Why people are depressed:

Depression:
Depression (major depressive disorder) is a common and serious medical illness that
negatively affects how you feel, the way you think and how you act. Fortunately, it is
also treatable. Depression causes feelings of sadness and/or a loss of interest in
activities once enjoyed. It can lead to a variety of emotional and physical problems
and can decrease a person’s ability to function at work and at home.

Some people think they have a clear sense of why they become depressed. Others
don't. It might not be easy to figure out. In most cases, depression doesn't have a
single cause. Instead, it results from a mix of things: your genes, events in your
past, your current circumstances, and more.
The most important thing to remember is that, unlike with normal sadness, there
doesn't need to be a "reason" to have clinical depression. It's not anyone's fault. It's
not a flaw in your character. It's a disease that can affect anyone and regardless of
the cause, there are many good ways to treat it.
Depression symptoms can vary from mild to severe and can include:

 Feeling sad or having a depressed mood

 Loss of interest or pleasure in activities once enjoyed
 Changes in appetite — weight loss or gain unrelated to dieting
 Trouble sleeping or sleeping too much
 Loss of energy or increased fatigue
 Increase in purposeless physical activity (e.g., hand-wringing or pacing) or
slowed movements and speech (actions observable by others)
 Feeling worthless or guilty
 Difficulty thinking, concentrating or making decisions
 Thoughts of death or suicide

Depression symptoms in children and teens:

Common signs and symptoms of depression in children and teenagers are similar
to those of adults, but there can be some differences.

 In younger children, symptoms of depression may include sadness, irritability,

clinginess, worry, aches and pains, refusing to go to school, or being
underweight.
 In teens, symptoms may include sadness, irritability, feeling negative and
worthless, anger, poor performance or poor attendance at school, feeling
misunderstood and extremely sensitive, using recreational drugs or alcohol,
eating or sleeping too much, self-harm, loss of interest in normal activities,
and avoidance of social interaction.
Depression symptoms in older adults:

Depression is not a normal part of growing older, and it should never be taken
lightly. Unfortunately, depression often goes undiagnosed and untreated in older
adults, and they may feel reluctant to seek help. Symptoms of depression may
be different or less obvious in older adults, such as:

 Memory difficulties or personality changes

 Physical aches or pain
 Fatigue, loss of appetite, sleep problems or loss of interest in sex — not
caused by a medical condition or medication
 Often wanting to stay at home, rather than going out to socialize or doing
new things
 Suicidal thinking or feelings, especially in older men
Causes of Depression:
 Life Events
 Genes
 Reacting to Life Events
 Minority/majority status
 Sleep habits
 Social media
 Medications and Substances
 Old age
 Where you live
 Health Conditions and Hormonal Changes
Life Events: The death of a family member, friend, or pet can go beyond normal
grief and sometimes lead to depression. Other difficult life events such as when
parents’ divorce, separate, or remarry can trigger depression. Even events like
moving or changing schools can be emotionally challenging enough that a person
may become depressed. Sometimes, though, a person may have depression without
being able to point to any particular sad or stressful event. And many people go
through difficult life events without becoming depressed.

Genes: Research shows that depression runs in families. Some people inherit
genes that make it more likely for them to get depressed. Not everyone who has
the genes for depression actually gets depressed, though. As with other health
problems like diabetes just having the genes doesn’t mean someone automatically
gets sick. It just means there’s a chance of it. Many people who have no family
history of depression still get depressed. So although genes are one factor, they
aren’t the only thing that can cause depression.

Reacting to Life Events: Life is full of ups and downs. Stress, hassles, and
setbacks happens. How we react to life’s struggles matters a lot. A person’s way of
thinking can contribute to depression or it can help guard against it. Research
shows that a positive outlook acts as a protection against depression, even for
people who have the genes, brain chemistry, or life situations that put them at risk
for developing it. The opposite is also true: People who tend to think more
negatively can be more at risk for developing depression.

