depression

Understanding Depression: A Psychodynamic Perspective on Symptoms, Causes, and Patterns

Depression affects many people, often in ways that feel confusing or hard to put into words. As a psychodynamic therapist, I support individuals in understanding both the clinical features of depression and the emotional patterns that shape it. My aim is to explain depression in simple language while keeping the information accurate and clinically grounded.

DSM-5 Symptoms of Depression

In the DSM-5, a Major Depressive Episode involves at least five of the following symptoms, present most days for at least two weeks, with at least one being low mood or loss of interest:

• Persistent low mood or sadness
• Loss of interest or enjoyment
• Changes in sleep, either too little or too much
• Appetite or weight changes
• Low energy and fatigue
• Difficulty concentrating or making decisions
• Feelings of worthlessness or excessive guilt
• Feeling slowed down or agitated
• Thoughts of death or suicide

These symptoms also need to cause significant distress or make it harder to function day to day.

Major Depressive Episode, Major Depressive Disorder, and Dysthymia

People often hear different terms and wonder what separates them. Here is a straightforward comparison.

Major Depressive Episode (MDE)
This refers to the actual episode of symptoms listed above. It describes what a person is experiencing right now or recently.

Major Depressive Disorder (MDD)
This is the diagnosis given when someone has had one or more Major Depressive Episodes. The episodes may be single or recurrent. MDD also requires that symptoms are not better explained by a medical condition, substance effect, or a manic episode.

Persistent Depressive Disorder (Dysthymia)
This is a long-lasting form of depression. The low mood is present for at least two years in adults and is accompanied by additional symptoms like low energy, poor appetite, low self-esteem, or hopelessness. The symptoms are often milder than MDD but more chronic. Many people describe dysthymia as feeling low or flat for a long time, even if they are still managing work or study.

Depressive Personality Structure

A depressive personality structure is not a DSM-5 diagnosis. It describes a long-term pattern in which low mood, guilt, self-criticism, or a pessimistic view of oneself and the world become part of how a person relates to life.

Common features include:

• Chronic self-blame
• Feeling responsible for others' feelings
• Suppressing anger or directing it inward
• Difficulty recognising personal needs
• A tendency to withdraw or give up easily
• Sensitive reactions to loss or rejection

From a psychodynamic perspective, this structure often develops early in life, where emotional needs may have been neglected, dismissed, or inconsistently responded to. Over time, these patterns create a familiar way of coping, even when it leads to depression.

Why Depression Happens: A Biopsychosocial View

Depression is best understood through biological, psychological, and social factors that interact with one another.

Biological factors
Genetics, physical health conditions, inflammation, hormonal shifts, chronic pain, and changes in brain chemistry can all influence mood.

Psychological factors
Thinking styles, personality traits, unresolved emotions, defence mechanisms, and unconscious conflicts all play a role. Many people unknowingly use strategies like shutting down feelings, blaming themselves, or withdrawing to stay safe emotionally.

Social factors
Stressful life events, relationship difficulties, trauma, isolation, financial stress, academic pressure, or ongoing conflict can contribute significantly to depression.

In therapy, I look at all three areas to understand the full picture.

Unconscious Patterns That Contribute to Depression

Psychodynamic therapy focuses on the emotional processes that operate outside conscious awareness. Some of the most common patterns include:

Turning anger inward
Many people who become depressed have learned that expressing anger, disappointment, or frustration is unsafe. Instead, these feelings get redirected toward the self, showing up as guilt, harsh self-criticism, or hopelessness.

Unresolved grief or loss
Losses from childhood or adulthood may not have been fully processed. They can resurface later as sadness, numbness, or withdrawal.

Defense mechanisms
Defences like avoidance, repression, people-pleasing, perfectionism, or emotional detachment may once have protected someone from pain. Over time, though, they can limit emotional expression and contribute to depression.

Attachment wounds
Early experiences with caregivers shape how we relate to ourselves and others. If a child’s needs were inconsistently met, criticised, or ignored, they may develop a pattern of expecting rejection or feeling unworthy. These patterns often continue unconsciously into adult relationships.

How I Work With Depression Psychodynamically

My approach involves:

Understanding your emotional world
Together, we explore current symptoms as well as the patterns underneath them. This includes how you respond to stress, how you relate to others, and how you experience emotions like sadness, anger, or fear.

Working through unconscious conflicts
Many depressive experiences are tied to unresolved emotional tensions. Therapy offers a space to bring these into awareness, so they no longer operate silently in the background.

Identifying and easing self-critical or self-attacking patterns
A gentle but consistent exploration of the inner critic helps reduce the internal pressure that maintains depression.

Supporting healthier emotional expression
Learning to express feelings safely and openly, rather than bottling them up or turning them inward, often leads to relief and reduces depressive symptoms.

Addressing the broader context
I also consider biological and social factors, and when needed, I encourage collaboration with GPs or psychiatrists for a comprehensive treatment plan. Therapy can sit alongside medication or lifestyle changes if those are beneficial.

When to Seek Support

If these descriptions feel familiar, it may be helpful to speak with a registered psychologist. Depression is treatable, and many people experience improvement through a combination of emotional insight, support, and practical coping strategies.

In therapy, you do not have to face these patterns alone. A safe therapeutic relationship can help you understand your experience, develop new ways of relating to yourself, and gradually find relief from depressive symptoms.

If you would like to explore whether psychological support may be helpful for you, you are welcome to make contact to discuss your situation in more detail.