Understanding the Causes of Depression: The Road to Darkness

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By Mike DuBose with Dr. Surb Guram, MD

At some point in life, everyone experiences sadness or worry. These feelings are often caused or enhanced by issues like relationship problems, death of friends or family members, retirement, job loss, personal or career failures, or negative world events and can give individuals a gloomy outlook on life. Fortunately, for most of us, these feelings are temporary. We still can experience joy over the little things even when we are going through one of life’s rough patches, and we know that, eventually, the cloud of sadness will pass.

Those who suffer from depression, however, don’t just experience a bout of sadness that lifts after a few weeks—it’s a lengthy, sometimes debilitating feeling that can last months or even years. During this time, the unpredictable rollercoaster of depression impacts all aspects of their lives and those of their loved ones. Depressed people face a complex, frustrating, and challenging road to understanding why they feel the way they do, learning how they can feel better again, and pulling themselves out of the depths of despair.

Depression is hard to explain to those who haven’t experienced it. Even trained psychiatrists, counselors, and medical doctors may not understand the true horrors of depression unless they’ve suffered through it themselves. Drawing from family experiences with situational depression, as well as interviews with individuals who have been diagnosed with several different variations of the illness, here’s an attempt to describe how it feels to be seriously depressed:

You’re unable to sleep at night. It’s like you can feel the negative hormones circulating in your bloodstream and the harmful acids eating away at your churning stomach. When you do manage to sleep, you wake up in the early morning hours dreading the appearance of the sun, your greatest enemy. It’s an effort just to get out of bed in the morning, much less to function as a parent, spouse, or employee. You feel guilty about all the people you’re letting down, but powerless to change anything.

Life is exhausting, and the only way you get through is to push your way forward, hour by hour, and sometimes even day by day. You put on a mask and try to keep your act up, hoping that the next day will get better...but the same dark, dreary cloud that was with you the night before greets you again the next morning. For temporary relief, you may escape by numbly staring at a television or smartphone screen, drinking too much alcohol, or abusing drugs. Your behavior might even drag loved ones into the dark pit with you, as if your depression is contagious. You feel anxious, find it hard to make decisions, and often procrastinate.

You feel embarrassed and angry about the illness and its impact on your life, but you hide your thoughts and feelings from others. Your depression becomes a secret! Yet the negative feelings are always lurking in the background, waiting to pull you down dark roads as despair, irritation, frustration, impatience, and unrealistic thoughts set in. “Will I ever get better?” you may wonder. “Is this all life has to offer?

The National Institute of Mental Health estimates that 19 million Americans are living with some form of depression, so chances are high that you or someone you know has experienced this difficult illness. Unfortunately, because most symptoms are mental and emotional rather than physical, some people don’t consider depression to be a serious illness. In reality, it’s just as real as cancer or a broken leg...and it’s no cause for shame, embarrassment, or denial!

Sadly, despite hard evidence that depression is beyond the control of those stricken with it, some individuals still view it as a weakness. They resist treatment, which can often be a deadly choice. Depression’s negative effects can extend to the body; as Harvard University Medical School reported, there is a direct link between depression and heart disease, among other serious medical problems. Even more dangerous: one in every 10 depressed individuals commits suicide, according to WebMD. Therefore, it’s very important to take the issue seriously and treat it as you would any other medical issue.

What Is Depression?

Whether you’re getting help for yourself or simply seeking to relate to what others are going through, it helps to understand what depression is and the causes of this serious (and sometimes deadly) disorder. The blanket term “depression” can refer to several different variations of the illness. No two people experience depression in the same way; indeed, as Mitch Golant, Ph.D. and Susan K. Golant note in their book, What to Do When Someone You Love Is Depressed, “There is a continuum of emotional experience that ranges from a simple case of the blues to full-blown clinical depression.” Throughout their lives, individuals may experience depression on different occasions and at varying levels of severity.

Scientists have classified six primary types of depression, which Harvard University Medical School lists as: major depression, persistent depressive disorder, seasonal affective disorder, bipolar disorder, perinatal depression, and premenstrual dysphoric disorder (the latter two are only applicable to women). Another variation, situational depression, is shorter-term than most other types of depression and typically occurs after a major, life-altering event. Of these seven types, the two most common forms are major depression (also known as clinical depression) and persistent depressive disorder, or dysthymia.

