It seems intuitively obvious that depression is a lack of belief in some expectations about the future, whether these expectations are real or illusory. — Question

If there's no "physical malfunction" causing the depression I would go along with the above. Though the way you put it you make it seem as if "normal" people are running on the placebo effect and I feel that's a bit of the mark.

If you don't separate the body and the mind, our brains are part of a whole living organism and living is highly teleological, despite many attempts from people to rationalize their way out of that and even some "success" by those who set themselves on fire or starve themselves or show other feats of great willpower / mind over matter, most cannot ignore their biological needs or "purpose".

Being able to delay gratification is (to my knowledge) the way in which we are able to learn, we can use our brains to focus our conscious attention on a certain task and we do so because we have a future goal in mind. Social complexity and our abstract / symbolic interpretation of the world have made the goals we strive for highly complex, subjective and very ethereal from a hard science point of view but it is very much the environment we live in as biological organisms. Basically I'm saying that we should view things like an existential crisis more like an animal with a broken leg then something which has no relation with the biological world.

So not having any goals / perceived purpose is akin to an organism losing functionality, which is actually what happens when someone is depressed. We seem wired to make use of our reward systems (where the way biological organism are driven to act are way more complex of course) in a way which makes them respond to a social environment more then the 'mere' biological environment, so much so that we can become unconvinced if we are asked to use them consciously, i.e: "Just go and have some fun!". We know we have more functionality then simply acting on impulse and it is our social environment which has made us put in the effort to restrain ourselves from doing so to a degree.

It might be my particular viewpoint but I wouldn't be inclined to use the words "placebo" to describe how we respond to an environment which I wouldn't call "illusory"..

I don't think I would attribute depression to lack of belief in anything. I think everyone has beliefs of some kind, and it is more the gap between beliefs about how things should be, and how they really are, that leads to mental illnesses like anxiety and depression. For me, depression feels like it is rooted in the past, while anxiety has a future feel to it. I think the hopelessness of depression comes from past experiences conflicting with learned expectations and instinctive desires. There's a bit of a future element, in that depressed people tend to feel like the possibility of positive change is very low. The worry and dread associated with anxiety is tied to expecting bad things to come. While the anxiety develops based on past experiences, it is very much forward-looking.

Here's an interesting article which I found in regards to the placebo effect.

The weird power of the placebo effect, explained.

Sorry for the delay in response, just that anything containing a reference to the placebo effect requires a lot of consideration. I hope to reply to your post, Gooseone and CasKev, soon enough.

Basically I'm saying that we should view things like an existential crisis more like an animal with a broken leg then something which has no relation with the biological world. — Gooseone

Apples and oranges, or in this case a broken foot and clinical depression. Sure, both might not be in working order; but, determining when the mind/brain is back in 'working order' is still an unknown art. I mean, people can't or should not stop taking medication just because they start feeling better. With a leg, you know it is back in working order. With depression, the only thing you can put absolute faith in, is the placebo effect, which is self-generated and not external, like an antidepressant.

For me, depression feels like it is rooted in the past, while anxiety has a future feel to it. — CasKev

This sounds like a perfect time to live in the present if you're disturbed by the past and future.

The worry and dread associated with anxiety is tied to expecting bad things to come. While the anxiety develops based on past experiences, it is very much forward-looking. — CasKev

So, is the horse leading the cart or otherwise? I mean, is the depression causing the anxiety or the anxiety causing the depression?

I would say that depression emanates from loss of some type. Loss of purpose, loss oof family, lots of hi hope, etc. One must find a way to fill the hole with something new in order to renew. Ultimately all renewal must come from within.

This sounds like a perfect time to live in the present if you're disturbed by the past and future. — Question

I agree, though maintaining a present focus can be very unpleasant when in the grip of mental illness. The underlying cause of depression can be based in past experience, but working at a subconscious level, leaving you with a miserable present experience, with no obvious immediate cause. The tendency is to try to escape the present through various means, be it excessive sleeping, alcohol and drugs, television, video games, or other activities requiring little motivation and effort.

is the depression causing the anxiety or the anxiety causing the depression? — Question

Though I have little experience with anxiety, I could imagine how having to deal with it for an extended period of time could lead to depression. Left untreated, with no resolution in sight, it is easy to see how someone could start to have feelings of hopelessness.

