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Deal with depression


Biological and environmental factors can cause depression.


GET HELP: It can be treated.

"HOW could I be depressed? I don't have any stress. Shouldn't stress be present to cause depression?" is a question occasionally posed to psychiatrists. The answer is not a simple yes or no. Consider a few scenarios.

Assume Mr. A and Mr. B are from the same socio-economic and educational background. Both of them face similar stressors, for example, loss of a significant business.

Mr. A worries about the loss, spends time brooding and blames himself for the setback. Gradually, he develops symptoms of depression like sadness, reduced interest, reduced ability to enjoy, ideas of hopelessness, helplessness, worthlessness and guilt.

Mr. B feels upset at the loss for couple of days, looks at the possible reasons for the loss and initiates corrective actions. He immerses himself in other activities. He does not develop depression.

Mr. C is also from the same background. He has no stressors. He gradually develops depressive symptoms for no apparent reason.

The above three scenarios are known to occur in the general population. In the first two scenarios, the stress is common but the consequences are different. It is because of the vulnerability of Mr. A to develop depression.

Stress as a factor

Personality traits, coping skills, psychological conflicts and biological factors determine the vulnerability or resilience of an individual to stress. For Mr. A, stress is not the cause of depression but a triggering factor. Mr. C developed depression spontaneously. This is because of biological factors.

Depression is associated with certain chemical changes in brain neurotransmitters. Serotonin and Nor adrenaline levels are low in the synapses (the junction between two nerve cells) of certain neural pathways.

Environmental factors are known to trigger these chemical changes. At times, these chemical changes happen spontaneously. Whatever the cause or trigger, the chemical changes seem to be the final common pathway.

Till the 1980s, depression was classified as endogenous (due to biological factors) and reactive (due to environmental stressors). Nowadays, this classification is not made as only a small number of persons have purely biological or environmental causes for depression. For most persons, it is a combination of both.


Antidepressant medications rectify the chemical imbalance and pave the way for clinical improvement of depression. But, medicines alone may not help if significant environmental stressors or psychological conflicts are not dealt with. These have to be addressed by counselling and psychotherapy.

The writer is a Chennai-based Consultant Psychiatrist. E-mail:

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