Against Depression by Peter D Kramer came out in 2005. Kramer examines what depression is, including apathy, guilt and listlessness. He covers the social attitude toward depression as well as the genetic role in depression. He moves on to cover the roll of ambivalence toward the human condition and then addresses the physical aspects and affects of depression.
Adrenal glands release stress hormones and cause the hippocampus to shrink. People who are depressed do indeed think less than people who do not suffer from depression. Overwhelmed neurons can become isolated and die. Excessive production of stress hormones can decrease bone density, cause us to age prematurely and cause us to slowly fail at our ability to bounce back from traumatic events. Depression affects multiple organs and multiple parts of our lives. For example, 60% of patients with heart-attacks also suffered from some level of depression!
He stresses that depression is NOT a normal variation of feeling and should not be except as such. Having a lot of empathy toward others is NOT depression either. There are emotionally intense people who never suffer from depression at all. Depression is, however, characterized by dependency and desperation. Descriptions of depression tend to focus only on the pain and confusion though.
Depression is what settles in stay in your life. It is characterized by its duration more than anything. Every feels one blue once in a while but not every feels blue for weeks, months or years at a time. And those who experience depression are likely to experience more than one episode of it. Those who suffer from it may experience 3, 4, 5 or 6 episodes during their lifetime. Fifteen years later 6% of patients were still depressed. Many were not receiving on-going treatment either. 40% of those who are depressed had another episode two years later. 60% had another episode with five years. 75% had another episode within ten years and 87% had another episode within fifteen years. With each episode the recovery time lengthened as well. On study showed that two years after the initial episode 20% of patients had not recovered. Ten years later 7% were still depressed or depressed again.
Depression has a rate of 38% heritability. If someone in your family has MAJOR depression then that rises to closer to 40% heritability. 60% of people who depressed are also neurotic, but not everyone who is neurotic is depressed. Major depression accounts for 20% of disabilities in women. 16% of Americans will suffer from Major depression in their lifetime. And 6-7% of Americans are suffering from major depression in any given year.
Dysthmia is a low mood for a long period of time without any major depression. It will present itself as a bad attitude more than an illness but still cause lots of issues such as work loss and even suicide attempts.
Ataraxia is known as serene detachment. A person will avoid disruptive passions by limiting his emotional investments. It is barely a state of contentment to ward of depression and involves a sober mistrust of comment and constant awareness of life’s pains.
The gene responsible for depression is known as the 5-HTT gene. If the 5-HTT gene is long then you are likely to be okay even if you are abused at some point in your life. However, if your 5-HTT gene is short then you are likely to develop depression at some point in your life.
In the end, nature and nurture play a role. What predicts an episode of major depression? Being robbed or assaulted, facing housing or financial problems, losing a job or even just problems at work, martial problems, divorce and losing a friend can all be triggers. A humiliating loss is the worst possible even for someone prone to depression. Interestingly, cancer patients often get depressed due to their illness. Pancreatic Cancer is associated with particularly high levels of depression. I guess there is a high plasma cytokine levels in Pancreatic Cancer patients which mimics an interferon-induced depression. Anyway, the more depressed you are the more you tend to continue to contribute to your own misery.
Alcoholism tends to cluster in families with depression. The combination of depression and drinking can be twice as devastating as depression alone. Low levels of stress will continue to cause episodes of depression even in the absence any real trauma. However, losing a parent at an early age may not be traumatic if that child has a supportive family and is able to finish high school. If we work to prevent low self-esteem early on then we can also work to prevent depression from developing.
Suicide is less frequent among those who are medicated for depression; however it can make depression worse in some people. Prozac offers protection and can stimulate new cell formation in the hippocampus. Psycho-Therapy is needed in addition to medication for most patients. Talk therapy alone can be successful for those with mild depression.
Why is that we romanticize melancholy? Certainly, Kay Jameson Redfield’s book Touched with Fire romanticizes it. But Kramer is decidedly against depression. He believes that the evidence linking depression to creativity is shaky at best. He says, “Romantic poetry, religious memoir, inspirational tracts, the novel of youthful self-development and grand opera and the blues portray depression as an affliction that inspires art and art forms.” Poets and writers in particular suffer from heroic melancholy—suffering for their art. Why is this? “Depression is becomes a universal metaphor, standing in for sin and innocent suffering, self indulgence and sacrifice inferiority and refinement,” Kramer says. Grief has become a model for romantic love and it shouldn’t be. Depression is not to be blamed on artistic temperaments or poor choices in life.
Many writers suffer from social awkwardness, depression, bi-polar disorder, epilepsy and narcissism. Writing does provide a sort of treatment for depression it seems. Perhaps dealing with depression is a matter of having certain tools at hand and a new way of dealing with difficult emotions. We might come to identify passion with an inner sense of security and confidence eventually. And then when we do not fear depression any longer we might be free to love more generously.