Mental health articles

OF mental health care and mentally ill

Main Causes of Depression

An analysis of the causes of depression could fill an entire book; therefore, a briefoutline of the major theories will be provided. These theories are generally dividedinto biological and psychological factors.

At first sight, the person who is grieving and a depressive person look rathersimilar; both seem to be drained and withdrawn. This similarity prompted thinkerssuch as Sigmund Freud to suggest that both states may have the same cause. Asmourning is motivated by loss, could depression by motivated by some other formof loss? Freud  noticed that not all his depressed clients had experiencedan actual loss but behaved as if they had. Freud’s hypothesis was that the causeof depression is bound up with early childhood experiences; in his /her childhood, depressed person will have developed an intense love for another person that isundermined and leads to disappointment in that person. The libidinal energy isreleased, but, unlike mourning where there is a gradual detachment from the lostperson and an eventual opening up to others as the grieving process subsides, thedepressed child identifies with the lost person and incorporates the lost personwithin themselves. The rage and anger that is normally expressed outwardly towardsthe lost person is now directed inwardly toward the person’s own sense of self.It is felt that it is this that creates the low self-esteem of the depressed person. Achild that has been deprived of love or has been abused will have had their loveundermined and in a sense will have ‘lost’ the significant love object. This sense ofself worth will have been greatly damaged, whereas in ‘normal’ grieving the senseof self worth is usually intact and survives the loss (Stirling & Hellwell 1999).The biological theory for depression centres on the chemical make-up of thehuman body, and of the brain in particular. Modern theories concentrate on theneurotransmitting chemicals in the brain and particularly on the alteration in thenumber and sensitivity of receptors. Three monoamine neurotransmitter systemshave been identified; these are noradrenaline, serotonin (or 5-HT) and dopamine.Analysis of the brain tissue of those depressed who have killed themselves hasindicated a lower than normal level of 5-HT. This, along with the discovery ofincreased receptor sites, indicates that a low level of 5-HT activity is most likelythe cause of depression in the majority of people who suffer from it. Medication,such as fluoxetine hydrochloride (Prozac), acts to block the receptor sites of 5-HTand, therefore, raise the level of serotonin and, as a consequence, lift the client’smood.

Research that has been carried out on identical and non-identical twins givesweight to the genetic and, therefore, biological explanation for depression. Thetreatment of bipolar depression involves the use of lithium carbonate, a naturallyoccurring chemical that is deficient in such clients; this also gives credence to thebiological explanation for depression.

A more recent explanation for the occurrence of depression has been called SAD(seasonal affective disorder). Some people report that their depressive symptomsare much worse in the winter months and not so pronounced, or entirely absent,during the spring and summer months. The amount of light available is the variablehere. A study by Rosenthal et al. (1984) showed that depressive symptoms in thesepeople were associated with sunlight and temperature: when some of the peoplein his study moved to the south of the United States of America from the north,their symptoms lessened. When they travelled north in the winter months, theirsymptoms worsened. Indeed, the use of light therapy where strong lighting is usedto artificially lengthen the days in winter has been found to produce significantimprovement in the mood of these people.

The accepted statistics for prevalence of depression (i.e. what proportion of thepopulation is suffering from depression at any one time) is 8.56%. The figuresare 10.05% for women and 6.1% for men (Royal College of Psychiatrists 2001).It is interesting that the figures for women are higher than those for men; you will find that this phenomenon is repeated amongst most reports you may lookat. There are various explanations for this, but the most convincing is that morewomen than men report depressive symptoms to their doctors. There may be severalreasons for this. It is thought that men are far more reluctant to go to their GP withdepressive symptoms and see such attendance as some form of weakness on theirpart. The study by Norman and Ryrie found that there wasa difference in the prevalence of depression between urban UK and Ireland (12.8%and 17.1% respectively) and urban Spain (2.6%). Sociologists put forward the viewthat such differences are due to cultural reasons).

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