Depression triggers are common. About 10% of Americans live with depression. According to the World Health Organization (WHO), depression is the leading cause of disability worldwide.

Depression isn’t always caused by a depressing situation. Many people become depressed, even when everything in their life is going well. The structural, physiological and biochemical changes that occur in the brain that cause depression can have one or more causes including:

  • Dysfunction in the brain’s mood regulation mechanism
  • Genetic vulnerability
  • Physical health problems
  • Stress or negative life events
  • Medication side effects
  • Various triggers

Depression is often triggered by a stressful or negative life event. Similarly, a recurrence of a previous depressive episode can be brought on by situational causes.

By identifying depression triggers, people can identify and be aware and be alert to signs of depression in themselves and in others.

1. Grief and Loss

Grief and loss – known as bereavement – are a significant situational trigger of depression. However, diagnosis may be tricky because the symptoms may just be taken as being a normal reaction to loss.

Handling grief is a personal experience. How grief is managed depends on the individual’s age, life experience, personality, state of mind and the situation being grieved. Grief can manifest itself in physical and mental symptoms, such as:

  • Depressed mood and full depression
  • Anxiety
  • Anger
  • High blood pressure and heart rate
  • High-stress hormone levels 
  • Sleep disturbances 
  • Immune system changes 
  • Substance use 

When grief becomes prolonged or intense it is known as complicated grief or prolonged grief disorder. Grief can become particularly complicated if it is accompanied by rumination.

It can be difficult to tell when the usual sadness of grief crosses the line to depression. People who are grieving should discuss the issue with their physician, particularly if they are having difficulty coping.

2. Rejection

People have an innate need for approval, affirmation, and acceptance from others. Rejection and social exclusion can be very stressful for people and have been associated with low self-esteem. Some people are especially sensitive to social rejection and have a high rejection sensitivity (RS). A person’s level of RS depends on their genetics and their prior experiences in life.

People with a high RS are more sensitive to social cues and pick up on the smallest hint of rejection. They respond intensely to any hints detected. Any perceived failure in being accepted causes anxiety. With perceived repeated failures, eventually social withdrawal and depression results. 

Even people without a high RS can try hard to gain others’ approval, and feel down after being rejected. Anger and aggression are common rejection reactions as well. This response is especially true when rejection involves a love-interest.

Conversely, depression itself causes an elevated RS, because people with depression tend to feel lower self-esteem and are therefore more sensitive to rejection. Their negative depression symptoms (such as depressed mood, lack of energy, social isolation and loss of interest in activities) may make them more likely to be rejected socially. The widespread stigma against depression and other mental health disorders may magnify the likelihood of rejection.

An individual’s RS is not necessarily fixed at a certain level. Counseling may help treat depression and prevent relapse.

3. Stress

Psychological stress is a major cause of depression because of its physical effects on the body and brain. In particular, stress causes hormonal changes that are present in about 70% of depressed people. The hypothalamus, pituitary, and adrenal glands are disrupted from their normal regulation of mood and emotion.

Stress releases the stress hormone cortisol, which results in physical changes to brain cells. Stress can even result in changes to the size of the hippocampus, the part of the brain that is known to be reduced in depressed people.

Psychological stress also activates the immune system, including the release of immune system chemicals (cytokines) that are associated with depression. These immune chemicals are active in brain tissue, including the hippocampus, which explains their role in producing symptoms of mental illness.

4. Illness

Illnesses may contribute to up to 10-15% of all cases of depression. This correlation can happen because:

  • The illness itself may be tragic, and receiving the diagnosis can be traumatic (e.g., cancer, HIV infection, Multiple Sclerosis)
  • The illness may cause depressive symptoms (e.g., hypothyroidism, vitamin B12 deficiency, mononucleosis)
  • The illness may have an inherent association with depression (e.g., Parkinson’s disease, erectile dysfunction, heart attack)
  • The medications used to treat the illness may cause depression (e.g., some heart medications, hormones, certain antibiotics)

There is a reciprocal relationship between illness and depression. Many illnesses or their treatments can cause depression, and depression is known to slow recovery and cause a higher risk of death in many illnesses. In the case of a chronic or terminal illness, co-occurring depression can magnify the suffering brought on by the illness itself.

Physicians should make their patients aware of a particular illness or medication that can cause depression and should watch for this side effect. Likewise, people who are ill should be aware of this common and debilitating effect of illness.

5. Lack of Sleep

Sleep has a reciprocal relationship with depression. First of all, sleep changes are a core symptom of depression. An individual has either increased or decreased sleep. About 75% of depressed people have insomnia, and about 40% sleep excessively (hypersomnia), with lots of overlap. Sleep problems are some of the major reasons that people seek help for their depression.

