We commonly talk about depression as the psychological result of a biological state – an imbalance of neurotransmitters in the brain. But the truth is that this isn’t something that stands alone. We know that some chemicals can directly affect these neurotransmitters – such as the pleasure derived from illicit drugs and the depression that emerges during withdrawal. But we also know that outside experiences alter these systems as well.
The causes of depression are varied, ranging from a genetic predisposition to the result of a chronic illness. In many cases, no cause can be determined. Some types of depression are linked with seasonal variation in sunlight exposure, the length of the day and whether or not allergens are present.
Depression is also linked to anxiety and stress. Someone who is prone to depression may be triggered by a particularly difficult time in their lives. The loss of a loved one, a divorce, incarceration, getting fired – all of these major life events increase the risk of depression.
The critical fact is that while these may be causes, they are not inescapable and do not necessarily force someone into depression. All of these major stressors happen every day to someone, but not everyone gets a major depressive disorder as a consequence. For this reason, when a clear cause is identifiable, that should be addressed, but even when no cause is apparent treatment is worthwhile. The focus should be on ameliorating symptoms and lessening the effects of the disease, rather than discovering the cause.
Part of depression is the feeling we can do nothing about it; that we are simply stuck in the mire and helpless. Getting proper care is difficult when patients just don’t see the point. But there is a point. The point is to improve and break the cycle of feeling blue about always feeling blue – the self reinforcing hopelessness and inability to turn things around.
As much as depression is understood on a neurochemical basis, what we do does matter. Our experiences influence our brain chemistry. If this weren’t so, we could hardly become depressed in the first place. Part of a treatment program will be devoted to identifying those things which seem to make the depression worse and those that help. Some therapists will ask patients to keep a “mood diary” to help identify any patterns. While these patterns may not be causative, they can give a hint to what treatment might work best. When drugs are prescribed, the same holds. Your physician will want to know what effects you feel while on the drug – how it’s helping and where it is not.
If there is a clear cause in an individual case, that cause may or may not be possible to attack directly. For seasonal onset depression, tricking the body into thinking it is a different time of year can help. For depression due to withdrawal from drug addiction, treating the addiction directly may help. But in all cases, the cause, while informative, takes a back seat to the well being of a particular patient and helping them overcome their particular experience with depression.