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What is depression and what can I do about it?

Depression is a mental health condition that causes a chronic feeling of emptiness, sadness, or inability to feel pleasure that may appear to happen for no clear reason.

Depression is the leading cause of disability worldwide, according to the World Health Organization (WHO).

It can undermine a person’s relationships, make working and maintaining good health very difficult, and in severe cases, may lead to suicide. In fact, depression contributes to nearly 40,000 suicides in the United States each year.

It can affect adults, adolescents, and children. This article examines what depression is and what causes it, as well as types of depression, treatment, and more.

What is depression?

Depression is a mood disorder that causes persistent feelings of sadness, emptiness, and loss of joy. It is different from the mood fluctuations that people regularly experience as a part of life.

Major life events, such as bereavement or the loss of a job, can trigger depression. But depression is distinct from the negative feelings a person may temporarily have in response to a difficult life event.

Depression often persists in spite of a change of circumstances and causes feelings that are intense, chronic, and not proportional to a person’s circumstances.

It is an ongoing problem, not a passing one. While there are different types of depression, the most common one is major depressive disorder. It consists of episodes during which the symptoms last for at least two weeks.

Depression can last for several weeks, months, or years. For many people, it is a chronic illness that gets better and then relapses.

Is it curable?

While there is no cure for depression, there are effective treatments that help with recovery. The earlier that treatment starts, the more successful it may be. Some people may never experience depression again after a single period of it. Others will continue to have relapses.

Many people experiencing depression recover after a treatment plan. Even with effective treatment, however, a relapse may occur. About half of people do not initially respond to treatment.

To prevent relapse, people who take medication for depression should continue with treatment — even after symptoms improve or go away — for as long as their doctor advises.

Find tips to help prevent depression from returning here .

Signs and symptoms

Depression can cause a range of psychological and physical symptoms, including :

• persistent depressed mood
• loss of interest or pleasure in hobbies and activities
• changes in appetite and body weight
• unusually slow or agitated movements
• decreased energy or fatigue
• difficulty sleeping or oversleeping
• excessive feelings of guilt or worthlessness
• difficulty concentrating or making decisions
• thoughts of death or suicide, or suicide attempts

If a person experiences five or more of these symptoms during the same 2-week period, a doctor may diagnose them with depression.

Depression may also cause other symptoms, including irritability, restlessness, chronic pain, headaches, and digestive issues.

Types of depression

There are several forms of depression. Below are some of the most common types .

Major depression

A person living with major depression experiences a constant state of sadness. They may lose interest in activities they used to enjoy.

Treatment usually involves medication and psychotherapy.

Persistent depressive disorder

Also known as dysthymia, persistent depressive disorder causes symptoms that last for at least 2 years .

A person living with this disorder may have episodes of major depression as well as milder symptoms that do not meet the criteria for major depressive disorder.

Postpartum depression

After giving birth, some people experience a brief period of sadness or heightened emotions that some people call the “baby blues.” This usually goes away in a few days to a few weeks.

Postpartum depression , or postnatal depression, is more severe.

There is no single cause for this type of depression, and it can persist for months or years. Anyone who experiences ongoing depression after delivery should seek medical attention.

Major depressive disorder with seasonal pattern

Previously known as seasonal affective disorder (SAD), this type of depression usually occurs during the winter and fall months, when there is less daylight. Less commonly, it may follow other seasonal patterns.

It lifts during the rest of the year and in response to light therapy.

This condition seems to particularly affect people who live in countries with long or severe winters.

What causes depression?

The medical community does not fully understand the causes of depression. There are many possible causes, and sometimes, various factors combine to trigger symptoms.

Factors that are likely to play a role include :

• genetic features
• changes in the brain’s neurotransmitter levels
• environmental factors such as exposure to trauma or lack of social support
• psychological and social factors
• additional conditions, such as bipolar disorder

Interactions between various factors can increase the risk of depression. For instance, a person with a family history or a genetic risk of depression may experience symptoms of depression following a traumatic event.

The symptoms of depression can include:

• a depressed mood
• reduced interest or pleasure in activities that a person previously enjoyed
• a loss of sexual desire
• changes in appetite
• unintentional weight loss or gain
• sleeping too much or too little
• agitation, restlessness, and pacing up and down
• slowed movement and speech
• fatigue or loss of energy
• feelings of worthlessness or guilt
• difficulty thinking, concentrating, or making decisions
• recurrent thoughts of death or suicide, or an attempt at suicide

Find out more about recognizing the hidden signs of depression here.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more .

Depression is nearly twice as common in females than males, according to the Centers for Disease Control and Prevention (CDC).

Researchers do not know why depression appears to be more common in females. However, a 2021 study proposes that the difference may be due to disparities in reporting. Researchers found that females were more likely than males to report and seek treatment for depression symptoms.

Some research suggests that exposure to gender discrimination increases the risk of depression.

Also, some types of depression are unique to females, such as postpartum depression and premenstrual dysphoric disorder .

According to data from the National Health and Nutrition study, which relies on self-reports of mental health symptoms, 5.5% of males report depression symptoms in a given 2-week period, compared with 10.4% of females.

Males with depression are more likely than females to drink alcohol in excess, display anger, and engage in risk-taking as a result of the disorder.

Other symptoms of depression in males may include:

• avoiding family and social situations
• working without a break
• having difficulty keeping up with work and family responsibilities
• displaying abusive or controlling behavior in relationships

Learn more about the symptoms of depression in men.

In college students

Time at college can be stressful, and a person may be dealing with other lifestyles, cultures, and experiences for the first time.

Some students have difficulty coping with these changes, and they may develop depression, anxiety, or both as a result.

Symptoms of depression in college students may include:

• difficulty concentrating on schoolwork
• sleeping too much
• a decrease or increase in appetite
• avoiding social situations and activities that they used to enjoy

Physical changes, peer pressure, and other factors can contribute to depression in teenagers.

They may experience some of the following symptoms:

• feeling irritable
• restlessness, such as an inability to sit still
• withdrawing from friends and family
• feeling guilty, helpless, or worthless

In children

The CDC estimate that, in the U.S., 4.4% of children and teenagers aged 3–17 have a diagnosis of depression. This figure has risen in recent years.

Depression in children can make schoolwork and social activities challenging. They may experience symptoms such as:

• defiant behavior
• vocal outbursts

Younger children may have difficulty expressing how they feel in words. This can make it harder for them to explain their feelings of sadness.

Learn more about mental health in trans people here.

In historically marginalized groups

Research shows that the prevalence of major depression among African Americans has been around 10.4% , compared with 17.9% among people who are white.

However, 56% of African Americans experience depression more chronically, compared with 38.6% of people who are white. This implies that though fewer African Americans may experience depression, those who do may experience it for longer. In addition, less than half of these African Americans have sought treatment.

Other research indicates that African Americans may have depression less frequently than non-Hispanic people who are white, but this may be due to the fact that many African Americans often do not have a proper diagnosis.

Triggers are emotional, psychological, or physical events or circumstances that can cause depression symptoms to appear or return.

These are some of the most common triggers:

• stressful life events, such as loss, family conflicts, and changes in relationships
• incomplete recovery after having stopped depression treatment too soon
• medical conditions, especially a medical crisis such as a new diagnosis or a chronic illness such as heart disease or diabetes

Find out more about depression triggers here .

Risk factors

Some people have a higher risk of depression than others.

Risk factors include :

• experiencing certain life events, such as bereavement, work issues, changes in relationships, financial problems, and medical concerns
• experiencing acute stress
• having a lack of successful coping strategies
• having a close relative with depression
• using some prescription drugs, such as corticosteroids, certain beta-blockers , and interferon
• using recreational drugs, such as alcohol or amphetamines
• having sustained a head injury
• having a neurodegenerative disease such as Alzheimer’s or Parkinson’s
• having had a previous episode of major depression
• having a chronic condition, such as diabetes, chronic obstructive pulmonary disease (COPD), or cardiovascular disease
• living with chronic pain
• lacking social support

Depression as a symptom

Depression can also occur as a symptom or comorbidity with another mental health condition. Examples include:

Psychotic depression

Psychosis can involve delusions, such as false beliefs and a detachment from reality. It can also involve hallucinations — sensing things that do not exist.

Some people experience depression with psychosis . A person living with psychosis, which is a serious psychiatric illness, may experience depression as a result.

Alternatively, a person living with depression may have a severe form of the condition that also includes psychosis symptoms.

Bipolar disorder

Depression is a common symptom of bipolar disorder. People with bipolar disorder experience periods of depression that may last weeks. They also experience periods of mania, which is an elevated mood that may cause a person to feel very happy, aggressive, or out of control.

What does bipolar disorder involve, and what types are there? Find out here .

Depression is treatable, though the treatment may depend on the exact type a person is living with.

However, about 30.9% of people do not respond to treatment or respond poorly. About 4 in 10 people achieve remission of their symptoms within 12 months, but depression can come back.

Managing symptoms usually involves three components:

• Support: This can range from discussing practical solutions and possible causes to educating family members.
• Psychotherapy: Also known as talking therapy, some options include one-to-one counseling and cognitive behavioral therapy (CBT).
• Drug treatment: A doctor may prescribe antidepressants .

Antidepressants can help treat moderate to severe depression. Several classes of antidepressants are available :

• selective serotonin reuptake inhibitors (SSRIs)
• selective serotonin and norepinephrine reuptake inhibitors (SNRIs)
• atypical antidepressants
• tricyclic antidepressants
• monoamine oxidase inhibitors (MAOIs)

Each class acts on a different neurotransmitter or combination of neurotransmitters.

A person should only take these medications as their doctor prescribes. Some drugs can take a while to have an impact. By stopping taking the drug, a person may not experience the benefits that it can offer.

Some people stop taking medication after symptoms improve, but this can lead to a relapse.

A person should raise any concerns about antidepressants with a doctor, including any intention to stop taking the medication.

Learn more about antidepressants and how they can help here .

Medication side effects

SSRIs and SNRIs can have side effects. A person may experience:

• constipation
• low blood sugar
• weight loss or weight gain
• sexual dysfunction

Find out more about the possible side effects of antidepressants here .

The Food and Drug Administration (FDA) requires manufacturers to put a “black box” warning on antidepressant bottles.

The warning indicates that, among other risks, these medications may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment. While there is an increase in risk, the absolute risk remains low.

Natural remedies

Some people use natural remedies, such as herbal medicines, to treat mild to moderate depression.

However, since the FDA does not monitor herbal remedies, manufacturers may not be truthful about the quality of these products. They may not be safe or effective.

In a 2018 systematic review of herbal remedies for depression, 45% of studies reported positive results from herbal treatments, including fewer side effects than standard antidepressants.

The following are some of the more popular herbs and plants that people use to treat depression:

• St. John’s wort: This is not suitable for people who are or may be living with bipolar disorder. Learn more here .
• Ginseng: Practitioners of traditional medication may use this to improve mental clarity and reduce stress . Find out more about ginseng here .
• Chamomile: This contains flavonoids that can have an antidepressant effect. For more information about chamomile, click here .
• Lavender: This may help reduce anxiety and insomnia. Learn more about lavender here .

It is essential for a person to speak with a doctor before using any type of herbal remedy or supplement to treat depression. Some herbs can interfere with the action of drugs or otherwise make symptoms worse.

Supplements

A person may take the herbs above as supplements to treat symptoms of mild to moderate depression. Other types of supplements can also help treat these symptoms.

It is important to remember that the FDA does not monitor supplements to ensure that they are effective or safe.

Nonherbal supplements that may help treat depression include S-adenosyl methionine (SAMe) — a synthetic form of a natural chemical in the body. They also include 5-hydroxytryptophan, which can help to boost serotonin, the neurotransmitter in the brain that affects a person’s mood.

Some research has suggested that SAMe may be as helpful as the prescription antidepressants imipramine and escitalopram, but more investigation is necessary.

Learn more about how herbs and supplements may help relieve depression here .

Food and diet

Some research suggests that eating a lot of sugary or processed foods can lead to various physical health problems and poor mental health. Results of a 2019 study suggest that a diet that includes many of these types of food can affect the mental health of young adults.

The study also found that eating more of the following foods helped reduce depression symptoms:

Can other foods worsen or improve depression symptoms? Find out here .

Psychotherapy

Psychotherapy , or talking therapies, for depression include CBT, interpersonal psychotherapy, and problem-solving treatment.

For some forms of depression, psychotherapy is usually the first-line treatment, while some people respond better to a combination of psychotherapy and medications.

CBT and interpersonal psychotherapy are the two main types of psychotherapy for depression. A person may have CBT in individual sessions with a therapist, in groups, over the telephone, or online.

CBT focuses on helping a person identify the connection between their thoughts, behaviors, and feelings. They then work steadily to change harmful thoughts and behaviors.

