Depression, a common experience Depression is referred to as ‘the common cold of the psyche’. Most people will experience episodes of ‘normal depression’. However, 25 percent of women and 20 percent of men will experience episodes of ‘clinical depression’ during their lifetime. Having a depressive episode is therefore commonplace and certainly no cause for shame.
What is a shame is that ‘clinical depression’ is often undiagnosed and untreated (or under-treated). This can sometimes happen because of the fear of disgrace associated with depression; or because doctors or health professionals don’t recognise depression for what it is. It can also occur because individuals may not recognise their own depression. Depression may come on as a conviction that this is the way the world is or, more indirectly, physically as a series of illnesses, aches and pains.
Some clinical depressive disorders seem to run in families, with family members prone to depression, or to mood swings, in the same way other families have a tendency to stomach ulcers, diabetes or migraines. However, for many people there is no family history of depression.
If the depression is minor or transient, it may resolve by itself and not require any intervention. If it is more intrusive and persistent, professional help should be sought. When the disorder becomes intractable and debilitating, specialist treatment is required.
Those who don’t respond to initial treatment may require expert review. Some people need to try several different anti-depressant medications, while others need to try quite different non-medication approaches. Such varying outcomes sometimes reflect the preference of the depressed individual or treating therapist. At other times, the outcomes reflect the nature of the differing depressive disorder and the fact that the ideal or best treatment is still not known. Sometimes, a poor outcome reflects a generally appropriate antidepressant treatment being given to the wrong depressive condition (for example, a non-melancholic disorder being misdiagnosed as melancholia and being so treated) or even to a non-depressive disorder (for example, an anxiety disorder). This underlines the importance of ensuring that the depressive sub-type is identified.
Remember that depression can be biological in its origin, but psychological in experience. Those suffering from depression may have to push themselves or be encouraged by someone else to seek advice or treatment. They may feel that nothing much can be done about the way they feel but, in fact, most depressive disorders can readily be cleared up. ✰
The purpose of ‘normal depression’
For most people, depression (even the commonly occurring ‘normal’ depression) is an unpleasant experience that often interferes with day-to-day functioning.
What then is the purpose of such a painful experience? This question can be linked to another one: what is the purpose of pain? Pain has one distinct advantage—the unpleasant side effects of pain mean that most of us will go to considerable length to avoid it. For example, if we did not find heat painful, we might get too close to a fire and suffer the consequences. It is for such reasons that many nerves in our bodies have heat receptors.
In a similar way, it could be argued that ‘normal’ depression can be an automatic defence response or a response cued by certain situations. Such a proposition has been explored recently by the American psychiatrist Randolph Nesse whose thesis is considered below, in particular how ‘normal’ depression may have offered a selective advantage to civilisation over time. To the extent that any of Nesse’s interpretations have validity, they allow the individual to question the meaning of a ‘depressed mood’.
What is normal depression trying to say? Is ‘normal’ depression a plea or cry for help?
It is unlikely that normal depression is a cry for help. If it is, then it is not a very useful or effective signal, as it is more likely to evoke negative responses from others.
Does depression help to conserve resources?
If someone is lethargic, has no appetite, lacks motivation and has no interest in conversation, might not such a state resemble hibernation in the animal world and be a way of conserving energy?
Nesse argues that depression is ‘poorly designed’ for such a purpose—at least in humans. The argument might hold for animals, where an animal continues to forage for as long as there is an adequate food source. But, when the food source runs low and the animal has to use up more energy foraging than would be obtained from eating the food, it would be wiser for the animal to stand still—even if starving—and wait for some other food source to turn up. It would stretch credibility to suggest that depression has such an advantage for humans.
Can depression resolve competition with a dominant figure?
Is depression a signal to a more ‘powerful’ competitor that a threat no longer exists (thus ending the conflict and the depression)? Does it represent a true wish on the part of an individual to resolve a conflict and obtain reconciliation, or is depression designed to lull the competitor into a false sense of security? Again, while of clear relevance to animals, its pertinence to humans can be questioned.
Can depression help us be more realistic in goal setting?
If a particular goal (for example, a new partner, or a new job) is starting to look ‘mission impossible’, somebody in a depressed mood state may feel compelled to reassess the situation before disengaging from the pursuit or escaping from the particular situation. To persist with a goal that looks unattainable requires considerable increase of effort from the normal, everyday pace of life and, if the goal is not achieved, the resultant depression will be even greater.
The argument is, then, that a depressed mood drives people away from tasks that will be unprofitable, or a waste of effort or dangerous. Failure to reach, or to renounce, a goal may be depressing in the short term, but the negative ‘cost’ or pain may be less than the costs and pain of persevering with the task. If a setback occurs in the pursuit of a major goal, it would make sense not to rush into chasing another significant goal. In such instances, moving into a depressive state (with symptoms such as pessimism and lack of initiative) might, as Nesse notes, ‘prevent calamity even while it perpetuates misery’.
There are several limitations to the interpretations considered by Nesse. First, they appear more relevant to animals than humans. Second, their benefits in contemporary society are not obvious. Even if true, such theorising is likely to have relevance only to ‘normal depression’ and perhaps to some forms of non-melancholic depression.
The answer is perhaps best addressed at the individual level. Consideration of their own patterns of behaviour might prove more useful to a depressed person, especially when the episode is over. Questions that could be asked include: ‘In what circumstances do I find myself getting depressed? What then is the message? Do I want to do anything about it?’
In both ‘normal’ and ‘non-melancholic’ depression some elements of the disorder may have homeostatic capacities, assisting a return to ‘normal’. Thus, sleeping excessively (as many depressed individuals do) may be an adaptive behaviour by restoring slow-wave sleep during times of stress. Carbohydrate cravings and eating chocolates, in particular, have comforting effects that trigger the release of endorphins to create a ‘feel good’ state. Eating more of certain foods may lead to an increase in the amine L-tryptophan, thus increasing the activity of serotonergic neurotransmitters in the brain, which may be disrupted during depression. Just as a pregnant woman may develop an aversion to cigarettes and alcohol because of potential damage to the foetus, some people may lose pleasure in drinking alcohol during their depression. And while some people may no longer be interested in smoking, others develop a craving for tobacco (which might then increase the level of brain neurotransmitter, dopamine, occuring in decreased levels in some depressive disorders). Thus, some symptoms in the less ‘biological’ types of depression may be a response to ‘painful’ psychological and social life situations; others may be adaptive attempts at normalising disturbed biological changes.
For the more ‘biological’ types of depression, such as melancholia, it is difficult to believe that such disorders are primarily adaptive or functional responses. The British satirist and writer Spike Milligan has observed: ‘I cannot reassure myself that it has been worthwhile . . . I do not hold with this romantic view of depression, that it has some purpose . . . As far as I am concerned it is without a redeeming feature.’
By contrast, the psychiatrist Kay Jamison has stated that, if given the choice as to whether or not she would have manic-depressive illness, she would change nothing. If she had not had the disorder, she would not have ‘felt more things, more deeply; had more experiences, more intensely . . . laughed more often for having cried more often; appreciated more the springs, for all the winters . . . Even when I have been most psychotic—delusional, hallucinated, frenzied—I have been aware of finding new corners in my mind and heart’.
As with winter, biological depressions exist, and test people to and beyond our comprehension of what is endurable. However, they can also provide a frame of reference for a new mood or a new season.
(extracted from) Dealing with Depression: A Commonsense Approach to Mood Disorders y Gordon Parker, publishhed by Allen & Unwin