A few days ago, I was having lunch with a friend. My friend knows that I am a stress researcher, but she (like many people) was surprised to find that I also study mental disorders like depression and anxiety.
So over lunch, she did what very few people do — at least outside of my professional circles.
She asked me point-blank: “Really now, just how strong is the connection between stress and depression? Can’t depression be caused by a lot of things?
She’s right, of course. Depression is what we call a “multifactorial” disease, meaning that it can be triggered by a lot of different things.
Here are just a few causes listed by the Mayo Clinic and others:
- Differences in brain function. The brains of depressed people work differently than those of non-depressed people. Some parts go into overdrive, causing depressed individuals to withdraw into an internal world of sadness, fear, shame and worthlessness. On the other hand, other parts of the brain become less active than normal. This impairs the depressed person’s ability to think clearly and make decisions. He or she can no longer function normally at home, work, or in relationships.
- Differences in brain chemistry. Certain brain chemicals become depleted in depression. Many antidepressant drugs work to replenish these chemicals to normal levels.
- Hormones. The rise and fall of certain hormones can wreak havoc on the brain. This is why depression often follows conditions that cause drastic changes in the body’s normal hormonal balance: pregnancy, menopause, thyroid problems, etc.
- Genetics. The risk of depression is greater if a close relative also has it. This is because changes in certain genes alter the way the brain develops or functions (see points above).
- Nutrition. The lack of certain vitamins and minerals increases the risk of depression. Often this is because they are involved in the production of important brain chemicals.
- Sleep disturbances. One of the clinical symptoms of depression is inability to get to sleep. In others, clinical depression causes them to sleep too much. Either way, depression is associated with disturbances in our sleep cycle. This can lead to fatigue, causing us to stop exercising and eat more poorly. None of this is likely to keep the brain in tip-top shape.
- Exposure to toxins. University Health News, an organization that collects “expert health advice from America’s leading universities and medical centers,” has reported on three kinds of chemicals particularly associated with depression: 1) prescription drugs that sometimes unintentionally mess with the balance of brain chemicals (see list here), 2) pesticides with organophosphates (a class of chemicals known to adversely affect the nervous system – they are closely related to the nerve agents used in 20th century warfare), and 3) mercury, a silvery metal that the U. S. Environmental Protection Agency (EPA) says causes symptoms of depression and anxiety.
- Inflammation. Inflammation is a protective mechanism the body uses to shield itself from disease-causing agents like bacteria. But too much inflammation can be a bad thing, leading to both physical and mental distress.1 The body manufactures its own inflammation-causing chemicals called cytokines. When healthy individuals are induced to make a lot of cytokines, they sometimes start exhibiting depressive symptoms. Medical disorders with rampant inflammation (chronic obstructive pulmonary disease, autoimmune disorders, cardiovascular disease) often also trigger depression. Interestingly, antidepressant drugs decrease the production of cytokines, which may be yet another way they fight depression.
Any one of these factors (and often more than one) can contribute to depression. But there is another factor that, in my opinion, beats them all.
It’s STRESS.
But you knew I was going to say that, right?
And what is stress, exactly?
Stress is our reaction to challenging life circumstances: problems at work, issues in an important relationship, and ongoing financial struggles. The “big” stressors of life include things like divorce, the death of a loved one, a major job move, or a major accident or illness. Another friend of mine, a healthcare professional, recently told me that most of her patients take antidepressants in addition to the medication needed for their various medical issues. This is because clinical depression often follows on the heels of physical illness.
You may think I am biased because I happen to study stress. But I’m not alone in seeing stress as the single largest contributor to depression. Other researchers have pointed out that if you look at the medical records of clinically depressed individuals, about 80% of them have recently gone through a stressful life event of some sort.2
That’s right.
In up to 8 out of every 10 cases of depression, stress is a contributing factor.
How does stress do this? Well, as just one example, stress tends to mess with our sleep patterns. When we get stressed out, many of us suffer from insomnia.
We also often stop exercising. And we stop eating right, filling up instead on comfort foods devoid of nutrients but filled with sugar, fat, salt, and empty calories.
And interestingly, feeling stressed out amps up the body’s inflammation response. Psychological stress increases the production of cytokines, which then produce symptoms of depression and anxiety.
Chronic stress also bathes the brain in stress hormones. These hormones are known to alter the brain’s structure and function, increasing feelings of irritability and anxiety and decreasing our ability to think clearly and make wise decisions.
So you can see that stress throws many contributing factors of depression all together. Then, like one big sucker punch, it slams them all – BAM – onto the brain at once.
Most of the major depressive episodes in my life have been tied to life stress: emotional abuse experienced in my childhood, my parents’ divorce, relationship stress, job stress.
I’m sure many of you can relate.
But I think that knowing all of this is a good thing.
You may say, “What on earth do you mean, a good thing? It’s not like we can avoid the big stresses of life, you know. So doesn’t this mean that, when life delivers yet another sucker punch, we will inevitably get knocked into depression?”
No.
And here’s why.
While we can’t control what life throws at us, we can control our reaction to it.