Interpersonal therapy aims to help people identify:

• emotional problems that affect relationships and communication
• how these issues also affect their mood
• how to improve relationships and better manage emotions

Aerobic exercise raises endorphin levels and stimulates neurotransmitters, potentially easing depression and anxiety. A 2019 paper states that exercise may be especially helpful with treatment-resistant depression.

Exercise offers the greatest benefits when a person combines it with standard treatments, such as antidepressants and psychotherapy.

Brain stimulation therapies

Brain stimulation therapies are another treatment option. For example, repetitive transcranial magnetic stimulation sends magnetic pulses to the brain, and this may help treat major depression.

If depression does not respond to drug treatment, a person may benefit from electroconvulsive therapy (ECT). Doctors do not fully understand how ECT works.

During the procedure, a person is asleep, and a doctor uses electricity to induce a seizure. This may help “reset” the brain, correcting problems with neurotransmitters or other issues that cause depression.

If a person suspects that they have symptoms of depression, they should seek professional help from a doctor or mental health specialist.

A qualified health professional can rule out various causes, ensure an accurate diagnosis, and provide safe and effective treatment.

They will ask questions about symptoms, such as how long they have been present. A doctor may also conduct an examination to check for physical causes and order a blood test to rule out other health conditions.

What is the difference between situational and clinical depression? Find out here .

Mental health professionals often ask people to complete questionnaires to help assess the severity of their depression.

The Hamilton Depression Rating Scale, for example, has 21 questions . The scores indicate the severity of depression among people who already have a diagnosis.

The Beck Depression Inventory is another questionnaire that helps mental health professionals measure a person’s symptoms.

Support hotline

National hotlines provide free, confidential assistance from trained professionals 24 hours a day. They may benefit anyone with depression who wants or needs to talk about their feelings.

Some of the support hotlines available include:

• Samaritans: This nonprofit organization offers emotional support to anyone who has feelings of depression or loneliness or who is considering suicide. Call or text 877-870-4673 (HOPE).
• National Suicide Prevention Lifeline: Call 1-800-273- 8255 (TALK) to speak with someone from this national network of local crisis centers.
• Lifeline Chat: This is an online chat service of the National Suicide Prevention Lifeline.
• Postpartum Support International: Call 1-800-944-4773. This organization helps people struggling with postpartum depression, as well as other mental health issues that are related to pregnancy, birth, and new parenthood.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

• Ask the tough question: “Are you considering suicide?”
• Listen to the person without judgment.
• Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
• Stay with the person until professional help arrives.
• Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

Is depression genetic?

A person with a parent or sibling who has depression is about three times more likely than other people to develop the condition.

However, many people with depression have no family history of it.

A recent study suggests that susceptibility to depression may not result from genetic variation. The researchers acknowledge that while people can inherit depression, many other issues also influence its development.

Learn more about whether depression has a genetic link here .

Is it a disability?

Depression is the leading cause of disability around the world, according to the WHO.

In the U.S., the Social Security Administration considers depressive, bipolar, and related disorders to be disabilities. If a person’s depression prevents them from working, they may qualify for social security disability insurance benefits.

The person must have worked long enough and recently enough to qualify for disability benefits. For more information, visit the administration’s website .

According to the CDC, about 11% of physician office visits note depression on the medical record. The figure is similar for emergency department visits.

Also according to the CDC, 4.4% of children and adolescents between the ages of 3 and 17 years — about 2.7 million people in the U.S. — have a diagnosis of depression.

The CDC also note that 4.7% of American adults have regular feelings of depression.

Frequently asked questions

Here are some common questions about depression.

What does depression do to the brain?

Depression can lead to changes in levels of neurotransmitters, which are molecules that transmit messages between nerve cells. In the long run, it may also cause physical changes to the brain, including reductions in grey matter volume and increased inflammation.

Does depression change your personality?

Research has turned up mixed results about whether or not depression can actually change a person’s personality.

However, according to one review of 10 studies, depressive symptoms may be associated with changes in several specific aspects of personality — including extraversion, neuroticism, and agreeableness — which could be temporary or persistent.

Does depression affect your thinking?

Depression can alter concentration and decision-making. It may also impair attention and cause issues with information processing and memory.

Depression is a serious, chronic medical condition that can affect every aspect of a person’s life. When it causes suicidal thoughts, it can be fatal.

People cannot think their way out of depression. Depression is not a personal failing or a sign of weakness. It is treatable, and seeking treatment early may increase the chances of recovery.

Because depression can be challenging to treat, it is important for a person to see a doctor with expertise in depression and to be willing to try several different treatments. Often, a combination of therapy and medication offers the best results.

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Last medically reviewed on August 5, 2022

• Psychology / Psychiatry

How we reviewed this article:

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• Depression (major depressive disorder)
• What is depression? A Mayo Clinic expert explains.

Learn more about depression from Craig Sawchuk, Ph.D., L.P., clinical psychologist at Mayo Clinic.

Hi, I'm Dr. Craig Sawchuk, a clinical psychologist at Mayo Clinic. And I'm here to talk with you about depression. Whether you're looking for answers for yourself, a friend, or loved one, understanding the basics of depression can help you take the next step.

Depression is a mood disorder that causes feelings of sadness that won't go away. Unfortunately, there's a lot of stigma around depression. Depression isn't a weakness or a character flaw. It's not about being in a bad mood, and people who experience depression can't just snap out of it. Depression is a common, serious, and treatable condition. If you're experiencing depression, you're not alone. It honestly affects people of all ages and races and biological sexes, income levels and educational backgrounds. Approximately one in six people will experience a major depressive episode at some point in their lifetime, while up to 16 million adults each year suffer from clinical depression. There are many types of symptoms that make up depression. Emotionally, you may feel sad or down or irritable or even apathetic. Physically, the body really slows down. You feel tired. Your sleep is often disrupted. It's really hard to get yourself motivated. Your thinking also changes. It can just be hard to concentrate. Your thoughts tend to be much more negative. You can be really hard on yourself, feel hopeless and helpless about things. And even in some cases, have thoughts of not wanting to live. Behaviorally, you just want to pull back and withdraw from others, activities, and day-to-day responsibilities. These symptoms all work together to keep you trapped in a cycle of depression. Symptoms of depression are different for everyone. Some symptoms may be a sign of another disorder or medical condition. That's why it's important to get an accurate diagnosis.

While there's no single cause of depression, most experts believe there's a combination of biological, social, and psychological factors that contribute to depression risk. Biologically, we think about genetics or a family history of depression, health conditions such as diabetes, heart disease or thyroid disorders, and even hormonal changes that happen over the lifespan, such as pregnancy and menopause. Changes in brain chemistry, especially disruptions in neurotransmitters like serotonin, that play an important role in regulating many bodily functions, including mood, sleep, and appetite, are thought to play a particularly important role in depression. Socially stressful and traumatic life events, limited access to resources such as food, housing, and health care, and a lack of social support all contribute to depression risk. Psychologically, we think of how negative thoughts and problematic coping behaviors, such as avoidance and substance use, increase our vulnerability to depression.

The good news is that treatment helps. Effective treatments for depression exist and you do have options to see what works best for you. Lifestyle changes that improve sleep habits, exercise, and address underlying health conditions can be an important first step. Medications such as antidepressants can be helpful in alleviating depressive symptoms. Therapy, especially cognitive behavioral therapy, teaches skills to better manage negative thoughts and improve coping behaviors to help break you out of cycles of depression. Whatever the cause, remember that depression is not your fault and it can be treated.

To help diagnose depression, your health care provider may use a physical exam, lab tests, or a mental health evaluation. These results will help identify various treatment options that best fit your situation.

Help is available. You don't have to deal with depression by yourself. Take the next step and reach out. If you're hesitant to talk to a health care provider, talk to a friend or loved one about how to get help. Living with depression isn't easy and you're not alone in your struggles. Always remember that effective treatments and supports are available to help you start feeling better. Want to learn more about depression? Visit mayoclinic.org. Do take care.

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.

Depression care at Mayo Clinic

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Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
• Sleep disturbances, including insomnia or sleeping too much
• Tiredness and lack of energy, so even small tasks take extra effort
• Reduced appetite and weight loss or increased cravings for food and weight gain
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or self-blame
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
• Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in children and teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

• In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.
• In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

• Memory difficulties or personality changes
• Physical aches or pain
• Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication
• Often wanting to stay at home, rather than going out to socialize or doing new things
• Suicidal thinking or feelings, especially in older men

When to see a doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, any health care professional, a faith leader, or someone else you trust.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 in the U.S. or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

• Call your doctor or mental health professional.
• Contact a suicide hotline.
• In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential.
• U.S. veterans or service members who are in crisis can call 988 and then press “1” for the Veterans Crisis Line . Or text 838255. Or chat online .
• The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

More Information

Depression (major depressive disorder) care at Mayo Clinic

• Male depression: Understanding the issues
• Nervous breakdown: What does it mean?
• Pain and depression: Is there a link?

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It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

• Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
• Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
• Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
• Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.
• Marijuana and depression
• Vitamin B-12 and depression

Risk factors

Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women than men are diagnosed with depression, but this may be due in part because women are more likely to seek treatment.

Factors that seem to increase the risk of developing or triggering depression include:

• Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic
• Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems
• Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
• Being lesbian, gay, bisexual or transgender, or having variations in the development of genital organs that aren't clearly male or female (intersex) in an unsupportive situation
• History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder
• Abuse of alcohol or recreational drugs
• Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
• Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)

Complications

Depression is a serious disorder that can take a terrible toll on you and your family. Depression often gets worse if it isn't treated, resulting in emotional, behavioral and health problems that affect every area of your life.

Examples of complications associated with depression include:

• Excess weight or obesity, which can lead to heart disease and diabetes
• Pain or physical illness
• Alcohol or drug misuse
• Anxiety, panic disorder or social phobia
• Family conflicts, relationship difficulties, and work or school problems
• Social isolation
• Suicidal feelings, suicide attempts or suicide
• Self-mutilation, such as cutting
• Premature death from medical conditions
• Depression and anxiety: Can I have both?

There's no sure way to prevent depression. However, these strategies may help.

• Take steps to control stress, to increase your resilience and boost your self-esteem.
• Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
• Get treatment at the earliest sign of a problem to help prevent depression from worsening.
• Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.
• Brown AY. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Nov. 17, 2016.
• Research report: Psychiatry and psychology, 2016-2017. Mayo Clinic. http://www.mayo.edu/research/departments-divisions/department-psychiatry-psychology/overview?_ga=1.199925222.939187614.1464371889. Accessed Jan. 23, 2017.
• Depressive disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed Jan. 23, 2017.
• Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression/index.shtml. Accessed Jan. 23, 2017.
• Depression. National Alliance on Mental Illness. http://www.nami.org/Learn-More/Mental-Health-Conditions/Depression/Overview. Accessed Jan. 23, 2017.
• Depression: What you need to know. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know/index.shtml. Accessed Jan. 23, 2017.
• What is depression? American Psychiatric Association. https://www.psychiatry.org/patients-families/depression/what-is-depression. Accessed Jan. 23, 2017.
• Depression. NIH Senior Health. https://nihseniorhealth.gov/depression/aboutdepression/01.html. Accessed Jan. 23, 2017.
• Children’s mental health: Anxiety and depression. Centers for Disease Control and Prevention. https://www.cdc.gov/childrensmentalhealth/depression.html#depression. Accessed. Jan. 23, 2017.
• Depression and complementary health approaches: What the science says. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/providers/digest/depression-science. Accessed Jan. 23, 2017.
• Depression. Natural Medicines. https://naturalmedicines.therapeuticresearch.com/databases/medical-conditions/d/depression.aspx. Accessed Jan. 23, 2017.
• Natural medicines in the clinical management of depression. Natural Medicines. http://naturaldatabase.therapeuticresearch.com/ce/CECourse.aspx?cs=naturalstandard&s=ND&pm=5&pc=15-111. Accessed Jan. 23, 2017.
• The road to resilience. American Psychological Association. http://www.apa.org/helpcenter/road-resilience.aspx. Accessed Jan. 23, 2017.
• Simon G, et al. Unipolar depression in adults: Choosing initial treatment. http://www.uptodate.com/home. Accessed Jan. 23, 2017.
• Stewart D, et al. Risks of antidepressants during pregnancy: Selective serotonin reuptake inhibitors (SSRIs). http://www.uptodate.com/home. Accessed Jan. 23, 2017.
• Kimmel MC, et al. Safety of infant exposure to antidepressants and benzodiazepines through breastfeeding. http://www.uptodate.com/home. Accessed Jan. 23, 2017.
• Bipolar and related disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed Jan. 23, 2017.
• Hirsch M, et al. Monoamine oxidase inhibitors (MAOIs) for treating depressed adults. http://www.uptodate.com/home. Accessed Jan. 24, 2017.
• Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 31, 2017.
• Krieger CA (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 2, 2017.
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Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature

Olivia remes.

