Neuropsychologist on Why Depression Is Not About Character

Expert Profile

Svetlana Leonidovna Pulya – Clinical Psychologist, Neuropsychologist at SM-Clinic.

Education and Qualifications

• 1991 – Saratov State Pedagogical Institute named after K.A. Fedin, specialty: "Teacher of English and German Languages."
• 2009 – Saratov State University named after N.G. Chernyshevsky, specialty: "Psychologist, Teacher of Psychology."
• 2022 – Russian National Research Medical University named after N.I. Pirogov, specialty: "Clinical Psychologist."
• 2003 – Advanced training course on "Human Psychology and Interaction with the Surrounding World" at the Higher School of Psychosocial Management Technologies.
• 2005 – Advanced training course on "Business Psychology" at the Higher School of Psychosocial Management Technologies.
• 2011 – Advanced training course on "The Art and Science of Coaching. Coaching in Management" at the International Coaching Academy.
• 2011 – Advanced training course on "Coach Mastery" at the International Erickson University of Coaching (IEUC, Canada) and International Coaching Academy.
• 2013 – Completed train-the-trainer program at the International Erickson University of Coaching (IEUC, Canada).
• 2017 – Advanced training course "Profiling. Operational Psychodiagnostics of Personality" at the International Academy for the Study of Lying.
• 2024 – Advanced training course in "Neuropsychology" with the right to conduct professional activities in "Neuropsychology, Neuropsychological Diagnostics, Correction and Rehabilitation" at the St. Petersburg Institute of Additional Professional Education for Psychologists and Psychotherapists.
• 2024 – Advanced training course "Crisis States, Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder: Causes, Manifestations, Overcoming" at the St. Petersburg Institute of Additional Professional Education for Psychologists and Psychotherapists.
• 2025 – Advanced training course "School Bullying: Assistance to Psychologists, Teachers, Children and Families in Prevention and Overcoming Bullying and Its Consequences" at the St. Petersburg Institute of Additional Professional Education for Psychologists and Psychotherapists.

Professional Experience

Has been practicing as a psychologist for over 23 years.

• 1991-2009 – Psychological and pedagogical activities, Saratov.
• 2009-2023 – Psychologist, business trainer, coach at Altair LLC, Moscow.
• 2023-present – Clinical psychologist, neuropsychologist at SM-Clinic medical holding at Yartsevskaya, 8.

Professional Skills and Research Interests: Medical-psychological assistance; neuropsychology; work with children: learning problems, behavior issues, fears, anxiety, stress; work with adults: family therapy, states of melancholy, resentment, loneliness, communication disorders, neuroses, anxiety; work with motivation; self-discovery and finding a way out of circumstantial dead ends.

"Depression Is Not About Circumstances. It's About Brain Neurochemistry"

– What are the most common misconceptions about depression that you encounter in your work? What do people still confuse with "bad mood"? What is considered depression from a clinical standpoint today, and what is not?

– The most dangerous misconception I encounter almost daily sounds like this: "Depression is when a person lies down and cries." Depression often looks completely different – as irritability, as an inability to derive pleasure from things that used to bring joy, as a strange "cotton-headedness" when you seem to function but as if through thick glass. The second misconception: "There needs to be a reason." Patients tell me: "But everything is fine – I have an apartment, a job, a family. Where does depression come from?" But depression is not about circumstances. It's about brain neurochemistry. Serotonin, dopamine, norepinephrine – when this system is unbalanced, no "objectively good life" helps.

From a clinical standpoint, depression is when symptoms are present most of the day, nearly every day, for at least two weeks. And it's not just sadness. It's depressed mood plus loss of interest in life, plus changes in appetite and sleep, plus difficulty concentrating, plus feelings of worthlessness. When a patient says: "I've been sad for three days because of a fight with my husband" – that's a normal emotional reaction. When they say: "For a month now I wake up with a feeling of leaden heaviness and don't understand why I should get up" – that's already a red flag.

– Why is depression one of the leading factors in loss of work capacity and quality of life, and not just bad mood?

– Because depression hits on all fronts simultaneously. First, cognitive functions suffer: it's hard for a person to concentrate, memory deteriorates, decision-making becomes torture. I work as a neuropsychologist and in testing I see that people with depression objectively have reduced indicators of attention and executive functions. Second, energy levels drop sharply. Imagine constantly wearing an invisible 20-kilogram backpack: every action requires titanic efforts. Brushing your teeth is already a feat, getting to work is a marathon.

