Tuesday, August 2, 2011

A left-brained take on depression

Yesterday's Philadelphia Inquirer Health Science section reports on evoluationary psychologist Paul Andrews' unorthodox take on depression:

Andrews, an assistant professor at McMaster University in Hamilton, Ontario, thinks depression, miserable as it is, serves a positive role, much as fever does in fighting infection.

He argues that the lethargy, lack of appetite, sleeplessness, and rumination that accompany depression help people focus on and ultimately solve their problems.

"Depressed mood states seem to promote an analytical processing style," Andrews said, that helps people break complex problems into smaller bites.
In other words, according to Andrews, depression promotes left-brained thinking, which is key to solving the problems that caused the depression in the first place.

Andrews' theory implies that taking medication, on the other hand, is counterproductive because, in as much as it alleviates the depression, it also curtails the analytical, problem-solving mindset. The problems persist, and once the patients go off the anti-depressants, the depression returns. Indeed:
In an analysis of 46 previous studies published last month in Frontiers in Evolutionary Psychology, Andrews and colleagues found that patients who used antidepressants were twice as likely to relapse when they stopped as those who were on placebos.
This is the first time I've ever read of a placebo being more effective than the drug!

As the rest of the article makes clear, Andrews is talking not about the kind of debilitating, physiologically based depression that hits certain people regardless of what's going on in their lives, but about situational depression:
Most depressive episodes come in response to specific events such as a breakup or job loss, Andrews said. Depending on the study, 15 to 40 percent of people say they have had major depression, the kind in Andrews' study, but almost everybody has had milder forms.

What does this mean for patients? "It looks like, if you can get better without taking antidepressant medication, you'll have a much better chance of not having a relapse," said Andrews, who is not a clinician.
The Inquirer is skeptical, but, if Andrews' study is accurate, the burden is on his detractors to explain why, when it comes to certain sorts of depression, the placebo outperforms the drug.


Lsquared said...

I always feel it necessary to comment on depression posts, even if, as this time, I'm rather late about doing so.

I realized about age 17 that my depression was not altogether normal (not the depression that I had experienced before) when I realized that I was deeply depressed and I couldn't think of a single thing that had gone wrong that could have caused the depression. No situation--all chemistry.

I realized about age 22 that my depression was not helpful when I noticed that I was depressed about my work and so was avoiding doing any work--or at least was avoiding all of the other people at work (I avoid people a lot when I'm most deeply depressed).

I realized about age 30 that my super-ego defense against the depression might be cracking when I spent part of a morning crying over a bird that had left its nest outside our window. I e-mailed my husband to tell him about it--someone sane had to know what was going on, and that clearly wasn't me.

A couple of years after that, I heard about the study that showed that women who had untreated major depression episodes showed measurable brain loss, and that treated depression didn't result in brain loss. That seemed like a good enough reason and I talked to my doctor. I've been on anti-depressants more-or-less ever since (it's seasonal--in good years I can go off for 2-6 months each year).

Meds are good. They don't stop me from being depressed (and nothing stops me from being analytical), but they do provide a safety net so I don't fall too far into it and stop functioning. Maybe there are depressed people who don't really need the meds, but I'm convinced that I (and presumably some other people) really do.

Katharine Beals said...


Thanks for sharing this very compelling account.

Yes, it seems to me to be absolutely essential to separate situational from physiological depression, and this article does not do a good job of that.

I'm glad that meds have worked for you. I know others who have experienced similar symptoms, and similar (if not total) relief from meds.