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Aetiology of depression
In the aetiology and course of depression, a complex set of biological factors have
been implicated. Some of these include neuroanatomical structures, genetic predisposition,
immune system processes and neurotransmitters and neuroendocrine system. Researches
have revealed that depression runs in families which implicates the role of both biological
and environmental factors. Twin studies show that almost one-third of the risk for developing
major depression in adults is rooted in the genetic dissimilarities among individuals.
Serotonin is an inhibitory neurotransmitter that regulates mood states, satiety and sleep
patterns. Reduced levels of serotonin have been implicated in depression. Additionally,
various studies have explored the role of serotonin-related genes in the development of
depression. Based on the current literature, the serotonin transporter (5-HTTLPR) gene has
been implicated in most studies. Other neurotransmitters that play a role in the development
of depression include norepinephrine and dopamine. One of the dominant models that have
emerged in recent years explaining the aetiology of depression focuses on the effect of stress
on body responses, highlighting the role of the endocrine system. Neuroanatomical pathways
including locus coeruleus systems, HPA axis and release of corticotrophin-releasing hormone
(CRH) along with parts of the limbic system have been implicated. Increased levels of the
glucocorticoid hormone, cortisol has been associated with a variety of mood disorders. In
addition to biological factors, psychosocial factors significantly contribute to depression.
Depression has been understood as an individual’s reaction the adverse environmental
situations. Using diathesis-stress perspective, researchers have identified three environmental
conditions (adverse childhood experiences, acute negative life events and chronic stress) that
put at individual at a higher risk of developing depression. Adverse childhood experiences
such as physical or sexual abuse, maltreatment, neglected have been linked to the
development of depression in adulthood, especially in women. One of the major factors that
contribute to depression is acute exposure to negative life events. Evidence from studies
reveals that stress through negative life events is a major trigger for most depressive episodes.
However, the impact of these acute life events is significantly determined by the subjective
meaning of these experiences. Lastly, another source of depression that has been commonly
studied is exposure to persistent and chronic stressful situations. The bidirectional effect of
stressful situation and depression on each other is an important feature of chronic stress.
Aetiology of Bipolar Disorder
Studies have identified multiple factors that form the aetiology of bipolar disorder.
Adopting the bio psychosocial approach, researchers have identified factors including genetic
factors, neuroanatomical structures, neurotransmitters, as well as other biological
abnormalities that contribute to the development of the bipolar disorder. Studies including
family studies, twin studies, adoption studies as well as linkage studies reveal that bipolar
disorder has higher genetic transmission risks. Individuals with first degree relatives suffering
from bipolar disorder are approximately 7 times at higher risk for developing bipolar disorder
than the general population. Additionally, linkage studies reveal that many chromosomal
regions are implicated in bipolar disorder. Involvement of ANK3, CLOCK gene and
CACNAIC has been found in bipolar disorder esp. bipolar type 1. In terms of biochemical
pathways, researches reveal that multiple biochemical pathways play an integral role in
bipolar disorder, therefore narrowing down to one has been a challenge. A variety of
neurotransmitters have been implicated in bipolar disorder. Medication used to manage
depression often increase the levels of monoamines that include dopamine, epinephrine,
serotonin have the potential to trigger mania and therefore provides evidence for the role of
these neurotransmitters in bipolar disorder. Other drugs including L-dopa which influences
serotonin and dopamine uptake inhibitors worsen manic episodes. Recent studies point
towards the role of glutamate in the development of most mood disorders. In addition to the
biological factors, psychosocial factors play a major role as precipitating factors that lead to
bipolar disorder. Studies conducted on the role of stressful events on bipolar disorder reveal
that individuals diagnosed with this disorder often experience amplified stressful situations
before the first onset of the mood episodes. Imminent studies reveal that stressful life events
have preceded both the episodes (manic/hypomanic or depressive episodes) found in bipolar
disorder. Approximately 20-66 per cent of patients reveal that they had experienced at least
one acute stressful situation in past 1—3 months before the onset of the episodes. Moreover,
these psychosocial stressors are the major factors contributing to increased relapse rates in
bipolar patients. An alternative aetiology for both depression and bipolar disorder is offered
by a psychodynamic perspective which views both of these disorders as related but different
types of ego defence strategies that an individual employs when faced with stress.
Reference
Ayano, G. (2016). Bipolar Disorder: A Concise Overview of Etiology, Epidemiology
Diagnosis and Management: Review of Literatures. SOJ Psychology, 1–8.
[Link]
Institute of Medicine, National Research Council, Education, D. O. B. A. S. S. A., Children,
B. Y. O., & Committee on Depression, Parenting Practices, and the Healthy
Development of Children. (2009). Depression in Parents, Parenting, and Children:
Opportunities to Improve Identification, Treatment, and Prevention (1st ed.). National
Academies Press.