Depression and its various incarnations2024-01-22

...if my black dog returns. He seems quite away from me now – it is such a relief. All the colours come back into the picture.

Winston Churchill

Depression is in essence a reduction in levels of activity of a person, a hibernation of sorts and withdrawal from life. It occurs as an adaptation to a hostile environment, or maladaptively, due to a malfunctioning internal switch. Of course, in some cases both scenarios can occur, resulting in vicious cycles and severe episodes.

The first paradigmatic type, exogenously driven, can heal and recover when the stressors are removed. If the stressors are learned behaviors due to childhood trauma, they need to be addressed and dissolved through a combination of therapy and biological treatments. If the stressors are current adverse environment conditions (or internal milieu ones in the case of medical illnesses), the environment needs to change or the person needs to find a different environment, rather than just numbing them with medications (or self-numbing with alcohol and drugs). Mitigating the upstream biological effects of stress (adrenergic, inflammatory, metabolic) permits faster healing and recovery of brain cells involved in depression.

The second paradigmatic type, endogenously driven, needs a biological fix for the internal switch. If the switch is permanently stuck on low, a stimulating antidepressant would do. If the switch is erratic and goes up and down (bipolarity), an antidepressant may amplify the erratic nature of the disorder (rapid cycling, mixed states) and thus be counterproductive, even dangerous. Mood stabilizers work best for both types of switch abnormalities, unipolar depression and bipolar (disorders).

Having longitudinal clinical information and ideally biological lab tests on a patient helps determine which type of depression we are dealing with (Step 1). That leads to which type of approaches should be used first and foremost- psychological, social, or biological (Step 2). Step 3 is dosing those treatments in a way that is not insufficient, or conversely, is not excessive. (We are doing our bit to provide clarity to patients, families, and doctors. Our Life x Mind app can help patients gather longitudinal data on how they feel, LRxImprove identifies social determinants, and our MindX One Blood Testing provides objective information about disease severity, risk, and medication matching—see