[Paleopsych] Adaptiveness of depression

[Lynn D. Johnson, Ph.D.]

I agree with Steve here; the issue of dietary change is ignored. He also 
downplays the social factors some, continuing to emphasize the medical 
approach to treatment. If diet and/or social change are implicated, then 
more Prozac is merely finger-in-the-dike.
Lynn

Steve Hovland wrote:

>Since this guy is an MD, one can assign a high
>probability to the possibility that he knows almost
>nothing about nutrition, including the importance
>of healthy fats in the diet.
>
>He mentions hormones without any consideration
>of what the body uses to build hormones.
>
>Steve Hovland
>www.stevehovland.net
>
>
>-----Original Message-----
>From:	Lynn D. Johnson, Ph.D. [SMTP:ljohnson at solution-consulting.com]
>Sent:	Tuesday, May 24, 2005 9:27 PM
>To:	The new improved paleopsych list
>Subject:	[Paleopsych] Adaptiveness of depression
>
>Apropos of our recent discussion on the survival value of PTSD, here is 
>an interesting expert interview from medscape psychiatry on depression. 
>FYI, the 1925 birth cohort had a lifetime prevalance of 4% for 
>depression; today it appears to be 17%; these guys say 25% but I think 
>that is high. In any case, it is an epidemic.
>LJ
>
>http://www.medscape.com/viewarticle/503013_print
>(registration required)
>
>Expert Interview 
><http://www.medscape.com/px/viewindex/more?Bucket=columns&SectionId=2036>
>Mood Disorders at the Turn of the Century: An Expert Interview With 
>Peter C. Whybrow, MD
>
>Medscape Psychiatry & Mental Health.  2005; 10 (1):  ?2005 Medscape
>
>Editor's Note:
>On behalf of Medscape, Randall F. White, MD, interviewed Peter C. 
>Whybrow, MD, Director of the Semel Institute for Neuroscience & Human 
>Behavior and Judson Braun Distinguished Professor and Executive Chair, 
>Department of Psychiatry and Biobehavioral Sciences, David Geffen School 
>of Medicine, University of California, Los Angeles.
>
>Medscape: The prevalence of mood disorders has risen in every generation 
>since the early 20th century. In your opinion, what is behind this?
>
>Peter C. Whybrow, MD: I think that's a very interesting statistic. My 
>own sense is that, especially in recent years, it can be explained by 
>changes in the environment. The demand-driven way in which we live these 
>days is tied to the increasing levels of anxiety and depression. You see 
>that in the latest cohort, the one that was studied with the birth date 
>of 1966, depression has grown quite dramatically compared with those who 
>were born in cohorts before then. So anxiety now starts somewhere in the 
>20s or 30s, and depression is also rising, so the prevalence now for 
>most people in America is somewhere around 25%.
>
>Medscape: Lifetime prevalence?
>
>Dr. Whybrow: Yes, lifetime prevalence.
>
>I think it's a socially driven phenomenon; obviously there's not a 
>change in the genome. I think we've been diagnosing depression fairly 
>accurately for a fair length of time now, since the 1960s, and the 
>people who were born in the 1960s are now being diagnosed with 
>depression at a higher rate than those who were born earlier and who 
>were diagnosed in the 1960s, 1970s, and 1980s.
>
>Medscape: And is this true of both unipolar and bipolar mood disorders?
>
>Dr. Whybrow: It's particularly true of unipolar disorder. There has been 
>a growth in interest in bipolar disorder, partly I think because of the 
>zeal of certain authors who have seen cyclothymia and other oscillating 
>mood states as part of a larger spectrum of manic-depressive illness, 
>much as Kraepelin did. And I think that has expanded the prevalence of 
>the bipolar spectrum to probably 5% or 6%, but the major increase in 
>prevalence, I think, would be diagnosed as unipolar depression.
>
>Medscape: Do you think that unipolar and bipolar mood disorders are 
>distinct, or do they lie on a continuum that includes all the mood 
>disorders in our nosology?
>
>Dr. Whybrow: The way I see it is they are both phenotypes, but they have 
>considerable overlap. If you think about them from the standpoint of the 
>psychobiology of the illnesses, I think they are distinct.
>
>Medscape: Why are women more vulnerable than men to depression?
>
>Dr. Whybrow: My own take on that is that it is driven by the change in 
>hormones that you see in women. Estrogen and progesterone, plus thyroid 
>and steroids, are the most potent modulators of central nervous system 
>activity. If you tie the onset of symptoms to menarche or the sexual 
>differentiation in boys and girls, you find that prior to that age, 
>which is now around 11 to 13, boys and girls have essentially the same 
>depressive symptoms. As adolescence appears, you find this extraordinary 
>increase in young women who complain of depressive symptoms of one sort 
>or another. Boys tend to have other things, of course, particularly what 
>some consider socially deviant behavior.
