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Comment by Freegile | Hacker News Reader

I often wonder if Depression really is a "disorder" that you either have or don't have. And that can be "cured".

Unlike having a broken leg or having the flu, depression seems to be something everybody has to a certain degree.

Is there any research on this available?

Depression has plenty of evidence linking it to inflammation. If we can start seeing it not in terms of mind/body dualism, or on some outmoded moral spectrum, but on the same terms as any other illness, like the common cold, we'll make a lot of progress with it as a society. Much like the common cold, it probably has many different causes (like colds are causes by many viruses) but the same disease phenotype.

What you might be getting at with the comment that "everyone has it" is that modern society seems to cause depression just as surely as swimming in sewage will cause other illnesses. Much like society prior to germ theory, widespread depression will continue until we can learn more about the causes and mechanisms. People used to think other illnesses were moral failing or spiritual possession until we discovered that it was from drinking water that someone else crapped in. So how many things are crapping on your mental health? Are they really inevitable and necessary, or just bad cultural programming and assumptions about what society should look like? How much might be from strictly physical causes like air pollution? (There's research backing that.)

    Depression has plenty of evidence
    linking it to inflammation

That would be interesting. What makes you think so? Any studies you can link to?

Somewhat dated now, but this is a good review from 2006.

Cytokines sing the blues: inflammation and the pathogenesis of depression

https://www.sciencedirect.com/science/article/pii/S147149060...

Hmm.. that seems like a journalistic article that one would have to pay $41.95 for to read it?

I would be more interested in a study. With clearly outlined methology.

It's a medical journal, Trends in Immunology, the same type of journal that all medical studies are published in. Unfortunately we still have a broken publishing system in the US so it is insanely expensive to read articles/studies published in these journals unless you work somewhere with an institution-level account.

Here's a few for depression and air pollution[1][2] Here's some studies on anti-inflammatory treatments for treatment resistant depression[3] And more relevant to the original topic, 5HT-2A receptor agonists may have anti-inflammatory effects. There's huge potential in a broad class of molecules that have been banned for moral, not medicinal, reasons.[4] Edit: picked another one [5]

1. https://www.ncbi.nlm.nih.gov/pubmed/30719959

2. https://www.sciencemag.org/news/2017/01/brain-pollution-evid...

3.https://www.healio.com/psychiatry/depression/news/online/%7B...

4.https://www.fasebj.org/doi/abs/10.1096/fasebj.2019.33.1_supp...

5.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788795/

That's just some quick googling. There's tons more out there to read!

Sorry, but none of these are studies about the relationship between depression and inflammation treatment.

Such a study would have to provide a measurement of the severity of the depression. Then split the patients in two groups. Give one group a placebo and the other one the inflammation treatment. And then compare the depression severity in those groups after the treatment.

Wow, aptly put, reading that made me smile :)

> depression seems to be something everybody has to a certain degree

One of the things that infuriates my wife, who suffers from clinical depression, is the conflation between "clinical depression" vs. the run of the mill use of "depression", eg, "I'm depressed because my team lost this weekend."

Many people think clinical depression is just like the trivial kind of depression but it the person can't shake it off. It is like telling a starving person that, hey, I was hungry a couple weeks ago but I simply got busy doing something and I forgot that I was hungry. You should try it!

My wife said this cartoon captures a lot of her own experiences.

https://hyperboleandahalf.blogspot.com/2011/10/adventures-in...

The author of that published an extended book of the same material.

    "clinical depression" vs. the run of the
    mill use of "depression"

This is exactly what I am interested in. If it is a qualitative difference or a quantitative.

If qualitative, it would be like a broken leg.

If quantitative it would be like high blood pressure.

I would be very interested if there is any research out there on this topic.

It's unfortunately a complex issue.

There are multiple kinds of depression. Some qualitative, some quantitative, and some a mix.

We categorize diseases by their symptoms, but multiple different diseases can have identical symptoms. When this happens, we often label that group of symptoms as one disease. We start to give it multiple different names once we have multiple kinds of treatments, each treating each kind. Psychology has this problem where multiple diseases have overlapping symptoms, and because we haven't found out a single magic bullet, we often think of depression as one thing today, when really it should be thought of as a myriad of different diseases that each give a similar profile of symptoms.

I don't have any research for you but I suffered from "real" depression up to my mid-20's. Everybody gets depressed from time to time but the "real thing" is definitely an actual disorder of some kind.

As for whether normal depression is adaptive, I think you would have to go back in time ~20K and see if pre-civilized humans suffered from it like we do.

It's entirely possible that civilization just kinda sucks and that's the whole reason so many people are so miserable. (E.g. https://en.wikipedia.org/wiki/Civilization_and_Its_Disconten... )

I've taken meds for it before and found it to be an awful experience. Being depressed in my opinion feels more like a systemic issue that can't be solved with any kind of drug.

If you lose people in your life and everything you ever loved is now gone for whatever reason then how can you do anything to yourself physically to stop being depressed? You would need spend time rebuilding your physical world so that you can rebuild your mental health.

Although the definition of "disorder" seems to imply a spectrum of behavior and once it gets to a threshold where it starts causing you significant daily difficulties they call it a disorder. That doesn't mean it is fake. Just that the environment you are trying to interact with doesn't lend itself to the behaviors you are exhibiting.

Everybody feels down from time to time, and that's normal. When you can't function at all for weeks, months or years on end, then it's clearly a disorder. "Can't function" can mean an inability to: get out of bed, to sleep normally, to bathe or otherwise take care of yourself, to experience pleasure, to eat normally, to work, and/or to concentrate. Usually these are combined with overwhelming feelings of: despair, worthlessness, hopelessness and/or isolation. Sometimes these people have suicidal thoughts and act on them.

People who have never experienced a mental illness often find it hard to understand what they are.

Labeling it as a disorder means it will be studied, medicines might be developed, people who benefit from some therapies might get help.

You don't take aspirin for a headache because it cures you. You take it so that you can function and do the things to want to do that day.

You also don't need to take medicine or do anything different just because you're sick. But it's worth studying and understanding what's going on.

So has it been studied? Are there popular theories on what the mechanics behind depression are? I would be curious to know these.

Both, headaches and depression to me seem to have been "intentionally" developed by evolution. Pain has a reason: Tell you to not do certain things. Low energy / self esteem might also have a reason: Tell you to stay at home.

A broken leg on the other hand was not developed for a reason by evolution.

Evolution was no longer a factor as soon as we developed a complex society. So depression as an illness of the highly developed brain that has several layers of consciousness should probably not be compared with something like that and even if you do compare it, cancer has a clear cut evolutionary case why it’s happening. Do you want cancer? The evolutionary outcome is not really helpful from an individual perspective.

Sapolsky on depression: https://youtu.be/NOAgplgTxfc

“Depression is agression turned inwards”.

He explains what our current understanding of depression is. I think you’ll have a whole new understanding of depression after watching this.

Everyone has blood pressure, and it's on a spectrum, but 'Hypertension' is still an actionable and curable disorder.

What cures it?

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