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January 27 2013

Depression Is Still a Mystery - We Need a New Model

Category:  SF Gate

By Deepak Chopra, M.D., FACP, Murali Doraiswamy, MD, Professor of Psychiatry, Duke University Medical Center, Durham, North Carolina and Rudolph E. Tanzi, Ph.D., Joseph P. and Rose F. Kennedy Professor of Neurology at Harvard University, and Director of the Genetics and Aging Research Unit at Massachusetts General Hospital (MGH).

The magazine ScienceNews begins a recent article on depression with a blanket judgment: “A massive effort to uncover genes involved in depression has largely failed.” A general reader would probably not feel the shock waves that spread from this assessment. Gene research is always going up and down. That doesn’t change the public’s general sense that depression is being handled pretty well. Billion-dollar antidepressants continue to flourish. Somewhere in the future, better ones will improve the situation even more.

Informed opinion on the subject is very different, however, because the model for depression that has been accepted for decades counts it as a brain disorder, and brain disorders are rooted in genetics. The failure to find the genes involved in depression strongly suggest – as more than one prominent researcher now concedes – that the genes of depressed people are not damaged or distorted compared with the genes of people who aren’t depressed. Alternatively, it may just be very difficult to find genes for a condition that is so pervasive in society today regardless of genetic composition. What follows is another false assumption. The most popular antidepressants supposedly worked by repairing chemical imbalances in the synapses - the gaps between two nerve endings – where the culprit seemed to be an imbalance of serotonin. But serotonin is directly regulated by genes, and some key research indicates that drugs aimed at fixing the serotonin problem either don’t work that way or that there wasn’t a serotonin problem in the first place.

The ScienceNews report doesn’t leave much wiggle room for a laissez-faire attitude on this point: “By combing through the DNA of 34,549 volunteers, an international team of 86 scientists hoped to uncover genetic influences that affect a person’s vulnerability to depression. But the analysis turned up nothing.” Nothing doesn’t mean something.

If the chain of explanation running from genes to the synapses and finally to the pharmaceutical lab is broken, a host of doubts arises. Is depression a brain disease in the first place, or is it, as psychiatry assumed before the arrival of modern drug treatment, a disorder of the mind? The latest theories haven’t gone back to square one. What we know isn’t black and white. There are many variables in depression, which leads to some fairly good conclusions:

• There are many kinds of depression.
• Each depressed person displays their own mixture of causes and symptoms.
• The mental component in depression includes upbringing, learned behavior, core beliefs, and judgment about the self.

The brain component includes wired-in neural pathways, with suggested overactivity or underactivity in certain areas of the brain whose cause isn’t understood. But depression isn’t localized just in a single region in the brain. The interaction of multiple regions is involved.
The genetic component may explain why depression runs in families, but no gene or group of genes seems to guarantee that a person will become depressed. We are talking instead about genes that make you susceptible to the disorder. What triggers these (unknown) genes remains a mystery. In any case, genes are not fixed but fluid in their output, so the genetic situation is changeable. Of course, we must also remember that finding genes for depression is much more difficult than trying to find genes for other more obvious disorders, like heart disease. This is because a depressed family member who may actually have genetic predisposition to depression may increase the odds that other family members also become depressed, even if they are not genetically predisposed. Depression can spread among family and close friends! In carrying out a genetic study to find “depression genes”, one must tell the computer program who in the family is suspected of carrying a depression gene.

Finally, there is an X factor, or maybe more than one. The X factor could be predisposition in young children that doesn’t blossom into depression for years. It could be social interactions that create a sense of helplessness or victimization.

A skeptic could look at this list and say, “so anything and everything can make me depressed.” That’s not really true. About 20% of people will experience a severe depression some time in their lives. At the moment there is a rash of depression among combat soldiers who served in Afghanistan (this would be directly related to a sudden increase in suicides, which is generally linked to depression) and among laid-off workers who are enduring long-term unemployment. In both cases, an outside event led to the depression, but we do not know why, in the sense that only a proportion of people become depressed under the same stimulus (war and losing your job).

