Running head: MAJOR DEPRESSIVE DISORDER1

Major Depressive Disorder

Name

Institutional Affiliation
 MAJOR DEPRESSIVE DISORDER 2

Major Depressive Disorder

Major depressive disorder which can also be simply called depression is a mental

disorder that causes mood changes which result in sadness, sorrow, irritability, and a sense of

loneliness for more than two weeks. Other symptoms include lack of interest in activities that are

normally enjoyable, low self-esteem, sleeping problems, reduced concentration, eating problems,

among several others. The symptoms may be present all the time or may cease for years only to

emerge again later. Major depressive disorder largely affects an individual’s quality of life

(Belmaker & Agam, 2008).

The prevalence of depression during a lifetime stands at between 7%-12% in men, and

20%-25% in women. Depressive disorders account for 40.5% of all mental illnesses (Papakostas

& Ionescu, 2014). Traditionally perceived as a disease of the elderly adults, the major depressive

disorder has crossed the age barrier and is affecting both the old and the young. Studies have

shown high major depressive disorder occurrence rates among young people, especially of ages

between 12 and 20 years. Cases of young people with major depressive disorder increased to

11.5% in 2014 from 8.7% in 2005 (Mojtabai, Olfson, & Han, 2016). It was also revealed that the

increase in cases of the major depressive disorder in young people has not been met by an

increase in mental treatment of young people.

Environmental, psychological, social, and genetic factors have all been associated with

the condition. Risk factors include substance abuse, some medications, family history of the

disease, lifestyle changes, and chronic illnesses (Egede & Zheng, 2003). Socioeconomic status

changes have been associated with the major depressive disorder in the elderly. Unemployment

has also been shown to be a popular trigger for the major depressive disorder (Park, Lee, Sohn,

Seong, & Cho, 2015). The major depressive disorder is managed using antidepressant drugs,
 MAJOR DEPRESSIVE DISORDER 3

counselling, and electroconvulsive therapy. This review seeks to find out the relationship

between genetic, psychological, and social factors in causing and maintaining major depressive

disorder.

Biological Causes of Major Depressive Disorder

Genetics has been strongly associated with the major depressive disorder, and various

studies have been carried out to shed more light on this topic. Research has shown that major

depressive disorder can be genetically inherited. This is the reason why people with major

depressive disorder family history are at a higher risk of getting the disease. Studies in

monozygotic and dizygotic twins have shown that major depressive disorder has a 37%

heritability rate (Belmaker & Agam, 2008).

Serotonin, dopamine, and norepinephrine are the monoamine neurotransmitters

associated with the major depressive disorder. Serotonin controls sleep, eating, mood, and sexual

behavior. Norepinephrine is responsible for responding to stressful situations. Dopamine is the

neurotransmitter responsible for the sense of pleasure. Lower than normal levels of these

neurotransmitters increases the chances of one getting depression. This explains why

antidepressants are targeted at increasing the levels of these neurotransmitters in the body.

Individuals with disrupted norepinephrinergic systems, cannot handle stress well, and may easily

lead to depression. Low levels of dopamine lead to lack of interest or pleasure in previously

enjoyable activities. Other neurotransmitters such as glutamate, acetylcholine, and Gamma-

aminobutyric acid (GABA) have been shown to have a role in the etiology of the major

depressive disorder.

The levels and functioning of these neurotransmitters are determined by an individual’s

genetics. Certain gene polymorphisms control the functioning of the neurotransmitters and their
 MAJOR DEPRESSIVE DISORDER 4

receptors, hence increase the likelihood of one getting major depressive disorder in a lifetime.

For instance, carriers of the short allele of the serotonin transporters have been shown to have a

higher prevalence of major depressive disorder (Rot, Mathew, & Charney, 2009).

Various hormones are also associated with depression. Underproduction of thyroid

hormones by the thyroid gland (hypothyroidism) has been shown to cause depression. Thyroid

hormone replacement usually leads to alleviation of depression. Cortisol, produced in the adrenal

gland is also highly linked to the major depressive disorder. High levels of cortisol cause

depression. Estrogen levels have been associated with the higher incidences of depression in the

female population as compared to male counterparts. Low estrogen levels, such as during the

post-partum and post-menopausal periods disrupt the functioning of neurotransmitters,

increasing vulnerability to depression (Schimidt et al., 2000). Low testosterone levels, especially

in men over fifty years has been linked to high incidences of depression.

Psychological Causes of Major Depressive Disorder

Life is fast in the 21st century. Some individuals have to do more than one job. Others

have to cope with tight deadlines, uncooperative colleagues, impatient customers, and heavy

workloads. All these make life highly stressful and may lead to depression. Stress has been

directly associated with depression. When one is stressed, the cortex of the brain stimulates the

hypothalamus to produce corticotropin, releasing hormone (CRH). CRH then leads to increased

cortisol production by the adrenal glands. High levels of cortisol have been shown to cause major

depressive disorder (Belmaker & Agam, 2008).

Individuals who have been exposed to negative life events for prolonged periods of time

are at a higher risk of developing depression (Kendler, Karkowski, & Prescott, 1999). Adults

who experienced physical and sexual abuse in their childhood are also at higher risks of getting
 MAJOR DEPRESSIVE DISORDER 5

major depressive disorder later in life (Belmaker & Agam, 2008). Low self-esteem, anger, and

rejection have also been shown to cause depression.

