A crushing weight. A bottomless void. A vast and inescapable darkness. There are a great number of metaphors that patients use to describe the physical and emotional pain of depression, but all of them speak to one fundamental truth: It hurts. Like nothing else in the world. Indeed, the aching intensity of depression probably accounts for the breadth of figurative language attached to it; the disease hurts so much that it can only be explained in the most abstract of terms, with depressives grasping at the ungraspable as they try to put their feelings into words.

Unfortunately, this ineffability means that depression is often only dimly understood by most of the population – by both the individuals who suffer from it and the friends and family members who care about them. People talk about depression without really knowing what they mean; they speak in generalities and stereotypes, repeating assumptions and analogies gleaned from the body of conjectural wisdom that constitutes depression knowledge in the popular consciousness. And that, of course, just isn’t good enough – not for anyone hoping to make a meaningful and lasting recovery from the disease, anyway. On the contrary, depression treatment – effective depression treatment – has to begin with a thorough and honest assessment of what depression actually is. Treatment, you might say, can only start with the truth.

And so, some numbers. According to most estimates, at least 18 million Americans, almost 10 percent of the population, suffer from some form of depression. That figure is consistent with statistics from around the globe; generally speaking, some 15 percent of citizens in the world’s most developed countries can be classified as depressives. 80 percent of all depression cases go untreated. Depression-related absenteeism, work time missed due to the symptoms of the disease, costs employers $51 billion a year in lost productivity. Perhaps most troubling of all, 15 percent of all depressed individuals will ultimately commit suicide.

But what of it, then? Numbers, in the end, are just numbers; they don’t – can’t – tell the whole story, not when depression is by its very nature an intimately personal condition. To thoroughly understand the disease, and to build a solid foundation for its treatment, it’s essential to engage depression on its own level – to explore its roots, consequences, and remedies, in terms that are relevant for the individuals who suffer from it. The questions, for us, are roughly these: Where does depression come from? What does it do to the people it afflicts? Most importantly of all, what are the steps we can take to combat it?

Given the the disease’s intensely personal nature, it is perhaps unsurprising that the precise causes of depression vary from case to case; there is no one harbinger of depressive episodes, no single trigger of depressive states. That said, we can identify a handful of broad factors that often predispose individuals to depression. Short-term depression is frequently caused by proximate emotional trauma, the sudden death of a loved one, for example, or the unexpected loss of a job. Long-term depression, on the other hand, typically stems from childhood traumas, abuse, neglect, chronic familial instability.

On a biological level, depression is frequently associated with chemical imbalances in the brain, which are themselves often related to structural irregularities (sometimes as result of physical trauma) in the hippocampus and frontal lobe. Though sometimes genetic in origin, these imbalances are generally activated only by a concrete incidence of trauma or stress; genes can contribute to depression, that is, but they aren’t, by themselves, a sufficient impetus to its onset. Depressive states are caused by something tangible, something external, in the life of the patient.

The impact of depression, unfortunately, is no less tangible than its causes. Depression is a two-headed disease: It affects patients physically and psychologically. This latter dynamic, the psychological, is generally better known and more thoroughly documented; most people understand that depressives suffer from crippling emotional pain, and are subject to the stress of deeply pessimistic thought and profoundly negative self-image. The physical symptoms of depression, however, can be just as debilitating as the psychological ones: Depressives, by virtue of their diminished immune systems, are prone to increased rates of chronic illnesses, including diabetes, heart disease, and cancer. Not only is depression a sickness in and of itself, it also triggers other sicknesses, in a sort of vicious cycle that often leaves patients bereft of all but the dimmest glimmer of hope.

The good news, though, is that such hope, dim as it might be, is not entirely unfounded. Depression treatment has evolved tremendously in recent years, with some new methodologies showing success rates above 90 percent. Traditionally, doctors have sought to heal depressives through a combination of medication and psychotherapy; drugs like Prozac and Zoloft address the chemical underpinnings of depression, while individual counseling sessions aim to resolve the the disease’s emotional roots. Recently, though, a third component has been added to that treatment regime: whole-person healing. This novel approach recognizes the totality of depression, and treats the disease accordingly; depressives suffer with their entire beings, and whole-person therapy is designed to confront the condition in all its forms. By promoting positive interpersonal relationships, fostering encouraging spiritual beliefs, and developing fulfilling behavior patters, whole-person therapy gives patients reason to believe in a better tomorrow In the darkness of depression, there may be more hopeful light.