Tag Archives: Mental Health

Ecology of the Mind


Ecology of the Mind

The birth of a movement.

22 comments , 25 June 2010

Photo by Jörg Klaus - bransch.net
Jörg Klaus

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For thousands of generations we humans grew up in nature. Our teachers were flora and fauna and our textbooks thunderstorms and stars in the night sky. Our minds were like the forests, oases and deltas around which our cultures germinated: chaotic, wild, fecund.

But in the last couple generations, we have largely abandoned the natural world, immersing ourselves in virtual realms. Today the synthetic environment rivals nature as a driving force in our lives, and the mental environment has become the terrain where our fate as humans will be decided. By emigrating from nature we’ve done something more than just move domiciles – we have fundamentally altered the context in which we live our lives.

Along with this transition to a new psychic realm, we have also seen the exponential rise of mental illnesses. Globally, humanity is now suffering from an epidemic of uncontrollable anxieties, mood disorders and depression. The United Nations predicts that mental disease will be bigger than heart disease by 2020.

Why is this happening? Why are we breaking down mentally?

If you ask psychologists what increases the general loading of psychopathology on the human animal, they will list a lot of things: the breakdown of community, the insecurity of social roles, the stresses of modernity and globalization and maybe even the chemicals in the air, water and food that may be affecting our brains in unknown ways. Others blame the thousands of aggressive, erotically charged marketing messages our brains absorb every day as the culprit. And still others say that heavy internet use leads to addictions and depression and that the digital revolution may be rewiring our brains in unhealthy ways. Nobody knows for sure.

But it’s tantalizing to guess.

What follows is just a beginning, an introduction to some of the mental pollutants, information viruses and psychic shocks we have to deal with daily – a survey of the threats to our “ecology of mind.”

Ecology of the Mind

For countless generations the ambient noise was rain and wind and people talking. Now the soundtrack is full-spectrum, undecodable. From the dull roar of rush-hour traffic to the drone of your fridge and the buzz of your monitor, various kinds of noise (blue, white, pink, black) are continuously seeping into our brains. And the volume is constantly being cranked up. Two, perhaps three generations have already become stimulation-addicted. Can’t work without background music. Can’t jog without earphones. Can’t sleep without an iPhone tucked under the pillow. The essence of our postmodern age may be found in this kind of incessant brain buzz. Trying to make sense of the world above the din is like living next to a freeway – you get used to it, but at a severely diminished level of mindfulness and well-being.

Quiet feels foreign now, but quiet could be just what we need. Silence may be to a healthy mind what clean air and water are to a healthy body. In a cleaner, quieter mental environment, we may find our mood calming and depression lifting.

Ecology of the Mind

From the moment your radio alarm sounds in the morning to the wee hours of late-night TV, micro-jolts of commercial pollution flow into your brain at the rate of about 3,000 marketing messages per day. Every day, an estimated 12 billion display ads, three million radio commercials, more than 200,000 TV commercials and an unknown number of online ads and spam emails are dumped into our collective unconscious. Corporate advertising is the single largest psychological experiment ever carried out on the human race. Yet, its impact on us remains unstudied and largely unknown.

Ecology of the Mind

The first time we saw a starving child on a late-night TV ad, we were appalled. Maybe we sent money. But as these images became more familiar, our capacity for compassion waned. Eventually these ads started to annoy us, even repulse us. And now we feel nothing when we see another starving kid.

The average North American witnesses half a dozen acts of violence (killings, gunshots, assaults, car chases, rapes) per hour of prime-time TV watched. As for sex in the media and porn on the internet, we all know what catches our attention and stops us from zapping the channels: pouting lips, pert breasts, buns of steel, buoyant superyouth. Growing up in a violent, erotically charged media environment alters our psyches at a bedrock level. It distorts our sexuality – the way you feel when someone suddenly puts a hand on your shoulder or hugs you or flirts with you – how we think about ourselves as sexual beings. And the constant flow of commercially scripted, violence-laced, pseudo-sex makes us more voyeuristic, insatiable and aggressive. Then, somewhere along the line, nothing – not even rape, torture, genocide, or war porn – shocks us anymore.

