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CAUSES OF DEPRESSION
Evidence from neuroscience, genetics, and clinical investigation demonstrate
that depression is a disorder of the brain. Modern brain imaging technologies
are revealing that in depression, neural circuits responsible for the regulation
of moods, thinking, sleep, appetite, and behavior fail to function properly,
and that critical neurotransmitters, chemicals used by nerve cells to communicate,
are out of balance. Genetics research indicates that vulnerability to depression
results from the influence of multiple genes acting together with environmental
factors. Studies of brain chemistry and of mechanisms of action of antidepressant
medications continue to inform the development of new and better treatments.
Some types of depression run in families, suggesting that a biological vulnerability
can be inherited. This seems to be the case with bipolar disorder. Studies of
families in which members of each generation develop bipolar disorder found
that those with the illness have a somewhat different genetic makeup than those
who do not get ill. However, the reverse is not true: Not everybody with the
genetic makeup that causes vulnerability to bipolar disorder will have the illness.
Apparently additional factors, possibly stresses at home, work, or school, are
involved in its onset.
In some families, major depression also seems to occur generation after generation.
However, it can also occur in people who have no family history of depression.
Whether inherited or not, major depressive disorder is often associated with
changes in brain structures or brain function.
People who have low self-esteem, who consistently view themselves
and the world with pessimism or who are readily overwhelmed by
stress, are prone to depression. Whether this represents a psychological
predisposition or an early form of the illness is not clear.
In recent years, researchers have shown that physical changes
in the body can be accompanied by mental changes as well. Medical
illnesses such as stroke, a heart attack, cancer, Parkinson's
disease, and hormonal disorders can cause depressive illness,
making the sick person apathetic and unwilling to care for his
or her physical needs, thus prolonging the recovery period. Also,
a serious loss, difficult relationship, financial problem, or
any stressful (unwelcome or even desired) change in life patterns
can trigger a depressive episode. Very often, a combination of
genetic, psychological, and environmental factors is involved
in the onset of a depressive disorder.
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