>
>The other interesting thing one sees quite starkly in bipolar illness is 
>that, after the age of 50 or so, when menopause occurs, severe bipolar 
>illness can actually improve. I've seen that on many occasions.
>
>Also interesting and relevant to the hormonal thesis is the way in which 
>thyroid hormone and estrogen compete for each other at some of the 
>promoter regions of various genes. In the young woman who has bipolar 
>disease -- this is pertinent to the work I have done over the years with 
>thyroid hormone -- and who becomes hypothyroid, estrogen becomes much 
>more available in the central nervous system, and you then see the 
>malignant forms of bipolar illness. Almost all the individuals who have 
>severe rapid cycling between the ages of about 20 and 40 are women -- 
>high proportions, something like 85% to 90%. So this all suggests that 
>there is an interesting modulation of whatever it is that permits severe 
>affective illnesses in women by the fluxes of estrogen and progesterone.
>
>There is, of course, a whole other component of this, which is a social 
>concern in regard to the way in which women are treated in our society 
>compared with men. It's far different from when I was first a 
>psychiatrist back in the 1960s and 1970s; women are much more 
>independent now, but there is still some element of depression being 
>driven in part by the social context of their lives, both in family and 
>in the workplace, where they still do not enjoy absolute equality.
>
>Medscape: Why would the genotype for mood disorders persist in the human 
>genome? What aspect of the phenotype is adaptive?
>
>Dr. Whybrow: I think you have to divide that question into 2. If we talk 
>about bipolar disease and unipolar disease separately, it makes more sense.
>
>If we take bipolar disease first, I think there is much in the energy 
>and excitement of what one considers hypomania that codes for 
>excellence, or at least engagement, in day-to-day activities. One of the 
>things that I've learned over the years is that if you find an 
>individual who has severe manic depressive disease, and you look at the 
>family, the family is very often of a higher socioeconomic level than 
>one might anticipate. And again, if you look at a family that is 
>socially successful, you very often find within it persons who have 
>bipolar disease.
>
>So I think that there is a group of genes that codes for the way in 
>which we are able to engage emotionally in life. I talk about this in 
>one of my books called A Mood Apart [1] -- how emotion as the vehicle of 
>expression and understanding of other people's expression is what goes 
>wrong in depression and in mania. I think that those particular aspects 
>of our expression are rooted in the same set of genes that codes for 
>what we consider to be pathology in manic-depressive disease. But the 
>interesting part is that if you have, let's say for sake of easy 
>discussion, 5 or 6 genes that code for extra energy (in the dopamine 
>pathway and receptors, and maybe in fundamental cellular activity), you 
>turn out to be a person who sleeps rather little, who has a positive 
>temperament, and so on. If you get another 1 or 2 of them, you end up in 
>the insane asylum.
>
>So I think there is an extraordinary value to those particular genetic 
>pools. So you might say that if you took the bipolar genes out of the 
>human behavioral spectrum, then you would find that probably we would 
>still be -- this is somewhat hyperbolic -- wandering around munching 
>roots and so on.
>
>Medscape: What about unipolar disorder?
>
>Dr. Whybrow: Unipolar is different, I think. This was described in some 
>detail in A Mood Apart .[1] I think that the way in which depression 
>comes about is very much like the way in which vision fails, as an 
>analogy. We can lose vision in all sorts of ways. We can lose it because 
>of distortions of the cornea or the lens; the retina can be damaged; we 
>can have a stroke in the back of our heads; or there can be a pituitary 
>tumor.
>
>I think it's analogous in the way depression strikes: from white tract 
>disease in old age to the difficulties you might have following a bout 
>of influenza, plus the sensitivity we have to social rank and all other 
>social interactions. Those things can precipitate a dysregulation of the 
>emotional apparatus, much as you disturb the visual apparatus, and you 
>end up with a person who has this depressive phenomenon. In some 
>individuals, it repeats itself because of a particular biological 
>predisposition. In 30% or 40% of individuals, it's a one-time event, 
>which is tied to the circumstances under which they find themselves. So 
>I think that's a very distinct phenomenon compared with bipolar illness.
>
>In its early forms, depression is a valuable adaptive mechanism because 
>it does accurately focus on the fact that the world is not progressing 
>positively, so the person is driven to do something about it. Sometimes 
>the person is incapable of doing something about it, or the adaptive 
>mechanisms are not sufficient, and then you get this phenomenon of 
>depression. I know that there have been speculations about the fact that 
>this then leads to the person going to the edge of the herd and dying 
>because he or she doesn't eat, et cetera, and it relieves the others of 
>the burden of caring for him or her. And that might have been true years 
>ago, when we lived in small hunter-gatherer groups. But of course today 
>we profess, not always with much success, to have a humanitarian slant, 
>and we take care of people who have these phenomena, bringing them back 
>into the herd as they get better.
