What Causes Depression?

There is no one cause of depression; it can be a comingling of several factors. While it is important to deal with the physical pain, as Dr. Stahl suggests, it is also important to figure out the root of the problem and address it. So many times I have seen people dealing with illness who are suppressing a truth or harboring pain; when we release these emotions, we can start on a path to healing. It is no different with depression.

Abuse: Dr. Ellen McGrath, psychologist and author, writes in Psychology Today:

In almost every case of significant adult depression, some form of abuse was experienced in childhood, either physical, sexual, emotional or, often, a combination.

Recovering from depression as an adult requires some detective work in ferreting out the nature of the exploitation. If you don't do it, you'll be crippled in recovering. It isn't advisable to unearth or recapitulate every nasty detail of past experience, but you do need to get a general map of the abuse landscape.

This point is extremely valuable: you don’t need to relive the abuse, nor do you need to remember the details. It is enough that you acknowledge that abuse did, in fact, occur and then work from there.

Drew Carey, best known for making people laugh, suffered from severe depression. He attempted suicide twice in his late teens and early twenties and describes going through college as a “functioning alcoholic.” Drew lost his father to a brain tumor when he was eight. The following year, he was molested. He kept the secret of this abuse, as well as the abuser’s identity, for decades. He found the strength to share this pain and says:

It's not something to be ashamed of. It shouldn't be talked about in hushed tones or behind closed doors. The way to take the shame away is to talk openly and not make a big deal about it. That's what I try to do, and people tell me they're glad. They say I'm taking some of the stigma away.

Besides removing stigma from abuse, Drew is also healing from depression. Releasing the rage, sadness, and confusion of abuse allows us to work with our minds and bodies to alleviate depression. It was only when I was ready to confront my past that I was able to look towards the future with any kind of hope.

It is not only physical or sexual abuse that triggers depression. A recent study done by researchers at Florida State University found that those who had suffered verbal abuse as children had 1.6 times as many symptoms of depression and anxiety than those who had not. They were twice as likely to have a mood or anxiety disorder in their lifetime. These children learn to be self-critical and negative, which leads to depression and anxiety. While many people tend to dismiss the devastating impact and emotional pain of verbal abuse, it can indeed lead to lasting consequences.

Dr. McGrath adds: “To undo the imprint of abuse, you must access it, expose it and process the experience. Otherwise, it creates a rotting core of self.”

Genetics: Depression can be passed down from generation to generation of families. Why exactly this occurs is not known by medical science. However, besides inheriting predispositions for depression or other illnesses, we learn behaviors and methods of coping that can lead to depression. For instance, if we see our parents handle stress or adversity by drinking or denying the truth, then that’s what we do as well. In this way, behavior is passed on as well as genes. Having a parent or sibling with depression increases the risk of developing it yourself by as much as three times. In a study of identical twins, it was found that when one twin was depressed, the other became depressed 76 percent of the time. Even when they were raised apart, they both became depressed 67 percent of the time.

Ernest Hemingway is one of America’s literary giants; despite the acclaim he received during his lifetime, he struggled with severe depression. Hemingway’s father committed suicide, and this had a tremendous affect on Ernest. He became an alcoholic, trying to find emotional pain relief in liquor. Besides his father’s depression, his mother had a bizarre fantasy that Ernest was actually his 18-month-old sister’s twin. She routinely dressed the young Ernest is dresses. He developed insecurity and anxiety as a result that plagued him throughout his life. Just shy of his 62nd birthday, Ernest committed suicide. Continuing the tragic family legacy, two of his sisters and his brother, as well as his granddaughter, also took their own lives.

Dr. George Zubenko, professor of psychiatry at the University of Pittsburgh, believes that depression is 40 to 70 percent genetic. Dr. Zubenko has found a group of genes that makes some people more susceptible to depression. The research team found 19 loci, which are small regions on the chromosomes where the genes are, that are associated with various depressive disorders. There were 81 families involved in the study, each of which had a member with major depressive disorder, which is known to run in families. In addition to finding areas on the chromosomes that are associated with depression, the study found that over 40 percent of those in the study died before age 65, mainly due to stroke, cancer, and heart disease – even more evidence that these conditions can be caused or exacerbated by depression.