1 Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK

João Francisco Mendes

2 NOVA Medical School, Universidade NOVA de Lisboa, 1099-085 Lisbon, Portugal; ku.ca.mac@94cfj

Peter Templeton

3 IfM Engage Limited, Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK; ku.ca.mac@32twp

4 The William Templeton Foundation for Young People’s Mental Health (YPMH), Cambridge CB2 0AH, UK

Associated Data

Depression is one of the leading causes of disability, and, if left unmanaged, it can increase the risk for suicide. The evidence base on the determinants of depression is fragmented, which makes the interpretation of the results across studies difficult. The objective of this study is to conduct a thorough synthesis of the literature assessing the biological, psychological, and social determinants of depression in order to piece together the puzzle of the key factors that are related to this condition. Titles and abstracts published between 2017 and 2020 were identified in PubMed, as well as Medline, Scopus, and PsycInfo. Key words relating to biological, social, and psychological determinants as well as depression were applied to the databases, and the screening and data charting of the documents took place. We included 470 documents in this literature review. The findings showed that there are a plethora of risk and protective factors (relating to biological, psychological, and social determinants) that are related to depression; these determinants are interlinked and influence depression outcomes through a web of causation. In this paper, we describe and present the vast, fragmented, and complex literature related to this topic. This review may be used to guide practice, public health efforts, policy, and research related to mental health and, specifically, depression.

1. Introduction

Depression is one of the most common mental health issues, with an estimated prevalence of 5% among adults [ 1 , 2 ]. Symptoms may include anhedonia, feelings of worthlessness, concentration and sleep difficulties, and suicidal ideation. According to the World Health Organization, depression is a leading cause of disability; research shows that it is a burdensome condition with a negative impact on educational trajectories, work performance, and other areas of life [ 1 , 3 ]. Depression can start early in the lifecourse and, if it remains unmanaged, may increase the risk for substance abuse, chronic conditions, such as cardiovascular disease, and premature mortality [ 4 , 5 , 6 , 7 , 8 ].

Treatment for depression exists, such as pharmacotherapy, cognitive behavioural therapy, and other modalities. A meta-analysis of randomized, placebo-controlled trials of patients shows that 56–60% of people respond well to active treatment with antidepressants (selective serotonin reuptake inhibitors, tricyclic antidepressants) [ 9 ]. However, pharmacotherapy may be associated with problems, such as side-effects, relapse issues, a potential duration of weeks until the medication starts working, and possible limited efficacy in mild cases [ 10 , 11 , 12 , 13 , 14 ]. Psychotherapy is also available, but access barriers can make it difficult for a number of people to get the necessary help.

Studies on depression have increased significantly over the past few decades. However, the literature remains fragmented and the interpretation of heterogeneous findings across studies and between fields is difficult. The cross-pollination of ideas between disciplines, such as genetics, neurology, immunology, and psychology, is limited. Reviews on the determinants of depression have been conducted, but they either focus exclusively on a particular set of determinants (ex. genetic risk factors [ 15 ]) or population sub-group (ex. children and adolescents [ 16 ]) or focus on characteristics measured predominantly at the individual level (ex. focus on social support, history of depression [ 17 ]) without taking the wider context (ex. area-level variables) into account. An integrated approach paying attention to key determinants from the biological, psychological, and social spheres, as well as key themes, such as the lifecourse perspective, enables clinicians and public health authorities to develop tailored, person-centred approaches.

The primary aim of this literature review: to address the aforementioned challenges, we have synthesized recent research on the biological, psychological, and social determinants of depression and we have reviewed research from fields including genetics, immunology, neurology, psychology, public health, and epidemiology, among others.

The subsidiary aim: we have paid special attention to important themes, including the lifecourse perspective and interactions between determinants, to guide further efforts by public health and medical professionals.

This literature review can be used as an evidence base by those in public health and the clinical setting and can be used to inform targeted interventions.

2. Materials and Methods

We conducted a review of the literature on the biological, psychological, and social determinants of depression in the last 4 years. We decided to focus on these determinants after discussions with academics (from the Manchester Metropolitan University, University of Cardiff, University of Colorado, Boulder, University of Cork, University of Leuven, University of Texas), charity representatives, and people with lived experience at workshops held by the University of Cambridge in 2020. In several aspects, we attempted to conduct this review according to PRISMA guidelines [ 18 ].

The inclusion and exclusion criteria are the following:

• - We included documents, such as primary studies, literature reviews, systematic reviews, meta-analyses, reports, and commentaries on the determinants of depression. The determinants refer to variables that appear to be linked to the development of depression, such as physiological factors (e.g., the nervous system, genetics), but also factors that are further away or more distal to the condition. Determinants may be risk or protective factors, and individual- or wider-area-level variables.
• - We focused on major depressive disorder, treatment-resistant depression, dysthymia, depressive symptoms, poststroke depression, perinatal depression, as well as depressive-like behaviour (common in animal studies), among others.
• - We included papers regardless of the measurement methods of depression.
• - We included papers that focused on human and/or rodent research.
• - This review focused on articles written in the English language.
• - Documents published between 2017–2020 were captured to provide an understanding of the latest research on this topic.
• - Studies that assessed depression as a comorbidity or secondary to another disorder.
• - Studies that did not focus on rodent and/or human research.
• - Studies that focused on the treatment of depression. We made this decision, because this is an in-depth topic that would warrant a separate stand-alone review.
• Next, we searched PubMed (2017–2020) using keywords related to depression and determinants. Appendix A contains the search strategy used. We also conducted focused searches in Medline, Scopus, and PsycInfo (2017–2020).
• Once the documents were identified through the databases, the inclusion and exclusion criteria were applied to the titles and abstracts. Screening of documents was conducted by O.R., and a subsample was screened by J.M.; any discrepancies were resolved through a communication process.
• The full texts of documents were retrieved, and the inclusion and exclusion criteria were again applied. A subsample of documents underwent double screening by two authors (O.R., J.M.); again, any discrepancies were resolved through communication.
• a. A data charting form was created to capture the data elements of interest, including the authors, titles, determinants (biological, psychological, social), and the type of depression assessed by the research (e.g., major depression, depressive symptoms, depressive behaviour).
• b. The data charting form was piloted on a subset of documents, and refinements to it were made. The data charting form was created with the data elements described above and tested in 20 studies to determine whether refinements in the wording or language were needed.
• c. Data charting was conducted on the documents.
• d. Narrative analysis was conducted on the data charting table to identify key themes. When a particular finding was noted more than once, it was logged as a potential theme, with a review of these notes yielding key themes that appeared on multiple occasions. When key themes were identified, one researcher (O.R.) reviewed each document pertaining to that theme and derived concepts (key determinants and related outcomes). This process (a subsample) was verified by a second author (J.M.), and the two authors resolved any discrepancies through communication. Key themes were also checked as to whether they were of major significance to public mental health and at the forefront of public health discourse according to consultations we held with stakeholders from the Manchester Metropolitan University, University of Cardiff, University of Colorado, Boulder, University of Cork, University of Leuven, University of Texas, charity representatives, and people with lived experience at workshops held by the University of Cambridge in 2020.

We condensed the extensive information gleaned through our review into short summaries (with key points boxes for ease of understanding and interpretation of the data).

Through the searches, 6335 documents, such as primary studies, literature reviews, systematic reviews, meta-analyses, reports, and commentaries, were identified. After applying the inclusion and exclusion criteria, 470 papers were included in this review ( Supplementary Table S1 ). We focused on aspects related to biological, psychological, and social determinants of depression (examples of determinants and related outcomes are provided under each of the following sections.

3.1. Biological Factors

The following aspects will be discussed in this section: physical health conditions; then specific biological factors, including genetics; the microbiome; inflammatory factors; stress and hypothalamic–pituitary–adrenal (HPA) axis dysfunction, and the kynurenine pathway. Finally, aspects related to cognition will also be discussed in the context of depression.

3.1.1. Physical Health Conditions

Studies on physical health conditions—key points:

• The presence of a physical health condition can increase the risk for depression
• Psychological evaluation in physically sick populations is needed
• There is large heterogeneity in study design and measurement; this makes the comparison of findings between and across studies difficult

A number of studies examined the links between the outcome of depression and physical health-related factors, such as bladder outlet obstruction, cerebral atrophy, cataract, stroke, epilepsy, body mass index and obesity, diabetes, urinary tract infection, forms of cancer, inflammatory bowel disorder, glaucoma, acne, urea accumulation, cerebral small vessel disease, traumatic brain injury, and disability in multiple sclerosis [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. For example, bladder outlet obstruction has been linked to inflammation and depressive behaviour in rodent research [ 24 ]. The presence of head and neck cancer also seemed to be related to an increased risk for depressive disorder [ 45 ]. Gestational diabetes mellitus has been linked to depressive symptoms in the postpartum period (but no association has been found with depression in the third pregnancy trimester) [ 50 ], and a plethora of other such examples of relationships between depression and physical conditions exist. As such, the assessment of psychopathology and the provision of support are necessary in individuals of ill health [ 45 ]. Despite the large evidence base on physical health-related factors, differences in study methodology and design, the lack of standardization when it comes to the measurement of various physical health conditions and depression, and heterogeneity in the study populations makes it difficult to compare studies [ 50 ].

The next subsections discuss specific biological factors, including genetics; the microbiome; inflammatory factors; stress and hypothalamic–pituitary–adrenal (HPA) axis dysfunction, and the kynurenine pathway; and aspects related to cognition.

3.1.2. Genetics

Studies on genetics—key points:

There were associations between genetic factors and depression; for example:

• The brain-derived neurotrophic factor (BDNF) plays an important role in depression
• Links exist between major histocompatibility complex region genes, as well as various gene polymorphisms and depression
• Single nucleotide polymorphisms (SNPs) of genes involved in the tryptophan catabolites pathway are of interest in relation to depression

A number of genetic-related factors, genomic regions, polymorphisms, and other related aspects have been examined with respect to depression [ 61 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 ]. The influence of BDNF in relation to depression has been amply studied [ 117 , 118 , 141 , 142 , 143 ]. Research has shown associations between depression and BDNF (as well as candidate SNPs of the BDNF gene, polymorphisms of the BDNF gene, and the interaction of these polymorphisms with other determinants, such as stress) [ 129 , 144 , 145 ]. Specific findings have been reported: for example, a study reported a link between the BDNF rs6265 allele (A) and major depressive disorder [ 117 ].

Other research focused on major histocompatibility complex region genes, endocannabinoid receptor gene polymorphisms, as well as tissue-specific genes and gene co-expression networks and their links to depression [ 99 , 110 , 112 ]. The SNPs of genes involved in the tryptophan catabolites pathway have also been of interest when studying the pathogenesis of depression.

The results from genetics studies are compelling; however, the findings remain mixed. One study indicated no support for depression candidate gene findings [ 122 ]. Another study found no association between specific polymorphisms and major depressive disorder [ 132 ]. As such, further research using larger samples is needed to corroborate the statistically significant associations reported in the literature.

3.1.3. Microbiome

Studies on the microbiome—key points:

• The gut bacteria and the brain communicate via both direct and indirect pathways called the gut-microbiota-brain axis (the bidirectional communication networks between the central nervous system and the gastrointestinal tract; this axis plays an important role in maintaining homeostasis).
• A disordered microbiome can lead to inflammation, which can then lead to depression
• There are possible links between the gut microbiome, host liver metabolism, brain inflammation, and depression

The common themes of this review have focused on the microbiome/microbiota or gut metabolome [ 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 ], the microbiota-gut-brain axis, and related factors [ 152 , 162 , 163 , 164 , 165 , 166 , 167 ]. When there is an imbalance in the intestinal bacteria, this can interfere with emotional regulation and contribute to harmful inflammatory processes and mood disorders [ 148 , 151 , 153 , 155 , 157 ]. Rodent research has shown that there may be a bidirectional association between the gut microbiota and depression: a disordered gut microbiota can play a role in the onset of this mental health problem, but, at the same time, the existence of stress and depression may also lead to a lower level of richness and diversity in the microbiome [ 158 ].

Research has also attempted to disentangle the links between the gut microbiome, host liver metabolism, brain inflammation, and depression, as well as the role of the ratio of lactobacillus to clostridium [ 152 ]. The literature has also examined the links between medication, such as antibiotics, and mood and behaviour, with the findings showing that antibiotics may be related to depression [ 159 , 168 ]. The links between the microbiome and depression are complex, and further studies are needed to determine the underpinning causal mechanisms.

3.1.4. Inflammation

Studies on inflammation—key points:

• Pro-inflammatory cytokines are linked to depression
• Pro-inflammatory cytokines, such as the tumour necrosis factor (TNF)-alpha, may play an important role
• Different methods of measurement are used, making the comparison of findings across studies difficult

Inflammation has been a theme in this literature review [ 60 , 161 , 164 , 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 , 177 , 178 , 179 , 180 , 181 , 182 , 183 , 184 ]. The findings show that raised levels of inflammation (because of factors such as pro-inflammatory cytokines) have been associated with depression [ 60 , 161 , 174 , 175 , 178 ]. For example, pro-inflammatory cytokines, such as tumour necrosis factor (TNF)-alpha, have been linked to depression [ 185 ]. Various determinants, such as early life stress, have also been linked to systemic inflammation, and this can increase the risk for depression [ 186 ].

