• Biochemical causes of depression are still hotly debated. Certainly it is possible to detect and even measure biochemical events in the brains of depressed people, but whether the chemical differences between depressed and non-depressed people are the cause or the effect of the depression is impossible to say. Lowered serotonin seems to be important in both depression and mania. Tryptophan, the essential amino-acid, is known to be linked to depression. One study found that the most common cause of post-natal depression was linked to shortages of tryptophan, and several other studies have confirmed the effectiveness of this amino-acid in the treatment of depression. Vitamin B6 also seems to keep people from being depressed. A study of fifteen depressed pregnant women found that those with the worst depression had the lowest blood levels of vitamin B6. This vitamin is also linked to the depression experienced by a certain number of women who take the Pill. This drug lowers B6 levels, but the depressive effect can be reversed by giving the vitamin with the Pill.
In another study doctors gave tryptophan and niacin to eleven patients with depression. They did this because they noticed that some people given tryptophan did not get better. After a month on the two substances the patients’ blood levels of tryptophan rose about 300 per cent and their depression fell by 39 per cent. Tryptophan has also been tested against a standard anti-depressant drug and found to be effective but to have fewer side-effects.
Hypoglycemia is another biochemical cause of depression-some experts claim it is the most common.
• We now know that many things in our environment (including foods and environmental chemicals) can affect the production of certain natural chemicals in the brain to alter mood.
• Social causes of depression are many and varied. Doctors think of depression as a ‘medical’ condition but sociologists see it as a condition associated with social malaise. At least a quarter of working-class mothers with young children living in central London suffer from a condition which, if they went to a psychiatric clinic, would be labelled depression. Women with no close, confiding relationship (boyfriend, spouse or similar) also fare badly when the going gets tough, as do women with three or more children at home under the age of 14.
Sociologists, then, claim that some people-and there are millions of them throughout the western world -are born into, or find themselves in, social and economic conditions which predispose to depression. This does not mean to say that depression is solely a social disease but that it can be caused or perpetuated by social factors. The vast majority of things that are wrong with society and which predispose to depression cannot be influenced by doctors at all.
• Drugs. More than 200 drugs have been claimed to cause depression but only a few do so with any frequency. Some drugs cause depression as a side-effect of their use and others do so only if they are withdrawn too rapidly.
Alcohol is the commonest drug to produce depression and it is often involved in suicides. Sedatives and anti-anxiety drugs, pain-killers and anti-rheumatics, stimulants, the contraceptive pill, blood-pressure drugs, steroids, certain antibiotics, and a host of other drugs, can all be culprits.
• Infections can cause depression, especially those caused by viruses. Meningitis and encephalitis (in which the brain is directly affected) produce serious brain-centered symptoms early on and depression later. It can often last for several months. Influenza, hepatitis and glandular fever are especially likely to cause long-lasting depression.
• Surgical operations can cause depression too but no one knows why. Operations that involve the loss of a part of the body (such as the removal of a breast or the uterus) are obvious causes but many people having quite minor and non-disfiguring operations can be depressed for months.
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