In our opinion, a major issue in the failure to solve this mystery is the difficulty in accurately encoding in the analysis who is clinically depressed and who is not. Depression "spreads" in families and among friends without the need for an inherited gene. One can be sure that there are genes which predispose a person to depression, but finding them requires accurately telling the genetic algorithm which family member is a likely carrier versus not--this is almost impossible.
The study about the failure to find the genes responsible for depression, which was published in the January 3 issue of Biological Psychiatry, took an unusual approach by focusing on individual depression symptoms (e.g. poor appetite) rather than on people with clinically diagnosed depression. This wasn’t necessarily better, only different. Relying solely on symptoms reported by people (without a doctor verifying the cause) can result in a lower number of those who would be considered clinically depressed if some people are in denial or don’t know the difference between depression and ordinary sadness. But more importantly, symptoms change not just over a lifetime but often on a daily or weekly basis; there is a sliding scale for each sufferer and also for the disorder as a whole.

In the end, the situation is too cloudy for anyone to offer either a pessimistic or optimistic prediction about where depression is heading. Drug treatment remains hugely popular, no matter what the basic science says. In cases of mild to moderate depression – the most common type – antidepressants produce remission of symptoms in only about a third of individuals, and in most recent studies, this is about the same as the placebo effect. Some symptoms of severe depression remain intractable, and yet in other cases, the chronically or more severely depressed perform the best with drug treatment. Hope is always better than giving up.
Our purpose was simply to underline that depression is joining other mental disorders, particularly schizophrenia, where no simple disease model works. There are too many variables, and patients follow highly individual paths as the disorder sets in. The mind-body connection has yet to be fully understood, but the present impasse suggests that we have to solve it, not rely on drugs that simply mask the underlying disorder by relieving symptoms. Human beings are sensitive creatures. Hearing the words “I don’t love you anymore” or “You’re fired” can lead to a complex downward spiral. Is there any doubt that this spiral originates in the mind, not the brain? It is time to give the mind its due importance while connecting its responses to secondary mechanisms in the brain.

Deepak Chopra, MD is the author of more than 70 books with twenty-one New York Times bestsellers and co-author with Rudolph Tanzi of Super Brain: Unleashing the Explosive Power of Your Mind to Maximize Health, Happiness, and Spiritual Well-being. (Harmony)

Murali Doraiswamy, M.D., Professor of Psychiatry, Duke University Medical Center, Durham, North Carolina and a leading physician scientist in the area of mental health, cognitive neuroscience and mind-body medicine.

Rudolph E. Tanzi, Ph.D., Joseph P. and Rose F. Kennedy Professor of Neurology at Harvard University, and Director of the Genetics and Aging Research Unit at Massachusetts General Hospital (MGH), co author with Deepak Chopra of Super Brain: Unleashing the Explosive Power of Your Mind to Maximize Health, Happiness, and Spiritual Well-being. (Harmony)

Depression Is Still a Mystery - We Need a New Model

Top comments

  • After suffering from repeated depressions I would say the trigger of them has always been coming from outside myself. Social/cultural causes I would call them. But when the illness once has been "awakened" by outside source, it becomes a more internal emotional and physical illness. So the cause of depression is outside of human, but the symptoms grows within her. That is my experience in the matter.

    Ylva Knutsson // 2013-01-27 19:33:05 // //
  • Depression is still a mystery - to Deepak Chopra. I challenge him (or any of his co-authors) to produce any outcomes comparable to what we do. We have the new model, but they think they know too much to listen and are stuck in the same paradigm that they complain about. They are still trying to make it go away instead of understanding what it is like to function highly during it. Our outcomes are described at along with how to achieve them. Where are your best outcomes described? Or is the reason you think the situation is too cloudy to be optimistic that you have not produced outcomes worth mentioning?

