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I'm most surprised to learn that this _isn't_ the current prevailing view in the medical profession. I am not a doctor, but it's always seemed more natural to me to view depression and anxiety as adaptive behaviours - albeit perhaps ones that can end up being triggered too far.

I read an article once (wish I could find it) that one advantage of mild depression was as sort a "call for help and support" from other embers of a close-knit social group, although I'm not sure how well-founded the claim was.

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Largely because articles like this generally focus on what I think of as “layman’s depression”, or “layman’s anxiety.” That is, a mild form of the condition that straddles the gray area between “personality” and “mild personality disorder,” that diminishes quality of life in a perceptible but not devastating way.

Then you go work on a psych floor and meet people whose depression is so severe it induces catatonia; people who look and feel like zombies and who would end their lives if given the chance; people whose depression comes with a healthy side-order of delusions. Extreme things that render someone incapable of even mild functioning.

Or severe anxiety - patients whose worry comes from no external stimulant, renders them incapable of anything but physically sickening levels of worry, and if you manage to somehow help them reason through the thing they are currently worried about ... find a new thing to attach their emotions to. Look at something like OCD, wherein one - for instance - May obsessively wash hands to stymie an overpowering anxiety that ones house may burn down (OCD sometimes has logical triggers between ritual and anxiety; often not.)

Interpreting that as “an adaptive response” is ridiculous.

An adaptive response “taken too far”, on the other hand, is the very definition of wide swaths of disease - autoimmune, cancer, etc.

I find the “gosh it’s just cultural mismatch” theory to be a modern stigma against mental disease. You can break any bone or system in the body - except for neuro/behavioral, that’s just another type of person that needs some cultural adaptation. /That’s/ never really broken.

How common is that extreme form of depression? Sounds like we need two different names for two very different diseases (or perhaps only one is actually a disease)

There are no diseases, only symptoms. We can name diseases forever but that gets us nowhere. They just have more depression, or are more depressed.

By the way, why don't people get SSRI's when they are depressed with a flu? I mean that is caused my lower serotonin as well. So for some reason we accept that depression because we have a reason for it?

https://www.inverse.com/article/40843-what-f-lu-do-es-t-o-yo...

You see, depression is fundamentally and immune disorder. We react negatively to something in the environment, like a bad job or marriage.

> By the way, why don't people get SSRI's when they are depressed with a flu?

One reason is SSRIs typically require a a few weeks to reach effective levels in your system; about how long it takes to recover from the flu.

> depression is fundamentally and immune disorder

You appear to be playing a free association game with words, not describing reality.

The idea that it take weeks for antidepressants to reach 'effective levels" is a misunderstanding of the science. It is is true for MOST people that, for example, fluoxetine and its metabolite, norfluoxetine will be at a certain level in the serum before they have resolution of symptoms, but this is not the case for all people.

It takes a very small dose to inhibit serotonin reuptake and this will happen with the first dose.

https://www.nature.com/articles/1395757 "The single dose caused only a slight increase in drug plasma concentrations but relatively clear changes in sleep structure."

And I was hoping you would all chime in and say it is useless for the flu. Because it might be very helpful

https://www.sciencedaily.com/releases/2012/07/120727171919.h...

> You see, depression is fundamentally and immune disorder.

That's a lot of certainty for something that is still very much uncertain.

> By the way, why don't people get SSRI's when they are depressed with a flu?

Because that's a short term, acute condition that will get better on its own? That's the same as saying "People in the hospital who can't breath are given oxygen, so why aren't runners who are breathing hard?" Because long term major depressive disorder is totally different than having a down couple of days.

More certain than ever actually:

https://www.sciencedirect.com/science/article/pii/S266635462...

Regarding oxygen use during running, it is already something: https://trainright.com/hyperoxic-training-little-know-traini...

As best I can tell there's not implication of causation there - it could be that depression causes the immune disorder, just as it causes any other number of conditions. I don't know the value in assuming we can categorize it like that.

