The Depths

The Depths: The Evoluntionary Origins of the Depression Epidemic  - Jonathan Rottenberg (2014)

What's the angle?
   Rottenberg is a psychologist who studies mood, "mood science." As I understand it, mood is somewhere between temperament and emotion. If temperament is the climate zone in which you live, mood is your seasonal weather, and emotion is your daily weather.
   He says that mood "is the great integrator." It sums up internal and external information to create an emotional attitude; it prepares you to behave in a general way. Anxious mood prepares you for threats and primes the emotions that help you respond to threats. Positive mood prepares you for exploration and seeking, priming the emotions that go along with that.
   What's the evolutionary function of depressed mood? Some guesses are:

1. De-escalate conflict and get out while you can: like an antidote to anger in social conflict; be sad instead, give-up fighting, especially if you are losing.
2. A "stop mechanism:" when you're in an impossible situation or have set unreachable goals, depression saps your motivation and helps you to give up. [sadly, two common tests of antidepressant medications are the "tail suspension test," where they hang a rat by its tail and see how long it struggles, and the "forced swim test," where they drop a rat into a bucket of water to time how long before it stops scratching the bucket walls and simply floats with its nose above water. The goal is to design a drug that will increase the amount of time the rat struggles to escape.]
3. Sensitivity to social risk: like loneliness, depression is the result of disconnection, and highlights the need to reconnect.
4. Depressive Realism: positive mood can lead to over-confidence; low mood sometimes gives you a more realistic assessment of your situation.
5. Grief/Bereavement: this like a combination of #2, 3 and 4; the death of a loved one brings on the impossible goal to reconnect; however it can bring the group together and help them assess what went wrong, if anything.

What causes depression?

   Rottenberg says that no one has identified the basis of depression as a "disease" or "disorder," as defined by the DSM, whether biological or psychological. There is a correlation between depression and high levels of the stress hormone cortisol and proinflammatory cytokines. And there are well-studied psychological and social risk factors that contribute to the likelihood of depression. [He doesn't even mention the serotonin based explanation.]

  He thinks that depression is simply an adaptation that, as our lifestyles have rapidly changed in the past few centuries, has become maladaptive for certain situations.

What are the psycho-social risk factors for depression?

• neurotic/anxious temperament
• trauma, especially early in life
• chronic stress, especially unpredictable, uncontrollable, or unexplained stressors
• loss events; loss is the big psychological theme
• lack of exposure to daylight
• lack of consistent and adequate sleep
• Overcommitment theory: based on the "stop mechanism" idea, this sees depression as a response to "overcommitment" toward impossible or hazardous goals (for example, saving your abusive spouse, pleasing your hyper-critical parent, so forth). Perfectionists are more likely to become depressed.
• "Sinking through thinking" or "rumination;" circular worrying.
• Happiness-Obsession: our culture has set happiness goals too high, and pursuing happiness as an end in itself often backfires.
• The biggest risk comes from the double whammy of serious loss plus no way forward.

How do people recover from depression?

    Three treatments have shown some degree of effectiveness: antidepressant medications, cognitive-behavioral therapy, and interpersonal therapy. However, about a third of depressed people will recover quickly on their own, or recover more quickly than can be attributed to treatment. Rottenberg hopes to study this group, but has three hunches as to why they recover quickly: 1) they have fewer complex life problems, 2) they have secret weapons, like a nimble mood system or a very healthy lifestyle, or 3) they are lucky - they have good things happen to them, like a fresh start or multiple positive turns-of-events.
   Rottenberg insists that the goal of recovery should be well-being, rather than an elimination of symptoms. Very shallow depression, too shallow to meet the DSM criteria, or lingering effects of depression, greatly increases the likelihood of repeat depression. "Mood-congruent memory" - the tendency to remember things that match your mood - can combine with "memory elaboration" - the process of creating a story or a web of memories - to trap you in sad thoughts and memories. And the more times we experience depression, the more easily our mood system is able to recreate that experience. People suffering with depression need ways to get well, stay well, and bounce back from the depressed moods that will inevitably accompany loss events.


