depression causes and effects essay

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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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Depression is likely to strike many people to some degree in their lifetime. According to the Centers for Disease Control and Prevention, 9.1 percent of people reported current major or minor depression. If you or someone you know is depressed, it can cause a marked drop in interest in pursuing life to the fullest, and can, unfortunately, drive a person to attempt suicide if left untreated. Help is available; call our hotline at to learn how to break the cycle of depression.

Free Online Depression Test

What are the types of depressive disorders.

Depression isn’t a single disorder, but rather a class of conditions separated by severity and duration. However, common factors exist among all types.

Major Depressive Disorder

Major depressive disorder occurs when the person has feelings of sadness, hopelessness, or anger that persist over a period of weeks and interfere with daily life. It can lead to suicide in severe cases.

Chronic Depression/Dysthymia

From the Greek for “poor mood,” dysthymia is characterized by a persistently sad disposition, as though the person is always in a bad mood. The symptoms last longer than with major depression, but they are not as severe.

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Atypical Depression

Atypical depression can be hard to diagnose and it often lasts for years. Some of the common symptoms of depression, such as decreased appetite, are reversed; the person may have cravings for chocolates or sweets.

Bipolar or Manic Depression

Bipolar disorder is characterized by cycling between depressive periods and manic periods in which the person engages in a lot of activity and feels extremely empowered and positive. The time between phases varies from person to person.

Seasonal Affective Disorder (SAD)

SAD often strikes people during the winter months. A lack of sunlight, exercise, and fresh air causes irritability and lethargy in people who suffer SAD.

Postpartum Depression

Postpartum depression occurs often with women who have recently given birth. The time of onset varies; it can occur as early as three months or as late as a year after delivery. It is moderate to severe.

Psychotic Depression

Patients who suffer psychotic depression exhibit psychotic symptoms along with the depression, such as delusions or hallucinations. The hallucinations can affect any or all of the senses. Usually, the delusions involve feelings of unwarranted guilt or inadequacy.

What Causes Depression?

Many potential causes for depression exist. It can be genetic, meaning the patient has a family history of depression. Personal trauma and sources of stress, such as a failed relationship or a lost job, can also cause depression. Social isolation as the result of conflict with family and friends can be a contributory factor, and certain medications, such as high blood pressure medication, have depression listed as a possible side effect. Take care of your mental health by taking a depression test today.

What Are the Signs of Depression?

If you notice that you or someone you know seems to be lethargic, socially withdrawn, or has declining physical health, depression may be present. There are several physical and emotional symptoms to look for when determining whether a person has clinical depression, but you should always seek an official diagnosis before making a decision.

Emotional Symptoms of Depression

The emotional symptoms of depression potentially include the following:

• Withdrawal from socializing
• Loss of interest in previously enjoyed hobbies
• Constant irritability or sadness
• Constant pessimism
• Feelings of inadequacy and self-loathing

Physical Symptoms of Depression

Depression doesn’t just affect the mind; it also affects the body. Some of the physical effects include erratic sleep habits, loss of appetite (or increased appetite with atypical depression), constant fatigue, muscle aches, headaches, and back pain. It’s easy to dismiss these symptoms as stemming from another condition, but they are often because of depression.

Short-Term and Long-Term Effects of Depression

In the short-term, depression is likely to cause loss of appetite, weight loss, and other physical symptoms. If you develop insomnia or hypersomnia (sleeping too much), you will be fatigued and lethargic. In the long term, you can experience malnutrition from not eating enough or become obese from eating too much. You can also experience a drop in short-term memory, finding it easier to forget things. Long-term depression can also lead to suicide; EverydayHealth states that over 66 percent of suicides have depression as a factor.

Is There a Test or Self-Assessment I Can Do?

A myriad of tests exists online to determine whether you may be depressed. Many of them ask the same questions: “Have you felt sad or angry at nothing in particular for more than X amount of time?” “Have you lost interest in normal activities?” “Have you lost interest in socializing?” Try to take a test from an official depression treatment organization or government website. Also note that even if the test says you’re depressed, you should seek an official diagnosis to confirm it is clinical depression. Psychological self-diagnosis is a risky venture at best, but with official evaluation, you can get proper treatment and medication.

Depression Medication: Antidepressant Drug Options

You have a variety of choices for antidepressants. Some of the most common are SSRIs, or selective serotonin reuptake inhibitors. These help the brain to regulate the release of serotonin and dopamine; these are brain chemicals thought to be responsible for creating feelings of happiness and satisfaction. Common brand names are Paxil, Prozac, and Zoloft.

Antidepressants: Possible Options

SSRIs aren’t the only type of antidepressant. Some older types that are still used are MAOIs (monoamine oxidase inhibitors), tetracyclics, and tricyclics. If SSRIs prove ineffective, you will likely be prescribed an MAOI or other medication, such as Marplan, Nardil, or Emsam. These drugs can have harmful side effects.

Medication Side Effects

The side effects of antidepressants might cover a wide range of symptoms, some of which include:

• Vision problems
• Irritability
• Constipation

Antidepressant Drug Addiction, Dependence and Withdrawal

If someone becomes dependent on antidepressants, addiction is a possibility. Abuse of antidepressants may not lead directly to death, but it can and will have adverse effects on the brain’s chemical balance, as well as the heart and respiratory system. Withdrawal, when weaning off the antidepressants, can send someone spiraling back into depression.

