Depression Keeps Coming Back? Here's What's Really Happening

Hey, it's Dr. Fox and I haven't done a video on depression and BPD in a while. So, I wanted to do that and in this video, I really want to talk about why depression keeps coming back and what it's really responding to, what what's really or likely to be going on. But there are times when depression, it doesn't feel like sadness. It feels like heaviness, like shutting down, like losing motivation even when nothing obvious went wrong. So, you can't pinpoint exactly what it is. And that's usually when you start wondering, why does this keep happening to me? What is going on? You try to explain it away perhaps as stress or exhaustion or burnout, but something doesn't fully fit. Something doesn't fully make sense. What makes this confusing is that these lower states, these depressive states show up after you've already been coping for a long time. You've been functioning. You've been holding things together as best you can, managing relationships, expectations, emotions. So, when that depression hits, those depressive symptoms hit or it comes back, it feels random or even worse, it feels very personal. It's almost like a personal attack can also feel like you have failed again. But there's another way to understand what's happening. And to make sense of this, we need to separate core content, which I talk about in a lot of my videos, from surface content, which I also talk about a lot of my videos. So core content is the deep emotional material your nervous system learned very early on. It's not a thought. It's not necessarily a belief. It's a felt truth about connection and safety. For many people with BPD or borderline traits, diagnosed or not, the core content often includes fear of abandonment, rejection sensitivity, chronic emptiness. These aren't problems to necessarily fix. their emotional signals you learned in relationships very early on and they were often survival strategies very early on but they kind of lingered they kind of hung around. So now these signals that you learn that keep manifesting in relationships and depression symptoms are this surface content that can come out of it. You could feel numb, low energy, loss of motivation, withdrawal, hopelessness. Those symptoms really matter, but they're not the core content. They're not the central component. They are how your system expresses distress when core content has been activated perhaps for too long. Or sometimes, you know, we even train ourselves how we respond to various activations. And when your core content gets activated, you might fall into a depressive state or could even be encouraged as a depressive state. And this isn't conscious. Not like you're, oh, now I'm going to get depressed. Obviously, I'm not talking about that. We're talking about that activation happens which can drive almost like a default response, an automatic response of depressive features, feelings, and perspectives. And depressive spirals also occur in BPD, but they're not major depressive disorder. I just want to kind of veer off a little bit and just explain that because this is where an important distinction often gets missed. Particularly if you are feeling depressed and you go in to your medical provider and you tell them, "I'm still depressed. " they are likely going to make a medication adjustment but it may be a depressive spiral which is part of BPD not a part of major depressive disorder in BPD and individuals with borderline traits and symptoms many depressive experiences are depressive spirals not major depressive disorder a depressive spiral is more of a statebased response that may linger for a bit tends to rise after emotional overload it can intensify after relational stress. It can even shift when emotional conditions change. And major depressive disorder is totally different and it's deeper and more intense. Major depressive disorder does not depend on relational activation in the same way. It persists even when circumstances improve. So it's not always consistent with what's going on the outside. Now the depressive spirals are more of like mild sadness dips, but they don't impact your ability to function or go to work or take care of yourself or shower, bathe, go to class if you're a student, whatever it may be. Major depressive disorder, the disorder part is that

