The costs of depression on a variety of levels are huge: Marriages and families splinter, individuals suffer, societies suffer the consequences of the often destructive behaviors of people coping badly or not at all with their depression, businesses suffer the negative effects of employees too disabled to function properly, the economic costs of greater health care expenses are greater for depressed patients, and there is the tragedy of suicide -- lives lost to despair and apathy. Depression is a terribly disabling disorder, and despite significant advances in treatment, the problem continues to grow.
Depression is a multi-dimensional disorder. It has biological components based in genetics, neurochemistry and physical health, it has psychological components that involve many individual factors such as cognitive style, coping style, and qualities of personal behavior. And, it has social components, factors that are mediated by the quality of one's relationships, including such variables as the family and the culture one is socialized into, and one's range of social skills. The best, most accurate answer to the basic question, "What causes depression?" is, "Many things."
Currently, however, the medical model of depression receives the greatest attention for a variety of reasons. The pharmaceutical industry in particular has invested literally tens of billions of dollars in advertising to the public as well as investing directly in individual physicians, encouraging us all to define depression as a disease caused by a neurochemical imbalance that requires medication to manage. The lion's share of research money goes to drug research, further elevating drugs to the status of being the source of hope for everyone who suffers depression. As a result, antidepressants are the most widely prescribed medication in the U.S., and are considered a first-line treatment approach, de-emphasizing the value of psychotherapy despite its success not only in treatment, but in the area of prevention.
This is a tragic misconception that is actually making the problem worse. It may sound extreme to some, but I stand by this statement: Depression is more a social problem than a medical one, and no purely biological cure will be found for it any more than biology alone will cure other social ills such as poverty or child abuse. This is not to say that antidepressant medications shouldn't be a part of treatment, especially in those specific instances where there are clear benefits medication can provide over psychotherapy. Rather, medications should be used more carefully and with an associated recommendation for a well-considered skill-building psychotherapy. No amount of medication can address the psychological and social dimensions of depression, assuring that people will be treated only one-dimensionally. Under-treating depresion is a reliable pathway to it increasing in prevalence, just as it is doing.
The social side of depression is especially important, yet is terribly under-considered in most people's consideration. We know, for example, that depression runs in families: The child of a depressed parent is anywhere from three to six times more likely to become depressed than the child of a non-depressed parent. The genetics research makes it quite clear that it isn't entirely -- or even mostly -- faulty genes responsible, especially since there is no "depression gene." It has more to do with the patterns of thinking, coping, behaving, and relating that parents (and other significant role models in our society) model day in and day out than it does one's genetic makeup. When you have the largest demographic group of depression sufferers now raising children, it should surprise no one that their children are the fastest growing group of depression sufferers. After all, parents can't teach their children what they don't know.
Furthermore, the more distressed one's marriage or primary relationship, the more likely one is to either already be or to become depressed. The quality of one's deepest relationship is a very large risk factor, yet many people never consider how powerful a good relationship can be in helping insulate its members against depression. Shining the spotlight on this very issue is why I wrote my most recent book, Depression is Contagious. (A lively interview on the subject).
These points provide excellent reasons to want to strengthen parents and marriages, something no antidepressant medication alone can accomplish. To think of depression as only an individual's biochemical disorder, as if he or she isn't a product of powerful social forces that operate in families, organizations, and cultures, or to reduce it even further to a purely biochemical phenomenon, is so terribly reductionistic as to disempower the very people who need help changing their lives, not just their brain chemistry. It's true: You are more than your biochemistry.
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