Sleep habits: There is a complex relationship between sleep and depression: poor
sleep habits can cause or exacerbate depression, and depression causes sleep
disturbances.

Social media: Social media can get overwhelming, lead to loss of productivity,
decrease self-esteem and confidence and cause changes in mood. Also, some
movies or TV series can trigger depression in some people.

Minority/majority status: Being a minority comes with its package of social pain.
They report feeling more guilt, embarrassment, shame and sadness than people
with higher status.
Medications and Substances: Many prescription drugs can cause symptoms of
depression. Alcohol or substance abuse is common in depressed people. It often
makes their condition worse by causing or worsening mood symptoms or
interfering with the effects of medications prescribed to treat depression.

Old age: Of course depression is not a part of normal aging, but the older person is
more vulnerable. There are many biological, social and psychological changes that
occur with growing old. Some people struggle with the process of aging and this
might culminate into a depression.

Where you live: Depression rates vary by country, state, and city. People living in
urban areas have a higher risk than those living in rural areas.

Health Conditions and Hormonal Changes: Certain health conditions change the
balance of hormones in the body, affecting a person’s mood. Some conditions,
such as hypothyroidism, are known to cause a depressed mood in some people.
When these health conditions are diagnosed and treated by a doctor, the depression
usually disappears. Because hormones affect mood, the normal hormonal changes
that go along with puberty can make some people more vulnerable to depression.
For some people, health conditions may cause depression even though the
condition itself doesn’t physically change the body’s hormones. For example,
undiagnosed learning disabilities might block school success and lead someone to
become depressed. Or illness might present challenges or setbacks that escalate
into depression. Whether or not these things lead to depression can depend a lot on
how well a person is able to cope, stay positive, and receive support.

It's often said that depression results from a chemical imbalance, but that figure of
speech doesn't capture how complex the disease is. Research suggests that
depression doesn't spring from simply having too much or too little of certain brain
chemicals. Rather, there are many possible causes of depression, including faulty
mood regulation by the brain, genetic vulnerability, stressful life events,
medications, and medical problems. It's believed that several of these forces
interact to bring on depression.
To be sure, chemicals are involved in this process, but it is not a simple matter of
one chemical being too low and another too high. Rather, many chemicals are
involved, working both inside and outside nerve cells. There are millions, even
billions, of chemical reactions that make up the dynamic system that is responsible
for your mood, perceptions, and how you experience life.

With this level of complexity, you can see how two people might have similar
symptoms of depression, but the problem on the inside, and therefore what
treatments will work best, may be entirely different.

Researchers have learned much about the biology of depression. They've identified
genes that make individuals more vulnerable to low moods and influence how an
individual responds to drug therapy. One day, these discoveries should lead to
better, more individualized treatment (see "From the lab to your medicine
cabinet"), but that is likely to be years away. And while researchers know more
now than ever before about how the brain regulates mood, their understanding of
the biology of depression is far from complete.

What follows is an overview of the current understanding of the major factors

believed to play a role in the causes of depression.

The brain's impact on depression

Popular lore has it that emotions reside in the heart. Science, though, tracks the seat
of your emotions to the brain. Certain areas of the brain help regulate mood.
Researchers believe that — more important than levels of specific brain chemicals
— nerve cell connections, nerve cell growth, and the functioning of nerve circuits
have a major impact on depression. Still, their understanding of the neurological
underpinnings of mood is incomplete.

Regions that affect mood

Increasingly sophisticated forms of brain imaging — such as positron emission
tomography (PET), single-photon emission computed tomography (SPECT), and
functional magnetic resonance imaging (fMRI) — permit a much closer look at the
working brain than was possible in the past. An fMRI scan, for example, can track
changes that take place when a region of the brain responds during various tasks. A
PET or SPECT scan can map the brain by measuring the distribution and density
of neurotransmitter receptors in certain areas.

