What is depression?

What causes it?

Those are common questions that I get asked every day. Some people erroneously attribute depression to weakness, lack of faith or lack of will. This stigma and ignorance can be a barrier that keeps people from seeking help. It also makes those who suffer from depression feel even worse. The truth is that depression is partially genetic and partially a product of our environment.

What is Depression?

Depression is a feeling. Sometimes we feel “down” or “blue” and the feeling resolves after a few hours or days. These ups and downs of life are normal and should be expected. However, when the feeling of sadness lasts for more than two weeks it is time to seek help. Depression is often accompanied by other symptoms.

Please continue reading to learn more about the symptoms and causes of depression….

…Depression is often accompanied by other symptoms. For example, people who are depressed can have trouble falling and staying asleep or conversely they will find they want to sleep all of the time. Interest in things commonly enjoyed can disappear. Feelings of guilt and hopelessness can be intense and constant. Concentration is often impaired and appetite can be minimal or conversely voracious. Time is spent staring into space or sitting around purposelessly. (See the questionnaire below for a quick screen of symptoms of depression).

**Please note: Periods of elevated or irritable mood, lasting for several days in a row, during which sleep is needed minimally (or not at all), with higher than normal energy, may be a sign of bipolar disorder. It is important to share these symptoms with your doctor as well.**

The most severe and worrisome symptoms are thoughts about being better off dead, harming, or killing oneself. Depression is dangerous when it distorts thinking, judgment and decision making. Depression can make it hard to remember the last time you felt “normal” and hard to believe you will ever feel “normal” again. It can be hard to believe someone we have known as a happy, well-adjusted and successful friend, neighbor, family member or colleague would want to kill themselves. However, depression is extremely powerful and sometimes suicide will seem like the only option.

If you or someone you know is feeling depressed and having any of these additional symptoms, it is important to get help right away. There is no reason to wait to seek help until you get to the point of thinking about harming yourself. You can speak with your primary care doctor or make an appointment with a psychiatrist. If you had blurry vision, would you wait until you were blind to call your doctor?

What Causes Depression
Some people are genetically predisposed to have a higher chance of having episodes of depression throughout their lifetime. If your parents or siblings have experienced depression, you are much more likely to as well. Knowing if you are at higher risk is important. Just as those with a family history of heart disease or cancer should be more diligent about screening, the same is true for those with a family history of depression. Overall, however, previous episodes of depression are 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 impact our thoughts. Negative thoughts not only impact our mood and feelings but our behavior and biology as well. (See the figure below). For example, depression can lead to self-isolation, poor diet and limited exercise. All of these factors negatively impact our biology. We know that the brain and its neurotransmitters change during an episode of depression and again during recovery. (See the image below.)  Depression negatively impacts our 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


and debilitating depression that negatively impacts the biological, psychological and social aspects of a person’s life.

The reason why it is so important to understand the causes of depression is because these areas serve as targets of treatment. A thorough plan is multifaceted and addresses all of these areas. I will cover many options in my next post. What I hope you will take from this blog is how much we know.

What We Know About Depression:

We know that some people are at higher risk of depression than others. We know that depression can negatively affect all areas of a person’s life. We know that the feelings of hopelessness and distorted thoughts and judgment can lead to self-harm and suicide. We know that like any disease, depression’s symptoms and causes can serve as the aim of our research and our treatments. Furthermore, like most diseases that go untreated, depression negatively impacts quality of life and has complications, namely suicide, that can be deadly. That is why it is so important that we decrease the negative stigma and encourage those suffering from depression to get help right away.

I hope you will share this message: Depression is a disease like any other. The knowledge in this series of posts should empower you and give you hope. If you or a loved one suffers from depression, please share my message and seek treatment.

In the next blog I will discuss some of the treatment options for depression I commonly employ with my patients.

Stay tuned,

Dr. Goldenberg

Twitter: @docgoldenberg

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