What causes depression? ~ a very subjective examination of a difficult subject

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.

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35 thoughts on “What causes depression? ~ a very subjective examination of a difficult subject

  1. Depression can also be reactive. That is, connected to a certain bad time in your life. This type can be treated successfully. Sometimes that bad period is no longer there, like the break up of a marriage. One can move on with help.

    But with bereavement, which can also cause depression, even if it goes away, it can return, especially at low times, or anniversaries of death, or the birthday of the person.

    But most people don’t understand depression, and it is confused with feeling or mood that is more shortlived than depression, the mental illness. That is why some might say it is related to putting life in perspective. Just ignorance really.

    • I’d not entirely forgotten reactive depression but I had forgotten the term so thank you for adding that one.
      When I was first being treated, I was diagnosed with double depression (nothing like a double espresso), that is a reactive depression coupled with clinical depression. There were life circumstances at the time that were literally making my life a misery; but where when well, I’d have been able to deal much better with circumstances, I was unable to cope with the clinical depression as well.
      Thanks for visiting.

  2. As always Viv you express the complexity of depression brilliantly. It was recently suggested to me that I get low because I read a certain type of book, or poetry: that I listen to certain genre of music or because I talk to people who, like me, struggle with depression. It is so hard to untangle these knots and explain what depression is about for me so I always seek a general explanation. This is perfect. Thank you.

  3. I am a big believer in the biopsychosocial model – i.e. some of us are born with biological (genetic) vulnerabilities to depression (and indeed, bipolar, personality disorders or schizophrenia) but not everyone who is vulnerable will encounter the kind of triggers that act as a kind of catalyst to developing a mental disorder. I like it because it explains why two people can have exactly the same traumatic experiences, but one recovers well and doesn’t have any further problems, while the other is plunged into a lifetime of unhappiness.

    I think most doctors acknowledge that we know there is an association between levels of neurotransmitters such as seratonin, dopamine, etc and abnormal mood state, but that science does not yet fully understand the nature of that association (Dr Mark Collins expressed this very well when I went to one of the SANE/Ruby Wax Mental Health Forums last autumn http://purplepersuasion.wordpress.com/2011/09/23/keeping-it-real-thoughts-from-this-weeks-mental-health-forum/). Hence medication is always a bit of sledgehammer to crack a nut. But I for one wouldn’t be without it; I know I would be so much more ill than I am now without taking the drugs. Doesn’t stop me complaining about the side effects!

    Yes, we can also reactive depressions, but we have to be very careful to recognise that grieving is normal after a bereavement, a relationship breakup, a redunancy, etc and that a period of acute emotional pain at this sort of time is *not* depression. Depression is abnormal sadness which has, in its intensity and its duration, gone beyond normal grief. Although I generally kindly disposed towards medication for depression, I take a dim view of antidepressants being foisted on people who are suffering because of a loss, and who really need to be listened to and nurtured through their grief.

  4. Thank you for this article… I’ve read quite a bit on depression on various blogs and yours is definitely up there as one of the best reasoned and tightly argued. You sum up very clearly the undeniable major problem – why do some people seem constantly to have to grapple with this horrible illness all their lives, while others, who may have more ’cause’ just bounce through Life, other than feeling appropriately sad during times of bereavement?

    For what it’s worth – my hunch is that it’s all in the genes. I suspect the genetic component involved in depression is far greater than the medical profession has so far suggested, while I think that diet and exercise can all play a part in helping to keep the Black Dog at bay… And some occupations tend to be afflicted with with depressive people – creative folks such as writers are right up there. Is it because the very nature of the job causes extra stresses (uncertain, low pay; constant rejection; large amounts of self motivation) or that the creative, solitary nature of the job attracts the depressive personality? Again, an interesting question…

    • I don’t know how much being a writer affects my depression, or how much depression influences my writing, but there is a correlation between thinking deeply about things and feeling deeply and often becoming deeply sad.
      Thanks for commenting; again, sorry not to be more forthcoming in reply.