Medication Overdose

It’s possible to overdose on antidepressants. There are several symptoms associated with overdose, such as uncontrollable shaking of the hands, lack of fine motor function, double vision, seizures, and coma. If these symptoms are present in someone you know, call your local Poison Control Center or 911 immediately.

Dual Diagnosis: Addiction and Depression

Drug addiction and depression often go hand in hand. According to the Anxiety and Depression Association of America, 20 percent of people with depression or similar mood disorders also have a problem with substance abuse. The staff at drug rehab facilities is therefore trained to help treat depression as well as drug addiction because the two disorders are often co-morbid.

Getting Help for Someone Who Is Depressed

It’s important to intervene if you notice someone is depressed. The more time the person spends depressed, the harder it can be for them to get out of it. Luckily, there are ample resources available. If you or someone you know is depressed, start by talking to a physician, who will then perform an examination and possibly refer you to a psychiatrist or psychologist. The mental health professional will start by talking to you and asking various questions to determine how long the depression has been going on, the severity of the symptoms, and whether any medications are being taken that might be worsening the bad moods.

A mixture of antidepressant medication (if cleared with a doctor) and behavioral therapy can help ease depression. Behavioral and cognitive therapies help you to recognize and alter negative self-talk that reinforces depressive thought patterns. Give our operators a call at today to learn more about recovering from depression and reclaiming your life.

Additional Resources

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PsychGuides may receive marketing compensation from the above-listed companies should you choose to use their services.

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• 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.
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• 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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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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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.

The Biology of Depression

Reviewed by Psychology Today Staff

Depression makes deep inroads on biology to bring about the many symptoms of depression, from sleep disruption and an inability to experience pleasure to lack of motivation and feelings of guilt. Many factors influence how a person reacts to stressful events, whether an individual gets depressed, and how the disorder manifests. These include genetic inheritance, life experience, temperament, personality traits, social supports, and beliefs.

Still, exactly how biological changes give rise to depressive symptoms is not well understood. Because of its complexity—and because the disorder contributes so much to human suffering—the biology of depression is a major subject of ongoing research.

On This Page

• What is the role of genetics in depression?
• Can genes for depression be modified?
• What happens in the brain with depression?
• How does lack of sleep alter brain function?
• How does the brain regulate mood?
• What role does serotonin play in depression?
• Does dopamine play a role in depression?
• How does nerve cell communication go awry in depression?
• How does stress affect the brain
• How does childhood stress affect adult brain function?
• What areas of the brain play a role in depression?
• What does brain imaging look at in depression?
• How does depresson itself change the brain?
• Can talk therapy change the way the brain functions?
• Why is nerve cell growth, or neuroplasticity, important?
• What are ways of stimulating neuroplasticity?

The inheritance of risk for depression is considered, at best, polygenetic—that is, a number of unknown genes each contributes a tiny risk under certain environmental conditions. None of them makes depression inevitable. The baseline risk of depression in the population is 10 percent; having a first-degree relative (parent or sibling) with depression doubles or triples an individual’s risk, to 20 to 30 percent over the course of a lifetime.

There are many non-genetic factors that contribute to risk of onset of major depression, and there are some inherited factors as well. To make matters a bit more complex, some non-genetic factors, including certain kinds of adverse childhood experience—such as repeated child abuse or neglect—can have a lasting impact on the function of genes (such as those that activate the stress system) to increase the risk of depression later on.

Variation of one gene associated with the serotonin system ( the serotonin transporter gene ) has been most linked to depression susceptibility—it is thought to moderate the impact of stressful life events—but the evidence has been disappointing. Life experience and lifestyle factors are believed to play more significant roles in depression risk.

Scientists know that the expression and function of many genes can be altered without doing the near-impossible—making any changes to the gene structure itself. Such changes are known as epigenetic modifications. Some life experiences can create vulnerability to depression through epigenetic changes. For example, in rat pups, lack of maternal care can permanently reset the sensitivity of receptors to stress hormones. If their mothers fail to lick and groom them, they grow up to display an exaggerated response to stress hormones and develop depression-like behavior in response to stress.

But there are also ways to strategically induce epigenetic changes to reverse symptoms of depression. For example, the nutritional supplement SAM-e , a synthetic version of a compound found in the body, contains a substance that chemically augments the activation and deactivation of genes. Some studies show it is effective against symptoms of depression.

Overexcitability of the stress response system, shifts in activity of various neurochemicals in the brain, diminished efficiency of nerve circuitry and nerve generation, disturbances in energy use nerve cells, the intrusion of inflammatory substances in the brain, upsets in the brain’s 24-hour (circadian) clock—all play a role in depression onset or progression and influence the kind and severity of symptoms.

Two major areas of the brain—the hippocampus (seat of memory) and the cortex (the thinking part of the brain)— undergo shrinkage . Both the size of nerve cells and the number of their connections with other neurons are reduced. At the same time, depressive behavior is linked to overactivation of the hypothalamus, which coordinates the stress response, and overactivity of the amygdala, which signals threat and generates negative emotions.

Reduced activity in the prefrontal cortex, which interprets and regulates emotional signals coming from the amygdala, accounts for the difficulties in decision-making and the cognitive fog that depressed people experience.

The human brain may be unique in its ability to generate new nerve connections, called neuroplasticity ; this is what underlies all adaptation and learning. In depression, neuroplasticity is impaired, especially in the hippocampus. In addition, reward centers of the brain shrink and fail to activate in response to stimulation. There are changes in sensitivity to the hormones that regulate feeding behavior, resulting in changes in appetite.