those depressive symptoms impact your ability to take care of yourself, take care of others, follow through on your responsibilities, whatever it may be. That's the depressive disorder stuff. What current research shows is that when you have BPD traits, even a few, you are more likely to experience depressive episodes over time. Not because your mood system is broken or that you're broken or defective in any way, but because your emotional system is already working harder to manage core content such as abandonment sensitivity, right? Rejection, emptiness. And the research shows that these traits increase the likelihood of new or recurring depressive episodes, but they do not consistently predict long-term unremitting depression. And that really matters. It suggests that what you experience is often episodic surface shutdown, not a permanent depressive state. And that's where sort of BPD and major depressive disorder. And about 85% of individuals with full disorder, borderline personality disorder also have comorbid major depressive disorder. And I talk a lot about that as well as how to manage it in my book complex BPD that you may find helpful if you want to check it out. But you know, those depressive spirals are part of the borderline experience, even those with borderline traits, but they're not depressive. And what happens is that more medication doesn't necessarily make it better because those depressive spirals and a lot of major depressive disorder for people with BPD, it's driven by those core content symptoms. So depression often feels very personal. Well, why is that? Because from the inside, depression feels like something is wrong with you. You should know better by now, right? is you're not trying hard enough. But when depressive symptoms are surface content, kind of the meaning changes a little bit. What you're experiencing isn't failure. It's a response. So your system has been managing emotional risk for a long time, often quietly, even alone. So you kind of maybe you stuff it down. You try to keep it contained and eventually it pulls energy inward and it it's like you're a sponge for the negative in the world and that pulls it inward and that creates that feeling that we call depression. Imagine someone who learned early that staying connected meant staying emotionally alert. You may totally resonate with that, right? is that as an adult they're capable, caring, responsible, but internally they're always tracking, did I say the wrong thing? Am I about to be left? abandoned? Am I too much for anyone to deal with, tolerate, love, or even like? They don't feel anxious all the time. They feel tired and worn out. And when that fatigue reaches its limit, surface strategies start to fall away. What remains looks like depression. And sometimes that feels like all you're left with. It can feel like internally all I'm left with is this depressive shell. And if this resonates, here's likely what it means or could mean for you is your depressive states are organized. They're not just random. Your symptoms are responses, not defects. Remember that. Don't internalize it and make it about who you are. We have to look at that depression as separate from who you see and who you believe you are. And your system shuts down when it reaches capacity. And that's totally normal. It's like when anything gets flooded, whether it's with anxiety or in this case depression, it shuts down due to overload. And you're not depressed because you can't cope or because you're insufficient. You're depressed because you've been coping without enough emotional safety. And when depression symptoms are treated as the core problem, which they are when we're working with BPD and major depressive disorder, you're left feeling perhaps less broken because there should be an attenuation. There's a lot of research to support this. There should be an attenuation, a lessening of those depressive symptoms. And that's a critical component. And if this made sense to you, if this clicked, you're like, "Wait a minute, that kind of makes sense. " Like, "My depression just doesn't go away with more medication or with just sort of simply trying to ignore it or distract yourself or anything like that because it's harder. So, if this made sense, it doesn't mean you were wrong to call it depression or that you're misunderstanding yourself. It means

there's more precise language that's available for you. " Now, not every depressive experience is major depressive disorder. There's also remember those depressive spirals which are less intense. And in treatment, and if you're in treatment, you should be monitoring those. I want to encourage you to do that because I do that with my clients that have depressive spirals. How long do they last? What's their degree of impact? because sometimes depressive spirals can spiral out of control and that can actually encourage a major depressive episode. But that isn't as common I think as many people believe and there's research to show that is that not every slide downward equals a major depressive episode. And that's different. So I don't want you to be blaming yourself. I want you to understand that depression keeps coming back because there's components of it that are built in to that personality makeup of BPD, but it's not always a major depressive episode. And making that distinction can really empower you. So, does your sadness, does your hopelessness, helplessness, worthlessness, does it impact your ability to get things done? And if it doesn't, that might be more of a depressive spiral. How intense is it? It's good to rate it. Also, how long is it lasting? Also important to rate it because over time and in treatment and in therapy when we're working with BPD core content, you'll start to see those depressive spirals and those depressive episodes are less common and less intense. And that's what we're going for. So when that depression keeps coming back, just know that maybe we shouldn't be focusing on treating the surface. We should core as to what's driving the depressive episode. So I hope you found this helpful. Please check out some of my other videos. Like, share, and subscribe. That's always awesome. And I'll see you next time. Thanks a lot and bye-bye.