Another study, reported by the National Institute of Mental Health, found that a particular gene increases our susceptibility to depression and anxiety. This gene weakens a mood-regulating circuit, which impairs the ability to process negative emotion. In people with this gene, brain scans reveal less gray matter and weaker connections in the circuits of the brain that regulate mood.

Our genes may indicate susceptibility, but they are not a foolproof predictor of depression. Take, for instance, Mariel Hemingway. She was raised in a family that was mired in depression – and high profile depression at that. While she certainly has a predisposition towards depression, Mariel strives for balance in her life. In her book, Finding My Balance, Mariel writes:

We all have different reasons for seeking a balanced life. When I started on my journey, I wasn’t reacting to the environmental hazards of today or the sheer pressure of life and work. I was just trying to survive.

Mariel has used yoga, diet, exercise, meditation, and a holistic approach to life to combat her genetic susceptibility to depression. Accepting her family history and taking steps to make peace with that has helped her maintain physical and emotional health. Recall A.B. Curtiss’ words: “Depression is a choice.” While depression is an illness, like cancer or heart disease, it is also something that we can fight against. And win. Mariel Hemingway could easily allow herself to succumb to depression. Instead, she works to keep her mind, body, and spirit whole. It is an amazing testament to the human will, as well as encouragement to the rest of us who struggle.

Gender: Women are twice as likely to develop depression. Female hormones, particularly estrogen, are the reason why women are more susceptible to migraine, fibromyalgia, celiac disease, and even heart disease (though they are not as likely to be treated in the early stages). Hormones directly affect brain chemistry and influence mood and emotions. Women’s hormones fluctuate greatly during the average lifetime, which is why women are more prone to depression after having a baby, before or during menstrual cycles, or before or during menopause.

In addition to biological factors, women also have added stressors in life that can contribute to depression. It is often women who have the responsibility of caring for children and even elderly parents, working, and attending to other obligations. Women are also more likely to live in poverty or experience abuse, both of which are associated with depression.

Women are also more likely to seek help for their depression than men. While men are more apt to “admit” to loss of energy and fatigue, women are more likely to report feelings of guilt, anxiety, and sadness. Men tend to isolate themselves socially whereas it is not as common for women to do that. While women may be more likely to develop depression, it seems to take a heavier toll on men. Jimmy Brown is a New York City firefighter who started experiencing symptoms of depression after September 11th. He says:

As a man, you're not supposed to be depressed. Growing up, men are supposed to be the providers. Men are supposed to be the pillar of strength. They're supposed to be the one everyone else turns to. You can't talk about it because, especially in the fire profession, a somewhat macho profession, you don't want to admit any weaknesses.

Men are four times more likely to commit suicide than women. Gender differences do exist in the experience of depression; it can be equally devastating and difficult to cope with. But the positive news is that no matter your gender, help is within your grasp.

Other Factors: Personal problems and major life events can also trigger depression. Even positive events, like moving to a new house or changing to a better job, can cause some people to slide into depression. This type of depression, unlike major depressive disorder, has a clear beginning; that is, you can trace your depression to a cause, such as when you lost your job. Adjustment disorder with depression is usually self-limiting and you can expect to feel a relief in symptoms in the six month period after the stressor has ended, unless it is ongoing. About ten percent of adults and 32 percent of adolescents suffer from situational depression at some point in their lives. Usually, people respond quite well to psychotherapy and learning new coping skills.

