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A Unified Approach to Understanding the Etiology of Depression

Cindy L. Ehlers, PhD; Ellen Frank, PhD; David J. Kupfer, MD

Arch Gen Psychiatry. 1988;45(10):948-952.

Abstract
• Results of biological and psychosocial studies of depression completed in the last decade have stimulated the need for new hypotheses that synthesize these findings in a unified etiologic theory. The importance of disruption of biological rhythms on the one hand, and psychosocial losses on the other, in the causation of depressive episodes suggest one possible unifying hypothesis. The concept of loss of "social zeitgebers," ie, persons, social demands, or tasks that set the biological clock, may provide the link between biological and psychosocial theories of etiology. We suggest that a disruption of social rhythms, which may result in instability in biological rhythms, could be responsible for triggering the onset of a major depressive episode in vulnerable individuals.

Author Affiliations
From the Division of Preclinical Neuroscience and Endocrinology, Scripps Clinic and Research Foundation, La Jolla, Calif (Dr Ehlers); and the Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic (Drs Ehlers, Frank, and Kupfer).

Footnotes
Accepted for publication Nov 2, 1987.

Reprint requests to Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA 15213 (Dr Kupfer).

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