Depression - if it's not a chemical imbalance, what causes it?

There have been several mainstream newspapers publishing articles about antidepressants and whether the science that low serotonin causes depression is correct. It is now coming to light that there is no evidence to support this. The studies also show that antidepressants are only slightly more beneficial than a placebo. So what might cause depression? 

It can be hard to come to terms with the information that the imbalance theory of depression is now incorrect. It gave an easy answer to a complex and difficult problem. I expect it will be hard for many people and the medical establishment to let this idea go as it is also a blameless solution, that is nobody's fault that someone has depression. I find the idea that there is blame or fault to be had, particularly unhelpful.

What is more helpful is for each of us to take responsibility for where we find ourselves, what is happening to us and find ways to support and look after ourselves while also finding the root cause and dealing with that. Often there are several contributing factors. It is my hope that the information coming to light will help people get the help and support they really need. 

Nutrition

There is evidence to support nutrition and mental health are closely linked(1). Low levels of B12, B6, Zinc and selenium have been linked to depression as well as omega-3, folate acid and tryptophan. Reducing sugar and saturated fat also improves mood(2).

 Socio-economic factors

There are studies that support the link between depression and a low socio-economic status(3).This of course makes sense. It is depressing to live in difficult circumstances, in bad housing without enough money to pay for the essentials of life but we have been encouraged to think that depression is just an individual's problem and not a societal one.   

Inflammation

There is evidence to suggest a link between depression and inflammation(4). Tests can be done to measure the levels of cytokines, a chemical protein, in the blood. The higher the level of cytokines the more inflammation there is in the body. This causes many illnesses in the body, such as allergies, asthma, autoimmune diseases, chronic infections, colitis, dermatitis, sinusitis, arthritis, and many others. It can also cause symptoms of depression; fatigue, depressed mood, changes to appetite and sleep, difficulties with concentration, motivation and social withdrawal.

It is worth looking at the things that cause you stress, the low level everyday stresses and the bigger irregular stresses. Learning how to calm your vagus nerve is very useful as well as eating well, sleeping well and having positive connections and interactions with others, bringing movement into your day. It is also helpful to deal with and process any difficult experiences and traumas you have had. 

Difficult childhood

There are now studies that link Adverse Childhood Experiences(5)  with physical and mental health problems during adulthood and again this is hardly surprising. I often work with individuals that come to me with depression, anxiety and low self esteem. Every time it links back to a difficult childhood. It is harder to identify a challenging childhood when on the outside everything looks normal. This is when it is often a drip, drip, drip effect of small everyday hurtful comments.

Having a caregiver that was unpredictable, kind one moment and punishing the next is challenging for a child to process. Being harshly punished or blamed incorrectly will start to take its toll on a child. It is easier to identify when there is explicit drug and alcohol use or abuse. Whichever strata of the social class you come from you can have experienced a difficult and traumatising childhood. If you now have difficulties with regulating your nervous system and are in ‘flight/flight/friend/freeze’ you may well have had a challenging childhood. We can have loving parents and still have had a difficult childhood.

Trauma response

Depression can be caused by being in the ‘freeze’ response. This is part of the ‘flight, fight, friend, freeze, flop’ survival response caused by the vagus nerve reflex, which is designed to keep us safe in times of danger. Unfortunately the society we live in and the families we’ve grown up in often trigger these responses for far longer than is optimal.

When we are in ‘freeze’ we can still go about our normal day, walking and talking, doing the things that need to be done but it can be hard to make decisions. We can behave irrationally and even if we know we are being irrational it can be hard to stop. There is also likely to be dissociation (where you feel that you're not quite ‘here’, spaced out or want to sleep), numbness, helplessness and hopelessness.

These are all useful things if your life is in danger and you are about to die - you want it to be as painless as possible, but this is unhelpful as a constant life state. There is now lots of information available about how to calm the vagus nerve and bring the nervous system into coherence. But first you have to be in a safe place. It will be hard to do this if you aren’t living and working in a safe place. It's important to identify if you feel unsafe or if you actually are unsafe. Here are some videos to help calm the vagus nerve. 

Ancestral trauma

I have been working with ancestral trauma for many years, and have seen how trauma can be passed on down the generations. There are now studies(6) that support that trauma can be passed on through the epigenetics in our DNA. The child or grandchild can have reactions to and trauma responses to situations and experiences that previous generations have had. This would include feelings of depression, suicide, loss and anxiety to name but a few.

A book I recommend to find out more is It didn’t start with you by Mark Wolyn, there is also a Nexflix series called Another Life which features ancestral trauma and the use of Family Constellations as a way to heal it. 

What you can do to help yourself

So how do you find out what is at the root of your depression? It can be a good idea to have a blood test to see if you are low or on the borderline for any nutrient deficiencies or have raised cytokines. If you do, working with a nutritionist may be useful for you.

Work with a therapist to find out what the underlying issues are, I have also written an article, My life looks good on paper, so why aren’t I happy? which might also be helpful to read. Often there are multiple factors and rather than looking for one answer look at how many might be relevant to you.

It can be difficult to really look at the issues that could be causing the depression. Often choices and decisions are brought to the forefront. It can feel easier to ignore and pretend that life is fine. Therapy might bring into awareness that you are unhappy in your partnership or marriage, that you really don’t like your job, that the happy childhood that you have come to believe was fine isn’t the whole truth. These are difficult and confronting things to address and only you can decide if depression is worth the price of keeping your life just as it is now. 

References:

(1) Nutrition and Mental Health: a handbook Edited by Martina Watts
(2) MIND Food and Mood project 
(3) Depression and socio-economic risk factors: 7-year longitudinal population study
(4) https://www.brainfacts.org/diseases-and-disorders/mental-health/2015/the-brain-inflamed 
(5) http://traumadissociation.com/ace
(6) Inherited Fear: BBC Radio 4 programme