There is some debate concerning the causes of depression. On the one hand, it is considered a physiological disorder of the brain. Signals are sent through the brain–and in fact the entire nervous system–by special chemicals called neurotransmitters. There are many of these, but the ones which seem to have the greatest impact on a person’s mood are serotonin, norepinephrine, and dopamine. Depression appears to involve a reduced amount of one or more of these, hindering brain signals and in turn causing the various symptoms of depression. MRI’s and brain tissue samples of depressed patients shows that these neurotransmitters are below normal.
While this is true, however, there are usually circumstantial influences as well. Depression almost always follows some upsetting or terrible event in someone’s life (it can come immediately or after some length of time). Cases in which people become depressed solely because of brain physiology, are exceedingly rare. Depression also goes hand-in-hand with low self-esteem, which is often an integral part of the depression (in other words, it can be a symptom, or a cause, or even both).
Thus, it’s evident that both physiology and circumstance cause depression. What is unknown is, the relationship between them. Do bad things happen to people, making them sad or distraught, which reduces their neurotransmitters, and allows “true” depression to set it? Or, are the neurotransmitters already reduced, so that when something upsetting happens, it triggers a “true” depression?
There’s no clear answer to this, yet. At the moment, most in the psychiatric community lean toward the first explanation.
In any case, it’s important to note that no one is to blame for depression. In many–but by no means all–cases, depression results from harmful childhood experiences. However, it is nonproductive and even incorrect to “blame” one’s parents, family, friends, etc. for the depression. Why? Because many people have unpleasant childhoods, but not all of them develop depression. It is not the sole cause. Depression can also follow divorce, bereavement, etc. but this does not mean that these things “caused” the depression all by themselves. There are a great number of factors, including physiology (which I’ve already mentioned). Once again, depression is an illness. If you got the flu, would you blame it on someone else? Of course not, that would be silly! Depression is exactly the same.
Stress can be defined as the degree to which you feel overwhelmed or unable to cope as a result of pressures that are unmanageable.
What is stress?
At the most basic level, stress is our body’s response to pressures from a situation or life event. What contributes to stress can vary hugely from person to person and differs according to our social and economic circumstances, the environment we live in and our genetic makeup. Some common features of things that can make us feel stress include experiencing something new or unexpected, something that threatens your feeling of self, or feeling you have little control over a situation.1
When we encounter stress, our body is stimulated to produce stress hormones that trigger a ‘flight or fight’ response and activate our immune system 2. This response helps us to respond quickly to dangerous situations.
Sometimes, this stress response can be an appropriate, or even beneficial reaction. The resulting feeling of ‘pressure’ can help us to push through situations that can be nerve-wracking or intense, like running a marathon, or giving a speech to a large crowd. We can quickly return to a resting state without any negative effects on our health if what is stressing us is short-lived 3, and many people are able to deal with a certain level of stress without any lasting effects.
However, there can be times when stress becomes excessive and too much to deal with. If our stress response is activated repeatedly, or it persists over time, the effects can result in wear and tear on the body and can cause us to feel permanently in a state of ‘fight or flight’ . Rather than helping us push through, this pressure can make us feel overwhelmed or unable to cope.
Feeling this overwhelming stress for a long period of time is often called chronic, or long-term stress, and it can impact on both physical and mental health.
Stress is a response to a threat in a situation, whereas anxiety is a reaction to the stress.
What makes us stressed?
There are many things that can lead to stress. The death of a loved one, divorce/separation, losing a job and unexpected money problems are among the top ten causes of stress according to one recent survey 5. But not all life events are negative and even positive life changes, such as moving to a bigger house, gaining a job promotion or going on holiday can be sources of stress.
What are the signs of stress?
When you are stressed you may experience many different feelings, including anxiety, fear, anger, sadness, or frustration. These feelings can sometimes feed on each other and produce physical symptoms, making you feel even worse. For some people, stressful life events can contribute to symptoms of depression.6 7
Work-related stress can also have negative impacts on mental health 8. Work-related stress accounts for an average of 23.9 days of work lost for every person affected 9.
When you are stressed you may behave differently. For example, you may become withdrawn, indecisive or inflexible. You may not be able to sleep properly 10. You may be irritable or tearful. There may be a change in your sexual habits 11.Some people may resort to smoking, consuming more alcohol, or taking drugs 12. Stress can make you feel angrier or more aggressive than normal 13. Stress may also affect the way we interact with our close family and friends.
When stressed, some people start to experience headaches, nausea and indigestion. You may breathe more quickly, perspire more, have palpitations or suffer from various aches and pains. You will quickly return to normal without any negative effects if what is stressing you is short-lived, and many people are able to deal with a certain level of stress without any lasting adverse effects.
If you experience stress repeatedly over a prolonged period, you may notice your sleep and memory are affected, your eating habits may change, or you may feel less inclined to exercise.
Some research has also linked long-term stress to gastrointestinal conditions like Irritable Bowel Syndrome (IBS), or stomach ulcers14 as well as conditions like cardiovascular disease15.