The commercial media are to the mental environment what factories are to the physical environment. A factory dumps pollution into the water or air because that’s the most efficient way to produce plastic or wood pulp or steel. A TV station or website pollutes the cultural environment because that’s the most efficient way to produce audiences. It pays to pollute. The psychic fallout is just the cost of putting on the show.

Ecology of the Mind

The information we consume is increasingly flat and homogenized. Designed to reach millions, it often lacks nuance, complexity and context. Reading the same factoids on Wikipedia and watching the same viral video on YouTube, we experience a flattening of culture.

Cultural homogenization has graver consequences than the same hairstyles, catchphrases, action-hero antics and video clips propagated ad nauseam around the world. In all systems, homogenization is poison. Lack of diversity leads to inefficiency and failure. Infodiversity is as critical to our long-term survival as biodiversity. Both are bedrocks of human existence.

Ecology of the Mind

At first all that information was pleasurable. It felt as if the sum of all knowledge was only a hyperlink away and we skipped joyously down the infotrail, sending emails to our friends, adding bookmarks and hopping from site to site late into the night. But as the initial glow wore off, we were left in a state of digital daze: unable to concentrate, feeling foggy, anxious and fatigued.

For many of us, what began as an exhilarating romp has become a daily compulsion. Our smart phones, netbooks and computers now keep us constantly online. While waiting in line at the supermarket or enjoying an evening walk or reading a book or even sitting at a concert, we keep texting our friends and receiving quick Twitter updates. We are drowning in an endless stream of connectivity. And future generations may be even more wired. A Pew Research Center study found that American teenagers send 50 or more text messages a day and one-third send more than 100 a day. Another study by the Kaiser Family Foundation reported that American children between the ages of 8 and 18 spend an average of 7 ½ hours a day using some sort of electronic device.

Our online lives may now be impairing our ability to follow a sustained line of thought, to think deeply about something and maybe even to reach “the heights of ecstasy and the depths of tragedy” in our creative lives. We may be suffering from the infodisease that Nicholas Carr first diagnosed in himself. “Over the past few years,” he writes, “I’ve had an uncomfortable sense that someone, or something, has been tinkering with my brain, remapping the neural circuitry, reprogramming the memory… what the Net seems to be doing is chipping away my capacity for concentration and contemplation. My mind now expects to take in information the way the Net distributes it: in a swiftly moving stream of particles. Once I was a scuba diver in the sea of words. Now I zip along the surface like a guy on a Jet Ski.”

Ecology of the Mind

In the race for economic expansion we depleted oil reserves, pulped ancient forests and pumped water until the wells ran dry. Now we’re depleting the “old growth culture” – sucking dry the history, mythology, music, art and ideas that previous generations have bequeathed to us. All of our past is being picked over, recycled, remixed, regurgitated and repurposed.

Jaron Lanier, the father of “virtual reality,” is perhaps the most respected and outspoken technologist to identify a troubling deficiency in our cultural health. In You Are Not a Gadget: A Manifesto, Lanier writes that our culture has become one of nostalgic remixing where authentic “first-order expression” is chopped up and mashed into a derivative piece of “second-order expression.” And although Lanier shies away from proposing an infallible metric for distinguishing between the two, he does suggest that what distinguishes first-order expression is that it contributes something “genuinely new [to] the world” whereas derivative works recycle, repeat and fail to innovate.

The result is a society that treats our cultural heritage as a resource for exploitation. Instead of producing new works of genuine art that replenish our mental environment, we celebrate the amateur whose mash-ups may be hilarious but contribute nothing of value to the cultural conversation. This situation becomes especially distressing when we consider that just as there is a finite amount of nutrients in our soil, there is a finite amount of creativity that the past can yield. Great art is rare, and only so many mash-ups can be released before the original power of a truly artistic creation is lost. And without the production of an authentic culture, our mental environment is in danger of becoming a clear-cut wasteland, overfarmed and depleted.

