It may be nearly impossible to suppress negative thoughts because the depressed brain just keeps sending these signals.
Encouraging the depressed patient to make changes in his or her life, to engage with the world, to exercise, to give thought to the positive aspects of life - these are all good things. However, your thoughts are running on your brain "hardware." You can't think yourself out of depression if the chemical messengers that propagate these thoughts around are out of whack. You have to understand depression as a disease of the brain. We generally talk about mental disorders as diseases of the mind (by definition), but you have to understand that the mind is instantiated in the brain. You can alter your brain circuitry through therapy and medications, but it's rarely as simple as just "thinking happy thoughts." Imagine the extreme case of a brain completely lacking the chemical signals for happy thoughts - dopamine, serotonin, the endogenous opioids, etc. The brain isn't magical - if you deplete the neurotransmitters involved in positive emotions, how do you make your brain produce those emotions? This is why people's mood crashes after they use cocaine - your brain basically dumps its stock of "feel good" neurotransmitters and you feel like shit until you can replenish your stores of dopamine, etc. Your brain can't send messages without the right neurotransmitters.
So yes, encourage your depressed friends to get out and do things, to engage with the world, to seek out positive experiences. But have some compassion - there are neurotransmitters underlying ideas such as willpower. It's not always a personal moral failure if you can't muster the willpower, desire, etc. to make some positive change in your life, or even just to take a simple action like get out of bed and face the outside world. The depressed patient may physically lack adequate neurotransmitter levels, have abnormal distribution of these transmitters, or have problems with the receptors for neurotransmitters involved in mood, motivation, etc. Just as the Parkinsonian patient may lack the dopamine needed to complete a smooth, rapid movement (no matter how much they try to "will" themselves to make the motion), the depressed patient may have a problem regulating the level of the mood regulating transmitter serotonin. No amount of "will power" or kicking oneself in the ass is going to make the depressed patient spring up and undertake a bunch of interventions to improve his or her life. Depression is a complex disease and the treatment can take a great deal of time, effort, medication, therapy, and support from loved ones. The ultimate goal is to rewire your brain, and that's rather hard to do.
Sorry if I've told the "just exercise!" or "get off your ass and do something!" crowds to fuck off, but you've got to understand the complexity, severity, and subtlety of the changes in the brain that can lead t depression. Some depression is probably mainly psychological - the treatment is to learn to think in a slightly different way, but you have to remember that severe depression is a disease of the brain with structural and chemical changes that can be very hard to fix. Often the changes have been reinforced over the period of years, may have underlying genetic factors, and be compounded by psychological problems.
And remember that what gets called "Major Depressive Disorder" is probably best thought of as a family of "Major Depressive Disorder
s". I read William Styron's classic account of his depression,
Darkness Visible: A Memoir of Madness, and was surprised at how different his experience of depression was from my own.
Keep at it, DepressedGAF! Personal stories of overcoming depression can be very powerful, but recognize that all sorts of different symptoms fit under the umbrella of "Major Depressive Disorder(s)." What worked for you may make someone else worse (I got much worse on a Wellbutrin/Celexa combo - others swear by these drugs). And simply saying "get out there and change your whole life!" is much easier said than done, especially when your brain's basic circuitry is a complete mess.
There's always hope, bleak as things may seem at times. If a therapy doesn't work, there are dozens more to try. End you life, on the other hand, and that's that.
Sorry for the long posts. I recognize that "tl:dr" might as well be my middle name, but I sincerely hope that you can find something in all this writing that resonates with you. I'm happy to answer any questions about whatever - the scientific literature, current theories of depression, new therapies, my own journey from severe depression to remission (knock on wood!), books about depression, treatment centers, why Nick Drake's album
Pink Moon is one of the great works of art "about" depression ever created, whatever.
