~~~my anecdote~~~

During my first semester of university, I suffered crippling depression and at some point tried to kill myself. Soon after I entered a mental hospital and started journaling. In one of my first journal entries, I noted that I was fairly smart, had great friends, had parents that loved me, had a full scholarship to university, and yet I hated my life and wanted to die. At the time, my condition certainly seemed like some sudden contingency resulting in brain malfunction.

What I did not then realize, and in fact did not at all realize until last year, was that I spent the first 16 years of my life in a literal doomsday cult. I was raised a Jehovah's Witness, and since that was really all I knew, even when I eventually came to the point where I disagreed with some of the doctrines, it never crossed my mind that there was anything at all nefarious about how that organization treats its members.

What you have to realize is that without exceptional self awareness or being adapt at adopting multiple perspectives, people are mostly blind to context of their own circumstances. That's usually fine; such awareness takes a ton of energy and most people just don't need it to stay alive. But when things do start going seriously wrong, and you're experiencing non-congenital mental disorders, is it really reasonable to believe that your mental state is "independent of external factors"? As if that's somehow the one thing the brain's constant processing of sensory data and immediate experience and past memories isn't effecting?

A relative of mine has been battling depression for decades. After this person retired, they had a noticeable improvement in mood and energy within months, and around two years later had started a new exercise regime, begun doing low-paying but enjoyable work again for the sheer joy of it, gotten involved in local government, and quit medication with the help of their doctor.

It's not clear what "independent of external factors" really means, but in this case quitting the job seems to have worked. It wasn't that the job was bad in the sense of prestige, but rather that the job was a massive stressor in physical and emotional ways.

Now, everyone is an individual, but I'd hate to see someone else spend decades fighting depression without access to every weapon they can use.

>Those techniques are what you called "short term solutions." I think of them as long-term preventative measures to stave off the chemical imbalance that can cause depression

What causes the chemical imbalances? Research on animals show that chronic stress causes depression, so it definitely can be caused by external factors. If your job is causing chronic stress then changing job is obviously a plausible cure for your depression.

To do that, you actually have to both be actually able to find and take a different job plus have the clarity to know that such a thing will improve your situation.

And with depression (or anxiety), this isn't so easy. It gets difficult to see opportunities and easier to blame yourself, thinking, "I'm lucky to have this crappy job and that they put up with me". It can make your job seem crappy, even when it isn't.

I get to see the way the chemicals affect my brain once a month. Once a month, I think I'm going to lose my job. That people dislike me. That people are suddenly treating me harshly and I must have done something wrong. I consider changing jobs.

This is like this even when I enjoy my work and actually like the folks I'm surrounded with. It doesn't stop with work, but is a handy example.

I likely should be on anti-depressants half the month - if you've not figured it out, I'm female and this is entirely hormone-related. Instead, I've adjusted life. Once I realize what is going on, I can relax some on the temporary nature of it all. Sometimes it works better than others.

The thing is when depression hits, for me, it is much like this. All the freaking time. Work becomes a relief from home, home becomes a relief from work, sleep a relief from it all. I literally don't have the capacity to sort out which things in life to change or what to do next. I get stuck.

This is why it is a long-term preventative measure. Gotta catch this stuff before the darkness sets in and messes with your sensors.

>before the darkness sets in and messes with your sensors

I like this language, "messes with your sensors." Depression is a disease within the brain, and naturally it's difficult to observe a system from within that system - especially when those observational tools are affected by the system itself.

So it's really hard to know you have depression and take the steps to treat it, when you have depression.

It is a marvelously true expression. _Whatever_ the cause, a real black-dog depression robs a person of all sense of effective agency. The leg is broken and needs a cast, and for many the drugs do work (personal experience). But then the person needs to learn to walk again. It may be a disease (there is a genetic component) but we don't know whether the observed neurotransmitter problems are cause or effect.

Freud said that the purpose of therapy was to replace neurotic misery with ordinary human unhappiness. Some Californians find that a bit of a downer, but it's true, and we can do something about unhappiness.

Depression seems to be caused by both external factors (such as crappy job) and internal thought processes (worrying too much, negative thoughts, etc) or a combination. And some people are just more prone to depression than others. In your case it sounds like some kind of CBT, ACT or mindfulness therapy might be helpful.

Hormones are well known to interact with the stress system and exacerbate depression.

You make a good point about depression itself causing issues with (for example) your job, making it difficult to know what is the source of the problem. I think the best that people can do in this situation is to take a break from work, and think carefully about what they really want from life.

> Research on animals show that chronic stress causes depression...

Source?

That sounds like an oversimplification in my opinion, as there are some pretty glaring problems with using other animals to model mental illness in humans.

Wouldn't the only real analogue be learned helplessness, or am I missing something?

