Ups and Downs
About Depression
I sat in a doctor’s office a few days ago, for someone close to me. To the outside, She now lives a low stress, with a peaceful family, under a safe roof. But what was inside is different. She has been quietly drowning in depression.
The signs were subtle—insomnia (the kind Matthew Walker warns about in Why We Sleep) and the long shadow of a traumatic past. Occasionally, a tantrum would flare up. But hey — everyone throws a tantrum sometimes! You would never have guessed she is actually sick. You certainly wouldn't understand why it is happening now, when the traumatic events had passed and the future is now looked so clear.
I hesitated to answer the call to the doctor out of classic denial, which is always that stubborn first step of grief. But eventually, I showed up. There, I learnt about her condition, and depression.
The doctor explained depression through two distinct forces: the "happiness" chemicals and the "sadness" ones. (Scientifically, it’s far more complex, but the metaphor stuck.) She suggested that happiness and sadness are not on the same spectrum. They aren't a seesaw where one goes up and the other must go down. Instead, they are two separate reservoirs.
When your happiness reservoir is full, you feel great, but the sadness reservoir doesn't necessarily drain. When the "highs" inevitably dip, the sadness—which never actually left—takes command. The depression episode kicks in. The explanation covers the unexpected suicide cases which we often heard or see.
"What?! I just had dinner with him last night and he looked so happy!"
He was truly happy during the dinner. But the happiness does not remove the sadness deep within. Perhaps, the gap it leaves when the transition from happy to sad happens is even harder to manage.
Arthur C. Brooks 1 echoes this. He notes that unhappiness isn't just the absence of happiness. Our brains process positive and negative emotions in entirely different hemispheres—the left side for the light, the right side for the dark.
It’s easier to grasp if you look at Herzberg’s Motivation-Hygiene Theory 2. Though usually applied to the office, it fits life perfectly. Herzberg argues that "Motivators" (like achievement) drive satisfaction, while "Hygiene Factors" (like salary or safety) prevent dissatisfaction. Removing a hygiene problem doesn't make you happy; it just stops you from being miserable.
In our context: money or health might only affect the "sadness" reservoir. Good health doesn't make you burst with joy every morning, but its absence will plunge you into agony. We spend so much time chasing "Motivators" to be happy, but we forget to fix what really makes us sad.
The Uphill Battle
The doctor noted that elevated sadness is often a legacy of trauma or a glitch in the body’s hormone regulatory system. It can also be both. Why We Sleep reminds us that sleep is the primary regulator here. Depriving yourself of it isn't just a bad habit; it’s an invitation to depression 3.
And while sleeping pills might seem like a shortcut, Matthew Walker argues they are more like a chemical "knockout" than a natural rest. They lack the restorative power of true REM sleep and come with their own set of risks 3. The gold standard isn't a pill; it’s therapy—specifically CBT-I.
I have done some research after that and during this writing. It appears that the depression is much more complicated than that - obviously, and surprisingly it still is an unsolved mystery today to the medical experts even with the advancement in the healthcare.
Here are the research that I have done. Full disclaimer: I am not an expert in the field. I am just a mere curious reader and writer. The experts who spend more than eight hours everyday definitely know more and better than I do. Nevertheless, I write to learn. First of all, there is not one single hormone that regulates sadness or happiness, but a combination of several hormones. A direct quote from Harvard Health Publishing 4 explains that:
To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.
The following is derived from the paper Relation between Depression and Hormonal Dysregulation 5. The endocrine system uses glands to control hormone levels. Hormonal changes affect mood and vice versa. The main hormones involved are corticotrophin hormone, cortisol, estrogen, progesterone and thyroid hormones. Maintaining hormone levels alone is insufficient. Nerve cell connections, nerve cell growth and the functioning of nerve circuits also have a major impact on depression 4.
Secondly, there are different types of depression—clinical depression such as Bipolar disorder and Major Depression, and non-clinical diagnosis types such as smiling depression. I find smiling depression better fits the explanation that the doctor gave. People suffering from smiling depression tend to mask their sadness, but they are still depressed internally. The masking behavior often comes from the fear of burdening others, embarrassment, denial, guilt and perfectionism. These people have a higher risk of suicide because they are less likely to get the required medical attention and they have the energy to follow through their suicidal thoughts. Smiling depression is the reason behind the unexpected suicide cases.
I put a stop here. In the future, we could explore more on the ways to spot depression victims around us and ways to help them.
Vice Versa
If mood can affect hormones just as much as hormones affect mood, it places the responsibilities on the patients. Neuroscientists claim that practising postures can have the same effect. It means that the patients — to a certain extent — have the ability to fix themselves.
But we have to be careful. If we say "you have the power to fix yourself," it’s easy to label those who can't as "weak." It makes empathy harder to reach.
It probably can be done, but it is not going to be easy. The hormonal change affects our mood and behavior in a subconscious manner. We behave like that unintentionally and perhaps unknowingly. To bypass the hormonal effects to take control of the mood consciously is to defy our subconscious. It is an uphill battle.
About Ups
Some takeaways from Arthur C. Brooks's video:
Happiness is a combination of enjoyment, satisfaction and purpose.
Enjoyment is enjoying with consciousness. Satisfaction is a reward for a job well done. Purpose is finding out what you live for.
Happiness is not about chasing dopamine. The craving for dopamine is endless, because it is addictive. Once you have satisfied the need for dopamine, you end up wanting more. Practising gratitude helps with getting satisfaction. To tell yourself that it is enough, to be satisfied with what you have had, those acts of gratitude help more with happiness rather than pure enjoyment.
Social media does not increase happiness. Arthur described it as junk food. It lacks the interaction, or oxytocin, you would need and you could only get from actual face-to-face social interactions such as eye contact, hand gestures, physical touch and so on. Junk food won't make you less hungry.
About Life
Applying Herzberg's Motivators and Hygiene Factors in life can help us to develop empathy. We should know that everyone has lows in life and that oftentimes the lows are what matter. It is not the case that someone with a great career and numerous fantastic achievements is immune to all the downs, nor can the ups balance out the downs. All it would take to ruin it all is probably just a broken marriage or the death of a loved one.
We have a new perspective now. Making or keeping a depressed person happy is not always the way. Because when the happiness hormone goes down, which it eventually will, a depressive episode kicks in. Instead, we should try to tackle the depressive episode together with the person. The key is to make their lows not be that low. We should look at the problems together and provide our support instead of shifting their attention elsewhere. Encouraging them to voice the issue and listening are so important. This is also why therapy is often suggested.
As Daniel Kahneman notes in Thinking, Fast and Slow 6, we are naturally loss-averse. We feel the downs much more sharply than the ups. So, reevaluate your goals. You might be overvaluing your fantasized goals and dangerously underestimating the cost of the sacrifices.