Depression can, and often does, accompany major illness. About one-third of people with major illnesses experience symptoms of depression. A certain amount of sadness and anxiety is perfectly normal when you are coping with a major illness, but this develops into depression in many people. The stress and worry of adjusting to the illness, making the necessary life changes, and worry about future treatment can trigger significant depression. The rates and severity of depression correlate to the severity of the illness. Forty to 65 percent of those who have had a heart attack experience depression. Here is a look at the depression rates of other major illnesses:

• Coronary heart disease – 18 to 20 percent
• Parkinson’s Disease – 40 percent
• Multiple sclerosis – 40 percent
• Stroke – ten to 27 percent
• Cancer – 25 percent
• Diabetes – 25 percent

Larry King suffered a heart attack and then underwent heart surgery. He suffered depression, he says, for about eight months. Since then, he’s been devoted to removing the stigma from depression and urging people to seek treatment. He also gives some advice for the loved ones of those who struggle with depression: don’t tell them to just get up. Don’t tell them to snap out of it. It doesn’t work that way. Instead, he urges people to talk about it. If they see a loved one struggling, talk to them about it.

Another factor to consider is substance abuse. About 30 percent of people who abuse alcohol and/or drugs have major depression. Substance abuse can cause depression, and depression can lead to substance abuse. When we feel depressed, we often seek to numb our pain. Whether we are trying to hide from our pasts or escape from our present, alcohol and drugs seem to provide refuge. Of course, this is an illusion, and the very thing we turn to for comfort hurts us. So we drink more. Drugs also can cause depression. Marijuana, for instance, slows brain functioning and decreases cognitive abilities. This often leads to depression. Other drugs, like cocaine, can trigger depression during the withdrawal phase.

Depression and Our Energy

Many people are skeptical of the mind body connection and illness. Our emotions can make us sick? Our minds can heal us? I have seen looks of disbelief and even outright mockery. Some people are not ready to believe that they have this tremendous power within them. But it is so easy to see in relation to depression. We can see how our body and soul are hurt, how each affects the other. When we have a serious illness, like heart disease, our spirits can flag. We become depressed, which then in turn threatens our health further. Or we are depressed, our souls are sick, and then our hearts follow suit.

Depression is imbalanced energy; it is the effect of negative emotion causing a traffic jam of sorts in our energy centers. Picture your chakras as flowing roads of energy; when you are aligned mentally, spiritually, and physically, then these highways allow energy – or traffic – to flow without obstacle. If, however, there is a blockage on one of these roads, the energy cannot go through. It backs up, like a line of cars stretching for miles. It is possible to get the traffic moving again if we first determine why it has stopped. An accident? A breakdown? It is the same with our energy. What has caused it to become blocked or imbalanced? Did we experience pain in our childhoods? Are we mourning the loss of a loved one or going through a big change in our lives? If we can remove these roadblocks, then we can allow the energy to flow and alleviate our depression.

American artist Georgia O’Keefe suffered depression and had to be hospitalized after her husband began an affair with a woman forty years his junior. She was devastated, but used her talent and passion to acknowledge that pain and release it. She did this by painting, and it freed her. Brooke Shields shared her experience of postpartum depression in her book, Down Came the Rain, letting mothers know they were not alone and that help was available. Mike Wallace, respected journalist, spoke out about his condition to his broad audience. Lorraine Bracco of the Sopranos wrote On the Couch, an account of her experience with depression, and spoke at the 2005 Annual Meeting of the American Psychiatric Association (APA) about the condition.

I give these examples to show you that there are all different ways to acknowledge pain and release it. We don’t all have to write a book or paint a picture. Perhaps your way of dealing with pain is to see a therapist, read self-improvement books, or seek out energy healing. There is no wrong or right way to facilitate healing – just the way that works to bring health to your body and soul.

We all have a different experience of depression, which means we all have different causes and issues at its core. For me, my childhood heartache caused scar tissue to build around my emotions. It became like Teflon. I blocked the pain in and kept new emotions from working their way in. While I did this unconsciously to prevent myself from hurting, it led to deep depression. Finally my body started to rebel against my refusal to acknowledge the truth and release the past. For others, a genetic predisposition may make them more susceptible to depression after a major life event. And in others, depression may seem like an ingrained part of their personality, like our great President Lincoln.