I assume with the oxygen thing you're intentionally missing my point which is that a regular momentary disruption isn't considered a disorder.

I agree with you, depression alters the immune system and the immune system can cause depression. But it is through the immune system that we feel the effect.

"momentary disruption isn't considered a disorder"

By definition it is. Duration is irrelevant. My panic attacks can last for only 2 minutes.

> You see, depression is fundamentally and immune disorder. We react negatively to something in the environment, like a bad job or marriage.

This is an atrociously overly simplistic statement. There are plenty of people who suffer from depression despite having everything going for them. A person can have not a single thing in the world to complain about and still have depression.

What about all the other things that might affect their immune system? Have they ruled them all out? Latent viral or bacterial infection? Allergies? Diet? Look at diet and Omega 6 consumption, that alone will screw with the immune system and throw the catecholamines off kilter.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950146/

“A person can not have a single thing in the world to complain about”

What person?

Gautama Buddha! =)

I'd still argue that a person with "everything going for them" can still have a "reason" to be depressed. Maybe they do a really good duck impression -- calm on the surface, kicking frantically below. That is, maybe there is something wrong with their life or their past that isn't visible to others, or even to themselves. Or maybe they have been pursuing the checklists of society and found that they aren't personally fulfilled by them, and must seek fulfillment elsewhere. Maybe they have a desire to be living one kind of life but can only excel in a different kind of life that only looks good from the outside.

Interpreting that as “an adaptive response” is ridiculous.

An adaptive response “taken too far”, on the other hand, is the very definition of wide swaths of disease - autoimmune, cancer, etc.

These two statements don't add up for me. If you do accept that various autoimmune disorders and cancers are essentially adaptive responses taken too far, then why can't depression similarly be considered the same? Or is your point that depression is simply an adaptive response, and it's not "taken too far" until people are at the catatonic state?

Sorry, your question is fair -- let me elaborate:

I feel the OP puts forward two statements, categorizing depression as "adaptive", or "adaptive response taken too far." I wish to address each of these separately.

Having seen what these maladies do, I believe that categorizing them as "adaptive" is a position that can only be borne from "have never seen these diseases in their full spectrum, largely responding to mild, layman's-presented versions of them."

Separately, addressing the concept of them being "adaptive responses being taken too far," I find essentially tautological. Give me a little leeway to oversimplify when I say that there are two broad categories of disease: exogenous (trauma, infection - things done to us by the external environment) and endogenous (things that occur from dysregulation of human physiology).

((Aside: the above is, like all models, wrong. There are interactions and predispositions between biology, exposure, etc. I aim to use the above to illustrate a point about "adaptive response gone too far", not to overlook the full biopsychosocial model of disease.))

Calling a non-exogenous disease "an adaptive response taken too far" is a tautology. All human physiology arises from homeostasis - it's all "adaptive" in purpose, if not in effect. So all endogenous disease can be described as "adaptive response that is acting maladaptively."

You don't have depression if you really hate your job / university degree / sad your mom died, you just hate your job / sad your mom died.

> I find the “gosh it’s just cultural mismatch” theory to be a modern stigma against mental disease. You can break any bone or system in the body - except for neuro/behavioral, that’s just another type of person that needs some cultural adaptation.

Also ties into minimization of mental illness, which is a form of stigma!

The examples you have given seem to be outliers where the system "human" broke out of its basic parameters, causing multiple other subsystems to fire out of control.

> That is, a mild form of the condition that straddles the gray area between “personality” and “mild personality disorder,” that diminishes quality of life in a perceptible but not devastating way.

I otherwise agree with your comment, but depression and anxiety aren't personality disorders or personality related at all. Depression is an affective disorder. Anxiety is its own class of disorder.

You’re quite right. That was a typo/brain fart, and by the time I noticed it my comment was past editing.

