By Karin Krisher
We know—the conversation about understanding depression is overdone—now.
But 20 years ago, depression was still relatively under the radar, and it took humble admissions from several prominent figures (most notably, Tipper Gore) for American society to recognize and generally accept that depression concerns a chemical imbalance, rather than a lifestyle choice.
Today, there persists a strong dichotomy in the treatment process: depressed people can either A) attempt to correct their chemical imbalance with prescription drugs, or B) change their lifestyle via therapy and personal effort, and wait for mood changes to come about naturally, depending on chosen environment.
But what if neither of these proposed solutions are actually solutions at all? What if depression is a fact about someone’s physical makeup, like blue eyes or big hands, and an attempt to “correct” it is doomed from the start? A newly published study suggested that might be the case.
Understanding Depression in Chemical Terms
The study showed that those with higher releases of dopamine in the striatum and ventromedial prefrontal cortex are more willing to work hard for rewards. In other words, a dopamine flood to the areas of the brain that play roles in motivation and reward will motivate those people, regardless of the reward.
“On the other hand, those who were less willing to work hard for a reward had high dopamine levels in another area of the brain that plays a role in emotion and risk perception, the anterior insula.” (Janice Wood, PsychCentral) That lack of motivation persisted even when the participants had knowledge that the resulting reward would be less.
Though the study explicitly refers to motivation as it relates to effort, its implications for mental health are staggering. For so many years, we’ve been “treating” depression, anxiety, schizophrenia and ADD/ADHD as if dopamine was a transmitter whose powers could be harnessed and regulated. Now, the truth is becoming clear: Location, location, location.
If one’s brain were hardwired to release dopamine to certain areas, redirecting it would be a massive task that employed the powers of geneticists, neurologists and psychologists alike—perhaps so massive that we should reconsider the very fact of any effort to “correct” chemical imbalances, and change the way we talk about depression.
Motivation is a huge factor in depression. If a person truly desires a reward, they’ll take the necessary initiative. In a world chock full of over-achievers, if a person isn’t willing to work hard because he or she doesn’t actually want the reward that badly, s/he is often faulted in a way, and relegated to a diagnosis of depression.
Or, taking it one step further, the reward the person wants might be different, as the release is in the area of the brain associated with emotion and risk. Perhaps (and this is speculative, but seems intuitive) s/he would be more motivated to take a large emotional risk for an emotional, rather than monetary, reward. But does that make that person, who the rest of society might label “unmotivated,” clinically depressed?
Talk About It
Talking to your patients about depression can be tough. Certainly, you don’t want to negate the reality of its existence. Certainly, what they feel is very real, and in this fast paced, whole-lot-of-work-for-little-reward world, stifling. Certainly, support is needed for that person to function happily amongst those who are in the striatum camp.
But what kind of support is the issue. Maybe we should focus on making the things we can’t change work for us, instead of trying, often without result, to change them. With that thought in mind, talk to your patients about depression and anxiety. It’s a reality that negatively impacts one in ten American adults—and now, we are learning, one that might never change.
That doesn’t mean there is no hope for overall happiness—only that hope needs a new direction.
Tell us about your experiences with understanding depression. Will this new information change how you view that conversation? In what ways?