Use of this technology has led to a better understanding of which brain regions
regulate mood and how other functions, such as memory, may be affected by
depression. Areas that play a significant role in depression are the amygdala, the
thalamus, and the hippocampus (see Figure 1).

Research shows that the hippocampus is smaller in some depressed people. For
example, in one fMRI study published in The Journal of Neuroscience,
investigators studied 24 women who had a history of depression. On average, the
hippocampus was 9% to 13% smaller in depressed women compared with those
who were not depressed. The more bouts of depression a woman had, the smaller
the hippocampus. Stress, which plays a role in depression, may be a key factor
here, since experts believe stress can suppress the production of new neurons
(nerve cells) in the hippocampus.

Researchers are exploring possible links between sluggish production of new

neurons in the hippocampus and low moods. An interesting fact
about antidepressants supports this theory. These medications immediately boost
the concentration of chemical messengers in the brain (neurotransmitters). Yet
people typically don't begin to feel better for several weeks or longer. Experts have
long wondered why, if depression were primarily the result of low levels of
neurotransmitters, people don't feel better as soon as levels of neurotransmitters
increase.

The answer may be that mood only improves as nerves grow and form new
connections, a process that takes weeks. In fact, animal studies have shown that
antidepressants do spur the growth and enhanced branching of nerve cells in the
hippocampus. So, the theory holds, the real value of these medications may be in
generating new neurons (a process called neurogenesis), strengthening nerve cell
connections, and improving the exchange of information between nerve circuits. If
that's the case, depression medications could be developed that specifically
promote neurogenesis, with the hope that patients would see quicker results than
with current treatments.
Figure 1: Areas of the brain affected by depression

Amygdala: The amygdala is part of the limbic system, a group of structures deep in

the brain that's associated with emotions such as anger, pleasure, sorrow, fear, and
sexual arousal. The amygdala is activated when a person recalls emotionally
charged memories, such as a frightening situation. Activity in the amygdala is
higher when a person is sad or clinically depressed. This increased activity
continues even after recovery from depression.

Thalamus: The thalamus receives most sensory information and relays it to the

appropriate part of the cerebral cortex, which directs high-level functions such as
speech, behavioral reactions, movement, thinking, and learning. Some research
suggests that bipolar disorder may result from problems in the thalamus, which
helps link sensory input to pleasant and unpleasant feelings.
Hippocampus: The hippocampus is part of the limbic system and has a central role
in processing long-term memory and recollection. Interplay between the
hippocampus and the amygdala might account for the adage "once bitten, twice
shy." It is this part of the brain that registers fear when you are confronted by a
barking, aggressive dog, and the memory of such an experience may make you
wary of dogs you come across later in life. The hippocampus is smaller in some
depressed people, and research suggests that ongoing exposure to stress hormone
impairs the growth of nerve cells in this part of the brain.

Nerve cell communication

The ultimate goal in treating the biology of depression is to improve the brain's
ability to regulate mood. We now know that neurotransmitters are not
the only important part of the machinery. But let's not diminish their importance
either. They are deeply involved in how nerve cells communicate with one another.
And they are a component of brain function that we can often influence to good
ends.

Neurotransmitters are chemicals that relay messages from neuron to neuron. An

antidepressant medication tends to increase the concentration of these substances
in the spaces between neurons (the synapses). In many cases, this shift appears to
give the system enough of a nudge so that the brain can do its job better.

How the system works. If you trained a high-powered microscope on a slice of

brain tissue, you might be able to see a loosely braided network of neurons that
send and receive messages. While every cell in the body has the capacity to send
and receive signals, neurons are specially designed for this function. Each neuron
has a cell body containing the structures that any cell needs to thrive. Stretching
out from the cell body are short, branchlike fibers called dendrites and one longer,
more prominent fiber called the axon.