    Bipolar Advantage // 2013-01-28 14:14:56 // //



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  • The new model that is coming through is that the MIND/ PSYCHE is the primary mechanism for the craetion and proliferation of all dis-ease. Sorry folks - this is not new however it is confronting for many. It will be realised soon enough. What we refer to as genetic or physical manifestations of illness are merely secondary bi-products of a source of internal conflict within our minds. In response to Bipolar Advantage, there is a plethora of documented evidence out there to support this - you need not look very hard at all, unless you wish to look in the opposing direction. What we are learning from depression as well as many other perceived illnesses is that the mind is the source of the issue. Chasing down physiological or genetic roads will simply produce the same lack luster results that lead us towards making more and more pharmaceutical companies rich without achieving any results greater than what has already been suggested is the success rate of a placebo. It is a complete change in our way of thinking that is required - the mind/psyche is the source of all dis-ease - it is the link we have been missing all along as we continue to stick our heads in the sand. Science complicates and misses what is an obvious and very simple starting point to our solution

    Change the paradigm change the result // 2013-02-11 23:20:57 // //
  • Excellent article! It`s important to note, relying on drugs means suffering physically and otherwise, the various side effects such as synthetic mood enhancers or anti-depressants cause hardening of arteries for instance. So clearly, you`d only want to take drugs for a short time. Further, in my experience with many patients, friends and family members that have fought depression over the years, some on and off, some regularly, including myself, ACTION, more than drugs, have long lasting benefits, as well as deeper and more profound benefits: and what I mean by action is, Exercise DAILY & Meditation DAILY, (daily because, like food, water, sleep, breath, our Minds need Nourishment!!! and in the West, we aren`t taught how to nourish the mind, heart and soul, not even in religion. "religious folks suffer depression too)~ Art/Creativity of some kind, whether writing, gardening, sculpting, etc; doesn`t need to be great art in any way, simply Creation as part of Who We Are inherently cannot be denied. Also essential, positive human interaction and interaction with nature regularly. Modern life separates us from much of this, in fact looks down on much that isn`t "work" and "adult" ~ in a westernized capitalist paradigm. Controlling our Mind means Controlling our Life; this is becoming more and more apparent in all aspects of neuroscience, psychology etc. Good Luck!

    Jonathan // 2013-01-31 13:34:27 // //
  • It is worth noting that depression often co-occurs with other diseases that are not clearly understood- Chronic Fatigue Syndrome, fibromyalgia, IBS, IC, Circadian Rhythm and other sleep disorders, lupus, etc etc. I think it is correct to conclude that there are probably multiple causes- viruses, prenatal events, etc. I agree very much that etiology needs to be an important focus, rather than just inventing more drugs to mask the symptoms.

    Christy Begley // 2013-01-29 15:53:23 // //
  • "But serotonin is directly regulated by genes" - really?? I am not a biologist, but I find this very difficult to believe. I would have thought that the factors controlling the amount of serotonin and where it is in the body are controlled by many different factors, including diet, sunlight, various hormones and activity of both the body and brain and the mind. "Is there any doubt that this spiral originates in the mind, not the brain?" - if you ask people who suffer depression due to Seasonal Affective Disorder, or pre-menstrual syndrome they would have many doubts about the lack of a biological, chemical trigger. I agree that the mind plays a large part in the development (and healing) of depression. And yes, in some cases the mind might be completely responsible for the depression. But you can`t rule out a biochemical cause just because there is no obvious genetic correlation. To do so runs the risk of making people feel like they are to blame for their condition, which just makes things worse. This article says we need a new model for depression - I agree - understanding and treatment options are appalling. But I can`t tell if the article is suggesting a new model (if so, it seems to be saying we need to focus on the mind, not the biology, which I think is wrong) or just saying "we need a new model" without presenting one. If the latter, where do you see as a good platform to start a discussion on the new model?

    Mahina // 2013-01-29 07:36:15 // //
  • I am not student of science hence I do not know about the role of genes in case of depression. I have my personal experience that I was in deep depression before three years for almost two years. I was having frequent suicidal thoughts as well in my mind. However I came out of it without any medication only by practicing meditation and yoga. Now I can analyse my thought process very well. I can see that though there was trauma that was leading me to depression however deep inside me there were different things. I was having very low self esteem and was dependent on other for my feeling. After practicing meditation and yoga I can see myself as a totally different person. There is sense of being inner fulfilment which is leading me towards totally different perspective of life. I don’t know what the role of my genes is in the entire process. Can anybody explain it?