Whatever the experience of depression, though, healing is possible. It takes tremendous work to heal from this illness; it is painful; it is tiring. But it is worth it.

Lynn came to see me while she was going through menopause. She found that in addition to the physical and emotional side effects – such as hot flashes, mood swings, and irritability – she was sinking into depression. She couldn’t understand why, really, when she had a loving husband, wonderful children and grandchildren, and a fulfilling job. She had a broken leg due to an accident earlier that year, she told me, but her leg was healing very well.

I sensed some disturbance around this issue and asked her to tell me what had happened. I could see her becoming progressively more upset as she did so. She was driving one afternoon in winter. Snow made the roads a bit slick and she was being cautious. Then suddenly another car struck her. A 16-year-old girl had been talking on her cell phone and missed the stop sign, slamming into Lynn’s car. After the accident, Lynn became severely depressed, which she attributed to the accident itself and the cost of replacing her car. She noticed that her leg was causing her immense pain and was swelling. When she went up and down the stairs, her legs would give out. She went to the doctor only to find out that her leg had been broken. This caused her considerable pain – as well as anger. She was enraged that it hadn’t been caught before then. She was enraged at the teenager who hit her. Her anger, while appropriate, darkened into a rage response that was far beyond the norm. She isolated herself inside her home, nursing a broken leg and a body full of negativity.

As she spoke of this teenager, I could see her energy centers becoming darker. They lost their translucent affect and hung like a cloud over her. She spewed forth venom about this young girl, calling her names that almost shocked me (and I’m hard to shock!). Her rage was directed at one target: this young woman who hit her. I stopped her, asking her if I could repeat back to her some of what she had said. As I did so, I could see a bit of disbelief on her face… a look of “Did I say that?”

Lynn had a family history of depression, though she’d managed to evade it herself throughout most of her life. She’d grown up in a household that used anger to deal with problems, so she never learned the coping skills necessary to deal with adversity in a healthy way. This accident was the trigger for her depression, and she displaced all her sadness, anger, and hopelessness onto the hapless teenage girl. I asked her to imagine this girl was her daughter. What would she say to her? Would she be angry? Sure. Would she disown her or think she was a valueless person who deserved to locked up with the key thrown away? No. The young woman made a mistake; she was driving irresponsibly. But she didn’t intend to hurt Lynn, and in all likelihood, she was devastated by her actions.

The roadblock that was causing Lynn’s depression was partly genetics and partly this rage. We worked on removing it by focusing on forgiveness. This doesn’t mean Lynn had to invite the girl over for coffee or that she had to condone her behavior. It meant that Lynn was releasing the girl’s power over her, that she was ready to move on from the emotional pain to a better state of mind and body.

Forgiveness is a tricky issue: it does not mean that we forget; it does not mean that we kiss and make up. Instead, we try to understand why the person hurt us. In Lynn’s case, it was accidental. It was irresponsibility. It was not intentional. In my case, my parents hurt me because their parents hurt them. They were broken and did not know how to be whole. I can understand this. It hurts, and it doesn’t excuse the abuse by any means. But it takes my father from being a monster to simply being a flawed human being. And we can deal with human beings. We can forgive them. For our sakes. Forgiveness is not for them but for us. And it takes a long time, especially in cases where abuse is an issue, but it is possible. It is necessary for our healing.

Healing

“I clung to unhappiness because it was known familiar state.” --Hugh Laurie

Sometimes dysfunction is more comfortable than the unknown. Many of us, like actor Hugh Laurie, cling to our depression because it is all we know. It seems odd to people who have not struggled with major illness, this kinship we feel with misery. But for those of us with depression or other chronic illness, we know that there is a comfort there. And a victim status. That is not to say that we aren’t, in fact, victims to a certain extent. Yes, we suffer. But sometimes we choose to suffer.