A combination of electrical and chemical signals allows communication within and

between neurons. When a neuron becomes activated, it passes an electrical signal
from the cell body down the axon to its end (known as the axon terminal), where
chemical messengers called neurotransmitters are stored. The signal releases
certain neurotransmitters into the space between that neuron and the dendrite of a
neighboring neuron. That space is called a synapse. As the concentration of a
neurotransmitter rises in the synapse, neurotransmitter molecules begin to bind
with receptors embedded in the membranes of the two neurons (see Figure 2).
 The release of a neurotransmitter from one neuron can activate or inhibit a second
neuron. If the signal is activating, or excitatory, the message continues to pass
farther along that particular neural pathway. If it is inhibitory, the signal will be
suppressed. The neurotransmitter also affects the neuron that released it. Once the
first neuron has released a certain amount of the chemical, a feedback mechanism
(controlled by that neuron's receptors) instructs the neuron to stop pumping out the
neurotransmitter and start bringing it back into the cell. This process is called
reabsorption or reuptake. Enzymes break down the remaining neurotransmitter
molecules into smaller particles.

When the system falters. Brain cells usually produce levels of neurotransmitters

that keep senses, learning, movements, and moods perking along. But in some
people who are severely depressed or manic, the complex systems that accomplish
this go awry. For example, receptors may be oversensitive or insensitive to a
specific neurotransmitter, causing their response to its release to be excessive or
inadequate. Or a message might be weakened if the originating cell pumps out too
little of a neurotransmitter or if an overly efficient reuptake mops up too much
before the molecules have the chance to bind to the receptors on other neurons.
Any of these system faults could significantly affect mood.

Kinds of neurotransmitters. Scientists have identified many different

neurotransmitters. Here is a description of a few believed to play a role in
depression:

 Acetylcholine enhances memory and is involved in learning and recall.

 Serotonin helps regulate sleep, appetite, and mood and inhibits pain.
Research supports the idea that some depressed people have reduced serotonin
transmission. Low levels of a serotonin byproduct have been linked to a higher risk
for suicide.
 Norepinephrine constricts blood vessels, raising blood pressure. It may
trigger anxiety and be involved in some types of depression. It also seems to help
determine motivation and reward.
 Dopamine is essential to movement. It also influences motivation and plays
a role in how a person perceives reality. Problems in dopamine transmission have
been associated with psychosis, a severe form of distorted thinking characterized
by hallucinations or delusions. It's also involved in the brain's reward system, so it
is thought to play a role in substance abuse.
 Glutamate is a small molecule believed to act as an excitatory
neurotransmitter and to play a role in bipolar disorder and schizophrenia. Lithium
 carbonate, a well-known mood stabilizer used to treat bipolar disorder, helps
prevent damage to neurons in the brains of rats exposed to high levels of
glutamate. Other animal research suggests that lithium might stabilize glutamate
reuptake, a mechanism that may explain how the drug smooths out the highs of
mania and the lows of depression in the long term.
 Gamma-aminobutyric acid (GABA) is an amino acid that researchers
believe acts as an inhibitory neurotransmitter. It is thought to help quell anxiety.
Figure 2: How neurons communicate

1. An electrical signal travels down the axon.

2. Chemical neurotransmitter molecules are released.
3. The neurotransmitter molecules bind to receptor sites.
4. The signal is picked up by the second neuron and is either passed
along or halted.
5. The signal is also picked up by the first neuron, causing reuptake, the
process by which the cell that released the neurotransmitter takes back some
of the remaining molecules.

Genes' effect on mood and depression

Every part of your body, including your brain, is controlled by genes. Genes make
proteins that are involved in biological processes. Throughout life, different genes
turn on and off, so that — in the best case — they make the right proteins at the
right time. But if the genes get it wrong, they can alter your biology in a way that
results in your mood becoming unstable. In a person who is genetically vulnerable
to depression, any stress (a missed deadline at work or a medical illness, for
example) can then push this system off balance.

Mood is affected by dozens of genes, and as our genetic endowments differ, so do

our depressions. The hope is that as researchers pinpoint the genes involved in
mood disorders and better understand their functions, depression treatment can
become more individualized and more successful. Patients would receive the best
medication for their type of depression.