In Lanier’s words, “we face a situation in which culture is effectively eating its own seed stock.”

Ecology of the Mind

We are on the brink of a synergistic catastrophe. Financial, ecological and ethical collapse loom on the horizon even as the rate of mental illness continues to climb. The world has literally gone mad.

But as more people trace their anxieties, mood disorders and depressions back to the toxins in our mental world, the first murmurs of insurrection can be faintly heard. From blackspotted billboards to breakaway attempts-at-downshifting, to revolutionary provocations in failing states, we are witnessing the birth pangs of the quintessential uprising of the 21st century. What will come is a rewilding of our souls, a riot against the production of fake corporate and commercial meaning. What begins here today will be known as the environmental movement of the mind.

Kalle Lasn is cofounder and editor in chief of Adbusters. Micah White is a contributing editor at Adbusters and is writing a book about the future of activism.

Love Rollercoaster: Dating with Bipolar Disorder


Love Rollercoaster: Dating with Bipolar Disorder

It’s easy to confuse love with mania — the trouble is that love is fleeting. There’s no cure for bipolar.
March 12, 2008  |  

At the end of my first date with Sara, she moved in with me.

You might think the date was extraordinary. It wasn’t. We’d gone to a Hollywood hamburger stand and gabbed about bands and writers for four hours. Until that night, we’d only spoken on the phone a few times. It didn’t matter. By the time the ice in my soda had melted, I’d fallen in love.

Sara was twenty-seven, and what people used to call a wag: smart, quick-witted, encyclopedic. She could recount every failed Everest expedition in mesmerizing detail — the sort of a talent I would expect of a rock climber, not someone who’d never gone camping. I kept wondering why no one had snapped her up. Then I found out.

“There’s something you should know about me,” she said, a couple of hours into the date. “I hope it doesn’t scare you off.”

Panicked thoughts raced through my mind. A jealous ex? An STD? I tried to remember if I’d sipped from her drink.

“I’m bipolar,” she said.

“Good,” I replied.

This was the odd humor Sara and I had already established, but I wasn’t entirely joking. I’d had several close bipolar friends, and had once been in a long-term relationship with a bipolar woman, Nyla, whom I still consider the smartest person I’d ever met. From a distance, I’d seen how much energy it took Nyla to keep her episodes under control: weekly doctor’s visits, blood tests, complicated regimens of medications.

And yet for all their problems, my bipolar buddies had always kept things interesting. Take my friend Jerome, hired one summer to drive a van full of rich and annoying European teenagers across the country. Somewhere in the Midwest, without telling the kids or his employer or anyone else where he was going, he simply got out at a gas station and walked away. “I was bored,” he told me. Irresponsible, yes, but hilarious.

I didn’t hear Sara’s story until later, but it didn’t have many funny parts. Her condition was rooted in a childhood depression that began when her father died suddenly of stomach cancer. At eighteen, she enrolled in the Ivy League university she’d dreamt of attending since childhood, and within a semester, was incapacitated by depression; she dropped out and returned to L.A. Suicide attempts followed. Then came her diagnosis, and years of experimenting with different psychiatric drugs until her doctors found the magic combination. Sidelined for years, she was finally looking forward again: doing PR for a record label and working part-time toward her bachelor’s degree.

How could you not admire such a person? When I looked at Sara, I felt inspiration, not pity. And even though I’m not the type to plunge quickly into relationships, I was convinced I was in love. I invited her back to my place. Aside from a quick trip to clean out her studio apartment a few weeks later, she never went home.

“Of the two of us,” I told her as we lay happily in bed, “I must be the crazier one.”

Nine months later I stood over her pale, unconscious body, frantically dialing 911 for the first time in my life.

