Nowadays, psychodynamic approaches for understanding depression admit that affective disorders are strongly influenced by genetic and biological factors.
The most predictive factor is the presence in one’s life of a highly stressful moment, as well as interpersonal relationships and nervous temper.

          In 2003, Caspi discovered the polymorphism in the area involved with serotonin transport, hormone that modulates the influence of stressful events on depression.

          Kendler (1999) showed that a third of the associations between stressful events and depression were misrelated, because people susceptible to depression live in high risky environments.

          The following were considered the most powerful stress factors:

• Death of a close relative
• Aggressions
• Serious marriage problems
• Divorce or separation
• Early abuse experiences, neglect or parental separation

          Kendler in 1992 reported that there is a high risk for major depression in women that had been separated from their parents in early childhood or during adolescence.

          In 2001, the same author stated that men are much more susceptible to the depressing effects of divorce or separation, and to the depressing effects of work related problems. In exchange, depression in women appears as a result of social problems involving people from the immediate entourage.   

          An early age human loss creates a certain vulnerability that can be the base for depression in the adult life.

          Major depression in adult life is more probable to appear when a person has had to deal with the loss of a parent. The effect caused by permanent separation was proved to be more overwhelming than the effect of death. Also, losing someone close before the age of 9, leaves more scars than losing someone in late childhood or adolescence. In 2003, Gillman noticed that small children with divorced parents develop a feeling of vulnerability and are more susceptible to depression later in life.

          Women with a history of physical or sexual abuse or childhood neglect, are twice more susceptible to develop negative relationships and low self-esteem in adult life, and they also have a risk of developing depression, 10 times higher than women with a normal and harmonious life. A stressful past, full of abuses and neglect, determines stress axis hyperactivity (hypothalamic-pituitary-adrenal axis), with increased stress hormones release (CRF, ACTH, cortisol). These hormones sensitize neurons, which become extremely active in depressive people exposed to stress, and so, they act in a dramatic manner even in contact with minor stress factors. A research concluded that the ACTH response to stress was 6 times higher in women with childhood history and diagnosed with depression, than in the rest of the people that participated to the research.

          Humiliating events are strongly associated with depressive episodes, especially when a person with an important position or job founds himself in an uncomfortable situation.

          Freud noticed that marked self-depreciation, frequent in depressive patients, is the result of anger turned towards the patient’s self.

          Karl Abraham used Freud’s idea of relating the present with the past. He suggested that depressive adults have suffered a serious diminished self-esteem during childhood, and that triggered the adult depression through a new loss, or a new disappointment. These events generate intense negative feelings towards present and past, persons that have vexed the patient by real or imaginary love withdrawal.

          A depressed person feels helpless, powerless, and his vulnerability triggers the depression mechanism.

          Arieti (1977) studied people that become severely depressed and noticed that they usually have a life model for someone else, instead of having one for themselves. He named the person they lived for the other dominant (husband, wife). These people often live for an ideal or organization and then, this becomes their dominant purpose. Although these individuals notice the harmful situation they are in, they do not feel capable of changing it.

          SUICIDE

          It is most frequently associated with a major depression, and the motivations are varied and often unknown. Some people see suicide as a satisfactory revenge against their parents or their life partner. It is often considered as a last resort to escape of the interior drama.

          Factors that anticipate suicide:

• Panic attacks
• Anxiety
• Severe interest and pleasure decrease
• Depressive agitation, which involves rapid mood changes, from anxiety to depression and anger
• Alcohol abuse
• Decrease in focus ability
• Global insomnia
• Desperation
• Suicidal ideation
• History of suicide attempts

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