Why Is Depression So Tenacious?

Psychologist Jonathan Rottenberg writes, “Why has depression become so prevalent? An ancient mood system has collided with a highly novel operating environment created by a remarkable species. Depression is worse in humans than in other mammals not because our species has more flaws but because of our unique strengths. Advanced language enables wallowing; our ability to set ambitious long-term goals sets up new opportunities for failure; our elaborate culture presents expectations for happiness that cannot possibly be fulfilled.” Read the Blog

Why Is Depression So Tenacious?

In an era of tight budgets, supporters of depression research argue that more funding is needed to find a cure. That’s logical-sounding but may be totally wrong. Depression’s toll has risen even as more research and treatment resources have been poured into combating it.

Some 38 million American adults struggle with depression. The World Health Organization projects that by 2030, the amount of disability and life lost due to depression will be greater than that from war, accidents, cancer, stroke, or any other health condition besides heart disease. Richard A. Friedman recently wrote, “Of all the major illnesses, mental or physical, depression has been one of the toughest to subdue.” Despite 26 different antidepressants to choose from, only a third of patients with major depression will experience a full remission after a round of treatment. Newer antidepressants are no more effective than those developed nearly 60 years ago.

Our main approach to depression is biomedical and assumes that depression is an illness. Yet the search to discover a fundamental defect in the brain that causes depression has foundered. There remains no biological test to diagnose depression, despite hundreds of physical assays, nor are there any genes that strongly predict it. Brilliant scientists cannot find the defect—even if they look with different or more expensive toys—because their search is animated by the wrong question: Where is the disease?

We can understand the puzzling tenacity of depression by posing the opposite question: How has nature built us with the capacity to become depressed? Depression is a byproduct of evolution, which has shaped not only the physical structures of our bodies but the basic mechanisms of our minds. Mood is a key adaption that we share with other animals.

Moods have been selected for because they flexibly tune behavior to situational requirements. High moods lead to more efficient pursuit of rewards. Low moods focus attention on threats and obstacles and restrain behavior.

Moods are a clever adaptation because they integrate multiple aspects of how well or poorly we are doing. Moods track key resources in our external environment (like food, allies, and potential mates) and our internal environment (for example, fatigue, hormone levels, and adequacy of hydration). When conditions are unfavorable, or when goals are unreachable, low moods pause behavior to ensure that an animal does not engage in fruitless efforts. This efficiency is important given that resources of every sort—time, energy, or money—are finite.

Just as pain protects us from injury, the unpleasant aspects of low mood are in keeping with its utility. People in a low mood may blame and criticize themselves, turn situations that went wrong over and over in their heads, and experience pessimism about the future. These characteristics, although uncomfortable, are also potentially useful in that a keen awareness of what has already gone wrong can help a person avoid similar stressors in the future. Experiments reported by psychologist Joseph Forgas have provided some of the strongest demonstrations of ways in which low mood benefits thinking and decision making.

No adaptation is perfect. Adaptations present tradeoffs between benefits and costs. Our big brains have enabled our dominance over the planet and have also made childbirth far more dangerous. Our propensity toward anxiety is at once an important defense against threats and a lurking vulnerability to paralyzing conditions. Low mood is useful on average, but it has its costs. Inaction carries risk in a dynamic world. In more severe forms of low mood, these costs are higher, such as damage to the body from the release of stress hormones.

Why has depression become so prevalent? An ancient mood system has collided with a highly novel operating environment created by a remarkable species. Depression is worse in humans than in other mammals not because our species has more flaws but because of our unique strengths. Advanced language enables wallowing; our ability to set ambitious long-term goals sets up new opportunities for failure; our elaborate culture presents expectations for happiness that cannot possibly be fulfilled.

How will we better contain depression? Expect no magic pill. One lesson learned from treating chronic pain is that it is tough to override responses that are hardwired into the body and mind. Instead, we must follow the economy of mood where it leads, attending to the sources that bring so many into low mood states—think routines that feature too much work and too little sleep. We need broader mood literacy and an awareness of tools that interrupt low mood states before they morph into longer and more severe ones. These tools include altering how we think, the events around us, our relationships, and conditions in our bodies (by exercise, medication, or diet).

For the last 20 years we’ve been listening to Prozac. It’s time to listen to depression.

Jonathan Rottenberg, Ph.D., is the author of The Depths: The Evolutionary Origins of the Depression Epidemic, now available where books are s

Restarting the National Conversation About Depression: A New Anti-Stigma Campaign

Our national conversation about depression for the last twenty years has been on hold, largely reduced to a narrow dialogue about the promise and peril of antidepressants: “To Prozac, or not to Prozac?”  Peter Kramer’s Listening to Prozac raised expectations that antidepressants would soon make depression obsolete. As this proved not to be the case, there was the predictable backlash. In Robert Whitaker’s Anatomy of an Epidemic, antidepressants (and other psychotropic medications) are not only ineffective, but the villain, responsible for worsening the epidemic of mental illness. The next movement will be a backlash to the backlash. If we do nothing different, we can conclude with supreme confidence that all the heated talk about drugs will continue to monopolize the stage and preclude a real conversation about mood and mood disorders.