You could compile an entire book of quotes comparing love to madness. But of all the psychological issues in the DSM-IV, only one really resembles the experience of love. “An illness that is unique in conferring advantage and pleasure,” writes Dr. Kay Jamison in one of the most famous memoirs of bipolar illness, An Unquiet Mind . It’s easy to confuse love with mania, Jamison says. The trouble is that love is fleeting. There’s no cure for bipolar.

The popular caricature of the disease — people swinging rapidly between happiness and sadness — isn’t the whole story. Most of us may have been unhappy enough at one time or another to recognize a fit of depression, but the other half of the disease (the mania that leads to everything from religious fervor to shopaholism to insatiable libido) is much harder to fathom. For instance, hypomania, which is a mild form of mania characterized by enviable productivity, can lead to what is called a “mixed state,” in which the bipolar individual is both miserable and energetic enough to do something about it. Before L had found an effective combination of meds, she drove halfway across the country in a mixed state, buying expensive clothes and jewelry for herself, with the goal of committing suicide when she reached California. Fortunately, her mania dissipated before she made it there.

Like such behavior, love is nonsensical. All relationships suffer from irrationality, which is why they can be particularly susceptible to the ups and downs of bipolar. The most obvious problem is the wild swings in libido: one week your partner wants sex all the time — maybe too often — and the next they’ve got the sexual impulses of a Buddhist monk. With both Nyla and Sara, I never knew what sort of response my advances would receive. And after sex, when I thought we’d both enjoyed ourselves, sometimes S would burst into tears. “What’s wrong?” I’d whisper, to which she’d cryptically reply, “I feel overwhelmed.”

Sara’s life was a constant battle against entropy. While most of us are bored by too much routine, Sara was obsessive about hers, and as her boyfriend, I found myself joining her in it. I, who have never liked TV, started watching hours of it with her every night. Infatuated with cleaning products, Sara taught me the joys of repetitive household maintenance. It took her all day to clean the bathroom, and when she was done, she would begin all over again. “It’s better than watching TV, isn’t it?” she’d say, as if these predictable tasks were the only options.

Our relationship became defined by obsessive routine, something that might normally have made me feel antsy and restless. But because Sara clung to the structure so fervently, I followed her lead. I began to drop off the social map. The parameters of our life together drew further and further inward, until we were living in a tiny, airtight box created by the quirks of her disorder. I became not only her enabler, but her progeny as well.

This probably isn’t how most people picture bipolar disorder. Yet despite this, more people than ever think they know what bipolar is — a mixed blessing for those who suffer from it. This is partially thanks to the ubiquity of advertisements for medications like Abilify and Zyprexa, and partially due to diagnoses, which have doubled over the last decade. A 1997 National Mental Health Association survey found that more than two-thirds of Americans had limited or no knowledge of the disease; almost a decade later, eight out of ten Americans think they know what bipolar disorder is. Everyone from disgraced New York Times reporter Jayson Blair to Debra LaFave, the high-school teacher convicted of seducing her fourteen-year-old student, has employed the bipolar defense. And if they don’t trumpet it as the explanation for their misdeeds, media experts are happy to do so on their behalf. Without ever having met her, Fox News contributor Dr. Keith Ablow all but diagnosed Britney Spears on air this month. “I would put on the list of possibilities a mood disorder like bipolar,” he said, further cementing it as the official catch-all for crazy people.

“There is never a story or scene with healthy, happy bipolars because even though that type comprises the bulk of the population, it doesn’t sell and isn’t exciting,” says a bipolar woman who maintains a blog about bipolar disorder called Weird Cake. “Top this off with sensational misinformation from people like Oprah, and you build a population that fears us and looks for us in dark corners.”