>
>So I think that it's a bit of a stretch to say that this has 
>evolutionary advantage because it allows people to go off and die, but I 
>think that in the bipolar spectrum there are probably genes that code 
>for extra activity, which we consider to have social value.
>
>Medscape: Let's go back to bipolar disorder. The current approach to 
>finding new treatments for bipolar disorder is to try medications that 
>were developed for other conditions, especially epilepsy. Do we know 
>enough yet about this disease to attempt to develop specific treatments 
>de novo?
>
>Dr. Whybrow: Well, we're getting there, but we're not really yet in that 
>position. You're quite right, most of the treatments have come from 
>either empirical observations, such a lithium, or because there is this 
>peculiar association between especially temporal lobe epilepsy and 
>bipolar disease, both in terms of phenomena and also conceptually. But 
>we do know more and more about the inositol cycle, we do know something 
>about some of the genes that code for bipolar illness, so I think we 
>will eventually be able to untangle the pathophysiology of some of the 
>common forms.
>
>I think the problem is that there are multiple genes that contribute to 
>the way in which the cells dysregulate, so it's probably not that we'll 
>find one cause of bipolar illness and therefore be able to find one 
>medication as we've found for diabetes, for example.
>
>Medscape: Let's talk about your new book American Mania: When More Is 
>Not Enough , in which you use mania as a metaphor to describe aspects of 
>American culture.[2]
>
>Dr. Whybrow: The metaphor came because of the work I've done over the 
>years with bipolar illness. In the late 1990s, when I first moved to 
>California, I was struck by the extraordinary stock-market bubble and 
>the excitement that went on. You may remember those days: people were 
>convinced that this would go on forever, that we'd continue to wake up 
>to the sweet smell of money and happiness for the rest of our days. This 
>seemed to me to have much in common with the delusional systems one sees 
>in mania.
>
>So the whole thing in my mind began to be an interesting metaphor for 
>what was happening in the country, as one might see it through the eyes 
>of a psychiatrist watching an individual patient. I began to investigate 
>this, and what particularly appealed to me was that the activity that 
>you see in mania eventually breaks, and of course this is exactly what 
>happened with the bubble. Then all sorts of recriminations begin, and 
>you enter into a whole new phase.
>
>The book takes off from there, but it has also within it a series of 
>discussions about the way in which the economic model that we have 
>adopted, which is, of course, Adam Smith's economic model, is based upon 
>essentially a psychological theory. If you know anything about Adam 
>Smith, you'll know that he was a professor of moral philosophy, which 
>you can now translate into being a psychologist. And his theory was 
>really quite simple. On one hand, he saw self-interest, which these days 
>we might call survival, curiosity, and social ambition as the 3 engines 
>of wealth creation. But at the same time, he recognized that without 
>social constraints, without the wish we have, all of us, to be loved by 
>other people (therefore we're mindful of not doing anything too 
>outrageous), the self-interest would run away to greed. But he convinced 
>himself and a lot of other people that if individuals were free to do 
>what they wished and do it best, then the social context in which they 
>lived would keep them from running away to greed.
>
>If you look at that model, which is what the book American Mania: When 
>More Is Not Enough does, you can see that we now live in a much 
>different environment from Smith's, and the natural forces to which he 
>gave the interesting name "the invisible hand," and which made all this 
>come out for the benefit of society as a whole, have changed 
>dramatically. It's losing its grip, in fact, because we now live in a 
>society that is extremely demand-driven, and we are constantly rewarded 
>for individual endeavor or self-interest through our commercial success, 
>but very little for the social investment that enables us to have strong 
>unions with other people. This is particularly so in the United States.
>
>So you can see that things have shifted dramatically and have gone into, 
>if you go back to the metaphor, what I believe is sort of a chronic 
>frenzy, a manic-like state, in which most people are now working 
>extremely hard. Many of them are driven by debt; other people are driven 
>by social ambition, but to the destruction very often of their own 
>personal lives and certainly to the fabric of the community in which 
>they live.
>
>
>      References
>
>   1. Whybrow PC. A Mood Apart: The Thinker's Guide to Emotions and Its
>      Disorders . New York, NY: HarperCollins; 1997.
>   2. Whybrow PC. American Mania: When More Is Not Enough . New York,
>      NY: WW Norton; 2005.
>
>
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