Social connections also suffer: a person distances themselves from loved ones, increasingly isolates themselves. Research shows that social isolation itself worsens brain condition, creating a vicious cycle. And most importantly – depression has a tendency to "become chronic." Without treatment, one episode increases the risk of the next. The brain seemingly "remembers" the depressive operating mode.

– Is there more awareness about depression in Russia today, or do people still wait until the last moment?

– Awareness is indeed growing. More often, young patients come saying: "I think I have depression, I want to figure it out." They read, understand terminology, are less embarrassed to talk about their condition. The 45+ generation generally remains more conservative: "I just need to pull myself together," "Our parents survived the war, and here I am falling apart," "If I go to a psychologist, it means I'm weak."

These beliefs are extremely persistent and seriously delay seeking help. Particularly concerning is that many come not when they're "just feeling bad," but after a serious personal or professional crisis – job loss, divorce, failure of important projects. In practice, it's often clear: had the person sought help a year earlier, a significant portion of these consequences could have been avoided.

– Based on your observations, how do instability, the information environment, economic and family stresses affect the frequency of depressive states?

– In recent years, I've been seeing more of what I call "background anxiety." It's present in almost everyone: the news flow, the sense of uncertainty, economic volatility – all this keeps the nervous system in a state of chronic tension. And chronic stress is a direct path to depression. Prolonged elevated levels of cortisol, the stress hormone, negatively affect the brain, primarily the hippocampus – the area associated with memory and emotion regulation. This is not a metaphor, but data from neuroimaging and neurobiological studies. I see many "quiet" depressions in people who appear to be coping: they work, raise children, pay mortgages. On the outside, everything is fine, but inside – a feeling of emptiness. They don't cry, they just stopped feeling anything.

– How does depression affect work performance, studying, parenting?

– On work performance – catastrophically. A person is physically present, but mentally absent. This state I call "just present": you're at your workplace, but productivity is close to zero – errors increase, deadlines are missed, conflicts with colleagues escalate. Some of my clients worked at 20% of their real capacity for years without understanding why.

Education especially suffers in adolescents. Depression masquerades as "laziness," "irresponsibility," "doesn't want to study." Parents punish, increase control, but the adolescent actually needs professional help, not pressure.

Parenting is a separate painful topic. Depression prevents being emotionally available to a child. An adult can feed, dress, drive to activities, but to truly be present – play, laugh, show warmth – there's simply no internal resource. Children sense this very subtly and often conclude: "Something's wrong with me, since mom or dad is always sad."

"Depression Is Easy to Miss Without Professional Diagnosis"

– What do patients most often present with who ultimately receive a diagnosis of "depression"? What complaints do they formulate themselves?

– Rarely does anyone immediately say: "I have depression." Much more often I hear phrases like:

"I'm constantly tired, even though I seem to sleep enough."

"I can't concentrate at work, my head is foggy."

"I don't want anything, not even what I used to love."

"I snap at loved ones over small things."

"I sleep poorly – or, conversely, sleep 12 hours and still feel exhausted."

"Anxiety, constant anxiety, and it's unclear about what exactly."

There are also "red flags" I watch for: noticeable weight loss or loss of appetite, early awakening at 4-5 AM with inability to fall asleep again, feelings of hopelessness ("nothing will change"), thoughts that loved ones would be better off without me. The latter is always a signal for immediate psychiatric involvement.

– How does clinical depression differ from burnout, seasonal blues, or acute stress reaction?

– Burnout is about work. A person is exhausted specifically professionally: they're cynical about their work, feel ineffective, but outside work can still enjoy life. Went on vacation – came alive. Depression doesn't work that way. It's everywhere: on vacation, at celebrations, in bed with a loved one – this "gray veil" doesn't disappear.

"Seasonal blues" is a seasonal story related to light deficiency and, among other things, vitamin D deficiency. It usually lasts 2-3 weeks and doesn't completely knock a person out of life.

Acute stress reaction has clear cause-and-effect. A loved one died – grief. Lost a job – fear, despondency. This is a normal reaction. What's abnormal is when six months pass and the person still can't get out of bed.

Clinical depression lasts at least two weeks, often has no obvious "trigger point," or the reaction turns out to be disproportionately severe and prolonged compared to the event.

– Are there age-specific manifestations of depression?

– Absolutely. Adolescents rarely say "I'm sad." They say: "I'm bored," "everything sucks," "leave me alone." Depression masquerades as irritability, aggression, withdrawal into gadgets. Academic performance drops, social circle narrows. Parents attribute everything to "adolescence," but it could be depression.

