Depression treatment needs overhaul

November 3, 2017 by Tess Redgrave, University of Auckland
Credit: CC0 Public Domain

The way depression is diagnosed and treated needs a major overhaul, say authors of a new review article in the scientific journal Brain, Behavior, and Immunity.

This is because current treatment of depression is ineffective and lacks a plausible, coherent theoretical basis, they claim.

A new theory for depression and its treatment is proposed in the article "Depression subtyping based on evolutionary psychiatry: Proximate mechanisms and ultimate functions," authored by Markus J. Rantala, from University of Turku in Finland; Severi Luoto, from the University of Auckland in New Zealand; Indrikis Krams from the University of Tartu in Estonia and University of Latvia; and Hasse Karlsson from the University of Turku.

"We argue that depression is not a single disease; it is a heterogeneous syndrome, with patients differing remarkably in symptom profile, pathophysiology and treatment responsiveness," says Severi Luoto, a PhD candidate in evolutionary psychology at the University of Auckland

"The evidence that is a group of separate syndromes comes from the observations that patients not only have many hundreds of unique symptom profiles, but many of the symptoms often have opposite features such as insomnia or hypersomnia, or an increase or decrease in appetite," he says.

The review article classifies depressive episodes into 12 subtypes based on evolutionary psychiatry. Using an evolutionary lens, the authors have observed patterns in the existing literature that haven't been previously identified.

"With the help of the 12 depression subtypes, it will be easier to find more effective treatments for depression," says Adjunct Professor Rantala, a member of the Turku Brain and Mind Center in Finland. "This is because the focus will be on treating the underlying reasons (triggers) of depression instead of merely focusing on the symptoms, which is how traditional psychiatry treats depression.

"We argue that the occurrence of symptoms (or patterns of symptoms) depends on the subtype of the . The particular manifestation of depressive symptoms may have more to do with what triggered the depression (i.e. the proximate mechanisms) than the personality of the patient."

The 12 subtypes are induced by:

  1. infection, in which sickness behaviour to combat pathogens and parasites may lead to symptoms such as loss of appetite, sleep disturbances, anhedonia, impaired concentration;
  2. long-term stress which is known to activate the immune system, causing an increase in proinflammatory cytokine levels that influence mood;
  3. loneliness;
  4. traumatic experience;
  5. hierarchy conflict where events such as unemployment, exclusion from a social group, bullying at school or professional hierarchy conflicts may trigger a depressive episode;
  6. grief;
  7. romantic rejection;
  8. postpartum events which lead to depression in 10-15% of women;
  9. the season, where Seasonal Affective Disorder (SAD) affects the individual at the same time each year;
  10. chemicals such as alcohol and cocaine;
  11. somatic diseases such as Alzheimer's, Parkinson's, migraine, epilepsy, stroke and traumatic brain injury; and
  12. starvation which is known to reduce mood and, when prolonged, can lead to apathy and social withdrawal.

Using these 12 subtypes, the authors go on to ask: How does a certain depressive state benefit the organism – what "ultimate function" does it have? For example, starvation-induced depression can be an adaption to save energy in order to increase the odds of surviving through a famine.

But not all proximate mechanisms that trigger depression end up producing adaptive responses.

For example short-term low mood is an adaptation to adverse life events in the majority of cases. However, Rantala and Luoto argue that an adaptive state of low mood may turn into pathological clinical depression when the patient's symptoms do not serve the purpose that natural selection has shaped them to serve.

"Chronic is what we could call an evolutionary novelty that arises from a mismatch between our current environment and our ancestral environment," says Luoto.

He adds that major depressive disorder constitutes one of the leading causes of disability worldwide: "Modern lifestyles – including a sedentary lifestyle with a diet high in energy and low in micronutrients – increase susceptibility to inflammatory dysregulation and chronic stress. These in turn increase the amount of proinflammatory cytokines in peripheral blood, leading to low mood and sickness behaviours characteristic of depression.

"If a depressive episode appears to be a response to an adverse life event, clinicians should evaluate whether the symptoms are adaptive or whether the depression episode has exacerbated into pathological depression," says Rantala.

