Additional Pieces for the Depression Puzzle

mental-health-2313428_640It is estimated that in 2016 16.2 million adults in the U.S. had at least one depressive episode. This is 6.7% of the population. With the amount of antidepressants that are prescribed each year, it is hard to deny that depression is a major problem for us. In the past three articles I have discussed why we need to look beyond serotonin for answers to depression, the role inflammation plays in depression, and why we need to look even more at our gut health. As you can see, we have had too narrow of a view of depression for a long time. There are many other possible causes for depression, anxiety, and other mental health disorders.

Today I will be looking at several other contributors that play a part in a depressed mood. These are in no particular order and it is not an exhaustive list. Please note that this is just a list for you to begin evaluating different possible areas of your life that may contribute to your negative mood. Likely, not all will apply. Perhaps one thing will be a major contributor or several things may add up to getting you where you are. It may be helpful to think of these as risk factors that increase your chances of becoming depressed as well as some may be ways that you may be misdiagnosed with depression. Each one has at least a correlation with depression even if they haven’t been able to prove a causational relationship. Still, they are worth evaluating for yourself, especially if you want to avoid medication or medication hasn’t worked for you.

Negative Thinking

Your thoughts and emotions are closely related. As soon as we have a thought we typically believe it as truth, even if it is not. As soon as we make negative statements such as “no one likes me” or “I’m a failure” our body and emotions respond. When we think this way over and over, it reinforces the thoughts and the negative mood.

Life Circumstances

Situations come up in our lives that are difficult to handle. It could be the loss of a loved one through death or divorce, loss of a job, or even moving to a new place. New situations can cause stress while you work to adjust, especially when you don’t have control over it. Many people find that they begin to feel depressed when they face new situations until they adjust to their new life or find ways to cope.


It is hard to find definitive data on this one online in terms of inactivity causing depression. We do know that depressed people often lack energy and exercise less. We also know that exercise helps to release endorphins in the brain which help boost mood. In terms of research we may only be able to draw a correlational relationship currently and not a causational one. Still I think it is important to note here because by exercising and moving your body more (like we are meant to do), then you could possibly help prevent depression.

Mineral Deficiencies

We need minerals in our bodies in order for our body to perform many of its natural functions. For instance, if your body doesn’t have enough folate it cannot convert tryptophan to 5-HTP.  Without enough vitamin B6, vitamin C, zinc, or magnesium you aren’t able to convert the 5-HTP into serotonin.  Many of these same minerals are needed in order for your body to convert glutamine into GABA which is a calming neurotransmitter.

Iron Deficiency

Many symptoms of low iron are the same as depression. Those with low iron may experience fatigue and weakness, apathy, decreased appetite, and headaches, which could be mistaken for depression.

Blood Sugar Imbalances

Stable blood sugar levels are needed for the brain to synthesize neurotransmitters such as serotonin and dopamine. When blood sugar spikes, more insulin is produced to help lower the levels of sugar in the blood. This excess insulin causes more tryptophan to cross the blood brain barrier than should and causes an excess of serotonin to be produced. Although this sounds good at first, this surge of serotonin can make you feel sleepy and then as it is used up you may experience a “crash” from it in which can cause you to feel depressed.

History of Abuse

Abuse (without treatment) tends to cause us to feel that we are not safe, that we are at fault for mistreatment, and that we aren’t good enough. All these negative beliefs can contribute to depression and feelings of hopelessness. In addition, abuse causes dysregulation of cortisol levels which can contribute to depression. The abuse may also cause you to change lifestyle habits that would help prevent depression.


Diet influences many of the other contributors I have already mentioned such as blood sugar, mineral deficiencies, and iron deficiency. Poor diet can also contribute to inflammation in the body which was discussed in a previous blog. Our body is not equipped to handle so much processed  food, with preservatives, artificial ingredients, chemicals and pesticides.

Food Sensitivities

Just because you don’t experience a rash or anaphalactic response to a food doesn’t mean you may not be sensitive to it. Eating foods that your body is sensitive to can cause an increase in inflammation in the body which I have discussed as a possible culprit of depression in a previous blog. Gluten and dairy are the top 2 foods that people may be sensitive to and that are likely to contribute to depression.


