Causes of Depression

I just didn’t care about anything any more.  If only I could’ve answered some of the many questions that tormented me, but I hadn’t found a single answer. Then I became indifferent to everything and the questions faded away.¹⁸

The current television ad campaign for Zoloft, one of the most popular new antidepressant medications, says of depression “although its cause is unknown, depression may be caused by an imbalance in the chemistry of the brain.”¹⁹ Downing-Orr says, “many scientist and health care professionals conceptualize depression as with biological or emotional and these conceptions then provide the framework for explaining the causes of depression.”²⁰ Neil Anderson says, “We can be depressed for biochemical reasons, but if there is no physical cause, then depression is often rooted in a sense of hopelessness or helplessness.”²¹ Dr. Lloyd-Jones begins his helpful book Spiritual Depression by emphasizing the role of individual temperament as a primary cause of depression.²²

As seen in the above discussion, the symptoms of depression are fairly well-defined and identifiable. But identifying the root cause of those symptoms is more difficult. This is due to several problems. First, many biases exist on toward depression at both the popular and clinical levels. Second, because depression is a mental illness, it tends to be much more complex than non-mental illnesses. Third, depression can sometimes be caused by other conditions and at other times should be considered a separate disease. Fourth, at this time there are no consistent testing methods to determine whether or not someone has a chemical imbalance.

Bias is also a problem in identifying the causes of depression. Depending on whether one is trained in medicine, psychiatry, or Christian counseling, one may have acquired biases that assume certain causes are more likely than others. Those that support a particular theory of the depression causes often support their theories with self-authenticating “case studies.” Many authors present their method as the method that worked when all the others failed. Biases may also be based upon stereotypes of patients based on their age or gender. For example, because women tend to be viewed as more emotional and weaker than men, it is more likely that a practitioner will assume the cause for their depression is emotional in nature.

Bias is also caused by what psychologists call “biases in attribution.” These biases occur when we attribute the causes of actions differently when judging ourselves verses when we judge others. “When we make a situational attribution, we identify the case in the environment (‘my depression is cased by a death in the family’); when we make a dispositional attribution, we identify the case in the person as an enduring trait (‘her depression is caused by a melancholy personality’).”²³ In other words, we may be more likely to classify depression as a personal weakness in others, while we assume external or biological causes in ourselves.

Below I have classified the major causes of depression into three categories: biological, psychological, and spiritual. These categories are not intended to be clean compartmentalized divisions nor are any of the causes mutually exclusive of one another. In fact, some of these causes of depression may in fact be effects of others and vice versa. This breakdown is meant to usefully categorize the various views and provide the reader with a broad range of options.

Physiological and Biological Causes of Depression

Because depression is clearly linked to physiological events menstruation and childbirth, continued research on other biological causes of depression is a vital field of study.

Neurochemical Causes of Depression. As in the above quote from a Zoloft ad, depression is often described as a chemical imbalance in the brain caused by neurotransmitters. Neurotransmitters are chemicals that transmit signals between nerve fibers running throughout the body. Neurotransmitters also regulate mood based on how much or how little of a given neurotransmitter is present. For example, when high amounts of adrenaline (epinephrine) are present, a person becomes highly energetic and enters what is called Fight-or-Flight mode. If other neurotransmitters are at abnormally low levels, a person may become lethargic and unresponsive because there is not enough neurotransmitter to pass messages to the brain.

Norepinephrine and serotonin are the two neurotransmitters most commonly associated with mood disorders. Unfortunately, there is currently no way to measure the levels of these two chemicals in the brain. Instead, doctors look for metabolites, which are the by-products left behind after the neurotransmitters are broken down.²⁴ Those with low levels of 2-methoxy-4-hydroxyphenylglycol (MHPG) or 5-hydroxyindoleacetic acid (5-HIAA) tend to have respectively low levels of norepinephrine or serotonin.

Sleep Mechanism and Depression. A common problem for those suffering from depression is sleeping either too much or too little. Depressed people often experience less rest from sleep because their sleep patterns are disrupted. Normally, people progress through several sleep stages over 90 minute periods and then experience rapid eye movement (REM) sleep for as little as 10 minutes at the end of the cycle. REM sleep normally increases in length throughout the night. But people with depression progress quickly to REM and experience REM for shorter amounts of time.

Interestingly, selective and total sleep deprivation works as an antidepressant. When depressed people are prevented from sleeping, although their mood is initially lowered, it gradually improves throughout the day and continues into the next sleepless day. It is thought that during sleep the body produces a substance with depressive effects. This substance is metabolized throughout the waking hours of the day and functions as a neuromodulator.

Researches do not yet fully understand why we sleep at all and its affects on mood are just beginning to be researched.  In the future, it may prove to be a valuable diagnostic tool.

