Why Are You Depressed?


This one tickles me a bunch.

I remember, back when I was in training, reading an article that truly shocked me.

I read that only about 70% of all depressed people actually had an identifiable event, when they came in seeking for their depression, that could actually be identified as having caused the depression.

My usual doesn’t-play-by-the-rules brain immediately wondered, “what the heck causes the other 30%?”

Since then I have seen theories blaming plastic manufacturing, many forms of industrial waste. American Fast food (allegedly “standard American” diet).

I remember asking a female experienced psychiatric nurse friend what she thought the 30% came from.  She did not skip a beat.


A “memory and reward” circuit problem.  It makes sense existentially, somehow.
Something you expect will be able to result in a positive reward doesn’t.  That seems to have something to do with depression.

It also does not eliminate any of the above very truncated list of causes.

Sometimes it is utterly impossible to differentiate, clinically, between a depressed person and someone who is physically ill.

The cause may just be something that does not turn up on a physical exam.

A patient whom I dearly love has a crazy (and excessive) history of infectious diseases.  I am, as we speak, trying to arrange for a family practitioner to refer her to an infectious disease specialist in order to look at things more closely.

This is one reason why everybody who comes to see me, even with seemingly banal anxiety or depression gets basic blood work.

The most common medical illnesses that show up in folks who say they are anxious or depressed are thyroid problems (hyper for anxious; low for depressed) and blood sugar problems (high for depressed; low for anxious.

There was a delightful woman who was depressed as well as anxious because she had trouble breathing.

She also presented to me with crying.

She was depressed mostly because she felt her primary care doctor had been ignoring her respiratory symptoms.
The emergency room doctor didn’t.  She was admitted to a hospital with double pneumonia.

When I look at the general direction of brain research, it seems as if —  with increasing study using methods such as fMRI (functional MRI) of what actual brain cells are actually doing) — are beautiful, wonderful, even elegant data.

I don’t think people are going to want to have neurosurgeons doing or even talking about things like deep brain stimulation to treat things such as anxiety and depression.

I am staying tuned on all fronts.

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