The continued ascendance of the conventional disease model of depression is part of the problem. The conventional approach tends to view the legions of the depressed and the formerly depressed as a “broken” people, an ever-afflicted group that will likely need repeated assistance over the life course because of their theorized defects. The biological defect model may have been created with good intentions, but it is both belittling and inaccurate. Depression like any mood state has a biology but it is simply not a disease in the same sense that Parkinson’s Disease is.  To try to maintain that depression is a brain disease is to cut off a more interesting conversation at the knees.

Happily there are exceptions to this trend. And Dan Lukasik is one of him. There are people who are hunger for more, and who reject the corrosive, age-old stigma attached to depression and depressed people, and who are fighting for a more honest and more balanced discussion of the topic. There are people who agree that it is high time for our society to revise its stance toward the millions who have battled depression.

I am a depression researcher and former depression sufferer who has looked at the poor state of the national dialogue and has been moved to try and change it. I am using social media, particularly Facebook, to restart our national conversation about depression. We desperately need this not only for adults. We also desperately need it for my daughter, Sophie, and for the rest of her generation, the teens who will soon be young adults. Our youth will face depression in high schools and on college campuses in epidemic proportions that will overwhelm them, their parents, and all counseling resources.

One major obstacle to a more affirmative national conversation is that depression has lacked a unifying public symbol that could bring it out of the dark like Livestrong© bracelets did for cancer or the rainbow flag did for LGBT. When most people think of depression, their first associations are to unfortunate images, such as a dark cloud, the color black, or a noose. One reason that depression stigma lives is that depression has a serious bumper sticker problem.

But this is essentially an issue of failed marketing and messaging. It is very hard to talk about depression when it is always on societies’ terms. Depressed and formerly depressed people are ever on the defensive. To change the terms of the debate, and spark more productive conversation.  I have developed a unifying symbol to function in a depression anti-stigma campaign. These are glow-in-the-dark wristbands that are printed with the phrase COME OUT OF THE DARK.

A few weeks back, I was using my Facebook page to probe for interest in these wristbands and I made an offer that I would give away a glow-in-the dark wristband to anyone who would be willing to send me a picture of themselves wearing it. I bought 200 bands from China and planned to give them away from time to time to readers who were interested. Initial response was rather tepid and I started to think it would be complete flop. Well, last Thursday, after I had given away a few dozen, for reasons that I do still do not completely understand, the wristbands went viral on the internet, and I was flooded with requests from all over the world. It’s hard to get an exact count but it’s definitely in the thousands.

I received requests from parents for their depressed children. From people who lost loved ones to suicide. From teachers for their classrooms. From therapists for their patients. From counselors for their support groups. And from many individuals who have been touched personally by depression, both those who have conquered depression and those who were still struggling with.

I think that part of the viral appeal of the wristband campaign is the slogan, which has several possible meanings

•   Let’s end society’s ignorance about depression.

•     Let’s support depressed people so they get well and stay well.

•     Let’s create an environment where people can speak freely about depression and no one feels compelled to conceal their pain.

And part of the appeal is that total strangers are giving you something for free that will make you feel more comfortable living in your own skin.

In any case, this has been a stunning development and my life has been turned a bit upside since Thursday since this all happened. I have a full-time job as a researcher at the University of South Florida and I have been thrust into the beginnings of a social movement. I’ve bought another 2,700 wristbands from China. I’ve enlisted friends, family, students, and total strangers in an effort to respond to the messages and prepare a mailing.  I’ve asked for donations. We’ve made a plan of action and my goal is to send out these 2,700 wristbands bands by October 1st. This will end the first phase of the campaign. There will be more to come, but I will need to take a break and develop a plan for the second phase.

People who have received  the wristbands are starting to return pictures. If you look at this gallery of the first wave of people who have come out of the dark, I think you can more easily understand why this campaign has taken on a life of its own. It’s both a social media campaign and a word-of-mouth campaign – both of which inevitably will shift the conversation about depression on more favorable terms.

The massive response to the Come-Out-of-The-Dark campaign tells me that change is in the wind. People are tired of hiding, tired of hedging. They are ready to reclaim their identities as fully human.

The stakes are high. Conservatively, 13 million US adults are currently in an episode of depression; more than twice that number have had depression in the past. When we add in caregivers, millions more are indirectly affected by the quality and the quantity of our national dialogue about depression.

But we have the momentum. At this rate I give the stigma of depression about another six months to live.

Jonathan Rottenberg is a leading researcher in the area of emotion and psychopathology, where he has focused on major depression. He recently edited Emotion and Psychopathology: Bridging Affective and Clinical Science, published by the American Psychological Association. Since receiving his PhD degree from Stanford University, he has been at the University of South Florida, where he is an Associate Professor of Psychology and Director of the Mood and Emotion Laboratory. His work has been generously funded by the National Institutes of Mental Health and he has authored over 35 scientific publications, including many in the top journals in psychology and psychiatry. His work has received national and international media coverage, reported in outlets such as Science News, Scientific American, The New York Times. He is author of the forthcoming book, The Depths: The Evolutionary Origins of the Depression Epidemic.

Blog: http://www.psychologytoday.com/blog/charting-the-depths
Book: http://www.amazon.com/books/dp/0465022219
Author page: https://www.facebook.com/charting.the.depths


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