Lesson 1 of 6 · What it looks like from the inside
What it takes away, in order
Pleasure goes first, and it goes quietly. Food, company, your own children, the surah you used to love. Still there, still known to be good, and returning nothing.
Then energy. Not tiredness that a night fixes. Something more like every task having a weight attached to it that other people cannot see.
Then thinking slows. Words come more slowly, decisions take three times as long, and you read the same paragraph four times.
And then the last thing, which is the cruellest, because it does not present itself as a symptom. It presents itself as the truth about you. You are lazy. You are ungrateful. You have always been like this. That voice is part of the illness, and it is very good at not sounding like one.
Both of the last two are studied rather than impressions. The slowing shows up on memory, attention and executive testing, and it is often still measurable after the mood has lifted. And one long line of work in cognitive therapy turns on the second point exactly: the beliefs depression produces about you are experienced as true rather than as symptoms, which is why arguing with them from the inside does not work.
What the research says
Depression comes with real, measurable deficits in concentration, memory and planning, and they are still there when mood has recovered. The slowness is a symptom of the illness, not evidence about your character.
A meta-analysis finding moderate deficits in executive function, memory and attention in depressed patients, still present in remission. It is the reason the slowing in this step is described as a symptom rather than as an impression.
Rock PL, Roiser JP, Riedel WJ, Blackwell AD (2013). Cognitive impairment in depression: a systematic review and meta-analysis. Psychological Medicine, 44, 2029 to 2040 doi
In this model depression switches on negative beliefs about yourself, the world and the future, and they are experienced as plain truth rather than as symptoms. That is a model with a large supporting literature behind it, and it explains why arguing with yourself does not work.
Sets out the model in which depression activates negative beliefs about the self, the world and the future which are experienced as true rather than as symptoms. This is a model with a large supporting literature rather than a single experimental finding, so it is offered as one line of research and not as a settled fact.
Beck AT (2008). The evolution of the cognitive model of depression and its neurobiological correlates. American Journal of Psychiatry, 165, 969 to 977 doi
One account describes a form of depression driven by a fixed, sweeping, negative conclusion about yourself. This is a theoretical account rather than an experiment, and it is cited for the shape of the claim rather than as proof of it.
Describes a subtype in which a stable, global, negative inference about the self is the proximal cause. Again a theoretical account rather than an experiment, and it is cited here for the shape of the claim, that the verdict about you arrives feeling like an observation.
Abramson LY, Metalsky GI, Alloy LB (1989). Hopelessness depression: a theory-based subtype of depression. Psychological Review, 96, 358 to 372 doi