There is a movement within psychiatry that wants to take a view similar to yours, although it is very much in a minority. I would point to figures such as the British psychiatrists Sami Timimi [1] and Joanna Moncrieff [2], associated with the groups "Council for Evidence-Based Psychiatry" [3] and "Critical Psychiatry Network" [4].

The emphasise the ideas that psychotropic medications are overprescribed (they are not totally opposed to their use in all cases, but do think that the evidence for their benefit is often overstated, and the evidence of harmful side effects is often unfairly minimised), that the DSM-5 and ICD-10/11 diagnostic manuals have very weak science behind them and encourage blaming the patient's brain for the patient's problems (in a very general way – advocates of the biological model can rarely point to anything specifically wrong with a given individual patient's brain, just the faith that some biological explanation is waiting to one day be discovered) even while ignoring the factors in the patient's social situation which may be a better explanation (but maybe a less socially convenient one – blaming the brain rather than the society eases society's conscience).

[1] https://en.wikipedia.org/wiki/Sami_Timimi

[2] https://joannamoncrieff.com

[3] http://cepuk.org

[4] https://web.archive.org/web/20200225204400/http://criticalps...

One thing that I learned during my psychology degrees that always stuck with me was that mildly depressed people are measurably better at judging probabilities of things happening. (Unfortunately I can't remember off the top of my head the structure of the study, or how much better they were). I wonder if that might fit into this, in that if you're mildly depressed presumably bad things are happening to you, so perhaps it's adaptive to be more realistic about your situation. Pretty hand-wavy stuff, but interesting to think about.

I remember reading an article like that. Also, it's a bit of a meme that if depression was 100% harmful then it would already be eliminated by evolution. I mean why shouldn't people prone to depression die off?

Don't make a mistake, I'm still working on improving my life and uncovering the root causes. It is a silent thief of life.

> I mean why shouldn't people prone to depression die off?

"Having a child will make me happy". And hell, maybe it will - it's the perfect ruse by our genes - keep us depressed until we reproduce.

Or maybe we leading a path in life with no meaning causes us to be depressed and seek a solution. Having a child puts one in the present moment and does give some meaning back though is not a cure for depression. I highly doubt the genetics make us depressed to have children.

The appendix is 100% harmful but not eliminated. As is nearsightedness.

Evolution is only affected by genotypes that prevent reproduction.

> The appendix is 100% harmful

It is not.

Much better examples would be cancer and auto-immune diseases. Evolution is not magical, it can't produce 100% fault-free organisms. Or maybe it will, given a few more billion years. But in a limited time span, there is no reason to expect it to correct any potential flaw in an organism (and experience obviously shows that it hasn't).

That's a rather antiquated view. Nowadays, the appendix is considered an active organ again, essentially a spawning zone for the gut flora. I recall reading that people that still have their appendix have a more diverse gut microbiome, and more importantly, their gut flora recover more quickly after antibiotic treatments.

Uhm, no.

https://academic.oup.com/mbe/article/35/12/2957/5112969

"the strongest signals of recent human adaptation in Europe did not coincide with the Neolithic transition but with more recent changes in environment, diet, or efficiency of selection due to increases in effective population size."

Evolution does not and cannot give a shit about you is why really. Elimination by evolution requires it to be both utterly nonviable and not tied to anything else. Look at sickle cell anemia - one copy protects against malaria via mild blood cell deformation. Two makes them concave.

There are plenty of non-optimal things kept around because there isn't sufficient pressure to ensure it dies out.

> Elimination by evolution requires it to be both utterly nonviable and not tied to anything else.

Neither of those things are required. Any disadvantage to reproduction frequency of an allele can lead to its extinction. Even a 'good' allele can lose to a 'better' one.

(The scare quotes are to acknowledge that these terms are just frequency re-stated)

Or sinuses!

