Depression is a serious health condition that is under recognized.  It is not a normal state of being.  When you are depressed you are at risk up to and including the risk of death.

While some cases of depression are the result of "environmental" factors, that is, the stresses and circumstances in a person's life, other cases result from an identifiable and measurable chemical imbalance in the brain.  Neurochemical disorders can be mild or severe, but they tend to be responsible for most severe cases of depression, usually marked by major changes in personality, detachment from reality and similar symptoms.  A neurochemical imbalance might be especially suspect when the person's circumstances don't seem to warrant sadness or anxiety, in general, life seems "good."

Historically, depression caused by neurochemical brain disorders has not always been identified as such.  Diagnoses by general practitioners have been more likely to list a change in circumstances or a failure of coping mechanisms as primary underlying factors.  But more recently, thanks to research by the National Institute of Mental Health and other organizations, medical and mental health professionals have greatly improved their ability to identify and cite neurochemical imbalance as the base cause of a patient's depression.

The result of this improvement in knowledge and identification has been an improvement in the accuracy of doctors' diagnoses, which in turn has improved treatments and results for patients.

Recent research into the causes of and treatments for depression suggests that short-term psychotherapies, sometimes called "talking" therapies, often may be as effective as anti-depressant medication for treating mild, moderate and occasional severe cases.  In the more severe cases of depression, where there are an array of serious psychological (e.g., deep despair, suicidal ideas or plans) and physical symptoms (e.g., problems with sleep, loss of appetite and weight, diminished concentration and memory), where the condition has been persistent, or where there is evidence that someone is experiencing ever greater functional difficulties, beginning treatment with medication appears to be the first line choice.  The reported best long-term outcomes for individuals with recurrent depressions have been achieved using a combination of medication and one of the available "evidence-based" psychotherapies (e.g., Cognitive-Behavioral Therapy, Interpersonal Psychotherapy).  Occasionally individuals will need to change medication when they have had little or no response, or have suffered problematic side effects.  For those who have achieved a partial or incomplete response but not full remission (the complete disappearance of symptoms), many specialists suggest augmenting the therapy with a second medication using one of the different classes of anti-depressants.

Once again, not every case of depression is related to a chemical disorder in the brain.  It also is worth noting that many anti-depression medications have side effects that must be taken into account.  The question for anyone depressed because of a neurochemical imbalance is, "Do the benefits outweigh the risks?"  This assessment should be made by the patient in conjunction with his or her doctor.

It might turn out that the best treatment for a neurochemical imbalance and the resulting depression is a combination of medication, "talking" therapy, and the development of life skills to manage and overcome future episodes of depression.