See for example:

http://www.nature.com/npp/journal/v33/n1/abs/1301574a.html

>there are some pretty glaring problems with using other animals to model mental illness in humans

Yes, but the research also looks into stress and depression in human subjects (see above).

The paper you linked to doesn't really show that "chronic stress causes depression", though.

The key sentence in the abstract, I think, is this:

    Here we provide an overview of the evidence that chronic stress, which can precipitate or exacerbate depression, disrupts neuroplasticity, while antidepressant treatment produces opposing effects and can enhance neuroplasticity.

The paper states that stress "contribute[s] to the development of major depression in susceptible individuals", as is well known. It also states that chronic stress correlates with features that are associated with major depressive disorder.

Notice there not being any mention of a causal relationship here.

Agreed. I should have said chronic stress can cause depression.

"Chronic stress can trigger the onset of depression in those predisposed", I would say.

Not really a cure, but a necessity. You still need treatment.

It depends. My own depression was completely cured by lifestyle changes, as was my wife's (different causes for each, but mostly related to jobs).

Treatment doesn't have to be medication or therapy, as I said in my post I consider exercise, meditation, and mindset modifications to be forms of treatment. It's certainly how I handle upticks in depression now that I don't medicate anymore.

- However, depression is a disease independent of external factors.

What? No disease is independent of external factors. You even list a bunch of things which affect it. Depression is a pattern, subject to countless factors. I think what you mean to say is, there isn't a single cause of depression, and it can manifest when many of the factors affecting it seem to be "pretty good", and it can not manifest when those factors seem to be "pretty bad".

>What? No disease is independent of external factors.

This statement is true only in the narrowest sense and is actively harmful to people with mental health issues. Let's compare depression and cancer to see why.

It is common to say something like "cancer is independent of external factors" to mean that anyone can get cancer. It doesn't matter how healthy of a lifestyle you live. Due to random chance, the guy who regularly works out and eats fresh vegetables and avoids toxic substances can get cancer when the guy who watches tv all day, eats nothing but twinkies, and smokes like a chimney might never get cancer. The first guy's cancer was out of his control.

When people talk about depression being "independent of external factors" what they're trying to say is depression can happen to anyone. It doesn't matter how healthy your "mental lifestyle" is. Depression, like cancer, is a disease. Some things may make depression more likely, but anyone can get it at anytime and there's nothing you can do to completely prevent it.

No one feels ashamed for getting treatment for cancer because society recognizes that cancer is disease that can happen to anyone. But people feel ashamed for getting treatment for depression because most people believe "depression doesn't happen to normal people." If you make statements like the parent's about depression but don't make similar statements about cancer, then you are actively contributing to the problem even if your statements are factually correct.

No one feels ashamed of seeking treatment for pneumonia, but there's no way you would say it's independent of external factors. That depression is affected by external factors should neither be controversial nor related to your concerns about society's acceptance of its treatment. You seem to be conflating "dependent on external factors" with "arises due to bad life decisions", which is bizarre as it's kinda the exact thing you're worried about.

In a strictly clinical discussion it is fine to use language like "dependent on external factors" with its technical meaning. But when you're talking to someone potentially suffering from depression and not a clinician, you need to be aware of how they will respond to your words. The average person conflates "dependent on external factors" with "arises due to bad life decisions" and so we need to adapt our language accordingly in an average conversation.

I'd think most people would mistake it as implying that depression was caused by, say, lead in your pipes or that time they were mugged and felt powerless. External factors seem to me to push the blame away, not towards, the individual. The alternative of saying that depression is causeless to me sounds more likely to induce people to think it's "just their fault" or "if there's no cause, why can't they snap out of it?" But I don't have much experience dealing with such people to know.

When you are down, nothing can really make you feel like it is not your fault or that you don't somehow deserve the feeling. Except perhaps, at least among the people I know, this knowledge: That feeling of worthlessness, itself, is the symptom of a condition you have. That condition is called Depression, and Depression lies. So the depressed person can maybe make it through for a little while longer by trying to actively distrust their own feelings and thoughts and waiting for the episode to pass. If they wait long enough, the episode will pass. If they can't wait, they may end up taking their own lives, which is really the only other option they see in the worst moments of this disease. So recognizing that it is a medical condition for which you are not to blame could be very useful for people right on the margin of surviving a depressive episode vs not surviving. I hope this was not too much of a reply!

> true only in the narrowest sense

I think it's true in the right-width-of-sense. Illnesses like depression are difficult because they certainly _do_ lie somewhere closer to the symptom side of the "symptom-disease" spectrum than cancer.

Alcoholism is good for comparison, because it presumably falls even further towards the "symptom" side of the spectrum. But there is certainly a spectrum!

So we have Cancer which is mostly-disease and Alcoholism which is mostly-symptom, and Depression which is somewhere in between.

