Lately I've been reading Peter Cramer's
book Against Depression, which is his follow-up to Listening
to Prozac, his groundbreaking book about depression and Prozac.
This is a fascinating book, as good as Listening to Prozac. If
you have any interest at all in learning more about depression, I would
strongly recommend this book, which is a philosophical and scientific
exploration of depression. Much of what follows is inspired by this
book.
New Research into the Causes
of Depression
In today's issue of Psychology
Now I want to talk about the new and exciting research on
depression done by Kenneth Kendler at the Virginia Commonwealth University.
Dr. Kendler has
looked at the causes of major depression. His research finds that there
are three pathways to depression. That means there are a number of
different ways that cause people to become depression.
The first is
what he calls the internal pathway. This includes two variables that
predict depression--childhood onset anxiety disorders (before age 18)
and neuroticism (a general trait of psychological disorder).
The second is
the external pathway. This path includes two variables: conduct
disorder and substance abuse. (Conduct disorder means getting into
trouble with the law.)
The third path
is through, not surprisingly, adversity in life. And this pathway is
the most complex. It starts in childhood with a disturbed family
environment, childhood sexual abuse, and the loss of a parent. It
continues with low educational achievement, lifetime trauma, low social
support, and the likelihood of divorce. Finally, it ends with current
stressors such as marital problems, life difficulties, and stressful
events in the last year before depression starts. Kendler believes that
much of the adversity is actually interpersonal difficulties.
What is worse is
that the factors are related to one another. If you have adversity in
childhood, you are more likely to develop conduct disorder and
substance abuse, and these disorders make it more likely you will get
into a bad marriage, lose your job, etc.
This complex
model was able to account for 52 percent of the likelihood of
depression in a one year period.
So far none of
this is really that surprising or interesting. After all, most people
would predict that a lousy childhood, getting into trouble, and being
anxious might lead to depression.
The really
interesting part of his research is how these factors influence one
another. And how the genetic component influences them. Genetic factors
influence all three of the major factors. If you are genetically prone
to depression, you are more likely to have a lousy childhood, get into
trouble and abuse substances, and be anxious and neurotic! How does
this work?
Kendler isn't
sure, but suspects that if you are prone to depression, your parents
might have been also, and this impaired their ability to parent well.
Or perhaps, it is harder to parent an anxious, depressed, neurotic
child. Or perhaps both are true; depressed parents have a harder time
parenting, and their children tend to me moodier and harder to deal
with. The genetic propensity to depression may also be connected to
substance abuse directly or as an attempt to self-medicate the
depression.
Other findings
from his research. He found that if you have an anxiety disorder before
age 18, this is a strong and independent predictor of depression.
So what can we
learn from this research?
There appears to
be a tragic path to depression. The depressed person is born with a
genetic tendency to depression which in turn is correlated with the
likelihood of a bad childhood. Then they do worse in school, get in
trouble more, turn to substance abuse, and then when adults pick bad
relationships, have more conflict in jobs and family, are more likely
to be traumatized. Basically their whole life goes poorly. Chaos and
conflict and loss and low social support leads to depression. A single
depression leads to future depressions.
This is all pretty depressing!
But what it shows is also the pathway to healing. For instance, therapy
in childhood may help prevent some of this. Treating early anxiety
disorders or substance abuse may prevent some of the later chaos.
It also shows why therapy is
so important in the treatment of adult depression. Although
anti-depressant medications may help with the biological problems in
depression, therapy is necessary to help clients learn new ways to
relate to people and how to make better interpersonal decisions. A
supportive therapist may also help buffer the effects of adversity and
loss and make depression a less likely outcome.
This research also suggests
that depression is not just a mood state, but is an illness that
affects many aspects of a person's life (and in a negative direction.)
We need to be aggressive in treating this serious and debilitating
illness.
Copyright © 2024 Andrew Gottlieb
All Rights Reserved