We are social beings. Our ancestors learned that by being in a group we could increase our chances of survival. Even though our world is very different now, the need to be close to others is still present. We need to feel that there are people out there that care about us, understand us, and will be there if we need. When we feel alone life feels more overwhelming and we are likely to come to negative conclusions about our own self-worth.

Lack of Purpose

If you are not moving towards a goal or have some way that you feel that you are contributing to society, you begin to feel stagnant. My depressed clients often discuss that their not knowing what they want to do with their life, doing things because they have to and not because they choose to, and not feeling driven or excited about what they are doing contributes to their depression. When they are able to see the reason for their actions, how they are helping others, and begin working towards goals, their moods often lift.

Sex Hormones

Our reproductive hormone system is a very complicated system that I am not equipped to discuss in detail. Most women can identify that their moods change with their cycle and that when their hormones are out of balance this makes it worse. Effects on mood are likely not due to the levels of a single hormone but likely due to a combination, the levels of each, and the timing of the shifts in levels. We do know that estrogen increases serotonin and serotonin receptors in the brain, however.  For men, low testosterone has been linked to depression.


I often encourage my clients to ask their doctors to evaluate them for a possible thyroid issues as it is not uncommon for people to be misdiagnosed with depression when it is really a thyroid issue. Symptoms of hypothyroidism such as fatigue, irritability, weight gain, and low mood may be mistaken for depression. If hypothyroidism hasn’t been treated for long periods of time it could cause imbalances in the neurotrasmitters in the brain as well.


Many of my clients come in expressing that depression is in their genes. We have come to understand that genes are part of what makes us who we are. The human genome project has been working to identify genes for all types of disorders and characteristics within us. Although a single gene hasn’t been determined to be the cause of depression, they have identified several genes that could have an effect on mood such as through the ability of the body to control production, transportation and activity of neurotransmitters. Even if they do find a gene or multiple genes responsible for depression, however, it is important to remember the role of the environment in determining whether these genes are expressed or not.

MTHFR Gene Mutation

The MTHFR gene has the instructions your body needs to make the MTHFR enzyme. This enzyme is responsible for converting folic acid into methyl-folate which is critical for your body to produce DNA, metabolize hormones, and detox the body. There can be either a single or double mutation in the gene and the more mutation, Because the MTHFR enzyme is needed for so many processes in the body, including the production of neurotransmitters, the gene mutation can affect mood as well as many other symptoms. Here are a few websites with even more information.

Parsley Health

Folate & Depression: A neglected Problem

MTHFR and Treatment Resistant Depression

Learned Helplessness

When we feel helpless to change our situation and lose hope it can contribute to feelings of depression. Situations that could cause us to feel helpless and depressed include chronic pain, ongoing abuse, and medical diagnoses.

Being too hard on yourself

Life can be hard and we can put too many expecations on ourselves. When we base our self-worth on our accomplishments we often feel bad when we fail. Being critical of yourself and beating yourself up emotionally and mentally can contribute to a negative self-worth and feelings of inadequacy.


Many prescription medications list depression as a possible side effect, If you are on medications you may check to see if this could be a cause. Please don’t discontinue any medications without your doctor’s approval.


Overall I think the most important thing to keep in mind is some information that the National Institute of Health’s Genetic Home Reference website sums up extremely well in my opinion.

“It is possible that what is currently considered to be a single disease called “depression” is actually multiple disorders with similar signs and symptoms; these disorders could have different genetic risk factors. The genetic variations related to depression may also be somewhat different between men and women. Researchers suspect that studies with many more people will be required to pinpoint the genetic variations that influence the risk of depression.”

They also go on to talk about how factors in the environment, many of which I have listed here, can interact with genetic factors to cause depression. I understand this as we shouldn’t be looking for a one size fits all remedy for depression. We need to really dig and see if there is another reason for the depression instead of just assuming it all begins with the neurotransmitters. If we address lifestyle and other health issues this can also have a big impact on our overall health and our risk for depression as well as help to treat the depression, even if it isn’t proven to be a direct cause.