Nevertheless, not everyone with elevated inflammation develops depression; therefore, this is just one route out of many linked to pathogenesis. Despite the compelling evidence reported with respect to inflammation, it is difficult to compare the findings across studies because of different methods used to assess depression and its risk factors.

3.1.5. Stress and HPA Axis Dysfunction

Studies on stress and HPA axis dysfunction—key points:

• Stress is linked to the release of proinflammatory factors
• The dysregulation of the HPA axis is linked to depression
• Determinants are interlinked in a complex web of causation

Stress was studied in various forms in rodent populations and humans [ 144 , 145 , 155 , 174 , 176 , 180 , 185 , 186 , 187 , 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 , 198 , 199 , 200 , 201 , 202 , 203 , 204 , 205 , 206 , 207 , 208 , 209 , 210 , 211 ].

Although this section has some overlap with others (as is to be expected because all of these determinants and body systems are interlinked), a number of studies have focused on the impact of stress on mental health. Stress has been mentioned in the literature as a risk factor of poor mental health and has emerged as an important determinant of depression. The effects of this variable are wide-ranging, and a short discussion is warranted.

Stress has been linked to the release of inflammatory factors, as well as the development of depression [ 204 ]. When the stress is high or lasts for a long period of time, this may negatively impact the brain. Chronic stress can impact the dendrites and synapses of various neurons, and may be implicated in the pathway leading to major depressive disorder [ 114 ]. As a review by Uchida et al. indicates, stress may be associated with the “dysregulation of neuronal and synaptic plasticity” [ 114 ]. Even in rodent studies, stress has a negative impact: chronic and unpredictable stress (and other forms of tension or stress) have been linked to unusual behaviour and depression symptoms [ 114 ].

The depression process and related brain changes, however, have also been linked to the hyperactivity or dysregulation of the HPA axis [ 127 , 130 , 131 , 182 , 212 ]. One review indicates that a potential underpinning mechanism of depression relates to “HPA axis abnormalities involved in chronic stress” [ 213 ]. There is a complex relationship between the HPA axis, glucocorticoid receptors, epigenetic mechanisms, and psychiatric sequelae [ 130 , 212 ].

In terms of the relationship between the HPA axis and stress and their influence on depression, the diathesis–stress model offers an explanation: it could be that early stress plays a role in the hyperactivation of the HPA axis, thus creating a predisposition “towards a maladaptive reaction to stress”. When this predisposition then meets an acute stressor, depression may ensue; thus, in line with the diathesis–stress model, a pre-existing vulnerability and stressor can create fertile ground for a mood disorder [ 213 ]. An integrated review by Dean and Keshavan [ 213 ] suggests that HPA axis hyperactivity is, in turn, related to other determinants, such as early deprivation and insecure early attachment; this again shows the complex web of causation between the different determinants.

3.1.6. Kynurenine Pathway

Studies on the kynurenine pathway—key points:

• The kynurenine pathway is linked to depression
• Indolamine 2,3-dioxegenase (IDO) polymorphisms are linked to postpartum depression

The kynurenine pathway was another theme that emerged in this review [ 120 , 178 , 181 , 184 , 214 , 215 , 216 , 217 , 218 , 219 , 220 , 221 ]. The kynurenine pathway has been implicated not only in general depressed mood (inflammation-induced depression) [ 184 , 214 , 219 ] but also postpartum depression [ 120 ]. When the kynurenine metabolism pathway is activated, this results in metabolites, which are neurotoxic.

A review by Jeon et al. notes a link between the impairment of the kynurenine pathway and inflammation-induced depression (triggered by treatment for various physical diseases, such as malignancy). The authors note that this could represent an important opportunity for immunopharmacology [ 214 ]. Another review by Danzer et al. suggests links between the inflammation-induced activation of indolamine 2,3-dioxegenase (the enzyme that converts tryptophan to kynurenine), the kynurenine metabolism pathway, and depression, and also remarks about the “opportunities for treatment of inflammation-induced depression” [ 184 ].

3.1.7. Cognition

Studies on cognition and the brain—key points:

• Cognitive decline and cognitive deficits are linked to increased depression risk
• Cognitive reserve is important in the disability/depression relationship
• Family history of cognitive impairment is linked to depression

A number of studies have focused on the theme of cognition and the brain. The results show that factors, such as low cognitive ability/function, cognitive vulnerability, cognitive impairment or deficits, subjective cognitive decline, regression of dendritic branching and hippocampal atrophy/death of hippocampal cells, impaired neuroplasticity, and neurogenesis-related aspects, have been linked to depression [ 131 , 212 , 222 , 223 , 224 , 225 , 226 , 227 , 228 , 229 , 230 , 231 , 232 , 233 , 234 , 235 , 236 , 237 , 238 , 239 ]. The cognitive reserve appears to act as a moderator and can magnify the impact of certain determinants on poor mental health. For example, in a study in which participants with multiple sclerosis also had low cognitive reserve, disability was shown to increase the risk for depression [ 63 ]. Cognitive deficits can be both causal and resultant in depression. A study on individuals attending outpatient stroke clinics showed that lower scores in cognition were related to depression; thus, cognitive impairment appears to be associated with depressive symptomatology [ 226 ]. Further, Halahakoon et al. [ 222 ] note a meta-analysis [ 240 ] that shows that a family history of cognitive impairment (in first degree relatives) is also linked to depression.

In addition to cognitive deficits, low-level cognitive ability [ 231 ] and cognitive vulnerability [ 232 ] have also been linked to depression. While cognitive impairment may be implicated in the pathogenesis of depressive symptoms [ 222 ], negative information processing biases are also important; according to the ‘cognitive neuropsychological’ model of depression, negative affective biases play a central part in the development of depression [ 222 , 241 ]. Nevertheless, the evidence on this topic is mixed and further work is needed to determine the underpinning mechanisms between these states.

3.2. Psychological Factors

Studies on psychological factors—key points:

• There are many affective risk factors linked to depression
• Determinants of depression include negative self-concept, sensitivity to rejection, neuroticism, rumination, negative emotionality, and others

A number of studies have been undertaken on the psychological factors linked to depression (including mastery, self-esteem, optimism, negative self-image, current or past mental health conditions, and various other aspects, including neuroticism, brooding, conflict, negative thinking, insight, cognitive fusion, emotional clarity, rumination, dysfunctional attitudes, interpretation bias, and attachment style) [ 66 , 128 , 140 , 205 , 210 , 228 , 235 , 242 , 243 , 244 , 245 , 246 , 247 , 248 , 249 , 250 , 251 , 252 , 253 , 254 , 255 , 256 , 257 , 258 , 259 , 260 , 261 , 262 , 263 , 264 , 265 , 266 , 267 , 268 , 269 , 270 , 271 , 272 , 273 , 274 , 275 , 276 , 277 , 278 , 279 , 280 , 281 , 282 , 283 , 284 , 285 , 286 , 287 , 288 , 289 , 290 ]. Determinants related to this condition include low self-esteem and shame, among other factors [ 269 , 270 , 275 , 278 ]. Several emotional states and traits, such as neuroticism [ 235 , 260 , 271 , 278 ], negative self-concept (with self-perceptions of worthlessness and uselessness), and negative interpretation or attention biases have been linked to depression [ 261 , 271 , 282 , 283 , 286 ]. Moreover, low emotional clarity has been associated with depression [ 267 ]. When it comes to the severity of the disorder, it appears that meta-emotions (“emotions that occur in response to other emotions (e.g., guilt about anger)” [ 268 ]) have a role to play in depression [ 268 ].

A determinant that has received much attention in mental health research concerns rumination. Rumination has been presented as a mediator but also as a risk factor for depression [ 57 , 210 , 259 ]. When studied as a risk factor, it appears that the relationship of rumination with depression is mediated by variables that include limited problem-solving ability and insufficient social support [ 259 ]. However, rumination also appears to act as a mediator: for example, this variable (particularly brooding rumination) lies on the causal pathway between poor attention control and depression [ 265 ]. This shows that determinants may present in several forms: as moderators or mediators, risk factors or outcomes, and this is why disentangling the relationships between the various factors linked to depression is a complex task.

The psychological determinants are commonly researched variables in the mental health literature. A wide range of factors have been linked to depression, such as the aforementioned determinants, but also: (low) optimism levels, maladaptive coping (such as avoidance), body image issues, and maladaptive perfectionism, among others [ 269 , 270 , 272 , 273 , 275 , 276 , 279 , 285 , 286 ]. Various mechanisms have been proposed to explain the way these determinants increase the risk for depression. One of the underpinning mechanisms linking the determinants and depression concerns coping. For example, positive fantasy engagement, cognitive biases, or personality dispositions may lead to emotion-focused coping, such as brooding, and subsequently increase the risk for depression [ 272 , 284 , 287 ]. Knowing the causal mechanisms linking the determinants to outcomes provides insight for the development of targeted interventions.

3.3. Social Determinants

Studies on social determinants—key points:

• Social determinants are the conditions in the environments where people are born, live, learn, work, play, etc.; these influence (mental) health [ 291 ]
• There are many social determinants linked to depression, such as sociodemographics, social support, adverse childhood experiences
• Determinants can be at the individual, social network, community, and societal levels

Studies also focused on the social determinants of (mental) health; these are the conditions in which people are born, live, learn, work, play, and age, and have a significant influence on wellbeing [ 291 ]. Factors such as age, social or socioeconomic status, social support, financial strain and deprivation, food insecurity, education, employment status, living arrangements, marital status, race, childhood conflict and bullying, violent crime exposure, abuse, discrimination, (self)-stigma, ethnicity and migrant status, working conditions, adverse or significant life events, illiteracy or health literacy, environmental events, job strain, and the built environment have been linked to depression, among others [ 52 , 133 , 235 , 236 , 239 , 252 , 269 , 280 , 292 , 293 , 294 , 295 , 296 , 297 , 298 , 299 , 300 , 301 , 302 , 303 , 304 , 305 , 306 , 307 , 308 , 309 , 310 , 311 , 312 , 313 , 314 , 315 , 316 , 317 , 318 , 319 , 320 , 321 , 322 , 323 , 324 , 325 , 326 , 327 , 328 , 329 , 330 , 331 , 332 , 333 , 334 , 335 , 336 , 337 , 338 , 339 , 340 , 341 , 342 , 343 , 344 , 345 , 346 , 347 , 348 , 349 , 350 , 351 , 352 , 353 , 354 , 355 , 356 , 357 , 358 , 359 , 360 , 361 , 362 , 363 , 364 , 365 , 366 , 367 , 368 , 369 , 370 , 371 ]. Social support and cohesion, as well as structural social capital, have also been identified as determinants [ 140 , 228 , 239 , 269 , 293 , 372 , 373 , 374 , 375 , 376 , 377 , 378 , 379 ]. In a study, part of the findings showed that low levels of education have been shown to be linked to post-stroke depression (but not severe or clinical depression outcomes) [ 299 ]. A study within a systematic review indicated that having only primary education was associated with a higher risk of depression compared to having secondary or higher education (although another study contrasted this finding) [ 296 ]. Various studies on socioeconomic status-related factors have been undertaken [ 239 , 297 ]; the research has shown that a low level of education is linked to depression [ 297 ]. Low income is also related to depressive disorders [ 312 ]. By contrast, high levels of education and income are protective [ 335 ].

A group of determinants touched upon by several studies included adverse childhood or early life experiences: ex. conflict with parents, early exposure to traumatic life events, bullying and childhood trauma were found to increase the risk of depression (ex. through pathways, such as inflammation, interaction effects, or cognitive biases) [ 161 , 182 , 258 , 358 , 362 , 380 ].

Gender-related factors were also found to play an important role with respect to mental health [ 235 , 381 , 382 , 383 , 384 , 385 ]. Gender inequalities can start early on in the lifecourse, and women were found to be twice as likely to have depression as men. Gender-related factors were linked to cognitive biases, resilience and vulnerabilities [ 362 , 384 ].

Determinants can impact mental health outcomes through underpinning mechanisms. For example, harmful determinants can influence the uptake of risk behaviours. Risk behaviours, such as sedentary behaviour, substance abuse and smoking/nicotine exposure, have been linked to depression [ 226 , 335 , 355 , 385 , 386 , 387 , 388 , 389 , 390 , 391 , 392 , 393 , 394 , 395 , 396 , 397 , 398 , 399 , 400 , 401 ]. Harmful determinants can also have an impact on diet. Indeed, dietary aspects and diet components (ex. vitamin D, folate, selenium intake, iron, vitamin B12, vitamin K, fiber intake, zinc) as well as diet-related inflammatory potential have been linked to depression outcomes [ 161 , 208 , 236 , 312 , 396 , 402 , 403 , 404 , 405 , 406 , 407 , 408 , 409 , 410 , 411 , 412 , 413 , 414 , 415 , 416 , 417 , 418 , 419 , 420 , 421 , 422 , 423 , 424 , 425 , 426 , 427 , 428 ]. A poor diet has been linked to depression through mechanisms such as inflammation [ 428 ].

