Why It Can Be Harder for Some Depressed People to Get Better

Depression affects more than 280 million people. While there are many effective treatments, for some it has become a chronic, debilitating illness with recovery far out of reach. This severe, persistent type of depression is what we call “treatment-resistant depression.”

But why do some have more difficulty escaping their cycles of chronic depression? Research suggests that this is because of a toxic blend of biological, environmental, and personal factors that traps sufferers in endless cycles of despair. Understanding what these factors are may help us to understand why recovery seems to be so elusive to some.

Genetic and Biological Factors

Genetics and biology account for between 40 and 50 percent of one's risk of getting depression. The very wiring of your brain and your genetic predisposition could make climbing out of depression extremely hard. There are three reasons why:

1. Genetic predisposition to being depressed: A family history of chronic depression increases one's risk of developing treatment-resistant depression. The way your family’s brains coped with depression gets imprinted in your genes and gets passed on to you. These genes impact your brain chemistry, neurocircuitry, and hormonal regulation, which makes you more prone to depression.
2. Faulty brain chemistry: The brains of the persistently depressed may run short on essential messaging chemicals like serotonin, dopamine, and norepinephrine. This breaks down the communication between the areas in the brain that regulate mood, motivation, and problem-solving.
3. Genes changing due to the environment: Poor lifestyle habits can activate negative genetic switches, which damage brain plasticity, thus making it harder to get out of depression. Even with all the right genes initially, bad lifestyle choices can eventually trigger and keep you in depression.

Environmental and Situational Factors

Prolonged exposure to various environmental and situational factors may not only cause depression but also may trap you in a seemingly inescapable cycle of despair. Several factors play a role here:

1. Unresolved early childhood trauma: Early childhood trauma caused by emotional, physical, or sexual abuse; neglect; or even the loss of a caregiver, rewires your healthy response to stress. It unconsciously affects how you view problems and can sabotage your future relationships and negatively affect the extent to which you can experience joy, pleasure, and happiness.
2. Chronic exposure to extreme stressors: Prolonged exposure to extreme, external pressures like work overload, poverty, family/relationship conflicts, and the like causes one to be in a constant state of hypervigilance. This "permanently" activates depression’s neurobiological mechanisms and physically rewires your brain.
3. Social isolation and loneliness: As social animals, we need social bonds and positive relationships with others to stay emotionally anchored. However, depressed people often self-isolate themselves as they fall deeper into their depressive spirals. They tend to withdraw, which causes loneliness, and the loneliness in return causes more social isolation. This worsens depression and makes escaping the dark hole even more challenging.
4. Inadequate personal and professional support systems: Navigating depression is exponentially harder without access to material resources, emotional support, or professional help. Access to evidence-based practices, psychologists, or medical treatment may be limited due to availability, costs, and accessibility. Similarly, you may also have poor or no social support systems in place.
5. Impact of cultural factors on treatment: Culture also affects the beliefs about the causes of and attitudes toward depression. Factors like the stigma attached to the causes of mental health problems (e.g., demon possession; laziness), the "OKness" for the expression of emotions in more masculine-dominated cultures, help-seeking behaviours (e.g., prioritizing family support over professional help), religious and spiritual beliefs, and the like affect the willingness to talk about depression or getting treatment.
6. Inappropriate treatment strategies: Treating depression is more effective when the approach is tailored to your needs, environment, and responsiveness to treatment. Unfortunately, treatment is often pharmaceutical and/or targets outcomes of depression rather than the causes. Therapeutic approaches (e.g., cognitive behavioral therapy or solutions-focused therapy) may also not be aligned with the way of thinking/functioning of the individuals. These mismatched treatment protocols may expose many to ongoing difficulties.

The Role of Personal Factors and Behaviours

Personal attributes and behaviours can also affect our inability to get out of depression. The way you handle your emotions, your thinking patterns, and your self-care regimen affects whether depression persists. Although there are many personal/behavioural factors that cause depression to linger, research highlights the most prominent to be the following:

1. Never learning proper coping skills: Those with treatment-resistant depression often lacked opportunities in early childhood or adolescence to develop solid emotional regulation and coping skills as well as those abilities that help foster resilience. Further, people also develop maladaptive coping skills like drinking alcohol, sexual promiscuity, rumination, gambling, overeating, and the like as means to temporarily cope with depression, but these ironically make it worse. Building positive coping skills and managing maladaptive coping behaviours is much harder for adults.
2. Hyperfocus on the negative: Chronically depressed brains tend to automatically reframe everything negatively and are hyperfocused on negative thoughts/experiences. This habitual, pessimistic cognitive pattern then reinforces already existing negative thoughts and lets any new information/experience be processed as being negative.
3. Personality factors and self-concept issues: People who aren't open to new experiences and who have low levels of conscientiousness, poor emotional regulation and emotional intelligence, poor perceptions of self-efficacy, and the like find it more difficult to escape from their chronic depression. Other factors like being overly rigid, having an external locus of control, having attachment issues, being pessimistic, and being impulsive tend to negatively affect the treatment of depression.
4. Poor self-care: Poor sleep, an unhealthy diet, a lack of exercise, and no social contact render those with depression more vulnerable and less resilient.
5. Self-stigma: Those who self-stigmatize their depression feel shame, guilt, and even embarrassment about their illness. This affects their ability to seek help and to be open about their mental health issues.

Conclusion

This complex interaction between your genes, environment, and personal factors makes treating treatment-resistant depression incredibly difficult. Knowing what these factors are and how to identify them may help change the way you view your problems and help to address them adequately.