Depression and Anxiety

Depression is closely related to anxiety, another type of mental disorder. There are many forms of anxiety, including generalized anxiety disorder, phobias, and panic disorder. The common thread is that their sufferers worry to a degree that interferes with their day-to-day lives.In a Psychology Today article, clinical psychologist Leon Seltzer, PhD, describes what life is like for individuals with anxiety disorders: “Experiencing fear—or even panic—with (objectively, at least) very little provocation, they live lives of chronic worry, insecurity, and a truly frightening sense of vulnerability. Tense, nervous, and hypervigilant (whether about a specific situation or just in general), it's difficult for them to relax or ‘let go.’” 

Since depression is often marked by symptoms like lethargy, sleepiness, and loss of interest in things one once enjoyed, it may sound like anxiety is a very different disorder. We think of depressed people as having very little energy at all, and of anxious people as being a bundle of nervous energy. However, depression and anxiety have more in common than is initially apparent. Both involve feelings of hopelessness and being overwhelmed by life, and both are driven by feelings of inadequacy and negativity about oneself. They can manifest themselves in physical ways, such as a depressed person’s weight loss or an anxious person’s panic attacks.

Researchers have not pinpointed the exact causes of anxiety or depression, but both are thought to be linked to a mix of environmental factors, genetics, and differences in brain chemistry. Seltzer notes in his article that anxiety and depression often occur within people at the same time, writing, “it's been estimated that 85% of depressed patients are also afflicted with generalized anxiety disorder (GAD)—and, more generally, that over 60% of depressives experience varying levels of anxious feelings and behavior. Further, no fewer than 53.7% of individuals with anxiety disorders concurrently experience major depression, and 35% of depressives are also estimated to suffer from panic attacks.”

Clearly, it’s not only possible, but actually common for anxiety and depression to coincide in one person at the same time. Those individuals suffering from both may become anxious about their depression and depressed about their anxiety! Fortunately, many prescription drugs used to fight depression also alleviate anxiety, and talk therapy—particularly, cognitive behavioral therapy—can be a very effective component of a treatment plan for anxiety as well as depression.

If you believe that you may have anxiety in addition to depression, be sure to speak with your doctor about it. Because the two disorders are so closely related, both must be treated for you to experience improved mood and return to a normal, happy life. You’ll want to seek a counselor with experience in treating both anxiety and depression to ensure that all of your therapy needs are addressed.

Diagnosing Depression

Although there are many similarities between the different categories of depression, their symptoms, causes, and treatments vary. According to the National Institute of Mental Health, “Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many.”

There is one strategy that is beneficial to all types and situations, though: if you are experiencing any type of depression, seek medical help. Your doctor can assess your medical condition and direct you to specialists who can assist you in regaining happiness. As with any profession, there are excellent mental health professionals out there, as well as some that do less than quality work. From our experience, the wait time to see good psychiatrists, psychologists, and counselors can sometimes be lengthy! However, it’s worth the effort for individuals with any type of depression to have hope again. As singer Demi Lovato, who has been diagnosed with bipolar disorder (also known as manic depression), said in Women’s Health magazine, “it’s possible to live well, feel well, and also find happiness with bipolar disorder or any other mental illness they’re struggling with.”

When you speak to your doctor about the possibility that you have depression, he or she will likely ask you about the following information to help reach a diagnosis:

  • Any symptoms you’ve had (including any that may seem unrelated to the reason for your appointment) and when they started, how long they have been occurring, and how severe they are
  • Major life changes or stressors you are going through or have recently experienced, including divorce, job loss, retirement, career change, moving, the death of a friend or family member, a serious accident, diagnosis of another serious medical issue, etc.
  • Personal and family history of depression
  • Medications, vitamins, and supplements that you are taking and their dosages

Your physician may want to run blood or other tests to rule out a physical reason for your depression. Some medical conditions (such as thyroid problems, medication side effects, viruses, brain tumors, or vitamin deficiencies) can cause symptoms similar to depression. Once your doctor has eliminated any other causes, he or she can help you understand the type of depression you have, its causes, and potential treatments. Your physician may also administer a “test” known as the PHQ-9 questionnaire, asking you specific questions about your mood and daily activities to assist in both diagnosing and staging your clinical situation.

