Black Clouds and Feeling Blue: A Compassionate Look at Depression

When Sadness Becomes Something More

Feeling sad or worn down is part of being human. We all go through stretches where we feel “off,” low, or emotionally fragile. But depression is different. It takes those familiar feelings and turns them into something heavier, more chronic, and harder to shake.

Depression affects far more than mood. It can shift appetite, energy, sleep, focus, and even the way you see yourself and the world. It’s a mind–body experience that lives in both our emotional and physical systems.

For decades, the dominant model focused on serotonin and the idea of a “chemical imbalance.” That theory helped shape treatment, but it isn’t the full story. A major review by Moncrieff et al. (2022) challenged the serotonin explanation, finding little evidence that low serotonin alone causes depression.

This doesn’t mean medication doesn’t work — it absolutely can. It simply means depression is more complex than one chemical, and understanding those layers can help people feel less confused and more empowered.

Let’s explore the different ways depression has been understood — through history, psychology, biology, and lived experience — to build a fuller, kinder picture of what so many people navigate.

Depression Through History: You’re Not Alone

Depression isn’t new. Ancient Greek physicians described it. Medieval scholars wrote about it. Freud defined it. And today we study it through brain scans, hormones, inflammation, and behavior.

Across all of human history, people have struggled with low mood, despair, and the sense that something inside feels dimmed or disconnected. I find something strangely comforting in that. It means you’re not broken or unusual — you’re part of a long lineage of people who have felt this way and eventually found their way through.

Beyond Brain Chemistry: The Internal Conflict Lens

Older psychodynamic theories viewed depression as the result of inner conflict — especially between desires we can’t act on and emotions we feel we must suppress.

While Freud’s explanations may not match modern science, newer research still shows that emotional suppression takes a toll. A well-known study by Gross & John (2003) found that people who regularly push emotions down tend to experience:

• more depressive symptoms
• greater stress
• lower life satisfaction

We often suppress emotions because expressing them feels unsafe. But those suppressed feelings don’t disappear. They turn inward.

When Anger Has Nowhere to Go

Imagine you’re in a toxic work environment with no real escape — a boss who belittles you, public criticism, constant pressure. You can’t quit, can’t speak up, and have no outlet.

What happens to the anger?

In many people, it gets turned inward. Psychodynamic theory even refers to depression as “anger turned against the self.”

I see this in patients all the time. They appear depressed, but underneath the sadness is anger that never had a safe place to go.

The Protective Numbness: When Feeling Nothing Feels Safer

For some, depression arrives not as sadness, but as numbness. When emotions feel overwhelming — grief, fear, shame, rage — shutting down can feel protective.

Bonanno et al. (2021) found that avoiding emotions may help in the short term but often worsens depression over time. When we numb ourselves to the painful emotions, we unintentionally numb joy and connection too.

You may not have chosen numbness consciously. It may have been your mind’s way of saying, “This is too much right now.” But there are gentler ways to feel again, especially with support.

Life Transitions: When Change Brings Darkness

Major life transitions can stir up unexpected emotions. Buying a home, getting married, becoming a parent, ending a relationship, or shifting careers — even positive changes can destabilize your sense of identity.

Holmes & Rahe’s classic research (1967) showed that any major life change, good or bad, can increase emotional stress.

And when hormones and identity shifts collide — such as in postpartum periods or menopause — depression can emerge even when nothing “bad” is happening externally. A meta-analysis by Amiel Castro et al. (2019) found that hormonal changes can influence mood, but psychological and social factors often determine whether those changes lead to depression.

The Existential Perspective: When Life Loses Meaning

Another lens for depression comes from existential theory. Here, depression isn’t seen as chemical or emotional conflict but as a loss of meaning, purpose, or deep connection.

Vos et al. (2015) found that therapies focused on meaning-making are often just as effective as traditional treatments for depression.

The pandemic highlighted this version of depression for many people — the isolation, loss of structure, and uncertainty created a kind of existential emptiness that felt different from traditional sadness.

The Body–Mind Connection: When Biology Contributes

In recent years, research has uncovered how physical health can directly influence mood:

• chronic inflammation
• gut permeability (“leaky gut”)
• microbiome imbalances
• environmental toxins
• disrupted hormones

A striking study by Clapp et al. (2017) showed that gut–brain disruption can trigger inflammatory signals that affect mood. Inflammation can change neurotransmitter metabolism and influence neural circuits involved in emotion.

In my practice, addressing inflammation, gut health, and toxic load through functional medicine often leads to significant improvement — especially for patients who haven’t responded to traditional treatments alone.

This doesn’t replace medication or therapy. It adds another path toward healing.

When There Is No Clear “Why”

Sometimes depression seems to come out of nowhere. No trauma, no loss, no obvious trigger.

This can feel especially confusing — and frustrating.

But research suggests that for some people, biological factors may drive depression even when life is stable. Köhler et al. (2017) found that inflammatory markers are elevated in many people with depression, even without other medical conditions.

This doesn’t make the depression any less real. It simply means the “cause” isn’t always obvious.

Finding Your Way Through

Regardless of what causes your depression, one truth remains:

Treatment helps.

Medication can be life-changing for some. Psychotherapy can help you understand patterns, develop tools, and navigate internal conflicts.

A meta-analysis by Cuijpers et al. (2021) found that combining medication and therapy often leads to better outcomes than either alone. Some people do well with just one approach.

And beyond the techniques, the relationship matters. The therapeutic alliance — the bond between you and your clinician — is one of the strongest predictors of positive outcomes across all treatment models (Flückiger et al., 2018).

Functional medicine and root-cause approaches also offer meaningful support by addressing inflammation, gut health, hormones, and nutritional factors that influence mood.

Most importantly: connection helps. Being seen, understood, and supported can shift things in a way that no theory or medication alone can.

If you’re struggling, you are not alone. And you don’t have to figure it out by yourself. Depression is not a personal failure — it’s a human experience, and help is available. With the right support, many people find their way back to themselves, often stronger and more self-aware than before.