Other Physiological Factors.  Other physiological explanations of depression involve the neuroendocrine system and circadian rhythms. Studies have also begun focusing on specific foods such as sugar and caffeine which appear to cause depression in some patients. A final factor for consideration is other diseases which may cause secondary depression.

The biological causes of depression can also be understood as symptoms of depression. It is difficult if not impossible to know which come first, the chemical imbalance or the change in mood.

Psychological Causes of Depression

Purely physiological explanations for mental illnesses tend toward assuming that what happens in the chemistry of the brain should replace what is sometimes called the “mind.” But psychological explanations of depression emphasize that the mind and body are distinct. Though psychologists usually recognize the affect of the brain on the mind, they tend to emphasize personal experiences, ways of thinking and learned behavior.

Many of the proposed psychological causes for depression could also be explained or understood in terms of underlying spiritual issues. We will consider this below, but in this section the terms are laid out as they are explained by secular psychologists.

Psychoanalytical Explanations. Sigmund Freud, perhaps more than anyone else, popularized psychological causes of mental illnesses and developed the idea of a mind-body split. Though many of his methods are no longer followed, his affect on psychological studies was profound.

Psychoanalysis is the study of previous experiences, typically childhood traumas, that affect a person’s present psychology. Major losses, whether perceived or actual, such as the loss of a parent through death, separation, or rejection are thought to make one more likely to develop depression later in life. If a person does not discover effective ways to deal with such loss early on, he or she is more likely to fall into depression when confronted with another major loss.

Freud emphasized the individual’s loss of self-esteem in depression. The psychoanalytic view suggests that low self esteem is often the result of anger inward when experiencing loss. The individual does not learn to express his or her anger or believes that it is wrong to do so and thus internalize it, destroying themselves.

Cognitive Theories of Depression. The cognitive view of depression emphasizes the way that people think about themselves, others around them, and their circumstances. A person is more or less likely to be depressed based on the way he or thinks about these things. “People with depression view themselves more negatively than their nondepressed counterparts.”²⁵ Dr. Aaron Beck, an influential cognitive psychologist, argues that depressed people think irrationally in three areas he called the cognitive triad: These individuals possess negative views of themselves, of their current position, and of their future possibilities.²⁶

Cognitive theory builds off of some of the ideas of psychoanalysis. During childhood and adolescence, people acquire a schemata, a way of thinking and viewing the world, based on their response to events. Through events like the loss of a parent, social rejection or criticism from parents and teachers, individuals may develop a negative schemata. This negative view of the world can continue to reinforce itself as each new event is interpreted through a negative bias.

Cognitive problems are further compounded by the tendency of depressed individuals to overgeneralize their experiences. For example a depressed individual might think, “Jessica did not compliment my new shirt, I must be the ugliest person in the world.” They also tend to explain good events negatively, attributing the event’s cause to luck rather than their own merit. They also have a tendency toward magnification or exaggeration. A scratch on a car might “destroy” it, making the individual “worthless.” As an individual’s thoughts become more negative, he or she may become more negative in their actions toward others, causing friends and family to reject them, which in turn reinforces negative thinking.

Behavioral Theories of Depression. Behavioral theory proposes that depression is not caused from by internal thought patterns, but by environmental factors that cause maladaptive behavioral and social behaviors.

There are many variations in behavioral theory, but they all stress the role of positive and negative feedback on an individual’s mood. A person may become depressed if he or she does not receive enough positive feedback or experiences too much negative feedback. This negative feedback may be due to the individual’s lack of sufficient social skills to elicit positive response. It may also be caused by major environmental changes, such as moving to a new city and starting a new job with different environment. A person’s daily activities or behavior such as waking up in the morning and visiting friends may be centered around his or her job schedule. If the individual losses their job, which functions as the core of that person’s behavioral reinforcement, this disruption may trigger depression.

Other potential factors that cause negative may be deficient social skills, the loss of a significant social relationship, or increases in an individual’s sensitivity to negative events or reduction in ability to enjoy positive events. As seen with cognitive causes of depression, behavioral causes tend to form a feedback loop in an individual’s thoughts and resulting behavior. This is compounded when a depressed person begins to feel a sense of helplessness and an inability to change his or her circumstances. Depressed individuals that have limited social networks or those that push away social support often continue further into depression.

As is the case with the proposed biological causes of depression, both negative thoughts and maladaptive behavior are also classic symptoms of depression and not necessarily the causes of a mood disorder.

Spiritual Causes of Depression

“Spiritual” causes of depression are in some ways as speculative as psychological or even physiological explanations. Just as there are currently no way to exactly measure brain chemistry, there are no ways for us to “see” all of what is happening spiritually within a person. Many of the spiritual causes of depression are essentially refined or redefined versions of psychological causes. For example, instead of talking about behavior, Christians talk about sin. In the area of cognition Christians emphasize not only one’s faulty view of oneself, but also a faulty view of God and his character. Finally, while secular psychology recognizes a distinction between body and mind, Christians should have a proper understanding of both the distinctions and interrelations between the human body and soul.

