Root Causes of Depression: History and Neurochemistry

The psychoanalyst George Atwood argued that even depression with no obvious trigger still has a story behind it—that people can descend into a painful mood while avoiding the very thing that brought them there. When there's no visible loss or disappointment, it's tempting to conclude the mood simply arises, in his words, "from within." But that conclusion often strips the depression of its context. Frequently, burnout, unresolved trauma, or anxiety are the hidden drivers beneath a depression that seems to have come from nowhere. There is usually a story there, often untold, and uncovering it is frequently the first therapeutic step.

Biology and Biography, Not Biology Versus Biography

Depression has real neurochemical dimensions—genetics, brain chemistry, and physiology all play a documented role, and medication is often an appropriate and important part of treatment. Psychiatric care and psychotherapy are not competing explanations for depression; they address different layers of the same experience. Where medication can help regulate the physiological symptoms of depression, therapy addresses something medication alone often cannot reach: the personal history and life context that shaped the depression in the first place.

In my clinical experience, treating a depressed mood as purely biological—without also exploring what it may be responding to—can leave the underlying story unexamined. Depression is rarely a random malfunction; it is often, at least in part, a meaningful response to a life context that has become unbearable. If you are currently taking psychiatric medication or considering a change to your treatment, I'd encourage you to make that decision together with your prescribing physician—this page isn't meant to suggest otherwise, only to describe what psychotherapy can add alongside it.

Restoring the Context of Suffering

In clinical practice, I view depression not only as a set of symptoms to be managed, but as a signal worth understanding. Alongside asking what may be happening biologically, therapy also asks "What has happened to your world?" This work focuses on rebuilding a sense of agency by exploring the narrative the depressed mood may be trying to convey.

• Discovering the Story: Alongside any medical evaluation, we explore the specific disappointments, hidden grief, or structural losses that may have triggered the depressive episode.
• Addressing the Emotional Void: We examine how past relational neglect or a chronic lack of empathic attunement in childhood creates a vulnerability to depression in adulthood.
• Processing Alongside Treatment: Using the therapeutic relationship as a safe container, we work through emotions that have been avoided or sequestered, as a complement to any medical or psychiatric treatment you're receiving.
• The Search for Agency: By understanding the history of the mood, patients often find they are not simply "broken," but are responding, in a comprehensible way, to a history of trauma or unmet needs.

Healing from depression often involves both a physiological and a psychological dimension. By honoring the personal history behind the pain—alongside, not instead of, appropriate medical care—we open the door to a more complete and lasting understanding.