Conversely, a lack of sleep is a known trigger for depression. Insomnia increases the risk of developing depression by four times. A clinical trial in adult twins showed that a sleep duration of five hours or less doubles the incidence of depression. Because these were twins, the genetic predisposition for depression was not a factor.

Another large study with adolescents showed that sleep duration of six hours or less per night increases the risk of depression by 25% to 38%. Developing depression can cause sleep disturbances, so a vicious cycle can ensue. Adolescents seem to be especially prone to sleep deprivation, usually self-imposed.

Addressing sleep problems appears to be an effective way to prevent depression, as well as treat depression and prevent relapse. Also, given the association between sleep problems and suicide risk, addressing sleep symptoms in depressed people is especially important.

 6. Rumination

Rumination is grief that has gotten out of control. The ruminating individual dwells on the grief rather than trying to embrace and deal with it healthily. The grief and pain become an obsession that interferes with normal life functions.

People who ruminate get stuck on thoughts like, “Why did this happen to me,” and, “How terrible is this?” They get caught up in self-pity and exaggerate the negative. They may also get angry with others who are handling their grief in healthier ways.

 It is not surprising that rumination has been identified as a major trigger for depression. It can cause depression, worsen and prolong existing depression, and it is a risk factor for suicidal ideation. Conversely, the impaired emotional regulation that is characteristic in depressed people can lead them to ruminate.

Experiencing grief is a normal part of life, but many people are poorly equipped for handling it, especially if it is a new experience for them. Their expectations of grief may be unrealistic. 

Researchers found that hope — internal confidence and motivation to succeed — is the antidote for rumination. People with high hope have better self-efficacy and a focus for continuing on with life despite the loss that they are grieving, rather than ruminating. People who are ruminating should receive grief counseling.

7. Money Problems

Financial problems can cause depression in several ways. A study that tracked 35,000 Americans to study the effects of money on mental health found that low household income is associated with increased risk of mental health disorders, especially depression. The study found that a drop in income increases the risk of depression.

Additional research found that financial difficulties and financial stress are associated with depression, which appears to worsen financial difficulties, beginning a vicious cycle.

People experiencing financial difficulties, such as drops in income or financial loss, should consider measures to improve their ability to cope with the stress associated with these changes.

8. Life Transitions

Life transitions, even positive ones, can have negative effects on a person’s mood. People are creatures of habit, so even positive life changes can take them out of their comfort zone and cause stress.

For example, a job promotion can involve leaving a familiar and comfortable job for one that is unfamiliar and difficult. The new job can involve leaving behind familiar people and being surrounded by strangers. It may also be more stressful and involve a steep learning curve. The collective effect is stress that may precipitate depression, despite the positive event of getting promoted.

If the life transition is a negative one, such as losing a job or getting divorced, then the stress and depressive effects will be even more of a shock.

There is a subtype of depression called adjustment disorder, where the individual develops depressive symptoms or even full depression after life changes.

People should anticipate the stressors of life changes, and be prepared for them. Those who are having difficulty coping should consider engaging their support system and even counseling. They should also be vigilant in looking for symptoms of depression that may follow these life changes.

9. Substance Use

Substance use and depression are closely related. Many of the mental and physical changes seen in depression and addiction are similar. They also share many risk factors, have overlapping symptoms and each can cause or trigger the other.

Recent discoveries revealed that drug and alcohol abuse can cause physical changes in the connections between the brain cells so that new pathways are formed that support addiction.

Many people use substances as a way to self-medicate their mental health symptoms. In many cases, people aren’t even aware that they have a treatable mental health disorder and have been living with their symptoms for so long that they assume that it is just normal.

When substance use and depression (or other mental health disorders) occur at the same time, it is referred to as comorbidity. When comorbidity occurs, it is crucial to treat both conditions at the same time. Trying to treat depression in the presence of active substance use is difficult. Likewise, trying to treat addiction in the presence of untreated depression greatly lowers the chance of success.

Managing Depression Triggers

One of the most important aspects of managing depression triggers is awareness of them so that individuals and their loved ones recognize them promptly and act accordingly.

Even if people are subjected to a trigger that they can’t immediately change — such as chronic illness, financial troubles, or a life transition — they can take action to reduce the stress from the event.

People with depression require professional help. It is a serious illness that can become chronic, and it is associated with disability, reduced quality of life, physical illness and even death. Comorbidity is especially dangerous and requires specialized care.

The Recovery Village offers comprehensive professional assessment and treatment programs for individuals experiencing co-occurring substance use and mental health disorders. If you are concerned about depression and substance abuse in yourself or a loved one, contact The Recovery Village to speak with a representative about how treatment can help.