In Truth Heals: What You Hide Can Hurt You, I write about this very thing. Maureen came to my office as an insulin-dependent diabetic. She was struggling with her relationship with her mother, who had always been disapproving and unloving towards Maureen. Maureen hung onto the pain and anger, perhaps hoping that someday her mom would love her. Here’s an excerpt:

Initially, Maureen found it difficult to relinquish her disease because she had become attached to it, as if it were an old friend. The same was true for her reluctance to move away from her mother. As much as she hated how her mother treated her, at least it was familiar.

Finally, enough was enough. Maureen moved to a new city, putting much needed distance between her mother and her.

The move marked her first act of individuation—of separating out who she really was from what her mother needed her to be—and it did her a world of good. At my suggestion, Maureen sought out a support group to help heal her core beliefs as well as to integrate a more holistic approach to life. She also took up Pilates exercises, which puts a great deal of emphasis on healthy breathing techniques. Learning to breathe more fully allowed Maureen to relax her body and let go of some of the constriction that had become second nature.

When we choose to let go, our energy is allowed to heal our body and soul. There are many ways to accomplish this in regards to depression. Antidepressants are usually the answer that many of us turn to, and while they can be helpful, they are only part of the solution. As many as two-thirds of those taking antidepressants still experience symptoms of depression. This is partly due to the medications themselves: it often takes a few tries before we get the right medication in the right dosage. This is why doctors urge those seeking help to stay the course; relief can be just a dosage increase away.

But many people experience symptoms because they are not dealing with the root cause of the depression. Medication can and does help a great many people, but you will continue to experience depression if you do not address what is causing it. Is it your family’s history of suppressing truth and hiding from problems? Is it due to a painful past? Is it the stress of burying emotions? Unlocking these issues can cause pain to bubble up to the surface, but it is a purifying pain. As the Marine Corps is fond of saying, “Pain is just weakness leaving the body.” While it hurts, you are actually strengthening yourself.

Researchers from the University of Michigan found that when people began taking antidepressants, the last symptom to lift was hopelessness. Typically, they responded well to medication, but this feeling of pessimism lingered for weeks and even months after. This may prompt people to discontinue their medication. If we can address this hopelessness in conjunction with medicine, then we can achieve healing. Energy healing doesn’t occur exclusive of or at the expense of modern medicine. We can use different methods and modalities to heal, which is what makes complementary medicine so effective. Using antidepressants, talking to a counselor, exercising, adopting a healthy diet, practicing yoga, prayer, art, music, volunteering – all of these and more can be helpful in lifting depression.

When you are depressed, it seems to take monumental effort to do anything. To pick up the phone and call a doctor or make an appointment to see a counselor may seem too overwhelming. I understand this, and I have felt this way myself. If you can make one initial step, it will make subsequent steps easier. For instance, if you can call your doctor and start a course of antidepressants, then you have started the battle. It will make it easier for you to get up and exercise or go to a counselor. Conversely, if you are able to go for walks every day, this renewed energy may help you pick up the phone and call your physician or an energy healing practitioner. The first step is to do something. There is always hope in having options.

Depression is an illness of the mind, brain, body, and soul. You cannot treat just the brain. You need to find a multi-pronged approach that works for you and will help you achieve healing on all of these levels. If it sounds impossible, be assured that it is not. If it sounds like a lot of work, be assured that it is! It is work – which is why it is sometimes easier to stay mired in depression. But imagine waking up in the morning and looking forward to the day. Imagine looking towards the future eagerly instead of with fear. For people with depression, this is a dream, and that dream can come true.

Truth will set you free from depression – only if you are willing to be set free. Truth heals when we allow it to. We began with a quote by Dorothy Rowe about depression being a prison in which you are both the prisoner and the jailer. Let’s end with the words of thirteenth century Persian poet, Jalal ad-Din Rumi:

Why do you stay in prison
When the door is wide open?

Move outside the tangle of fear-thinking.
Live in silence.

Live in peace, live in truth. It is possible to quiet the numbing voice of depression. The door is open and it is for us to step through.