Depression is one of the most debilitating and costly conditions in the world today. According to the WHO (world health organization) over 264 million people suffer from depression globally. Between medical costs, loss of productivity, and missed days from work the total cost of depression is reported to be 210.5 billion per year. While some are more likely to experience major depression no one is completely safe from this mental illness. By raising our awareness and understanding of this condition we can live our lives in a way that may reduce the likelihood of depression. We can also be more prepared to deal with this condition if it does arise. Before we can understand what causes depression or how to treat it we need to understand what it is.
What is depression?
Depression (also known as major depressive disorder) is a mental health illness that negatively impacts how you think, feel, and act. It is marked by feelings of sadness, worthlessness, low energy, increased fatigue, and a general loss of interest in life. Those in the throes of major depression experience a sense of great despair and meaninglessness. They can’t seem to find any purpose or reason to go on living. 15% of people struggling with depression will eventually commit suicide.
One of the major problems with diagnosing depression is that half of Americans with this condition won’t seek out any help. The people who do seek out help usually go to primary care physicians who don’t know much about psychiatric conditions. According to the DSM-5 for an individual to be diagnosed with MDD (major depressive disorder) they must be experiencing five or more of the below symptoms within a 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
2. Decreased interest or pleasure in most activities, most of each day
3. Significant weight change (5%) or change in appetite
4. Change in sleep – Insomnia or hypersomnia
5. Change in activity – Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Guilt/worthlessness – Feelings of worthlessness or excessive or inappropriate guilt
8. Concentration -diminished ability to think or concentrate, or increased indecisiveness
9. Suicidality – Thoughts of death or suicide, or has a suicide plan
While the DSM-5 looks to diagnose Major depressive disorder, having even a couple of these symptoms over several weeks can be an indication of a mild form of depression.
What causes depression?
To understand what causes depression it is best to look at this condition through the bio-psycho-social model. This model looks at the interaction of our biology, psychology as well as social and environmental factors. Our body, mind, and environment are interconnected feedback loops. Problems with our physical health can often cause problems with our mental health and vice versa. For example, a person with heart disease is more likely to become depressed just as a person with depression is more likely to have heart disease. We can have physical issues and still cope well mentally but additional social or environmental factors can push us over the edge.
It is often not one thing but a combination of factors that breed depression. Adverse and difficult life events can serve as triggers for depression. But we may find it surprising that even a positive change such as getting married or having a baby can activate depression. Major changes can shift our sense of identity which is distressing for some. As our stress levels increase so does the likelihood of depression.
Are depression and anxiety-related?
There is a direct correlation between depression and anxiety. Anxiety can trigger depression and depression can trigger anxiety. While depression is a low energy state and anxiety is a high energy state they often arise from similar factors. 50% of patients with an untreated anxiety disorder will descend into major depression within five years.
Is Depression Genetic?
For a long time, it was believed that depression was caused strictly by biological or genetic factors. Children, whose parents are depressed are more likely to become depressed but is this due to genetics? While there are genes that are related to depression, they only become a factor when they are activated through the environment. This indicates that learned behavior may be a greater influence on depression than our genetic makeup.
Trauma’s correlation with depression
The more traumatic experiences you had as a child the more likely you are to become depressed as an adult. Almost all mental health issues stem from unprocessed and unhealed traumas. For example, 81% of patients diagnosed with borderline personality disorder at Cambridge hospital experienced severe childhood trauma. We often think of trauma as violence or sexual molestation but trauma can be much more subtle.
A parent’s inability to respond in emotionally intelligent ways to their child’s distress can create trauma. Our ability to deal with adversity is greatly shaped by the level of security we experience with our primary caregiver in our first two years of life. Children who grow up experiencing a secure connection with their caregiver will be more resistant to depression as adults. Those who lack that security tend to be less stable psychologically and more prone to depression.
Depression is disconnection from what is meaningful
Each case of depression is unique but at its core, all depression is a form of disconnection. The more we experience disconnection from what is meaningful to us the more likely we are to experience depression. Let’s explore some of the ways we can experience disconnection in our lives.
1.Disconnection from meaningful relationships
Social media has allowed us to connect to more people than ever before. The problem is most of these connections are superficial. What matters in relationships is not quantity but quality. When we lack meaningful relationships we experience loneliness. Loneliness isn’t the physical absence of others but the inability to connect on a sense of shared meaning. New meta-analysis research shows that loneliness may be as hazardous to your health as smoking or obesity. The lonelier we get the harder it becomes to form new bonds. As we withdraw from social contact we become more prone to depression.