Disruption of the sleep-wake cycle is one of the hallmarks of depression and is a major source the mood disturbance in major depression. Lack of sleep upsets the body’s circadian clock that orchestrates the natural daily rhythm of most biological functions, including patterns of secretion, release, and activity of many neurochemicals in the brain.

Sleep deprivation is thought to impede the transmission of neural signals. One result is that sleep deprivation makes people emotionally reactive , increasing activity in the amygdala and decreasing it in the emotion regulation center of the prefrontal cortex. Sleep deprivation impairs the brain’s ability to control negative thoughts.

Mistimed light input resulting from sleep disturbance also disrupts the dopamine-sensitive nucleus accumbens. Studies show that people with mood disorders benefit from maintaining a strict sleep/wake routine, rising in the morning and going to sleep at night at the same time every day.

Emotions are fleeting responses to stimuli; mood is a more sustained state of emotion. Like emotions, mood probably originates with activity of the amygdala, where emotions are coded. But it also involves the prefrontal cortex, which, through bundles of two-way circuitry with the amygdala, helps regulate emotional response and influences the general state of reactivity of the amygdala.

Under normal conditions, moods are relatively stable. But the persistence of negative mood in major depression suggests something is amiss in the nerve pathways between the amygdala and cortex.

Another important influence on mood is the circadian rhythm that governs the timing of much physiological activity, most prominently the sleep-wake cycle . Disturbances in biological rhythms are known to disrupt mood, and studies of depressed patients find that they exhibit abnormal patterns of many body functions, from temperature regulation to hormone secretion.

The neurotransmitter serotonin is one of many signaling chemicals in the brain associated with depressive symptoms. Under normal conditions, serotonin inhibits pain, influences the processing of various emotions, and mediates many mental capacities important in social life .

But like the other neurotransmitters involved in depression, its production and activity are affected by the hormones the body secretes in response to threat or stress, such as cortisol. One result is a functional lack of serotonin, which, among other things, disrupts the circuitry that regulates moral emotions. Growing evidence suggest that is why those who are depressed are haunted by excessive self-blame and a sense of guilt.

The neurotransmitter dopamine, which mediates motivation and desire, is one of several brain signaling chemicals that are implicated in depression . It is associated with two of the most prominent features of depression—anhedonia, or the inability to experience pleasure, and appetite alterations.

Many neurons that use dopamine to relay signals are sensitive to the effects of stress, which can alter their excitability and activity. Studies have also shown that reward-generating areas of the brain—such as the nucleus accumbens, where dopamine signals originate—may be underactive in depression.

Where once researchers and clinicians focused on the role of neurotransmitters such as serotonin in depression, they now know that neurotransmitters are only one part of a much larger story of how nerve cells function in circuits to relay messages from one part of the brain to another. In fact, many experts see depression as a nerve circuit disorder, marked by a power failure in the brain’s wiring, affecting communication between one area of the brain and another.

The nerve cell connections between the amygdala and the prefrontal cortex (PFC) are sometimes called the “depression circuit;” depression results when emotion-laden signals from the amygdala overpower the ability of the PFC to regulate the signals. The prolonged or excessive release of stress hormones can lead to a failure of activation of key nodes in neural networks or impair the strength of signals between them, especially when processing emotion-related or reward stimuli.

It’s important that depression is now seen as a nerve circuit disorder, because that influences the search for effective treatments.

Stress can be beneficial to the brain, depending on how intense and long-lasting the stressor is. In brief bursts, stress fosters alertness, learning, and adaptation. Severe or prolonged stress, however, can disrupt many aspects of brain function and lead to depression .

Such stress dysregulates the normal stress response through the overproduction of cortisol. Cortisol is especially toxic to cells in the brain’s hippocampus, and one consequence of uncontrolled stress is shrinkage of the hippocampus, manifest in the impaired memory and learning that are characteristic of depression.

Cortisol also turns off the generation of new nerve cells in some areas of the brain, affecting the circuitry of the brain. In addition, prolonged cortisol exposure affects production of the insulating myelin sheath surrounding nerve cells, diminishing the overall efficiency or nerve signaling.

Severe or sustained early life adversity shifts the course of brain development and can lastingly impair emotion regulation and cognitive development. Excessive or prolonged activation of the stress response in childhood, studies show, can sensitize the stress response system so that it overresponds to minimal levels of threat, making people feel easily overwhelmed by life’s normal difficulties.

Severe or prolonged childhood adversity can affect the function of genes important for the wiring of the brain, so that emotional control is difficult—overproducing neural connections in regions such as the amygdala that signal threat and other negative emotions while underendowing neural connectivity in brain areas responsible for behavioral control, reasoning, and planning.

Nevertheless, adult brains retain the capacity for neuroplasticity. Although it takes effort, and often the guidance of psychotherapy, people can learn to overcome many of the ill effects of early adversity.

Many areas of the brain contribute to the symptoms of depression, such as the hippocampus, which is the seat of memory and learning, and the superchiasmatic nucleus, which is the “body clock” that paces all physiologic activity, notably the sleep-wake cycle. But brain imaging studies suggest that there is a primary “depression circuit,” consisting of the amygdala, which flags emotion-related stimuli; the prefrontal cortex, which analyzes and interprets experience, modulates emotional reactivity, and controls attention; and the two-way network of nerve fibers that connect them.