Having experienced major depression for several years, without developing problems with anxiety, I doubt that a strong causal relationship exists in that direction. When depressed, the tendency is to shut down and escape the present. There isn't much of a future focus, aside from the loss of hope regarding positive change.

As for the placebo effect, I can see how it could apply to someone in a depressed state. For example, telling someone they are being given an effective antidepressant, and instead substituting a sugar pill. The expectation and hope tied to the possibility of recovery could have an effect on the brain's functioning, even though there has been no real change in present circumstances.

As for the placebo effect, I can see how it could apply to someone in a depressed state. For example, telling someone they are being given an effective antidepressant, and instead substituting a sugar pill. The expectation and hope tied to the possibility of recovery could have an effect on the brain's functioning, even though there has been no real change in present circumstances. — CasKev

This would only confirm that the depression is attitude-based. But if there's a chemical imbalance in the brain, then the sugar pill won't do anything to alleviate that depression because the sugar pill wouldn't have targeted the primary source of the person's depression.

I think for many people depression starts with the brain, which then, invariably, infects their attitude, outlook on life, and so on. Equally many people will then try and fix their attitude, but can't because that's not the source of their depression. Those who overcome their depression are the ones who work on their brain and their attitude at the same time, so that in the end they're on top of themselves.

It seems intuitively obvious that depression is a lack of belief in some expectations about the future, whether these expectations are real or illusory. This is called a loss of hope, which seems intrinsically tied to the placebo effect and expectation fulfillment. With this predicament of losing hope, an individual gives up the beneficial effects of the placebo effect. — Question

It seems intuitively obvious, but perhaps that is not the case.

The problem (as I see it) is that untangling mood (which is biological) and belief (which is intellectual) may be practically impossible. Which comes first, the chicken or the egg? Is it mood altering belief or is it belief altering mood, or both?

Another problem in this conundrum of whether one is actually depressed (which is a mood disorder) or whether one is afflicted with other kinds of problems (which can rattle one's mind to the point of dysfunction). If it's being afflicted by too many problems, then belief and altered responses to problem solving will probably work really well.

Then there are placebos. Yes, the placebo effect is real; it occurs sometimes but it isn't effective all the time in all cases and one can get carried away with miraculous placebo effects.

One of the core problems here is that depressed, rattled, messed up minds are the only minds available to examine their internal dialogues (this is personal testimony). People who have bright, up-beat, positive minds are just as limited. We can't escape our own heads.

My own experience points towards depression being a mood disorder which is NOT caused by ideas, beliefs, or a lack thereof. It's more that mood tips the balance of ideas and beliefs toward the upbeat or the downbeat. Mood is biological (it's a property of the limbic system) and it is a difficult target to hit with blunt antidepressants. Therapy can help the individual by stimulating their cognitive resources, but there are limits here too.

Depressed people either do, or do not, get better, and whatever happens, it's difficult to state what the cause was. Was it a successful or unsuccessful placebo effect, did the medication work or not, did the limbic system change on its own, and did the intellectual forces of the mind overcome the biological system of mood? It is never possible to say with certainty (at least with the analytical tools we have now).

The example of an existential crisis possibly being a cause for depression could be seen as a form of a negative placebo lying at the root of the problem. The depression might then be a secondary symptom.I must admit that the physical vs mental cause for depression is a very difficult debate though, a physiological issue might very well be the cause of a certain stream of thought.

Also, the death of a loved one, losing a job, things like that; they're obvious reasons why some people can become depressed yet it's still the subjective perception of our environment which is generating the physical response here. The very stance on whether you call such circumstances real or illusory or the way you might think of a very obvious biological response as a placebo effect can be a factor whether someone is able to strive for a goal in a healthy manner or starts to suffer from a depression.

With depression, the only thing you can put absolute faith in, is the placebo effect, which is self-generated and not external, like an antidepressant. — Question

Doesn't that imply that all motivation is, in fact, placebo?

Maybe this research area is of your interest btw; https://en.wikipedia.org/wiki/Psychoneuroimmunology

I think for many people depression starts with the brain — Heister Eggcart

Though some brains may start out being more susceptible to mental illness, I lean toward most depression starting with a build-up of negative experiences that aren't properly addressed at the time of occurrence, combined with an unconstructive belief system. Emotions and thoughts get repressed, and the subconscious mind replays them within the context of the beliefs, prolonging the effect of the initial events.

