Understanding depression: its possible causes, signs, and management techniques for recovery
Depression can be misunderstood as simply “feeling low”. However, depression is rather, a more complex mental health condition, which impacts the lives of approximately 280 million people worldwide (World Health Organisation, 2023).
Without paying proper attention to its causes or symptoms, depression can impact daily functioning, relationships, and even one’s physical health. Depression is often, however, unfortunately misinterpreted or even dismissed.
What is depression?
Depression is a chronic mental condition, characterised as a mood disorder which leads to persistent feelings of low mood, in addition to loss of interest (Chand and Arif, 2021).
People with depression often report corresponding feelings of emptiness, irritable mood, alongside corresponding psychological and somatic, or physical, changes which affect the individual’s functioning (Ormel et al., 2019) and thus negatively impact their quality of life.
As such, depression does not usually go away with “positive thinking” or the passing of time since an emotionally negative event has occured, for example, in contrast to occasional sadness or “a case of the blues”.
Thus, recovering from and ultimately overcoming depression requires an active approach to treatment, including lifestyle changes, talking therapy and (where appropriate) medication.
Signs and Symptoms of Depression:
The first step toward getting help for depression is to recognise its signs and symptoms.
Depression is often associated with chemical imbalances in the brain (encapsulated by the monoamine deficiency hypothesis (Delgado, 2000) which suggests that depression is the result of a underlying depletion, or deficiency, of one of the monoamine neurotransmitters: serotonin, norepinephrine and/or dopamine). Depression treatment often requires a holistic, yet robust approach including the following:
- Lifestyle adjustments, including eating a balanced diet, exercising regularly and maintaining an active social life,
- Professional support, including attending therapy sessions and support groups,
- (Where clinically indicated) taking antidepressant medication as prescribed by a medical professional, to balance underlying imbalances in brain chemicals (neurotransmitters).
Common signs of depression can include (but are not limited to):
- Low mood, or persistent sadness
- Loss of interest in daily activities or pastimes (anhedonia)
- Significantly decreased energy levels (fatigue)
- Significant changes in appetite (weight loss or gain)
- Difficulties with attention/concentration, judgement, or decision-making
- Sleep difficulties, including either insomnia or oversleeping
- Feelings of guilt, or no self-worth (worthlessness)
- Physical (somatic) symptoms, such as headaches or stomach upsets with no clear immediate cause
- Thoughts of self-harm or suicide (suicidal/self-harming ideation)
The experience of depression varies from person to person; although some people may experience few symptoms of depression (and thus exhibit mild depression), others may find that living with depression’s symptoms causes great disturbance to their everyday lives, indicating more severe depression.
Types of Depression:
There are several key, or most common forms, of depression, which most diagnoses of depression generally fall into.
Some of the common medically recognised forms of depression include:
- Major depressive disorder (MDD) can be defined medically as severe depressive symptoms, including a persistent depressed mood, loss of interest/pleasure in previously enjoyable activities, recurrent thoughts of death and other physical and cognitive symptoms (Marx et al., 2023). Clinically, for diagnosis of MDD, the symptoms must be present for a period of at least two weeks (Falk et al., 2023), affecting daily functioning alongside day-to-day life.
- Persistent depressive disorder (PDD), which is also known as dysthymia, is a longer term form of depression lasting for at least two years (in adults) or for at least a year (in children and adolescents; Patel et al, 2024.)However, PDD is usually milder than MDD in its symptoms, although PDD symptoms can still affect everyday life.
- Postpartum depression frequently appears in mothers who have recently given birth, causing feelings of sadness alongside anxiety and exhaustion. This emotional strain often makes the transition into motherhood even more challenging for new mothers.
Atypical depression does not neatly fit into the usual categories of depression (for example, MDD or PDD, hence ‘atypical’). People with this type of depression often notice a lift in mood (mood reactivity; Asnis et al., 1995) when positive events happen, unlike the persistent low mood seen in other subtypes of depression.