Again, it is difficult to constrict diet to the ‘social determinants of health’ category as it also relates to inflammation (biological determinants) and could even stand alone as its own category. Nevertheless, all of these factors are interlinked and influence one another in a complex web of causation, as mentioned elsewhere in the paper.

Supplementary Figure S1 contains a representation of key determinants acting at various levels: the individual, social network, community, and societal levels. The determinants have an influence on risk behaviours, and this, in turn, can affect the mood (i.e., depression), body processes (ex. can increase inflammation), and may negatively influence brain structure and function.

3.4. Others

Studies on ‘other’ determinants—key points:

• A number of factors are related to depression
• These may not be as easily categorized as the other determinants in this paper

A number of factors arose in this review that were related to depression; it was difficult to place these under a specific heading above, so this ‘other’ category was created. A number of these could be sorted under the ‘social determinants of depression’ category. For example, being exposed to deprivation, hardship, or adversity may increase the risk for air pollution exposure and nighttime shift work, among others, and the latter determinants have been found to increase the risk for depression. Air pollution could also be regarded as an ecologic-level (environmental) determinant of mental health.

Nevertheless, we have decided to leave these factors in a separate category (because their categorization may not be as immediately clear-cut as others), and these factors include: low-level light [ 429 ], weight cycling [ 430 ], water contaminants [ 431 ], trade [ 432 ], air pollution [ 433 , 434 ], program-level variables (ex. feedback and learning experience) [ 435 ], TV viewing [ 436 ], falls [ 437 ], various other biological factors [ 116 , 136 , 141 , 151 , 164 , 182 , 363 , 364 , 438 , 439 , 440 , 441 , 442 , 443 , 444 , 445 , 446 , 447 , 448 , 449 , 450 , 451 , 452 , 453 , 454 , 455 , 456 , 457 , 458 , 459 , 460 , 461 , 462 , 463 , 464 , 465 , 466 , 467 , 468 , 469 ], mobile phone use [ 470 ], ultrasound chronic exposure [ 471 ], nighttime shift work [ 472 ], work accidents [ 473 ], therapy enrollment [ 226 ], and exposure to light at night [ 474 ].

4. Cross-Cutting Themes

4.1. lifecourse perspective.

Studies on the lifecourse perspective—key points:

• Early life has an importance on mental health
• Stress has been linked to depression
• In old age, the decline in social capital is important

Trajectories and life events are important when it comes to the lifecourse perspective. Research has touched on the influence of prenatal or early life stress on an individual’s mental health trajectory [ 164 , 199 , 475 ]. Severe stress that occurs in the form of early-life trauma has also been associated with depressive symptoms [ 362 , 380 ]. It may be that some individuals exposed to trauma develop thoughts of personal failure, which then serve as a catalyst of depression [ 380 ].

At the other end of the life trajectory—old age—specific determinants have been linked to an increased risk for depression. Older people are at a heightened risk of losing their social networks, and structural social capital has been identified as important in relation to depression in old age [ 293 ].

4.2. Gene–Environment Interactions

Studies on gene–environment interactions—key points:

• The environment and genetics interact to increase the risk of depression
• The etiology of depression is multifactorial
• Adolescence is a time of vulnerability

A number of studies have touched on gene–environment interactions [ 72 , 77 , 82 , 119 , 381 , 476 , 477 , 478 , 479 , 480 , 481 ]. The interactions between genetic factors and determinants, such as negative life events (ex. relationship and social difficulties, serious illness, unemployment and financial crises) and stressors (ex. death of spouse, minor violations of law, neighbourhood socioeconomic status) have been studied in relation to depression [ 82 , 135 , 298 , 449 , 481 ]. A study reported an interaction of significant life events with functional variation in the serotonin-transporter-linked polymorphic region (5-HTTLPR) allele type (in the context of multiple sclerosis) and linked this to depression [ 361 ], while another reported an interaction between stress and 5-HTTLPR in relation to depression [ 480 ]. Other research reported that the genetic variation of HPA-axis genes has moderating effects on the relationship between stressors and depression [ 198 ]. Another study showed that early-life stress interacts with gene variants to increase the risk for depression [ 77 ].

Adolescence is a time of vulnerability [ 111 , 480 ]. Perceived parental support has been found to interact with genes (GABRR1, GABRR2), and this appears to be associated with depressive symptoms in adolescence [ 480 ]. It is important to pay special attention to critical periods in the lifecourse so that adequate support is provided to those who are most vulnerable.

The etiology of depression is multifactorial, and it is worthwhile to examine the interaction between multiple factors, such as epigenetic, genetic, and environmental factors, in order to truly understand this mental health condition. Finally, taking into account critical periods of life when assessing gene–environment interactions is important for developing targeted interventions.

5. Discussion

Depression is one of the most common mental health conditions, and, if left untreated, it can increase the risk for substance abuse, anxiety disorders, and suicide. In the past 20 years, a large number of studies on the risk and protective factors of depression have been undertaken in various fields, such as genetics, neurology, immunology, and epidemiology. However, there are limitations associated with the extant evidence base. The previous syntheses on depression are limited in scope and focus exclusively on social or biological factors, population sub-groups, or examine depression as a comorbidity (rather than an independent disorder). The research on the determinants and causal pathways of depression is fragmentated and heterogeneous, and this has not helped to stimulate progress when it comes to the prevention and intervention of this condition—specifically unravelling the complexity of the determinants related to this condition and thus refining the prevention and intervention methods.

The scope of this paper was to bring together the heterogeneous, vast, and fragmented literature on depression and paint a picture of the key factors that contribute to this condition. The findings from this review show that there are important themes when it comes to the determinants of depression, such as: the microbiome, dysregulation of the HPA axis, inflammatory reactions, the kynurenine pathway, as well as psychological and social factors. It may be that physical factors are proximal determinants of depression, which, in turn, are acted on by more distal social factors, such as deprivation, environmental events, and social capital.

The Marmot Report [ 291 ], the World Health Organization [ 482 ], and Compton et al. [ 483 ] highlight that the most disadvantaged segments of society are suffering (the socioeconomic context is important), and this inequality in resources has translated to inequality in mental health outcomes [ 483 ]. To tackle the issue of egalitarianism and restore equality in the health between the groups, the social determinants need to be addressed [ 483 ]. A wide range of determinants of mental health have been identified in the literature: age, gender, ethnicity, family upbringing and early attachment patterns, social support, access to food, water and proper nutrition, and community factors. People spiral downwards because of individual- and societal-level circumstances; therefore, these circumstances along with the interactions between the determinants need to be considered.

Another important theme in the mental health literature is the lifecourse perspective. This shows that the timing of events has significance when it comes to mental health. Early life is a critical period during the lifespan at which cognitive processes develop. Exposure to harmful determinants, such as stress, during this period can place an individual on a trajectory of depression in adulthood or later life. When an individual is exposed to harmful determinants during critical periods and is also genetically predisposed to depression, the risk for the disorder can be compounded. This is why aspects such as the lifecourse perspective and gene–environment interactions need to be taken into account. Insight into this can also help to refine targeted interventions.

A number of interventions for depression have been developed or recommended, addressing, for example, the physical factors described here and lifestyle modifications. Interventions targeting various factors, such as education and socioeconomic status, are needed to help prevent and reduce the burden of depression. Further research on the efficacy of various interventions is needed. Additional studies are also needed on each of the themes described in this paper, for example: the biological factors related to postpartum depression [ 134 ], and further work is needed on depression outcomes, such as chronic, recurrent depression [ 452 ]. Previous literature has shown that chronic stress (associated with depression) is also linked to glucocorticoid receptor resistance, as well as problems with the regulation of the inflammatory response [ 484 ]. Further work is needed on this and the underpinning mechanisms between the determinants and outcomes. This review highlighted the myriad ways of measuring depression and its determinants [ 66 , 85 , 281 , 298 , 451 , 485 ]. Thus, the standardization of the measurements of the outcomes (ex. a gold standard for measuring depression) and determinants is essential; this can facilitate comparisons of findings across studies.

5.1. Strengths

This paper has important strengths. It brings together the wide literature on depression and helps to bridge disciplines in relation to one of the most common mental health problems. We identified, selected, and extracted data from studies, and provided concise summaries.

5.2. Limitations

The limitations of the review include missing potentially important studies; however, this is a weakness that cannot be avoided by literature reviews. Nevertheless, the aim of the review was not to identify each study that has been conducted on the risk and protective factors of depression (which a single review is unable to capture) but rather to gain insight into the breadth of literature on this topic, highlight key biological, psychological, and social determinants, and shed light on important themes, such as the lifecourse perspective and gene–environment interactions.

6. Conclusions

We have reviewed the determinants of depression and recognize that there are a multitude of risk and protective factors at the individual and wider ecologic levels. These determinants are interlinked and influence one another. We have attempted to describe the wide literature on this topic, and we have brought to light major factors that are of public mental health significance. This review may be used as an evidence base by those in public health, clinical practice, and research.

This paper discusses key areas in depression research; however, an exhaustive discussion of all the risk factors and determinants linked to depression and their mechanisms is not possible in one journal article—which, by its very nature, a single paper cannot do. We have brought to light overarching factors linked to depression and a workable conceptual framework that may guide clinical and public health practice; however, we encourage other researchers to continue to expand on this timely and relevant work—particularly as depression is a top priority on the policy agenda now.

Acknowledgments

Thank you to Isla Kuhn for the help with the Medline, Scopus, and PsycInfo database searches.

Supplementary Materials

The following are available online at https://www.mdpi.com/article/10.3390/brainsci11121633/s1 , Figure S1: Conceptual framework: Determinants of depression, Table S1: Data charting—A selection of determinants from the literature.

Appendix A.1. Search Strategy

Search: ((((((((((((((((“Gene-Environment Interaction”[Majr]) OR (“Genetics”[Mesh])) OR (“Genome-Wide Association Study”[Majr])) OR (“Microbiota”[Mesh] OR “Gastrointestinal Microbiome”[Mesh])) OR (“Neurogenic Inflammation”[Mesh])) OR (“genetic determinant”)) OR (“gut-brain-axis”)) OR (“Kynurenine”[Majr])) OR (“Cognition”[Mesh])) OR (“Neuronal Plasticity”[Majr])) OR (“Neurogenesis”[Mesh])) OR (“Genes”[Mesh])) OR (“Neurology”[Majr])) OR (“Social Determinants of Health”[Majr])) OR (“Glucocorticoids”[Mesh])) OR (“Tryptophan”[Mesh])) AND (“Depression”[Mesh] OR “Depressive Disorder”[Mesh]) Filters: from 2017—2020.

Ovid MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions(R)

• exp *Depression/
• exp *Depressive Disorder/
• exp *”Social Determinants of Health”/
• exp *Tryptophan/
• exp *Glucocorticoids/
• exp *Neurology/
• exp *Genes/
• exp *Neurogenesis/
• exp *Neuronal Plasticity/
• exp *Kynurenine/
• exp *Genetics/
• exp *Neurogenic Inflammation/
• exp *Gastrointestinal Microbiome/
• exp *Genome-Wide Association Study/
• exp *Gene-Environment Interaction/
• exp *Depression/et [Etiology]
• exp *Depressive Disorder/et
• or/4-16   637368
• limit 22 to yr = “2017–Current”
• “cause* of depression”.mp.
• “cause* of depression”.ti.
• (cause adj3 (depression or depressive)).ti.
• (caus* adj3 (depression or depressive)).ti.

Appendix A.2. PsycInfo

(TITLE ( depression OR “ Depressive Disorder ”) AND TITLE (“ Social Determinants of Health ” OR tryptophan OR glucocorticoids OR neurology OR genes OR neurogenesis OR “ Neuronal Plasticity ” OR kynurenine OR genetics OR “ Neurogenic Inflammation ” OR “ Gastrointestinal Microbiome ” OR “ Genome-Wide Association Study ” OR “ Gene-Environment Interaction ” OR aetiology OR etiology )) OR TITLE ( cause* W/3 ( depression OR depressive )).

Author Contributions

O.R. was responsible for the design of the study and methodology undertaken. Despite P.T.’s involvement in YPMH, he had no role in the design of the study; P.T. was responsible for the conceptualization of the study. Validation was conducted by O.R. and J.F.M. Formal analysis (data charting) was undertaken by O.R. O.R. and P.T. were involved in the investigation, resource acquisition, and data presentation. The original draft preparation was undertaken by O.R. The writing was conducted by O.R., with review and editing by P.T. and J.F.M. Funding acquisition was undertaken by O.R. and P.T. All authors have read and agreed to the published version of the manuscript.

