(by guest author John Preston, Psy.D)
A number of factors can contribute to depression. There are the usual suspects, e.g. loss of a loved one (due to death, separation, or divorce), assaults to one’s self-esteem (e.g. being fired, demoted, failing an exam, or being rejected in a romantic relationship), developing a serious illness. Additionally, a number of situations that contribute to depression are commonly encountered among those in medical school, internship, or residency:
- Prolonged exposure to significantly stressful situations.
- The perception of powerlessness. For example, the belief that “no matter what I do, I still cannot stay on top of things.” Chronically feeling overwhelmed.
- A lack of self-confidence. Developing doubts about one’s self.
- Sleep deprivation: This is a very common but often overlooked cause of depression. This can be due to the choice to regularly sleep less (e.g. spending long hours into the night studying or being on call). Also, a loss of restorative (slow wave) sleep can be caused by the overuse of caffeine or other stimulants and by chronic anxiety. Prolonged stress or anxiety disorders result in high levels of stress hormones such as cortisol and norepinephrine. These hormones significantly reduce the time spent in slow wave sleep. Stress often results in difficulty falling asleep (initial insomnia) and, in addition, the loss of restorative sleep. The daytime exhaustion that results is often combated with increased caffeine use. Caffeine also interferes with the ability to enter slow wave sleep.
- In attempting to overcome initial insomnia, people often turn to the use of alcohol and benzodiazepines, most of which also interfere with restorative sleep. Fatigue and chronic loss of slow wave sleep contribute to cognitive problems (especially the ability to maintain attention and concentration).
Stress may lead to impaired sleep, daytime fatigue, excessive caffeine, alcohol or tranquilizers use, and symptoms of depression. Continue reading “Depression: Often Obvious, Sometimes Hidden”