While the causes of depression are not fully understood, research suggests it results from a combination of biological, environmental, and psychosocial influences. Risk factors may include profound early losses and emotional trauma. And it appears to occur more often in people with low self-esteem, who are easily overwhelmed by stress, and who see the world through a pessimistic lens.

Many factors can play into why a person becomes depressed—from a response to stressful life events like losing a job to getting divorced or retiring. Just as the causes of depression can vary, so too can the symptoms of depression manifest in myriad ways, which is why depression is frequently described as a spectrum disorder. For some people, depression is so crippling that simply getting out of bed can feel overwhelming. While for others, they are able to function in their daily lives but feel so miserable that they find no joy in activities that once gave them pleasure. 

What becomes difficult in all types of depression—is that it can be severe and stubbornly persistent and the things you need to do to feel better, like exercising or socializing often seem impossible to put into action.

Fortunately, depression is among one of the most treatable disorders. The best outcomes involve psychotherapy, medication or a combination of the two—to reduce present symptoms and prevent further episodes.

Case of Judith

Take, for example, Judith, a businesswoman who had consulted with me for chronic feelings of depression. 

“I feel so stuck. I drag myself to work—I drag myself home. I feel no joy in my work or my relationships.”

Judith also complained of anxiety and severe irritability when she felt misunderstood by her family and friends. She had a tendency to be overly preoccupied with her weight (though not more than 10 pounds overweight). And she was often very impatient with her herself—after a few weeks of therapy and medication, she wondered why she couldn’t “snap out” of negative feeling states.

During the course of therapy, it was revealed that both of Judith’s parents had been alcoholic since her early childhood. When they were sober, they acted like reasonable parents, but when they drank heavily, they would forget to feed her and put her to bed. The next day, her parents, nursing their hangovers, would be distant and withdrawn. Some of these memories go back to before she was five years old. 

Many researchers believe that early neglect and emotional trauma may cause subtle changes in brain function that leave people more vulnerable to depression later in life. This includes profound early losses, such as the death of a parent or the withdrawal of a loved one’s affection.

Such early traumas become indelibly etched on a child’s psyche.

Neuropsychologist Louis Cozolino notes how healthy early trusting relationships allow us to build self-confidence, regulate our emotions, and develop realistic expectations.

For depressed people who have experienced such losses, psychotherapy is a powerful tool to help repair neural network integration. By developing healing narratives, alternative perspectives, and in some cases going on an antidepressant or mood-stabilizing medication, you can help to regulate difficult feeling states and prevent or manage the recurrence of future setbacks.

As the work of psychotherapy continued, Judith was able to gain a conscious understanding of the sources of her depression. She understood how she felt abandoned by her parent’s neglect and how angry and sad she felt about their limitations. She also became more aware of how certain situations triggered the hopelessness she felt as a child and learned to develop new coping strategies for when these feelings arose.


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