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Right. Physical factors and emotional factors are all involved in depression. To say it is one or the other is a complete misunderstanding.

To further complicate things, stress can deplete serotonin. So then you can't respond to the stress as well. So then serotonin gets more depleted, which basically causes more stress.

So then, you're trying to find your way out of what started as an emotional issue, but even with better coping mechanisms, you can't, because your very ABILITY to bounce back is gone.

So even with depression that starts with emotion, you have to get on a positive PHYSICAL improvement upswing, so that increased physical ability to deal and increased emotional ability to deal once again start reinforcing and you end up with a positive upward spiral instead of a negative downward one.

It's not easy to bring a downward spiral to a halt, and turn it into an upward spiral. Can it be done? Yes, but no one should assume it's just an easy thing to do.