Causes and Treatments of Clinical Depression

Research has taught us much about clinical depression recently, although it is still unknown what triggers the depressive episodes.  However, it is believed that there is not one single trigger that causes the depression to surface, but it is usually a combination of triggers and researchers hope to find out what these are.


Through research, scientists feel that you may inherit traits of depression.  Scientists also feel that they are closing in on which traits lead to this depression.  For example, in identical twins that were studied, research shows that if one twin suffers from depression, there is better than a 70% chance that the other twin will suffer from depression, also.  This same study also tested siblings where one of the children was adopted into the family and the rate of depression in the adopted child was greatly decreased, unless the adopted child's biological parents suffered from depression.

Chemical Imbalances in the Body

Research shows us that if someone has an imbalance of neurotransmitters, chances are they are suffering from clinical depression.  Neurotransmitters are like telephone lines in the brain that allow cells to interact with one another.  Two of the major neurotransmitters related to clinical depression are norepinephrine and serotonin.  If your body lacks the proper amount of serotonin, it will cause problems such as insomnia, extreme irritability, and high anxiety.  If your body has a decreased level of norepinephrine, you may feel tired, depressed, and feel less alert than usual.

Other Factors That May Cause Clinical Depression

There are other chemicals in the body that are known to be altered in people who suffer from depression.  A hormone named cortisol is produced when the body is reacting to situations such as, fear, anger or stress.  People who do not suffer from depression have a peak in their cortisol level usually in the morning, and their cortisol level will decrease as the day goes on.  Those who suffer from clinical depression have a cortisol peak much earlier in the day and their cortisol level does not go down until the early evening.

It is unknown if these differences in cortisol levels are what causes the depression or if the depression leads to the imbalance in the cortisol levels.  However, it is known that the cortisol level in the body increases in people who are constantly under stress. 

There are other factors that lead to depression.  Many medications have been known to cause certain forms of depression.  In the 1970s doctors realized that patients who were taking Reserpine for their high blood pressure had developed many symptoms associated with depression.


Clinical depression is said to be among the most treatable of mental illnesses.  Over 80% of people who suffer from clinical depression have had great success with treatment, and most all people with depression have seen at least a small measure of improvement with proper treatment.  Scientists are getting closer to finding out how to properly treat this illness and are hopeful that they will find better treatments in the future.

Before anybody suffering from clinical depression starts a treatment program, they should undergo a thorough evaluation by their physician.  Since this is a very intricate illness, it has been found that there are many factors that contribute to their depression.  These factors may be the following:

The evaluation should include, not just your psychiatric history but your complete medical history.  This will allow your physician to detail your emotional and physical history.  Your physician may also order a mental status examination to find any changes in your moods, thoughts, or speech patterns that may be manifestations of depression.  Usually, a complete physical exam is ordered to make sure there are no medical problems that have been undiagnosed that may be causing the depression.

Medications Used to Treat Depression

In the early 1950s, research taught us about the effects that medications have on depression.  How well the medications work depends on factors such as:

Medications may be adjusted up and down in dose until the proper level is reached.  Often, the psychiatrist will prescribe a combination of medications until they find out which combination works best for the patient, since each patient is different.  Usually, after the patient starts taking the antidepressant medications, they notice a difference after four to six weeks.

 Physicians generally prescribe one of four major types of medications used to treat depression: 


This usually involves communication between a therapist and a person that suffers from behavioral or emotional problems.  The therapist uses techniques that are based on psychological principles geared towards helping the patient gain insight about themselves and to help change their thoughts, feelings, and behaviors.  There are many forms of psychotherapy that have proven useful in helping people with depression. 

In the 1980s, scientists announced the results of research on the effectiveness of short-term psychotherapy in the treatment of depression.  The results show that for some categories of patients, under certain circumstances, that cognitive behavioral therapy and interpersonal therapy were just as effective as medications.  Although the medications relieved the symptoms of depression more quickly, the patients who received psychotherapy instead of medication had just as much relief from depression after 16 weeks.  In general, psychiatrists are in agreement about severely depressed patients benefiting from a combination of medications and psychotherapy.

Interpersonal Psychotherapy

This form of therapy is based on the theory that personal relationships can cause depression.  The depression may make these relationships more problematic.  The therapist tries to help the patient understand their depression and how the interpersonal conflicts are related to the depression.

Cognitive and Behavioral Therapy

This method of treatment is based on the belief that people's emotions are being controlled by their outlook on life and their opinions of the world.  Depression in this form results when the patient is harsh on themselves, believes that they will fail in whatever they attempt, and make inaccurate assessments of how others perceive them.  They feel hopeless and have a negative outlook on the future.  The therapist, in this case, would use a variety of techniques called "talk therapy" and behavioral modification in trying to alleviate the person's negative thought process and beliefs.


Psychoanalysis is based on the concept that depression is related to a conflict in the person's past that they have buried in their unconscious.  The patient will meet with their therapist on an average of 3 to 5 times a week, in hopes to identify and resolve these past conflicts that have caused their depression.

Psychodynamic Psychotherapy

This form of therapy is based on psychoanalysis and is less intense due to the fact that the patient only meets with their therapist once or twice a week, over a shorter period of time.  It is based on the belief that human behavior is determined by genetics, past experience, and current reality.  It recognizes the significant effect that our emotions and unconscious motivation can have on our behavior.

Electroconvulsive Therapy (ECT)

ECT works by affecting the same transmitters in the brain that are affected by medication.  As medications have grown more effective, ECT, as a form of treatment for depression has been decreased.  However, for patients who cannot take medication for reasons such as, heart disease, old age, malnutrition, or patient's like myself, who have difficulty or do not respond to antidepressant medications, or are suffering from a very severe case of manic depression, ECT has been found to be very effective.  For people like myself, ECT can be a life-saving treatment when all other treatments and therapies have failed, or when a person has been deemed suicidal.

Recently, it has been found through research that a sub-type of depression, called seasonal affective disorder exists.  Research suggests that this newly found disorder comes from some people's sensitivity to seasonal changes and the amount of daylight.  A therapeutic session of being covered in light from what scientists call a "light box", has proven to be a highly effective form of treatment for this type of depression.

Source:  John's Hopkins Medical Handbook, 2000