Understanding the roots of depression for lasting recovery
Depression is a condition that goes far beyond passing sadness. It is an emotional, cognitive, and physical state that profoundly affects how we perceive ourselves, others, and life in general. It is characterized by loss of pleasure, persistent fatigue, feelings of guilt or worthlessness, and a negative view of the future.
Depression does not present itself in a monolithic form. In reality, it unfolds along a clinical continuum where intensity varies considerably from one subject to another. Classical nosography distinguishes three levels of severity, each involving specific psychic adjustments and consequences on daily functioning.
Mild depression (or mild depressive episode): At this stage, suffering is clearly present, but the individual manages, at the cost of constant psychic effort, to maintain a functional facade. They continue to work and assume their family and social responsibilities, but everything seems to have lost its flavor. It is the reign of the "gray." What clinics often call dysthymia (or persistent depressive disorder) also falls into this category: a chronic morose mood that settles in for years. The subject sometimes becomes so accustomed to it that they believe it is part of their personality, forgetting that a more vibrant psychic life is possible. A feeling of emptiness dominates, accompanied by a dull weariness.
Moderate depression: The waterline begins to give way. The adaptation efforts that sufficed during mild depression are now exhausted. The impacts become obvious to those around them and in the socio-professional sphere. Work absences become frequent, and social avoidance increases drastically. The Ego is monopolized by the management of anxiety and sadness, leaving little libidinal energy available to invest in the outside world. The guilt of "no longer being able to cope" attaches itself to the symptomatology, creating a vicious cycle where the person constantly devalues themselves while witnessing their own loss of vital momentum.
Severe (or major) depression: This involves a major collapse of the narcissistic structure. The subject is then incapable of performing the most basic tasks, such as getting up, washing, or eating. This extreme form is accompanied by intense psychomotor inhibition. The moral suffering is described as intolerable, often punctuated by recurrent suicidal ideation. Psychoanalysis sometimes compares these states to "melancholia," where, as Freud wrote, it is the Ego itself that has become impoverished and emptied of its essence. Discourse is saturated with overwhelming self-accusations or a certainty of imminent ruin, which often requires urgent care.
Identifying a depressive state requires paying attention to a constellation of symptoms that, taken in isolation, might seem insignificant, but which, through their accumulation and persistence over time, indicate the illness. These manifestations revolve around four main axes: affective, cognitive, somatic, and behavioral.
Affective and emotional dimension: The key word is anhedonia, meaning the radical inability to experience pleasure or interest in formerly invested activities. Depressive sadness has a particular coloring: it often appears unshakable, heavy, and anesthetizing. Some patients describe more of a terrifying emotional void or a hypersensitive irritability, where the slightest annoyance provokes outbursts of anger or fits of tears. Mood is generally at its lowest in the morning, making the very idea of facing a new day particularly painful.
Cognitive dimension: The depressive subject's thinking is hindered. Attention, concentration, and immediate memory are drastically diminished, which fuels a feeling of intellectual incompetence. The Superego (the critical agency of the psychic apparatus) shows implacable severity, bombarding the Ego with reproaches, guilt-inducing ruminations, and a fundamental feeling of unworthiness. The patient increasingly perceives themselves as a legitimate burden on their loved ones.
Somatic and physical dimension: The body often becomes the direct mouthpiece of psychic distress. Sleep disorders are almost systematic (stubborn insomnia, anxious early awakenings, or conversely, refuge hypersomnia). Appetite undergoes significant variations. Added to this is an abysmal fatigue, an asthenia that yields neither to sleep nor to rest, as well as the frequent appearance of unexplained physical pain (headaches, muscle tension).
Behavioral dimension: There is a generalized slowing down (bradypsychia and psychomotor retardation) or, on the contrary, unproductive anxious agitation. Withdrawal into oneself is massive. The depressive subject isolates themselves, flees from solicitations, and cuts themselves off from their social network. The loss of libido and sexual desire completes this general disinvestment in the relationship with others and the world.
In the treatment of depression, psychodynamic and psychoanalytic psychotherapy offers a distinct path. Unlike approaches focused exclusively on the rapid eradication of the surface symptom, the analytic approach considers the depressive symptom as a compromise formation, a coded message from the unconscious attempting to signify repressed suffering.
Understanding the meaning of loss: The dynamics of depression are intimately linked to unresolved mourning processes. This does not necessarily mean the death of a loved one, but "object losses" in the metapsychological sense of the term: the loss of an ideal, a status, an infantile illusion, or the loss of an idealized self-image. The therapist helps the patient identify these unconscious losses and accomplish the genuine psychic mourning work necessary to break free from them.
