There are many different ways to experience depression; people may have very different symptoms and still have the same depression diagnosis. When it comes to the impact of depression on emotions, psychopharmacology guru Dr. Stephen Stahl identified two categories of mood symptoms in his book Stahl’s Essential Psychopharmacology (affiliate link): decreased positive affect and increased negative affect.
Decreased positive affect
Decreased positive affect involves impaired ability to experience positive emotions, including:
- anhedonia (inability to experience pleasure)
- loss of interest
- loss of self-confidence
These symptoms represent a lack of positive things that would normally be present. Dopamine and norepinephrine appear to be the main neurotransmitters involved in these symptoms.
Increased negative affect
Increased negative affect involves the presence of negative emotions, including:
Symptoms of decreased negative affect are difficult emotions that are experienced to a greater extent than they would be at baseline. Serotonin and norepinephrine appear to play a key role in these symptoms.
Experiencing decreased positive affect
While I certainly have increased negative affect thrown into the mix some of the time, overall, my mood symptoms have been much more in the decreased positive affect category. Other than thinking the guinea pigs are cute, I just don’t seem to have the capacity to feel much of anything positive. When I’m being mindful of things in nature, I’m able to feel interest and curiosity, but that’s about it. Perhaps, in a way, it’s a good thing that there’s not a ton of negative stuff kicking around in my head most of the time, and probably on a day-to-day basis, decreased positive affect is easier to cope with than increased negative affect.
When it comes to treatment, though, I wonder if with decreased positive affect there’s less to sink your teeth into in terms of creating change. It makes me wonder if perhaps that’s why counselling has never really gotten off the ground for me.
What can you do about it?
With decreased positive affect it seems like there would be less to grab onto from a CBT perspective than increased negative affect. Sure, CBT would suggest behavioural activation and all that crap, but I’ve done that before and it doesn’t make a difference. It’s not that I’m biased against behavioural activation in its various forms, and I think it’s the kind of thing that can be quite effective for some people some of the time, but when I’ve tried activation with the hope of motivation following along later, it just hasn’t happened.
That’s part of why my trip to Italy a few months back was important to me. When I’m well, travelling is my passion; it’s what matters most to me, and I find it exciting and fulfilling and all that jazz. The fact that I felt “meh” throughout the trip wasn’t necessarily all that emotionally distressing in and of itself, but I think it really reinforced in my head that the lack of happiness truly is a capacity issue rather than a circumstances issue.
Is happiness out of reach?
So if lack of happiness is in fact a capacity issue, is there any point in trying to choose happiness? I’m not saying I shouldn’t look for positives. I keep a daily gratitude log, and I make a point of writing down accomplishments and other positive things in my bullet journal. I try to be very attentive when it comes to practicing self-care. All of these things are important to help keep negativity at bay, and I certainly intend to continue doing them.
But trying to find happiness or joy where there is none available seems kind of like an exercise in futility. It’s not that I haven’t felt those things before; I used to experience them quite regularly. But I’ve come to accept that illness has taken that away from me, at least for the time being. It’s not a conclusion that has much emotion attached to it, and it’s not something that I’m invested in, in the sense that I wouldn’t be willing to let it go. But for now, at least, it just is.
Do you struggle more with decreased positive affect or increased negative affect? Do you think it makes a difference in how we experience our illnesses?