There are numerous examples of Biblical characters struggling with depression. Some are clearly identified as depressed, while others are more inferred based on their responses to situations. Jeremiah, in the book of Lamentations, expresses deep pain and agony of the soul: “Is it nothing to you, all you who pass by? Look and see if there is any sorrow like my sorrow, which was brought upon me” (Lam. 1:12). One of the most familiar passages is Psalm 42-43.  Psalm 42 begins with, “As the deer pants for the water brooks, so my soul pants for You, O God” (42:1), and continues with:

“Why are you in despair, O my soul?
And why have you become disturbed within me?
…
O my God, my soul is in despair within me” (Psalm 42:5-6)

The phrase “Why are you in despair, O my soul?” is repeated at the end of Psalm 42 and again in Psalm 43. Some authors have also suggested that Job, Saul, Elijah and even Jesus in the desert showed signs of depression.²⁷

Depression can be more difficult to deal with in Christian circles because the expectations for “life and life abundant” is much higher and because of emotional ties particular theological positions. Just as scientists have biases toward exclusively physiological explanations of depression and psychologists towards exclusively psychological explanations, Christians often gravitate toward interpreting all events in spiritual terms. While it is true that “our battle is not against flesh and blood,” Christians should also keep in mind that the physical world is real and that simple explanations are often incomplete. The following discussion will consider three major spiritual areas: thoughts, sin and the demonic realm.

Christian Thinking. Admitted many theological and biblical discussions have little or no bearing on one’s life. But in the area of depression, the Christian’s thought life plays a major role. The cognitive theory of depression in psychology has done much to help explain the significance of many of Paul’s charges such as “taking every thought captive” (2 Cor. 10:5), “if there is anything excellent or praiseworthy – think about such things” (Phil. 4:9), and to have the mind of Christ (1 Cor. 2:16).

The two most common areas of faulty Christian thinking are one’s view of oneself and one’s view of God. The earlier comments about overgeneralizing events are often applied to specifically Christian ideas such as, “I sinned in area X, therefore I must be an evil person, unworthy of God.” False doctrine, especially in the area of salvation, may also play a critical role. If one incorrectly believes that is possible to lose one’s salvation, he or she may experience depression from anxiety.

Many Christians also develop faulty views of God which can result in depression. Often Christian’s project onto God their own false expectations of themselves or false expectations placed upon them by parents or teachers. In his discussion of Psalm 13:1-6, Neil Anderson says, “Even though he believes in God, David is depressed because what he believes about God is not true. How can an omnipotent and omniscient God forget about David for even one minute, much less forever?”²⁸ Depressed people also tend to feel abandoned by God, characterized by David’s words, “My God, my God, why have you forsaken me?” (Ps. 22:1). “Does God abandon God’s people? No. Do people with depression feel that God has abandoned them? Yes?”²⁹

Sin and Depression. No other cause of depression should be as carefully discussed as that of sin. Unfortunately, the stigma in society at large surrounding mental illnesses is heightened rather than lessened in the Christian discussion. But at the same time, sin is very real and very harmful. Often depressed people are characterized by irrational guilt and shame, yet those that fail to deal with habitual sin often fall further and further into depression.

Consider the following statement, “Compassion cannot ignore unbelief or son. Too often, family and friends think the depressed person is very fragile and cannot handle any frank discussion about sin or hard-heartedness. But to ignore these issues when they are obvious in someone’s life is to treat that person without love or compassion.”³⁰ Some might consider this approach too harsh, while others might consider it too soft. Either way, assuming that sin alone is the cause and cure of depression is probably no more helpful than assuming that medical treatments alone can cure depression. But ignoring sin is equally unhelpful.

Spiritual Warfare. In C.S. Lewis’s The Screwtape Letters, an elder demon Screwtape writes lessons to his nephew Wormwood on how to cause the most damage to his human “student.” Screwtape suggests to Wormwood that his most successful course of action is either to cause his student to think about demons and the spiritual realm so much that it causes him to obsess and fear it or to ensure that his student never thinks about spiritual things and remains woefully ignorant on the matter.³¹ While it is true that those who do emphasize demonic activity often go to extremes, others tend to react too strongly against such overemphasis and ignore or downplay the reality of spiritual realm and its affects on our lives. As is true elsewhere, a balanced approach is vital.

Biblically, there is a good deal of support for the idea that demons can cause mental and spiritual depression. Job experienced severe ailments, both physical and spiritual, and it is very clear that God allowed Satan to directly cause the problems. Saul was tormented by “a demon sent from God” (1 Sam. 19:19). Jesus cast demons out of many people during his ministry on earth. Even Paul was sent a “messenger from Satan”³² (2 Cor. 12:7).

Similar to any of the other causes of depression, spiritual warfare may or may not play a role in a particular individual’s depression. And if it does play a role, it is probably one of several factors that should be considered.