An Annoying Quirk Of Our Evolution

https://www.youtube.com/watch?v=WSSmJLb468k

But what I meant is that according to the theory of evolution, individuals with disadvantageous traits reproduce less often. If they reproduce less often, they pass their genes less often. I think they say the trait is regressive.

I don't know who conducted the original study, but I remember that Martin Seligman opened his book Learned Optimism with a discussion of an experiment exactly along these lines.

Two groups of people -- a group of clinically depressed people, and a control group -- were asked to operate some apparatus that was programmed to fail a certain percent of the time. They were then asked to estimate how much actual control they had over the apparatus.

The control group consistently overestimated, while the depressed people were spot on.

A try it yourself experiment: simply start giving accurate time estimates to project managers, and see how long it takes them to call you a pessimist :)

https://en.wikipedia.org/wiki/Depressive_realism

I think there is also data that intelligent people are more susceptible to depression, so that might influence that result. Cannot find the source of it though.

I struggle with mild depression, especially in the long winter months in the Northeast U.S. Anecdata, I know, but I'm much better at estimating times (arrival times, how long it will take to pack for a trip, when we will actually leave to get to an appointment) than my wife who is eternally optimistic.

This comes in handy on estimating project times as well though only for me internally as most people don't want to hear realistic project times.

Those who are successful in life have walked a path of failure, yet they keep getting up and trying again, learning from their mistakes and growing. This at its heart is a healthy kind of optimism.

Those who call themselves a realist, who believe it will fail, shoot themselves in the foot, because they do not get to learn the valuable lesson that comes from that failure. Without trying and failing growth is stunted. Trying is a win-win. You either get what you aimed for, or you learn and grow.

One scenario is if one grows up in a dangerous situation, you're shut down from risk taking, because taking a risk in a situation like that could seriously harm you. Meanwhile those who grew up in a safe environment could safely explore and open themselves up to positive hypotheticals worth attempting.

Another scenario is that when one fails instead of learning how to do better next time they create an assumption that any remotely close scenario in the future will end in failure. When one believes a negative dangerous outcome will happen, and they're thrown into that situation, it creates anxiety. This is why anxiety and depression often go hand in hand.

There's a general bucketing in the modern world of all unhappiness being depression that should be treated, which I don't think really fits what's going on. There are absolutely cases where anxiety and depression are a medical issue which warrant treatment with medication, but there are also completely legitimate reasons for those conditions. If your lifestyle is one of never leaving the house, zero social contact, with the bank imminently foreclosing on your house then depression and anxiety are entirely appropriate - so long as those feelings then cause you to do something about the problem.

Naming these two medical conditions "Depression" and "Anxiety" is pretty unfortunate. They are completely different from"feeling depressed" and "feeling anxious". Having depression or anxiety in the medical sense will not cause you to do anything about any problem, because they are debilitating. They reflect long-term changes to your brain chemistry that may or may not respond to medication - transiently feeling anxious or depressed is not that.

Seems like depression is like tissue regeneration. It tries to fix things then it bails out. Depression is often called a pit, when you're in it, you haven't the slightest idea nor capability to do whatever. The only evolutionnary value I see in this is making you so sluggish you'll be left out by whoever or whatever is harming you because time goes on and they'll move.

I am a bit confused by your comment. When you write 'legitimate reasons', do you mean from a _moral_ stand point? I can't otherwise make sense of 'legitimacy' in this context.

edit: Do you mean 'legitimate' in the context of it increasing evolutionary fitness in some way?

I'm not a doctor, but I was also very surprised that this is "news" to the medical world. I has just always assumed that this was a well known thing, because it just seems completely logical to me.

Just asking "what could the evolutionary purpose of depression be?" should already lead to the conclusion that it's most likely a mental defense mechanism, or byproduct of one, that can most likely be triggered by experiences rather than just be part of a persons genetics.

But apparently it wasn't all that obvious after all.

There are lots of obvious and completely logical things about the world, like the sun and planets go around the earth, animals cannot feel pain, and insects form spontaneously from rotten matter. But some of them are not correct despite being obvious and logical to everyone, and thus we have science.