    Deeps // 2013-01-29 04:14:08 // //
  • A very telling statistic you share in this article is that only 1/3 of the people on anti-depressants experience remission symptoms, which is about the same as a placebo effect. This points to depression being a mental issue, not a genetic one. Thank you for sharing this.

    Simone // 2013-01-28 23:02:07 // //
  • Depression is a gut problem, isn`t it? Ask anyone who has cured their depression through nutrient dense and fermented foods.

    Daisy // 2013-01-28 21:28:56 // //
  • I really think it's the food, the environment, medication is not always the answer.....i tried a little walking over the weekend

    Sheki Williams // 2013-01-28 20:20:46 // //
  • Depression is still a mystery - to Deepak Chopra. I challenge him (or any of his co-authors) to produce any outcomes comparable to what we do. We have the new model, but they think they know too much to listen and are stuck in the same paradigm that they complain about. They are still trying to make it go away instead of understanding what it is like to function highly during it. Our outcomes are described at along with how to achieve them. Where are your best outcomes described? Or is the reason you think the situation is too cloudy to be optimistic that you have not produced outcomes worth mentioning?

    Bipolar Advantage // 2013-01-28 14:14:56 // //
  • Great article, dr. Chopra, I had relatives that have committed suicide, and had depression problems. It is so sad. Hoping that one day science will help us to understand it better.

    Marina Rivas // 2013-01-28 10:35:58 // //
  • This is an excellent article. I`m doing graduate work right now to be a therapist and depression etiology and treatment is definitely divisive among professionals. As with everything, there is no concrete answer but most likely a combination of many factors.

    Terri // 2013-01-28 08:25:52 // //
  • It does seem that some disorders, like Bi-Polar, are a chemical imbalance. Could it be that other disorders are caused by chemical imbalances caused by secretions which arise from our feeling hopeless and helpless in situations. What about post traumatic stress and its affects, it is like finding yourself in a whole and you keep on digging, a vicious cycle which some don`t seem to have the wherewithall to reason themselves out of. There are the people who do not know they are depressed and the others which are in denial. There is alot of alcohol abuse, which alcohol in quantity is a depresant, which affects not only the drinker, but those around them, which can make those around them depressed. I believe that there is not just one answer for where depression comes from, but that it is mostly caused by social influences throughout a persons life and that some, well could be born with an imbalance.

    Athena // 2013-01-28 08:15:10 // //
  • pointless little article, I'm sorry. Depression is hardly a mistery. It's a mystery how the human race is still overpopulating the planet inspite of depression and the underlying knowledge that we've messed up big time and have no idea how to fix it. It's more of a collective sense of guilt and regret that because we feel like individuals, we can't explain in any way that makes sense.

    Paula Hernandez Cu // 2013-01-28 02:23:05 // //
  • Try this for a model. The merkaba or double tetrahedron inside a sphere. Make it in three dimensions and centering around the heart. Have one of the triangles represent the upper three masculine chakras of thought, but also in a perpendicular axis corresponding to the left brain or pingala, and also in an axis from inside the body to outside, being the outside the body or exterior world. Then represent the feminine lower chakras of emotion, also represented in a perpendicular axis corresponding to the right brain or ida, and also in the in/out axis, that of inside the body. So we have two tetrahedra representing the chakras, and each being represented in three separate dimensions or axes of X Y and Z. Then we have the circle or sphere surrounding those as a boundary condition, a surface condition, perhaps mediating the inside world to the outside, a division of private to public. Depression Mania and Schizophrenia will be an imbalance in the chakras somehow, or violating the boundary condition, related to purpose in life, the true central self as a balance between force and gentleness. We could throw in some Jung too. Unity, infinity, zero, the self, divides into the ego and the shadow. Too much upper ego, or not enough expression of lower shadow will cause an imbalance. Cure is re-parenting, taking into account the clients individual imbalances, and correcting them, encouraging self expression, self control, self defense, boldness, gentleness, etc etc etc, a relationship with the interior self and balancing in relationships in exterior world. In extreme cases of psychosis, examining all thoughts and feelings and suggesting possible new realities, encouragement of one's individuality within the whole, etc etc etc. Emphasis on developing friendships, rebalancing family dynamics etc.