The fact that these complications lead to weird moral baggage (socially-derived feelings of guilt, etc.) is completely separate from a good analysis of the situation. Depression and cancer are just very different phenomena.

This thing you assert hasn't been proven though. We still don't know what causes depression, we don't know what causes cancer and we don't know what causes alcoholism. Out of the 3, we understand how cancer works the most, because it is the most life threatening one, and affects the most people, and is also probably easier to understand. So we are putting more money and effort into cancer research.

There's as many known external factors for cancer as depression. And as with cancer, they've got only a small impact of likelihood of reducing your risks of getting the disease.

It's therefore unknown if depression is caused by external factors, or simply triggered by them, or a combination, and if so, we're not exactly sure what all the factors which have an influence are.

As it stands today, it's still very possible depression is caused by generic defects, bacterial infection, virus, or some other unknown external factor like polution, exposure to some toxins, or very early development problems, etc.

Honestly, I'd love to be enlightened on some very definite research that knows what causes depression, but as far as I'm aware, science doesn't know.

So there is this problem that some people have depression, and we assume it's just there lifestyle, or they were raised poorly. This is due to the nature of mental diseases, which we understand poorly, and often we associate our mental state as our conscious of our own doing free will. Like someone who is naturally grumpy, we say that's who he is, no one questions that it might be he's got a disease, maybe there is a brain anomaly, or a weird communication of his neurones happening that don't balance out his emotions properly and skew him to being grumpy. But being a grumpy guy would never affect your life enough that you'd seek medical help. So people who are depressed, they're like grumpy guy, except it affects their life so much that we put some research into addressing it. Sad truth is we found very little yet.

With that said, we can see how socially we should be careful how we speak of this, because we're often giving the impression that external factors is the known cause, and that a few lifestyle change is the cure. Except that's false. The cause is unknown, and exercise is just the best we got to help. Imagine if we thought similar of cancer, we'd cut funds for cancer research, we'd just tell people they should eat better, stop smoking and exercise. And everyone who gets cancer got it because they probably didn't follow the right lifestyle.

Robert Sapolsky compares depression to cancer in another way.

https://www.youtube.com/watch?v=NOAgplgTxfc

The acceptance for cancer is great, but I believe both cancer and depression can be avoided with good chance due to factors you decide yourself. Living healthily, eating healthily.

Er, no. You can reduce your risk of cancer greatly by living and eating healthily, but you cannot avoid it. Being alive is in itself a cancer risk, because there are many different cancers and many different ways they can arise - and some of those ways are pretty much purely random.

Having a chance to avoid and reduce the risk of it sounds like the same to me.

Indeed, they do sound the same. They are not.

If I buy a lotto ticket, I have a chance to avoid losing. If I win, it's over. If I lose, it's over. It's only good for one drawing.

However, I have some risk of cancer as long as I am alive. I may be able to do things to reduce that risk, but my chances are infinite as long as I breath. I can choose not to play the lotto, but I can't choose not to get cancer.

Let us assume the goal of a human is to 'lead a long and happy life'.

The chance you win the jackpot with Lotto is miniscule. It is basically so small, that it isn't worth the investment. You're better off not taking that chance because the risk isn't worth the reward. These games are, basically, fallacies designed to manipulate humans, tricking them into behaviour they should not [logically] resort to.

With cancer, you have genetic risks to get (certain types of) cancer, sure.

However, for example living next to a highway increases the chance you get cancer. So, not living there increases your chance of not getting cancer [at a young(er) stage of your life]. Which increases the goal of human life as we agreed upon.

So I agree they're not the same, but your example of Lotto (or similar games) I find rather bad.

I think with regards to cancer this is related to risk/reward. People take risks such as speeding, eating overburned food, or living near a highway. They feel the risk is worth the reward, and they live under the assumption they get away with it.

Brain damage, such as from a concussion, can result in depression along with other psychological problems. Yeah, the concussion is an external factor in the sense that something hit your head, but there's not a whole lot you can do about fixing that factor yourself.

If you think of depression as a self-sustaining feedback loop in your mind, it may very well persist regardless of external factors; in such situation it sounds reasonable to focus on killing off the factors that sustain the feedback loop, with the expectation that once gone, it won't restart again (at least not any time soon).

>However, depression is a disease independent of external factors.

Citation needed. The popular theory of depression being caused purely by a "chemical imbalance" independent of all other factors remains unproven, though it does make for a good and simple advertising ploy for big pharma in that it makes their consumers believe the only way to happiness is through their patented drugs.

I had depression from doing poorly in graduate school.

I felt inadequate and useless. You can call it temporary sadness, but I constantly contemplated suicide and nothing helped.

No matter how much I studied, I still didn't get new concepts as quickly as others and needed to study all the time which sometimes wasn't enough. Once I failed the qualifying exams, I quit and got a software engineering job where I'm doing really well and have plenty of money.