  5. Such a very big subject and hard to give a response that isn’t just a ragbag of bits and pieces.

    When my husband was at university, he was deeply depressed about the state of the world and finally went to the doctor. After listening, this wise man said, “I don’t think you’re depressed, I think you’re sad.” This made a big impression on me, because sadness is something we can all recognise – it’s such a homely little word, and yet any one of us can think of things that bring a lump to the throat and know that here is some unresolved sadness. I think we all carry around an enormous burden of grief we haven’t dealt with, things that were too traumatic or simply at too inconvenient a time (My mother dying the week before a first Ofsted inspection springs to mind), stuff that we just put in boxes because we couldn’t deal with it at the time. For all of us, I think there’s a good case for doing emotional housekeeping from time to time (preferably during a buoyant phase!) when we actively seek out and let ourselves experience the emotions that we pushed down when they were too painful to feel. It isn’t comfortable but it can be cathartic.

    However, although that explains a lot, it doesn’t explain the Black Pit days, when I’m in a place that has no exit, and I know it’s forever; even though I’ve been there before and come out the other side, it’s still forever and the sides are too steep to climb. Where do they come from?

    Deep, inaccessible stuff, but I think there are avenues worth pursuing. I think your chicken-and-egg theory about the chemical imbalances being a result rather than a cause has a definite ring of truth and the internal haemorrhaging may well be the perfect metaphor. Because if you extend the sadness process above, I suspect there are griefs and traumas and furies and violences (some done to us, but mainly done by us) that we can’t face, not just because they are unbearable, but because they are too unacceptable to acknowledge.

    At some level, we all feel ‘not good enough’, that there are parts of ourselves that would be unacceptable to others. But what if we knew something so awful about ourselves that we had to banish it from our consciousness? A young child sees the world in black and white – no political correctness, just joy, grief, love, hate, fury, calm. As we grow older, we inculcate moral, religious and societal rules and scruples that may be at odds with that innocent honesty. At a very young age it occurs to us that maybe it’s not ok to hate your mum for bringing home a new baby. Maybe it’s not acceptable to want to kill your dad for preferring him or her to you. Is it wicked to masturbate? These impulses and others that are no longer safe to feel, get pushed into the unconscious, like Jung’s Shadow, as we rush to show the world that we are the very opposite of who we know ourselves to be. ( How many of us have spent a lifetime trying to be a ‘good girl’ after scratching, biting or silently hating siblings? Or the unacknowledged homosexual who feels the need to become the ‘queer-basher’? ).

    Are we so ashamed of a part of who we are that we’ve had to exile them forever? And is it that never-ending pain, that a part of ourselves goes forever unwanted and unloved, that is the root of our despair?

    Not main-stream, but ideas that have been useful to me. To check it out, try counting back in years, briefly picturing the then you (I’m fifty, forty five, I’m forty, I’m thirty five……) until you get to 10, then go back a year at a time, and see how each you feels. If you get to a year that feels faintly uncomfortable, try dialoguing with the 5 or 6 year old you. Ask her how she feels – suggest some emotions. Was this a year when she felt anger? Or fury? Or rage? Or shame? Sometimes a yes or no (or just a grunt in the solar plexus) comes more easily than a dialogue, to start with, and often a different word with a different charge will provoke a reaction.

    Take a while, and different sessions to play around with this, till something takes shape. Then ask her, is there something that would make a difference? Is there something that you could do, or say or feel that would help her turn this around? Maybe you as the adult can hold her safe while she says or screams her rage at the people who hurt her? Does she need you to pass her the hammer as she beats someone to pulp, while you tell her that it’s alright to feel anger? Can she use your hand to write a letter or draw a picture of what she’s ashamed of? Would ‘wringing a towel’s neck’ help her express how she feels? And accept and allow whatever comes up. Again and again, accept and allow. (Though don’t be surprised if the conscious you does disapprove – it’s hard to accept cruelty or viciousness in yourself. Just remember she’s giving you an honest and truthful reaction, and better out than in!)

    There are plenty of self-interrogative techniques out there, and you can do a lot on your own, but a group of like-minded people is great to offer support and fresh ideas. Sorry to be so long-winded – it’s easier to talk about this kind of stuff than write it. Keep up the good fight.

    • I am stunned by this comment; lots of fabulous ideas. Am working with something similar.
      I can’t thank you enough for taking the time to share this; just sorry I cant respond more fully at present.

