According to the Anxiety & Depression Association of America (ADAA) “264 million people worldwide live with depression. In 2017, around 17.3 million adults age 18 or older in the U.S. had experienced at least one major depressive episode in the last year.”
Causes of depression may include:
- Lifestyle and Personality Factors
- Social and Psychological Factors
- Family factors
- Environmental factors
- Medication
- Biochemical factors (brain chemistry)
- Underlying health condition
- Gut–Brain Axis
Lifestyle and Personality Factors
Lifestyle Factors
- Physical inactivity
- Lack of sleep
- Alcohol intake
- Tobacco smoking
- Poor nutrition (including excess caffeine or sugar)
- Lack of leisure time (fun and recreational activities)
- Work home imbalance (overworking)
- Retirement
- Common Triggers
- Chronic health conditions
- Chronic stress
- Difficult life transition
- Financial problems
- Grief and loss
- Childhood trauma
- Increased social media usage
- Stressful life events
- Overwhelmed
- Rejection
- Unemployment
Personality Traits
- Anxious
- High negative and low positive emotionality (reacting with negative or positive emotions)
- Heightened stress reactivity
- Irritability
- Moodiness
- Negative self-focus
- Rejection sensitive
- Reserved
- Self-critical
- Socially avoidant
Social and Psychological Factors
Social Factors
- Experiencing traumatic situations
- Lack of social support
- Harassment (long term)
- Bullying (long term)
- Work stress
- Relationship problems
- Persistent Discrimination
- Immigration (displacement, lack of social integration)
- Childbirth-related distress (Postpartum Depression)
- Stressful or traumatic events
- Isolation
- Neglect
- Loneliness
- Loss of support
- Lack of social support
- Recent stressful life experiences
- Toxic relationships and interactions (lowers self-esteem)
Psychological factors
- Cognitive distortion
- Negative patterns of thinking
- Over-stressing the negative
- Judgment problems
- Low coping skills
- Difficulty understanding and expressing emotions
Family factors
- Abusive relationships
- Marriage Problems
- Divorce
- Family Troubles
- Loss of a loved one
- Unsafe home environment
- Abusive relationships that undermine self-confidence
- Social failures such as friendships
- Separation from a parent
Medications
Depression can be a side effect of certain medications
- Anticonvulsants
- Antimalarial drugs
- Antineoplastic drugs
- Corticosteroids
- Dopamine promoter
- Immunosuppressive drug
- Muscle relaxant
- Stimulant
Biochemical factors (brain chemistry)
Monoaminergic neurotransmitter deficiency hypothesis
- Symptoms of depression are due to insufficient levels of neurotransmitters serotonin, norepinephrine and/or dopamine
- Recovering these neurotransmitter levels will have anti-depressive effects
Imbalance of excitation–inhibition
- Glutamatergic system dysregulation (glutamate excitatory neurotransmitter)
- Cortical GABAergic Dysfunction (Gamma-aminobutyric acid (GABA) primary inhibitory neurotransmitter between nerve cells in the brain and spinal cord)
Underlying health condition causing depression
Medical conditions can mimic the symptoms of depression and it is important to investigate and rule out general medical causes
Cardiac, GI, & Inflammatory conditions
- Cardiac conditions
- Myocardial infarction
- GI conditions
- Dysbiosis
- Peptic ulcer disease
- Inflammatory Bowel Disease (IBD) (Crohn’s disease and ulcerative colitis)
- Irritable bowel syndrome (IBS)
- Inflammatory conditions
- Polyarteritis nodosa
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Temporal arteritis
Endocrine conditions
- Adrenal dysfunction
- Carcinoid syndrome
- Cushing disease
- Diabetes Mellitus
- Parathyroid disease (hyperparathyroidism, pseudo-hyperparathyroidism)
- Pheochromocytoma
- Pituitary disease
- Thyroid disease (hyperthyroidism, hypothyroidism)
Hormonal factors
- Hormonal fluctuations
- Adrenal insufficiency (Addison’s disease)
- Diabetes
- Hormonal therapy
