The Real Cause Of Depression Is About Way More Than Just Serotonin
Many of us have been taught that depression is the result of a genetic chemical imbalance. And while there is certainly a genetic component to depression, and, yes, neurotransmitters like serotonin do play a role in mood, depression actually has many potential root causes.
This is good news, since a genetic chemical imbalance sounds like a destiny you have to resign yourself to, but many environmental factors are often completely under our control. You have the power to address these causes of depression at the root and walk away from depression, no matter how long you've been depressed or how strong your family history of depression may seem. Here's a quick rundown of some of the other common causes of depression, beyond serotonin, and what you can do about them:
Inflammation and depression are intricately linked1. The cytokine or inflammatory theory of depression is an emerging and evidence-based way of explaining many cases of depression. When some people are inflamed, they feel depressed. For these folks, taking antidepressants to address a chemical imbalance is barking up the wrong tree. They need to address the inflammation at the root by cultivating a diverse ecosystem of beneficial gut flora2, eliminating inflammatory foods, and supporting their immune system with rest and nutrition so that they can quell the inflammation and, in turn, heal their depression.
2. Thyroid dysfunction
Thyroid dysfunction is common, it often goes undiagnosed, and the symptoms are notorious for masquerading as depression and anxiety. I think thyroid issues are often at the root of many cases of panic disorders, brain fog, and even bipolar disorder—and yet somehow it's not standard of care to rule this out before starting psychiatric medications! I can't count the number of times I've met patients who have been diagnosed with depression, anxiety, or bipolar disorder—and who have been treated with psych meds for years—only to find out after some basic labs that they have an autoimmune thyroid condition. Once they manage their thyroid condition, the psychiatric symptoms improve.
3. Hormone imbalance
Hormone imbalance is not a single, simple issue, but it often plays a role in a woman's mental health3. While there are plenty of labels for these issues—such as premenstrual dysphoric disorder, postpartum depression, and postpartum anxiety—I'm not that interested in whether someone "meets criteria" for a condition. If you're struggling with low mood or anxiety, and we have reason to think your hormones are out of balance or in a state of flux, then this is an area to focus on.
If your mood dips precipitously in the days before your period, or if you have irregular periods, acne, extremely painful menstrual cramps, or excessively heavy menstrual bleeding, those are red flags that hormone imbalance is an issue for you. If you're experiencing any of these symptoms and you're depressed, chances are your mood symptoms won't fully improve until you get your hormones into a good flow. Achieving that is a whole other matter, but to give you the basics, it often requires dietary changes, rehabilitating your sleep schedule, detoxing your environment of endocrine-disrupting chemicals, and actually moving the needle on your daily stress load.
4. Micronutrient deficiencies
While this is probably the last thing on your psychiatrist's mind when they're writing your script for Prozac, vitamins and nutrients like folate, B124, zinc, the omega-3 fatty acids1, and vitamin D all play a role in mood. If you grew up in a traditional, preindustrial society, generations of tribe wisdom would have passed down a diet that meets your nutritional needs. These days, we have outsourced our food production to large food companies that don't always have our subtle micronutritional needs in mind. Your best bet for correcting any subtle deficiencies is to go back to eating the way your great-great-great-grandmother ate. Eat real foods from a diverse array of meats, fish, poultry, veggies, fruits, starchy tubers, nuts, and seeds to ensure you're checking all the boxes of the daily nutritional scavenger hunt. You may want to work with a functional medicine doc or naturopath to test your nutrient levels to make sure you don't have any serious deficiencies and so you can eat or supplement accordingly. But you can never go wrong with a diverse diet of real foods!
5. Blood sugar
Blood sugar matters to your mood5. I emphasize this one more when it comes to anxiety, but really, anxiety and depression so often travel together. Conventional doctors often see your blood sugar as a binary concept—you either have diabetes or you don't. As usual, the truth is more nuanced. I have many patients who are not diabetic or prediabetic, but their body is mismanaging blood sugar (or their diet is putting them on a blood sugar roller-coaster), and this is creating periodic states of anxiety and doom whenever their blood sugar crashes.