      • not sure where to reply – to Gil or Viv..the threads…
        Yes saddness is definitely worth thinking about. Grief and sadness pushed back inside seem to lead to depression.
        I am currently have 6 weeks of appointments of CBT [if only it were a little longer, but that is what the nhs offers]. Both the therapist and I want to look at the thoughts and feelings now. But some of the examinations of thoughts throw me back to about 7-9 years old. Which is just not possible to deal with in the sessions. [I also discovered how much I hide and lock up, not many people “see” me, see my depression – even when faced with someone who might be able to guide me]. Back to childhood, I don’t “feel” a depressed child I feel a sad child, perhaps a little confused, occasionally lonely in my aloneness. A few years later, new school, bullying, non acceptance and I can feel that it becoming depression and horribly somatised. Somehow when younger I had mechanisms to keep the feelings as feelings then it changed. I had lost regular contact with grandparents and thereby physical contact [my mother not a hand holder hugger or kisser] that might have made a difference – but also just growing up – I think Gills point about all the judgemental stuff that we take on: morals, social acceptability etc are relevant by the time we hit mid teens, perhaps earlier.
        all of these writings here are helpful. thank you – Viv and all

  6. Hello Viv,

    You really express so well what your inner landscape looks and feels like. My heart goes out to you. I have never suffered from depression, but was once married to a man who did and experienced first hand what it was like for him.

    There is a woman named Byron Katie who suffered from depression for years and who found a way to heal herself. She has a great website (easy to find) and lots of fabulous videos on youtube. Her message may or may not resonate for you. That would be for you to decide, but it might be worth checking out.

    All the best,
    Sara

  7. In my case, I guess the chemical imbalance is the answer for a number of reasons. First, my bi-polar disorder runs strongly through my family. My father and my brother also suffer from it. So, in my case, the origin of the disorder is clearly genetic. Second, I spent over 10 years on a strict regiment of Tegretol, and it worked extremely well.

    However, neither of those explain how, after 6 years in psychotherapy, I managed to wean off the Tegretol and manage the disorder through recognizing triggers and avoiding them.

    • I do wonder about genetic and also whether it is actually genetic or whether it is phenotypical rather than genotypical (nurture rather than nature), family patterns of thought, behaviour, belief, attitude….

  8. like the list and the confusion, well don’t like it, I mean respond to it. reactive depression is sort of life circumstance depression.
    then the complicated don’t know why I am depressed and oh damn some reactive deprssion on top as icing….
    thanks for blog. will keep an eye

  9. someone said in the new scientist so perhaps somewhere else as well that people with depression were realists, in that, if you were stuck in a dangerous situation such as stranded in antarctica it would be better to be with someone with depression. can’t remember the whole of the reasoning, but I liked it. basically I think some crazed optimist would wear you and and use little thought in decision making…. so not useful if your companion with depression was on a bit of an up…
    I think chemicals are a big part – but what affects the chemicals is the question

  10. I found that my depression began during my teen years. Then, with various social/emotional issues, was exacerbated: my then husband’s passive aggressive behaviour, my divorce, an abusive boss, menopause, my late mother’s cancer battle, moving, finding a new job, bereavement issues. All managed to trigger a depressive episode. I quit my job, gave up a career, and I am trying to find some contentment in spending time with hubby #2, volunteering through Hospice, and getting outdoors to take photos.

    I am convinced that it is related to hormones and stress and the interaction of all the above. My body reacts the same way to stress: depression.

    My antidepressants work well for me. I still mourn my career, but find solace in blogging and volunteering, and grandkids.
    I wrote a book about the whole ordeal of caring for dying parents, and firmly believe that journaling is a form of healing.

    Thoughtful post.

  11. As I’m spending January at home with a nervous breakdown caused by DayJob (it took them 24 years, with failed attempts in 1992 and 1996, but this time I snapped), I totally relate. I don’t know if it’s job stress, chemical imbalance, mid-life crisis or wrong diet. Or all of the above. I only know it will pass.
    And even those days when I wonder what am I still doing here, I know I’m here for a reason. So I’ll keep going.
    And to reply to the last “cause” – when guild was making me feel even sicker, at least two people told me “Now it’s time to be selfish. Take care of yourself. Regroup and keep going.” And they’re right. We can be selfish sometimes, especially to disentangle ourselves from depression. Yes we can. Actually, we must.
    Hugs

  12. This is an incredibly thoughtful post, Viv. The thing that makes me maddest is the “count your blessings” approach (even more than the pull yourself together one which makes me furious but I just chalk down to ignrance and try to explain why that’s not quite so easy). That can have a serious negative effect on anyone going through the darkest days – it adds a huge burden of guilt to the existing depression (“I have all this and *still* I feel terrible – what kind of monster am I?”)