Exploring aggression turned against the self: In clinical practice, it is very frequently observed that depression masks intense repressed anger. Not daring or not being able to express this hostility towards disappointing love objects of the past, the psyche turns this violence against the Ego. It is this punitive dynamic that generates the self-deprecation so characteristic of the depressive picture. Psychotherapy provides a space to verbalize these ambivalent affects, allowing the tyranny of this alienating guilt to be gradually defused.
The lever of transference and structural reworking: The core of this therapy's effectiveness lies in the transferential relationship. Through free association, the patient will actualize, within the consulting room, their problematic modes of relationship and early narcissistic deficiencies. The psychologist offers neutral listening and a containing framework, acting as a benevolent receptacle. The ultimate goal is not to return the patient to their previous state of functioning (because it was precisely that state that laid the groundwork for the depression), but to foster the emergence of a reworked psychic organization, capable of investing in new desires and tolerating the inevitable lack inherent in existence.
While the psychodynamic approach relies on complex metapsychological foundations, its effectiveness in treating depression is now solidly corroborated by contemporary scientific research. The demands of "Evidence-Based Practice" have pushed the clinical community to validate its methods through vast controlled trials and rigorous meta-analyses.
One of the most landmark publications in this field is the meta-analysis conducted by Jonathan Shedler in 2010, published in the prestigious journal American Psychologist. This large-scale research demonstrates that psychodynamic therapy achieves effect sizes equivalent to those of other so-called empirically validated treatments, such as cognitive-behavioral therapies or antidepressant treatments in the context of depression. More specifically, psychodynamic therapy not only drastically reduces severe symptoms, but it also addresses the underlying personality structures that cause the suffering.
Furthermore, the extensive work of researcher Falk Leichsenring on the efficacy of psychodynamic psychotherapies confirms this level of performance, particularly regarding depressive disorders and complex personality pathologies.
What fundamentally distinguishes the psychodynamic approach in the scientific literature is what researchers call the "sleeper effect." Unlike purely symptomatic treatments where benefits tend to fade quickly after consultations end, data proves that patients who have undergone psychodynamic therapy continue to see their depressive symptoms regress and their resilience improve months or even years after the end of treatment. By profoundly modifying attachment dynamics and soothing unconscious conflicts, psychodynamic therapy actively prevents the risk of relapse and represents a lasting, transformative investment for the individual.
Feeling down is a passing state of sadness, tied to a specific event, that fades on its own within a few days. Depression is a defined mental health disorder that sets in over several weeks or months, simultaneously affecting mood, sleep, appetite, energy and concentration, and that does not resolve through willpower alone.
Where low spirits can be lived through, depression locks you into a state of suffering that resists your usual resources and lastingly impairs your functioning. If your symptoms have persisted for more than two weeks, it is time to consult a psychologist.
The symptoms of depression occur continuously for at least two weeks and combine several of the following signs: persistent sadness, loss of interest or pleasure, sleep and appetite disturbances, marked fatigue, difficulty concentrating, self-deprecation, and sometimes morbid thoughts.
In detail:
The intensity and combination of these symptoms define mild, moderate or severe depression. In Quebec, nearly one person in fifteen experiences a depressive episode during their lifetime.
Unipolar depression corresponds to depressive episodes without alternation with other mood states. Bipolar depression, on the other hand, is part of a bipolar disorder and alternates with phases of mania or hypomania: overflowing energy, a sense of omnipotence, reduced need for sleep, impulsive behaviours.
This distinction is clinically decisive: the two conditions are not treated in the same way. In the bipolar case, follow-up with a physician or a psychiatrist is generally indicated in addition to psychotherapy, particularly for mood stabilization.
The causes of depression are multifactorial and rest on a biopsychosocial model: biological factors (genetic predispositions, neurochemical imbalances), psychic factors (unprocessed grief, unconscious conflicts, excessive demands on oneself), and environmental factors (isolation, precariousness, distressing life events such as a loss or a breakup).
The psychoanalytic approach has provided specific insights. Freud, in Mourning and Melancholia (1917), describes depression as anger turned against oneself: what cannot be reproached to the lost object turns into self-reproach. Melanie Klein saw in it a difficulty integrating the good and the bad within the same loved person. For his part, Juan David Nasio describes depression as the loss of an illusion of absolute security: the love object was invested without limit, in a dependent manner; its loss is experienced as the tearing away of a support indispensable to mental equilibrium.
These readings do not exclude one another: they describe different dimensions of the same phenomenon, which explains why several therapeutic paths can be effective.