The quick fix to keep your blood sugar stable is to eat regular meals, snacking on nuts, and perhaps taking a spoonful of coconut oil or ghee in a pinch to give yourself a safety net of healthy fats. The definitive solution is to shift over to a real food diet, where you're getting your carbohydrates in the form of starchy tubers (like sweet potatoes) rather than refined carbs (like bread, crackers, and pasta), you're getting plenty of healthy fats, and you're simply not consuming sugar outside of fruit. This will help your body manage glucose more effectively, and it will keep your mood stable6.
Despite the flourishing yoga and wellness industry, the real fix to chronic stress continues to elude us. For many, developing a yoga or meditation practice is the ticket to reducing your overall burden of stress; but for others, I think it's necessary to make bigger, more fundamental changes to the ways we spend every single minute of our day. If you want to decrease stress, begin to shift away from phones, screens, social media, fluorescent cubicles, shopping, clutter, sterile environments, dings, pings, notifications, and addiction to busyness, and shift toward nature, stillness, slow food, dirt, bugs, physical connection with human beings, fulfilling work, living more simply, owning less stuff, and doing less overall. I'm asking you to go beyond simply reading a book about minimalist home décor; I'm telling you to hurl your phone across the room and choose how you spend the moments of your life!
7. Social isolation
Oh, social isolation. It should really be listed as No. 1 on this list. There is probably no more impactful factor affecting our moods. I would even give you my blessing to do such sacrilegious acts as eating gluten and cooking with canola oil if it meant you had a vibrant community. And yet, I put it as No. 7 because I always like to offer a proactive solution and I'm not yet sure exactly how to fix this one. Finding your tribe and building in enough ways to connect with them daily is hard to do. There's no five-step plan that can connect you with your circle of supportive kindred spirits. This one takes time. What I do suggest is that you make it a priority, and when you're presented with an opportunity to build your social life in a way that feels good to you, say yes. And most importantly, don't let an opportunity for connection pass you by because you had your face in your phone.
Trauma is often at the heart of depression. If you've experienced trauma, or if you've lived through chronic micro-traumas—or anything in between—please pour the time, money (if you can), and radical self-love into giving yourself the opportunity to process and unburden yourself as much as possible. Great treatments for trauma include EMDR, acupuncture7, emotional freedom techniques, art therapy, and all forms of energy work, such as craniosacral therapy and bioenergetic osteopathy.
9. Psychospiritual snafu
You hate your job, you work too much, your friends are self-absorbed, you're energetically misaligned with your city, you're indoors 95 percent of every day... You've got a case of psychospiritual snafu—and that can cause depression. We are not robots that can be put into any environment or any behavior and go on functioning seamlessly. We are fleshy, electric piles of psychospiritual soul juice, and what we do/say/think/feel/experience during the day matters on an incredibly deep level. If we try to force our body into submitting to a life it knows is out of alignment with what we're here to do or be, the body is going to communicate to us a loud and resounding "nope!"
Depression is classic body language for "something's not right, please adjust." Rather than resent our depressive symptoms, or attempt to beat them into submission with drugs or unhealthy coping mechanisms, I often recommend that my patients attempt to listen to the symptoms and hear them as a wise and loving plea from deep within you. If you're trapped in a psychospiritual snafu, I urge you to trust that tiny voice telling you what doesn't feel right, and make bold changes until you're back on track.
While there are certainly genetic factors at play with depression, don't take that as a reason to do nothing and despair about your hereditary chemical imbalance. In my experience, most cases of depression are caused by environmental factors that are eminently changeable. I hope you're able to recognize which ones pertain to you and find a way to chip away at these causes to reclaim your well-being.
Are your self-care practices doing more harm than good? This doctor thinks so.
Ellen Vora, M.D. is a board-certified psychiatrist, acupuncturist, and yoga teacher, and she is the author of the No. 1 bestselling book The Anatomy of Anxiety. She takes a functional medicine approach to mental health—considering the whole person and addressing imbalance at the root. Vora received her B.A. from Yale University and her M.D. from Columbia University.