In a sense, a life of flourishing can be described very simply: It is the opposite of depression. Though you may be familiar with what depression feels like and how debilitating it can be, you may be surprised at how exceptionally common it is in our society.
In 2020, the National Institute of Mental Health estimated that 8.4 percent of adults in the United States had experienced a major depressive disorder in the previous year.1 Add to that all the people with bipolar depression, subclinical depression, and dysthymia—a less severe but more persistent and longer-lasting form of depression—and we’re talking about a substantial segment of the population, including many of our friends, family members, and coworkers. I’m sure you know many people living with depression. Maybe you’re one of them.
As a psychiatrist, I have focused my career on combating major depressive disorder—and let me tell you, I hate depression. It is a pernicious and tenacious enemy. Not only is depression both common and debilitating, but it is also pervasive. Unlike most other medical conditions, which may affect one or more parts or systems in the body but leave the mind intact, depression impinges on every aspect of a person: body, mind, and soul (that aspect of ourselves that relates to the supernatural or transcendent).
Severe depression may cause altered moods, disordered sleep, changes in weight, an inability to concentrate, sexual dysfunction, and many other incapacitating symptoms. In fact, depression’s reach goes even deeper than our physical and mental selves. Whereas cancer may metastasize within the body but leave our cognition and personality intact, depression metastasizes throughout our entire being—affecting our deepest sense of identity, our sense of purpose, our faith in God, and our hopes for this life and the next.
People with depression don’t just feel like a more limited version of themselves; they don’t feel like themselves at all. Understandably, this can make them question the value of their existence. Depression is one of the worst states of disease a person can experience, and it has been found to be the second leading cause of disability worldwide.2 The authors of a 2015 research study that sought to quantify all medical suffering on a scale from 0.0 to 1.0 found that enduring a day with severe depression (0.66) was even worse than a day when a person has a nonfatal heart attack (0.43) or a day living with unrelieved terminal cancer (0.57). In short, depression was found to be more debilitating than nearly every illness covered in the survey.3
Though the researchers defined death as the extreme end of the spectrum (1.0), some of my patients have told me they would prefer death. These people are not being overly dramatic; sadly, it’s simply a common feeling.
In the course of my clinical work, I see both the suffering caused by depression and people getting healed of their depression. It is truly awe-inspiring to witness, not unlike a resurrection.
While I believe there are practices, along with professional treatment, that can help a depressed person heal, my primary focus is on how to live life to the full—that is, to flourish. Flourishing means living a life that develops as it should—like an acorn will flourish by growing into a healthy oak tree without the hindrance of drought, disease, or weeds. People who flourish grow into a more developed version of themselves, without the hindrance of mental illness, bad habits, or unedifying relationships. Flourishing people have good habits of body, not slowed down by unnecessary sugar crashes or sleep deprivation. Flourishing people have activities that are meaningful, relationships that are full of love, and a relationship with God or the transcendent that pulls them forward into the future.
Flourishing doesn’t just mean happiness—which many people assume is the opposite of depression. Recovery from depression doesn’t merely mean feeling happy again. It’s about feeling a full range of emotions. Depression often paints a monochromatic gray over its victims’ emotions, regardless of their actual circumstances, but recovery helps people experience a variety of appropriate emotions. Sometimes that emotion is happiness, but if one’s circumstances are objectively bad, then the appropriate feeling might be sadness, anger, grief, or some other seemingly negative emotion. Flourishing means being able to respond appropriately to our circumstances and take meaningful steps to improve the quality of our lives—in every aspect.
First Steps for Those Who Are Depressed
So where do we begin in our efforts to turn a life of depression into a life of flourishing?
First, remember that you are worthy of care.
You have a truly devastating condition that affects your body, mind, and soul. You ought to be provided with mental health care that addresses your entire being. This may include treatments such as psychotherapy, medication, or brain stimulation.
Second, it’s important for you to know that treatment works.
Psychotherapy works. Medications work. Brain stimulation works. Like any medical treatment, there are exceptions to the rule, but most people who get treatment find relief. If you are one of my patients, or if you have tried all this and it hasn’t helped, you are the exception. But you should know that psychiatry is rapidly advancing, and we may well have new treatments soon.
Third, in combination with treatment, there are steps you can take to move against your burdens.
While there’s no guarantee you’ll ever be fully free of all symptoms of depression in this life, there is value in fighting the disease regardless. You are meant to thrive, and it is worth the effort to pursue a return to full health.
So, how do you fight? Where do you start?
There are a range of action steps you can take in different areas of your life. If you are dealing with depression, you may need to begin with the simpler ones. There’s nothing wrong with that. Quite the opposite! As you start to improve, you may be able to choose more ambitious goals. In any case, it’s likely your suffering is only temporary. Medical and other treatments may provide relief from your depression, perhaps sooner than you imagine.
Some people describe themselves as “depressive,” as if depression itself is an inseparable part of their being. But I want you to know that your depression can be fully separated from who you are, restoring you to a healed and complete person. Your suffering is not essentially who you are; it is a condition that can often be successfully treated. Not unlike a resurrection, you can be “brought back to life,” free of the disease you once had.
The best way to start moving toward a reality characterized by freedom from depression is by fighting the disease. Look for positive things you can do that you’re not doing now, or for negative things you’re doing that you should stop. Take one step at a time and believe that it’s worth it, even if it feels futile. Step by step, you may be able to find your way out of the dark forest of depression and keep going—not just back to “normal” but on to flourishing.
1. National Institute of Mental Health, “Major Depression,” updated January 2022, https://www.nimh.nih.gov/health/statistics/major-depression.
2. Alize J. Ferrari et al,, “Global, Regional, and National Burden of 12 Mental Disorders in 204 Countries and Territories, 1990–2019: A Systematic Analysis for the Global Burden of Disease Study 2019,” Lancet Psychiatry 9, no. 2 (February 2022): 137–150, https://doi.org/10.1016/S2215-0366(21)00395-3.
3. Ferrari et al., “Global, Regional, and National Burden”; Joshua A. Salomon et al., “Disability Weights for the Global Burden of Disease 2013 Study,” Lancet Global Health 3, no. 11 (November 2015): E712–E723, https://doi.org/10.1016/S2214-109X(15)00069-8.
Adapted from The Opposite of Depression: What My Work with Suicidal Patients Has Taught Me about Life, Hope, and How to Flourish by David M. Carreon, MD. Copyright © (2024). Used by permission of Tyndale House Publishers, a Division of Tyndale House Ministries. All rights reserved.
Dr. David M. Carreon is a psychiatrist and cofounder of Acacia Mental Health, a clinic in Silicon Valley working to transform mental health care. He studied and served at Stanford, where he earned his MD, completed a psychiatry residency, and worked as a professor. He is a leading clinician in the treatment of major depressive disorder, achieving success in some of the most challenging cases using an approach that combines the latest technologies and the oldest truths. His research has focused on human agency and on new ways to restore freedom through treating depression. He loves teaching; going on dates with his wife, Abigail; and excessively long brunch conversations. Carreon’s newest book, The Opposite of Depression, will release on April 9, 2024 from Tyndale Momentum.
Author photo by David Ling Photography, Copyright © 2023. All Rights Reserved.