In this model of depression, the amygdala becomes hyperactive, sending out a constant flood of emotions, and the PFC becomes hypoactive, unable to regulate the stream of emotional input. Through feedback loops, the failure of the PFC further dysregulates the amygdala and leaves unchecked its inherent bias toward negative emotions.

Some types of brain imaging, such as CT scans and magnetic resonance imaging (MRI), take static pictures of the brain to determine whether any specific structures are larger or smaller than normal in depressed patients. Positron emission tomography (PET) scans and functional magnetic resonance imaging (fMRI) look at the brain in action, to see whether and where there are problems in the way the brain processes specific types of information .

In fMRI studies, normal controls and depressed patents are typically given some task to perform in the scanner. For example, subjects may be asked to look at a series of pictures, some of them with emotionally disturbing content, to see how the brain handles negative stimuli. The brain scanners measure blood flow or metabolic activity, based on the concentration of agents earlier injected into the bloodstream. Comparison of hot spots and dead spots of activity between controls and depressed patients highlight areas of the brain that malfunction in response to challenging stimuli.

The longer an episode of depression lasts, the greater the likelihood of a recurrence of depression. That is because depression changes the brain in ways that are only now yielding to understanding. If left untreated, depression can become a progressive disease leading to neurodegeneration.

The sustained stress that triggers depression releases a cascade of hormones linked to shrinkage of the hippocampus, a part of the brain essential for learning and storing and retrieving memories. Prominent changes to other brain areas, including the amygdala, create a sustained tendency to generate negatively coded emotions.

Untreated depression also changes the activity of substances that help regulate the mitochondria, the energy factories of all cells, especially critical to function of the brain because it is such a metabolically active organ. Depression also causes changes in the network of brain areas involved in processing physical pain , and the degree of hyperactivity in such areas as seen on brain scans correlates with the severity of depression that patients experience.

Recent studies show that like other neurodegenerative conditions, longstanding depression increases levels of inflammatory substances in the brain that further impair its function , affecting many brain regions and circuits of connectivity.

The most studied form of psychotherapy—cognitive behavioral therapy (CBT)—has been shown to produces long-lasting changes in emotion, cognition, behavior, and somatic symptoms of patients with depression and other mental health conditions. Using functional magnetic resonance imaging (fMRI), researchers find that CBT alters patterns of connections between brain regions, notably in circuits related to the processing of emotions.

Images show decreased reactivity of the brain’s amygdala, which processes emotion, and increased activity in the prefrontal cortex, the thinking and executive control center of the brain, indicating more control over emotional reactions and memories, and greater flexibility in finding solutions to problems . The changes in cognition power help reduce negative emotionality by increasing people’s ability to calmly manage experiences and thoughts that stir emotions.

Throughout life, the growth of new nerve cell connections, or neuroplasticity, is the major way brains adapt to new or challenging circumstances. It’s called learning, and it’s the brain’s major means of problem-solving. Depression is characterized by a loss of plasticity—negative neuroplasticity; patients feel imprisoned in their own repetitive negative thoughts.

It’s long been known that prolonged or excessive outpouring of stress hormones curbs the growth of nerve cells, particularly in the hippocampus, seat of memory and learning.Such changes are reflected in a smaller size hippocampus and impaired memory in depressed patients.

Changes also occur in the prefrontal cortex, undermining regulation of emotional experience, limiting the ability to set goals, and much more. All effective treatments of depression restore the capacity for mental and behavioral change and are known to stimulate the growth of new nerve cells —they enable the brain to rewire itself.

All known therapies for depression stimulate the growth of new nerve cell connections. But the growth of new nerve cell connections is not dependent on antidepressant drugs. Researchers find that there are many ways to bring about neuroplasticity.

One of the most effective ways is aerobic exercise. And it doesn’t have to be intense to have an effect. In fact, all physical activity is linked to the generation of neurotrophic factors, chemicals that stimulate the growth and recovery of brain cells.

Research also pinpoints diet, and especially i ntermittent fasting as a way to generate BDNF , or brain-derived neurotrophic factor, one of the best studied agents of nerve cell growth. Intermittent fasting is known to be neuroprotective, shielding brain cells from the degeneration that often accompanies aging.

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7 Depression Research Paper Topic Ideas

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.

Cara Lustik is a fact-checker and copywriter.

In psychology classes, it's common for students to write a depression research paper. Researching depression may be beneficial if you have a personal interest in this topic and want to learn more, or if you're simply passionate about this mental health issue. However, since depression is a very complex subject, it offers many possible topics to focus on, which may leave you wondering where to begin.

If this is how you feel, here are a few research titles about depression to help inspire your topic choice. You can use these suggestions as actual research titles about depression, or you can use them to lead you to other more in-depth topics that you can look into further for your depression research paper.

What Is Depression?

Everyone experiences times when they feel a little bit blue or sad. This is a normal part of being human. Depression, however, is a medical condition that is quite different from everyday moodiness.

Your depression research paper may explore the basics, or it might delve deeper into the  definition of clinical depression  or the  difference between clinical depression and sadness .

What Research Says About the Psychology of Depression

Studies suggest that there are biological, psychological, and social aspects to depression, giving you many different areas to consider for your research title about depression.