And this makes all the difference.
This is not a new idea – in Western culture and thought, it goes back almost 2000 years to the writings of stoic philosopher Epictetus:
That alone is in our power, which is our own work; and in this class are our opinions, impulses, desires, and aversions. What, on the contrary, is not in our power, are our bodies, possessions, glory, and power. Any delusion on this point leads to the greatest errors, misfortunes, and troubles, and to the slavery of the soul.”3
For many, the holidays are not a season of peace and joy. They are instead a time of grief and hardship, for re-living old pain or licking fresh wounds.
For many, the holidays are the most stressful time of year.
If this is what the holidays mean to you, I’d like to share three of the most powerful stress management beliefs I know of.
#3: Live by the Serenity Prayer.
Some recovery groups use this version:
God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.”
This powerful prayer, written by American theologian Reinhold Niebuhr, echoes the same idea expressed above — making peace with what we cannot change and focusing on what we can.
I recently read Gary Mendell’s story in USA Today. His son, Brian, died after a prolonged battle with opioid addiction. Brian had been through eight treatment programs. He was 25 when he died and had not used in over a year.
Gary stated that the only thing that kept him alive in the weeks following Brian’s death was the Serenity Prayer. He meditated on the first line, “God give me the serenity (peace) to accept the things I cannot change.” He knew that Brian had been a good person battling a terrible disease. He also knew that Brian’s battle was over and there was nothing more he could do to help his son.
And then he started thinking about the second line, “Give me courage to change the things I can.” Gary decided to form a nonprofit program to help other families battling addiction: Shatterproof. Shatterproof has three core objectives: 1) to reduce the number of new people affected by this addiction, 2) to develop a research-based consumer guide for the best treatment, and 3) to change the American mindset about addiction, to start thinking about it as a disease rather than a character flaw.
Gary’s story is an outward application of the Serenity Prayer, helping others avoid the same loss and tragedy he and his wife experienced.
There is also an inward application that helps us deal with the stress we create within our own minds.
What did Epictetus say was in our control? In the above quote, he lists the following:
- our opinions – what we like and don’t like;
- our impulses – our sometimes reckless and hasty decisions that lead to trouble;
- our desires – what we desperately want or feel like we can’t live without; and
- our aversions – what ticks us off.
Too often we feel that these things control us, but really it’s the other way around.
We control how we think, feel, and behave. Which means we have the power to change our minds if our opinions, impulses, desires, or aversions are causing us unnecessary stress, depression, or anxiety.
Epictetus also wrote the following:
Happiness and freedom begin with a clear understanding of one principle: Some things are within our control, and some things are not. It is only after you have faced up to this fundamental rule and learned to distinguish between what you can and can’t control that inner tranquility and outer effectiveness become possible.”
#2: Live one day at a time.
Human beings are unique in their ability to worry, not only about the present, but also over past mistakes and future fears.
This is a heavy burden for the mind to bear.
One way to lighten the load is to focus only on the challenges of today.
Gary Mendell is trying to make a difference in the opioid crisis – a colossal problem in our country and around the world. But my guess is, he is not trying to tackle the whole problem all at once. Like the rest of us struggling to deal with the problems of life, he must take it one day at a time, one small victory at a time, to help other families avoid the same tragedy that he and his wife experienced.
We would do well to use the same strategy in fighting our personal demons, the worries and fears that terrorize our souls.
Corrie Ten Boom was a member of the Dutch Resistance during World War II. She and her family hid Jews in their home until they were reported to the Nazi authorities. Corrie, her sister Betsie, her father, and other members of her family were imprisoned and later sent to the camps.
Betsie died at Ravensbruck. Corrie’s and Betsie’s elderly father did not survive imprisonment – after only nine days, he died in a hospital corridor at the Hague.
In her book, The Hiding Place, Corrie told a story from her childhood, when a neighbor’s baby died. For the first time in her young and protected life, death became real to her. From that point on she was terrified that death would come for her and her beloved family.
Her father quickly noticed the change in Corrie and asked her what was wrong. “You can’t die!” she wailed. “I need you!”
Her father thought for a moment. “Corrie,” he asked gently, “when we take the train to Amsterdam, when do I give you your ticket?”
It was an odd question, Corrie thought. But she answered, “Well…just before we get on the train.”
“Exactly. And our wise Father in heaven knows when we need things, too. Don’t run ahead of him, Corrie. When the time comes for one of us to die, look into your heart. You will find there the strength you need – just in time.”4
Here is the entire Serenity prayer:
God, give me grace to accept with serenity
the things that cannot be changed,
Courage to change the things
which should be changed,
and the Wisdom to distinguish
the one from the other.Living one day at a time,
Enjoying one moment at a time,
Accepting hardship as a pathway to peace,
Taking, as Jesus did,
This sinful world as it is,
Not as I would have it,
Trusting that You will make all things right,
If I surrender to Your will,
So that I may be reasonably happy in this life,
And supremely happy with You forever in the next.Amen.”
#1: Believe that there can be MEANING in stress and suffering.