This research was funded by The William Templeton Foundation for Young People’s Mental Health, Cambridge Philosophical Society, and the Aviva Foundation.

Conflicts of Interest

The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Causes and Risk Factors of Depression

Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.

Carly Snyder, MD is a reproductive and perinatal psychiatrist who combines traditional psychiatry with integrative medicine-based treatments.

Verywell / Joshua Seong

Common Causes of Depression

• Family History & Genetics
• Brain & Body Causes
• Lifestyle Causes
• Next in Depression Guide How Depression Is Diagnosed According to the DSM-5

If you or a loved one are struggling with depression, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. 

For more mental health resources, see our National Helpline Database .

Depression is one of the most common mental disorders in the United States. It can affect anyone at almost any age, but what causes depression in some people is not always known . Potential depression causes can include genetics, brain chemistry, life events, medical conditions, and lifestyle factors.

The Centers for Disease Control and Prevention reported that approximately 1 in 5 U.S. adults have received a depression diagnosis in their lifetime. The World Health Organization estimates that 5% of men and 9% of women experience depressive disorders in any given year.

This article discusses common causes of depression. It covers the genetic, biological, and environmental factors that can play a role in the condition.

Researchers suspect there are actually many different causes of depression and that it is not always preventable. Factors that can contribute to depression include:

• Brain chemistry
• Certain medical conditions
• Substance use
• Poor nutrition

Depression does not have a single cause. There are many factors that play a role in increasing the risk that a person will develop the condition. Women experience depression at higher rates than men (10.5% of women vs. 6.2% of men), which experts suggest may be due to hormonal factors.

Family History and Genetics

A family history of depression may increase your risk of developing the condition. You are more likely to experience symptoms of depression if others in your family also have depression or another type of mood disorder . Estimates suggest that depression is approximately 40% determined by genetics.

Twin, adoption, and family studies have linked depression to genetics. While studies suggest that there is a strong genetic component, researchers are not yet certain about all the genetic risk factors for depression.

Studies show that having a parent and grandparent with depression doubles the risk of having the condition.

It is still unclear exactly which genes play a role in depression, but researchers do know that there are many different genes that can play a role. By better understanding how they function, gene researchers hope to be able to create more effective treatments.

It is important to remember that no single cause of depression acts in isolation. Genetics may increase your risk and environmental influences may then determine how likely you are to develop depression. 

Brain and Body Causes of Depression

Some causes of depression are related to the brain and body. These can raise your risk for depression.

Brain Chemistry Imbalances

One potential biological cause of depression is an imbalance in the neurotransmitters which are involved in mood regulation. Certain neurotransmitters, including dopamine, serotonin , and norepinephrine, play an important role in mood.

Neurotransmitters are chemical substances that help different areas of the brain communicate with each other. When certain neurotransmitters are in short supply, it may lead to the symptoms we recognize as clinical depression.

This theory of depression suggests that having too much or too little of certain neurotransmitters causes, or at least contributes to, depression.

While this explanation is often cited as a major cause of depression, it remains unproven and many experts believe that it doesn't paint a complete picture of the complex factors that contribute to the condition.

Medications to treat depression often focus on altering the levels of certain chemicals in the brain. Some of these treatments include selective serotonin reuptake inhibitors (SSRIs) , serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants (TCAs).

Physical Health and Certain Medical Conditions

You may be more likely to experience symptoms of depression if you have a chronic illness, sleep disorder, or thyroid condition. Depression rates also tend to be higher among people who have chronic pain, diabetes, multiple sclerosis, and cancer.

The mind and the body are linked. If you are experiencing a physical health problem, you may discover changes in your mental health as well. 

Illness is related to depression in two ways. The stress of having a chronic illness may trigger an episode of major depression. In addition, certain illnesses, such as thyroid disorders, Addison's disease, and liver disease, can cause depression symptoms.

Female Sex Hormones

It has been widely documented that women experience major depression about twice as often as men. Because of the incidence of depressive disorders peaks during women's reproductive years, it is believed that hormonal risk factors may be at play.

Women are especially prone to depressive disorders during times when their hormones are in flux, such as around the time of their menstrual period , pregnancy, childbirth, and perimenopause. The risk of depression declines after menopause.

Hormone fluctuations caused by childbirth and thyroid conditions can also contribute to depression. Postpartum depression may occur after childbirth and is believed to result from the rapid hormonal changes that take place immediately after giving birth.

Some Common Causes of Depression

Lifestyle causes of depression.

There are also a number of lifestyle factors that can play a role in causing depression. While many of the risk factors for depression, such as sex or family history, cannot be changed, people have much more control over lifestyle factors.

Circadian Rhythm Disturbances

One type of depression, called seasonal affective disorder  (officially known as major depressive disorder with seasonal pattern) is believed to be caused by a disturbance in the normal circadian rhythm of the body.

Light entering the eye influences this rhythm. During the shorter days of winter, when people may spend limited time outdoors, this rhythm may become disrupted.

People who reside in colder climates where there are short, dark days may be at the highest risk. 

In addition to disruptions in circadian rhythm, reduced sunlight can also lead to a drop in serotonin levels in the brain, which may influence mood. Seasonal changes can also alter melatonin levels in the body, which can disrupt sleep and contribute to mood changes.

While you cannot control seasonal shifts, there are steps you can take to minimize the effect these changes have on your mental health. Light therapy, spending more time outdoors, eating a healthy diet, and exercising regularly may help combat seasonal depression.

Poor Nutrition

A poor diet can contribute to depression in several ways. A variety of vitamin and mineral deficiencies are known to cause symptoms of depression. In addition, diets high in sugar have been associated with depression.

Some studies have found that diets either low in omega-3 fatty acids or with an imbalanced ratio of omega-6 to omega-3 fats are associated with increased rates of depression.

Stressful life events, which overwhelm a person's ability to cope, can also be a cause of depression. Researchers suspect high levels of the hormone cortisol, which are secreted during periods of stress , may affect the neurotransmitter serotonin and contribute to depression.

Grief and Loss

Following the loss of a loved one, people who are grieving experience many of the same symptoms of depression. Trouble sleeping, poor appetite, and a loss of pleasure or interest in activities are a normal response to loss.

The symptoms of grief are expected to subside over time. But when symptoms get worse, grief may turn into depression.

Substance Use

Drug and alcohol use can contribute to depressive disorders. But even some prescription drugs have been linked to depression.

Some drugs that have been found to be associated with depression include anticonvulsants, statins, stimulants, benzodiazepines, corticosteroids, and beta-blockers. It's important to review any medications that you've been prescribed and to speak with your physician if you are feeling depressed.

Centers for Disease Control and Prevention.  National, State-Level, and County-Level Prevalence Estimates of Adults Aged ≥18 Years Self-Reporting a Lifetime Diagnosis of Depression — United States, 2020 .

National Institute of Mental Health. Major depression .

Lohoff FW. Overview of the genetics of major depressive disorder . Curr Psychiatry Rep . 2010;12(6):539-546. doi:10.1007/s11920-010-0150-6

National Institute of Mental Health. Chronic illness & mental health .

Weissman MM, Berry OO, Warner V. A 30-year study of 3 generations at high risk and low risk for depression . JAMA Psychiatry . 2016;73(9):970-977. doi:10.1001/jamapsychiatry.2016.1586

Ng E, Browne CJ, Samsom JN, Wong AHC. Depression and substance use comorbidity: What we have learned from animal studies . Am J Drug Alcohol Abuse . 2017;43(4):456-474. doi:10.1080/00952990.2016.1183020

Yang L, Zhao Y, Wang Y, et al. The effects of psychological stress on depression .  Curr Neuropharmacol . 2015;13(4):494-504. doi:10.2174/1570159x1304150831150507

Knüppel A, Shipley MJ, Llewellyn CH, Brunner EJ. Sugar intake from sweet food and beverages, common mental disorder and depression: Prospective findings from the Whitehall II study .  Sci Rep . 2017;7(1):6287. doi:10.1038/s41598-017-05649-7

Larrieu T, Layé S. Food for mood: Relevance of nutritional omega-3 fatty acids for depression and anxiety .  Front Physiol . 2018;9:1047. doi:10.3389/fphys.2018.01047

Zisook S, Shear K. Grief and bereavement: What psychiatrists need to know .  World Psychiatry . 2009;8(2):67-74. doi:10.1002/j.2051-5545.2009.tb00217.x

Qato, DM, Ozenberger, K, Olfson, M.  Prevalence of prescription medications with depression as a potential adverse effect among adults in the United States . JAMA.  2018;319(22):2289-2298. doi:10.1001/jama.2018.6741

Aziz R, Steffens D. What are the causes of late-life depression? . Psychiatr Clin North Am . 2013;36(4):497-516. doi:10.1016/j.psc.2013.08.001

Wigner P, Czarny P, Galecki P, Su KP, Sliwinski T. The molecular aspects of oxidative & nitrosative stress and the tryptophan catabolites pathway (TRYCATs) as potential causes of depression .  Psychiatr Res . 2018;262:566-574. doi:10.1016/j.psychres.2017.09.045

By Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.  

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Top 20 best books on american history, the causes of depression essay sample, example.

The first—and surprising—risk factor for developing depression is gender. About 20-25% women in the United States develop serious depression, sometimes not just once in their lives; for comparison, only about 12% of male Americans face the same problem—or maybe, they visit a doctor’s office less often (All About Depression.com). This is probably connected to the fact that in today’s America, women often have to deal with a wide range of roles, such as business woman, mother, wife, housekeeper, and so on—and these roles often conflict with each other. Unhappy marriages, hormonal changes, and heredity can be contributing factors.

Another group of factors that lead to depression are different psychological problems. Most often, low self-esteem is the major cause, since it makes a person treat themselves with neglect, prevent them from believing in their own strengths, and see the world pessimistically. Other possible psychological reasons are stress, perfectionism, chronic anxiety, avoidant personality disorders, and so on (PsychCentral).

Personal factors, such as complicated life situations, a tragic family history, childhood traumas, living in stressful environments for a long time, and other similar life circumstances can garner depressive conditions. Genetic proneness is also related to this group of causes. At the same time, it does not mean that a person will automatically develop depression if he or she had cases of depression in their family, or they are in a complicated life situation. This group of factors mostly creates premises, and is commonly combined with other risk factors (Beyond Blue).

Alcohol, by the way, is as strong of a cause of depression as genetic factors or psychological problems. Although it is usually considered that alcohol helps people get rid of stress, and increase their communication, in fact it is a depressant that increases a person’s chances to develop depression (femah.net). These are not the only possible causes of depression, but commonly, this disorder is caused by an aggregate of the factors described above. It is likely that women develop depression more often than men; also, people with psychological problems and complicated personal circumstances are more prone to developing depression. The usage of alcohol not only does not help people get rid of stress, but on the contrary, increases the risks of developing depression. These factors should be taken into account in one’s daily life in order to avoid depression.

“Causes.” All About Depression. N.p., n.d. Web. 11 Feb. 2015.

“What are the Risk Factors for Depression?” Psych Central.com. N.p., n.d. Web. 11 Feb. 2015.

“What Causes Depression.” Beyond Blue. N.p., n.d. Web. 11 Feb. 2015.

“Alcohol as a Depressant.” Femah.net. N.p., n.d. Web. 11 Feb. 2015. .

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Essay On Depression: Causes, Symptoms And Effects

Our life is full of emotional ups and downs, but when the time of down lasts too long or influences our ability to function, in this case, probably, you suffer from common serious illness, which is called depression. Clinical depression affects your mood, thinking process, your body and behaviour. According to the researches, in the United States about 19 million people, i.e. one in ten adults, annually suffer from depression, and about 2/3 of them do not get necessary help. An appropriate treatment can alleviate symptoms of depression in more than 80% of such cases. However, since depression is usually not recognized, it continues to cause unnecessary suffering.

Depression is a disease that dominates you and weakens your body, it influences men as well as women, but women experience depression about two times more often than men.

Since this issue is very urgent nowadays, we decided to write this cause and effect essay on depression to attract the public attention one more time to this problem. I hope it will be informative and instructive for you. If you are interested in reading essays on similar or any other topic, you should visit our website . There you will find not only various essays, but also you can get help in essay writing . All you need is to contact our team, and everything else we will do for you.

Depression is a strong psychological disorder, from which usually suffers not only a patients, but also his / hers family, relatives, friends etc.

General information

More often depression develops on the basis of stress or prolonged traumatic situation. Frequently depressive disorders hide under the guise of a bad mood or temper features. In order to prevent severe consequences it is important to figure out how and why depression begins.

Symptoms and causes of depression

As a rule, depression develops slowly and insensibly for a person and for his close ones. At the initial stage most of people are not aware about their illness, because they think that many symptoms are just the features of their personality. Experiencing inner discomfort, which can be difficult to express in words, people do not ask for professional help, as a rule. They usually go to doctor at the moment, when the disease is already firmly holds the patient causing unbearable suffering.

