Looking at Depression Through an Evolutionary Lens

Preconference to Explore Varied Treatment Approaches

COLUMBUS, Ohio—Psych Congress cochair Charles Raison, MD, gave attendees a “10,000-foot view” of what depression is at the Psych Congress Regionals meeting here, and will explore the idea more at the upcoming Psych Congress 2018 preconference.

As 1 of 4 speakers who presented “New Perspectives in Advanced Psychopharmacology: Improving the Quality of Care for Patients With Depression,” Dr. Raison provided attendees with a new way of thinking about depression, based on work which he and other researchers have done.

 “I’m not claiming that this provides a universal understanding of depression or even necessarily that it’s right,” Dr. Raison said in opening his talk. “But it’s good to think about things, sometimes raise our head a little bit above the intense struggle we have on a daily basis in the clinical world and just think about a 10,000-foot view.”

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Dr. Raison is the Mary Sue and Mike Shannon Chair for Healthy Minds, Children & Families and professor, Human Development and Family Studies, School of Human Ecology, and professor, Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison.

Although there is little known about the genetic causes of depression, Dr. Raison said much has been established about the environmental causes. The most depressing things in the world, he said, are getting sick and experiencing circumstances that induce or cause the perception of loss, primarily in personal relationships. When the cause of a suicide is known, he noted, it is related to disrupted relationships half of the time.

“These are the things that really are depressogenic—loss of status, loss of connection with somebody that you rely upon for your sense of who you are, being shamed, failing at what you think you should be doing in life … and then this feeling that you are trapped in your circumstances and you can’t get out of them,” Dr. Raison told attendees.

“So it’s this combination of losing one’s health and wellness in the world and then having losses that make you feel like a failure as a human being, compared to other human beings.”

Why is it that these experiences contribute to depression? The answer, Dr. Raison said, may be rooted in human evolution.

Humans are naturally driven to survive, reproduce, and leave offspring in order to pass on their genes. Dr. Raison suggested that things that indicate to humans that they are failing at this evolutionary mandate are the things that make them the most depressed.

For example, being ostracized from a group you were born into 10,000 years ago was an almost certain death sentence, he said. Today, being left out of a group would not have the same practical effect, but can still lead to serious depression.

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“The things that make us depressed today that seem unrealistic were not unrealistic 10,000 years ago, 50,000 years ago,” Dr. Raison said. “They were true signals that you were at risk of failing at these twin mandates—survival and reproduction.”

He urged clinicians to remember the theory when talking to patients about the things in their life which are making them depressed. The concept may provide a clue as to why certain factors contribute to depression, when it may not be clear on the surface, he said.

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The theory has broad implications for mental health treatment, Dr. Raison argued.

Across human evolution, three proximal mechanisms have been reliably associated with overall reproductive success: health, affiliation, and agency—the ability to chart your own course and influence your life and the lives of others.

While clinicians can work to help patients achieve these 3 mechanisms, a set of techniques being brought into mental health treatment can target depression by just giving people the perception that they have these mechanisms, Dr. Raison said.

“One of the core features is transforming people’s consciousness and perceptions in ways to give them the powerful perception that they have agency in their lives and are interconnected in ways they didn’t realize they were,” he said.

Dr. Raison will discuss the modality, which he calls “ancient practices,” further at the daylong Psych Congress 2018 preconference, being held Oct. 24 in Orlando, Florida, in advance of the national Psych Congress meeting.

The concepts play a large part in a book Dr. Raison coauthored with Psych Congress Steering Committee member Vladimir Maletic, MD, MS, titled The New Mind-Body Science of Depression. The book will be given to all attendees of the preconference. Dr. Maletic will also speak at the preconference, presenting “Do Glia Get the Blues? Neurobiological Basis for Advanced Treatment of Depression.”

In addition, Psych Congress cochair Rakesh Jain, MD, MPH, will present “What a Wonderful World: Positive Psychiatry and Its Implications for the Advanced Psychopharmacologist,” and Steering Committee member Saundra Jain, MA, PsyD, LPC, will present “Walking on Sunshine: Wellness Interventions in Medication Partial Responders—A Practical Manual-Based Approach.” A book by Drs. Jain, WILD 5 Wellness Ancient Practices for Modern Times: A Prescriptive & Proven 90-Day Mental Wellness Program, will also be given to all preconference attendees.

Following their presentations, all 4 speakers will take part in an interactive panel discussion on several complex patient cases.

—Terri Airov

Reference

“New perspectives in advanced psychopharmacology: improving the quality of care for patients with depression.” Presented at the Psych Congress Regionals meeting; Columbus, OH; June 9, 2018.