Types of Depression

There are several different types of depression  that are dependent on how an individual's depression symptoms manifest themselves. Depression symptoms may vary in severity or in what is causing them. For instance, major depressive disorder (MDD) may have no identifiable cause, while postpartum depression is typically linked to pregnancy and childbirth.

Depressive symptoms may also be part of an illness called bipolar disorder. This includes fluctuations between depressive episodes and a state of extreme elation called mania. Bipolar disorder is a topic that offers many research opportunities, from its definition and its causes to associated risks, symptoms, and treatment.

Causes of Depression

The possible causes of depression are many and not yet well understood. However, it most likely results from an interplay of genetic vulnerability  and environmental factors. Your depression research paper could explore one or more of these causes and reference the latest research on the topic.

For instance, how does an imbalance in brain chemistry or poor nutrition relate to depression? Is there a relationship between the stressful, busier lives of today's society and the rise of depression? How can grief or a major medical condition lead to overwhelming sadness and depression?

Who Is at Risk for Depression?

This is a good research question about depression as certain risk factors may make a person more prone to developing this mental health condition, such as a family history of depression, adverse childhood experiences, stress , illness, and gender . This is not a complete list of all risk factors, however, it's a good place to start.

The growing rate of depression in children, teenagers, and young adults is an interesting subtopic you can focus on as well. Whether you dive into the reasons behind the increase in rates of depression or discuss the treatment options that are safe for young people, there is a lot of research available in this area and many unanswered questions to consider.

Depression Signs and Symptoms

The signs of depression are those outward manifestations of the illness that a doctor can observe when they examine a patient. For example, a lack of emotional responsiveness is a visible sign. On the other hand, symptoms are subjective things about the illness that only the patient can observe, such as feelings of guilt or sadness.

An illness such as depression is often invisible to the outside observer. That is why it is very important for patients to make an accurate accounting of all of their symptoms so their doctor can diagnose them properly. In your depression research paper, you may explore these "invisible" symptoms of depression in adults or explore how depression symptoms can be different in children .

How Is Depression Diagnosed?

This is another good depression research topic because, in some ways, the diagnosis of depression is more of an art than a science. Doctors must generally rely upon the patient's set of symptoms and what they can observe about them during their examination to make a diagnosis. 

While there are certain  laboratory tests that can be performed to rule out other medical illnesses as a cause of depression, there is not yet a definitive test for depression itself.

If you'd like to pursue this topic, you may want to start with the Diagnostic and Statistical Manual of Mental Disorders (DSM). The fifth edition, known as DSM-5, offers a very detailed explanation that guides doctors to a diagnosis. You can also compare the current model of diagnosing depression to historical methods of diagnosis—how have these updates improved the way depression is treated?

Treatment Options for Depression

The first choice for depression treatment is generally an antidepressant medication. Selective serotonin reuptake inhibitors (SSRIs) are the most popular choice because they can be quite effective and tend to have fewer side effects than other types of antidepressants.

Psychotherapy, or talk therapy, is another effective and common choice. It is especially efficacious when combined with antidepressant therapy. Certain other treatments, such as electroconvulsive therapy (ECT) or vagus nerve stimulation (VNS), are most commonly used for patients who do not respond to more common forms of treatment.

Focusing on one of these treatments is an option for your depression research paper. Comparing and contrasting several different types of treatment can also make a good research title about depression.

A Word From Verywell

The topic of depression really can take you down many different roads. When making your final decision on which to pursue in your depression research paper, it's often helpful to start by listing a few areas that pique your interest.

From there, consider doing a little preliminary research. You may come across something that grabs your attention like a new study, a controversial topic you didn't know about, or something that hits a personal note. This will help you narrow your focus, giving you your final research title about depression.

Remes O, Mendes JF, Templeton P. Biological, psychological, and social determinants of depression: A review of recent literature . Brain Sci . 2021;11(12):1633. doi:10.3390/brainsci11121633

National Institute of Mental Health. Depression .

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition . American Psychiatric Association.

National Institute of Mental Health. Mental health medications .

Ferri, F. F. (2019). Ferri's Clinical Advisor 2020 E-Book: 5 Books in 1 . Netherlands: Elsevier Health Sciences.

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.  

Essay on Depression Cause And Effect

Students are often asked to write an essay on Depression Cause And Effect in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Depression Cause And Effect

Understanding depression.

Depression is a mental health issue. It makes people feel sad and lose interest in things they used to enjoy. It’s not just feeling blue; it’s a serious condition that affects a person’s daily life.

Causes of Depression

Depression doesn’t have one single cause. It can be due to many factors. These can be biological, like changes in brain chemicals, or environmental, like stressful life events. Sometimes, it can also be genetic, meaning it runs in families.

Effects of Depression

Depression affects a person’s feelings, thoughts, and actions. They may feel hopeless, lose appetite, or have trouble sleeping. It can also make it hard for them to focus or make decisions.

Depression and Physical Health

Depression can also affect physical health. People with depression may feel tired all the time or have aches and pains. In severe cases, it can make them think about suicide.

Treating Depression

Depression is treatable. Treatments include talking therapies, medication, and self-care practices. It’s important to seek help if you think you or someone else may be depressed.

250 Words Essay on Depression Cause And Effect

Depression is a serious mood disorder. It’s not just feeling sad or upset, but a condition that affects a person’s thinking, feeling, and behavior. It can make everyday tasks difficult and can lead to physical health problems.