Psychodynamic therapy for depression starts from the principle that the symptoms have a meaning to be discovered. The patient speaks freely about what is going through them — memories, dreams, current situations, feelings — while the psychologist identifies the repetitions and inner conflicts that maintain the depressive state. Sessions last 50 minutes, generally once or twice a week.
Concretely, the work creates a space where what could not be said, thought or felt can finally unfold. The grief that needed to be done can finally be lived; the aspects of your personality previously refused can be integrated.
A meta-analysis by Jonathan Shedler published in 2010 in American Psychologist showed that psychodynamic psychotherapy is as effective as CBT or antidepressants for depression — with an important advantage: its benefits often continue to deepen after the end of treatment.
To learn more, see our page on psychodynamic psychotherapy.
Yes. Several medical conditions can produce symptoms resembling depression: hypothyroidism, deficiencies in vitamin B12, vitamin D or iron, undiagnosed sleep apnea, chronic inflammatory diseases, side effects of certain medications (corticosteroids, beta-blockers, interferon) or early neurological disorders. A medical evaluation with a blood workup is recommended in parallel.
Before or during the start of psychotherapy, we therefore recommend a consultation with your family physician, including at a minimum a TSH measurement (thyroid function). This does not rule out that a psychic dimension is also at play — often the two coexist and reinforce each other.
Yes, and it is in fact a very common situation in consultation. It is often after a few meetings that one manages to identify unsuspected causes: old grief never lived through, inner conflicts that have closed in on themselves, or exhausting narcissistic demands. The meaning emerges gradually over the course of psychotherapy, not necessarily beforehand.
Many people come to consultation saying “yet I have no reason to feel this way: I have a good job, loved ones who care about me, I should be fine.” This observation is precisely the sign that an unconscious dimension is at work.
This is one of the areas where analytically oriented psychotherapy is particularly useful: it does not require you to arrive with an already constructed narrative. What appears as “without reason” almost always carries a meaning that has not yet been able to be put into words.
Yes, in many cases. Mild to moderate depressions respond very well to psychotherapy alone, with effects that are often more lasting over time than medication alone. It should also be noted that medication alone does not cure depression: it relieves the symptoms biochemically; if the cause persists, the depression will return once the medication is stopped.
For severe depressions, particularly with suicidal ideation or marked impairment of functioning, the combination of medication + psychotherapy generally remains the most effective treatment.
Medication can then act as a temporary support that makes psychotherapeutic work possible. The decision is always made on a case-by-case basis, in consultation with your psychologist and, where applicable, your physician. At the Montreal Psychologist Network, we regularly work with patients on medication, as well as with patients who do not wish to take it or do not need it.
It is time to consult a psychologist if your symptoms have lasted more than two weeks, affect your daily functioning (work, relationships, pleasure), if persistent fatigue resists rest, or if morbid thoughts appear. You do not need to be in crisis to consult: psychotherapy is all the more effective when it is undertaken early.
Other signs that warrant a consultation: your loved ones are worried and tell you so, you have lost pleasure in activities that mattered to you, or you have already been through a depressive episode in the past. A first meeting makes it possible to take stock without longer-term commitment.
If you are going through a crisis and suicidal thoughts are present, immediately contact the 9-8-8 (Suicide Crisis Helpline, 24/7) or go to the nearest emergency room.
The duration of treatment depends on the severity and how long-standing the depression is. A reactive depression to an identifiable event (grief, breakup, job loss) is generally worked through over a few months at a rate of one weekly session. A depression that has been established for a long time may require one to two years, or even more.
At the outset, you and your psychologist agree on a framework — frequency, initial objectives — which is regularly reassessed. No duration is imposed: therapy ends when the work is done, or when you feel you have obtained what you were looking for.
Yes. At the Montreal Psychologist Network, all our members are psychologists registered with the Ordre des psychologues du Québec (OPQ), trained in the psychodynamic approach and regularly supervised by experienced clinicians. Our offices are located at the Cabinet Atwater (2222 boul. René-Lévesque Ouest), with secure teleconsultation appointments also available.
Services are offered in French, English, Spanish, Portuguese, Arabic and Persian. To make an appointment, call us at 514-497-8014 or write to info@psychologues-montreal.net.
If you are experiencing depression and feel you could benefit from a psychoanalytic exploration of what you are going through, we invite you to contact us. You do not need to have reached a crisis point to seek support – therapy is equally effective as a tool for personal growth.
Our team of experienced psychologists understands the complexity of depression and is dedicated to supporting you with respect, professionalism, and authentic compassion.
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Montreal Psychologist Network inc. – Psychotherapists trained in psychoanalytic approach at the service of your well-being.
Note: Most blog articles are available in French only.
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