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Notes

• the WHO projects that by 2030 the amount of worldwide disability and life lost attributable to depression will be greater than for any other condition, including cancer, stroke, heart disease, accidents, and war. 2
•  Two-thirds of those treated with antidepressants continue to be burdened with depressive symptoms. 7
• moods are internal signals that motivate behavior and move it in the right direction 13
• the mood system is the great integrator 13
• anxious mood narrows the focus of attention to threats 14
• good moods broaden attention and make people inclined to seek out information and novelty 14
• theoretical explanations of low mood 23
• helps de-escalate conflicts, helps one side yield
• a "stop mechanism," discouraging effort in situations in which persisting in a goal is likely to be wasteful or dangerous
• help sensitize people to "social risk" and helps them reconnect when they are on the verge of being excluded from a group
• enables people to make better analyses of their environments (depressive realism) 24
• If we had to find a unifying function for low mood across these diverse situations, it would be that of an emotional cocoon, a space to pause and analyze what has gone wrong. 28
• We return to a glaring problem with defect models: no one has identified the basis of the disease, the underlying defect in the  mind or brain that causes deep depression. 32
• two mouse tests for antidepressants - the tail suspension test and the forced swim test (how long will they struggle to escape, vs give up and conserve energy) 47
• chronic stress, esp chronic but unpredictable stress cause depressive symptoms in mammals
• social situations are the strongest drivers of mood (in mammals) 54
• no evidence has emerged to suggest that bereavement-related depressions are substantially different from other depressions 66
• the theme that most consistently predicts depression is loss 67
• talk therapies usually seek to address or uncover loss events in clients 69
• we recover more quickly from a bad event if we can readily explain it. We would expect, then, that events that generate mixed feelings and/or confusing thoughts would be a powerful impetus toward persistent low mood. 83
• the most important and well-studied depression-prone personality trait is neuroticism 87
• light exposure and sleep schedule 89
• sinking through thinking; rumination 98
• the perils of persistence; overcommitment theory; depression occurs b/c we can't let go of certain goals that we can't/aren't reaching; "inability to disengage from efforts from a failing goal" 104
• perfectionists are more likely to become depressed 105
• what may be most important for exposing humans to the risk of depression is that they are able to pursue highly abstract goals and to set goals in domains where programs is difficult to measure 106
• our culture has set happiness goals too high; and achieving positive mood states is difficult as an end in itself; rather it usually accompanies the achievement of other goals 110
• the strongest depression-inducing situations present a double whammy: serious losses and no route (or an overly hazardous route) forward 121
• emotion context insensitivity - depressed people react less to emotional stimuli 121
• depressed people showed less moment-to-moment change in emotional behavior than nondepressed people 131
• research on the stress hormone cortisol indicate that many depressed people chronically overproduce this hormone 132
• on average, an episode of major depression last about six months 132
• like cortisol, proinflammatory cytokines are high in depression 137
• why do some people come out of depression more quickly and fully
• hunch 1 - early improvers face fewer complex life problems
• 2 - early improvers have secret weapons against depression (nimble mood system, good life habits)
• 3 - early improvers are lucky (fresh start events, multiple positive events)
• depression symptoms are usually lost in reverse order to that in which they were acquired 155
• chronic depression has a greater power to alter a person's self-concept than briefer episodes do 159
• residual depression symptoms are one of the strongest predictors of the return of deep depression 160
• one reason we're not winning the fight against depression is that our available treatments leave so many in partial recovery limbo 167
• evidence that the mood system has an easier time going from limbo back to deep depression than it did getting there the first time 169
• mood-congruent memory - increased ability to think of content that matches our current mood state
• memory elaboration - creating a story, connecting memories into your identity; deep depression strengthens the web of sad mood 173
• we need to understand how the experience of well-being might help people do things that keep them well 191
• Barbara Fredrickson: broaden-and-build model of positive affect focuses on the ways that it functions to broaden attention and build resourses. The functions of positive mood are in essence the opposite of the functions of low mood and negative emotions. 191
• inert placebo pills are about 82 percent as effective as antidepressants 197