COMMENTARY

Understanding Depression

Matt A. Goldenberg, DO

Disclosures

October 10, 2014

What Causes Depression

We know that some people are genetically predisposed to have a higher chance of episodes of depression throughout their lifetime. Educate your patients that if their parents or siblings have experienced depression, they are much more likely to as well. Understanding that they are at higher risk is important. Just as those with a family history of heart disease or cancer should be more diligently screened, the same is true for those with a family history of depression. Overall, however, a history of previous episodes of depression is the best predictor of future episodes.

The other area depression comes from is our environment. Stressors and triggers at home and work and memories can all negatively affect our patients' thoughts. I educate my patients about the following: Negative thoughts affect not only mood and feelings, but also behavior and biology (Figure 1).

Figure 1.

Contributors to depression.

For example, depression can lead to self-isolation, poor diet, and limited exercise. All of these factors negatively affect biology. We know that the brain and its neurotransmitters change during an episode of depression (Figure 2).

Figure 2.

Neuroimaging of depressed vs nondepressed brain.

Depression negatively affects behavior by decreasing engagement in recreational activities and making chores and hygiene more likely to be deferred. Not being able to keep up with responsibilities at work and at home can lead to additional negative thoughts, including "being a failure." Ever-increasingly negative thoughts, biology, and behavior all then enhance the feeling of depression. It is truly a vicious cycle. What starts as something minimal can quickly snowball into severe and debilitating depression that negatively affects the biological, psychological, and social aspects of our patients' lives.

The reason why it is so important for primary care physicians to understand the causes of depression, and to educate patients about them, is because these areas serve as targets of treatment. A thorough plan is multifaceted and addresses all of these areas.

What Else Do We Know About Depression?

We know that some people are at higher risk for depression than others. We know that depression can negatively affect all areas of a person's life. We know that feelings of hopelessness and distorted thoughts and judgment can lead to self-harm and suicide. We know that as for any disease, the symptoms and causes of depression can serve as the aim of our research and our treatments.

Furthermore, like most diseases that go untreated, depression negatively affects quality of life and has complications, the most serious of which is suicide. This is why it is so important that we decrease the negative stigma and encourage those suffering from depression to get help immediately.

We have all the tools needed to provide an empathetic and supportive environment to begin the process of recovery with our patients. If anyone you know is suffering from depression, please assist them in obtaining treatment right away.

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