However, individuals with atypical depression also experience unique symptoms, such as depression accompanied with severe anxiety, or struggling with increased appetite leading to weight gain, and experiencing hypersensitivity to rejection alongside excessive sleep (hypersomnia).
As such, Davidson and colleagues (1982) have defined two broad subtypes of atypical depression – Type A, characterised by concomitant severe anxiety, and Type B, characterised by unique vegetative symptoms, such as changes in appetite, sleep, weight and/or libido (generally increased. These symptoms can thereby affect social interactions, educational pursuits, and/or work life negatively.
Identifying the type of depression is crucial in helping determine the most effective course of action for an individual to take, in conjunction with their support network (friends, family, professionals etc.) and thereby working towards a treatment plan.
What Causes Depression?
Depression is often caused by a range of factors, including psychological, biological, and environmental (including social) factors:
- Biological factors, including imbalances in neurotransmitters linked with positive mood such as serotonin, norepinephrine and dopamine, can greatly influence the origin and emergence of depressive symptoms.
- Psychological factors, such as chronic stress, low self-esteem, or traumatic events can cause, or trigger, depressive symptoms.
- Environmental factors such as a chaotic home environment, financial difficulties, or job stress, can act as triggers for the emergence of depressive symptoms.
- Following on from this, social factors, such as loneliness, a resultant lack of social support, or relationship difficulties, can contribute to (or aggravate) existing depressive symptoms.
Understanding the underlying causes of depression thus facilitates treatment of individuals struggling with depressive symptoms in a more personal, individualised manner.
Is Depression Treatable?
Depression is not a permanent illness, by any means. As such, depression is treatable and there are an array of effective treatments and therapies which can facilitate and support depression recovery:
- Professional Help
- Various types of psychotherapy, including Cognitive Behavioral Therapy (CBT) and psychodynamic psychotherapy, can support individuals to reframe their negative thoughts, thereby developing healthier thinking patterns.
- Counselling can help provide a safe space wherein individuals can discuss their emotions and feelings openly alongside the challenges they face.
- Antidepressant Medicines:
- Antidepressants, or medicines that treat depression, can help balance neurotransmitters (brain chemicals) such as serotonin and dopamine, the deficiency or imbalance thereof playing a key role in depressive symptom pathology, but should always be used under the medical guidance of a mental health professional.
- Common classes of antidepressant medicines include:
- Selective serotonin reuptake inhibitors (SSRIs) (e.g. fluoxetine (Prozac) and sertraline),
- Serotonin-norepinephrine reuptake inhibitors (such as venlafaxine (Effexor)),
- Tricyclic antidepressants (such as, amitriptyline (Elavil)).
- Building a Support Network
- In order to reduce isolation and build emotional resilience, individuals with depressive symptoms can express their feelings in the company of friends, family, or to therapy/support groups in a therapeutic context.
- Practice Self-Care
Individuals struggling with depression can incorporate positive habits into their lifestyle to boost their mood and wellbeing.
These habits can promote self-care and thereby support overall mental health and wellbeing:
- Activities such as treadmill running or lifting weights can help elevate mood by releasing mood-raising endorphins.
- A balanced diet, comprising of appropriate amounts of carbohydrates, proteins and fats alongside being rich in vitamins and omega-3 fatty acids can foster optimal brain health, through supporting healthy levels of dopamine and serotonin.
- Practicing sleep hygiene, for example by not using electronic devices for 60-120 minutes before bedtime can allow individuals with depressive symptoms to have better-quality sleep by limiting their exposure to blue light before sleeping. This helps promote balanced neurotransmitter activity and thereby supporting mental wellbeing.
- Mindfulness practice, including guided meditations, can support individuals to reduce their stress levels significantly, promoting emotional balance.
Why Is Therapy Important For Depression Recovery?
One of the key treatments for depressive symptoms is therapy, which has a number of benefits directly relevant to depression recovery.
