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Ah yes….time for an incredibly complex subject.  You’d think we’d have a clear explanation for why people get depressed, but we don’t have one simple explanation.  Since this is a somewhat short post, I’ll be simplifying a lot of things greatly…

The research shows there may be some simple biological “predisposition” to being depressed.  However, this is not very powerful, explaining at a maximum 20% of the propensity to become depressed (based on twin studies).

There do seem to be a number of common factors that are associated with depression.  On is negative ‘distorted thinking.’  The depressed person seems to see themselves as inadequate of defective in some way.  They look at the future, and it looks bleak to them.  When they think about their past, all they can see is negatives.  They look at their lives today, and the same thing occurs.  They tend to not feel they have much control over what happens in their lives.

Now, in my practice, I find the determinants of depression to be incredibly complex.  It is always specific to the individual.

“Procrustes (the stretcher), also known as Damastes (subduer) and Polypemon (harming much), is a figure from Greek mythology. He was a bandit from Attica, with a stronghold in the hills outside Eleusis. There, he had an iron bed into which he invited every passerby to lie down. If the guest proved too tall, he would amputate the excess length; victims who were too short were stretched on the rack until they were long enough. Nobody ever fit in the bed because it was secretly adjustable: Procrustes would stretch or shrink it upon sizing his victims from afar. Procrustes continued his reign of terror until he was captured by Theseus, who “fitted” Procrustes to his own bed and cut off his head and feet (since Theseus was a stout fellow, the bed had been set on the short position). Killing Procrustes was the last adventure of Theseus on his journey from Troezen to Athens.” (1)

Milton Erickson, M.D., always taught that it was important to not put the patient on “the Procrustean Bed of psychological theory,” and that you need to understand why each patient has the symptoms that they have.  I have found this very much to be the case.  With that in mind, I’ll try to elucidate some of the factors I’ve observed.  If these things don’t fit your situation, not to worry…remember that are very much personal and individual factors in each person’s depression.  I’ve sort of integrated an array of theoretical positions and observations from my clinical practice in what I describe below.

Early in life (<18 years of age), depression often involves components of the family life (such as divorce, family strife or conflict, a bad relationship with a parent) or extreme circumstances (such as rape, sexual molestation, traumas, learning disabilities, peers or problems relating to peers, and so forth). 

In ages 18-25 it may relate to problems with the transition to adulthood (moving out from living with the parents, college, attempting to decide on a major, career decisions, marriage, and so forth).  These factors are often triggered by some earlier problems that occured in a transitional period (birth, potty training years, puberty, and so forth).  Any conflicts that a person has about independence and dependence emerge at this point.  If their early environment did not result in a secure ability to form attachments and function independently, they will very often become depressed at this point. 

In ages approximately 26-50, there are often relationship problems, and failure to obtain goals in life that often come into play (such as finding out that marriage is more difficult than they though “people do not live happily ever after,” financial problems, and failure to achieve things that they always thought they would achieve).

In approximately the ages 50-65, depression often occurs as one reflects on their life and realize that their lives were not what they expected.  In their current lives, they don’t feel like they are contributing significantly to the younger generation.  They realize that their early fantasies about how life would be are just that and are disappointed. 

In ages, 65+, the notion of loss and loneliness begins to start to become clear and salient.  Long-time friends and close relatives begin to die.  If they retire, they find that retirement was not what they expected.  If they are married, they discover that by spending more time with their spouse, there are more problems in the relationship than they realize.  Again, at this stage, the notion of contributing to younger generations becomes even more salient.

Now, things occurring early in life make it more likely that at any of these transition points, that a person will become depressed (an early loss of a close relative, a significant separation from the mother in the first few years of life, being adopted or in foster care, rape or sexual molestation, disturbed family relationships, physical or emotional abuse, having a significant early disability–learning or other physical disabilities, and so forth). 

In the years of approximately 50+, a factor that often emerges…most often in men, is problems with physical health.  When a man who has had his primary source of pride from his work comes to the point where he has developed multiple physical problems, and can no longer work, this is close to a universal experience that produces depression in men when it occurs.  I have often seen that in combat veterans, that their traumatic experiences often emerge into their conscious in horrifying detail when these circumstances occur.  Women also experience a similar tendency towards depression with the development of physical symptoms during this time period.

At any period, when there are serious physical problems, symptoms of depression are more likely to occur.

Now, so far, everything I have described is rather depressing….and calls for some solutions to this problem. 

I have seen a number of factors that are tremendously beneficial.

1). Have a thorough medical workup to make sure you do not have physical causes to your depression (such as hypothyroidism, sleep apnea, heart problems, B12 and Vitamin D deficiencies, neurological problems, and other medical concerns).

2). Exercise and a healthy diet may address the physical aspects of depression (low energy or becoming easily fatigued, poor appetite, sleep problems, and so forth).  Exercise helps to reduce stress hormones in the body which build up over time and slow the metabolism and result in a number of physical consequences.  With your diet, make sure you avoid fast food, junk food, soft drinks, excessive sugar, excessive carbohydrates, and artificial sweeteners.  Eat a good variety of fruits, vegetables, and meet.  Fatty fish (such as samon, or mackerel, may be beneficial because of the Omega-3 fatty acids that they contain).

3). Give yourself a break.  Work on not “beating up on yourself.”  This self-directed anger only increases your depression.  You can also do a search on “distorted thinking” or “maladaptive thinking,” to learn more about how negative thinking is involved in depression and ways to work on changing this thinking.

4). Find something that gives you a deeper meaning in life (faith in God and worship, volunteering, helping others, etc…).

5). Develop hobbies.  Find things that you enjoy, and do them frequently (cooking, sewing, fishing, hunting, sports, reading, spending time with friends, etc…).  Now, I find that television is rarely beneficial in lifting mood, so if this is something you enjoy, you need to find something better.

6). Find a competent and trained psychotherapist who you make a good match with.  This can help you to explore the individual factors that contribute to your depressed mood.

7). If you are so depressed that severe consequences might occur, you might consider medication for helping you address the problem.  If you are not that severely depressed, you may find certain other remedies of benefit (St. Johns Wort, Omega-3, B12, Vitamin D–or sunlight, psychotherapy, and many of the other things I outlined above). 

Again, I’ve simplified things quite a lot here with what can be a very complex problem in an effort to give an overview and potential solutions.

(1). http://en.wikipedia.org/wiki/Procrustean