"Some depressive responses to adverse life circumstances can be beneficial to the patient," adds Luoto. "So understanding the psychological and physiological underpinnings of depression is important and might remove some of the stigma around it.

"Future depression treatments should employ an analysis of patterns together with an in-depth interview and a blood test to reveal inflammation and stress hormone levels."

The review article further argues that subtyping depression episodes based on the original triggers of the mood change will help to find the best customised interventions for each patient. For example, in the case of depression induced by chronic stress, "interventions should seek to reduce stress levels either by using cognitive psychotherapy, exercise or medication that alleviates stress. Depression induced by loneliness in which are elevated should focus on reducing loneliness, thus alleviating the stress."

"The focus of a treatment regime based on evolutionary psychiatry focuses on an individual's long-term mental and physical well-being instead of myopically fixating on the short-term alleviation of symptoms," say the authors.

They conclude by stating their hope that "the present subtyping based on an evolutionary and immunological approach to depression will prove its practical utility on a vast scale, helping to develop more effective therapeutic treatments and drugs that are targeted to the specific subtypes of ."

Explore further: One in three hospitalized patients experience symptoms of depression, study shows

More information: Markus J. Rantala et al. Depression subtyping based on evolutionary psychiatry: Proximate mechanisms and ultimate functions, Brain, Behavior, and Immunity (2017). DOI: 10.1016/j.bbi.2017.10.012

Related Stories

One in three hospitalized patients experience symptoms of depression, study shows

June 2, 2017
About one in three hospitalized patients shows symptoms of depression, potentially affecting their clinical outcomes, a new Cedars-Sinai study has found.

Depression brings other disorders

April 28, 2017
Levels of residual morbidity in mood disorder patients followed up long-term under community conditions of treatment are remarkably high. Both unipolar major depressive disorder and bipolar disorder patients tend to be ill ...

Lack of nutrients and metabolic syndrome linked to different subtypes of depression

November 26, 2012
A low intake of folate and vitamin B12 increases the risk of melancholic depressive symptoms, according to a study among nearly 3,000 middle-aged and elderly Finnish subjects. On the other hand, non-melancholic depressive ...

Clinical interviews effective in predicting postpartum depression

March 20, 2017
For non-depressed, pregnant women with histories of major depressive disorder, preventive treatment with antidepressants may not necessarily protect against postpartum depression, according to new UCLA research. In addition, ...

New treatment hope for menopausal depression

August 19, 2013
A trial involving middle-aged Australian women is investigating the use of a hormone treatment for symptoms of menopausal depression.

Psychologist links burnout and depression

December 15, 2014
Research by City College of New York psychology Professor Irvin Schonfeld in the Colin Powell School for Civic and Global Leadership suggests a strong connection between burnout and depression.

Recommended for you

Greening vacant lots reduces feelings of depression in city dwellers, study finds

July 20, 2018
Greening vacant urban land significantly reduces feelings of depression and improves overall mental health for the surrounding residents, researchers from the Perelman School of Medicine and the School of Arts & Sciences ...

New study questions use of talking therapy as a treatment for schizophrenia

July 20, 2018
The findings of the first meta-analysis examining the effectiveness of Cognitive Behavioural Therapy for psychosis (CBTp) on improving the quality of life and functioning and reducing distress of people diagnosed with schizophrenia ...

People love to hate on do-gooders, especially at work

July 20, 2018
Sometimes, it doesn't pay to be a do-gooder, according to a new University of Guelph study.

Perfectionism in young children may indicate OCD risk

July 19, 2018
Studying young children, researchers at Washington University School of Medicine in St. Louis found that kids who possess tendencies toward perfectionism and excessive self-control are twice as likely as other children to ...

Younger children tend to make more informed decisions

July 19, 2018
A new study from the University of Waterloo has found that in some ways, the older you get the worse your decision making becomes.

Finding well-being through an aerial, as opposed to ground-level, view of time

July 19, 2018
Do today and yesterday and tomorrow loom large in your thinking, with the more distant past and future barely visible on the horizon? That's not unusual in today's time-pressed world—and it seems a recipe for angst.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.