Risk factors for depression:

• being female;
• the presence of depression in family anamnesis;
• early depression in anamnesis;
• early loss of parents;
• the experience of violence in anamnesis;
• personal features;
• stressors (parting, guilt);
• alcohol / drug addiction;
• neurological diseases (Parkinson's disease, apoplexy).

Signs of depression

Depression influences negatively all the aspects of human life. Inadequate psychological defense mechanisms, in their turn, affect destructively not only psychological, but also biological processes.

The first signs of depression are apathy, not depending on the circumstances, indifference to everything what is going on, weakening of motor activity; these are the main clinical symptoms of depression . If their combination is observed for more than two weeks, urgent professional help is required.

Psychological symptoms:

• depressed mood, unhappiness;
• loss of interest, reduced motivation, loss of energy;
• self-doubt, guilt, inner emptiness;
• decrease in speed of thinking, inability to make decisions;
• anxiety, fear and pessimism about the future;
• daily fluctuations;
• possible delirium;
• suicidal thoughts.

Somatic symptoms:

• vital disorders;
• disturbed sleep (early waking, oversleeping);
• eating disorders;
• constipation;
• feeling of tightness of the skull, dizziness, feeling of compression;
• vegetative symptoms.

Causes of depression

It is accepted to think in modern psychiatry that the development of depression, as well as most of other mental disorders, requires the combined effect of three factors: psychological, biological and social.

Psychological factor (“Personality structure”)

There are three types of personality especially prone to depression:

1) “Statothymic personality” that is characterized by exaggerated conscientiousness, diligence, accuracy;

2) Melancholic personality type with its desire for order, constancy, pedantry, exessive demands on itself;

3) Hyperthymic type of personality that is characterized by self-doubt, frequent worries, with obviously low self-esteem.

People, whose organism biologically tends to depression development, due to education and other social environmental factors form such personality features, which in adverse social situations, especially while chronic stress, cause failure of psychological adaptation mechanisms, skills to deal with stress or lack of coping strategies.

Such people are characterized by:

• lack of confidence in their own abilities;
• excessive secrecy and isolation;
• excessive self-critical attitude towards yourself;
• waiting for the support of the close ones;
• developed pessimism;
• inability to resist stress situations;
• emotional expressiveness.

Biological factor:

• the presence of unfavorable heredity;
• somatic and neurological head injury that violated brain activity;
• changes in the hormonal system;
• chronobiological factors: seasonal depressive disorders, daily fluctuations, shortening of REM sleep;
• side effects of some medications.
• Heredity and family tendency to depression play significant role in predisposition to this disease. It is noticed that relatives of those who suffer from depression usually have different psychosomatic disorders.

Social factor:

• the presence of frequent stress situations, chronic stress;
• adverse family relationships;
• adverse childhood experience, the absence of tenderness from parents, ill-treatment and sexual harassment, interpersonal loss, severe methods of education, negative childhood memories;
• urbanization;
• significant changes in the life;
• population migration;
• increased lifetime.

People in a state of chronic stress suffer from depression more often. If some acute stress situation happens during the period of chronic stress, the probability of depression symptoms development increases.

If you decide to fight the depression, remember that you are not alone! Every fifth person in the world at least once in the life experienced depression. If you notice the signs of depression that disturb you for more than two weeks, you should go to the specialist.

Do not delay visit, in this case time does not heal. The professionalism of the doctors and a complex program of treatment will help to get rid of any kind of depression.

Where to go for help

If you do not where to go for help, ask your family physician, obstetrician, gynecologist or the clinic. In an emergency situation, the emergency doctor can provide temporary help for patients with emotional problems and give them an advice where and how they can ask for the further help.

Here is the list of people and organizations that can diagnose and suggest a course of treatment, or can give a direction to the examination and treatment.

• Family doctors.
• Such specialists as psychiatrists, psychologists, social workers and consultants on mental health.
• Health maintenance organizations.
• Local centers for the treatment of mental illness.
• The Department of Psychiatry in hospitals and outpatient clinics.
• Programs at universities and medical schools.
• Family assistance services and social services departments.
• Private clinics and institutions.
• Care centers in the workplace.
• Local health and (or) mental health communities.

It is very important in depressive episode treatment to understand that this is depression of a certain person, do not make attempts to excessive generalization of symptoms and factors of disease development. It requires personal approach to each patient.

So, as you can see, depression is a serious disease that requires professional treatment. If you manage to recognize the signs of depression at its early stage and ask for professional help, you can successfully overcome this problem. I hope this essay about depression was useful for you, and you got what you were looking for.

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Primary Care Online Resources and Education

Conclusion depression.

Depression is one of the most common conditions in primary care, but is often unrecognized, undiagnosed, and untreated. Depression has a high rate of morbidity and mortality when left untreated. Most patients suffering from depression do not complain of feeling depressed, but rather anhedonia or vague unexplained symptoms. All physicians should remain alert to effectively screen for depression in their patients. There are several screening tools for depression that are effective and feasible in primary care settings. An appropriate history, physical, initial basic lab evaluation, and mental status examination can assist the physician in diagnosing the patient with the correct depressive spectrum disorder (including bipolar disorder). Primary care physicians should carefully assess depressed patients for suicide. Depression in the elderly is not part of the normal aging process. Patients who are elderly when they have their first episode of depression have a relatively higher likelihood of developing chronic and recurring depression. The prognosis for recovery is equal in young and old patients, although remission may take longer to achieve in older patients. Elderly patients usually start antidepressants at lower doses than their younger counterparts.

Most primary care physician can successfully treat uncomplicated mild or moderate forms of major depression in their settings with careful psychiatric management (e.g., close monitoring of symptoms, side effects, etc.); maintaining a therapeutic alliance with their patient; pharmacotherapy (acute, continuation, and maintenance phases); and / or referral for psychotherapy. The following situations require referral to psychiatrist: suicide risk, bipolar disorder or a manic episode, psychotic symptoms, severe decrease in level of functioning, recurrent depression and chronic depression, depression that is refractory to treatment, cardiac disease that requires tricyclic antidepressants treatment, need for electroconvulsive therapy (ECT), lack of available support system, and any diagnostic or treatment questions.

Antidepressant medications’ effectiveness is generally comparable across classes and within classes of medications.  The medications differ in side effect profiles, drug-drug interactions, and cost.  The history of a positive response to a particular drug for an individual or a family member, as well as patient preferences, should also be taken into account.  Most psychiatrists agree that an SSRI should be the first line choice.  The dual action reuptake inhibitors venlafaxine and bupropion are generally regarded as second line agents.  Tricyclics and other mixed or dual action inhibitors are third line, and MAOI’s (monoamine oxidase inhibitors) are usually medications of last resort for patients who have not responded to other medications, due to their low tolerability, dietary restrictions, and drug-drug interactions.  Most primary care physicians would prefer that a psychiatrist manage patients requiring MAOI’s.

Psychotherapy may be a first line therapy choice for mild depression particularly when associated with psychosocial stress, interpersonal problems, or with concurrent developmental or personality disorders. Psychotherapy in mild to moderate depression is most effective in the acute phase, and in preventing relapse during continuation phase treatment. Psychotherapy is not appropriate alone for severe depression, psychosis, and bipolar disorders. For more severe depression, psychotherapy may be appropriate in combination with the use of medications. The most effective forms of psychotherapy are those with structured and brief approaches such as cognitive behavioral therapy, interpersonal therapy, and certain problem solving therapies. Regardless of the psychotherapy initiated, “psychiatric management” must be integrated at the same time.

Patients, who live with depression, and their family and friends, have enormous challenges to overcome. Primary care physicians can provide compassionate care, important education, psychiatric monitoring, social support, reassurance, and advocacy for these patients and their loved ones.

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Anxiety Disorders and Depression Essay (Critical Writing)

Introduction, description section, feelings section, action plan, reference list.

Human beings become anxious in different situations that are uncertain to them. Depression and anxiety occur at a similar time. Anxiety is caused due to an overwhelming fear of an expected occurrence of an event that is unclear to a person. More than 25 million people globally are affected by anxiety disorders. People feel anxious in moments such as when making important decisions, before facing an interview panel, and before taking tests. Anxiety disorders are normally brained reactions to stress as they alert a person of impending danger. Most people feel sad and low due to disappointments. Feelings normally overwhelm a person leading to depression, especially during sad moments such as losing a loved one or divorce. When people are depressed, they engage in reckless behaviors such as drug abuse that affect them physically and emotionally. However, depression manifests in different forms in both men and women. Research shows that more women are depressed compared to men. This essay reflects on anxiety disorders and depression regarding from a real-life experience extracted from a publication.

“Every year almost 20% of the general population suffers from a common mental disorder, such as depression or an anxiety disorder” (Cuijpers et al. 2016, p.245). I came across a publication by Madison Jo Sieminski available who was diagnosed with depression and anxiety disorders (Madison 2020). She explains how she was first diagnosed with anxiety disorders and depression and how it felt unreal at first. She further says that she developed the need to get a distraction that would keep her busy so that she won’t embrace her situation. In her case, anxiety made her feel that she needed to do more, and everything needed to be perfect.

Madison further said that the struggle with anxiety is that it never seemed to happen, but it happened eventually. She always felt a feeling of darkness and loneliness. She could barely stay awake for more than 30 minutes for many days. Anxiety and depression made her question herself if she was good enough, and this resulted in tears in her eyes due to the burning sensation and overwhelmed emotions. In her own words, she said, “Do I deserve to be here? What is my purpose?” (Madison 2020). Anxiety made her lose confidence in herself and lowered her self-esteem. She could lay in bed most of the time and could not take any meal most of the days.

Madison said that since the sophomore year of high school, all was not well, and she suddenly felt someone in her head telling her to constantly worry and hold back from everything. She could wake up days when she could try a marathon to keep her mind busy. However, she sought help on 1 January 2020, since she felt her mental health was important, and she needed to be strong. She was relieved from her biggest worries, and what she thought was failure turned into a biggest achievement. She realized that her health needed to be her priority. Even after being diagnosed with depression disorders, she wanted to feel normal and have a normal lifestyle like other people.

Madison was happy with her decision to seek medical help even though she had her doubts. She was happy that she finally took that step to see a doctor since she was suffering in silence. She noted that the background of her depression and anxiety disorders was her family. It was kind of genetic since her mom also struggled with depression and anxiety disorders. Her mom was always upset, and this broke her heart. She said it took her years to better herself, but she still had bad days. Madison decided to take the challenge regarding her mother’s experience. Also, Madison said she was struggling to get over depression since her childhood friends committed suicide, and it affected her deeply. She also told the doctor how she often thought of harming herself. The doctor advised her on the different ways she could overcome her situation after discovering she had severe depression and anxiety disorders.

After going through Madison’s story, I was hurt by the fact that he had to go through that for a long time, and something tragic could have happened if she had not resorted to medical help. I felt emotional by the fact that she constantly blamed herself due to her friends who committed suicide, and she decided to accumulate all the pain and worries. The fact that I have heard stories of how people commit suicide due to depression and anxiety disorders made me have a somber mood considering her case. In this case, you will never know what people are going through in their private lives until they decide to open up. We normally assume every person is okay, yet they fight their demons and struggle to look okay. Hence, it won’t cost any person to check up on other people, especially if they suddenly change their social characters.

Madison’s story stood out for me since she had struggled since childhood to deal with depression and anxiety disorders. In her case, she was unable to seek help first even when she knew that she was suffering in silence (Madison 2020). However, most people find it hard to admit they need help regardless of what they are going through, like Madison. People who are depressed cannot work as they lack the motivation to do anything. In my knowledge, depression affects people close to you, including your family and friends. Depression also hurts those who love someone suffering from it. Hence, it is complex to deal with. Madison’s situation stood out for me since her childhood friends committed suicide, and she wished silently she could be with them. Hence, this leads to her constant thoughts of harming herself. Childhood friends at one point can become your family even though you are not related by blood due to the memories you share.

Depression and Anxiety disorders have been common mental health concerns globally for a long time. Depression and anxiety disorders create the impression that social interactions are vague with no meaning. It is argued by Cuijpers (2016, p.245) that people who are depressed normally have personality difficulties as they find it hard to trust people around them, including themselves. In this case, Madison spent most of her time alone, sleeping, and could not find it necessary to hang around other people. Negativity is the order of the day as people depressed find everything around them not interesting.

People who are depressed find it easy to induce negativity in others. Hence, they end up being rejected. Besides, if someone is depressed and is in a relationship, he/she may be the reason for ending the relationship since they would constantly find everything offensive. Research shows that people who are clinically depressed, such as Madison, prefer sad facial expressions to happy facial expressions. Besides, most teenagers in the 21 st century are depressed, and few parents tend to notice that. Also, most teenagers lack parental love and care since their parents are busy with their job routines and have no time to engage their children. Research has shown that suicide is the second cause of death among teenagers aged between 15-24 years due to mental disorders such as suicide and anxiety disorders.