There is no a priori reason to think depression has an "evolutionary purpose" any more than to think a broken bone does.

Indeed. Although many practitioners are open about it that they cannot really influence those factors, so the try to offer the best individualized solutions to for respective patients.

But to claim there are no environmental factors that might benefit depression is very likely just plain wrong. But in practice these factors are declared out of scope because neither patient nor psychologist can change those.

Of course numbing yourself down with meds has other repercussions and maybe hinders that environmental factors are considered and changed.

Because this actually IS the prevailing view, but it is not really actionable.

What is the alternative to drugs?

A real advantage of depression is you won't challenge authority so you'll be more likely to appease the Alpha members of the group.

So what?

How would this help a doctor treat a mental health patient?

A combination of targeted therapy and short courses of drugs designed to ease the therapy process and control symptoms in the short term?

In my experience most psychiatrists recommend some form of talk therapy in addition to medication and my impression is that the consensus view is medications + therapy are more effective than either by themselves (also recommended are exercising , sleeping well, and other general health stuff most doctors lecture their patients about)

What you you suggest doctors do when short term treatment regimens become decades long?

If only the symptoms are treated it is illogical to expect the condition to go away. In fact, it's likely to get worse.

That is also common knowledge and practice.

My point when I said it is not actionable -- was that removing adversity is actually impossible most of the time, the therapist/psychiatrist has to give the client/patient the tools so he can help himself out, to better cope with adversity.

The therapist knows you're anxious because you had shitty parents, because you have a shitty boss and so on and so on, but that knowledge in itself is not actionable.

It would be great if we all stopped being pricks to one another, make a big circle and hug eachother, but since that's not going to happen anytime soon, we have to learn how to cope with adversity.

> What is the alternative to drugs?

A social safety net. A society that thinks providing the communication resources and facilities for people with common interests to socialize about those interests is as important as providing highways.

> How would this help a doctor treat a mental health patient?

You don't have to be a doctor to dispense pills. You can always anesthetize people who are panicking, but I'm not sure that should be called "treatment."

Talking therapy probably works because it's the opportunity to talk to someone with no ulterior motives at length about your problems. We could provide that.

> facilities for people with common interests to socialize about those interests

We have that. It's even called a highway! The information superhighway.

It hasn't cured depression and anxiety, and may have worsened it.

> A social safety net.

I believe this would be great. But perhaps not, perhaps this was only in the what Ovid calls the Golden Age -- perhaps small communities of hunter-gatherers, perhaps never in the way we imagined.

But I don't see this happening unless we revert to much smaller communities.

I think we could realistically cut world military spending by 90% before we could offer everybody that social safety net.

So we DO need pills, because we cannot realistically offer 1 in X the support they need, the best we can do is offer pills that work long enough that they help themselves or some psychotherapy.

Psychotherapy can be greatly helped in a lot of cases by pills.

I have seen the light when I started experimenting with drugs(illegal and legal) -- it is such an incredible release to know you have the power to change your mental state, even if chemically.

Having a Xanax in my walled, completely stopped my panic attacks, I haven't had one in years.

> A real advantage of depression is you won't challenge authority

Not true. It can give a fatalistic outlook and raise aggression. I know a (depressed) guy that almost got himself killed in traffic, because he would rather die than yielding to a pushy road user.

I would look at other fields of medicine, e.g. research around how certain diets and fasting protocols can reverse metabolic syndrome and type-ii diabetes along with a variety of other positive health benefits.

So what is a major focus of research? Finding ways to isolate/synthesize specific compounds to make a patentable drug that can be given in lieu of patients making lifestyle changes, because a) you can't patent a lifestyle change and put it in a pill and make billions of dollars off it and b) because patients are generally assumed to be unwilling/unable to make the lifestyle changes.