- Overactive thyroid
- Pregnancy
- PCOS
- Menstrual cycle
- Menopause
- Stress
Metabolic conditions
- Hypoglycemia
- Hypokalemia
- Hyponatremia
- Hypoxia
- Porphyria
Respiratory conditions
- Asthma
- Chronic obstructive pulmonary disease (COPD)
- Pulmonary embolism
- Sleep apnea, obstructive/nonobstructive
Gut–Brain Axis and Depression
- The human microbiome consists of over 100 trillion bacteria, 10 times the number of human body cells
- 60% of anxiety and depression patients experience intestinal function disturbance (including dysbiosis and inflammation of the gut)
- Increased antibiotics prescriptions are correlated with mood disorders (changed the microbiota)
- Microbiota supports host metabolism (produces short-chain fatty acids, choline, and bile acids)
- Complex carbohydrates such as dietary fiber absorbed and fermented by gut microbiome into short-chain fatty acids such as butyrate, acetate, propionate enters the circulation and plays a role in the brain via the gut-brain axis
- Bidirectional link between the central nervous system (CNS) and the enteric nervous system (ENS)
- ENS aka the second brain operates independently of the central nervous system (CNS) (brain and spinal cord)
- Regulates gastrointestinal function (intestinal digestive and absorption)
- Composed of 200–600 million neurons
- Fight or flight response of the central nervous system leads to slowing down or stopping digestion by the ENS
- Controls vagal and sacral parasympathetic nerve fibers and visceral sympathetic nerve fiber
- The vagus nerve is the primary connection between the brain and intestinal tract and parasympathetic nerves
Dysbiosis and intestinal permeability
- Leads to the production of proinflammatory endotoxin—lipopolysaccharide (LPS)
- LPS is a component of the outer membrane of Gram-negative bacteria, there is about 1 g of LPS in the human intestinal tract
- Enter the blood system
- Increased LPS migration could increase the immune response
- Activate the inflammatory system
- Increases norepinephrine in plasma, linked to mood disorder
Stress
- Changed gut microbiome (decreased Bifidobacterium, and Lactobacillus)
- Produced proinflammatory reaction
- Effected mood through the HPA axis (hypothalamic–pituitary–adrenal axis)
- Changed intestinal permeability (intestinal barrier function)
- Enabling different molecules to enter the bloodstream
- Lead to hypersensitivity
Gut microbiome secretes neurotransmitters
- Serotonin (aka 5-hydroxytryptamine (5-HT))
- Gut microbiome manufacture about 95 percent of the body’s supply of serotonin
- Serotonin stabilizes mood, feelings of well-being, and happiness
- Also involved in sleep, and digestion
- Acetylcholine (regulates memory, attention, learning and mood)
- Dopamine, gamma-aminobutyric acid [GABA], glycine (regulates sleep, appetite, mood and cognition
Complicated grief (CG)
- Chronic grief that interferes with the healing process and living a normal life
- Symptoms of complicated grief may overlap the symptoms of major depression
- CG symptoms are associated with loss
- Depression can co-occur with complicated grief and exacerbate CG symptoms
- In CG, it is important to seek help from a healthcare provider to assist with all stages of grief
Signs and symptoms
- Extreme focus on reminders of the loved one or excessive avoidance of reminders
- Problems accepting the death
- Lack of trust in others
- Sleeping problems
- Withdrawal from social interactions and activities once enjoyed
- Feeling a sense of loss of purpose in life
- Suicidal ideation
- Impulsiveness. etc.
When to see a doctor
Seek a healthcare provider when experiencing disproportionate and persistent sadness, loss of interest in activities that were once enjoyed, and lack of interest in life to address your root cause
DISCLAIMER
This information is intended for educational purposes only and it is not intended to take the place of consultation with your physician.
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