    Timothy Manning // 2013-01-28 01:17:52 // //
  • No mystery here. As others commented it is enviroental. I know for over 30 years n it is pathetic that the answer is in a poll. Their is help but it is limited We need just loving fellow humans who listen we can trust n a society will not still roll it's eyes. Health coverage is always poor with your employer. Me I fooled them all n have worked 35 years with many companies only recently in 2012 I am disabled due to joint disease as I had a knee replacement as my drug of choice was run till the pain lifted and it always did. It is still tabu n nonexistent in poor countries. Ironic. C there love n respect of life rule here no surprise money rules n government is for sale no surprise n pharmaceuticals are an investment to my fellow fighters I say I love you do your best as u c it taking care of u. Pray exercise eat well n find what helps u n when u don't feel we'll I believe u n it is ok to lay down get a massage or turn off your phone. Lastly I tell u what a old man told me 30 years ago "it's not your fault" I am proud of the courage we display!

    John Chiappetta // 2013-01-27 23:31:25 // //
  • I was diagnosed with Bi-polar Disorder some years ago at age 33 after suffering symptoms since my teenage years. A doctor once told me to stop taking my anti- depressants and I slipped into the worst depression of my life. I couldn`t even taste my food at one stage. My regular psychiatrist putting me back on anti-depressants was the only thing that saved me. I was later put on Lithium and when I had a manic episode, I was taken off anti-depressants. I now take two mood stabilisers. I know that without drugs I would be in a mental hospital or dead. I realise that Bi-polar is different from depression, but I wanted to stress that drugs do have their place. People can be very negative about them and insist on all manner of alternative medicine, but I know that is not for me. Touch wood, at almost 43 years of age, I feel pretty normal and no longer hear voices. So I a grateful. It can always be worse.

    Wendy // 2013-01-27 22:46:04 // //
  • Depression is the absence of purpose - that expression of existence. Yes, you do need a new model.

    Alaya Dannu // 2013-01-27 21:18:21 // //
  • Maybe feeling like crap for years is the new normal. Maybe it`s the old normal as well but no one talked about it. I have prayed to be removed from this earth without fear of return to it for over 7 years. I`m done with this planet and can`t wait to leave. Nothing undone except maybe my taxes. Some would say I am depressed, I spend a lot of energy making pretend all is OK so I don`t have to listen to gagging solutions for magic happiness like "just go look at a sunset, meditate, take a vacation". Maybe we are supposed to be miserable for sustained periods of time. Just because it makes others feel uncomfortable doesn`t mean that it has to be changed. Drugs do not heal the situation that causes the death wish. They made me much worse. It would be easier if others accepted that I could care less about anything.

    nuitgoddess // 2013-01-27 21:14:23 // //
  • Depression is a spriritual illness. I suffered from it for many yrs. and no longer do. It is because we have no yardstick to measure ourselves. We listen to others. Something inside me told me that I was a good person. When I sought out the professional. He told me that my parents should be in his office, not me . I believed him and decided to be my most authentic self.

    joanne dye // 2013-01-27 21:12:02 // //
  • Depression is only possible prior to embracing ur life purpose.....

    Starseed Awakenings // 2013-01-27 20:07:23 // //
  • I just finished reading Super Brain, and will read it again and again. This is a life changing book. As a person who was born and raised in a family with the "genetic" predisposition to depression and anxiety, I am ready to re-write my story.

    Katie Lynne Young // 2013-01-27 19:59:40 // //
  • I feel it's our bodies way of telling us, something's not right - emotionally, environmentally, etc. if we allow, acknowledge, flow & surrender to this imbalance we will eventually find the answer. Ask within, 'what am I to learn from this?' ~<3~

    Helen Russo // 2013-01-27 19:54:47 // //
  • Alternative therapies like qigong, reiki, yoga, and nutrition are necessary elements to traditional treatments!

