The quiet toll of internalized shame and depression

When you think of depression, you might picture someone who’s lethargic or who doesn’t want to socialize. Understandably, shame might not cross your mind. That’s because the relationship between shame and depression isn’t talked about much.  

Depression can distort your feelings about yourself. For example, you might think, “I’m not good enough,” even though this isn’t true. This can easily lead to feelings of embarrassment and hit at deeper shame wounds. 

The shame that can come with depression can also convince you that seeking support isn’t an option. But everyone deserves help. A therapist can teach you to recognize when depression is contributing to shame, uncover its causes, and help you get back to feeling your best. 

Signs of shame-based depression

Depression often leads to self-isolation. And when you don’t have a support system around you to help you reflect on your feelings, it can be even harder to tell if shame is one of the factors contributing to your depression. But there are some red flags to keep on your radar. 

Signs you might be dealing with shame-based depression include:

• Recurring feelings or thoughts of self-worthlessness

• Inability or internal resistance to believe compliments or praise

• Isolating yourself to avoid judgment 

• Repetitive self-criticism 

• Perfectionism

• Overly apologizing, especially for things that you didn’t cause

• Feeling ashamed of your depression

It’s not your fault if you feel shame during a depressive episode. In fact, people with major depressive disorder (MDD), also known as clinical depression, are more likely to feel emotions like shame and guilt. In other words, a depressed brain often defaults to shame. 

Depression and shame can also feed into each other. This can happen because depression can cause rumination, or replaying negative thoughts, which can lead to shame and feelings of self-worthlessness.

Like other emotions, feelings of shame aren’t permanent. But shame can make people feel like there’s something inherently wrong with them. If you experience shame enough, you might start to believe you’re unworthy. Research shows that higher levels of shame tend to lead to more depressive symptoms. 

Some people turn toward self-harm when depressed. They may see it as an emotional catharsis or as a necessary punishment for feeling shame. Know that while self-harm might feel good in the moment, without interventions like therapy, self-harm increases the risk for suicide.*

*A note on safety: The 988 Suicide and Crisis Lifeline offers 24/7 confidential support through trained crisis counselors. If you or someone you care about is experiencing emotional distress, self-harm, or a suicidal crisis, please call or text 988. For life-threatening emergencies or immediate assistance, call 911.

Factors that can contribute to the shame-depression cycle

You might wonder why your depression spurs shame and someone else’s doesn’t. Shame-based depression doesn’t just come out of the blue. It’s often influenced by many different factors — many out of your control. 

Factors that can make someone more likely to experience shame and depression together include: 

• Repeated negative messages during childhood: Did your parents or caregivers repeatedly tell you, verbally or through actions, that you were unworthy of love or a constant disappointment? If so, these messages can resurface when your depression hits. Research shows that emotional or physical mistreatment or abuse during childhood can turn into shame and depression later on in life.

• Trauma: Trauma, including emotional trauma, can rewire the brain. For example, some research shows that many people feel shame after developing post-traumatic stress disorder (PTSD) or PTSD symptoms. However, experts have found a strong relationship between PTSD and depression, given that around half of people with PTSD also have depression. 

• Childhood and adolescent bullying: If you were bullied as a child, you’re at a greater risk of developing mental health complications like depression. And while experts think shame probably doesn’t directly cause depression, it can indirectly influence whether you go on to become depressed. 

• Perfectionism: Someone with impossibly high standards for themselves may feel shame when, by no fault of their own, they don’t meet them. Often, perfectionism is something you were taught. But it’s possible to unlearn it with the right support. 

• Social dynamics: It can be difficult to not internalize other people’s behaviors and self-blame when you feel depressed. For example, if your boss passes you over for a promotion, you might think, “There’s something wrong with me,” instead of, “There was another candidate with more experience.” Looking outside of yourself when you’re experiencing symptoms of depression can be a challenge because the brain usually focuses inward. 

Overcoming depression, guilt, and shame

Shame and depression often reinforce each other. When they’re treated together, this can help weaken the bond between them. As a result, someone’s depressive symptoms often lessen along with their feelings of shame. 

For example, self-compassion can be a powerful antidote for shame-based depression. It also helps emotional regulation kick in, which can help you slow down your thoughts and think more positively. Research shows that when someone with clinical depression is kind and understanding to themselves, it can help them feel significantly better. 

But how can you practice self-compassion? When you recognize negative thoughts, like, “I can’t do this,” or, “Things will never improve,” stop. Take a few breaths, and then ask yourself: “Is it true that I’m unworthy?” “Is it true that I can’t do better?” More often than not, you’ll probably find the answer is “no.”

How professional support can help 

Of course, when you’re depressed, it’s usually hard to summon positive feelings toward yourself or challenge your depressive thoughts. What can make a difference is bringing on someone as a support, like a therapist, psychiatrist, or both. They can also help you get to the root causes of your negative self-talk, which can be a gamechanger. 

A mental health provider might suggest different types of therapy, including:

• Cognitive behavioral therapy (CBT): CBT is a type of therapy that helps you challenge and replace negative thought patterns. CBT is also highly effective in managing depression. 

• Compassion-focused therapy (CFT): This type of therapy helps you focus on the present moment so you can acknowledge your feelings nonjudgmentally. CFT is centered on self-compassion and is designed to treat depression. A small study showed group CFT even reduced depression symptoms with treatment-resistant depression. 

• Trauma-informed therapy: Given that trauma can lead to depression and shame, a trauma-informed therapist may be the best choice for you. They can help you process your trauma in a safe environment and help you address it. Eye movement desensitization and reprocessing (EMDR) is a type of trauma-informed therapy, as is somatic therapy.

Dig deeper:

• Compare somatic therapy and EMDR

Clinician’s take

One reason shame can make it harder to seek help for depression is that it often convinces people that their struggles mean they’re ‘weak’ or ‘broken.’ In turn, they might hide their pain instead of reaching out to others. The truth is, asking for help is a sign of strength and self-respect, and it can be the first step toward feeling lighter and more connected.

Ashley Ayala, LMFT

Clinical reviewer