The causes of depression vary, but parents' cognition directly determines the speed and degree of recovery of children

01. The etiology and pathogenesis of depression are two different things

Recently, we have published several articles analyzing the main causes of depression – caused by patients suffering from superimposed psychological trauma and constant self-denial.

But many parents still have questions:

If the main cause of depression is superimposed psychological trauma, then why do many experts say that "the pathogenesis is related to the concentration of neurotransmitters"?

And why do many depressed patients take antidepressants, their conditions are relieved, and some even go to recovery?

These questions are well asked, asking the difference between "etiology" and "pathogenesis", and why antidepressants have a therapeutic effect on depression.

The cause refers to the source of the disease and is the cause in the first place.

The pathogenesis refers to how the initial source is triggered, step by step, one by one, leading to depression.

It's like when I type an A on my keyboard now, and an A appears on the computer screen. My action of typing on the keyboard is "etiology"; The keyboard is pressed, an electrical signal is formed, transmitted to the host, and through a series of complex computer science and physics processes, finally An appears on the screen, which is the "pathogenesis".

This article wants to explain to you the pathogenesis of depression and the relationship between the cause and pathogenesis.

02. The upstream factor of the onset of depression is "chronic stress"

We have previously shared an interview with Professor Yang Fude, President and Chief Physician of Beijing Huilongguan Hospital.

In it, he mentions that human mental activity can be reduced to a "stimulus-regulation-feedback" cycle. For example, external events will stimulate the nerve center of the brain, change the concentration of neurotransmitters in the brain, and then affect people's emotions, will, desires, emotions, etc., which in turn will form feedback on people's cognition.

He also said that although abnormal concentrations of neurotransmitters in the brain are associated with depression, this is only the middle and lower reaches of the entire circuit, not all, let alone the source, "The pathogenesis of depression is very complex, and we know very little about the upstream."

I very much agree with Professor Yang Fude's analysis of the abnormal role of neurotransmitter concentrations, which is not the cause of depression, but only an intermediate link. And neurotransmitter concentrations are unlikely to change abruptly for no apparent reason. Otherwise, depression becomes a condition that is completely controlled by neurotransmitters, which becomes a frightening philosophical problem.

However, although the change of neurotransmitter concentration is an intermediate link, it transmits information between brain cells and can regulate people's emotions, so abnormal neurotransmitter concentrations will in turn further affect the patient's mood and behavior, falling into a vicious circle.

The main role of mainstream antidepressants is that such drugs can restore the concentration of neurotransmitters in the patient's brain to normal, breaking this vicious cycle, and the patient's emotional symptoms will be relieved. However, because each patient's constitution is different, whether antidepressants will be effective and how effective they can be also varies from person to person.

In addition, even if the patient's emotional symptoms are relieved after taking antidepressants, if the cause problem is not solved and the upstream factors of the disease still exist, the patient's condition will be unstable, up and down. The most common is that the patient has an effect at the beginning of taking the drug, but after encountering some negative stimuli, the condition fluctuates again, and the effect of the drug becomes not obvious.

So what is the upstream factor of depression, that is, the cause of the source? Professor Yang Fude said that "we still know very little about the upstream, and the cortex, gray matter, white matter, and neural circuits of the brain all belong to the upstream", but I do not agree with this.

Through the multidisciplinary diagnosis and treatment model (MDT) that combines psychiatry, scientific psychology and education, especially the practice of pathological memory repair under deep hypnosis, we have found that psychosocial factors are the real upstream and main cause of depression.

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Specifically, we said at the beginning of the article - the main cause of depression is caused by patients suffering from superimposed psychological trauma and continuous self-denial.

We also found that superimposed psychological trauma can affect patients in four ways: strong negative emotions, distorted cognition, picture memory of traumatic situations, and physical discomfort.

In fact, in medicine, there is a concept very similar to the superimposed psychological trauma we proposed - chronic stress. Moreover, there are now many scientific studies that have found that chronic stress is an important cause of depression.

Stress refers to the non-specific adaptive response of organisms after receiving various stimuli during survival. Most of the stress body can gradually adapt to itself, but if some stimuli do not adapt, it may cause physical and psychological abnormalities, which is the case with many diseases such as depression.

According to the duration, stress can be divided into acute stress and chronic stress. Chronic stress is small but long-lasting and can cause damage to the central system. If there are frequent stressful and anxious events in life, or if the events persist, it is easy to form chronic stress for people.

Studies have found that people with depression experience more chronic stressful events before a depressive episode than healthy people. These stresses cause dysregulation of the brain's "hypothalamic-pituitary-adrenal axis," which then leads to chronically elevated glucocorticoid levels.