The brain's malfunctioning can sometimes be corrected using medication, but I believe this to be a case of treating the symptom, rather than the underlying problem. A more permanent approach involves revisiting the negative experiences, and examining the belief systems that have allowed the adverse effects to live on.

The question for me is whether the brain can return to its properly functioning state once the damage has been done, or will it need to rely on the mental crutch of antidepressants indefinitely. My gut feel is that the brain can repair itself as the negative experiences and beliefs are addressed. The tricky part is figuring out what may be at play at the subconscious level. Developing awareness of thought and emotion, and having someone to guide you through them, can be quite helpful in this regard.

Depression seems to be characterized by many thoughts, behaviors, and expectations about the future. However, people get lost in this forest of descriptive characterizations about depression. I've been pondering about the core belief that depression is characterized by and, I think, the issue is rather than wrong beliefs is rather a lack of belief in anything.

Expectations run on beliefs, so too is the placebo effect a belief about the effect of some action or activity. Even if we assume that depression is a result of a negative belief system, then such an individual would have to adapt to a situation or otherwise perish. The fight or flight response is part of that mechanism of adaptation.

It seems intuitively obvious that depression is a lack of belief in some expectations about the future, whether these expectations are real or illusory. This is called a loss of hope, which seems intrinsically tied to the placebo effect and expectation fulfillment. With this predicament of losing hope, an individual gives up the beneficial effects of the placebo effect.

Before I ramble further, I'm wondering about any other beliefs or thoughts on the matter. — Question

I think that while placebo effect may have it's uses, it is dangerous for the medical and/or behavioral health community to think of it as a kind of panacea for treating patients for various ills that are difficult to fix by their nature (such as so called "psychosomatic" problems) and can be more counter productive than productive when used.

Often when people have mental or behavioral health issues they are told by their peers, superiors, and/or family to "snap out of it" and if that doesn't work (which it is almost a given it won't in anything but the most trivial issues) they go and seek "professional help". However even if and when they go to seek the professional help they need to get better, they more often than not (or least in my own experience) find individuals who are merely going to tell them every thing will be 'fine' once everything gets a little better where they can "snap out" of the funk they are in and go about their lives, However if things never really get better and/or they are unable to easily just "snap out of it", then essentially they are just completely screwed until things change for the better or they just die for whatever reason.

While this may not seem to tie into the placebo effect immediately, it can if one factors in the "don't worry/ be happy" mentality behavioral health try to preach to their patients when they encounter someone who is obviously unhappy about the problems in their lives. I don't know if the placebo effect is tied someway into this philosophy in the behavioral health community or it is completely separate (which I doubt), but I believe it acts in one way or another as a sort of crutch that professionals try to lean on too much when they don't have easy answers

Think of it this way, if someone comes into a hospital after being impaled with a metal pip sticking through their chest and a leg nearly severed off after a motorcycle accident, the problem is relatively much more simple and easier to fix than someone that comes into a place where they need help with trying to deal with the trauma of being abused as a child since a behavioral health specialist can't see any problems (beyond the possible personality quirks caused by abuse) and even if they have decent idea of what is wrong there is almost no way (other than possible help getting access to prescriptions and/or social service, which really isn't their type of thing) for them to help "fix" any problem.

While it may be cynical to say that after 4+ years of college and whatever other training they get all they can do is pat someone's hand and tell them "don't worry/be happy" until they get too bored of it to bother coming back, but that is basically it. And to me the idea of the magical "placebo effect" that can help people without even the use of drugs gives them the illusion that since mental problems are just "imaginary things" anyways, perhaps "imaginary pill" can easily fix them when whatever real resources they have (which is almost nil outside of pills anyways) doesn't work or work well.

