How Depression Works
It's an understatement to say that depression is complex. The medical term is "multifactorial condition" - basically a fancy way of saying complicated. In fact, depression is one of the most complex psychological conditions because of all the different factors that can have varying impacts and influences on a potential diagnosis. Understanding how depression affects each person involves examining biological, psychological, and environmental aspects of a person's life. This illustration by Erica Singleton shows the impacts that all of these factors have on a person effected by depression. Click to see , here.
There are seven main types of factors and considerations we typically review when looking for depressive characteristics (and in many cases some of these would be joint observations with psychiatrists and other medical professionals):
- Depression is often associated with imbalances in neurotransmitters, which are chemical messengers in the brain.
- Medically speaking, serotonin and norepinephrine are neurotransmitters that play a crucial role in mood regulation. In depression, there may be deficiencies or irregularities in the function of these neurotransmitters. For a quick 2-minute video explaining "SNRI's", click here.
- We would typically discuss recent mood changes and dive into what may be triggering changes, swings or anything atypical. We might also consult with a patient's other treating physicians to gather a more complete diagnosis.
- Chronic stress, a common trigger for depression, can lead to structural changes in the brain.
- The hippocampus, responsible for memory and emotion regulation, may undergo atrophy in individuals with depression.
- The prefrontal cortex, involved in decision-making and emotional control, can also be affected.
- We research each individual's recent history to better understand the day-to-day habits, responsibilities and a person's situation to get a clearer pictures on the stresses that might be weighing on him or her.
- Genetic predisposition contributes to the susceptibility to depression. Individuals with a family history of depression may have a higher risk. The American Psychiatric Association states that if one identical twin has depression, the other twin has a 70% risk of developing it, however genetics do not make depression inevitable.
- Specific genetic variations are associated with an increased likelihood of developing depressive disorders, but recent studies have shown that it is likely a combination of genes that impact depression (and depression can be treated and mitigated with therapy and medications)
- A part of every evaluation is a discovery period focused on the family, relationships and looking at health histories of immediate family members. This is all designed to get a clearer picture of the complete situation.
- Stressful life events, such as loss of a loved one, relationship issues, or financial difficulties, can trigger depressive episodes. This is a great article from Harvard Medical School on how stress works and its impact on depressive thoughts.
- Chronic exposure to stressors without adequate coping mechanisms can contribute to the development and exacerbation of depression.
- Similar to exploration of neurobiological changes and the impacts of stress, an individual's environment (work, home, and social) are all rich ingredients for diagnosing and then treating depressive thoughts.
- Cognitive factors, such as negative thought patterns and distorted thinking, play a role in depression.
- Past trauma or adverse childhood experiences can increase vulnerability to depression later in life.
- Once we have a clearer picture of the individuals family, history and current situation, then we can start to learn more about the how all of these external factors and environments are affecting the individual. There is usually a logical reason for reactions and thinking patterns, but we need to peel back the connections and influences to better understand the individual's reality.
- Hormonal fluctuations, particularly in women during periods such as pregnancy, postpartum, and menopause, can influence the onset or exacerbation of depression.
- Thyroid imbalances are also linked to depressive symptoms.
- This is where the understanding of the physical situation comes into play. Some studies from the CDC have shown that obesity increases the risk of depression.
- Inflammation in the body may be linked to depression. Chronic inflammation can affect the brain and contribute to mood disturbances.
- The immune system's response may play a role in the development of depressive symptoms.
- Certain personality traits, such as perfectionism or a tendency toward self-criticism, can increase the risk of depression.
- Coping styles and resilience in the face of challenges also influence susceptibility.
- This is typically the last step in our evaluations of individuals because it's the most personal and specific. We need to first gather the larger macro context and then dive into specific personality traits.
It's important to note that depression is a heterogeneous condition, meaning it can manifest differently in individuals and even across time of the same individual as physical, environmental and social interactions change. The interplay of these factors creates that complex, multifactorial web, making each person's experience unique. Moreover, the understanding of depression is continually evolving as research uncovers new insights into its mechanisms.
Effective management of depression often involves tailoring treatments to address the specific factors contributing to an individual's depression. Additionally, early detection and intervention are crucial in preventing the progression of depressive symptoms and improving overall well-being.