Another goal of gene research, of course, is to understand how, exactly, biology

makes certain people vulnerable to depression. For example, several genes
influence the stress response, leaving us more or less likely to become depressed in
response to trouble.

Perhaps the easiest way to grasp the power of genetics is to look at families. It is
well known that depression and bipolar disorder run in families. The strongest
evidence for this comes from the research on bipolar disorder. Half of those with
bipolar disorder have a relative with a similar pattern of mood fluctuations. Studies
of identical twins, who share a genetic blueprint, show that if one twin has bipolar
disorder, the other has a 60% to 80% chance of developing it, too. These numbers
don't apply to fraternal twins, who — like other biological siblings — share only
about half of their genes. If one fraternal twin has bipolar disorder, the other has a
20% chance of developing it.

The evidence for other types of depression is more subtle, but it is real. A person
who has a first-degree relative who suffered major depression has an increase in
risk for the condition of 1.5% to 3% over normal.

One important goal of genetics research — and this is true throughout medicine —
is to learn the specific function of each gene. This kind of information will help us
figure out how the interaction of biology and environment leads to depression in
some people but not others.
Temperament shapes behavior

Genetics provides one perspective on how resilient you are in the face of
difficult life events. But you don't need to be a geneticist to understand
yourself. Perhaps a more intuitive way to look at resilience is by
understanding your temperament. Temperament — for example, how
excitable you are or whether you tend to withdraw from or engage in social
situations — is determined by your genetic inheritance and by the
experiences you've had during the course of your life. Some people are able
to make better choices in life once they appreciate their habitual reactions to
people and to life events.

Cognitive psychologists point out that your view of the world and, in
particular, your unacknowledged assumptions about how the world works
also influence how you feel. You develop your viewpoint early on and learn
to automatically fall back on it when loss, disappointment, or rejection
occurs. For example, you may come to see yourself as unworthy of love, so
you avoid getting involved with people rather than risk losing a relationship.
Or you may be so self-critical that you can't bear the slightest criticism from
others, which can slow or block your career progress.

Yet while temperament or world view may have a hand in depression,

neither is unchangeable. Therapy and medications can shift thoughts and
attitudes that have developed over time.

Stressful life events

At some point, nearly everyone encounters stressful life events: the death of a
loved one, the loss of a job, an illness, or a relationship spiraling downward. Some
must cope with the early loss of a parent, violence, or sexual abuse. While not
everyone who faces these stresses develops a mood disorder — in fact, most do not
— stress plays an important role in depression.

As the previous section explained, your genetic makeup influences how sensitive
you are to stressful life events. When genetics, biology, and stressful life situations
come together, depression can result.

Stress has its own physiological consequences. It triggers a chain of chemical

reactions and responses in the body. If the stress is short-lived, the body usually
returns to normal. But when stress is chronic or the system gets stuck in overdrive,
changes in the body and brain can be long-lasting.
How stress affects the body
Stress can be defined as an automatic physical response to any stimulus that
requires you to adjust to change. Every real or perceived threat to your body
triggers a cascade of stress hormones that produces physiological changes. We all
know the sensations: your heart pounds, muscles tense, breathing quickens, and
beads of sweat appear. This is known as the stress response.

The stress response starts with a signal from the part of your brain known as the
hypothalamus. The hypothalamus joins the pituitary gland and the adrenal glands
to form a trio known as the hypothalamic-pituitary-adrenal (HPA) axis, which
governs a multitude of hormonal activities in the body and may play a role in
depression as well.

When a physical or emotional threat looms, the hypothalamus secretes

corticotropin-releasing hormone (CRH), which has the job of rousing your body.
Hormones are complex chemicals that carry messages to organs or groups of cells
throughout the body and trigger certain responses. CRH follows a pathway to your
pituitary gland, where it stimulates the secretion of adrenocorticotropic hormone
(ACTH), which pulses into your bloodstream. When ACTH reaches your adrenal
glands, it prompts the release of cortisol.

