Two out of the three causes of depression have been covered in the last chapter: (1) biochemical factors and (2) an individual’s psychiatric makeup. We now move on to the third factor: socio-circumstantial causes.

These refer to incidents, setbacks, and experiences linked to social and circumstantial issues. Examples include relationship conflicts, separation, airplane disasters, breakups, the death of a loved one, and childhood trauma. Depression can also be triggered by tragedies and major circumstantial turmoil, such as air disasters or armed conflicts. These socio-circumstantial factors complicate the situation, especially when the individual already has pre-existing vulnerabilities. The risk of developing depression increases significantly when biological predispositions and perfectionist tendencies converge—some might even call it a disaster waiting to happen.

Depression is a clinical mental disorder with hereditary characteristics, meaning it can be passed down through family lines.

If someone’s parents or blood relatives have had episodes of depression in the past, this could increase the chances of similar struggles among family members.

The good news is that while heredity plays a role, it is ultimately the existing circumstances that determine whether these genetic factors will manifest.

Dr. Li encountered such a case while working at the Institute of Mental Health. The patient came from a family with a history of depression, yet only the younger of two sisters developed the condition, while the elder frequently visited her at the hospital. This case illustrates that hereditary factors do not guarantee the onset of depression.

Always remain cheerful and stay happy as much as possible. Do not worry unnecessarily but be grateful in all circumstances—this mindset can help safeguard against depression.

Clinical Diagnostic Standards for Depression

Dr. Li emphasized that only qualified professionals can conduct diagnostic assessments based on medical standards. Strictly speaking, laypersons—including counselors, family members, and friends—are not qualified to diagnose a patient’s condition. However, having a general understanding of depression can help us offer appropriate support and guidance.

Family members are in a unique position to play a crucial role by observing symptoms during their daily interactions with the individual.

Clinical diagnosis is based on ten major symptoms, but only a professional psychiatrist can make an official determination.

It is strongly advised that if you suspect a loved one is struggling with depression, you encourage them to seek consultation with a qualified psychiatrist. The psychiatrist will assess the individual’s daily actions and behaviors, piecing together a complete picture before making a diagnosis. No effective treatment can take place without such a thorough and comprehensive evaluation.

We encourage everyone to educate themselves about these clinical symptoms to help reduce stigma and provide better support to those affected.

Dr. Li shared a case of a patient who became deeply distressed after a neighbor casually suggested he might have depression. This remark led to a downward spiral of anxiety and worry. However, after attending a seminar and gaining a better understanding of depression, he felt relieved to learn that he did not actually have the condition.

Total recovery from depression is possible if the condition is identified and treated early. However, neglecting proper intervention can lead to regret and even irreversible consequences. As the saying goes: “While prevention is better than cure, understanding is the light that guides the way.”

Genuine support and heartfelt love within the family are paramount and should never be underestimated. If five or more of the following ten symptoms persist for more than two weeks, seek clinical assessment immediately. Early intervention can make all the difference.

The Ten Symptoms of Depression^[1]

1. Emotional Fluctuations – The individual feels persistently sad and may tear up easily. They might struggle to answer questions, as their emotions are overwhelmed by depressive pressures.
2. Loss of Interest – The individual loses interest in previously enjoyable activities, often without apparent reason.
3. Weight Changes – Friends who haven’t seen them in a while may be shocked by their appearance. Weight loss (or, in some cases, weight gain due to binge eating) of 2–5 kilograms within a month is common. While depression is most prevalent in individuals aged 25–55, increasing numbers of younger patients are being diagnosed.
4. Changes in Sleep Patterns – Sleep disturbances fall into three categories: excessive sleeping (12–14 hours a day), insomnia, or restless, poor-quality sleep.
5. Increased Irritability – The individual becomes impatient and irritable over trivial matters. They struggle to calm down, feel constantly insecure, and may experience frequent panic attacks.
6. Persistent Fatigue and Lethargy – The person feels drained, listless, and sluggish. They lack motivation and may struggle to get out of bed.
7. Negative Thought Patterns – The individual views themselves as worthless, believes they are a failure, and assumes that everyone dislikes them. These persistent negative thoughts can lead to self-harm or suicidal ideation.
8. Attention Deficit – They find it difficult to focus or make decisions, even on simple matters, and may struggle with memory loss.
9. Suicidal Thoughts – Individuals experiencing extreme despair may contemplate ending their lives. It is crucial to be vigilant and provide support at the right time. Avoidance of the topic of suicide can be harmful; instead, approach it with care, compassion, and wisdom. Keep dangerous objects out of reach, and ask direct yet empathetic questions like, “Are you seriously thinking about taking your own life?” Guiding them towards professional help can be life-saving.
10. Physical Symptoms with No Clear Medical Cause – In some cases, symptoms such as migraines or digestive issues may have no clear physical explanation. If emotional distress is suspected, a psychiatric evaluation should be considered. As the saying goes: “Check early, suffer less.”

If five or more of these symptoms persist for over two weeks, seeking psychiatric help is essential. This applies to family members, friends, or even yourself.

For Discussion

1. Depression is classified as a mental disorder. To what extent does genetics play a role? How would you approach this question?
2. There are ten major symptoms of depression. How many must be observed before a diagnosis is warranted? For how long should these symptoms persist before seeking professional help?
3. How can one show care and support to a family member experiencing depression?