In a nutshell if there is a way to use the placebo effect productively, then it has yet to be found and because it can not be used effectively behavioral health professionals (as well as others) should just leave it alone until they have a better understanding of it. Even if it is tempting to believe that more people can be helped by just telling them "don't worry/be happy" than not doing it, there is no science to back up that such techniques work; at least I don't think there is any. While it is pretty much a given that this may make a impotent behavioral health support community feel even more impotent than they already are (which I have even been told would happen by one of the behavioral health specialist I see), I believe the existence of behavioral health support communities is to help their patients and not merely an end unto itself, and a method that may only help the psych of the professionals without helping the actual patient is a counter productive and dangerous method to employ since it may give the illsusion something is being done when it isn't.
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The most helpful thing for me in understanding depression, was the realization that its basically a very very bad habit. (please don't think i'm trivializing it)

I think expectations of the future is but one part of it,i wouldn't ignore the power of how people view themselves. Thoughts like 'i'm useless' generally speak more about how the person sees themselves then about how they envision their own future.
I gain happiness from the way i perceive myself entirely separated from any view of how my life will be in the future. regardless of what happens in the future, my pride is still a positive feeling now.
having a purpose filled life is great, but i think its importance is a bit exaggerated. simply experiencing positive experiences from moment to moment is all that is required for a happy and fulfilling life.
I think this drive to make something of yourself, to push to be better, to never be happy with who you are and what you have done, is itself a major cause of depression.

I see depression as basically just bad/unhealthy thinking habits, with a wide variety of causes of cause.

The way to fix depression is to train your brain to think more positively, loving kindness meditation is one great tool. this is of course, far more easily said then done.
People need to stop taking passing thoughts so seriously, they don't actually say much about you as a person.

Depression seems to be characterized by many thoughts, behaviors, and expectations about the future. However, people get lost in this forest of descriptive characterizations about depression. I've been pondering about the core belief that depression is characterized by and, I think, the issue is rather than wrong beliefs is rather a lack of belief in anything.

Expectations run on beliefs, so too is the placebo effect a belief about the effect of some action or activity. Even if we assume that depression is a result of a negative belief system, then such an individual would have to adapt to a situation or otherwise perish. The fight or flight response is part of that mechanism of adaptation.

It seems intuitively obvious that depression is a lack of belief in some expectations about the future, whether these expectations are real or illusory. This is called a loss of hope, which seems intrinsically tied to the placebo effect and expectation fulfillment. With this predicament of losing hope, an individual gives up the beneficial effects of the placebo effect.

Before I ramble further, I'm wondering about any other beliefs or thoughts on the matter. — Posty McPostface

A good friend of mine does a lot of scientific research on the question of hope and the efficacy of treatment. He is found that optimism about the result of your treatment generally correspond with a better outcome from treatment. Very interesting point to ponder, as you yourself mention.

I have been on depression medication for a long time. I've since fully recovered. I don't know how much the medication helped, but I am too afraid of back sliding to go off of it, unfortunately.

I tend to think my recovery is a combination oh pharmaceuticals, cognitive and dialectical behavioral therapy practices, mindfulness, improved life circumstances, and self help. But I'll probably never know for sure.

I tend to think my recovery is a combination oh pharmaceuticals, cognitive and dialectical behavioral therapy practices, mindfulness, improved life circumstances, and self help. But I'll probably never know for sure. — Brian

Same here. I'm also reluctant to stop the medication, as there is no guarantee that the brain is not permanently damaged by prolonged periods of depression. To me, it's not worth the risk to try and find out.

In regards to Brian's and CasKev's point about when to stop taking medication... Unfortunately, I'm in the same boat, as I have quit and tried tapering off my antidepressant, with a return of feeling, and that's important, feeling emotions. For the majority of time it was a mix of both feeling positive and negative emotions; but, since I've been on antidepressants for almost a good decade, feeling again was almost discomforting.

I believe there are other alternatives to the mainstay SSRI's, think Ketamine or rather novel drugs like NRX-1074, which I have been following the progress with great interest.

However, in this specific case, SSRI's seem to remove the high's and low's of affect. I've grown to like SSRI's due to making me a more mellow person and less passionate about... well most things.

Unfortunately, I'm in the same boat, as I have quit and tried tapering off my antidepressant — Posty McPostface

You don't really know if you've healed until you've tried going off medication for awhile. Even then, it can be a waiting game. I know that you can go off medication, be on a high for weeks to months, and then slip right back into the gutter, even when you've learned better. But again, you basically always end up having to just gamble either way, which sucks.

Unfortunately, there is a great deal of resentment around the current standard treatment options for depression, in terms of pill form. SSRI's tend to dull people out, and some people react differently to the pickup in energy levels from SSRI's. Sometimes people feel 'good enough' or have more energy from the medication to go through with suicide, as I've read.

I've always been an advocate for CBT; however, I take my medication as a measure of insurance from depression. Your milage may vary.