I was interested in this article, which is about the pet theory Andy Thomson (psychiatrist at the University of Virginia) has that there is overall an evolutionary advantage to depression:
Like most evolutionary psychology theories, it has some interesting stuff but a strong whiff of just-so story about it. (The article writer even uses the phrase “just-so story,” which makes me happy.)
The part I was most suspicious of was his attempt to find an evolutionary advantage to the worst and most severe symptoms of depression — you know, the can’t-get-out-of-bed kind. Oh, it give you time alone to think! is sort of his point, and I just don’t buy it.
But, what if depression the mental disorder is a malfunction of something that presents an advantage in other areas? What if the capacity to experience major depressive disorder is a piggyback on something that does confer an advantage? A lot of the body seems to work that way, after all. Look at the huge number of auto-immune diseases, some of them deadly, does that mean we’re better off without our immune system?
One study cited within the article suggests there might be a cognitive advantage to a slightly melancholy mood — but it’s a long way from “melancholy” all the way to severe, long-lasting depression.
Take that with this article about how a new statistical analysis of clinical drug trials suggests that antidepressants don’t actually work all that well:
http://www.scientificamerican.com/article.cfm?id=antidepressants-do-they-work-or-dont-they
The distinction is between statistical advantage over a placebo — which is there — compared to a clinical advantage — which doesn’t seem to be there except in the most severe cases of depression.
In other words, for most depressed people, antidepressants might help, but only slightly, and probably not enough to be worth the cost, addiction, unwanted physical effects, risk, and other side effects of medication.
Anyway, I wanted to throw this out there because I know that so many of you have experienced depression, treated and untreated, drugged and undrugged. Do you have an opinion? A story to share? I’m interested.
Thanks for the link!
Doctors, nurses, and a psychologist have all wanted me to go on antidepressants. I have refused because my (biased and uninformed) opinion has been that the potential side effects aren’t worth it, at least for me.
It has always seemed to me that people go on antidepressants, feel better for awhile, and then they either stop working or the side effects get too severe.
I think I just corroborated everything you say below… heh.
That’s my anecdotal impression as well. See below.
It’s such a complex problem. For one thing, it’s very difficult to objectively measure success in treating depression, beyond keeping someone from committing suicide. You can tell whether a bone break has healed cleanly pretty easily, so you can tell that putting a cast on helped. But here’s something I realized just recently, after but unrelated to 24 years under various therapies: I never had any adult models of happiness or contentment growing up, so to be honest I don’t even know what I’m aiming for! My default ideas of what “normal” looks like in terms of day to day existence are barely suppressed anger or utter detachment. Just another wrinkle…
In terms of medications, I’ve been on a lot of meds that didn’t really work, I’ve been on meds that worked but had side effects with which I could not cope, and I’ve been on meds that at least raised my baseline mood out of the regularly suicidal to the merely mostly unimpressed. That may not sound like much, but it was really quite the watershed to move out of constantly having suicidal thoughts. The problem that I have had though is that over time the meds become less effective, even at increased doses, and even with other medications to boost the effectiveness.
To be honest I’ve reached a point where I am trying to find some alternatives to medication, since I’ve pretty much exhausted that route as far as my comfort level goes. There are also issues with medication effectiveness due to my gastric bypass, since with the shortened GI tract I don’t absorb things at normal rates.
As far as there being at least some evolutionary advantage to depression, in my opinion it’s like most things – if it has hung around in the genome this long, it probably provides something of some use that we haven’t noticed or figured out, or it’s a byproduct of something else that’s useful. In this case, I think it may well be a byproduct of being sensitive, or maybe compassionate might be a better word – that whatever biochemical quirks make someone notice the sorts of things that urge them toward forming bonds with other people (definitely advantageous in terms of having more kids) also predispose them to the biochemical quirks that result in depression.
All unsupported, anecdotal and off the top of my head, but definitely my opinions.
Well, you were tops on my list of people who I know have had both positive and negative experiences with antidepressants. The question of “how do you measure success?” is a really good one.