Despite depression being a major concern globally, it can be controlled and contained if specific actions are taken. Any person needs to prioritize their mental health to avoid occurrences of depression and anxiety orders. Emotional responses can be used to gauge if a person is undergoing anxiety and depression. The best efficient way to deal with depression and anxiety is to sensitize people about depression through different media platforms (Cuijpers et al. 2016). A day in a month should be set aside where students in colleges are sensitized on the symptoms of depression and how to cope up with the situation. Some of the basic things to do to avoid anxiety and depression include; talking to someone when you are low, welcoming humor, learning the cause of your anxiety, maintaining a positive attitude, exercising daily, and having enough sleep.

Depression and anxiety disorders are different forms among people, such as irritability and nervousness. Most people are diagnosed with depression as a psychiatric disorder. Technology has been a major catalyst in enabling depression among people as they are exposed to many negative experiences online. Besides, some people are always motivated by actions of other people who seem to have given up due to depression. Many people who develop depression normally have a history of anxiety disorders. Therefore, people with depression need to seek medical attention before they harm themselves or even commit suicide. Also, people need to speak out about what they are going through to either their friends or people they trust. Speaking out enables people to relieve their burden and hence it enhances peace.

Cuijpers, P., Cristea, I.A., Karyotaki, E., Reijnders, M. and Huibers, M.J., 2016. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta‐analytic update of the evidence . World Psychiatry 15(3), pp. 245-258.

Madison, J. 2020. Open Doors .

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IvyPanda. (2022, June 16). Anxiety Disorders and Depression. https://ivypanda.com/essays/anxiety-disorders-and-depression/

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IvyPanda . 2022. "Anxiety Disorders and Depression." June 16, 2022. https://ivypanda.com/essays/anxiety-disorders-and-depression/.

1. IvyPanda . "Anxiety Disorders and Depression." June 16, 2022. https://ivypanda.com/essays/anxiety-disorders-and-depression/.

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IvyPanda . "Anxiety Disorders and Depression." June 16, 2022. https://ivypanda.com/essays/anxiety-disorders-and-depression/.

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Causes Behind the Great Depression

This essay about the causes of the Great Depression paints a vivid picture of the complex factors leading to one of history’s most devastating economic downturns. It starts with the stock market crash of 1929, likened to a game of Jenga that was bound to topple. The narrative then explores deeper issues, such as the stark inequality in wealth distribution, risky banking practices that led to widespread failures, protectionist trade policies that stifled global commerce, and environmental disasters like the Dust Bowl. By using relatable analogies and avoiding technical jargon, the essay makes it clear that the Great Depression was not the result of a single event but a combination of systemic problems, including overconfidence, economic disparity, financial recklessness, and natural calamities, creating a perfect storm that took years to overcome.

How it works

The Great Depression wasn’t just a bad day on Wall Street; it was a years-long nightmare that affected millions. Imagine, for a moment, the world before the crash of 1929. It was the Roaring Twenties, an era that roared a bit too loudly and partied a bit too hard, setting the stage for a hangover that would last an entire decade. But what exactly tipped the first domino and sent the rest tumbling down? Let’s take a closer look without the jargon and the textbook talk.

First off, picture the stock market in the late ’20s like a game of Jenga that’s gone on for too long. Everyone knows it’s about to topple, but nobody wants to make the move that brings everything crashing down. Then comes October 1929, when the market finally crashes, wiping out fortunes overnight and shocking the entire system. But here’s the thing: this wasn’t just about stocks. It was the spark that lit the fuse, exposing a bunch of problems that had been simmering for a while.

One of the big issues was how the pie was sliced. The economy was booming in the ’20s, but the riches weren’t exactly shared evenly. Imagine a pie where just a few folks at the top got almost all of it, while everyone else was left with crumbs. Not exactly a recipe for a healthy economy, right? This meant that when things went south, most people didn’t have the savings to protect themselves, and consumer spending took a nosedive.

Then there were the banks, playing fast and loose with people’s money. Many had gambled on the stock market, and when it crashed, they were left holding an empty bag. With no safety net in place, a wave of panic led to bank runs, where everyone rushed to withdraw their cash, causing even more banks to collapse.

Don’t forget the global scene. The U.S. decided to slap high tariffs on imported goods, thinking it would protect American jobs. Sounds good in theory, but it actually backfired. Other countries retaliated, trade slowed to a crawl, and the global economy took a hit, dragging the U.S. down further with it.

Lastly, the Dust Bowl deserves a mention. It’s like Mother Nature said, “You think you’ve got problems?” and then threw severe dust storms across the plains, ruining crops and farms. This disaster added more pressure to an already stressed agricultural sector, which had been struggling due to overproduction and falling prices.

So, there you have it. The Great Depression wasn’t caused by just one bad day or one bad decision. It was a mix of overconfidence, unequal wealth, risky banking, stubborn policies, and some really bad weather. It’s a reminder that economies are delicate ecosystems, and it takes careful management to keep them balanced. Let’s just hope we’re a bit wiser now, ready to spot those Jenga blocks teetering before they bring the whole tower down again.

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3 Signs of Hidden Depression

Despite the emotional tempest, signs of depression may be subtle..

Updated April 10, 2024 | Reviewed by Ray Parker

• What Is Depression?
• Find counselling to overcome depression
• Depression isn't always obvious.
• Noticing hidden signs can expedite evaluation and intervention.
• Sighing, frustration, and agitation can be revealing of underlying depression.

Depression is a ubiquitous term, and it seems most people have some idea, if not entirely accurate, of what it means. The symptom of sadness might come to mind for some, while others envision a suicidal gothic character. What lies between these extreme ends of the continuum—an isolated, fleeting symptom and an almost caricature representation—is vast. There are subtypes of depression, and even people suffering from the same subtype can present differently.

Further, some people are more internalized or externalized in their expression and possess greater or lesser abilities in managing. Jane, for instance, upon evaluation, might possess eight symptoms but seems OK because she works and cares for her family. Joe, on the other hand, might have five and be unable to care for himself. The severity of depression isn't necessarily weighed by several symptoms but by how impaired someone is by them. Regardless, given Joe’s symptoms are more visual, he might get help and live a higher quality of life while Jane silently suffers through life, or, worse, to a tragic ending.

With this in mind, it is important to pay attention to hidden signs of depression. There might be more to someone always sighing, frustrated, and agitated than meets the eye.

Unusual and Subtle Signs

Would it surprise you that depression can be hidden in plain sight, perhaps chameleonized as a "different issue?"

People arriving for sleep problems, anger , or infidelity may just be presenting the tip of the depression iceberg. As I wrote about in this earlier post, for instance, aggressive or thrill-seeking behaviors can be downstream effects of an internalized process. This is especially true for males/cultures where displaying emotional “weakness” is considered dishonorable.

Internalized emotional pressure, coupled with insomnia and poor diet , might escape as anger reactions. Cheating or indiscriminate sex may assuage one’s low self-image , providing a sense of desirability or thrill in the face of an otherwise flat internal landscape. Providers should always provide careful diagnostic assessments, as no symptom/behavior exists in a vacuum. Trying to address the anger or infidelity alone will only provide tenuous abatement at best, like clipping back a weed but leaving the root to grow it back.

More Complicated Dynamics

Anyone who has worked with angry people knows that “They’re just an angry person” isn’t likely. This is also the case with someone who sighs a lot, acts frustrated, and appears rattled. There’s an internal conflict being expressed, and often, a mood or personality complication behind it.

Behaviors are expressions of thoughts and feelings.

People who are depressed often present with sighing, frustration/irritability, and agitation, but if the package presents itself sans obvious depression, don’t write it off. Depression could be driving that demeanor, but the person is otherwise managing to conceal the foundational struggle. Take the case of Jessie (composite identity), who was referred by his employer to the employee assistance program for appearing increasingly discontent over recent months.

Jessie was never the life of the office, but he was dependable and pleasant enough. Insidiously, he had taken to exaggerated exhaling throughout the day, as if trying to externalize some burden so his day could go on. His work quality and productivity were not suffering, but he uncharacteristically became frustrated if there was a meeting or he was approached by colleagues, which disrupted his work. In meetings, it was hard not to notice his being fidgety or that he might roll his eyes and look about in an “I can’t believe this” gesture like his time was being wasted.

Jessie’s workload hadn’t changed, and there was no inter-collegiate problem present. However, his supervisor, Jenna, was concerned that his demeanor, despite his ongoing productivity, was placing a burden on the office milieu and referred him to the employee assistance program.

The Sigh-Depression Connection

Sighing alone isn’t necessarily a signal of negative emotionality ( Danvers et al ., 2021). We sigh every few minutes, as it is normal for respiratory function to inflate alveoli in the lungs (Li et al., 2016). However, when pronounced sighs are presented regularly with other observations, as Jenna noticed, maybe it’s time to check in with the person or oneself.

This is because we sigh more when stressed or emotional. Vlemincx et al. (2022) noted that “[Sighs reset] emotional states by facilitating emotional transitions.” Perhaps more frequent sighing helps people mired in negative emotions constantly reset to a manageable emotional state.

Agitation, of course, is not only a physical expression of one’s restless mental state but can serve as stimulation/preoccupation/distraction. It can also be an expression of frustration, which is not unusual in depressed people. This, of course, lends itself to sighing, too.

The inherent poor sleep and appetite of depression alone can cause irritation/agitation, but couple that with cognitive slowing and rumination of depression, and someone’s emotional experience could be akin to a pot with a lid on it beginning to boil; we don’t see the roil, but the shaking indicates something is up inside.

We all periodically roll our eyes, grunt, and/or hold our foreheads when frustrated, but when that fleeting state(s) becomes a trait, chronic internal turmoil likely keeps it afloat.

Clinical Implications

When encountering someone like Jessie, exploring their internal landscape is required for effective therapy :

After exchanging pleasantries, I said, “So, Jessie, we briefly spoke on the phone that you were referred because of seeming frustrated and on edge at work lately. What can you tell me about that?” Jessie went on to describe what Jenna did in the EAP referral.

“Seems like it’s become more noticeable over time," I replied. "I’m curious about what you can tell me about your experience as it was all building. Like, what changed? What has been on your mind in conjunction with all this?”

Though not directly answering the thought process question, Jessie reflected that for several months, he had been feeling “a grey mood” and could get irritable. He also slept more. It wasn’t the first time it happened. He remembered a similar event when his parents divorced when he was in his teens, 15 years earlier. Now, his mother had just divorced again and began “guilting” Jessie into doing things for her around the house. He set hard boundaries , engendering never-ending squabbling between him, his mother, and his siblings.

Jessie thought he kept any signs of bad moods hidden. Work was the most stimulating thing in his life at the moment, and he figured being occupied wouldn’t allow his bad mood to show through to colleagues. Work was an escape, but some of his inner world was escaping at work. Thankfully, it brought him to therapy, where he was able to work through his familial problems and not be left to stew in his emotions privately.

Robbins (2011) provides a good reminder of why it is important to keep vigilant for people like Jessie:

Because depression most immediately affects people’s inner mood and cognitive landscape, it is often “invisible” to outsiders. Thus, depression’s privacy can impede its early detection and thereby adequate treatment. These issues are compounded when the social stigma surrounding depression leads to patients intentionally hiding symptoms. Therefore, identifying observable, behavioral markers of depression is an important scientific endeavor with theoretical and clinical implications.

Danvers, A.F., Milek, A., Tackman, A.M., Kaplan, D.M., Robbins, M.L., Poslinelli, A., Moseley, S., Raison, C.L., Sbarra, D., & Mehl, M.R. (2021). Is frequent sighing an indicator of dispositional negative emotionality? A multi-sample, multi-measure naturalistic-observation study. Journal of Research in Personality , 90 , https://doi.org/10.1016/j.jrp.2020.104046

Li, P., Janczewski, W., Yackle, K., Kam, K., Pagliardini, S., Krasnow, M.A., & Feldman, J.A. (2016). The peptidergic control circuit for sighing. Nature, 530, 293–297 .

Robbins, M.L., Mehl, M.R., Holleran, S.E., & Kasle, S. (2011). Naturalistically observed sighing and depression in rheumatoid arthritis patients: a preliminary study. Health Psychology, 30 (1), 129-33. doi: 10.1037/a0021558. PMID: 21299301; PMCID: PMC3059549

Vlemincx, E., Severs, L., & Ramirez, J.M. (2022). The psychophysiology of the sigh: II: The sigh from the psychological perspective. Biological Psychology, 173 , https://doi.org/10.1016/j.biopsycho.2022.108386

Anthony Smith, LMHC, has 23 years of experience that includes the roles of therapist, juvenile court evaluator, professor, and counseling supervisor.

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