What people never understand is that depression isn't about
the outside; it's about the inside.
To say that depression is complex would be an understatement. Not only does it produce a variety of emotional, physical, and mental symptoms, but it can also be brought on by a host of different factors. Indeed, the intersection of chemical, lifestyle, and even genetic factors that contribute to this mental illness can make effective diagnosis and treatment challenging.
Yet, as one of the most common mental illnesses in the world, depression is a major public health issue that demands a comprehensive treatment approach. Not only is it associated with intense emotional pain, but it is also the number one cause of injury or illness for men and women across the globe and the leading cause of disability in the U.S. Moreover, people with depression face an increased risk of death from suicide and certain other illnesses including heart disease. 
At certain stages in life, most people experience feelings of:
These are normal and typically pass with time. Yet, for 322 million people worldwide, these feelings linger and manifest as a severe form of low mood, resulting in a diagnosis of depression as a psychiatric disorder. 
While many people with depression seek medication to treat their condition, only 6% use medication alone. For the majority of individuals living with depression, treatment through both medication and health professionals is pursued  – with the knowledge that, just as depression touches multiple areas of life, there are also many different strategies that can be used to alleviate its symptoms.
For adults in their middle ages and beyond, specific age-related factors can impact the way depression is brought on or managed. It therefore takes clinicians with a keen understanding of adult physiology to develop coping strategies that work for each individual, whether that’s alongside or independent of medications.
At Cenegenics, our age management specialists are acutely aware of not only the physical factors that influence the mental and physical wellbeing of adults, but also how conditions like depression can be significantly improved by optimizing health in key areas like:
In this guide, we’ll take a closer look at depression and how our specialists can help you meet its many challenges to improve your quality of life. Let’s start by discussing some of the symptoms of depression.
What Are the Symptoms of Depression?
Depression is complex in the fact that it cannot be diagnosed simply based on a physical exam, lab tests, a psychiatric evaluation, or by using criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).  It is commonly defined as feelings of sadness, emptiness, or hopelessness that persist for two weeks or longer and prevent someone from pursuing regular activities.  In addition, symptoms may include:
- Lack of energy
- Trouble sleeping (too much or too little)
- Appetite changes
- Difficulty concentrating
- Complete lack of interest in socialization or previously enjoyable activities
- Feelings of guilt and worthlessness
- Physical symptoms, including headaches, stomachaches, and back pain
- Irritability, restlessness, or frustration
- Thoughts of suicide or death 
Oftentimes, people who have depression don’t experience every symptom. Its effects can also vary in intensity but are commonly experienced nearly every day.
Each person experiences depression differently and, in fact, there are multiple types of depression, some of which are brought on by distinct causes or circumstances.
Are There Different Types of Depression?
The DSM-5 lists nine different types of depression, of which major depression is the most common. Major depression, often referred to simply as depression, may be experienced as recurring episodes over the course of an individual’s life. Some additional forms include:
- Postpartum depression, which occurs after giving birth and is experienced by mothers who may feel disconnected from their new babies or fear they will hurt their children
- Seasonal affective disorder (SAD), a form of depression brought on by a lack of natural sunlight during the winter months
- Manic depressive disorder, or bipolar disorder, in which the patient alternates between depressive episodes and mania 
Although conditions like postpartum depression and SAD are associated with specific circumstances, the culprit behind major depression isn’t always so easy to identify.
What are the Causes of Depression?
While sadness can be triggered by a multitude of circumstances, there are certain life events that can actually trigger depression. Illnesses, including chronic pain and cancer, as well as bereavement, social isolation, and stressful events including money troubles or divorce, can bring on the mental illness. Conversely, it’s also possible that a person to experience depression suddenly and without any discernible cause.
Although it’s not always precisely known what causes depression, experts suspect a variety of factors could be involved, as with most types of mental disorders, including:
- Brain chemistry: Neurotransmitters, or naturally occurring brain chemicals, may have something to do with depression. Their interactions with neurocircuits, which help to regulate mood, could contribute to the mental illness and the ways in which it’s treated.
- Hormones: Hormone changes which could stem from thyroid issues, aging, and pregnancy, are also thought to be a possible trigger for depression.
- Physical differences: Scientists have observed physical changes in the brains of individuals with depression. For instance, the frontal lobe is less active in people with depression. While the significance of these differences has not yet been determined, it could help researchers pinpoint causative agents more accurately in the future.
- Genetics: People whose blood relatives have experienced depression are more likely to experience it themselves, though researchers are still working to identify genes involved with the condition. 
In addition to direct causes, scientists suspect that there are several factors that could explain why certain individuals may be more likely to be diagnosed with depression. The following factors are thought to play a role in a person’s risk:
- Medications, including sleeping pills and blood pressure drugs
- Chronic illness or pain
- A history of preexisting mental health disorders, including anxiety, eating disorders, or post-traumatic stress disorder
- Traumatic or stressful life events
- Certain personal characteristics, including pessimism, low self-esteem, or extreme dependence on others
You May Not Just Be Sad – In Conclusion
Depression is a very complex mood disorder that can affect multiple facets including a person’s emotional, physical and mental state. Depression can not only increase risk of death by suicide, it can also increase risk of certain chronic diseases including heart disease.
Depression can be triggered by multiple causes including:
- Certain medications
- Personal relationship conflicts
- Death or loss
- Major events
- Personal problems
- Serious illness
- Substance abuse
Cenegenics can help reduce certain risk factors such as a dependence on sleeping pills and blood pressure medications, as well as reducing the risk of chronic illness through the use of nutrition, exercise, nutraceutical supplementation and hormones, when clinically indicated.
Learning how to properly deal with stress, manage weight, get better sleep, and improving your cognition can help lower the risk of depression in some instances.
Next Steps in Understanding Depression
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About the Contributor
Global Director of Nutrition & Exercise
Rudy Inaba is Cenegenics’ Global Director of Nutrition & Exercise. He is a recognized fitness and sports nutrition consultant with nearly 15 years of experience in clinical exercise physiology and lifestyle management. After pursuing his Master of Science in Clinical Exercise Physiology at the University of Nevada Las Vegas, Rudy joined Cenegenics where he leads 20 clinical locations nationwide in their advancements in kinesiology, nutritional biochemistry, and their analyses of industry research & market trending.
This guide was produced with contributions from the following key resources:
The Cenegenics Education and Research Foundation
The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy
Jeffrey Park Leake, M.D., CPT
Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Educational Foundation.
Todd David Greenberg, M.D., CSCS
Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.
 “Depression.” Anxiety and Depression Association of America (ADAA). Retrieved from URL: https://adaa.org/understanding-anxiety/depression#
 ADAA, see above.
 “Major Depression.” National Institute of Mental Health. Nov. 2017. Retrieved from URL: https://www.nimh.nih.gov/health/statistics/major-depression.shtml#part_155029
 “Depression (major depressive disorder) Diagnosis.” Mayo Clinic. 03 Feb. 2018. Retrieved from URL: https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013
 “Depression.” U.S. Department of Health & Human Services Office on Women’s Health. 18 Oct. 2018. Retrieved from URL: https://www.womenshealth.gov/mental-health/mental-health-conditions/depression
 Grohol, John M., Psy.D. “Depression.” PsychCentral. 18 Nov. 2018. Retrieved from URL: https://psychcentral.com/disorders/depression/
 Cagliostro, Dina, PhD. “Depression: Persistent Sadness & Loss of Interest in Life.” Psycom. 28 Sept. 2018. Retrieved from URL: https://www.psycom.net/depression.central.html
 Mayo Clinic, see above.