Middle-aged people (my main group is 30-45 years) more often come with "functional" complaints. They continue working but feel they're living "on autopilot." Lots of anxiety, lots of guilt: "I'm a bad mother," "I can't cope."

Elderly people are the most difficult category to diagnose. They complain more about the body: pain, weakness, memory deterioration. Depression at this age often looks like dementia, though in reality it may be so-called pseudodementia – a condition that responds to correction. To see this requires quality neuropsychological diagnostics.

"Antidepressants Are Not a 'Crutch' or 'Addiction,' but a Tool That Helps Restore Neurochemical Balance"

– In what cases is working with a clinical psychologist sufficient, and when is a psychiatrist and medication therapy necessary?

– I work with mild and moderate depressive episodes – this is the field of psychotherapy. Cognitive-behavioral therapy in such cases shows very good results: we work with negative automatic thoughts, change behavioral patterns, the person masters self-help tools.

But there are situations when I must involve a psychiatrist or psychotherapist:

– Severe depression with suicidal thoughts or intentions;
– Psychotic symptoms (delusions, hallucinations);
– A condition where the person stops eating, doesn't get out of bed, can't take care of themselves;
– Absence of any positive dynamics with regular psychotherapy over 4-6 weeks.

Antidepressants are not a "crutch" or "addiction," but a tool that helps restore neurochemical balance and gives a person the resource for psychotherapeutic work. In practice, I've repeatedly seen how a properly selected medication in 3-4 weeks literally brought people back to life.

– How is work usually structured with a person in depression: what does the first appointment start with?

– The first appointment is primarily diagnostics. I conduct a clinical interview: when symptoms started, how they manifest, what preceded them, whether there were similar episodes before. Additionally, I use standardized questionnaires – for example, the Beck Depression Inventory, anxiety assessment scales.

As a neuropsychologist, I necessarily assess cognitive functions: memory, attention, executive functions. This is important because depression gives a characteristic cognitive profile that differs, say, from burnout or isolated anxiety disorder.

At the first stage, my task is stabilization. Not examining all childhood traumas, but very concrete things: normalizing sleep, basic activity level, reducing symptom severity. Sometimes this starts with a simple step – agreeing that the person will go out for a 10-minute walk every day. Small steps, achievable goals, first small victories that restore a sense of control over one's own life.

– What requests do you most often encounter from people with depression: about the meaning of life, work, relationships?

– All three themes are present, but in different proportions depending on age.

At 30-35, relationships and work usually come to the forefront:

"I don't understand why I'm unhappy in my marriage."
"I hate my job but I'm afraid to change anything."

At 35-45, questions of meaning and self-realization are more common – the classic midlife crisis amplified by depression:

"I did everything right, why do I feel so empty?"
"I feel like I'm living someone else's life."

After 45, themes of role loss, fear of aging, "empty nest," and health are added:

"The children grew up, and I don't understand who I am now."

But there's also a universal thread running through all age groups – loss of contact with oneself. Depression often catches up with those who for years ignored their own needs, feelings, boundaries. On the outside they "functioned," but at some point the psyche said: "stop."

– What do you advise relatives who notice signs of depression, but the person refuses to see a doctor? What phrases should never be said?

– Never say:

"Pull yourself together."
"Others have it worse."
"You just need to walk more/exercise/find a hobby."
"You're just seeking attention."
"At your age I worked and raised three children, and nothing happened."

Such phrases intensify feelings of guilt and shame. The person is already angry at themselves for not being able to "pull themselves together," and your words only confirm their worst thoughts about themselves.

What really helps:

"I see that it's hard for you. I'm here."
"You're important to me, and I'm worried about you."
"Let's find a specialist together, I can help with the appointment."
"This isn't weakness – it's an illness, and it's treatable."

And it's very important not to become a "rescuer" and home therapist. The role of loved ones is to be there, support, and gently guide the person toward professional help, not try to treat them on their own.

– How can employers and HR services notice that an employee needs help without violating boundaries?

At the workplace, I would pay attention to such "red flags":

• Sharp drop in productivity;
• Increase in sick days, especially short "one-day" absences;
• Isolation from the team, refusal of joint lunches and events;
• Irritability and conflict in a person who was previously calm;
• Increasing errors, inattention, forgetfulness.

It's important not to diagnose ("I think you have depression"), but to express care and offer resources:

"I've noticed that lately things haven't been easy for you. If you want to talk – I'm here. If you need support – we have a corporate psychologist / employee assistance program."