    Philip Loveless // 2013-01-27 19:50:08 // //
  • treat someone with kindness and take care of their every need for as long as it takes with no time factor involved, no pressure, setting reasonable limits and boundaries and see how fast depression resolves. no purpose in life is depression. no boundaries is mania. schizophrenia may be a break from reality from a paranoid home environment secondary to occult anger, projection of subconscious feelings, and an overactive imagination needed to escape it.

    tim // 2013-01-27 19:42:35 // //
  • Is it Chemical imbalance .? ....

    Fabiola Cárdenas // 2013-01-27 19:37:55 // //
  • It's from believing lies that others tell you, or you tell yourself.

    Robin Margaret Tretter // 2013-01-27 19:37:34 // //
  • depression needs to be defined more clearly i feel medication is dispensed to easily while it may be effective in treatment i think there are alternatives depending on the severity of the depression; meditation, exercise and accepting life can be difficult at times....

    Mary Ann Gullo // 2013-01-27 19:36:13 // //
  • After suffering from repeated depressions I would say the trigger of them has always been coming from outside myself. Social/cultural causes I would call them. But when the illness once has been "awakened" by outside source, it becomes a more internal emotional and physical illness. So the cause of depression is outside of human, but the symptoms grows within her. That is my experience in the matter.

    Ylva Knutsson // 2013-01-27 19:33:05 // //
  • I enjoyed your article and I`ve also been a follower of your previous writing like your book, "Quantum Healing," it shed much light on the subject of Depression which in many cases is still taboo in the world and in the business world. Thank you for sharing and becoming an inspiration to me personally on my own quest in living and writing "My Journey" as I did a few years back after reading your book. // 2013-01-27 19:31:08 // //
  • Yup diet is a huge part of it... I think social conditioning is the biggest culprit though, because we're not conditioning the system to adapt to us, we're conditioning our young to adapt to the system... like robots. And of course none of us are. We drill into our babies heads and suppress parts of them to such an extent that they don't know themselves anymore. It happened to us, and our forefathers and mothers... Raises all kinds of issues, crime and disease culminating and worsening as time passes...

    Chy Tooksilly // 2013-01-27 19:28:43 // //
  • Depression is a mystery to those who dont know the meaning of life. To me its obvious.

    Bil Zen // 2013-01-27 19:26:05 // //
  • What about the artificial food most of us eat?

    Paige Harmon Maston // 2013-01-27 19:24:48 // //
  • if it isnt chemistry, it's environmental. It's pretty easy to differentiate!

    Taumy Laughlin // 2013-01-27 19:23:48 // //
  • Try Googling "school makes me feel" or "school makes me"... and look at the options both in the search box and at the bottom of the page

    Chy Tooksilly // 2013-01-27 19:23:29 // //
  • It'll remain a mystery, like so many other diseases, until we acknowledge the unbalanced and artificial lifestyle we live out, within the unbalanced and artificial system we've set up for ourselves as a collective. We don't want to examine too closely, change, eradicate, or replace it, despite the fact that we see so many dysfunctional aspects of it.:/

    Chy Tooksilly // 2013-01-27 19:20:39 // //
  • I would read your article but I am trying to figure out how to survive.

    Jennifer Renae Merrifield // 2013-01-27 19:14:37 // //
  • It is the system.

    Jennifer Renae Merrifield // 2013-01-27 19:13:37 // //
  • Sexy models pls kthx!

    Jim Sharp // 2013-01-27 19:09:05 // //
  • If you ask me: depression comes from the fact that men and women have totally different views on raising kids. This is a result of the patriarchal way of raising the kids, where women had to obey what men said. Now that women have more influence, they raise their kids differently but those kids have to live in a society where this difference in raising is not yet accepted. It is a vicious circle that can only be broken if all religion and all differences between a man and a woman are dissolved. I doubt if that can ever be done cause we women are a different species from men, but we can come together more and more. The above observation is of course subjective and comes from my own experience.... When I now observe my own children in raising their kids, a lot has already changed. Hopefully teaching children to enliven themselves in the circumstances of their sister or brother in a family will have a positive influence at younger age in not developing depression...

    LivinginPeace // 2013-01-27 13:17:18 // //