The boost in cortisol readies your body to fight or flee. Your heart beats faster —
up to five times as quickly as normal — and your blood pressure rises. Your breath
quickens as your body takes in extra oxygen. Sharpened senses, such as sight and
hearing, make you more alert.

CRH also affects the cerebral cortex, part of the amygdala, and the brainstem. It is
thought to play a major role in coordinating your thoughts and behaviors,
emotional reactions, and involuntary responses. Working along a variety of neural
pathways, it influences the concentration of neurotransmitters throughout the brain.
Disturbances in hormonal systems, therefore, may well affect neurotransmitters,
and vice versa.

Normally, a feedback loop allows the body to turn off "fight-or-flight" defenses
when the threat passes. In some cases, though, the floodgates never close properly,
and cortisol levels rise too often or simply stay high. This can contribute to
problems such as high blood pressure, immune suppression, asthma, and possibly
depression.

Studies have shown that people who are depressed or have dysthymia typically
have increased levels of CRH. Antidepressants and electroconvulsive therapy are
both known to reduce these high CRH levels. As CRH levels return to normal,
depressive symptoms recede. Research also suggests that trauma during childhood
can negatively affect the functioning of CRH and the HPA axis throughout life.

Early losses and trauma

Certain events can have lasting physical, as well as emotional, consequences.
Researchers have found that early losses and emotional trauma may leave
individuals more vulnerable to depression later in life.

Profound early losses, such as the death of a parent or the withdrawal of a loved
one's affection, may resonate throughout life, eventually expressing themselves as
depression. When an individual is unaware of the wellspring of his or her illness,
he or she can't easily move past the depression. Moreover, unless the person gains
a conscious understanding of the source of the condition, later losses or
disappointments may trigger its return.

Traumas may also be indelibly etched on the psyche. A small but intriguing study
in the Journal of the American Medical Association showed that women who were
abused physically or sexually as children had more extreme stress responses than
women who had not been abused. The women had higher levels of the stress
hormones ACTH and cortisol, and their hearts beat faster when they performed
stressful tasks, such as working out mathematical equations or speaking in front of
an audience.

Many researchers believe that early trauma causes subtle changes in brain function
that account for symptoms of depression and anxiety. The key brain regions
involved in the stress response may be altered at the chemical or cellular level.
Changes might include fluctuations in the concentration of neurotransmitters or
damage to nerve cells. However, further investigation is needed to clarify the
relationship between the brain, psychological trauma, and depression.
 Seasonal affective disorder: When winter brings the blues

Many people feel sad when summer wanes, but some actually develop
depression with the season's change. Known as seasonal affective disorder
(SAD), this form of depression affects about 1% to 2% of the population,
particularly women and young people.

SAD seems to be triggered by more limited exposure to daylight; typically it

comes on during the fall or winter months and subsides in the spring.
Symptoms are similar to general depression and include lethargy, loss of
interest in once-pleasurable activities, irritability, inability to concentrate,
and a change in sleeping patterns, appetite, or both.

To combat SAD, doctors suggest exercise, particularly outdoor activities

during daylight hours. Exposing yourself to bright artificial light may also
help. Light therapy, also called phototherapy, usually involves sitting close to
a special light source that is far more intense than normal indoor light for 30
minutes every morning. The light must enter through your eyes to be
effective; skin exposure has not been proven to work. Some people feel
better after only one light treatment, but most people require at least a few
days of treatment, and some need several weeks. You can buy boxes that
emit the proper light intensity (10,000 lux) with a minimal amount of
ultraviolet light without a prescription, but it is best to work with a
professional who can monitor your response.

