Knowing that causation is a matter of counterfactual dependence, we may reflect on the nature of counterfactual dependence to account for the nature of causation. For example, in his paper "Counterfactual Dependence and Times Arrow," Lewis sought to account for the time-directedness of counterfactual dependence in terms of the semantics of the counterfactual conditional. If correct, this theory can serve to explain a fundamental part of our experience, which is that we can only causally affect the future but not the past. Probabilistic causation
Interpreting causation as a deterministic relation means that if A causes B, then A must always be followed by B. In this sense, war does not cause deaths, nor does smoking cause cancer or emphysema. As a result, many turn to a notion of probabilistic causation. Informally, A ("The person is a smoker") probabilistically causes B ("The person has now or will have cancer at some time in the future"), if the information that A occurred increases the likelihood of Bs occurrence. Formally, P{B|A}≥ P{B} where P{B|A} is the conditional probability that B will occur given the information that A occurred, and P{B} is the probability that B will occur having no knowledge whether A did or did not occur. This intuitive condition is not adequate as a definition for probabilistic causation because of its being too general and thus not meeting our intuitive notion of cause and effect.
Another model, the cortico-striatal model, suggests that abnormalities of the prefrontal cortex in regulating striatal and subcortical structures result in depression. Another model proposes hyperactivity of salience structures in identifying negative stimuli, and hypoactivity of cortical regulatory structures resulting in a negative emotional bias and depression, consistent with emotional bias studies. Diagnosis
Clinical assessment
A diagnostic assessment may be conducted by a suitably trained general practitioner, or by a psychiatrist or psychologist, who records the persons current circumstances, biographical history, current symptoms, family history, and alcohol and drug use. The assessment also includes a mental state examination, which is an assessment of the persons current mood and thought content, in particular the presence of themes of hopelessness or pessimism, self-harm or suicide, and an absence of positive thoughts or plans. Specialist mental health services are rare in rural areas, and thus diagnosis and management is left largely to primary-care clinicians. This issue is even more marked in developing countries. Rating scales are not used to diagnose depression, but they provide an indication of the severity of symptoms for a time period, so a person who scores above a given cut-off point can be more thoroughly evaluated for a depressive disorder diagnosis. Several rating scales are used for this purpose; these include the Hamilton Rating Scale for Depression, the Beck Depression Inventory or the Suicide Behaviors Questionnaire-Revised.Primary-care physicians have more difficulty with underrecognition and undertreatment of depression compared to psychiatrists. These cases may be missed because for some people with depression, physical symptoms often accompany depression.