Existential Depression: Answers to 4 Important Questions

What is existential depression?

The term “clinical depression” is considered a synonym for a diagnosis of major depressive disorder. In contrast, existential depression is not an official diagnosis but refers to depression that is characterized by questions about purpose, meaning, and spiritual distress.  Existential depression is also sometimes referred to as an existential crisis.

It has been argued that existential depression isn’t the same as depression that doesn’t include a crisis of meaning. From this argument, it follows that the evidence-based medication and psychotherapy recommended for major depressive disorder might not be equally efficacious for existential depression.  Some experts have suggested that existential depression isn’t truly a disorder but a “non-pathological mental state” that requires a different approach than “conventional” depression.

Put succinctly, existential depression focuses on the meaning of life. It is thought to be distinct from depression that stems from neurochemical imbalances or adverse life experiences. In some cases, existential depression is accompanied by existential guilt. Existential guilt is characterized by a strong belief that one is an inadequate human who is uniquely and inherently flawed. It is a sense of being a bad “other” rather than part of the collective good “we.”

Existential depression is not the same as more common diagnoses such as seasonal depression or bipolar depression. The primary diagnosis of someone suffering from depression and mania would not be existential depression.

It is not uncommon for people to ask themselves “big questions” about life, purpose, and meaning. But, in some cases, the fact that there is no definitive “right” answer to these questions can trigger feelings of intense despair and distress. The result is existential depression.

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There is no specific existential depression test. However, common existential depression symptoms include despair and suffering driven by characteristic thoughts, such as:

  • My life has no meaning.
  • I have no purpose.
  • Nothing is of value.
  • Life doesn’t make any sense.
  • I don’t belong.

If these thoughts ring true for you, it’s possible that you are depressed.

Existential depression can also be accompanied by symptoms of typical depression such as poor appetite, disturbed sleep, low motivation, poor concentration, feelings of hopelessness and worthlessness, slow or agitated movements, and a preoccupation with death, including suicidal ideation.

Why Doesn’t Everyone Have Existential Depression?

When a person begins to contemplate the purpose or meaning of life and can’t come up with a satisfactory answer, the existential crisis can begin. For others, not knowing why life matters may be more tolerable, and a decline in depression or crisis doesn’t follow. In some cases, existential depression may leave the person with the inability to value anything. In other words, nothing matters. The drive to get better, to push through avoidance or lack of motivation can drop to zero if there is nothing of value in life or the world.

Unfortunately, suicidality or reckless behavior is one outcome of existential depression. After all, if there is no meaning or purpose to life, why bother preserving it?

A common trigger for existential depression is a potential or confirmed terminal illness. Existential crises in cancer patients have been reported widely in the literature.

The other group of people thought to be more prone to existential depression are those who are intellectually gifted. Perhaps the ability to think at a “higher” level and to question what others take as givens can help explain the higher rates of existential depression in this group of people.  

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How to Deal with Existential Depression

When it comes to existential depression, it may be less about overcoming existential depression and more about dealing with it.

One way of dealing with existential depression is to normalize the desire to “make sense” of life. The person is not alone in their quest to understand why they are here and what they should be doing with their life.

 It can be a challenge, but using an approach called “radical acceptance” can help some people who are having a crisis of meaning. Radical acceptance is coming to terms with realities that we wish weren’t true. In this case, it means accepting that uncertainty about the purpose of life may be enduring. The challenge is to accept this reality while continuing to embrace all the positives – whether that be laughter, love, or happiness – that life offers.

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How to Help Someone with Existential Depression

Existential depression can be difficult to treat. In many cases, it may be most helpful to try and support someone as they explore meaning and spirituality by asking themselves difficult questions about life.  The typical goal of treating disease to cure may not hold for existential depression. Instead, the goal is often about validating the questions being asked about life while reducing the accompanying despair.

Due to existential crises being so common in specific settings (e.g., hospices, palliative care units), efforts have been made to identify specific treatments that may help. Meaning-centered psychotherapy (MCP) is one such treatment. MCP is designed to focus on countering the belief that life is meaningless. The end goal is to have people develop a sense of meaning that helps them navigate their existential crisis and alleviate some of the associated distress.

It has been argued that the goal of treating existential depression is to help a person “live meaningfully.”   Meaning can make suffering, loss, and the randomness of life more tolerable. Being aware that many other people struggle with the same questions can often be a great comfort to those in the midst of a crisis of meaning.

In cases where existential depression is accompanied by suicidality, professional care becomes paramount.

Final Thoughts

Existential questions and exploration are the norms rather than the exceptions. The exploration can transition into a crisis and a depression if the “need” to know the unknowable is so strong that it gets in the way of enjoying life in the moment.

Therapy that allows for a guided exploration of life’s big questions while addressing any associated despair and hopelessness can offer a way out of an enduring existential crisis.