Depression is often used to describe a number of different emotions. When someone is sad, bored, or disappointed they might describe those feelings as being depressed. Depression may include feelings of sadness, but it is not the same as sadness. Everyone feels sad and disappointed at times. Life is full of ups and downs, setbacks and losses. To feel sad or blue is an appropriate and normal reaction. Sadness can also occur for short periods of time with no specific reason.
Now let’s look at how we can tell the difference between sadness and depression: (adapted from The Feeling Good Handbook by Dr. Burns)
1) Depression involves a loss of self-esteem. Grief, disappointment and sadness do not. The way a person thinks and feels about who they are does not change when experiencing sadness..
2) Depression lasts much longer than sadness. Depression is persistent and can last 2 weeks or more.
3) People who are depressed function less productively. Depression impairs their ability to function; whereas people who are simply sad or disappointed continue to function normally.
4) When people are depressed they think distorted thoughts. Their view of life is unrealistic. They may see events through the eyes of failure, defeat, abandonment or deprivation. They may indulge in self-blame and self-criticism. The future looks hopeless and filled with more pain and suffering from which they cannot escape.
5) Depression is a serious illness. Depression is not a harmless part of life.
6) People who are depressed often feel hopeless even when there is reason to be hopeful. They get stuck in a rut of believing that things won’t ever get better.
Many people wonder why some people become depressed while others don’t. And, what causes depression? Depression is not caused by just one thing. There is a combination of factors including genetic, chemical, physical, sociological causes. Behavioral patterns learned in one’s family-of-origin also influence behavior patterns that can lead to depression. Psychological reactions to a person’s environment and external influences are commonly believed to be a major contributor to depression as well. It’s important to remember that each situation is unique and needs to be assessed individually.
Let’s look at some of the factors that determine who becomes depressed.
1) Biological factors. These causes are endogenous (from within; inherited; biological)
Genetic factors: Depression seems to run in families. There is genetic link, especially with bipolar disorder (or manic depression). Depression is 1.5 to 3x more common among people with first degree biological relatives with the disorder than among the general population.
Chemical: Imbalances of neurotransmitters (serotonin, dopamine and norepinephrine) contribute to depression. A common question about chemical imbalances is: How much do psychological factors (life experiences, beliefs, etc.) lead to mood changes that in turn change brain chemistry? Or is it the reverse? That again depends on the individual case.
Disease or illness: Depression can co-occur with some physical conditions. It can be a symptom of a disease or illness such as thyroid dysfunction, heart disease, post-stroke, anemia, ADHD, or anxiety.
Medications and drugs: Another biological factor associated with depression is prescription drugs. Depression is a side effect of certain medications. Recreational drugs can disturb chemical balance in the brain, especially excessive drinking of alcohol.
Hormones: Hormonal states such as an overproduction of stress hormones or premenstrual dysphoric disorder; perimenopause, etc. can also contribute to depression.
2) Psychological factors. These causes are exogenous (reactive/situational). They are triggered by external events, social losses, or problems.
Losses and unmet needs: Depression is often the result of losses and unmet needs. Losses are a major part of life that occurs frequently. Series of losses not fully grieved increase the risk for depression. Every one has needs for love, understanding, acceptance, appreciation, purpose, peace, support, value, respect and the list goes on. When these needs are unmet for a prolonged period of time they can trigger depression.
Family patterns: Everyone has had their values and beliefs shaped and developed by prominent people in their upbringing. This may include primary caregivers, siblings and relatives as well as teachers, friends, and other relationships. The primary influence will come from the immediate family in which core beliefs, worldviews and values are established. Every family has a set of rules and its own way of functioning. We learn to view the world based on what we learned in our family. If we learned how to deal with problems effectively, we are more likely to feel competent and strong. If we learned unhealthy coping, we may be more likely to feel overwhelmed, fearful and helpless. This can lead to a greater chance of developing depression. Therefore, if patterns of learned helplessness and poor coping result in much of the depression suffered, then this way of related to problems can be unlearned. This requires learning new skills, and developing new core beliefs and values.
Distortions of thinking: This factor is probably the most commonly believed to be the underlying cause of depression. Long ago, a philosopher named Epicetus said, “People are disturbed not by things, but by their view of things.” In other words, thoughts and perceptions determine our feelings and moods. If we can change our thoughts, then we can change the way we feel. We will discuss this factor in greater detail in the upcoming lessons.
Prolonged stress, abuse, debt: These factors can all trigger depression, especially in those individuals at higher risk for developing it.
It has been a long held belief among professionals and the general population that most depression is caused by psychological factors. Some report that less than 10% of depression is caused by genetic and chemical factors. However, recent research shows that both genetic and psychological factors play a major role in the cause of depression. The onset of depression may initially be triggered by stressors. Yet, genetics and temperament may be more significant in repeated episodes. For that reason the treatment of depression must address all the various factors that contribute to its cause and maintenance.