There are few side effects to light therapy, but you should be aware of the
following potential problems:

 Mild anxiety, jitteriness, headaches, early awakening, or eyestrain can

occur.
 There is evidence that light therapy can trigger a manic episode in
people who are vulnerable.
 While there is no proof that light therapy can aggravate an eye
problem, you should still discuss any eye disease with your doctor before
starting light therapy. Likewise, since rashes can result, let your doctor know
about any skin conditions.
 Some drugs or herbs (for example, St. John's wort) can make you
sensitive to light.
 If light therapy isn't helpful, antidepressants may offer relief.
Medical problems
Certain medical problems are linked to lasting, significant mood disturbances. In
fact, medical illnesses or medications may be at the root of up to 10% to 15% of all
depressions.

Among the best-known culprits are two thyroid hormone imbalances. An excess of
thyroid hormone (hyperthyroidism) can trigger manic symptoms. On the other
hand, hypothyroidism, a condition in which your body produces too little thyroid
hormone, often leads to exhaustion and depression.

Heart disease has also been linked to depression, with up to half of heart attack
survivors reporting feeling blue and many having significant depression.
Depression can spell trouble for heart patients: it's been linked with slower
recovery, future cardiovascular trouble, and a higher risk of dying within about six
months. Although doctors have hesitated to give heart patients older depression
medications called tricyclic antidepressants because of their impact on heart
rhythms, selective serotonin reuptake inhibitors seem safe for people with heart
conditions.

The following medical conditions have also been associated with depression and
other mood disorders:

 degenerative neurological conditions, such as multiple sclerosis, Parkinson's

disease, Alzheimer's disease, and Huntington's disease
 stroke
 some nutritional deficiencies, such as a lack of vitamin B12
 other endocrine disorders, such as problems with the parathyroid or adrenal
glands that cause them to produce too little or too much of particular hormones
 certain immune system diseases, such as lupus
 some viruses and other infections, such as mononucleosis, hepatitis, and
HIV
 cancer
 erectile dysfunction in men.
When considering the connection between health problems and depression, an
important question to address is which came first, the medical condition or the
 mood changes. There is no doubt that the stress of having certain illnesses can
trigger depression. In other cases, depression precedes the medical illness and may
even contribute to it. To find out whether the mood changes occurred on their own
or as a result of the medical illness, a doctor carefully considers a person's medical
history and the results of a physical exam.

If depression or mania springs from an underlying medical problem, the mood

changes should disappear after the medical condition is treated. If you have
hypothyroidism, for example, lethargy and depression often lift once treatment
regulates the level of thyroid hormone in your blood. In many cases, however, the
depression is an independent problem, which means that in order to be successful,
treatment must address depression directly.

Depression medications

Sometimes, symptoms of depression or mania are a side effect of certain drugs,

such as steroids or blood pressure medication. Be sure to tell your doctor or
therapist what medications you take and when your symptoms began. A
professional can help sort out whether a new medication, a change in dosage, or
interactions with other drugs or substances might be affecting your mood.

Keep in mind the following regarding drugs that may affect depression and mood:

 Researchers disagree about whether a few of these drugs — such as birth

control pills or propranolol — affect mood enough to be a significant factor.
 Most people who take the medications listed will not experience mood
changes, although having a family or personal history of depression may make you
more vulnerable to such a change.
 Some of the drugs cause symptoms like malaise (a general feeling of being
ill or uncomfortable) or appetite loss that may be mistaken for depression.
 Even if you are taking one of these drugs, your depression may spring from
other sources.
Risk Factors for Depression: Depression can affect anyone even a person who
appears to live in relatively ideal circumstances.

Several factors can play a role in depression:

 Biochemistry: Differences in certain chemicals in the brain may contribute

to symptoms of depression.
 Genetics: Depression can run in families. For example, if one identical twin
has depression, the other has a 70 percent chance of having the illness
sometime in life.
 Personality: People with low self-esteem, who are easily overwhelmed by
stress, or who are generally pessimistic appear to be more likely to
experience depression.
 Environmental factors: Continuous exposure to violence, neglect, abuse or
poverty may make some people more vulnerable to depression.