Chronic elevation of glucocorticoids leads to a decrease in serotonin (considered to be the neurotransmitter most closely associated with depression) in the brain, increases neurotoxic substance synthesis, dendritic atrophy of the hippocampus and limbic system, and neurological inhibition, resulting in mood and cognitive impairment. (Research Progress on the Relationship between Stress, Inflammation, P11 and Depression, Ma Xuxia et al., 2020)

In other words, chronic stress formed by negative life events, that is, superimposed psychological trauma as we understand it from scientific psychology, leads to a series of pathophysiological changes in the body, especially the brain, including abnormal concentrations of neurotransmitters, and eventually leads to depressive symptoms.

To put it simply and bluntly, according to the neurotransmitter hypothesis, in fact, the concentration of neurotransmitters in our brains is not static, and as we are happy, sad, nervous, and angry, the concentration of neurotransmitters will change. However, for healthy people, this change is within a normal range, and the change time is shorter. For people with depression, neurotransmitter concentrations are more likely to deviate from the normal range and last longer.

03. Complete internal attribution mode is more likely to lead to depression

Of course, there are many studies and discoveries on the pathogenesis of depression, and the above neurotransmitter hypothesis is only one of them, and there is no unified conclusion.

Some people believe that many people have experienced chronic stimulation, or superimposed psychological trauma, and some healthy people have experienced more and more serious than depressed patients, but why don't they have depression?

Therefore, the upstream of the onset of depression, that is, the main cause, is actually a genetic factor? Because certain people have predisposing genes for depression, they are more likely to suffer from depression when experiencing chronic stress?

Regarding the genetic factors of depression, we have also analyzed in detail before. Research on the causative genes of depression has been going on for years, but there has been no answer, and we think research has reached a dead end. Previous scientific articles have even pointed out that the candidate genes for depression found by researchers in the past are not clearly related to depression.

Now, more and more researchers believe that depression is not the inheritance of disease-causing genes, but that the expression of genes is faulty, which belongs to epigenetics. However, gene expression can be affected by many acquired factors and is reversible. Therefore, this so-called heredity is not inheritance as understood by the public at all.

So why do people who have also experienced negative life events and traumatic events, some people suffer from depression, and some people do not? We found that this involves the cause of depression and another psychological factor in the pathogenesis – the attribution pattern.

If a person encounters setbacks, blows, interpersonal conflicts, completely attribution, thinking that the responsibility and the reason are because of their own bad, "I'm stupid, I'm stupid, I'm bad", it is easy to lead to depression. In the words of traditional psychoanalysis, this is "attack from within" and "attack on the self."

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If on the contrary, a person encounters setbacks, blows, interpersonal conflicts, completely external attribution, thinking that it is all the fault of others and society, and it is all bad from the outside world, although this is not easy to lead to depression, but it is easy to lead to personality disorders.

The attribution model adopted by mental health people is comprehensive attribution, which not only sees their own shortcomings and shortcomings, but also sees others and objective factors, although it is quite depressing, but does not blindly deny itself; Although he is quite angry, he will not put all the responsibility on others. So rationality soon returned, and emotions returned to stability.

People with a comprehensive attribution model, even if they encounter stress (or traumatic events), even if it is a relatively major trauma, once appeared in an acute stress state, but it is not easy to form superimposed psychological trauma, not easy to suffer from depression.

If comprehensive attribution is done better, individuals will also consciously self-reflect, actively think about how to improve their shortcomings, how to minimize the adverse influence of others and the outside world in the future, quickly adjust their mentality and emotions, continue to work hard, and constantly improve. This is what we often call the more frustrated character or high inverse quotient (AQ).

Therefore, the traumatic event is a stress from the outside world, and the attribution model is the individual's cognitive adjustment process, and then make the corresponding response mode, the mode is different, the results are naturally different.

After depressed patients suffer from traumatic events, their coping patterns are negative, which is more likely to trigger large and lasting brain pathophysiological changes, which in turn lead to more depressed mood, more negative cognition, and a vicious circle.

It is hoped that the majority of patients and parents can see the main causes and pathogenesis of depression more deeply through this article. Especially the parents of patients, after mastering this knowledge, they should find an effective recovery roadmap with their children.

However, some parents are stuck at this point: how to find a recovery roadmap that suits their children and their families? This involves the principles and pros and cons of various current treatment methods for depression, including psychiatric drug treatment, psychotherapy/psychological counseling, physical therapy, exercise therapy, nutritional therapy, traditional Chinese medicine and so on.

In the future, we will also write articles analyzing how these methods play a role in depression and which patient groups are suitable, so stay tuned.