As we move towards a framing of depression that incorporates functionality and adaptivity, we should not lose sight of important conceptual and scientific nuances
I think your analysis of this study is spot-on, Awais. I think the first thing to say about it is (as you indicate) that the population studied is quite unlike the patients seen by most psychiatrists in clinical settings; i.e., the authors studied "...participants with a history of depression but no extensive treatment history (no prescribed medication from a psychiatry specialist and no history of psychotherapy)...."
Accordingly, it is impossible to tell how many--if any--of the study subjects met criteria for Major Depressive Disorder (MDD). So far as I can tell, the term "depression" as used in the study is clinically ambiguous, if not meaningless.
As you note, having a "low mood" is a useful alerting signal that "something is wrong" and needs correction. But that is a far cry from what some have argued (notably Andrews and colleagues); i.e., that clinically significant depression is in any evolutionary sense "adaptive". (I think the quotes from Nesse make this clear). I looked at the "adaptive rumination hypothesis" (ARH) in detail some years ago and found little empirical support for it. See:
At the same time, it is not unreasonable--as a didactic strategy--to teach patients that low mood ("depression" in a very superficial, colloquial sense) represents a "...functional signal that alerts the individual that something in life needs more attention (Signal condition)." I think this is almost trivially obvious to most clinicians.
But again--when we are seeing patients with the full panoply of MDD symptoms and signs, who are clearly incapacitated and suffering, it is far from clear that the "signal condition" explanation is either empirically justifiable or clinically useful. In any case, such an "explanation" is clearly not a fact regarding the ultimate nature (ontology) of major depressive disorder.
I love this one. I see the appeal of seeing depression as functional -- it really does shift the meaning for me. As someone with bipolar, however, it’s been most helpful to me in recent depressions to use more of the disease model. Or, to be more honest, this mild depression. As in: I’m down now, I was up before, but there’s nothing wrong with my life, it’s full of meaningful work and connection, and I’m just going to keep doing those things that are meaningful to me, and I know it’ll shift. I might sleep more during this time and be less social, and maybe I’ll eat too much candy for comfort, or conversely maybe I’ll try to live really well knowing that might bring solace faster, but I know it’s temporary and is just part of how my chemistry works.
If I asked myself, what is this depression telling me, I (and maybe many depressed people) might see it like: something is WRONG with my life, I better fix it, which in a depressed state isn’t an especially effective thought, as we might get stuck on “something is wrong” and be too depressed to try to fix it.
I think your analysis of this study is spot-on, Awais. I think the first thing to say about it is (as you indicate) that the population studied is quite unlike the patients seen by most psychiatrists in clinical settings; i.e., the authors studied "...participants with a history of depression but no extensive treatment history (no prescribed medication from a psychiatry specialist and no history of psychotherapy)...."
Accordingly, it is impossible to tell how many--if any--of the study subjects met criteria for Major Depressive Disorder (MDD). So far as I can tell, the term "depression" as used in the study is clinically ambiguous, if not meaningless.
As you note, having a "low mood" is a useful alerting signal that "something is wrong" and needs correction. But that is a far cry from what some have argued (notably Andrews and colleagues); i.e., that clinically significant depression is in any evolutionary sense "adaptive". (I think the quotes from Nesse make this clear). I looked at the "adaptive rumination hypothesis" (ARH) in detail some years ago and found little empirical support for it. See:
https://www.psychiatrictimes.com/view/major-depression-adaptive-clinical-data-say-no
At the same time, it is not unreasonable--as a didactic strategy--to teach patients that low mood ("depression" in a very superficial, colloquial sense) represents a "...functional signal that alerts the individual that something in life needs more attention (Signal condition)." I think this is almost trivially obvious to most clinicians.
But again--when we are seeing patients with the full panoply of MDD symptoms and signs, who are clearly incapacitated and suffering, it is far from clear that the "signal condition" explanation is either empirically justifiable or clinically useful. In any case, such an "explanation" is clearly not a fact regarding the ultimate nature (ontology) of major depressive disorder.
Regards,
Ron
Ronald W. Pies, MD
I love this one. I see the appeal of seeing depression as functional -- it really does shift the meaning for me. As someone with bipolar, however, it’s been most helpful to me in recent depressions to use more of the disease model. Or, to be more honest, this mild depression. As in: I’m down now, I was up before, but there’s nothing wrong with my life, it’s full of meaningful work and connection, and I’m just going to keep doing those things that are meaningful to me, and I know it’ll shift. I might sleep more during this time and be less social, and maybe I’ll eat too much candy for comfort, or conversely maybe I’ll try to live really well knowing that might bring solace faster, but I know it’s temporary and is just part of how my chemistry works.
If I asked myself, what is this depression telling me, I (and maybe many depressed people) might see it like: something is WRONG with my life, I better fix it, which in a depressed state isn’t an especially effective thought, as we might get stuck on “something is wrong” and be too depressed to try to fix it.