Depression is an often misunderstood diagnosis, and the dialogue on social media tends to oversimplify, or even perpetuate outdated information that can be harmful.
The Biopsychosocial Model
Clinical depression is understood by the psychological and psychiatric disciplines under the biopsychosocial model, which recognizes the biological, psychological, and sociological influences of clinical presentations, including depression.
Biological influences, for example, might include factors such as heritability/genetics, and the function of neurotransmitters or other aspects of brain health that can contribute to depression.
Psychological influences include aspects of our individual psychology, such as internalized trauma, limiting beliefs, low self-esteem, or learned helplessness, which can all also contribute to depression.
Sociological influences broaden our consideration to include factors such as systemic injustice and inequality, family/community/cultural dynamics, the impact of stigma, and even social determinants of health. Broader concerns, such as the availability & accessibility of resources like fresh food, mental health treatment, adequate healthcare, and much more, are all included within this domain.
Depression Doesn’t Have a Single Cause
Deeply embedded within the biopsychosocial approach is an understanding that depression is not caused by any one factor, but is a response to a complex interaction of factors that pose a level of stress and disconnection from resources.
Depression is not understood solely as a dysfunction of the brain, contrary to outdated models perpetuated on social media, like the monoamine hypothesis, which was an early attempt to understand depression in terms of a deficiency of neurotransmitters such as dopamine and serotonin.
The causal claims of the monoamine hypothesis (that depression is caused by neurotransmitter deficiency/imbalance) have not panned out in modern research. To claim that depression is caused by a brain that is unable to produce adequate amounts of serotonin, for example, is not just a gross oversimplification, but a harmful one at that, because it incorrectly asserts that a person with depression suffers from a fixed chemical imbalance, which is often not the case. Individuals regularly float in and out of meeting the criteria for depression as these biopsychosocial factors change.
The Role of Medication and Therapy
That being said, one beneficial aspect of the monoamine hypothesis is that it gave us an appreciation for how depression interacts with the brain. It turns out, medications targeting neurotransmitter function can help. Antidepressants like SSRIs/MAOIs/etc may not “cure” depression or fully attack its root; however, they do often serve as life-saving medications, and serve a critical role, especially when an individual is unable to access time-intensive treatments like regular psychotherapy.
Therapy is also an effective treatment for depression, and the combined approach of pairing medication with therapy appears to be the most efficacious treatment protocol overall. (See this article from the American Psychiatric Association to learn more.)
Depression: In Summary
In summary, clinical depression is not solely a pathology of the brain or necessarily a chronic illness that is destined to afflict us for our entire lives. It is a description of our current functioning, which is a response to the myriad of biopsychosocial influences that act on our mental health.
It can be treated effectively with both therapy and medication. And it can even be improved through special attention to aspects of daily life, such as getting adequate sleep/hydration, engaging in physical exercise, cultivating social bonds and meaningful connections, participating in hobbies, and satisfying higher-level needs like discovering a sense of purpose or meaning.
And while some forms of depression are indeed more chronic—and it is important to differentiate between different presentations—it is important to know that support nonetheless exists to make life with depression purposeful and fulfilling.
