What We Get Wrong About Depression

These popular myths are worth debunking

 



KEY POINTS

  • Depression is unlikely to be driven by a single molecule or brain pathway

  • Depression is a reflection of what happens in our bodies and brains, not just what happens in the "mind"

  • Preventive care for depression is under-appreciated but may be key

  • While pharmaceuticals are necessary for some, evidence for non-drug interventions in depression is growing



Depression is one of the biggest contributors to global disability, with hundreds of millions of people affected by this condition. But while the science of depression has advanced over the last decades, there are still several things we tend to get wrong. Here are 4 of the biggest misconceptions about depression.



Myth #1: Depression is caused by one thing


Recently, scientific research has been calling attention to the idea that serotonin may not play a central role in depression. This has increased interest in other pathways that may better describe how depression develops. These alternate explanations range from excessive stress to elevations in brain inflammation. But while it’s tempting to try to pin depression on a single molecule or even a single pathway, it’s far more likely that what we call “depression” is actually pretty varied, a destination that can be reached along many different roads.


Thinking about why a person may feel depressed is a great example of the complexity of our emotions. One person’s experience of the death of a close friend may induce depressive symptoms while another person may have similar thoughts in the context of contracting the flu. In the first case, stress pathways may be more significant, while in the second, inflammation may play a larger role.


When we move beyond a need to define depression as a singular imbalance in a chemical or brain state, we can start to appreciate why an intervention that is effective for one person may not benefit another. It also increases the value of personalized solutions for depression.


Myth #2: Depression is a disease of the mind, not the brain and body


In ancient Babylon, people who experienced frequent nervous breakdowns were thought to have angered their personal god. Ancient Greeks believed depression stemmed from a buildup of black bile in their spleen. But while we’ve heavily refined our ideas of mood based on modern science, there’s still a pervasive and archaic undercurrent of belief that depression represents a reflection of a nebulous “mind” that is located somewhere outside the body. In truth, our thoughts, behaviors and moods are a reflection of our brain state, and our brain state is a part of and a reflection of the state of our body as a whole.


The reframing of mood issues including depression as being tethered to our neurobiology has more than just academic importance. When we view people’s thoughts as a reflection of their minds rather than their brains, it’s easier to blame and judge them. We can invoke terms like “insufficient willpower,” as a reasonable explanation for why a depressed person doesn’t just get out of bed and go to work. We can feel better justifying the ill-founded notion that a person can just power through their low mood rather than asking what’s happening in their brains to drive their negative thoughts. Expanding on this further, we can then ask what may be influencing the brain and look at pathways ranging from brain connectivity issues to stress hormones to issues with the gut-brain connection and neuroinflammation.




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Myth #3: Anti-depression interventions should only start after diagnosis


In the last decades, it’s become abundantly clear that we’re doing a poor job at prevention. Chronic disease ranging from cardiovascular disease to diabetes are now the top causes of death and disability around the world, even though we have well-researched strategies to prevent many people from developing these deadly conditions. But while this remains a major issue for diseases of the body, as relates to brain and specifically mental health, we’ve almost completely neglected the idea of preventive care.


Often, the first time we think about something like depression is when we or someone close to us are experiencing significant mood symptoms that may be interfering with quality of life. In fact, in order to be diagnosed with clinical depression, interference with our usual daily activities is a requirement. But most of the time, depression doesn’t just pop up overnight. And unfortunately, once it’s officially diagnosed, the treatments for depression carry high rates of side effects and are not effective for a sizable proportion of those receiving care.


This is what makes brain, and especially mental health preventive care so significant, because in reality, it should be something we engage in across our lifespan. Dietary changes that prioritize a Mediterranean pattern diet, regular exercise, and even getting outside with regularity are all simple steps that could significantly help to decrease the epidemic of depression being experienced today.



Myth #4: Pharmaceuticals are the only interventions with evidence for benefit in depression


In Western society, we’ve become accustomed to the idea that every medical problem should be targeted by a specific drug, because that’s the only thing that will really work to rapidly influence our physiology. When it comes to depression, some people will most benefit from rapid pharmaceutical intervention with antidepressants, and working with a qualified mental health provider is an important step for those with significant mental health issues. Yet it’s also important for us to recognize that the most commonly prescribed antidepressants fail to work in around 1/3rd of cases, and that they carry a high rate of side effects ranging from GI to sexual issues.


This scenario makes it all the more empowering to know that non-drug interventions for depression may help improve symptoms as well as prevent disease. Obvious among these is psychotherapy, but a number of lifestyle interventions have additionally shown promise. Among the most studied of these are the antidepressant effect of physical activity. There’s also the growing understanding of the connection between a diet low in processed foods and excessive alcohol and high in fruits, vegetables, nuts, healthy oils, whole grains and fish and lower risk for depressive symptoms. Getting the right among of sleep has similarly been linked to substantially lower risk for depression. It’s notable that exercise, a whole food-based diet and sleep may all act on multiple pathways linked to better brain and mental health including the lowering of inflammation and an increase in healthy neuroplasticity.




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A version of this article I wrote was also published on Psychologytoday.com




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