Why It’s Not “All in Your Head”

“It’s all in your head.” 

You’ve heard this said before of depression and other mental illnesses. I want to start this post out by stating I, myself, the owner of a mental health blog, used to stand behind this statement before I was educated on the difference between normal sadness and actual depression.

Depression is not “all in your head” as most would have you believe, though your brain does have a significant impact on your vulnerability and reaction to events/genetic pre-dispositions that leave a person susceptible to depression.

Let’s start with the basics. There are many different causes of depression and I’m sure some that haven’t yet been discovered. It’s just not as simple as saying a person just has a chemical imbalance. Here’s a list showing some of the different things that can cause depression (please note this list is not all inclusive):

Stressful Life Events
Stress is a very common occurrence in our lives. We live in a fast-paced world with an “I want it now” mentality. It’s actually healthy for our bodies to experience stress now and then, as it improves performance by mobilizing your body’s responses; however, chronic stress and acute stress (like the death of a loved one or losing your job) can cause depression in certain individuals.

Both chronic and acute stress can lead to overactivity of your body’s stress-response system. Overactivity of this system can cause an increase in cortisol (aptly named “the stress hormone”) combined with a decrease of serotonin and dopamine, along with other neurotransmitters.

Cortisol is a steriod hormone produced by adrenal glands located in the top of each kidney. When an idividual is faced with a stressor that triggers the “fight-or-flight” response, cortisol supplies immediate energy to the body’s largest muscles by flooding them with glucose. It then inhibits insulin production to encourage immediate use of the glucose (rather than storing it), while also simultaneously narrowing our arteries. Meanwhile, epinephrine increases the heart rate, causing blood to pump harder and faster.

Serotonin is the “happy molecule” of the brain, directly affecting mood, appetite control, and sleep. Most people are familiar with serotonin and understand low levels of serotonin can cause mood changes. Dopamine is the “motivation molecule” of the brain, owning your pleasure-reward system. You may be unfocused, lethargic, or otherwise unmotivated if your dopamine levels are low.

As you can see, these three components are actively used to help the body through typical and everyday stressors. If, once a stressor has been addressed/resolved, these components of the body are unable to reset themselves to resume everyday function, it has been proven to cause depression in certain individuals. It’s also important to note that an imbalance in any/all of the above can cause depression.

Trauma comes in many forms, almost too vast to list, because each person reacts to negative/traumatic situations differently. Someone who has been a victim of trauma (e.g., sexual abuse/harassment, domestic violence, a shooting) may develop depression following the event.

This is where it can get complicated. Those who continue experiencing extreme symptoms of stress may have developed Post-Traumatic Stress Disorder (PTSD). Depression is a symptom of PTSD; however, the following symtpoms overlap in both disorders:

  • Trouble concentrating
  • Avoidance of social contact
  • Irritability
  • Abuse of drugs or alcohol

To be formally diagnosed with PTSD, symptoms must have been present for at least three months, cause you great distress, and disrupt your work and/or home life. Additional symptoms of PTSD that may be developed are as follows:

  • Reliving the event
  • Avoiding situations that remind you of the event
  • Negative changes in beliefs and feelings
  • Feeling keyed up (also known as hyperarousal)

For more details on symptoms of PTSD, please see this article by the National Center for PTSD.

Loss of a Loved One
There is a fine line between regular grief and depression following the loss of a loved one. While grief may trigger depression, not everyone who grieves will experience depression.

Pay attention to the following when looking at symptoms:

  • Duration of your symptoms: People who are grieving often experience symptoms that come and go, almost in waves, or fluctuate with regard to their level of severity.
  • Acceptance of support: This may be a good indicator of whether it’s grief or depression, as depressed individuals tend to isolate themselves, while those who are grieving are usually more receptive to support from loved ones.
  • Ability to function: Those who are grieving are usually able to attend work/school and keep themselves busy with usual activities, while those who are depressed may not be able to indulge in such activities.

