Depression is no laughing matter. It can range from a temporary case of the blues, to sadness over a specific event, to a persistent feeling of hopelessness and worthlessness that leads you to contemplate suicide. Depression can grab you by the throat and toss you into a black hole of melancholy.

Depression is characterized by a transient or long-term inability to cope with life. A depressed person has low self-esteem, pessimism, and trouble dealing with stress. Some 17 million Americans are affected by depression. Depressions come in different shapes and sizes and have a number of physical causes.

Heredity is one factor in depression. Major depression, also known as clinical depression, is a mental disorder characterized by serious depressive episodes. It affects as much as 20% of the world’s population and tends to run in families. For example, if a twin suffers from depression, there is a 70% chance that the other twin will also be depressed. Dysthymia is a more benign form of depression that also tends to be hereditary.

There is also a strong family history of depression in those with bipolar disorder. Also known as manic depression, bipolar disorder is a two-headed monster: depression combined with mania. Bipolars bounce helplessly between manic moods characterized by sleeplessness, grandiosity, extravagance, and lack of good judgment; and depression, which brings lethargy, worthlessness, a lack of concentration and feelings of guilt. But unlike major depression, manic depression is not sexist; it affects males and females equally.

Another contributor to depression is the environment. A common depressive disorder is Seasonal Affective Disorder (SAD) or winter depression. This is likely caused by a chronic deficiency of corticotropin-releasing hormone, stress, and less sunlight, leading to depression and energy loss as well as a tendency to sleep too much and eat too much of the wrong foods. People who suffer from SAD may also have insufficient vitamin D intake, which requires sun exposure to be processed in the body. Research has shown that SAD can be alleviated with light therapy provided through special light boxes, avoidance of simple carbohydrates in favor of complex carbs and proteins, and exercise. A daily supplement containing vitamin D and certain foods may raise the spirits of those who suffer from SAD.

Other suspected environmental factors in depression are allergies, air pollution, heavy metals, and exposure to overcrowding, poverty, violence, physical and mental abuse, and neglect.

A 1990 study of women and depression published by the American Psychological Association found that poor women and women of color are more likely to be depressed, as are women who suffer from sexual and physical abuse. The report also concluded that more married women than married men get depressed. Another interesting finding from The National Center for Health Statistics is that Asian American women over 65 have the highest suicide rate of all ethnic groups.

Depression can be caused by brain dysfunction, such as too many or too few of the neurotransmitters serotonin and epinephrine. As well, changes in brain structure and brain tumors may contribute to depression.

Certain medications, street drugs, and alcohol can all bring on depressive symptoms. Depression can also result from deficiencies of certain vitamins like B6, B12 or folic acid.

Not surprisingly, the stress of living with serious diseases and conditions like cancer, heart disease, and diabetes can make people feel depressed. Even less life-threatening but chronic conditions like hypothyroidism, hypoglycemia and candidiasis may lead to depression.

The American Psychiatric Association’s Office of HIV Psychiatry reports that depression is a big issue among people with HIV. If HIV treatment fails or there is poor social support or substance abuse, depression can result. HIV medications can also contribute to a patient’s depression.

Hormones also play a role in depression. In general, females are twice as susceptible to depression as males, probably because of their more complicated hormonal systems. A fascinating recent study conducted at Tel Aviv University found that women who overdo it when applying their favorite scents may be masking the depression brought on by certain diseases that lead the body to attack their olfactory systems. This decreases their ability to detect smells.

Obesity is an important factor in depression, particularly among women. Another new study at the Group Health Cooperative in Seattle has concluded that middle-aged obese women are more than twice as likely to become depressed, and vice versa. The participants included mostly white, middle-class women ages 40 to 65. Researchers postulated that obesity is tied to low self-esteem, depression, and weight-losing efforts.

In the area of alternative medicine, the Indian medical science of Ayurveda treats depression as an imbalance of the three doshas (body types). Chinese herbologists claim that depression is caused by stagnation of liver qi (vital energy).

Clearly, depression is a complex disorder with many physical causes and a myriad of treatments. But don’t despair. There’s hope. Here are a few proactive things you can try to help yourself climb out of that black hole:

• Get a complete physical to rule out disease-based depression
• Consider psychotherapy or cognitive behavioral therapy
• Consider prescription antidepressants if your doctor feels it is appropriate
• Cut out or reduce alcohol and recreational drugs
• Try meditation to help with stress levels
• Think about nutritional supplementation, especially of the B vitamins
• Avoid refined carbohydrates
• Get involved in an exercise regimen
• Examine your life situation and determine if there is room for improvement

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