Common Myths About Depression
Depression is one of the most common psychological symptoms and mental health issues for which people seek help in psychotherapy. Unfortunately, it often comes with misconceptions that inhibit people from finding proper help. I want to present some of the myths about depression here and share the perspectives that sometimes remain overlooked.
Depression Is Not Caused by a Chemical Imbalance in the Brain
One of the most common myths about depression is that it's caused by a chemical imbalance in the brain. This belief is based on the paradigm that depression stems from a physiological disorder and that there's a clear distinction between a 'chemical balance' and a 'chemical imbalance'.
This paradigm is also based on the so-called medical model approach to mental health, which falsely treats mental health by implying that there are distinct concepts of being mentally healthy and mentally ill, and posits that there is a distinct and clear difference between mental health and mental illness.
Implying that depression is caused by a chemical imbalance in the brain may also give certainty to those professionals who might feel daunted, overwhelmed, lost, and helpless in the face of reality: that depression is a complex psychological phenomenon with numerous potential causes and may be unique to the individual. Many professionals facing this reality may feel helpless in supporting those affected.
Another major contributor to this assumption seems to be the false logic that fuels it. Because antidepressants have been used to treat depression (a trend that has recently been challenged for its controversies and adverse effects), and because antidepressants are largely based on altering the levels of serotonin in the brain, there is a false logic implied: that depression is caused by low levels of serotonin in the brain. In fact, research suggests that there is no evidence that depression is either caused by or related to low levels of serotonin in the brain (Moncrieff et al., 2021).
Depression Is Not a Standardised Mental Health Disorder
This myth is also a residue of the perception that depression is a unified and standardised mental health disorder experienced similarly by every person coping with depressivity. The truth is that depression not only carries a wide range of experiences for the affected individual, but these experiences can vary substantially amongst different people, making their subjective experience of depression very different from one another. Studies also suggest that experiences of depression may vary based on cultural factors (see Adams et al., 2021).
As such, someone experiencing depression as a result of a depressive disorder may experience it quite differently from someone who experiences it as a symptom of borderline personality disorder (BPD), complex PTSD, or dependency, etc.
Depression Is Not a Standalone Mental Health Disorder
The assumption that depression is a standalone mental disorder, independent of other mental health disorders and issues, is flawed. It is based on the previous paradigm that depression is a standardised and unique psychological condition. While depression may occur as a distinct mental health disorder, such as depressive disorder, depression is often a symptom of underlying mental health issues.
For instance, depression commonly accompanies dependency and is seen in codependent relationships. It is also common with personality disorders, especially borderline personality disorder (BPD), but also with narcissistic personality disorder (NPD) when a person can no longer attain their internal image of perfection. Additionally, depression often occurs with complex PTSD (C-PTSD) and bipolar disorder.
It is important to note that the quality of depression will also differ depending on the underlying mental health condition as well as on the individual's unique internal psychological conflicts.
Depression Is Not Caused by Life Events
There is a belief amongst some that depression is caused by life events or difficult life circumstances. Clinical experience shows that this is usually not the case. Although depression may be triggered by life events and whilst life circumstances may be a contributing factor, depression is normally not caused by such events. From a psychological perspective, depression is mostly a product of an individual's psychological functioning; of their internal world stimulated by interpersonal relationships or life circumstances. The roots of depression are mostly inherent to the psyche rather than the situation.
This is similar to how exposure to a potentially traumatic event does not necessarily mean an individual will experience trauma. Rather, trauma will result from the individual's subjective experience of the potentially traumatic event, and their experience will also be determined by their psychological makeup.
So, for depression to occur, the life-event hypothesis alone is insufficient. An individual needs to be predisposed to depression, and this predisposition stems from their psychological makeup, which is rooted in childhood experiences and, as evidence mounts, often stems from childhood trauma (see Heim et al., 2008; Negele et al., 2015). So, the factors that determine a person’s proneness to depression are their personality functioning, personality traits, internalised perceptions of themselves, others, and the world – aspects that may have been influenced by childhood trauma, environment, and cultural background.
The fact that depression is caused by internal psychological factors, such as personality traits and personality functioning, is not new to psychotherapists who work with depression. Clinical experience supports this view, showing that depression can often be successfully worked through in the psychotherapeutic process and often permanently resolved regardless of changes in the individual's life circumstances.
For instance, for someone struggling with dependency or codependency in relationships, depression may be an unconscious response to a perceived or anticipated rupture in the relationship. So, whilst depression is triggered by the person's relationship issues, it is still their internal response to the situation. In other words, and as we often see in psychotherapy, as the person resolves their internal conflicts that underpin the depressive symptoms, they may continue to experience similar ruptures in their relationships; however, without them continuing to cause depression. We can see a similar process with those struggling with, for instance, borderline personality disorder (BPD), where not only symptoms of depression may diminish with psychotherapy but also their levels of anxiety and the occurrence of panic attacks.
Another example would be someone who had a childhood experience of a depressed, unengaged, aloof, or withdrawn caregiver. Such an individual may have internalised the depression as part of their childhood trauma and may experience depression in adult life as an ongoing state rather than a condition that occurs periodically. Depression, in such cases, is a way of life regardless of what their life is like. Again, because it is an internalised experience, such depression may be resolved through psychotherapy—so, alleviated regardless of the individual's changes to their life.
Finally, it needs stressing that depression may also be a co-morbid symptom of mental health disorders that may be neurologically or biologically predetermined, in which case its underpinnings need to be taken into account as a part of treatment planning.
Ales Zivkovic, MSc, Psychotherapist
Related:
The Hidden Faces of Dependency
The Sense of Meaning and Purpose
References:
Adams, L. B., Baxter, S. L. K., Lightfoot, A. F., Gottfredson, N., Golin, C., Jackson, L. C., Tabron, J., Corbie-Smith, G., & Powell, W. (2021). Refining Black men's depression measurement using participatory approaches: a concept mapping study. BMC public health, 21(1), 1194. https://doi.org/10.1186/s12889-021-11137-5
Heim, C., Newport, D. J., Mletzko, T., Miller, A. H., & Nemeroff, C. B. (2008). The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology, 33(6), 693–710. https://doi.org/10.1016/j.psyneuen.2008.03.008
Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2023). The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry, 28(8), 3243–3256. https://doi.org/10.1038/s41380-022-01661-0
Negele, A., Kaufhold, J., Kallenbach, L., & Leuzinger-Bohleber, M. (2015). Childhood Trauma and Its Relation to Chronic Depression in Adulthood. Depression research and treatment, 2015, 650804. https://doi.org/10.1155/2015/650804