As a result, half of all American adults say they wouldn’t date a bipolar person. Back when I dated Sara, I wasn’t one of them. I’d read in Psychology Today that ninety percent of marriages involving a bipolar person end in divorce, but I figured that statistic applied to couples who were ill-informed about the illness, people who weren’t prepared to meet it head-on. I also ascribed the figure to reporting bias: there were plenty of people out there who were bipolar and lived drama-free lives, and thus never made it into the statistics. Yet even with everything I knew about the disorder, I still constantly discovered new challenges, as basic as figuring out who my partner really was, as mundane as whether I should say something when she started cleaning the toilet bowl for the third time in a row.

Even in the most even-keeled people, dating can be a crisis between ideality and reality. We’re constantly told that the key to successful dating is to be yourself. However, “when you have a psychiatric illness, it’s a part of you,” says a bipolar Brit who keeps a pseudonymous blog: Social Anxiety and Bipolar Diary of Annie. “You cannot tell where your personality ends and the illness begins.”

Locating this gulf between personality and illness often falls to the significant other. “I find it difficult to realize when my daydreams cross a line into unhealthy hypomania,” says Annie. “This is where I rely on my friends to put me right and stop me from getting carried away.” The role of caregiver can strain any relationship. While Sara took her meds and saw her psychiatrist faithfully, she also neglected her physical health, leaving me with the choice between watching her eat nothing but popsicles all day long, or nagging her about it.

And as anyone would, she resented it when I played nutritionist. I eventually decided the only way to preserve the relationship was to let her do what she wanted. As her physical health seemed to deteriorate, I resisted temptations to call her doctor. But according to David Oliver, I should have. Oliver, who is not a psychiatrist, runs one of the internet’s most popular sites on bipolar disorder, Bipolar Central. He launched his bipolar consulting business because he was dissatisfied with the professional care his bipolar mother received.

“There’s a huge flaw in the system,” says Oliver. “They give you fifteen minutes at the doctor, they forget to tell you there are ten to twelve different meds, or to warn you about the side effects you’re experiencing.”

That lack of professional supervision means people in relationships with bipolar individuals must step outside the normal boundaries, according to Oliver — communicating with your boyfriend’s doctor behind his back, for instance. Such actions have saved lives; they’ve also violated trust, and in the end, I found myself unable to tell where the line separating those two requirements was. “It has been my experience that some people [with a bipolar partner] use the disorder as their immunity card,” says Danielle. “Nothing in the relationship is their fault because they’re dating or married to a bipolar person.” My relationship with Sara was filled with gray areas — the popsicle issue, for instance — in which I could never figure out the right thing to do.

Which is why some bipolar people prefer to date others with the same disorder. Thirty-seven-year-old librarian James Leftwich struggled for years with relationships because of his schizoaffective disorder — essentially bipolar coupled with schizophrenia’s delusions or hallucinations. Tired of being misunderstood by a population generally unfamiliar with his condition, he created NoLongerLonely.com, one of the few dating websites for the mentally ill. In four years, he says, the site has helped produce countless relationships and at least six marriages. But even for someone with a similar illness, another person’s mental health is not an easy thing to be responsible for, and Leftwich says even he isn’t sure he would use his own website right now. “Personally, I’m in a frame of mind where I’m not sure I want someone with a mental illness,” he says.

On the other hand, an issue like bipolar disorder may encourage a healthy sense of compassion. When twenty-eight-year-old software engineer Jil told her husband about her illness on their very first date, she was happy that he seemed a little bewildered and had lots of questions — it meant he cared. “I also wanted to be a better person because of him, and when I feel no other reason to swallow those pills that stabilize my mood, I do it for his sake, not just my own,” says Jil.

It was a sunny Saturday morning. Just a few minutes earlier I’d been lying on the couch, reading one of the self-help books Sara had given me to help ease us through our crumbling relationship. Then, without warning, she stumbled out of the bathroom and collapsed on the floor. I think I would have lost it had she not regained consciousness a minute or so later, or if the paramedics had not arrived as quickly as they did. After I gave them the names of Sara’s medications and watched them load her into the ambulance, I called her mother, a woman I’d only spoken to a few times. She received the news almost serenely. It wasn’t the first time her daughter had been whisked off to the hospital.

