Depression and its symptoms continue to be a serious topic following the suicide of Robin Williams. I recently reported on the symptoms of depression (here) and on suicide as a symptom of depression (here). But neither article covered what caused these symptoms. So, how and why should we understand the symptoms of depression?
Much of the debate surrounds the classification of depression either as a brain disease or as “something-else.” For example, David Pilgrim of the University of Liverpool argues that depression is “something-else” and that describing the symptoms of depression as a disease,
dims our sense of what it is to be human and [turns] profound sadness into a medical conditions [that] brings with it the prospect of corrective action….Instead of making depression a disease like any other, to be treated with a technological fix, we must stand back and find a way of appreciating the role of suffering in human life and of helping ourselves and others when we are miserable.
If you felt this explanation was abysmally unhelpful, I agree with you. Such arguments fail to provide a framework for understanding depression in meaningful terms. Without such a framework, informed questions cannot deepen our knowledge of depression and the 16 million people who suffer from depression’s symptoms are left without progress.
By understanding depression as a disease–specifically a brain disease–we can ask questions that promise to lead to tangible solutions. Namely, is there evidence that the brain of a person suffering from depression differs from a person without depression?
Yes, there is. A lot of it.
The Proceedings of the National Academy of Science of the U.S.A recently reported that persons with symptoms of depression had increased brain activity in regions involved in attention, self-understanding, and emotion. In fact, 16 subsequent studies have reported similar increases in brain activity in persons with symptoms of depression. The Journal of Neuropsychiatry further reports that 10 additional studies found increased brain activity in these same regions when persons with symptoms of depression looked at pictures of faces. These are the beginnings of a diagnostic test for depression.
These studies do not promise to treat depression or its symptoms. But they do provide starting points for subsequent depression studies and for further depression research–for example, by monitoring the effects of therapy on these brain regions, researchers could determine whether a new anti-depressant or psychotherapy would be helpful.
Are there currently treatments for depression?
Yes, there are many treatments for depression. A recent study in the leading Journal of the American Medical Association showed that across 718 patients, the superiority of anti-depressant medication over placebo increased with increases in symptoms of depression; plainly, the more depressed you are, the more helpful depression medication will be for you. This also showed that all “depression” is not equal; there are different severities and categories of depression.
Is depression all the same disease?
It appears that depression is not all the same disease, just as “cancer” is not all the same disease. Since President Nixon declared a “War on Cancer” in 1971, cancer diagnosis has become highly specialized; what was once known just as “cancer” is now classified by location, stage, grade, and molecular markers. Cancer treatments are equally specific; many are equally effective. But this progress wasn’t made in a decade–according to the National Cancer Institute, we’ve built on over 250 years of research.
Since President Bush declared the 1990s the “Decade of the Brain”, huge progress has been made in understanding the brain as the organ that produces our intellectual and emotional life. We understand what brain regions are associated with the symptoms of depression. Understanding how these regions malfunction and produce the symptoms of depression is on the horizon, as are more helpful therapies.
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