Consider the upside of down to fight depression

Justin Thomas

• Last Updated: November 02. 2009 10:14PM UAE / November 2. 2009 6:14PM GMT

The consensus appears to shift each decade as to how depression should be treated. Its incidence, however, appears only to increase. Indeed, the World Health Organisation has reported that by 2030 depression will have “the greatest burden” of any disease worldwide. Scientists define burden as the total loss of life in number of years a certain disease causes. Depression already creates the greatest burden in a number of developed nations.

But a vital question to treating the disease remains: why do people get depressed? Psychologists generally agree that the types of problems commonly implicated in triggering depressive episodes involve social dilemmas and what we call “avoidable stressors”. Examples include anything from failing an important exam to uncovering a marital infidelity. Such events invariably give rise to complex questions such as “what should I do”, “what did I do wrong”, and “why is this happening to me”. This is all common sense; bad things happen that could have been avoided, and some of us get depressed – but why?

One new and fairly radical theory suggests that humans get depressed because depression is actually helpful. In other words, depression evolved as an adaptive response to help us solve the complex social problems life occasionally throws at us. The authors of this challenging idea, known as the Analytical Rumination Hypothesis, argue that the symptoms of depression function to keep us focused on solving the complex problems that triggered our depression in the first place. Depressed mood promotes an analytical, ruminative thinking style. Other depressive symptoms such as the diminished ability to experience pleasure, social-withdrawal and low energy levels all minimise the likelihood of us being distracted from focusing on our problems.

The more time and energy we can devote to analysing the triggers of our sadness, the more likely we are to arrive at useful answers and solutions, the argument goes. So rather than viewing depression as a disorder or a disease, the Analytical Rumination Hypothesis views it as an adaptive response to complex social problems, in much the same way a fever is an unpleasant but adaptive response to infection.

Depression then is viewed as a trade-off and “persistent analytical rumination” may help solve the problem that has triggered the episode. Yet, the downside of this is that there are fewer cognitive resources left to devote to other things such as work, study, family and friends. This can lead to what clinicians call impaired social and occupational functioning.

But being in a state of heightened analytical focus has its advantages. A large body of research has shown that depressed individuals are often more accurate in their perceptions of reality. In one study, a computer game was rigged so that players either win or lose but winning and losing is actually always out of the player’s control. When non-depressed individuals play the game and win, they are quick to erroneously believe it is as a result of their skill. But depressed individuals who win are far more likely to spot the ruse and correctly identify the artificiality of their victory.

Other studies report that depressed individuals are more accurate at what psychologists call “mind reading”. This essentially means that they are better at inferring the intentions and beliefs of others on the basis of the behaviours they observe and the situation in which they are performed.

Depressed individuals also appear to be better at detecting deception and accurately interpreting subtle facial cues that signal emotion. All of these heightened abilities are the by-products of a depressive analytical processing style that enhances accuracy on complex tasks.

So if you have a complex life problem might it actually help to be depressed? This theory has serious implications for many of the modes of therapy currently used to treat depression. The current conventional wisdom is that “depressive-rumination” is harmful and that it may actually cause depressive episodes to be prolonged or worsened. And for this reason many psychological treatments for depression actually try to prevent the brain from focusing too much on its pains. This is typically achieved by encouraging the client to engage in pleasurable and ultimately distracting activities. Similarly, antidepressant drugs such as Prozac work by altering the levels of serotonin in the brain and have no obvious connection with resolving or managing any triggering problems.

This is perhaps why the current rates of depressive relapse are so high, especially when depression is treated with medications alone. The average person who is diagnosed with major depressive disorder will recover, however, they can expect at least four more major episodes during their lifetime.

The upwards advance of divorce rates, fragmented families and competitive materialism in the developed world are fertile ground for the types of problems that can trigger depression. In addition to addressing such social ills, more research aimed at treating and preventing depression is critical to reversing current trends.

If the prediction of the World Health Organisation about the rise of depression is to be avoided, a consideration of these theories might be critical to that effort.

Justin Thomas is a psychologist in the Department of Natural Science and Public Health at Zayed University in Abu Dhabi