Now I'm really happy and never have such thoughts, so for me it was a matter of fixing a condition where I kept failing.

"However, depression is a disease independent of external factors."

Blanket statements like this (and quite a few in the article too) should be suggestions at best. That might be your experience but it sure as hell isn't mine. I think we can agree to disagree on this and possibly recognize that depression is not a one size fits all disease. What works for you might not work for me. Thus presenting any analysis or solution as fact simply confuses people and can be quite dangerous. Presenting the chemical imbalance theory as fact is especially misleading and extremely dangerous. It's much harder to admit we know a lot less than we actually do, but it's also much more helpful.

I think the observations in your last paragraph are very wise.

I've recently begun to wonder if pursuing 'happiness' is even a useful goal. I'm not really sure what 'happiness' is, or whether it exists. In the past, I have conflated transitory 'ups' in my life, caused by external factors, with sustainable and lasting happiness. When those external factors change, as they always do, it never seems to end well. But it's such a difficult thing to avoid; even being aware of all of this I'm pretty sure I'm going to fall in to this same trap at some point in the future.

Happiness for me can be just as much reflecting on the awesome things that have happened to me in the past, and where I am now, as much as it can be looking forward to the future.

I don't think there's something wrong with setting "happiness" as a goal - I think the important thing is separating that goal from other ones. So not attaching "achieving happiness" to "when I get a raise," instead just looking at internal things you can do to "be happy" in whatever situation.

But exercise, good diet, and not being in a stressful situation does help.

>However, depression is a disease independent of external factors.

Just to clarify, are you saying that systems as intensely interconnected as brains in bodies in the world only ever enter depressive states... for no externally visible reason? What kinds of external factors are you counting (or discounting) here?

Not parent, but I think I can help clarify. As goofy as it can sound: "being depressed" or in a "depressive state" can have many causes and some of them are obvious, but those states are not the disease of depression, exactly. They are serious, of course, and can be life threatening in their own right. But the distinction here is that depression can act like any other disease or illness - like, would making more friends improve tuberculosis? Too often we treat depression as a puzzle that can be solved. But it can just be something a person "has" and is stuck with, and needs medical treatment for.

That's not what the person I replied to said. They said

>However, depression is a disease independent of external factors.

Which sounds like "all depression is a disease independent of external factors". Further supporting this interpretation is that they "completely disagree" with the person they were replying to, as if their comment stood in contradiction.

If we are weakening the parent to just say "There exist cases of depression not caused by external problems" then they don't really contradict what they are replying to. The person they were replying to said "When you are depressed, see if there's a serious problem in your life" because they acknowledged that potential causes of and contributors to depression were numerous and heterogeneous.

When I'm debugging a program, the bug can come from lots of places. When I see a bug, I should definitely see if I'm failing to validate input. If someone told me "I completely disagree. Bugs are caused by hardware failures" I would tell them "if you are saying that all bugs are caused by hardware failures, you are simply wrong. If you're saying that some bugs are caused by hardware failures, then that in no way contradicts the wisdom of seeing whether I'm not validating my inputs".

I think this is mostly about what the formal and informal definitions of being depressed are. Informally people describe depressive states, and feelings of sadness, loss of hope, desperation, and so on as "being depressed". Those feelings are awful, but if they are coherent with real circumstances like grief, or a job you hate, then those feelings are somewhat appropriate and changing circumstances should help. Depression, the disease, is not coherent with reality or circumstances. It unfortunate that the same word it's used for these related but different states.

>Depression, the disease, is not coherent with reality or circumstances.

Where are people getting this idea? I mean, I suppose I could accept it as a definitional exercise in the same way that I can accept the idea that "gurple" is a bluish tint of red. But if you look at, say, a recent DSM, it doesn't say that external circumstances preclude a diagnosis of depression.

I have in my life been very closely connected to several people with depression and maybe that experience is influencing my opinion too much, I will check out some resources and diagnostic criteria, as it has been a while!

It's likely not wise to have a one size fits all approach. I've been in depression in a really bad work/life situation before, definitely beyond the "sadness" you describe. My immune system was compromised, I had an autoimmune flare, I quit work, and slowly became better both physically and mentally.

Then again I think I was very fortunate to have an externally driven depression that I could distance myself from (if I were broke and didn't have parents to support me, who knows if I could have had the courage to quit).

"depression is a disease independent of external factors."

I'm not sure this is fair.

Depression can often come from bad or non-existent relationships.

Loneliness, being away from family, having toxic relations with family, esp. those with whom you live, can definitely be sources of depression.

I only get depressed when I'm away from family for too long, for example.

I understand one can possibly shape one's view and change that, but often the 'external' issue is a reasonable thing to address.

But of course, often it's not like this.