Complicated Grief
Symptoms of complicated grief are as follows and tend to be more common in traumatic deaths (e.g.; young child, suicide, car accident):

  • trouble thinking about anything other than your loved one’s passing
  • lasting longing for your deceased loved one
  • long-lasting bitterness over the loss
  • feeling as if your life no longer has meaning
  • trouble trusting others
  • difficulty recalling positive memories of your loved one
  • grieving that gets worse instead of better

Underactive Thyroid
This is one I wasn’t aware of until I started seeing my doctor for depression. Your thyroid is a butterfly-shaped gland in the base of your neck that controls metabolism. As part of the endocrine system, the thyroid uses iodine from foods you eat to produce Triiodothyronine (T3) and Thyroxine (T4) hormones.

These hormones travel through the bloodstream to reach almost every cell in the body, regulating the speed with which cells/metabolism work. As an example, they regulate your heart rate and how fast your intestines process food. Low levels of T3 and T4 may result in a slower heart rate and weight gain, while high levels of the hormones can cause a rapid heart rate and weight loss.

With regard to depression, we’re focusing on low T3 and T4 levels, which can cause a condition called Hypothyroidism. Depression is a common symptom of Hypothyroidism, but you may also experience the following symptoms: trouble sleeping, tiredness/fatigue, and difficulty concentrating (all of which are also symptoms of depression).

If you struggle with depression, it could be a symptom of Hypothyroidism. To see if this is the case for you, ask your doctor to perform a simple blood test to see where your T3 and T4 levels are at. Some depression caused by Hypothyroidism is resolved when the thyroid is brought back to normal levels.

Certain medications to treat other medical conditions are also known to cause depression in at-risk individuals. The following list was compiled by Harvard Medical School and is also viewable in this article published on their site.

Remember, when a doctor prescribes you a medication, their experience and your history shows them the benefits of taking said drug(s) will typically outweigh the setbacks. That being said, you know your body better than anyone else, and medication-induced depression may be improved by talking to your doctor about your symptoms and possibly switching to a different medication. If you believe you’re experiencing depression brought on by use of a particular medication (or medcications), please talk with your doctor as soon as you can.

  • 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 (Adalt CC, Procardia XL); dixogen (Digitek, Lenoxicaps, Lanoxin); disopyramid (Norpace); methyldopa (Aldomet)
  • Hormones – anabolic steroids; danazol (Danocrine); glucocorticoids such as prednisone and adrenocorticotropics hormone; 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); antacides such as cimetidine (Tagamet) amd ranitidine (Zantac); antiseizure drugs; baclofen (Lioresal); cancer drugs such as asparaginase (Elspar); cyclosporine (Neoral, Sandimmune); disulfiram (Antabuse); isotretinoin (Accutane); levodopa or L-dopa (Larodopa); metoclopramid (Octamide, Reglan); narcotic pain medications (e.g., codeine, Percodan, Demerol, Morphine); withdrawal from cocaine or amphetemines

Genes control every part of our bodies, and since mood is affected by multiple genes, it can vastly impact, as well as identify at-risk individuals. Their function throughout your life is to turn different genes on and off at the appropriate times so the right proteins are made at the right time. If, for some reason, a gene (or genes) gets the timing or the process wrong, it can alter an individual’s biology in such a way that it may cause depression.

Have you ever noticed that every person’s struggle with depression is entirely different, although they may have similar symptoms? Genes themselves prove depression is not a one-size-fits-all condition, as every person’s genes are specific to their own body. Genetic studies are still developing, but our access to gene-specific information is so much more vast now than it was in the past. Hopefully, as genetic studies gain more ground, we’ll be able to determine more specific information related to susceptability of certain individuals because of genetic pre-disposition.

So, when someone tells you that depression is “all in your head”, you can respectfully disagree. It can be caused by a variety of things throughout your entire body that usually are not within an individual’s control. Depression is a real condition, and so many people that struggle with it are afraid to talk about it because of the associated stigma.

If you are experiencing symptoms that are only getting worse instead of better, or that persist over time, please do not ignore them. Seek guidance from a trusted loved one, a medical professional, a religious leader, a counselor. Or one of many anonymous crisis lines (see the “In Crisis?” panel on the right-hand side of the page for some readily available crisis resources).

Remember, you’re never alone in your struggle. As a reminder, if you need any help finding doctors/resources near you, please contact me and I’ll be happy to help.

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