My impression — and obviously I’m not a clinical researcher — is that antidepressants might provide a biochemical jolt to get the brain out of an unusually low cycle, but that taking them long-term tends to just reset the baseline, and now that jolt is no longer an option.
For what it’s worth, I think Cognitive Behavioral Therapy looks promising as a treatment.
Yes. Of the therapeutic modalities I have worked with, Cognitive Behavioral Therapy and Dialectical Behavioral Therapy have been the methods I have had the most success with, largely because they are fairly practical and skills based. CBT teaches you to retrain your thinking processes; DBT teaches you set of skills to deal with balancing the input from both your emotional self and your logical self, treating both sets of input as equally valid sources of information about the environment that deserve to be evaluated and which you can then choose to act on or not act on depending on your goals and what your core values are. DBT’s ultimate goal is to help you develop a life you feel is worth living… The engineer in me loves DBT because it is so results-oriented. They give you multiple options, and if something works, use it – and if it doesn’t, use something else. It’s only about 15 years old though, but the extra cool thing is it was developed at UW.
to be honest I don’t even know what I’m aiming for
What a subtle and sobering thought. You are right, of course.
I’m fortunate to have had several bouts of general productivity and happiness throughout my life, alternating with the depressions; this gives me something to aim for, although not generally (it’s depressing to try) to compare myself to. I don’t know what my life would be like if not for the memory of that happiness.
Oh wait, I also have to throw another kink in here…
There’s depression and depression. Because I have experienced at least two distinctly different kinds of depression: one the suicidal, probably dopamine/serotonin biochemical related physical defect one, and one the classical female suppressed anger-turned-inward-and-manifesting-as-depression one.
The latter came out when I was in DBT, another reason I totally “heart” that type of therapy, because it is big on somatic as well as thought response for identifying emotional response. Before DBT I would never ever have called myself an angry person. In DBT I learned not only was I angry, I was really really angry about a lot of things, and I was determined not to admit it, and it was eating at me and… manifesting as depression. Surprise!!
So, yeah. One more reason that depression is tricky. Because SSRIs are not going to do jack for depression that is really suppressed anger.
We know that SSRIs usually don’t work, and that they may increase the risk of suicide in young people. I also have long and loudly suspected that SSRIs increase the risk of homicide, but that’s sideways from your journal entry topic.
We also know that, in many cases of depression, physical activity does in fact reduce depression. May I suggest that the evolutionary advantage of depression is that it rewards exercise?
I have an alternate theory: that depression is the brain’s “punishment” for a lack of a sense of purpose, and that the threat of it is what drives us to do all the crazy nonsensical things we like to do. It would explain why it’s so prevalent among writers. Because why else would a person do such an absurd thing, unless it’s to keep our own brains from trying to destroy us?
I was going to say that a lot of writers also have had the “bed-ridden as a child” experience, and that it could be true that however you’re bed-ridden, be it through a bad accident, disease, or depression (if depression isn’t a disease), being forced to live inside yourself like that is good for the creative imagination. However, it doesn’t seem like a very good argument for being bed-ridden; it’s more like when life hands you lemons, you make lemonade. Sometimes that trick doesn’t work for very long either; cf. Virginia Woolf or David Foster Wallace.
However, it doesn’t seem like a very good argument for being bed-ridden; it’s more like when life hands you lemons, you make lemonade
Yes, it hardly means that “being bed-ridden” is a survival strategy.
Gah, I hate evolutionary psychology. I’m not sure why, maybe because it seems like they’re trying to explain away everything. Like you say, “just so stories.”
There’s plenty of crap in our genes that is the result of mutations and whatnot that doesn’t give us an advantage, it just doesn’t kill us before we breed.
I’m absolutely fascinated by evolutionary psychology. I’m fascinated by the question it purports to answer — why do we do these crazy things, anyway?
And I’m equally fascinated by the weird sociological quirks revealed by the astonishingly high rubbish-to-science ratio in most of what’s out there. Especially when it comes to anything related to dating or sex roles. Hoo boy, you want to see some pseudo-science rearing its ugly head. People get so weird about it too.
