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Causes
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Q. What causes depression?
The group of symptoms which doctors and therapists use to diagnose
depression ("depressive symptoms"), which includes the important
proviso that the symptoms have manifested for more than a few weeks
and that they are interfering with normal life, are the result of an
alteration in brain chemistry. This alteration is similar to
temporary, normal variations in brain chemistry which can be
triggered by illness, stress, frustration, or grief, but it differs
in that it is self-sustaining and does not resolve itself upon
removal of such triggering events (if any such trigger can be found
at all, which is not always the case.)
Instead, the alteration continues, producing depressive symptoms and
through those symptoms, enormous new stresses on the person:
unhappiness, sleep disorders, lack of concentration, difficulty in
doing one's job, inability to care for one's physical and emotional
needs, strain on existing relationships with friends and family.
These new stresses may be sufficient to act as triggers for
continuing brain chemistry alteration, or they may simply prevent the
resolution of the difficulties which may have triggered the initial
alteration, or both.
The depressive brain chemistry alteration seems to be self-limiting
in most cases: after one to three years, a more normal chemistry
reappears, even without medical treatment. However, if the alteration
is profound enough to cause suicidal impulses, a majority of
untreated depressed people will in fact attempt suicide, and as many
as 17% will eventually succeed. Therefore, depression must be thought
of as a potentially fatal illness. Friends and relatives may be
deceived by the casual way that profoundly depressed people speak of
suicide or self-mutilation. They are not casual because they "don't
really mean it"; they are casual because these things seem no worse
than the mental pain they are already suffering. Any comment such as,
"You'd be better off if I were gone," or "I wish I could just jump
out a window," is the equivalent of a sudden high fever; the
depressed person must be taken to a professional who can monitor
their danger. A formulated plan, such as, "I'm going to jump in front
of the next car that comes by," is the equivalent of sudden
unconsciousness: an immediate medical emergency which may require
hospitalization.
Depression can shut down the survival instinct or temporarily
suppress it. Therefore, depressed suicidal thinking is not the same
as the suicidal thinking of normal people who have reached a crisis
point in their lives. Depressive suicides give less warning, need
less time to plan, and are willing to attempt more painful and
immediate means, such as jumping out of a moving car. They may also
fight the impulse to suicide by compromising on self-injury --
cutting themselves with knives, for example, in an attempt to
distract themselves from severe mental pain. Again, relatives and
friends are likely to be astonished by how quickly such an impulse
can appear and be acted upon.
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