Amongst the benefits of therapy, it can support individuals to improve coping skills and resilience, to identify and rectify patterns of unhelpful thoughts and behaviours, manage their relationships better and ultimately address underlying concerns which may be contributing to their depression.
Popular approaches to therapy for individuals with depression include:
- Cognitive Behavioral Therapy (CBT), which focuses on helping the individual to recognise and thereby understand psychological patterns of unhelpful thoughts and behaviours.CBT supports individuals to explore their thoughts, thereby challenging self-limiting or unhelpful thoughts and beliefs, and thus developing more positive, balanced ways of thinking.
- Psychodynamic therapy is a form of talking therapy, often defined as ‘an exploratory approach to therapy’, which facilitates a safe space for the individual to uncover and thereby understand underlying, potentially unresolved psychological issues (including suppressed emotions) that they may be struggling with.
Psychodynamic therapy does not only focus on symptom relief but more importantly it focuses on the root causes of depressive symptoms, for example emotional wounds and thought patterns which may be hidden under the surface but continue to impact your daily life.
- Psychodynamic therapy is a form of talking therapy, often defined as ‘an exploratory approach to therapy’, which facilitates a safe space for the individual to uncover and thereby understand underlying, potentially unresolved psychological issues (including suppressed emotions) that they may be struggling with.
- Dialectical Behaviour Therapy (DBT) is an evidence-based approach to therapy, which supports individuals struggling with depression to develop practical skills for emotional regulation, distress tolerance and mindfulness.
The structured framework of DBT can help support individuals with depression to build healthier coping mechanisms, thereby improving their relationships.
- Dialectical Behaviour Therapy (DBT) is an evidence-based approach to therapy, which supports individuals struggling with depression to develop practical skills for emotional regulation, distress tolerance and mindfulness.
In essence, therapy provides individuals facing challenges with depression the long-term tools for symptom management, strengthening emotional resilience, and rebuilding confidence.
If someone is battling persistent sadness, feeling detached from life, or struggling motivation, professional therapy can act as a beacon of hope and control for an individual to reclaim their life, providing the support and psychological skills they need to rediscover hope and take back control over their lives.
Looking to begin your journey towards depression recovery?
References:
- Asnis, G. M., McGinn, L. K., & Sanderson, W. C. (1995). Atypical depression: clinical aspects and noradrenergic function. The American journal of psychiatry, 152(1), 31–36. https://doi.org/10.1176/ajp.152.1.31
- Chand, S. P., & Arif, H. (2021). Depression. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430847
- Davidson, J. R., Miller, R. D., Turnbull, C. D., & Sullivan, J. L. (1982). Atypical depression. Archives of general psychiatry, 39(5), 527–534. https://doi.org/10.1001/archpsyc.1982.04290050015005
- Delgado P. L. (2000). Depression: the case for a monoamine deficiency. The Journal of clinical psychiatry, 61 Suppl 6, 7–11.
- Falk, A., Joseph, R., Smith, S., & Wilk, A. (2023). Mood and Anxiety Disorders: Major Depressive Disorder. FP essentials, 527, 7–12.
- Marx, W., Penninx, B. W. J. H., Solmi, M., Furukawa, T. A., Firth, J., Carvalho, A. F., & Berk, M. (2023). Major depressive disorder. Nature reviews. Disease primers, 9(1), 44. https://doi.org/10.1038/s41572-023-00454-1
Ormel, J., Kessler, R. C., & Schoevers, R. (2019). Depression: more treatment but no drop in prevalence: how effective is treatment? And can we do better? Current Opinion in Psychiatry, 32(4), 348–354. https://doi.org/10.1097/yco.0000000000000505
- Patel, R. K., Aslam, S. P., & Rose, G. M. (2024). Persistent Depressive Disorder. In StatPearls. StatPearls Publishing.
World Health Organization. (2023, March 31). Depressive disorder (depression). World Health Organization; World Health Organization. https://www.who.int/news-room/fact-sheets/detail/depression
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