I have a good job and a loving family. How can I feel depressed?

Anthony's comment:

It seems it would make sense to examine your daily routines to see if indeed problems do exist. It is also important to be evaluated for a medical condition as a cause of the depression. Psychiatrists routinely consider the possibility of medical conditions as a cause and may recommend a medical workup. I have often been surprised myself when I learn about a famous person, for example, who admits to having taken antidepressants, who seems to me to "have it all." I may even wonder, "what's your problem?" when in fact this shows what appears on the surface to be an admirable life often has many other unknown aspects to it.

As noted previously here, depression is not a condition that depends solely on a person's life circumstances. Certainly, stressful situations such as loss of job, family problems, or relationship difficulties can trigger the onset of a depressive episode. However, a lack of obvious stressful circumstances does not make a person invulnerable to becoming depressed. This can make it difficult sometimes for others to understand, because they may think, "What do you have to be depressed about?" The depression may be viewed as a lack of personal willpower. You may feel guilty about being unhappy, and again, the idea of needing to "pull myself together" becomes part of your thinking. These thought patterns could impede initiation of treatment. With that said, sometimes when there are no obvious external stressors present, there may be "internal" ones. Perhaps you feel like a failure for not having reached certain goals. Perhaps an unrelated event has triggered fears and anxieties that now fuel a depressive episode. These are potential avenues to be explored in a therapy, to help with recovery, and to maintain remission.

Are there medical conditions that could be cause for my depression?

Many medical conditions can have depression associated with them, ranging from endocrine (hormonal[1]) disorders, cardiac conditions, cancers, and vitamin deficiencies. Most often, depression occurs independently of another medical disorder, but if physical signs and symptoms exist other than those typically found in depression, a medical/physical examination to exclude physical causes for depression is warranted. Because of their medical background, psychiatrists routinely consider medical conditions as possible causes for depression and thus will assess a person's medical history. Your psychiatrist may consider obtaining laboratory tests as part of screening for medical conditions or may defer this evaluation to your primary care physician. If a medical condition exists, it may be difficult to determine with certainty whether the depression is physiologically related or merely co-occurring with the illness. Treatment of the medical disorder may or may not result in resolution of the depression, but resolution of the depression would support the physiologic connection. Even if so connected, it is possible that treatment for depression will still also be needed. Depression can

Table 2. Differentiating Depression From Medical Problems

Endocrine: hyper- or hypothyroid, Cushing's disease, Addison's disease, diabetes

Infection: AIDS, Lyme disease, hepatitis

Cancer: pancreatic, occult, brain

Neurologic: dementia, Parkinson's disease, stroke

Cardiac: coronary artery disease, heart failure, heart attack

Medications: antihypertensives, steroids, oral contraceptives

have adverse effects on the body and its recovery from illness; thus it is very important to treat coexisting depression vigorously. For example, postrecovery cardiac patients do more poorly when depressed, and thus depression is usually treated more vigorously now in this population than it had been in years past. Table 2 provides a list of some medical conditions that can be associated with depression.

More often, depression worsens existing medical conditions or is the cause itself for physical symptoms. Depression and anxiety can be associated with several physical ailments for which there are no physical cause associated with them. Sometimes, a symptomatic person does not endorse depressed mood, or there is denial of a depressed or anxious mood (perhaps because of negative associations with the idea of mental illness). Instead, the emotional distress is expressed through physical symptoms. Such persons may see many different doctors seeking a "medical" cause of their symptoms. Missing a mood disorder[2] in such cases can result in an overuse of healthcare services—not to mention persistent morbidity and decreased productivity in the person. Afflicted persons often show improvement in the physical symptoms with an antidepressant or therapy.

Missing a mood disorder in such cases can result in an overuse of healthcare services—not to mention persistent morbidity and decreased productivity in the person. Afflicted persons often show improvement in the physical symptoms with an anti-depressant or therapy.

  • [1] referring to the chemicals that are secreted by the endocrine glands and act throughout the body.
  • [2] a type of mental illness that affects mood primarily and cognition secondarily. Mood disorders predominantly consist of depression and bipolar disorder.
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