Major (Clinical) Depression

If you have been experiencing some or all of the following symptoms on most days, then you may have major depression (also called clinical depression):

  • An all-consuming dark or sad mood, often to the point where it’s noticed by others
  • Feelings of emptiness or being “dead inside”
  • No longer caring about foods, activities, or other things you once enjoyed
  • Withdrawing from friends and family members
  • Feelings of worthlessness; excessive self-criticism or guilt
  • A sense of hopelessness or helplessness
  • Constant fatigue, moving or talking slower than usual, or feeling like you’re always “dragging”
  • Irritability
  • A fog that hampers thinking
  • Restlessness and/or anxiety
  • Inability to concentrate, remember things, or make decisions
  • Changes in appetite; significant weight loss or weight gain
  • Unexplained physical issues (like headaches, pain, or digestive problems) that don’t clear up with treatment
  • Disrupted sleep patterns (wanting to sleep all the time or having trouble sleeping)
  • Sexual problems or lack of a desire for intimacy
  • Recurrent thoughts of death or attempting suicide

According to the American Psychiatric Association, depression usually appears during individuals’ late teenage years to early twenties, although it can strike at any age. Some people with the illness will only experience one episode in their entire lives, but most will have several periods where they endure this severe sadness. Women are more likely to suffer from major depression than men: some studies say that one in three women will have a major depressive episode at some point in their lifetime.

The University of Michigan Depression Center notes that “many factors may contribute to the onset of depression, including genetic characteristics, changes in hormone levels, certain medical illnesses, stress, grief, or substance abuse.” For more than 50 years, scientists thought that an imbalance of serotonin, a chemical messenger in the brain, was the primary cause of depression, but that assertion is being questioned more frequently as new research surfaces. One issue is that there is no way to measure the level of serotonin in the living brain, so there can be no evidence proving the link between serotonin levels and depression. Many researchers still believe that serotonin plays a role, but they also point to many other neurotransmitters—including acetylcholine, norepinephrine, dopamine, glutamate, and gamma-aminobutyric acid (GABA)—that should also be considered for their potential impact on mood.

Although depression’s causes are unclear, certain risk factors are widely recognized as making someone more likely to have depression:

  • Differences in certain chemicals in the brain
  • Family history of depression
  • Personality tendencies like pessimism and low self-esteem
  • Environmental factors like poverty or extended exposure to violence, neglect, or abuse
  • Childhood sexual, physical, or emotional abuse
  • Abusing alcohol and other drugs

Some medications are also known to increase the risk of depression, including: prescription and over-the-counter sleepingaids, sedatives, tranquilizers, beta-blockers, contraceptives, anti-convulsants, anti-migraine drugs, anti-psychotics, and hormonal agents. Depression can also be exacerbated by other illnesses (and vice versa). According to the National Institute of Mental Health, “Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present.”

Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder (SAD) is a specific type of depression that is linked to the time of year. Sufferers generally experience depression during the fall and winter, when natural sunlight decreases, and feel better in spring and summer. During the seasons when they are depressed, people with SAD have many of the same symptoms associated with major depression.

Scientists believe that SAD may be related to alterations in the body's natural daily patterns (also known as circadian rhythms) that surface with the change in seasons. Reduced sunlight, as is common in winter months, is related to a decrease in serotonin in the brain, which may also have an impact on seasonal depression. Melatonin, which affects sleep quality and mood, is another brain chemical whose levels may change across the seasons, potentially influencing individuals’ likelihood of SAD. Family history of Seasonal Affective Disorder, having major depression or bipolar disorder, and distance from the equator (those who live further away are exposed to less sunlight on winter days than those who live close to the middle of the earth) are all cited by the Mayo Clinic as risk factors for SAD.

Situational Depression

Some individuals experience a disorder much like major depression, but on an episodic rather than chronic basis. This situational depression usually stems from a person’s inability to adjust to a source of great stress or grief. It can be caused by major life changes like divorce, a significant loss (like the death of a parent, close relative, friend, or beloved pet), unemployment, business failure, relationship problems, or traumatic event (such as being the victim of a crime or surviving a natural disaster). Many symptoms of situational depression, such as fearfulness, insecurity, hopelessness, and loss of interest in work or activities, are the same as those experienced by people suffering from major depression.

