Mental health

Should We Be Looking for a Root Cause for Depression?

tree in a forest with extensive root system

I was recently reading an article on Medium that argued that to fully treat depression, one must do the inner work to get to the root cause.  That didn’t sit particularly well with me, hence this blog post.

I’m of the perspective that mental illness is complex, and the causes are just as complex, so if we get too reductionistic we lose sight of what else could be in the picture.

By reductionistic, I mean simplifying the cause down to 100% attributable to one thing.  That could go in a medical/biological direction, or it could go in a situational/trauma direction.  I don’t see either as particularly helpful.

I conceptualize the causes of depression on a continuum from fully biological to fully situational.  A few people are at either extreme, but a lot of people are somewhere in the middle.  I also like the idea of a diathesis-stress model, which looks at the interaction between genetic and psychological factors to produce illness.

Whether it’s saying that everyone only needs meds, or everyone needs to do a psychotherapeutic deep dive to get at their deepest inner wounds, saying that depression only exists a certain way excludes and can even alienate people who don’t experience depression in that particular way.

It makes a lot more sense to me to consider everyone with depression as a unique individual who may have multiple factors contributing to their depression.  When those factors are identified, they can be addressed in whatever way seems most helpful for the individual.

Trying to fit people into a particular box is most likely going to end up leaving some people undertreated.  Throwing meds at someone whose depression is primarily related to unaddressed trauma is likely to be just as ineffective as having someone whose illness is quite biologically rooted go to psychoanalytic therapy to try to figure out if their depression is because they were sexually attracted to their opposite-sex parent (okay, that’s my anti-Freudian bias jumping in there).

Personally, I think my own illness has a strong biological component.  I say that for a few reasons.  I have experienced trauma since the onset of my illness, but not before.  Sure, there were some difficult things scattered here and there throughout my life, but nothing significant.  I was happy, secure in who I was, had a core group of good friends, had a career that I found very meaningful…  And then everything fell apart.  There was a situational stressor, but certainly nothing so significant that an expected response would be me psychotic and trying to strangle myself while locked in a seclusion room.

My symptoms tend to lean towards melancholic depression, which is thought to be more biologically rooted.  I have responded best to biological treatment, particularly ECT.  While I may have negative thoughts related to my situation and the effects of my illness, I don’t have self-esteem issues or any sort of obvious lingering psychological disturbance.

Does that mean I think people don’t have depression linked to trauma?  Of course not.  But I think it’s rather unhelpful when people say depression is always linked to trauma, because I (and many others) just don’t fit in that box.

So let’s throw away the boxes, and recognize people for the complex individuals that they are.

Book cover: Managing the Depression Puzzle by Ashley L. Peterson

My new book, Managing the Depression Puzzle takes a holistic, everything up to and including the kitchen sink look at how to put together the pieces of your unique depression puzzle. It’s available on Amazon and other online retailers, as well as the MH@H Store.

31 thoughts on “Should We Be Looking for a Root Cause for Depression?”

  1. I do not have a degree in medical science, and even if I did, I wouldn’t pretend to know everything there is to know about the human brain and it’s conditions, because as you mentioned, everyone is different. I must agree with you here. I also don’t believe there always is a cause, you can dig & dig, and there may be “triggers,” for depression, but it can also just be a chemical imbalance, there isn’t necessarily a specific cause or cases to depression. I think sometimes “we” get too caught up on trying to fix people. Instead of ending this stigma that having depression means something is wrong. It’s okay to not be okay. And sometimes I think people need to hear that. They’re not abnormal because they feel sad or can’t get out of bed, or whatever. I think we need more acceptance than fixing, but that’s just my personal belief.

