Root Causes of Why You’re Feeling Down in the Dumps

And it’s not due to COVID.

As Mental Health Awareness Month 2020 draws near the end, let’s talk about depression.

Depression is defined as a period of at least two weeks during which a person experiences:

• a depressed mood
• loss of interest and/or 
• loss of pleasure in daily activities,

plus problems with: 

• sleep (disrupted or too much)
• appetite (over/under) 
• low energy
• poor concentration
• feelings of guilt or low self-worth

Depression impacts more women than men, and the postpartum period is a particularly vulnerable time for onset of depression. We also often see depression rates rise in the elderly. 

In 2017, about 7.1% of American adults (about 17.3 million people), had a major depressive episode. When we look at adolescents, depression rates skyrocket: 13.3% of American adolescents were diagnosed with a major depressive episodein 2017. Depression rates in children under age 12 were not studied, though given the number of adolescents starting at age 12 with depression diagnoses, we can imagine that there is a substantial number of struggling kids before their twelfth birthdays.

When we look at rates of depression, we must also remember several points that impact the accuracy of the date:

• Not all individuals responded to the survey assessing depression rates, and given depression causes decreased motivation to complete tasks, the depressed sample may be underrepresented in the data. 33% of those selected to participate did not respond; were the majority of these people depressed? 
• Reporting on the survey may not have been accurate, or individuals may not have been objective in rating their present symptoms and functioning 
• Those that had depressive symptoms but did not meet diagnostic criteria for major depression were not counted as “depressed.” 
• Those that were institutionalized, deployed, or homeless were excluded from the data set, and of course these populations have increased depression rates. 
• The survey was only provided in English. Immigrants that are struggling to assimilate may have increased rates of depression. 

So I would postulate that 4.5% is an extremely low estimate for depression rates in the United States.
And, of course, these numbers are pre-COVID.

Bottom line, either you or someone you love has struggled with some flavor of depression at some point.

Conventional Medicine’s Take on Depression

Ah, the gold standard. 

In fact, this was how I was trained as a clinical social worker and therapist. It’s very linear. Cause & effect. But we need to realize that for the majority of people, these two treatment options do not get at the ROOT CAUSE of depression.

So then why are we depressed?
 
One root cause of depression is situational: Sure, if we are grieving or experienced trauma or a tragedy, we can expect to experience mental health symptoms for a period of time. But these feelings should resolve, particularly with emotional support and coping tools. Let’s keep this as a separate, normal response to life.
 
We must then consider long-standing, entrenched depression.
 
I was taught that depression is a brain problem.The chemicals in the brain are out of balance. Only medication can “fix” that. Sort of.
 
I’m going to challenge the narrative long-upheld by the majority of psychiatrists, physicians, and mental health providers.

DEPRESSION IS NOT IN AND OF ITSELF THE PROBLEM, it’s a symptom of something deeper.
We must learn to figure out why the body is causing low mood.
Don’t shoot the messenger. 
 
While body chemistry may indeed be “off,” we need to come back to WHY? Why is the body out of balance? Why is the body creating these particular symptoms?
 
And with that question, let’s quickly look at some of the root causes of depression through a functional medicine lens…
 
Hold on tight, because this isn’t a linear model. This is a several-things-contribute-and-combine-together model, and please note that it is not all-encompassing, but rather some of the most common. 

Some root causes of depression…

1. Nutrient deficiencies from: poor digestion and/or absorption; poor gut health/microbiome dysbiosis; medical conditions; genetics; poor blood sugar control; lack of access to healthy food due to allergies, financial, dietary choices, etc. 
2. Stress from: acute or chronic situational; trauma history; mismatched expectations to reality; poor social supports; socio-economic status; chronic low-grade infections; gut dysbiosis
3. Medical conditions including, contributing to, or resulting in: impaired airway function; increased inflammation; limited diet; increased nutritional need; poor neurotransmitter production; poor blood sugar control; autoimmune condition
4. Inadequate movement causing: poor neurotransmitter production; poor tissue oxygenation; poor blood sugar control
5. Poor sleep caused by: poor neurotransmitter production or breakdown; nutrient deficiencies; medical conditions/pain
6. History of mood disorders, contributed to by: genetics; any of the above chronic situations

Put another way…

Sooooo…how confident are you, that tossing a few sessions of psychotherapy alongside a daily dose of Prozac is going to take care of the depression?

Each case of depression is unique, with its own combination of driving factors. And none of them are blatantly a “brain” issue. Therefore, blanket recommendations of “medication and therapy” will not work the vast majority of the time to make depression disappear forever. 

Instead, finding the unique root cause, and then modulating and healing it with diet and lifestyle changes, must happen for you to feel better and maintain those gains long term.

Functional nutrition for the win!

References

American Psychiatric Association [APA]. (2013). Desk reference to the diagnostic criteria from DSM-5 (5th ed.). Arlington, VA: Author. 

National Institute of Mental Health. (2020). Major depression. Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression.shtml