Early Losses Life Events And Temperament - What Causes Depression: Depression
Content provided by the Faculty of the Harvard Medical School
Early losses, life events, and temperament
Physical factors such as genes, hormones, and brain function aren't the only contributors to depression; life events also play a role. Profound early losses, such as the death of a parent or the withdrawal of a loved one's affection, may resonate throughout life, eventually expressing themselves as depression. When an individual is unaware of the wellspring of his or her illness, he or she can't easily move past the depression. Moreover, unless the person gains a conscious understanding of the source of the condition, later losses or disappointments may trigger its return.
The British psychiatrist John Bowlby focused on early losses in a number of landmark studies of monkeys. When he separated young monkeys from their mothers, the monkeys passed through predictable stages of a separation response. Their furious outbursts trailed off into despair, followed by apathetic detachment. Inwardly, the levels of their stress hormones rose. Later investigators extended this research. One study found that the stress response — specifically the CRH system and HPA axis — got stuck in overdrive in adult rodents that had been separated from their mothers too early in life. This held true whether or not the rats were purposely put under stress. Some research suggests that having an overactive HPA axis may lay the groundwork for depression (see "Hormones and the HPA axis").
Interestingly, antidepressants and electroconvulsive therapy relieve the symptoms of animals distressed by such separations.
The role of trauma
Early losses are not the only life events indelibly etched on the psyche. A small but intriguing study in the Journal of the American Medical Association showed that women who were abused physically or sexually as children had more extreme stress responses than women who had not been abused. The women had higher levels of the stress hormones ACTH and cortisol, and their hearts beat faster when they performed stressful tasks, such as working out mathematical equations or speaking in front of an audience. This hypersensitivity to stress occurred whether or not the women were suffering from major depression at the time.
Many researchers believe that early trauma causes subtle changes in brain function that account for symptoms of depression and anxiety. The key brain regions involved in the stress response may be altered at the chemical or cellular level. Changes might include fluctuations in the concentration of neurotransmitters or damage to nerve cells. However, further investigation is needed to clarify the relationship between the brain, psychological trauma, and depression.
The link between stress and depressionEver taken on so many commitments at work or home that you can't possibly fulfill the promises you've made? Or maybe you've recently suffered a financial setback? Or perhaps you've had a painful disagreement with your spouse or teenager? All of these situations — and plenty of others, minor or momentous — are commonly recognized sources of stress. Even positive events, such as buying a house or getting married, can be stressful. Any stressor can trigger a host of responses in hormonal and neurological systems. Yet the same stressor can induce different reactions in different people. You may thrive on making split-second decisions at work, but the same situation might send a friend's heartbeat skyrocketing. Your friend, in turn, might be unfazed by a social situation that would bother you considerably. Or one of you might just be far more sensitive to life's stresses. Over time, it might take less and less stress to provoke a mood shift. This process may reflect incremental changes that occur in the brain over time. Eventually, the changes might build to a depression or usher in a relapse. How you react to stress is probably defined by your genes. Research reported in 2003 found that one gene that influences how your body uses serotonin comes in two forms, called the long and short forms. The researchers found that people with the short form are more likely to become depressed when under stress than those with the long form. More studies are needed to confirm this finding and figure out how to use it in treating stress-related depression. While your body is designed to deal with many sources of stress, some varieties may put you at greater risk for depression or anxiety. Research from the National Institute of Mental Health has found that long-term or severe stresses have far-reaching effects. For example, investigators studying a fairly small group of women who had survived physical or sexual abuse in childhood noted that they were more likely to have overly sensitive and longer-lasting reactions to stressful experiences (see "The role of trauma," above). And some animal studies have found that traumas early in life, such as separation from a mother, can wreak long-lasting biological changes (see "Early losses, life events, and temperament"). |
Temperament shapes behavior
In addition, how resilient you are in the face of difficult life events, such as a job loss or divorce, may depend partly on your temperament and view of the world. Temperament — for example, how excitable you are or whether you tend to withdraw from or engage in social situations — certainly helps dictate behavior. According to cognitive therapists, so, too, do unacknowledged assumptions about the workings of the world that you develop early on and automatically fall back on when loss, disappointment, or rejection occurs. Yet while temperament or world view may have a hand in depression, neither is unchangeable. Therapy and medications can shift thoughts and attitudes that have developed over time.
A few words about griefIt's quite common for someone to appear depressed after the death of a loved one. We often use the word grief to describe this feeling. A distinction can be made between grief that becomes depression and grief that slowly ebbs. Your grief may initially be so deep that it interferes with every aspect of your life. But usually, a steady improvement occurs over two to six months. Many people find it helpful to join a bereavement group or talk with a counselor or therapist as they come to terms with their loss. Consider seeking help if your distress leaves you unable to function for more than two months or if you feel overwhelmed or suicidal at any time. |
Medications and mood changes
Sometimes, symptoms of depression or mania are a side effect of certain drugs, such as steroids or blood pressure medication. Be sure to tell your doctor or therapist what medications you take and when your symptoms began. A professional can help sort out whether a new medication, a change in dosage, or interactions with other drugs or substances might be affecting your mood.
The table below lists drugs that may affect mood. However, keep in mind the following:
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Researchers disagree about whether a few of these drugs — such as birth control pills or propranolol — actually affect mood.
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Most people who take the medications listed will not experience mood changes, although having a family or personal history of depression may make you more vulnerable to such a change.
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Some of the drugs cause symptoms like malaise (a general feeling of being ill or uncomfortable) or appetite loss that may be mistaken for depression.
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Even if you are taking one of these drugs, your depression may spring from other sources.
Medications that may cause depression |
| Antimicrobials, antibiotics, antifungals, and antivirals acyclovir (Zovirax); alpha-interferons; cycloserine (Seromycin); ethambutol (Myambutol); levofloxacin (Levaquin); metronidazole (Flagyl); streptomycin; sulfonamides (AVC, Sultrin, Trysul); tetracycline |
| Heart and blood pressure drugs beta blockers such as propranolol (Inderal), metoprolol (Lopressor, Toprol XL), atenolol (Tenormin); calcium-channel blockers such as verapamil (Calan, Isoptin, Verelan) and nifedipine (Adalat CC, Procardia XL); digoxin (Digitek, Lanoxicaps, Lanoxin); disopyramide (Norpace); methyldopa (Aldomet) |
| Hormones anabolic steroids; danazol (Danocrine); glucocorticoids such as prednisone and ACTH; estrogens (e.g., Premarin, Prempro); oral contraceptives (birth control pills) |
| Tranquilizers, insomnia aids, and sedatives barbiturates such as phenobarbital (Solfoton) and secobarbital (Seconal); benzodiazepines such as diazepam (Valium) and clonazepam (Klonopin) |
| Miscellaneous acetazolamide (Diamox); antacids such as cimetidine (Tagamet) and ranitidine (Zantac); antiseizure drugs; baclofen (Lioresal); cancer drugs such as asparaginase (Elspar); cyclosporine (Neoral, Sandimmune); disulfiram (Antabuse); isotretinoin (Accutane); levodopa or L-dopa (Larodopa); metoclopramide (Octamide, Reglan); narcotic pain medications (e.g., codeine, Percodan, Demerol, morphine); withdrawal from cocaine or amphetamines |
| Last updated: | January 23, 2007 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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