Dr. Victor Frankl was a neurologist and psychotherapist in Vienna, Austria in the 1930s.
After the Nazi takeover of Austria in 1938, Frankl was prohibited from treating “Aryan” patients because he was Jewish.
In 1942, he, his wife, and parents were deported to a concentration camp in German-occupied Czechoslovakia. Through several more transfers, Frankl was separated from the rest of his family and finally reached a camp in Dachau. He worked there as a physician until the camp was liberated by American soldiers in 1945.
Frankl’s wife died at Bergen-Belsen; his mother and brother died at Auschwitz. Of his immediate family, only Frankl and his sister survived the war.
After the war, Frankl returned to Vienna where he resumed his psychiatric practice. There he developed a new form of therapy called “logotherapy.” Central to logotherapy is this belief: striving to find meaning is the primary and most powerful motivating force known to man.
Frankl’s approach to mental healing was profoundly transformed by the suffering he and others had experienced. It in fact became an integral part of this new form of therapy. This man had lost his wife and most of his family and had been dehumanized in the Nazi camps. Yet he concluded that even in the most horrific circumstances, life could still have meaning.
In his powerful book, Man’s Search for Meaning, Frankl wrote:
There is nothing in the world, I venture to say, that would so effectively help one to survive even the worst conditions, as the knowledge that there is a meaning in one’s life…
Let me cite a clear-cut example: Once, an elderly general practitioner consulted me because of his severe depression. He could not overcome the loss of his wife who had died two years before and whom he had loved above all else.
Now how could I help him? What should I tell him?
Well, I refrained from telling him anything, but instead confronted him with the question, ‘What would have happened, Doctor, if you had died first, and your wife would have had to survive you?’
‘Oh,’ he said, ‘for her this would have been terrible; how she would have suffered!’
Whereupon I replied, ‘You see, Doctor, such a suffering has been spared her, and it is you who have spared her this suffering; but now, you have to pay for it by surviving and mourning her.’
He said no word but shook my hand and calmly left my office.
Suffering ceases to be suffering in some way at the moment it finds a meaning…”5
Stress-induced depression and anxiety can be serious problems for many of us over the holidays.
I hope you will find, as I have found, peace and comfort in the three stress-reducing beliefs described above.
1Berk, M., Williams, L. J., Jacka, F. N., O’Neil, A., Pasco, J. A., Moylan, S., … & Maes, M. (2013). So depression is an inflammatory disease, but where does the inflammation come from?. BMC medicine, 11(1), 200.
2Hammen, C. (2018). Risk factors for depression: An autobiographical review. Annual review of clinical psychology, 14, 1-28.
3Ritter, H., Morrison, A. J. W. (1846). The History of Ancient Philosophy, 4, 204.
4Ten Boom, C., Sherrill, J. & Sherrill, E. (1971). The Hiding Place. Bantam Books. 28-29.
5Frankl, V. E. (1963) Man’s Search For Meaning. Washington Square Press, Inc. 164, 178, 179.
Dr. Pamela Coburn-Litvak has published research articles on exercise and stress in Neuroscience and Neurobiology of Learning and Behavior. Her latest book, Leaving the Shadowland of Stress, Anxiety, and Depression, was published in 2020.
After receiving a Ph.D. in Neurobiology and Behavior from the State University of New York at Stony Brook, she served as both Assistant Professor of Physiology & Pharmacology and Special Assistant to the Vice President for Research Affairs at Loma Linda University in Loma Linda, California. She then joined the Biology department at Andrews University and developed courses in human physiology as well as the neurobiology of mental illness. She also founded Rock @ Science LLC, a company that specializes in health and science education and web development. She co-developed the brain and body physiology segment of the Stress: Beyond Coping seminar with its creator, Dr. William “Skip” MacCarty, DMin.
Dr. Coburn-Litvak currently lives in California with her husband. Their two daughters are mostly grown and attending school elsewhere.
When she’s not studying or teaching about stress, she enjoys stress-relieving activities like puttering around the garden, taking nature walks with her family, knitting, cooking, and reading.
I appreciate your succinct description of how to face depression!
Thank you, Christine! I hope that it is helpful to anyone struggling with stress-related depression!
Thanks, Pamela. Good stuff. Thank you for sharing solid, practicable insights. This is a worthy project indeed!
Thanks so much for reading, Erik! I really appreciate it!
I need you to come to our juvenile facility here in Grand Junction. We are implementing a a trauma informed / trauma responsive environment for our youth. This change from punitive to trauma responsive is different and causes stress in addition to the stress of working with youth through their trauma and then add that staff are also humans! We need you. Please let me know what you offer for a whole staff of about 100. Thanks
Hi Jacque – Thanks so much for your interest! My presentations will: 1) give you and your staff some background into exactly why trauma leads to problems with anxiety and depression, and 2) provide some research-based solutions based mostly in cognitive behavioral therapy methods. I offer both specific one-hour presentations and also a full-scale seminar (up to 6 hours) on stress management techniques. Here is the link to my professional speaking site: https://speakerhub.com/speaker/pamela-coburn-litvak. I surely hope we can work together!
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