Joe: Like if you experience a trauma as a kid, or one of your parents die? Can that cause depression?
RP: Well, it’s always hard to know if some single thing is a “cause” of a depressive bout, Joe. It’s usually a combination of things and it’s safer to call things “risk factors” rather than “causes.” Major stress early in life, such as child abuse or neglect, probably increases the risk of later depression .
And there’s good evidence that parental separation—for example, when parents divorce—is a risk factor for depression .
And just to round out the “social” component that goes into that funnel, there’s the issue of social support. Think about people with no friends or family to help them deal with the stresses and losses of life—it’s not surprising that a lack of social supports increases the risk of major depression 
Joe: Okay, I get the “bio, psycho, social” thing, Doc. But I still have some trouble with the idea of taking the antidepressant. I mean, some of my friends—they say that I’m just using a crutch.
RP: Well, Joe, there’s nothing wrong with a crutch if you’ve got a broken leg! But let me give you a different image to keep in mind. As I see it, medication is like a bridge between feeling terrible and feeling better. But you still have to walk across that bridge.
[illustration like this, about here]
Joe: Meaning, I got to do the work in therapy, maybe change the way I see things, change my mental habits?
RP: That’s exactly right, Joe. And we have some evidence that medication and psychotherapy together work better or faster than one or the other alone  , and that each may work on different “pieces” of the depression.
In my experience, medication is usually more helpful with low energy, poor concentration, poor appetite and insomnia. Psychotherapy often helps more with low self-esteem, excessive guilt and distorted ways of thinking . Almost always, I advise a combination of medication and therapy for severe major depression.
This sort of dialogue may not work for you in your practice, but some version of it might. Bumper sticker pseudo-explanations, whether biological or psychological, are a disservice to our patients, who deserve a basic discussion of causes and risk factors in major depression and other psychiatric illnesses. The good news is that, for many patients, the initial discussion needn’t take more than five minutes