  2. My depression stems from my childhood and there’s no way to pull it out by the root. I would have to change the family I was born into which is impossible. I’ve had mild depression since I was very little, and occasionally, episodes of major depression. It takes multiple triggers to lead to a major depressive episode that can last months. After a while, I’m able to pick up the pieces, move on, and get off of the meds. I’m currently med-free until I need them again and the doctor is aware that I quit taking them. I know I shouldn’t suddenly stop taking antidepressants and my doctor was informed.

    Lately, I’ve had to do things to protect my delicate mental health which includes eliminating as many of the triggers as possible, as suggested by the CBT therapist. It’s a good solution short-term but I know I can’t sustain it forever. I practically ran away from social media because I couldn’t deal with it.

    1. That’s great that you’re working on being proactive around triggers. Some triggers will be inevitable, but good to take control over the ones that aren’t.

  3. For me it doesn’t matter where it stems from! Can we now take it away please? 😯 I think that maybe there is predisposition in the genes. But as I feel it at the moment, for me, the life experiences enhance that vulnerability. I am fully aware that people can be ‘just’ depressed with ‘no difficulties’ in life (which is impossible). But hormones also play a role, the support you have… I once red that poor people are not as depressed as other people. One, they are not getting diagnosed and 2nd they tend to attribute the depressive feelings ‘to life’. It is very complex and each person is different. There is not 1 pill that will make ‘all the depression of the world’ go away and there is not one psychotherapy to ‘fix’ all. I believe depression has a function and that function is for me to let me heal through this and in a more unpleasant frame: to keep me alive through shielding me from other harm. A bit cryptic, sorry, but I don’t know how to phrase it more gently.

  4. very good subject! no matter how hard they try to fit all people in one category, it simply won’t work! we all have different genetic predisposition for one disease or another; to add, with depression it’s about having one trigger after another during our life, which increase our cortisol level and makes us more prone to develop true depression ! And as you have mentioned, Medications alone, without truly treating the trauma (trigger) with therapy {in my opinion} wont be as effective!
    Thanks for sharing this! More medical professionals should read this !

  5. Mine depends on the day, so it’s pointless to look for a root cause. Sometimes I’m depressed because of physical pain. Other days I’m in a dark place because of my wasted life. Other times I miss my mom so much it’s unbearable. Then there are past things I go over & over trying to resolve… yet other times I can barely remember them!

  6. I have taken classes in psychology in the past. I feel like this is how it is taught to many people going into the field. It is hard to see how it can be biological when it is taught that it comes from trauma.

    I would say mine stems from trauma. I was bullied through all my years in school until I graduated high school. I know that was the main cause. It could have been my upbringing too. I don’t know for sure though.

    I do think sometimes there is no cause. It can be learned. If you are raised by someone who has a mental illness, a child can pick on it.

  7. I’ve found that most therapists I’ve encountered or had treatment from, want to do that root identifying though. I’m not sure WHY either. Maybe it’s so they can put on the proper kind of mental bandage? Prescribe the correct treatment? It’s never helpful. And if ‘they’ ever do find out what caused my own depression, I’ll willingly listen. Because it’s not ONE thing…it’s a bundle of different things, environment, genetics, brain chemistry, pain, physical problems, unhealthy habits. It’s so convoluted that the whole “root cause” idea has to fly out the window in my case. It’s not one thing, it’s LOTS of things and yeah it can be argued that a ‘root cause’ (unidentified) caused the rest, but I just don’t think so. And maybe that contributes to the whole picture…if we aren’t willing to embrace the idea that one thing caused our unhappiness (as such), are we therefore unwilling to be healed. The last thing is the idea that once that root is identified, and figuratively pulled out, that the depressive is ‘cured’. Right. Personally I can’t be cured. I can take my meds and monitor the situation and be vigilant that I’m doing the best things for treatment of my depression, but there is no cure. Education is key. Thanks for providing that to your readers!

