Money worries, a difficult relationship or an illness — external circumstances are often thought to be the reason for depression. But why do some people develop depression and others don't?More than one in ten people in Germany were diagnosed with depression in 2022. In total, that's around 9.5 million people, and the trend is rising. This is the result of a study by the German-based AOK health insurance company.

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Women are more affected, according to the study. I am one of them. In the spring of 2024, I began to feel unwell. Nothing was fun anymore. Along with the joylessness came hopelessness and guilt — not being a good mother, not being a good friend or wife. The inner tension drove me out of bed at the crack of dawn, with a thousand worries and fears in my head.

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But my life has certainly been harder before. For example, when I was a single mother, had to work, and finish my studies. Or during the COVID-19 pandemic. I asked myself: Why do I feel worse and worse now, even though my life has improved significantly compared to the decade before?

Genetic predisposition is a key factor

"You have to distinguish between stress, grief, and other normal reactions to difficult life circumstances on one hand and the illness of depression on the other. These are two different worlds," says Ulrich Hegerl, psychiatrist and chairman of the German Depression Aid Foundation and Suicide Prevention.

"Most people — and I used to think this too — believe that depression is a reaction to difficult life circumstances," says Hegerl. This assumption can become problematic.

A key factor in depressive illnesses is the predisposition for it, according to Hegerl. For those with such a predisposition, certain life circumstances could trigger a period of illness.

Such a predisposition could be genetic in nature. "The predisposition can also be acquired through traumatic events in childhood," says the psychiatrist.

Larger salience network as an indicator of depression?

Studies support the idea that depression is much more than an uncomfortable, emotional downturn.

In one recent study, researchers were able to show that a specific network in the brain is more extensive in people with depression than in healthy individuals.

This salience network (attention network) functions like a filter in the brain. It controls our attention and directs it to relevant external stimuli. And it is important for regulating our emotional response to these stimuli.

How exactly this works is still not entirely clear. According to the study, however, the size of the salience network correlates with certain symptoms of depression, such as the loss of joy and motivation.

Therefore, the researchers suspect that the enlargement of the salience network could serve as an indicator of depression – even if the person has not yet experienced depressive symptoms.

Stigmatization of people with depression

So, it's not my fault. Relief was a central feeling when I received my depression diagnosis. I could stop feeling bad for feeling bad. I could stop pushing myself through the day with the message "Don't be such a baby."

However, Hegerl's statements and the study results also mean that I will always be susceptible to depressive episodes. Psychotherapy and medication could prevent a relapse, according to Hegerl, as could exercises.

"People affected should make an emergency plan," suggests the psychiatrist. "What are the first signs? What can I do then?" This may, however, also mean that those affected have to make their situation visible to others and talk about their depression.

I found this difficult, and I felt ashamed. "One of the biggest challenges in dealing with depression is the stigmatization caused by a false understanding of the illness," says Hegerl.

That's where my shame comes from. I now know enough about my depression to no longer treat it like a personal weakness. But do the people I encounter know that too?

This article was originally written in German.

Sources:

AOK Gesundheitsatlas: Depressionen Verbreitung in der Bevölkerung Deutschlands Ursachen, Folgen und Präventionsmöglichkeiten (2024)

Nature: Frontostriatal salience network expansion in individuals in depression (2024)

(The above story first appeared on LatestLY on Dec 30, 2024 07:30 PM IST. For more news and updates on politics, world, sports, entertainment and lifestyle, log on to our website latestly.com).