Internal Vs. External Depression

The other night, my boyfriend and I had an interesting conversation about the best ways to escape from a bout of depression. He told me that he usually has to make changes to his environment to improve his mood when it’s sliding downhill, because his problems tend to stem from his surroundings.

“When I’m honest with myself,” he said, “I can usually figure out where my sadness is coming from, and make changes to my life. Then I start to feel better.”

I thought about that, and it completely astonished me.

“I’m the opposite,” I replied after a quiet moment. “I always think making lifestyle changes will pull me out of depression, because that’s just intuitive. But it never works. If I decide to cut a toxic friend out of my life, I always just find a new friendship to be depressed in. If I decide to move to another city, I’m just depressed in that city. Nothing I do ever seems to fix my mood.”

I started noticing this trend a long time ago, when therapy stopped improving my depression despite how hard I devoted myself to getting better. I switched therapists several times, bought – and used! – workbooks, and cycled in and out of therapy groups for years. But still, my brain continued to plague me with irrational sadness, baseless anxiety, and myriad symptoms of borderline personality disorder.

The best explanation that I’ve been able to come up with for this is that my depression is mostly biological in origin, whereas my boyfriend’s depression is mainly environmental in origin. He doesn’t start to feel symptomatic until something in his surroundings goes wrong. My brain, on the other hand, doesn’t give a damn what’s happening around me. It’ll decide to malfunction at the drop of a hat, because (to the best of my amateur knowledge), parts of it are congenitally damaged. That’s why behavior therapy and skills training work well for people like my boyfriend, but they fall flat for people like me. He has a measure of control over his triggers, because they’re external. Mine are internal, so I don’t have that control.

However, that’s not a death sentence for me. I can still treat my depression; I just have to approach that treatment differently than someone like my boyfriend would. When he’s feeling unwell, it’s probably smart for him to make lifestyle changes before trying out biological treatments, like antidepressant medication. I’m just the opposite, though: when I’m sick, therapy doesn’t help me until I’ve modified my chemistry with medicine.

The greatest benefit of knowing that my depression is more organic than environmental in origin is that it’s much easier to see my most effective treatment path. I could have skipped past a lot of pain and sadness had I known years ago that cognitive behavior therapy wouldn’t do anything but frustrate me until I’d attended to my screwed up brain chemistry. Ever since I figured that out, though, I’ve been able to find chemical treatments for my depression, which have (finally!) proven helpful. Because of that, my symptoms have abated to the point where I can find relief from therapy for the first time ever.

I encourage everyone who suffers from depression to closely examine what might be causing it – whether it’s chemical factors or environmental factors – and adjust their treatment plan to accommodate that.

One thought on “Internal Vs. External Depression

  1. Hi Zoe, I think you are totally correct about the two types of depression you described. Your type, without exterior causes, triggered by BPD, and the type of depression that most people can suffer from, usually triggered by an event with significant emotional implications, like the serious health problems of a family member, for example. I think there is a third one that has a genetic predisposition, lies dormant if is not triggered by exterior causes, but it can hit as hard as the one caused by BPD if it’s triggered by problems that for most people would not be insurmountable. The big problem with this type of depression is the false belive that the sufferer has that it’s something temporary that will just go away eventually, without any need for medical help.
    I was consistently happy throughout my childhood and even throughout my adolescence, so I did not seek medical help because I considered myself a “normal” person, only to see my depression get worse over time. I just never could adapt to the problems that you have to face as an adult living in a failed and dysfunctional country after I was shielded from those problems by my family when I was younger.


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