  8. In my opinion, (I too have had trauma in my life, Lord knows I have), however… I think that my trauma has been worked through quite well overtime in which I sought therapy.
    When I have suffered through bouts’ of depression, I don’t reflect on the past trauma. It’s just my mood slips away fro me. No trigers, it just sinks. When it sinks, that’s when I’m in trouble.
    Knock on wood, I seem fine for now. But, I am truly afraid of for how long.

  9. That is so true. With depression, there could be: brain chemistry (serotonin, dopamine…), hormones (postpartum, PMS, PMDD), other hormones (SAD, melatonin), trauma, grief from death of a loved one, ingrained negative cognitive schemas, etc., etc. I definitely don’t think there’s one cause of depression, and I too get peeved whenever someone starts saying, “It’s your fault. You just need to overcome your issues.” Uhuh. Right, like my brain chemistry’s all messed up, and that’s my fault. Or my hormones are out of whack, and that’s my fault. Or my loved one died, and that’s my fault. Or it’s midwinter with not enough sunshine, and that’s my fault. People like that are more than ignorant. The ignorance is okay, because not everyone’s educated or aware. What’s not okay is the heavy judgment and sense of moral superiority that comes with it. Barf. Great blog post!

  10. As with all complex issues, looking for a single cause as a definite answer will most likely fail. Personally, I don’t think it’s too important to know these causes anyway. We are probably not capable of recognizing every single one of them but we still have to put up with the consequences in our lives. I don’t need to know exactly why I’m reacting in the way I do, as long as I am able to find strategies in dealing with certain issues. Life is often incredibly unpredictable, hence uncontrollable. I used to avoid as many potential triggers as possible, just to make sure I would be able to go through the day relatively unharmed. But life laughs at you, if you try too much to control it – so, this attempt was doomed to fail.
    Now, I’m building my mind and habits in a way which allow me to deal with unexpected events easier and even get something out of them. I have been reading a lot recently about post traumatic growth research which allowed me to change many of my long-hold but toxic internal views about myself. I don’t know whether this is the answer to all my questions but so far it’s working and that’s the only thing which matters right now.

  11. I felt that getting to the root of my issues was helpful in terms of understanding myself. When I became depressed, I didn’t understand myself at all and couldn’t think of a reason why I would be depressed. I now understand myself and the things I’ve experienced much better. I would not say that has ‘cured’ me, though, and it did get to a point where my therapist didn’t feel that there was much more she could do for me. Probably there are a mixture of factors rather than one cause, and certainly there isn’t one solution for me.

  12. I agree with you. This also relates to any mental illness. Not everything is related to trauma. I experienced bullying in high school and also got my heart broken at 19 which I think is part of why I developed anxiety. I also think it’s because I’m a highly sensitive person. Those tend to suffer more from anxiety and depression. I agree that everyone is different so the solution will also be different.

  13. I like this piece and agree with you, and many other commenters here. As someone who has a “moderate complexity” illness, as put on my psychiatric paperwork, it is so hard to hear people say I just need to unlearn my trauma. I’ve had anxiety since early childhood, and developed bipolar depression in middle school… sure, trauma happened throughout my life as with everyone’s lives. I can do the work, struggle through “unlearning trauma” (whatever that really means), and still be biochemically predisposed to the mental illnesses I have. I have family members with the same symptoms and diagnosis. So honestly, I don’t care if there is a root cause and I don’t care to find it. What I want is the mechanism to help get myself out of bed, to find healthy coping mechanisms, to use my manic episodes productively rather than recklessly — and none of that is going to come from exploring the root cause of my illness.

  14. What a great read. Therapists tend to put us all in one category. Saying it doesn’t matter where it comes from…”this” is how it’s treated. I think there are many reason for depression..and anxiety. This article has made me see that more clearly. One can push and push ….for the treatment to work…but we are not all one in the same. There are many reasons for our illness.

  15. You are absolutely right. I can’t agree with you anymore:)

    As humans, we are complex organisms with intricacies and nuances of human experiences. We should be seen as a whole being instead of just certain parts (for example, biological made-up).

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