Additionally, there are medications that seem to have caused depression in some people - or at least symptoms that look like depression: certain asthma medications, certain blood pressure medications, certain hepatitis medications, smoking cessation medications all seem to cause these types of symptoms in some vulnerable populations and therefore whenever you're starting a new medication, if you are struggling from depression, it's a good idea to run the new medication by your doctor to make sure that there's nothing that would require additional monitoring. Other biological contributors to depression that we think about are substance abuse and really addictions of any sort: alcohol, recreational drugs, gambling addiction, sex addiction - all of these can contribute to symptoms of depression in many individuals and have to be very thoroughly considered in the diagnosis. Psychological factors also have to be considered as potential contributors to depression, so people who tend to think in all or nothing terms (for example: everything is all good or everything is all bad) will often be more subject to depression. People with low self-esteem are at a significantly higher risk of depression. People who don't deal with adversity or don't have as much of a coping system may be at higher risk for depression than many others.
In all honesty, modern science doesn't really know what causes depression. Some people will tell you that it is due to a deficiency in the neurotransmitter (a fancy word for a chemical in the brain called Serotonin.) While Serotonin does seem to play an important role in the regulation of mood, to say that depression is just the result of too little Serotonin is probably a gross simplification. While we don't really know what causes depression, we do know a number of things that seem to contribute to the risk of developing depression and probably all together are impacting the development of depression in a person. Here we have to think of a few different common causes. One is biological causes. Genetics, for example, can increase the risk of depression in some individuals, so if a person's family member who has depression, they may be at risk for depression themselves. Certainly not a guarantee that they're going to develop it and not even necessarily likely that they're going to develop it, but their risk may be a little bit higher than the rest of the population. Certain medical conditions seem to affect depression. Things like heart disease, diabetes, Parkinson's, stroke - all seem to travel together with depression and some of them may be involved in causing depression.
When talking about the causes of depression, it is important to note that while we lump everyone together as having major depressive disorder, in reality, these may be very different conditions. A person who has depression related to lack of sleep may be very different than a person who has depression related to low thyroid hormone, may be very different from someone who has depression due to poor coping skills. We generally group them together with the same term as a sort of final common pathway that they're all showing the same symptoms, but in reality they may be very different conditions that in the future we may better understand and be able to individualize the treatment in a more specific way.
Some patients who take medications may find that no medication is working for them or that they are extremely sensitive to side effects even at very, very low doses of the medicine. If that is the case, you might want to discuss with your doctor the possibility of genetic testing. This is a new area that is still being explored, but what we call pharmacogenetics: The way that a person's genetic profile might affect the way they metabolize or process and medication can be significant in some individuals. While this is not usually pursued as a first line or a first step in treatment, it may be something to ask your doctor about if you are in that situation.
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