Most individuals with situational depression begin experiencing symptoms within three months of the stressful or traumatic event. Although it can last longer, in most cases, this type of depression is usually short-term, ending within six months or when the problem that triggered the depression is resolved. Adjustment disorder can occur in anyone at any age, but is most typical during the parts of life where people make major changes (retirement, adolescence, etc.).

Persistent Depressive Disorder (Dysthymia)

People with persistent depressive disorder, also called dysthymia, exhibit symptoms of depression for at least two years, although they may not always be as severe as those experienced as part of major depression. Harvard University Medical School notes, “Many people with this type of depression type are able to function day to day, but feel low or joyless much of the time.” Common symptoms of persistent depressive disorder are similar to those related to major depression and include:

  • A generally low mood for long periods of time
  • Loss of interest in daily life
  • Avoidance of social activities
  • Hopelessness
  • Tiredness and a lack of energy
  • Trouble concentrating
  • Anger and irritability
  • Decreased productivity and activity levels
  • Loss of appetite and weight
  • Sleep changes
  • Decreased energy
  • Low self-worth or self-esteem

The precise cause of persistent depressive disorder is still unknown, but scientists report that many of the same factors believed to cause major depression (differences in brain biology and chemistry, genetics, and personal history) are also triggers for persistent depressive disorder. The Mayo Clinic notes several risk factors, including:

  • Having a first-degree relative with major depressive or other depressive disorders
  • Traumatic or stressful life events, such as the loss of a loved one or financial problems
  • Personality traits that include negativity, such as low self-esteem or being too dependent, self-critical, or pessimistic
  • History of other mental health disorders, such as a personality disorder

Bipolar Disorder

Bipolar disorder differs from depression in that people who have it experience deep “lows,” but also “highs.” Reflecting the swings from depression to euphoria (also known as “mania”) and back again that typically occur in those who have it, bipolar disorder is sometimes called “manic depression.” Symptoms of mania are very different from those of depression:

  • Excited, elated mood
  • Impulsiveness
  • High energy
  • Talking faster and more
  • Getting distracted easily
  • Irritability
  • Less need for sleep
  • Racing thoughts
  • Unrealistically high self-esteem
  • Accelerated pursuit of pleasure (overspending, alcohol and other drug use, sexual promiscuity, etc.)
  • Increased risk-taking

After an individual “comes down” from a manic episode, however, they may enter a depressed period, feeling ashamed and guilty about what they did while they were in a manic state. In their depressive state, people with bipolar have symptoms similar to that of major depression. Interestingly, manic and depressive episodes may conform to the seasons, as in individuals with seasonal affective disorder.

More than five million adult Americans have bipolar disorder, according to Depression and Bipolar Support Alliance figures. Individuals usually develop the disorder between their teens and thirties, and it typically lasts a lifetime. Men and women are equally as likely to have bipolar disorder, and it exists across all races and socioeconomic groups. According to the National Institutes of Health, as many as one in every five people with bipolar disorder will take their own lives.

Like major depression, bipolar disorder’s root cause remains unknown, but one prominent theory is that it results from physical differences in the brain (rather than emotional trauma, as in many other mental health issues). One thing that is certain is that it tends to be hereditary. Evidence also suggests that two chemicals in the brain, serotonin and norepinephrine, become disordered in people with bipolar. In fact, greater than two-thirds of people with the disorder have at least one close relative with bipolar or major depression, the National Institute of Mental Health reported.

Perinatal Depression

Unique to women, perinatal depression occurs during pregnancy or in the first 12 months after giving birth (it is also known as postpartum depression if it takes place after delivery). Between 10 and 20 percent of women experience perinatal depression or anxiety. Postpartum Support International calls it “the most common complication of childbirth.”

Perinatal depression is different from the “baby blues” (mild anxiety and depression that dissipates within two weeks of giving birth) in that it’s much more severe, mirroring major depression in many ways. Symptoms can appear abruptly any time in the year after delivery. They include:

  • Feelings of extreme sadness, hopelessness, guilt, or shame
  • Anger or irritability
  • Anxiety, especially worries about the baby
  • Lack of interest in one’s infant or family
  • Exhaustion
  • Appetite and sleep disturbances
  • Persistent crying or weepiness
  • Loss of interest, joy, or pleasure in activities the mother previously enjoyed
  • Thoughts of harming oneself or the baby

Physical and emotional factors are thought to contribute significantly to perinatal depression. The hormones estrogen and progesterone drop dramatically after a woman gives birth, and hormones produced by the thyroid gland also decrease, which can make a new mother feel depressed and tired. Sleep deprivation from dealing with a crying newborn can add to these feelings, as can worries about life, the baby, and the future.