2.Disconnection from meaningful work
Another pathway to depression is spending the majority of your life doing work you don’t enjoy. While this number has decreased there are still 13% of people in the US who are actively disengaged from their work which is a politically correct way to say they hate what they do for a living.
3.Disconnection from meaningful values
What truly matters in life? Most wouldn’t say material possessions yet many of us live like that is our highest goal. One meta-analysis study showed a correlation between materialistic values and increased levels of depression and anxiety. On average Americans who make 75k or more won’t increase happiness by increasing their income. This number has to be adjusted to where you live but the majority of happiness is experienced through having our basic needs met. Still many of us fall for the illusion that more money equals more happiness. Our hunger to acquire more possessions is often due to our desire for more status. But status is a zero-sum game that alienates us from others and doesn’t bring us any lasting fulfillment.
4.Disconnection from Nature
Our disconnection from nature is another factor that can be hurting our mental health. The biophilia effect states that humans exposed to nature tend to experience lower levels of stress, as well as increased well-being and healing. Being stuck in a concrete jungle looking at brick walls all day creates the opposite effect. We have evolved to thrive in natural landscapes and find a sense of fulfillment just being in their presence. While there are advantages to living in big cities they come with more than just financial costs.
The current treatments for depression include talk therapy, medication, and electroconvulsive therapy (ECT). The safest of these treatments is talk therapy although it is slow acting and not always effective. Therapy helps a patient understand their condition but it doesn’t necessarily show them how to change. Antidepressants work a lot quicker but can come with unpleasant side effects. Medication can also require some testing to figure out the right dose and drug combination. Antidepressants work about 50% of the time and if side effects are experienced they are usually preferred to depression. The combination of therapy and medication is more effective for treatment than either one alone. Electroconvulsive therapy (ECT) is the riskest but also potentially most effective form of treatment. The side effects are usually short-term memory loss and in some cases long-term memory loss. ECT has a significant impact between 75-90% of the time and half of those who saw positive results will still feel good a year after treatment. Others may need repeated rounds of ECT treatment or ongoing maintenance sessions.
Alternative treatments for Depression
Both therapy and antidepressants are well-known modalities but there are new breakthrough treatments moving into the spotlight. Ketamine, an anesthetic, and once-popular party drug has shown promise for providing fast-acting relief to those suffering from depression. Ketamine clinics are popping up all around the world, providing ketamine in the form of intravenous infusion or nasal spray. The ketamine seems to trigger a response that repairs damaged neuron synapses in the brains of depressed patients.
The other alternative treatment for depression is psychedelic plants. Studies done in NYU and John Hopkins showed that psilocybin (the psychedelic compound found in mushrooms ) was effective in alleviating anxiety and depression in cancer patients. After only one experience 80% of the patients reported an improvement in mood and a reduction in anxiety. These benefits seemed to last for up to 6 months after the initial experience. Additionally, 67% of participants reported that this was one of the top five most meaningful experiences in their lives. There are still many legality issues surrounding psychedelics but increasing evidence of positive effects is encouraging a release of restrictions.
Depression is a mental illness that causes millions of people in the world debilitating despair and meaninglessness. There is no one cause of depression but rather a cocktail of biological, psychological, social, and environmental factors that contribute to this condition. While some genes are related to depression they have to be activated by the environment first. Nurture rather than nature seems to have a greater influence on our propensity to experience depression. This is evident with child-hood trauma, which depending on its frequency and severity increases the likelihood of depression.
While the causes of depression vary, at its core most depression is a disconnection from what is meaningful. Luckily there are many treatments available for those suffering from depression. A combination of antidepressants and therapy is the current go-to treatment although it is not effective for all. Those needing a more immediate intervention may opt in to try ECT (electroconvulsive therapy) although there are the potential side effects of memory loss. Both ketamine and psychedelic therapies are promising alternative treatments that may help those who haven’t seen relief from traditional methods.
What is most important for us to realize is that depression isn’t an individual problem but a collective crisis that is greatly impacted by our society. By gaining a deeper understanding of this condition we can work together towards creating a culture that is more conducive to our mental health.