Ideally, the company should have a culture of mental health care: basic training for managers, anonymous support programs, the option of "mental health days."

– What can a person do themselves before visiting a specialist? Where is the boundary of self-help?

– There are several basic things that really support, although they won't cure depression by themselves.

• First, sleep schedule. Go to bed and get up at the same time, even if you really want to "throw everything off." Depression "loves" chaotic schedules.
• Second, movement. Even 10-15 minutes of walking a day. This doesn't replace therapy, but helps the brain "stay afloat": it's shown that physical activity stimulates production of BDNF – a protein that supports neuroplasticity.
• Third, live social contact. At least one short conversation a day – by voice or in person, not just texting.

A simple mood diary is also useful: write down what I'm feeling and what events preceded it. This gives a sense of at least some control and becomes valuable material for subsequent work with a specialist.

The boundary of self-help is very clear: if you don't feel better within two weeks, if thoughts about the meaninglessness of life or that "loved ones would be better off without me" appear, if it becomes difficult to perform basic functions – work, take care of yourself – this is a signal that professional help is needed. And the sooner a person receives it, the higher the chances of avoiding severe consequences.

"People Don't Perceive Depression as a Serious Illness"

– What most prevents people with depression from getting help?

– First, stigma. "I'm normal, I don't need a psychologist." "What will relatives think?" "If they find out at work, my career is over."

Second, fear of psychiatrists and medication treatment: "They'll put me on a registry," "They'll put me on pills that will turn me into a vegetable." These are myths, but they're still very persistent.

There's also a financial factor. Quality psychotherapy costs money, and not everyone can afford sessions at 5-7 thousand rubles every week.

A separate problem is distrust of the profession: "Psychologists just take money, but there's zero benefit." This is often the consequence of an unsuccessful first experience when the person encountered an unqualified specialist.

And finally, devaluation of one's own condition: "It's not cancer, I'll endure it." People don't perceive depression as a serious illness that also requires treatment, like diabetes or hypertension.

– How much do online formats help expand access to care?

– Online therapy has become a real revolution in the accessibility of psychological help. I work with people from different regions of Russia and from abroad, and for many this is the only real opportunity to receive qualified support where there simply aren't specialists of the needed profile nearby. For people with depression, the online format also lowers the entry threshold: no need to get ready, travel, spend energy on the road – you can connect literally from your room, and sometimes from bed. When every action is difficult, this matters.

Of course, online help has limitations. For severe depression with high suicidal risk, for psychotic symptoms, for pronounced functional impairments, in-person contact and more intensive monitoring are necessary. But for mild and moderate depressive episodes, research shows that online psychotherapy, including cognitive-behavioral, is comparable in effectiveness to in-person work if standards are maintained and there's live contact with a specialist.

"Depression Is Not Character Weakness or Bad Mood. It's a Brain Disease That Responds to Treatment"

– Has there been a case that best demonstrates that timely help can radically change a destiny?

– A 38-year-old woman came to me with a successful management career – I myself worked in this environment for 10 years and understand its context well. She was on the brink: sharp drop in productivity, conflicts with colleagues, three sick leaves in two months.

Formally, the request sounded like "learn to manage stress," but diagnostics showed moderate depression. She wasn't lying in bed or crying all day – she was "functioning," but on her last reserves.

We worked for about six months: psychotherapy plus, on recommendation, an antidepressant for the first three months, as well as careful work with the body, routine, gradual return of physical activity.

After six months, she was a different person – not "fixed," but as if she had spread wings that had been tucked away for many years. She not only returned to productivity but also got a promotion, was able to build new relationships with her spouse that had suffered for years due to her condition, returning to old hobbies – drawing.

If she had come a year later, there would have been high risks that she would have lost both her job and her marriage. In this case, timely help literally changed her life trajectory.

– If you had the opportunity to convey just one thought to a wide audience for World Mental Health Day, what would you say?

– Depression is not weak character or "bad mood." It's a brain disease that responds to treatment for the individual person. You wouldn't walk around with a broken leg, telling yourself to "pull yourself together" – you'd go to a traumatologist. It's the same with depression: it's a breakdown, just invisible to the eye, and it requires professional help just as much, not shame, self-flagellation, or waiting for it to "pass on its own." Seeking help is not a sign of weakness; it's perhaps the strongest and most responsible step you can take toward yourself and your loved ones.

Source: Data from a global survey conducted by international statistics collection and analysis company Statista (survey conducted in 2023)