Risk factors for perinatal depression include:

  • Personal or family history of depression, anxiety, or postpartum depression
  • Premenstrual dysphoric disorder (PMDD) or PMS
  • Inadequate support in caring for the infant
  • Unplanned or unwanted pregnancy
  • Young age of the mother
  • Infant sickness, special needs, or hospitalization
  • Financial- or relationship-related stress
  • Pregnancy, birth, or breastfeeding complications
  • Major life events like job loss, death of a friend or family member, or moving
  • Having multiple babies (twins, triplets, etc.)
  • Having gone through infertility treatments
  • Thyroid imbalance
  • Any form of diabetes (types 1 and 2 or gestational)

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) affects only women of childbearing age. It has many similarities to premenstrual syndrome (PMS), but is much more severe. The symptoms, which usually start at ovulation and end at the beginning of menstruation, are:

  • Mood changes (anger, sadness, hopelessness, anxiety) and swings between different moods
  • Withdrawal from usual activities
  • Self-critical thoughts
  • Irritability
  • Trouble concentrating
  • Panic attacks
  • Excessive sleepiness or insomnia
  • Fatigue
  • Changes in appetite or food cravings
  • Weight gain
  • Gastrointestinal problems, including bloating and constipation
  • Skin problems like acne
  • Muscle pain
  • Breast or pelvic pain

PMDD is clearly linked to the female menstrual cycle, but like other depressive disorders, it has an unclear etiology. Johns Hopkins School of Medicine reported that it might be spurred by abnormal reactions to hormone changes (especially serotonin levels). There are some common risk factors, however, including family history of PMS or PMDD; personal or family member depression, postpartum depression, or other mood disorders; low education levels; and substance use.

The bottom line: Depression is a serious health problem and deserves to be treated like any other illness. However, some individuals sense that there is a stigma surrounding depression and other mental health issues and refuse to seek help, despite the growing societal acceptance that depression isn’t a reason for shame. Celebrities such as Jon Hamm, Ashley Judd, Alec Baldwin, Eric Clapton, Owen Wilson, Lady Gaga, Jean Claude Van Damme, and hundreds of others have spoken publicly about their battles with depression, helping to show that even wealth and fame aren’t enough to prevent depressive disorders. Along with groups like Families for Depression Awareness, seeing depression spoken about openly in the news raises awareness of its prevalence and seriousness. Those who avoid seeking treatment can expect to live a life of misery! Fortunately, there is hope: treatment helps over 80% of individuals who seek it, according to the National Mental Health Association. If you have symptoms of depression, don’t prolong your suffering. See your physician for an examination and start treatment to live a better, happier, and healthier life!

Read our second segment in this two-part series at https://www.mikedubose.com/blog/treating-depression-emerging-from-the-darkness to learn more about treatments for depression.

About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, research, experiences, successes, and mistakes. You can e-mail us at katie@dubosegroup.com.

Mike DuBose, a former licensed counselor, received his graduate degree from the University of South Carolina and is the author of The Art of Building a Great Business. He has been in business since 1981 and is the owner of Research Associates, The Evaluation Group, Columbia Conference Center, and DuBose Fitness Center. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional business, travel, and personal articles, as well as health articles written with Dr. Surb Guram, MD.

Dr. Surb Guram, MD is a board-certified internist and a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.

Katie Beck serves as Director of Communications for the DuBose Family of Companies. She graduated from the USC School of Journalism and Honors College.

© Copyright 2018 by Mike DuBose—All Rights Reserved. You have permission and we encourage you to forward the full article to friends or colleagues and/or distribute it as part of personal or professional use, providing that the authors are credited. However, no part of this article may be altered or published in any other manner without the written consent of the authors. If you would like written approval to post this information on an appropriate website or to publish this information, please contact Katie Beck at Katie@dubosegroup.com and briefly explain how the article will be used; we will respond promptly. Thank you for honoring our hard work!