Who is affected by stress?
All of us can probably recognise at least some of the feelings described above and may have felt stressed and overwhelmed at some time or another. Some people seem to be more affected by stress than others. For some people, getting out of the door on time each morning can be a very stressful experience. Whereas others may be able to cope with a great deal of pressure.
Some groups of people may be more likely to experience stressful life events and situations than others. For example, people living with high levels of debt, or financial insecurity are more likely to experience stress related to money16, 17, people from minority ethnic groups or whose who are LGBT (lesbian, gay, bisexual and transgender) may be more likely to experience stress due to prejudice, or discrimination18,19,20, and people with pre-existing or ongoing health problems may be more likely to experience stress related to their health, or stress due to stigma associated with their condition.
How can you help yourself?
There are some actions that you can take as an individual to manage the immediate, sometimes unpleasant, signs of stress and identify, reduce, and remove stressful factors that may cause you to feel overwhelmed and unable to cope. If you feel comfortable, talking to a friend or close colleague at work about your feelings can help you manage your stress.
However, sometimes individual actions on their own are not enough to reduce long-term stress for everyone. We can often be affected by factors that are beyond our direct control. Communities, workplaces, societies, and governments all have a role to play in tackling these wider causes of stress.
1. Realise when it is causing a problem and identify the causes
An important step in tackling stress is to realise when it is a problem for you and make a connection between the physical and emotional signs you are experiencing and the pressures you are faced with. It is important not to ignore physical warning signs such as tense muscles, feeling over-tired, and experiencing headaches or migraines.
Once you have recognised you are experiencing stress, try to identify the underlying causes. Sort the possible reasons for your stress into those with a practical solution, those that will get better anyway given time, and those you can’t do anything about. Take control by taking small steps towards the things you can improve.
Think about a plan to address the things that you can. This might involve setting yourself realistic expectations and prioritising essential commitments. If you feel overwhelmed, ask people to help with the tasks you have to do and say no to things that you cannot take on.
2. Review your lifestyle
Are you taking on too much? Are there things you are doing which could be handed over to someone else? Can you do things in a more leisurely way? You may need to prioritise things you are trying to achieve and reorganise your life so that you are not trying to do everything at once.
3. Build supportive relationships
Finding close friends or family who can offer help and practical advice can support you in managing stress. Joining a club, enrolling on a course, or volunteering can all be good ways of expanding your social networks and encourage you to do something different. Equally, activities like volunteering can change your perspective and helping others can have a beneficial impact on your mood.
4. Eat Healthily
A healthy diet will reduce the risk of diet-related diseases. There is also a growing amount of evidence showing how food can affect our mood. Feelings of wellbeing can be protected by ensuring our diet provides adequate amounts of nutrients including essential vitamins and minerals, as well as water.
5. Be aware of your smoking and drinking
If possible, try to cut right down on smoking and drinking. They may seem to reduce tension, but in fact they can make problems worse. Alcohol and caffeine can increase feelings of anxiety.
Physical exercise can be an excellent initial approach to managing the effects of stress. Walking, and other physical activities can provide a natural ‘mood boost’ through the production of endorphins. Even a little bit of physical activity can make a difference, for example, walking for 15-20 minutes three times a week is a great start.21
7. Take Time Out
One of the ways you can reduce stress is by taking time to relax and practicing self-care, where you do positive things for yourself. Striking a balance between responsibility to others and responsibility to yourself is vital in reducing stress levels.
8. Be Mindful
Mindfulness meditation can be practiced anywhere at any time. Research has suggested it can be helpful for managing and reducing the effect of stress, anxiety, and other related problems in some people22. Our ‘Be Mindful’ website features a specifically-developed online course in mindfulness, and details of local courses in your area.
9. Get some restful sleep
Sleep problems are common when you’re experiencing stress. If you are having difficulty sleeping, you can try to reduce the amount of caffeine you consume23 and avoid too much screen time before bed24. Writing down your to do list for the next day can be useful in helping you prioritise but also put the plans aside before bed25. For more tips on getting a good night’s sleep read our guide ‘How to sleep better’.
10. Don’t be too hard on yourself
Try to keep things in perspective and don’t be too hard on yourself. Look for things in your life that are positive and write down things that make you feel grateful.
If you continue to feel overwhelmed by stress, seeking professional help can support you in managing effectively. Do not be afraid to seek professional help if you feel that you are no longer able to manage things on your own. Many people feel reluctant to seek help as they feel that it is an admission of failure. This is not the case and it is important to get help as soon as possible so you can begin to feel better.
The first person to approach is your family doctor. He or she should be able to advise about treatment and may refer you to another local professional. Cognitive Behavioural Therapy (CBT) has been shown to be helpful in reducing stress by changing the ways we think about stressful situations26, this might include focusing on more positive aspects of a situation and reassessing what their likely impact might be. Other psychosocial interventions that can be helpful include brief interpersonal counselling, which can give people the opportunity to discuss what causes them to feel stress and develop coping strategies; and mindfulness-based approaches27.