Sara’s wasn’t an overdose, or a suicide attempt — at least, not an overt one. I’d known Sara was severely anemic, that her pills had made her stomach bleed. For months I’d asked her what her doctors were doing about it, and she’d given me cheerful answers about iron infusions and blood transplants. I no longer believed her, but I wasn’t sure what I was supposed to do. I researched her medications and learned all sorts of frightening things. One of them wasn’t even indicated for her disorder; it was an epilepsy medication that the drug companies encouraged psychiatrists to use off-label.

But it was difficult for me to voice my reservations about her care. Sara liked hospitals. She loved Scrubs. She admired doctors, detested any criticism of the medical system, and talked about her psychiatrist as if he were a best friend. When she spent a night at a sleep-study clinic (she thought she was narcoleptic), she talked about it as if it were a slumber party. She kept getting into fender benders from falling asleep on the freeway, yet still insisted on driving to volunteer at the hospital that had saved her after her suicide attempt. It was more than simple gratitude, she admitted; the hospital’s rituals made her feel safe and comfortable. She talked about it the way other people talk about visiting their grandparents.

When I told Sara what I’d learned about her medications, she told me she would rather die than get off of them, and pointed out that she knew the cost of them better than I did. She couldn’t remember words, for instance — she who had wanted to be a writer. But those pills had given her a reason to live. Did I know better than her doctors did? No, I supposed I didn’t. I knew that for us to have a healthy relationship, though, I needed to trust her. The trouble was, I no longer did. At that moment, I decided I couldn’t stay with Sara any longer.

That day, when I got to the hospital, I found her looking happier than I’d ever seen her. I was baffled. Five minutes earlier the doctor had informed us that her life was in danger if she didn’t find some way to fix her anemia. But she seemed at peace now. That was the worst part about it — in her hospital gown, sitting up on her austere gurney bed, she looked as if she were finally at home.

I have my own theory about relationships with the bipolar: the successful ones are those in which the relationship simply isn’t in competition with the disease. Sara seemed to regard the illness as a more intimate part of her than I could ever understand — not just a profoundly affecting experience, the way other serious diseases are, but almost the entire essence of her existence. In the end, I simply wanted there to be more.

Justin Clark has written for L.A. Weekly, Psychology Today and Black Book

Another reason for Seasonal Depression?


The Evolutionary Advantage of Depression

By Brian Gabriel


inShare25 Oct 2 2012, 11:08 AM ET 27

Genes influencing depression also bolstered our ancestors’ immune systems — an understanding that’s informing experimental therapies. 


Van Gogh, At Eternity’s Gate (Wikipedia)

More people die from suicide than from murder and war combined, throughout the world, every year. In the United States, suicide recently surpassed automobile accidents as the leading cause of violence-related death, according to a study appearing in the American Journal of Public Health.

The majority of individuals who commit suicide suffer from depression or another mood disorder. Depression is a devastating illness characterized by persistent sadness and myriad well-known symptoms. Increasingly, researchers are identifying how genes contribute to depression. As we learn more about the human genome, scientists are finding evidence that while depression seems incredibly maladaptive, it was actually adaptive (helpful) to our ancestors.

Recently Dr. Andrew Miller and Dr. Charles Raison, physicians at Emory University and the University of Arizona, respectively, authored a paper “The evolutionary significance of depression in pathogen host defense” in which they proposed that some of the alleles (forms of genes) that increase one’s risk for depression also enhance immune responses to infections.

Commenting on their hypothesis, Dr. Miller noted, “Most of the genetic variations that have been linked to depression turn out to affect the function of the immune system.” Dr. Charles Raison of the University of Arizona added, “The basic idea is that depression and the genes that promote it were very adaptive for helping people — especially young children — not die of infection in the ancestral environment.”

As recently as 1900, the top 3 causes of death in the U.S. were via infectious agents: pneumonia, tuberculosis, and diarrhea. Infants and young children were especially susceptible as 30.4% of all deaths occurred before the age of 5 years.