Depression can be caused by many factors. One main cause is changes in the brain. Certain chemicals in the brain, like serotonin and dopamine, play a major role in our mood. When these chemicals are out of balance, it can lead to depression.

Other causes of depression include life events, such as the death of a loved one, a major illness, or stress. Genetics can also play a role. If someone in your family has depression, you might be more likely to get it too.

Depression can have a big impact on a person’s life. It can make it hard to get out of bed in the morning, go to school, or do other daily activities. It can also lead to physical problems, like headaches or stomachaches, and can make it hard to eat or sleep.

Depression can also affect a person’s relationships. It can make it hard to connect with others and can make a person feel isolated.

Depression is a serious condition that can affect every part of a person’s life. It’s important to understand its causes and effects, so we can help those who are suffering. If you or someone you know is dealing with depression, don’t hesitate to reach out for help.

500 Words Essay on Depression Cause And Effect

Introduction.

Depression is a serious mood disorder that affects how you think, feel, and handle daily activities. It’s more than just feeling sad or low. It’s a constant feeling of sadness and loss of interest that can stop you from doing normal activities. Different types of depression exist, with symptoms ranging from relatively minor to severe. Generally, depression does not result from a single event, but from a mix of events and factors.

Depression can be caused by a combination of many things. Some people might have a genetic tendency towards it. It can also come from certain life events, like losing a loved one, going through a divorce, or being under a lot of stress. Sometimes, depression can also be caused by physical health problems.

Biological Causes

Our bodies and brains are closely linked. Changes in your body’s hormone levels can affect your mood and feelings. Certain medical conditions can also cause depression. For example, some people may feel low and unhappy when they are sick or in pain. This can lead to depression.

Psychological and Social Causes

Depression can also be caused by psychological and social factors. These include a difficult childhood, loneliness, relationship problems, work stress, or living in poverty. Sometimes, a traumatic event can trigger depression. This could be something like a natural disaster, a personal crisis, or a violent attack.

Depression doesn’t just affect your mind; it also affects your body. Some common effects of depression include:

Physical Effects

Depression can cause many physical symptoms, including aches and pains, loss of appetite, weight changes, feeling tired all the time, and sleep problems. It can also make existing physical health problems worse.

Emotional Effects

People with depression often feel sad, anxious, guilty, or hopeless. They may lose interest in things they used to enjoy. They might find it hard to concentrate or make decisions. In severe cases, they may even think about suicide.

Social Effects

Depression can make it hard to maintain relationships. People with depression might withdraw from friends and family. They may find it hard to perform at work or school. This can lead to social isolation and other problems.

Depression is a serious condition that affects millions of people around the world. It’s caused by a mix of genetic, biological, environmental, and psychological factors. Depression can cause significant suffering and can negatively impact a person’s life. But with the right treatment, most people with depression can get better. Understanding the causes and effects of depression can help us to support those who are suffering and to seek help if we need it ourselves.

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

• Essay on Depression And Anxiety
• Essay on Depression Among Students
• Essay on Depletion Of Natural Resources

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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/

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

IvyPanda . (2022) 'Anxiety Disorders and Depression'. 16 June.

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/.

Bibliography

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

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The Great Depression – Cause and Effect, Essay Example

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The Great Depression was the longest and most severe financial crisis in the history of the United States, lasting from 1929 until 1939. Even though the recent financial crisis has been termed as the second worst, it pales in comparison to the Great Depression in which unemployment rate exceeded 20 percent at its highest point. Industrial production declined by 47 percent and the real GDP fell by 30 in the U.S. between the peak and trough of the depression. Even though the depression was triggered by a decline in aggregate demand but numerous factors contributed towards its severity including stock market crash, bank panics, and monetary contraction (Romer).

The stock market crash of 1929 has been widely credited as the starting point of the Great Depression. As people lost investments, their uncertainty regarding the future increased. They responded by scaling back their spending activities including purchase of durable goods. The firms also responded to declining demand by suspending their capital investments. This resulted in real GDP falling rapidly in late 1929 and throughout the 1930 (Romer).

As the aggregate demand in the U.S. fell, it also led to decrease in the prices of the goods and services. This is because quantity demanded and price has a positive relationship. Because the nominal wages didn’t decline as much as the general price levels, the real wages of the workers grew and labor became a more expensive factor of production. Faced with a declining demand, the manufacturers could not afford expensive labor and thus, they responded by cutting their workforces (Bernanke). As unemployment rose, it put even greater downward pressure on the consumption activities.

Another reason was the loss of confidence in the banks as a consequence of stock market crash as well as Federal inaction on the failing banks. The bank runs resulted in loss of bank reserves such as gold and currency etc. which means the bank could not provide any more loans. This resulted in contracting money supply which negatively affected both the consumption activities by the consumers as well as the investing activities by the businesses (Wheelock). Falling consumption and investing activities meant falling GDP and lower demand for labor force.

The Fed also made the matters worse by pursuing a contractionary monetary policy. Modern economics has come to the conclusion that decreasing interest rates is a better strategy to spur growth during struggling times and this is how the Fed has dealt with the recent financial crisis and how it acted in the wake of internet bubble bust. But Fed raised interest rates during the Great Depression which made borrowing even more expensive and further reduced consumption and investing activities. It also hurt consumption in another way. The public and the businesses came to expect deflation in the future due to declining price levels which further discouraged them from borrowing. This is because they expected their incomes to fall in the future (Romer).

