If you’ve ever been depressed–and more than a third of Americans have been at some time in their lives–you know what it’s like. You feel helpless and hopeless, have trouble sleeping and find no pleasure in activities that used to make you happy, even sex and eating.
Depression may be the most disabling disease in the world, according to a World Health Organization survey published in The Lancet [September 8, 2007]. An international team of researchers concluded that depression takes a greater toll than any of the four major chronic illnesses–angina, arthritis, asthma and diabetes. And persons with these physical disorders fare worse when they also have depression.
Yet history tells us that some of the world’s great leaders–including Abraham Lincoln and Winston Churchill–have battled depression. Aristotle, in the fourth century B.C., went so far as to say that “all men who have attained excellence in philosophy, in poetry, in art and in politics, even Socrates and Plato, had a melancholic habitus; indeed some suffered even from melancholic disease.” One example is the evolutionary scientist, Charles Darwin, who fell into deep depression after the death of his 10-year-old daughter.
An Evolutionary Theory
Wondering why a disease so disabling could be so widespread and so frequently associated with great accomplishments, evolutionary psychiatrists J. Anderson Thomson, Jr and Paul W. Andrews came up with a controversial theory that was published in the Psychological Review [June, 2009].
Drs. Thomson and Andrews believe that persons who tend to become depressed have a ruminative tendency. When something painful happens–such as the death of a 10-year-old daughter–thoughts about that event drive away all other thoughts and the depressed person becomes unable to think about anything else.
This obsessive rumination about something outside our control becomes extremely disabling. But Thomson and Andrews also see a positive side. The part of the brain that is being used to ruminate is also involved in working memory and an extremely analytical style of thinking.
According to their hypothesis, depression exists “for the specific purpose of effectively analyzing the complex life problem that triggered the depression.”
Some individuals emerge from adversity on their own and are wiser for the experience. Most of us need some help, and, as a practicing psychiatrist, Dr. Thomson helps his patients think through their alternatives and find solutions that help them become more functional.
Although the evolutionary theory may be new, Dr. Thomson’s practice seems closely akin to traditional talk therapy, which has always played an important role in the treatment of depression.
The most prevalent mode of talk therapy at present is cognitive behavioral therapy. The patient is helped to identify negative and self-defeating thoughts and replace them with more positive and functional ones. For example: Mr. Darwin, nothing is going to bring back your daughter; why not learn to enjoy your memories of the pleasant times you spent together?
Studies have found that expressive writing–asking the patient to write about his or her problems–is also effective in shortening episodes of depression. This is another example of an active process of the mind that leads eventually to resolution of the dilemma.
Psychologists who are critical of the analytic-rumination hypothesis point to the many variants of depression–post-stroke depression, late-life depression, extreme depressive condition, depression associated with heart disease or with the side effects of prescription medications. Alzheimer’s disease often occurs in conjunction with depression; is this part of the analytic-ruminative process? In many cases, depression occurs without any precipitating event or conflict. There is also psychotic depression–severe depression plus delusional thoughts or hallucinations that can sometimes lead to massive violent attacks.
Thomson has cut back on prescribing antidepressant medication because he feels drugs, in some cases, may actually make it harder for patients to work through the dilemmas they face. The woman married to an alcoholic may feel better after taking Prozac, but her problems are still there and need to be worked out.
Yet it’s clear that whatever positive effects can come as a result of thinking through or talking through problems, medications will remain an important part of treatment. These drugs work primarily on neurotransmitters such as serotonin, norepinephrine and dopamine.
The newest and most widely prescribed are selective serotonin reuptake inhibitors (SSRIs)–Prozac, Zoloft, Lexapro, Paxil and Celexa–and selective norepinephrine reuptake inhibitors (SNRIs) such as Wellbutrin.
Older tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) are effective but generally have more serious side effects. All antidepressants take about four to six weeks to show a full effect. But that’s still a much faster response than talk therapy and a reason they should be considered as part of therapy.
Most therapists believe in stopping depression as early as possible. Gloomy thoughts beget gloomy thoughts. And there is a strong potential for suicide, even during treatment.
As the author of the World Health Survey put it, depression is bad for your physical health, making chronic medical conditions such as heart disease and diabetes more difficult to control.
Many cases go undetected, sometimes masked as chronic pain, chronic fatigue syndrome or another physical ailment. Symptoms, which are highly variable, include:
• sad, empty or anxious mood;
• generally negative (glass is half empty) attitude toward life;
• hopelessness and helplessness;
• loss of interest in hobbies and activities once enjoyed;
• restlessness and irritability;
• loss of interest in sex;
• fatigue, low energy level;
• difficulty concentrating, remembering details, making decisions;
• difficulty sleeping (or sleeping too much);
• loss of appetite (or eating too much);
• aches and pains that do not get better with treatment;
• suicidal thoughts.
Depression is more than feeling sad. Winston Churchill called it the “black dog”; and this dog chews away at your ability to eat, sleep, experience pleasure and function normally in every day life.
While you may think at the time that you have no hope and that there is nothing that can help you, depression is 100 percent treatable. Your capacity to do extraordinary things has not been limited by your present condition.
REFERENCES:
Paul W. Andrews and J. Anderson Thomson, Jr., “The bright side of being blue: depression as an adaptation for analyzing complex problems,” Psychological Review, July, 2009.
Paul W. Andrews and J. Anderson Thomson, Jr., “Depression’s evolutionary roots,” Scientific American, August 25, 2009.
Jonah Lehrer, “Depression’s upside,” New York Times, February 28, 2010.
Sharon L. Naismith, et al, “Disability in major depression related to self-rated and objectively measured cognitive deficits: a preliminary study,” BMC Psychiatry, 2007;7.
National Institute of Mental Health, “Depression.”
Steven Reinberg, “Depression may be world’s most disabling disease,” HealthDay, September 7, 2007.
Tiffany S. Thompson, MSN, AGNP-C, et al, “The effect of anxiety and depression on symptoms attributed to atrial fibrillation,” Pacing Clinics in Electrophysiology, 2014;37(4):439-446.
“What is depression? What causes depression?” Medical News Today, last updated April 25, 2014.
08/25/2014
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