Depressive symptoms like social withdrawal, lack of energy, and a loss of interest in once enjoyable activities were actually advantageous to our ancestors.

Thanks to improvements in public health and medicine (improvements like antibiotics), not a single one of the previous 3 leading causes of death are among the top 5 killers in the U.S today. Over the past century, infant mortality has dropped substantially, so that by 1997 only 1.4% of all deaths occurred before the age of 5 years. Although infection is no longer a top killer, infection was the primary cause of death for many of our ancestors.

Today, certain mutated versions of a gene called “NPY” are associated with increased inflammation (an immune process helpful in fighting off infections). Mutated NPY genes likely allowed our ancestors to better fight off infections (especially in childhood), and individuals with the mutated NPY gene were more likely to pass along the mutated NPY gene to offspring.

Interestingly, researchers at the University of Michigan’s Molecular and Behavioral Neuroscience Institute discovered that individuals with major depressive disorder were more likely to have the mutated NPY gene. The normal NPY gene codes for higher levels of a neurotransmitter known as Neuropeptide Y, which appears to help ward off depression by increasing one’s tolerance of stress. So the same mutated NPY gene that likely protected our ancestors against pathogens also increases our chance of developing depression.

Drs. Miller and Raison believe that acute (or severe but short-term) stress can not only lead to depression, but also jump-start the immune system. The physicians note that in the environments in which our ancestors lived, acute stress was often associated with the threat of physical harm or physical wounds. And unlike today, wounds readily led to infection and death. Therefore, Drs. Miller and Raison believe that evolution favored individuals whose immune systems operated under a “smoke-detector principle.”

Although smoke detectors often react to false alarms (for me, burnt toast), if you removed the detector’s battery and a real fire occurred, the consequences could be severe. Similarly, immune responses to acute stress are typically not necessary — not every stressful situation results in a wound and infection. However, if our ancestors became wounded even a single time and didn’t experience a piqued immune response, they might die from an infection.

It turns out that depression may not be a mere trade-off for a vigorous immune response. Dr. Miller suggests that depressive symptoms like social withdrawal, lack of energy, and a loss of interest in once enjoyable activities were actually advantageous to our ancestors. For example, a loss of energy might ensure that the body can leverage all of its energy to fight an infection. Also, social withdrawal minimizes the likelihood of being exposed to additional infectious agents. In this way, Drs. Miller and Raison note that “depressive symptoms are inextricably intertwined with — and generated by — physiological responses to infection that, on average, have been selected as a result of reducing infectious mortality across mammalian evolution.”

Recently Dr. Miller and Dr. Raison completed a separate study in which they attempted to treat patients with “difficult to treat” depression with a novel drug infliximab. Infliximab works by disrupting communication between immune cells and consequently reduce inflammation.

While infliximab did not significantly improve depression symptoms in the group being studied as a whole, it did reduce depression symptoms among a subset of study participants who showed elevated levels of inflammation. Inflammation was measured using blood tests for “C-reactive protein” (CRP). The higher the participants’ level of CRP, the more likely the participant was to respond positively to infliximab.

As Drs. Miller and Raison suggest, the theory that depression evolved to better resist infectious agents could lead to improvements within the field of immunology and novel treatments for depression. The physicians also suggest that in the future, we may be able to utilize simple biomarkers (like CRP) to predict which individuals will best respond depression treatments that modulate our immune systems (like infliximab).

Drs. Miller and Raison concede that chronic stress has been shown to impair the immune system. However, evolutionary processes may still allow for improved infection responses to acute (or short-term) stressors.

The physicians also noted that inflammatory biomarkers are not elevated in all individuals with depression. Individuals with major depressive disorder and elevated levels of inflammation may represent a unique subset of individuals with depression. Therefore, while immune-modulating therapies may be effective in treating some cases of depression, these therapies may not be effective against all types of depression.