Part of my recovery consists of putting two and two together, in this case, connecting depression and stress. I’ve learned to see links between things I’ve done and felt that I never knew were connected to depression. Blowing up in rage, feeling extreme anxiety, even panic at meeting a group of new people, deep fears and fantasies, memory loss – understanding that all of those problems fitted in with depression was surprising but also comforting. That painful barrage of living began to take shape as a single condition, and the new knowledge gave me a sense of empowerment. All that mess wasn’t just me, fixed in fate forever. It was part of an illness that I could work on and start to recover from.
Now, thanks to research about the multiple impacts of stress on body systems, I can add another link. My well-hidden inner boiling in response to the pressure of every obligation, every unmet goal, every imagined requirement I impose on myself – all that too has a connection to depression but perhaps a different one than the others. The response to the extreme stress I so often feel may be a major cause of depression rather than one of its many effects. To find out more about this, there is one book everyone has to read: Robert Sapolsky’s Why Zebras Don’t Get Ulcers, Third Edition.
Sapolsky is renowned as a brilliant translator of research language into vivid prose. This is no ponderous tome but a continuously interesting story about the impact of stress on the systems of the human body and the phases of life. There is a danger these days that a model of depression (and many other ills) as purely stress-related can become as dominant as the theory based on neurotransmitters like serotonin. Sapolsky gives a balanced view of the research that is a corrective to any jump to that conclusion. His section on stress and depression links information from many disciplines in ways I had never thought about.
There are a few key points that resonate with my experience:
- He draws a sharp distinction between the disease of major depression, with its severe impacts and destructiveness, and the transient blues and bad moods that are part of everyday life. (We might avoid a lot of misunderstanding if we could find an altogether different name for this condition, something that won’t be confused with normal human emotions.)
- Major depression is not about simple passivity. Though it may look like a depressed person is inactive – unable to get out of bed, perform daily tasks or interact with other people – there can be a highly stressful conflict going on inside that person most of the time. (Finally, I thought, researchers are beginning to understand what I go through!)
- Stress produces high levels of glucocorticoids that shut down certain chemical processes to prepare the body to react for survival. For most animals (he likes to use zebras to make this point), the stress response is a reaction to external threats, like an attacking predator. When the external threat is gone, the stress response subsides, and normal physiology resumes.
- The interesting thing about people is that they can experience extreme stress from purely psychological events. In people psychological and emotional stressors may be sustained through daily life, thus setting the stage for prolonged damage on numerous body systems caused by the altered chemistry of the stress response.
- The research Sapolsky reviews is finding more and more links between the prolonged exposure to excessive levels of glucocorticoids and numerous impacts related to depression, including misfunctioning of the neurotransmitter systems, loss of memory, slowing down of physical reactions and psychomotor function, diminishing effectiveness of the immune system and many others.
- The damage caused by excessive exposure to the chemistry of stress and depression seems to make a permanent change after a number of depressive episodes. The research on this relates to long-term reduction in the size of certain parts of the brain as well as chronic neurochemical imbalances. Because of these changes, the recurrence of depression becomes self-perpetuating. The link with triggering experience is broken. (That’s something that became clear to me about fifteen years ago. People would always ask me what’s causing depression. It’s just there, I would say. It’s a background condition that becomes dominating at times, and at other times recedes. But I could never tie it to a specific event.)
- This self-sustaining rhythm that major depression develops is also a fact that no one can explain.
- So don’t get too comfortable with the concept of depression as caused by glucocorticoids. The links are clearly there, but they don’t explain everything. For one, not everyone is affected in the same way by stress. Whether or not responses to repeated trauma and stressful events will lead to major depression depends in part on genetics. (Specific genes are now being identified that tie into a tendency for certain neurochemical processes to misfire.) It also depends on psychological traits – there are some personalities that tend to react to stressful experience in ways that can trigger depression. These factors of genetics and personality don’t imply a destiny pointing to major depression but rather a predisposition that may be activated by life experience.
- Sapolsky looks to an eventual explanation that ties together the impact of stress, genetics, personality development and behavioral responses. As he puts it: ”…it is the interactions between the ambiguous experiences that life throws at us and the biology of our vulnerabilities and resiliencies that determines which of us fall prey to this awful disease.”
That’s the approach to explaining depression that I can learn from – an honest appraisal of research with conflicting results and lots of unanswered questions. The neat models offering definitive explanations for this illness all have their strong points, but none so far has been able to explain adequately all the complexities of the condition millions of us live with. So I have to keep building my own skills for coping by learning from whatever source makes sense. And Sapolsky’s insights and caution make a lot of sense.
Photo Credit: Eraxion – Stockxpert