It has been suggested that the conscious and the unconscious sections of the mind might

get into a conflict referred to as repression. This is a state where an individual is unaware of their

wishes and motives. This leads to depression. Such conflicts are manifested through problems in

gaining trust, strained interpersonal relationships, among others. Also, depression may occur

where one turns their anger towards themselves. For instance, a child in a hostile family might

turn the anger towards themselves resulting.

Social Causes of Major Depressive Disorder

An individual’s interpersonal and social relationship with their environment has a

relationship with the development of the major depressive disorder. For instance, hostility

between spouses can lead to depression. Moreover, when a spouse is depressed, the partner is

also likely to fall into depression. Depressed parents have also been shown to cause major

depressive disorder in their children. Loss of loved ones, isolation, discrimination and social

isolation also cause depression. Parental loss either through death or separation during childhood

has been shown to cause major depressive disorders in the children. Separation during childhood

has been shown to have a higher likelihood of development of major depressive disorder in

children than death (Agid et al., 1999).

Traumatic events such as rape, witnessing of a violent act, or terrorism can also trigger a

major depressive disorder. After experiencing such trauma, the victims start getting sleep

problems, loss of interest in activities that previously fascinated them and get detached. They

also turn aggressive and violent. Socio-economic factors and discrimination amplify the effects

of traumatic events in causing major depressive disorder (Mao et al., 2009). Social anxiety
 MAJOR DEPRESSIVE DISORDER 6

disorder, which is commonly known as social phobia, leads to major depressive disorder. A

study carried out in adolescents, and young adults showed that social phobia increases the

incidence of major depressive disorder (Stein et al., 2001).

Interaction Between Biological, Psychological, and Social Causes of Major Depressive

Disorder

Various studies have shown that no single factor can directly be stated as the cause of the

major depressive disorder. On the contrary, the condition is brought about by a combination of

all the three factors. For instance, stress both social and psychological has been put forward as a

cause of the major depressive disorder. However, further studies into the subject have shown the

crucial involvement of biological factors. Stress leads to the production of high levels of cortisol,

which then leads to major depressive disorder. Likewise, biological factors determine how an

individual responds to stress. This is the reason why some people may develop the condition,

while their colleagues working under the same stressful conditions do not develop depression.

It is therefore right to state that biological, psychological, and social factors together

cause the major depressive disorder. The condition affects an individual emotionally, physically,

socially, and mentally. It is also a major cause of disability in the world. Moreover, the condition

is exhibiting a trend of progressively crossing over to the younger generation. This new trend has

not been countered with equal force. Mental treatment for young people should be scaled up.

More research also needs to be done for better understanding of the condition. A better

understanding would lead to better treatment and management.

 MAJOR DEPRESSIVE DISORDER 7

References

Agid, O., Shapira, B., Zislin, J., Ritsner, M., Hanin, B., Murad, H., . . . Lerer, B. (1999).

Environment and vulnerability to major psychiatric illness: a case control study of early

parental loss in major depression, bipolar disorder and schizophrenia. Molecular

Psychiatry, 163-172.

Belmaker, R., & Agam, G. (2008, Jnuary 3). Major Depressive Disorder. The New England

Journal of Medicine, 358, 55-68.

Egede, L. E., & Zheng, D. (2003, January). Independent Factors Associated With Major

Depressive Disorder in a National Sample of Individuals With Diabetes. Diabetes Care ,

26(1), 104-111.

Kendler, K. S., Karkowski, L. M., & Prescott, C. A. (1999, June). Casual Relationship Between

Stressful Life Events and the Onset of Major Depression. American Journal of

Psychiatry, 156(6), 837-841.

Mao, L., Kidd, M., Rogers, G., Andrews, G., Newman, C., Booth, A., . . . Kippax, S. (2009,

February). Social factors associated with Major Depressive Disorder in homosexually

active, gay men attending general practices in urban Australia. Aust N Z J Public Health,

331, 83-6.

Mojtabai, R., Olfson, M., & Han, B. (2016, November). National Trends in the Prevalence and

Treatment of Depression in Adolescents and Young Adults. Pediatrics, e20161878.

Papakostas, G., & Ionescu, D. (2014, December). Updates and trends in the treatment of the

major depressive disorder. J Clin Psychiatry, 1419-21.

Park, J. E., Lee, J.-Y., Sohn, J. H., Seong, S. J., & Cho, M. J. (2015, September). Ten-year trends

in the prevalence and correlates of major depressive disorder in Korean near-elderly

 MAJOR DEPRESSIVE DISORDER 8

adults: a comparison of repeated nationwide cross-sectional studies from2001 and 2011.

Social Psychiatry and Psychiatric Epidemiology, 50(9), 1399-1406.

Rot, M. a., Mathew, S. J., & Charney, D. S. (2009, February 3). Neurobiological mechanisms in

major depressive disorder. Canadian Medical Association Journal, 180(3), 305-313.

Schimidt, P. J., Nieman, L., Danaceau, M. A., Tobin , M. B., Roca, C. A., Murphy, J. H., &

Rubinow, D. R. (200). Estrogen replacement in perimenopause-related depression: A

preliminary report. American Journal of Obstetrics & Gynecology, 183, 414-20.

Stein, M. B., Fuetsch, M., Muller, N., Hofler, M., Lieb, R., & Wittchen, H.-U. (2001). Social

Anxiety Disorder and the Risk of Depression: A prospective Community Study of

Adolescents and Young Adults. Arch Gen Psychiatry, 58(3), 251-256.

 MAJOR DEPRESSIVE DISORDER 9

Appendixes

Search attempts on Google scholar database