Chemical Imbalance or Difficult Times?

Many Factors Can Contribute to Depression

Those suffering from depression in the 21st century have an advantage over those in previous eras --today we know that depression is a disease process and not just a personality quirk. Once a mental disorder is classified, treatments can be identified and refined, giving new hope where before there was none. Still, there is much light to be shed on the differentiations between the various manifestations of the disease.

Historically, physicians made a distinction between what appeared to biologically-based (endogenous) clinical depression and situational (exogenous) depression. Because there was no obvious trigger, endogenous depression was believed to be caused by a chemical imbalance and was treated with medication. Situational depression was thought to be caused by painful life experiences and therapy was recommended to address the "underlying cause." The borders became more blurred as science progressed, and it became clear that major depressive disorder was caused by many different factors, thus splitting depression into two types was not the best approach.

There's No Lab Test

A trend of thought exists that since all depression has its origins in the mind and body, it's all chemical. Proponents of such a viewpoint may believe that clinical depression can only be helped by popping pills and that situational depression requires psychotherapy.

However, the whole notion of biological versus situational depression is overly simplistic. Given the same unfortunate event, two different people - we'll call them Jen and Jane -- may respond in completely different ways. After the death of a dear pet, Jen may become clinically depressed but Jane may bounce back. What caused Jen to become so depressed and not Jane? It could be that Jen has a pre-existing genetic vulnerability to depression, but it took a bad life experience to bring it out. So if we simply concluded that Jen's depression was situational, we would miss an important part of the picture.

Treatment of Depression

Even if we could easily divide depressed people into the categories described above, it would not dictate how treatment is conducted. Most people who receive antidepressant medication will show some improvement in their mood, no matter what the cause of the depression is believed to be. This is even true of people suffering depression as a result of PTSD. Likewise, even people who become depressed for no clear reason can be helped by psychotherapy for depression. Thus people who are depressed should try whichever type of treatment appeals to them the most, and then consider other treatment options if they do not improve.

That being said, major depressive disorder is a very serious problem, and any treatment plan should be undertaken under the supervision of a qualified mental health professional.


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