So, "how would this help a doctor treat a mental health patient?" is perhaps the wrong question, because it won't because the doctor isn't interested or trained nor has the time to guide a person through a lifestyle change. It nonetheless may be very relevant to you in deciding whether you'd rather be on insulin for the rest of your life vs. finding a way to lose weight. Just as it may be helpful for you to consider whether makes changes to lower/resolve sources of stress and anxiety in your life is a better option for managing mental distress than being on an SSRI/benzo indefinitely.

I wouldn't hold my breath waiting for the AstraZeneca "how to be happy without psychopharmaceuticals" guide to living.

> What is the alternative to drugs? Another one is lifestyle intervention. Gut problems for example may lead to depression, as gut is an important factor in neurotransmitter production. Metabolic problems will lead to lowered levels of energy. The chronic disease epidemic is real.

Depression may come for many different reasons, and the underlying factor should be looked for

> I'm most surprised to learn that this _isn't_ the current prevailing view in the medical profession.

In the UK I speak to very many mental health care professionals, and I've only ever met one who pushed the biological model above the bio-psycho-social model. Everyone else is keenly aware of the wider determinants of mental health.

There's some attempt to build this into the system, but it's pretty difficult because of the way the NHS and Public Health are set up at the moment. There's a lot of regional variation.

> I read an article once (wish I could find it) that one advantage of mild depression was as sort a "call for help and support" from other embers of a close-knit social group, although I'm not sure how well-founded the claim was.

In the same vein I also read something about how depression helps in momentarily retiring from the group to be perceived as a non-threat and the rumination is the symptom of a brain dedicating resources to finding solutions to a problem. Pop psychology most likely I suppose.

I went to therapy because of this. When I chose the therapist I focussed on choosing one that has a proper website and appears to use modern methods. Actually it was also the therapist's opinion that certain behaviours made sense at some point. In fact the therapy method didn't even require making a formal diagnosis because all these diagnoses are just summaries of statistics and not necessarily match the black box inside our head. Instead after the 3rd or 4th session I got a questionnaire in which I had to fill in what should be improved and what the goals should be.

Also of course there was some kind of homework after each session. Usually the therapist then asked me how I could accomplish that goal. Then I came up with something and the therapist also told me "you are an expert for yourself, you know this best". That was both really surprising and encouraging. The therapy actually really improved my quality of life tenfold. I'm still wondering whether it was the method (Systemic therapy) or just the overall setup that made it so successful.

I agree, especially since the ACE Study was released decades ago:

https://en.wikipedia.org/wiki/Adverse_Childhood_Experiences_...

Could the article have been by Robert Sapolsky? He discusses something like that in one of his later books, the one with a chimp on the cover where he talks about how male chimps leave their childhood tribes and head out to seek mates... and the adjustment of moving from a close-knit social group to a new alien group is covered.

He's an endocrinologist/anthropologist by profession I think, but his books are sort of more about anthropology and psychology.

I've read a similar article although with a different angle, stating that the advantage of depression is that members of a tribe which are a burden to the rest will eventually withdraw completely and/or kill themselves and therefore cease being a burden to the tribe. That said, I don't know how well-founded the claim was either.

It's hard to determine what our ancestors actually did. I'm sure you could argue any number of solutions they might have used. I'm wondering though what the prevalence is of these afflictions were back then or now in modern hunter-gatherer societies. The latter is not proof of anything, but it would be an indication of what a possibility might be like.

Going with a very medicalized framework could very well be an adaptive behavior on part of the professionals too.

The common sense approach makes it much harder to build a rich field of scientific looking knowledge and products.

This is horrible. If a therapist thinks depression is purely neurological then they will not try to cure the person and instead resort to talking to help comfort them.

This view needs to change.

But this doesn't make economic sense. Billions could be lost from prescription revenues worldwide if this became the prevailing view. Hence, we will all continue to be "sick" and treatable with medication, rather than adaptively responding to adversity.

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