Men are genetically engineered to be exactly the way they’re portrayed in beer commercials! Don’t argue! It’s evolution!
I spent two and a half days on antidepressants once, before realizing that I’d rather do the necessary work myself, without chemical intervention. It’s been mostly successful; the older I get the more coping strategies I develop. I still engage in a major, months-long bout of depression every three to five years, but this winter — however bleak the world looked when I was at my worst — has been by far the easiest and least destructive I’ve ever coped with.
I think that SSRIs have a mental effect similar to the physical effect of chiropractic. Over the long term I’m not convinced that they have any effect at all — but in the short term, they can zero out a perception of pain, and provide you with enough mental or physical space to lay down some healthier habits of exercise or thought. Chiropractic sets your musculoskeletal system in temporary alignment, but it’s up to you to take advantage of this respite by learning some new exercises and strengthening the muscles which will keep it in alignment. Similarly, SSRIs clear out your mental and emotional chaff, but you can’t rely on them to keep it clear; you need to take the time they provide, before their side effects undermine their usefulness, to learn new habits of thought.
This is of course far more difficult than it sounds.
While I’m here, have a perfectly cynical theory, which I hope no one will read who’s currently suffering from a depressive bout; move along please; nothing to believe here. Everybody happy? Good. So evolutionary benefit operates on populations as much as on individuals: perhaps suicidal depression is simply a way of removing unfit individuals from the gene pool. If some of us have a trigger to kill ourselves before we reproduce, how is this fundamentally different (on an evolutionary biological level) from the existing biological trigger which causes many fetuses to miscarry before they’re born? Rather than being of evolutionary benefit in its own right, or the side effect of a benefit elsewhere, depression could just as easily be the side effect of an evolutionary failure.
Well, it’s all about coping, isn’t it?
Just to throw a whole kink into it, depression is more common among men and anxiety based disorders are a lot more common among women. When I wrote a paper on suicide statistic in college (yes I know, I was that girl), it was interesting to me to note that in general men were much more successful at suicide than women. Addtionally, divorced men were more highly suicidal than any other category. How does this relate? Well if you think abut depression in a social format, it seems that there is definitely gender based types of depression. The idea that a good counter to anxiety is a social interaction and building, and a counter to depression is partner connection you can see why it may have evolutionarily developed this way.
It may be either a reaction or a driving force of social behavior in a community setting. Now lay on top of that our current society where the community is fragmented and disjuncted and depression morphs into a completely different problem. Now you no longer have the community to balance these typea of things and hence we see a large increase in depression/anxiety disorders.
In conclusion, this is why it is important to go to cons….just saying.
Of course you’re right.
I’ve seen that about men being more successful at suicide. The theory was that they either 1. were more serious about actually wanting to die as opposed to, I guess, symbolically wanting to die, or 2. used different methods that were more macho and hence, deadlier.
Going to Potlatch today. And, while I’ve never been diagnosed with, nor treated for, depression, I still think it is important to go to cons.
There are some huge flaws in the paper on antidepressant effectiveness you’re referring to — the biggest one being that it completely ignores the issue of effect modification.
Essentially, most antidepressants work really well for group A of people with depression, not at all for group B, and make things worse for group C. When you average it all out, what you see is a small but statistically significant improvement — but that doesn’t mean that what you actually see *clinically* is a small but statistically significant improvement in the individuals treated.
What more research now is focusing on — including some of ours here — is figuring out how to tell in advance which people will respond well to which antidepressants. For example, there’s a gene that has a massive effect on your response to SSRIs — if you have one version of the gene, you’re less likely to get depressed in the first place, and more likely to respond well to SSRIs if you do get depressed. If you have the other version of the gene, you’re more vulnerable to depression, SSRIs don’t work for you, and the side effects of SSRIs can be worse.
So I think what you’re saying is that antidepressants have a big payoff, but only for group A, and the crucial thing is to determine if you’re a member of group A?