Thus, it is apparent to some extent that the Great Depression occurred due to inappropriate government response to the crisis which also happened because our understanding of Macroeconomics was still in its infancy. The Great Depression continues to be a topic of intense research and the lessons from the Great Depression have helped us a repeat of a crisis of a similar magnitude. The U.S. government has become a lot better at financial crisis management and is more willing to intervene in the markets when the circumstances demand.

Bernanke, Ben S. “The Macroeconomics of the Great Depression: A Comparative Approach.” Journal of Money, Credit and Banking February 1995: 1-28.

Romer, Christina D. “Great Depression.” Encyclopaedia Britannica 20 December 2003.

Wheelock, David C. “An Overview of the Great Depression.” St. Louis: Federal Reserve Bank of St. Louis, 2007.

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• What is a recession? 

Recessions and the business cycle

• What is a depression? 

Recession vs. depression

• How recessions affect you 
• Recession FAQs

What is a recession?

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• A recession and a depression describe periods during which the economy shrinks, but they differ in severity, duration, and scale.
• A recession is a decline in economic activity spread across the economy that lasts more than a few months.
• A depression is a more extreme economic downturn, and there has only been one in US history: The Great Depression, which lasted from 1929 to 1939.

Economic downturns are a lousy time for everyone. You may be worried about losing your job and being able to pay your bills — or you may be alarmed at just how abruptly that little red line that represents your investment portfolio has dropped. It's even worse if that red line represents your 401(k) savings. As a result, it can be helpful to know the signs of a recession, as well as the different ways this term is defined. 

While you've probably heard the terms "recession" and "depression" before, you may not know what they actually mean and what the difference is between the two. Chiefly, a depression is a more severe, long-lasting recession that extends beyond the confines of a single country's border and into the economies of other nations.

To help you better understand the business cycle and prepare for the twists and turns of an economic crisis, here's what you need to know about recessions, depressions, and how they're different. 

What is a recession?  

Defining a recession , technical definition .

The technical definition of a recession is "a significant decline in economic activity that is spread across the economy and that lasts more than a few months," according to the National Bureau of Economic Research (NBER), a nonprofit organization that officially declares U.S. recessions and expansions. 

An economic recession is often defined as a decline of real (meaning inflation-adjusted) gross domestic product (GDP) for two consecutive quarters — but it's not that simple. Over the course of a business cycle, you might see GDP contract for a period of time, but that doesn't necessarily mean that there's a recession. 

The NBER takes a broader view. The group defines recessions as "a significant decline in economic activity spread across the economy, lasting more than a few months," with indicators including:

• Decline in real GDP
• Decline in real income
• Rise in unemployment
• Slowed industrial production and retail sales
• Lack of consumer spending

The NBER's view of recessions takes a more holistic outlook of the economy, meaning recessions are not necessarily defined by one single factor. But many of these factors are intertwined, meaning a significant drop in something like GDP could rattle consumer spending or unemployment.

In simpler terms 

A recession can be defined as a time during which the economy shrinks, businesses make less money and the unemployment rate goes up. The business cycle is not characterized by neverending increases in GDP. As a result, there are times when this economic yardstick is decreasing, and if it declines for a long enough time, the economy has entered recession. 

These periods of economic decline frequently last about a year, according to figures provided by the International Monetary Fund (IMF). 

During these times, many economic indicators experience notable declines. Investment and production both decline, according to an IMF paper. Consumption also declines, which reduces the overall demand for goods and services created by corporations. 

This, in turn, can reduce profitability and motivate companies to lay off employees in an effort to ensure their bottom line remains healthy. 

It is worth noting that while recessions frequently last about a year, expansions generally last longer , as the economy is usually growing in size, according to the IMF. 

More specifically, the global organization examined 21 advanced economies between 1960 and 2007, revealing that they were in recession roughly 10% of the time, at least according to this sample. 

Causes of recession

Generally speaking, expansion and growth in an economy cannot last forever. A significant decline in economic activity is usually triggered by a complex, interconnected combination of factors, including:

Economic shocks 

An economic shock is an unpredictable event that causes widespread economic disruption, such as a natural disaster or a terrorist attack. The most recent example of such a shock was the COVID-19 outbreak, which triggered a brief recession. 

Another example of an event that served as a shock to the economy was Hurricane Katrina. One estimate was that this natural disaster caused $200 billion worth of damage, according to figures from the U.S. Bureau of Labor Statistics. 

High interest rates 

High interest rates make it more expensive for consumers to borrow money. This means that they are less likely to spend, especially on major purchases like houses or cars. Companies will probably reduce their spending and growth plans as well because the cost of financing is too high.

Asset bubbles

During an asset bubble, for example a housing bubble , the prices of investments like tech stocks in the dot-com era or real estate before the Great Recession rise rapidly, far beyond their fundamentals. These high prices are supported only by artificially inflated demand, which is caused by overly optimistic expectations of future asset values. This artificially inflated demand eventually dissipates, and the bubble bursts. At this point, people lose money and confidence collapses. Both consumers and businesses cut down on spending and the economy goes into recession. 

Loss of confidence

The sentiment of consumers has a substantial impact on the economy. Consumer spending accounts for close to 70% of U.S. GDP, so when these individuals tighten up their purse strings, it can tip the economy into recession. Even if this change in mindset is not enough to trigger a recession, a drop in consumer demand gives companies less incentive to produce goods and services, which can in turn motivate them to lay off employees in order to maintain profitability.