    In my experiences the causes can be manifold and vary greatly from person to person, as do the “treatments” (though I think it’s wise to deouple cause and treatment from an individual’s perspective – certainly when faced with someone who’s problem is acute, and where they are possibly a danger to themselves, or more likely are in danger of slipping out of the employment net altogether. In those cases the underlying cause is less important than intervening to relieve the symptoms and try to enable some degree of minimal functionality).

    Your last point is something I think also varies – I know there are times I find “it will end” the worst thing that someone can say to me – the other thing you point out “I am not alone” is what I need to hear most (that was the subject of our recent exhibition “What There Is Instead of Rainbows” http://eightcuts.com/eight-cuts-gallery/what-there-is-instead-of-rainbows/). I think the fact that people’s responses differ so much is what can make it difficult for those who surround us, and the only real advice I could offer them is “listen to us when we’re well”

    • No, you don’t see it coming at all but after 40 years I have begun to sense when it is approaching and try to be prepared.
      Thanks for visiting.

  13. Pingback: Changing Your health for Recovery Coming from Major depression | Depression Blog

    • Hi Suzanne,
      there is something to be said for seeing it as a battle and one of the spirit but I do feel that many of the approaches used by some extreme Christian teachings are both wrong and unhelpful and often desperately damaging.
      nice to see you here.

  14. You’ve had some wonderful comments and observations to an already insightful post, Viv. For my pennyworth, just adding to the many possible things that can explain or help, here’s some things I have found helpful.

    Hevs’ Shrink’s Tips as follows: my shrink suggested (backed up by very successful trials and studies if you Google it) 1000mg a day of EPA Fish Oil. It needs to be the EPA and most chemists sell capsules with around 250mg or so inside. So I have been taking 1000mg (4 caps from Lloyds) a day for 2 or 3 weeks and already sensing a shift. However, for the last 10 days or so, I’ve also been using one of those SAD lamps – because my depression always seems to worsen in winter, although it has occurred at any time of year, often a reaction to stress, I think. We are noticing the last couple of days that I am starting to care about my appearance again, smile and laugh more and generally be more upbeat. I do take an antidepressant but very naughtily cut it in half around December and have been advised to get back to the prescribed dose. This could take another couple of weeks to kick in, by which time I imagine I could be gambolling about like a spring lamb, cracking jokes, etc.

    One of the other big things (amongst all the myriad things out there) for me is to try, just to try, to get out of “self” in some way – whether that be spiritually, or helping, calling or calling on someone else, or just meeting up for coffee with a friend or to walk the dog with another friend with her dog… you get the drift. I know it’s often the last thing I want to do. But… just anything to stop being alone in that head of mine – which can be a dangerous place to be. The trouble with depression, I find I might drag myself out to buy a paper, give the newsagent the money and then dissolve into tears for absolutely NO apparent reason. Having a partner and friends who understand (not many, granted) really helps me to simply accept that this is one of those times and, as you say, it too shall pass.

  15. P.S. Sorry about this but just another thought: the “this too shall pass thing” is important – although it can seem just piffle by well-meaning souls when we are deep in the slough of despond. What I’ve found, having suffered depression for many many years (and yes both ma and pa had it), is that the years have taught me to have *patience* with it and to believe that there will be brighter days, even when my head is shouting at me “Yes, but what’s the point of it all?” 🙂 Again, a thoughtful post and will subscribe.

  16. Hi Heather,
    many thanks for commenting. I had heard some good things about fish oils but despite trying them for about 6 months a few years ago, I didn’t find they helped me much. I have a SAD lamp that takes the edge off the winter blues and I use that on darker days.
    I did write a post about 2 years back that gave a few hints of things I have tried that work to some degree.
    https://zenandtheartoftightropewalking.wordpress.com/2010/04/16/10-things-to-help-depression/
    As you can see many of these coincide with your suggestions though since my dog has passed away walking is not quite the same.
    I do believe that reminding MYSELF it will pass is helpful, but as Dan said, when others say it to you, it can be worse than useless.
    Thank you for your kind and helpful suggestions and best wishes for a spring of joy!

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