What causes depression? ~ a very subjective examination of a difficult subject
I’m in the middle of a depressive phase at the moment, but even within that there are peaks and troughs so I can make a very ham-fisted shot at this very fraught subject. My personal experience has been of depression itself, without add-ons or other mental health issues other than sometimes severe anxiety. Watching my own patterns in the last few years has made me suspect a possible bi-polar slant too, but until that becomes pressing I don’t intend to pursue that as a diagnosis.
I’m going to do a run-through of the usual and not so usual suspects for the causes and try and briefly explore the evidence. I am not a medical practitioner, nor an expert in anything so be aware these are opinions only.
Chemical imbalances: in the last thirty years, this has been much discussed and researched as a cause for depression. The basic brain chemicals get out of whack with each other and the resulting imbalance is seen to cause depression and other mental health issues. Serotonin, the feel-good “drug” is an example of that. Brains of people suffering with depression were discovered to be malfunctioning in regard to this chemical. A good analogy to this would be to see that the some of the brain had a kind of serotonin gobbling tapeworm that ate up all the good stuff and stopped the rest of the body/brain using it to feel good. The drugs used to treat this were SSRIs, that is Selective Serotonin Re-uptake Inhibitors, which stopped the brain reabsorbing serotonin. I was on an SSRI for many years, off and on, but it only ever took the edge off the depression and in the end, the side effects outweighed the benefits.
My problem with this theory of brain chemical imbalances is a) that it fails to explain quite why the brain gets out of sync with it’s balances and b) the body’s ability to self-right itself is such that untreated most standard cases of depression right themselves within about six months. Treated with drugs or left untreated, many cases of depression actually seem to heal themselves. This then leaves folks like me for whom the medication didn’t work and who spend months in deep depression, which may lighten and then return. I can’t remember a year in my life where I didn’t have at least one spell of debilitating depression. I don’t mean feeling a bit blue or whatever. Everyone has those and that is not depression. And finally c) I also wonder if the chemical imbalances are caused by depression itself. It might be like treating anaemia by giving iron but never discovering that the reason someone is deficient in iron because they have internal bleeding of some kind that has gone undiagnosed. The chemical imbalances might be the result of depression and not the cause.
Trauma: back in the first world war, breaking under pressure was labelled LMF, that is Lack of Moral Fibre, and soldiers who cracked were sometimes punished by being crucified on gun-wheels. By the end of the war, the term Shell shock had come about and that was the start of the understanding of what we now term Post Traumatic stress disorder. Now those with PTSD often suffer serious depression as well as other dreadful symptoms but can we really reverse this and say that those with depression are suffering from PTSD too? Life is tough. Most of us have been through and seen things that haunt us, but is trauma the cause of depression? I know of cases of people who go through terrible things and never suffer a day of depression; I also know of people who have led sheltered, protected lives and whose day to day existence is marred by constant battles with the Black Dog.
Dietary Imbalances: there is no doubt that eating a good balanced diet feeds both body and mind, but can a lack of a few nutrients really cause depression? Well, there is good evidence that lack of certain essential fatty acids depletes the brain, but whether this causes depression or not is still uncertain. In theory, taking supplements of certain fish oils may help. But given that the body is amazing at self-regulating and that enormous numbers of people eat a dreadful diet deficient in lots of nutrients, it surprises me that better evidence has not been presented to support this theory. I tried various much-touted supplements and tried to eat more oily fish, and after a good six to twelve months could see no real changes.
Evil Spirits: medieval physicians often ascribed melancholy to the unwelcome attentions of demons, often referred to as the Noon-Day Demon. Serious psychosis and aberrant behaviour was often attributed to actual demonic possession and it may surprise and even horrify some that exorcisms do still take place, very infrequently, of psychiatric patients, and it may surprise that on some occasions, it works and the person is restored to sanity. Please don’t ask me to quote examples of this, because I probably can’t. The information came to me anecdotally from various sources I trust but am not at liberty to disclose. In some ways, this may be very like the shock-treatments carried out in Victorian or earlier Bedlams, where patients were subjected to extreme shocks like being hosed down with ice cold water. While I believe that demonic possession is possible I also believe it is also phenomenally rare. However, depression is not something I would ascribe to this cause!
Life circumstances: Modern life puts pressures on us many of us find hard to cope with. Stress and worry, not to mention illness and failure, can put a heavy burden on us. Grief and sorrow are a normal part of life, and while they are excruciatingly painful, they pass in their own time. It is when the normal grieving process goes on longer than normal and it can pass into depression. This too will pass. Each and every one of us will lose people and things we love and will be subject to hardships. So why do some never descend into the miserable hell of depression?
Spiritual/psychological problems: I believe that we are beings of soul, of spirit and that a denial of this aspect of self can unbalance us. This doesn’t mean to say that those who have no faith in a higher power are going to be more subject(or less so) to depression. But the psyche, that nebulous thing, is something that needs attention whether you believe in eternal life or not. If we find ourselves at odds with ourselves internally, whether this is spiritual or psychological, then problems do crop up. The classic mid-life crisis is an example of this. The call to inner work is a strong one that is strangely easy to resist, possibly because of the fear of breaking down rather than breaking through.
Being ungrateful, lazy and selfish: I am adding this one not because I believe it is a cause but because, sadly, others do. A few weeks ago, someone used a private conversation I had with them to air their own agenda publicly, that depression is something to be overcome by being grateful for the good things in your life, and that if you are depressed then you just need to be thankful for those things, pull up your socks, tackle the problems again and get on with it and stop crying for the moon. I was very angry and very hurt by both the betrayal of confidence but mainly for the fact that it was so clear that a great number of people misunderstand what depression is and how destructive it can be.
As you can see from this brief run-through, it’s a minefield of epic proportions. If it’s dietary, HOW can you find out exactly what you are missing and replace it? If it’s psychological, HOW can you pinpoint what is wrong and formulate a plan to deal with it? If it’s a chemical imbalance, HOW can you be sure that what a doctor offers you is really going to help? If it’s spiritual, HOW can you begin to understand what you need to do to get through?
The last few months, I have noticed something very interesting. Many of my friends and contacts online and beyond have mental health issues, and I have explored this both publicly and privately and two important things have emerged from it.
The first thing is I AM NOT ALONE. During really bad days, the kind and encouraging words and acts of both friends and total strangers have helped me limp to the end of another day. Some have made me laugh, some have made me cry(which is not a bad thing) with their kindness.
The second thing is THIS TOO WILL PASS. People have said to me, you’ve been through this before, you know you will come through to the other side. Now, on a bad day, I often think, I have had enough, I want this to stop. I often think, there is no other side, just this blank blackness. Remembering there is an end is often the only thing that keeps you going. Tomorrow is another day is not just for Scarlet O’Hara.