It is worth noting that the confidence of business executives, as well as other key decision makers in corporations, has a substantial impact on the health of the economy. If these decision makers become less confident, then they could cut budgets, laying off workers and potentially reducing expenditure on capital equipment in an effort to bolster profitability. 

To understand the macroeconomic variables that constitute recessions, Giacomo Santalego , PhD, a senior lecturer of economics at Fordham University, says it's important to acknowledge the relationship between recessions and the business cycle.

A business cycle tracks the up-and-down fluctuations natural to any capitalistic economies. Because the cycle traces the wide-ranging upward and downward comovements of economic indicators, it is often a focal point for monetary and fiscal policy as governments attempt to curtail the effects of these peaks and valleys.

Business cycles are understood as having four distinct phases:

• Expansion: This phase represents a period of economic growth, also considered the "normal" phase of the business cycle. It is often characterized by an increase in employment and a swelling of consumer spending and demand, which leads to an increase in the production and cost of goods and services.
• Peak: The highest point of a business cycle that signifies when an economy has reached its crest of output. Here, there's nowhere to go but down, sending the economy into a contraction phase. This can happen for any number of reasons, either investors get too speculative and create an asset bubble or industrial production starts outpacing demand. This is commonly seen as the turning point into the contraction phase.
• Contraction: A period that is marked by a decline in economic activity often identified by a rise in unemployment as well as a bear market . Additionally, GDP growth falls under 2%. As growth contracts, the economy enters a recession. 
• Trough: A peak is to an expansion what a trough is to a contraction. A trough marks the bottom of a business cycle's economic activity and marks the start of a new wave of expansion and a new business cycle. This is a turning point that's followed by a new wave of expansion. 

It's important to note that business cycles do not occur at predictable intervals. Instead, they are irregular in length, and their severity is reflected by the economic variables of the time. That said, the average post-World War II business cycle lasted 65 months, according to the Congressional Research Service . 

What is a depression? 

An economic depression is typically understood as an extreme downturn in economic activity lasting several years, but the exact definition and specifications of a depression are less clear. 

"The way people think about it is a depression is a more widespread and severe recession," says Laura Ullrich, senior regional economist with the Federal Reserve Bank of Richmond, says, "but there is no clear-cut moment where we can say 'we hit X unemployment rate or Y GDP growth — we're now officially in a depression.'"

The NBER notes that economists differ on the period of time that designates a depression. Some experts believe a depression lasts only when economic activity is declining, while the more common understanding is that a depression extends until economic activity has returned to close to normal levels. 

A depression is a more severe recession. However, it's a little tricky to concretely, quantifiably describe the difference between a recession and a depression, mainly because there's only been one. 

Because economists do not have a set definition for what constitutes a depression, the general public sometimes uses it interchangeably with the term recession. However, the difference makes itself evident when you compare the Great Recession to the Great Depression. 

Generally speaking, a depression spans years, rather than months, and typically sees higher rates of unemployment and a sharper decline in GDP. And while a recession is often limited to a single country, a depression is usually severe enough to have global impacts.

How recessions affect you 

Job losses .

One major consequence of economic downturns is job losses. When the economy starts to contract, revenues decline, which gives companies substantial incentive to lay off employees in order to turn a profit. A perfect example of how a downturn can cause employers to eliminate jobs is the recession that coincided with the COVID-19 pandemic. The global pandemic began in early 2020, and during March, April and May of that year, the nation's employers shed 1.5 million jobs, according to figures from the Bureau of Labor Statistics. Further, economic downturns result in reduced tax revenue, which can prompt governments to lay off workers. Many state governments, in particular, need to balance their budgets each year, which can cause them to slash jobs. 

Reduced income 

Economic downturns can lower the income of residents by eliminating jobs and lowering wages. In addition, companies reduce investment in capital equipment during recessions, which lowers productivity. This can, in turn, adversely impact wages. Lowered incomes can have significant impacts on the economy in the long-term, for example undermining nutrition and making it more difficult for people to pursue college education. Both of these adverse effects can impact productivity in the long-run. 

Difficulty finding work 

One very noticeable impact of an economic downturn is a tighter labor market. When the economy goes into recession, many jobs will get eliminated, both in the public and private sectors. This can increase the number of applicants for every available position, resulting in a highly competitive labor market. This increased competition for jobs can undermine the power that employees have to demand adequate compensation, which can in turn place downward pressure on salaries and wages. 

Declining investments 

One common challenge that investors encounter during economic downturns is the impact that falling asset values can have on their net worth. When the economy goes into recession, the value of assets held by everyday investors, for example stocks and real estate, can decline substantially. This can undermine the value of their retirement accounts and also wealth they hold outside of these accounts, for example in brokerage accounts. When investors feel less wealthy, it can make them less likely to spend, something referred to as the wealth effect . This can in turn contribute to further economic contraction. 

Recession FAQs 

The length of a recession varies, from a matter of months to multiple years. According to IMF research cited in this piece, recessions typically last a year. 

Economists at the National Bureau of Economic Research (NBER) officially declare US recessions. 

Yes, you can prepare for a recession by paying off debt, building up savings and also creating a diversified investment portfolio. 

Governments may respond to recessions by cutting taxes or spearheading other forms of economic stimulus in order to fuel expansion. 

Yes, there are different types of recessions, which can vary in terms of length and intensity. A depression, for example, is a severe recession. 

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