Grammy award-winning country singer Naomi Judd recently revealed the extent of her struggle with depression on The Today Show: “I didn’t get off my couch for two years…I was so depressed that I couldn’t move.”

The depression seemed to come “out of nowhere,” she said and completely “immobilized” her, even affecting time spent with family and friends.

According to Judd, depression – in her case – was not about being happy or sad, it was a chemical imbalance: “We don’t make enough of the good neurochemicals in the brain. It’s a disease. It has nothing to do with our character.”

However, researchers suggest the causes of depression might be more complex. According to neuroscientist Joseph Coyle, MD, of Harvard Medical School, quoted in National Public Radio’s blog: “Chemical imbalance is sort of last-century thinking. It’s much more complicated than that.”

The chemical Coyle is referring to is serotonin. Serotonin is a neurotransmitter that sends messages across your brain about your mood, appetite, and memory, according to Scientific American.  Beginning in the 1980s, low levels of serotonin were believed to cause depression.

However, according to Coyle: “What’s being looked at are processes that are much more fundamental than just serotonin levels. We need to move beyond serotonin.”

Other Causes of Depression

While experts continue to study what causes depression, the Mayo Clinic suggests other factors can lead to depression:

• Physical changes. A recent study of more than 3,000 people who reported symptoms “indicative of depression” by The University of Edinburgh found that physical changes in the brain could be associated with depression: “Alterations were found in parts of the brain known as white matter, which contains fibre tracts that enable brain cells to communicate with one another by electrical signals. White matter is a key component of the brain’s wiring and its disruption has been linked to problems with emotion processing and thinking skills.”
• Hormones. Pregnancy, thyroid problems, menopause and more can change the body’s balance of hormones, which can trigger depression.
• Inherited traits. People with blood relatives who have struggled with depression are often more susceptible.

Additionally, other risk factors may put certain people at risk for depression. Some of these risk factors can include traumatic events, other mental health illnesses, alcoholism, chronic illness, and certain medications.

Prolonged depression can lead to social isolation, anxiety, suicidal feelings, physical illness and more, which can further complicate the mental illness.

When to Seek Help

Naomi Judd’s story – and other personal accounts shared by celebrities – are significant steps in reducing stigma surrounding mental illness.  Knowing that there are several different factors that can cause depression is another step forward in having new conversations about mental illness.

Contacting your healthcare provider is a great first step.  If you aren’t sure how to approach your healthcare provider, visit the National Alliance on Mental Illness for tips to consider when reaching out.

Judd herself encouraged Today Show viewers not to ignore signs of depression: “One of the things that happens with depression is throughout my life I’ve had a lot of tragedies…and you just keep squelching it down, you just keep suppressing it and all of a sudden one day if you don’t deal with it, it starts coming out sideways.”