next, and to make matters more confusing, it is possible that any one
complex could influence all the others. Nevertheless, it helps to think of
the symptom complexes as separate because depressions generally tend
toward one set of symptoms more than others, and treatment is most often
based on which sort of symptoms seem most prominent. The four are:
- Sadness or unhappiness
- Lack of motivation
- Rumination
- Sleep disturbance
SADNESS OR UNHAPPINESS. Depressed people are either sad or have a
diminished capacity to be happy. The distinction may seem irrelevant if
you have to spend time with them, but if you’re trying to help them, it is
extremely important. Sad people are experiencing too much negative
emotion and are actively miserable. They cry out in pain and loss. People
with diminished capacity to be happy don’t cry, or feel much of anything
other than the existential emptiness of melancholia.
There is some evidence that sad people have too much activity in the
thalamusand hypothalamus, parts of the limbic systemresponsible for raw
emotion. Unhappy people may have too little activity in the hippocampus,
the nucleus accumbens, and other areas associated with pleasure and
reward, some of which are also parts of the limbic system. Whatever systems
are involved, sad people need to have their emotions toned down, and
unhappy people need to have theirs stimulated. Though both groups may
be called depressed,they often respond to different medications and dif-
ferent psychotherapeutic approaches.
LACK OF MOTIVATION. Some depressed people can’t seem to get them-
selves going, and others seem to be perpetually moving, but with little focus
or direction. Again, there is some speculation as to differing amounts of activ-
ity in different areas of the brain, perhaps the basal ganglia and the limbic
system, but nobody is really sure. What we do know is that depressed or not,
agitated people are often anxious and irritable and need some basic calming.
RUMINATION. Some depressed people have negative thoughts that just
won’t stop. It’s as if their brains have faulty brakes. Thoughts move around
Explosions into Sadness ❧ 155