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How to Teach Patients About the Causes of Depression
Frequently, patients will ask about the cause of their depression. One of the most common questions I am asked is, “Doctor, is this a chemical imbalance or a situational depression?” My typical reply is “Yes.”
I explain to them that at some very basic level, everything that we experience, whether a sense such as touch, taste, sound, smell, or feel, or a perception, a memory, or a thought, ultimately is a manifestation of a complex series of electrochemical reactions occurring in our brain. There is no getting around that fact. It is simply how we work as people.
Spending any amount of time in a neurological intensive care unit or working with patients with traumatic brain injuries should be enough to snuff out any lingering fantasies of dualism (the thought that the mind is separate from the brain).
However, I go on to explain to patients that this in no way discounts the impact of experience, interactions with the environment, relationships, etc., on depressive symptoms. Do life events contribute to the development of depression and other psychiatric symptoms? Absolutely! The reason this is so is that these life events alter neurophysiology.
Things that happen to us, experiences that we have, and lessons that we learn all change our brain. We see strengthening of certain circuits in the brain and weakening of others. We see increasing degrees of synaptic connections between certain collections of neurons. This is likely, at least in part, the physiologic basis of learning. The same types of changes are at work in modulating our mood and anxiety.
There are likely some patients whose depression is almost entirely biologically/genetically based. They simply didn’t do a very good job of picking their parents.
With nearly 60 candidate genes that can confer some vulnerability to depression, they had the bad luck of the genetic draw to receive enough suboptimal versions of enough genes from dad and mom to put them at increased risk for depression. Similarly, there are likely some patients who did a great job of picking their parents—they were the winners in the genetic lottery. However, despite this, life events conspired against them to push their neurophysiology towards a vulnerability to depression.
Helping patients understand the two side of this coin can help them understand the importance of both pharmacological as well as psychotherapeutic treatment approaches.
How do you discuss the causes of depression with patients?
Chris Bojrab, MD, is the president of Indiana Health Group, the largest multidisciplinary behavioral health private practice in Indiana, established in 1987. He is a board certified psychiatrist and a Distinguished Fellow of the American Psychiatric Association who treats child, adolescent, adult, and geriatric patients. His areas of interest include psychopharmacology, sleep disorders, and gambling addiction. For more information and disclosures, visit www.chrisbojrabmd.com
The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.
