New research is challenging the assumption that the world's most common mental ailment is just a chemical imbalance in the brain.
"Death was now a daily presence, blowing over me in cold gusts. Mysteriously and in ways that are totally remote from normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain. But it is not an immediately identifiable pain, like that of a broken limb. It may be more accurate to say that despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room. And because no breeze stirs this caldron, because there is no escape from the smothering confinement, it is entirely natural that the victim begins to think ceaselessly of oblivion." —William Styron
Melancholy is a fertile muse. No sooner had William Styron become the poet laureate of depression after describing his bout with madness in Darkness Visible when all manner of confessions followed. Mike Wallace. Art Buchwald. Dick Cavett lined up to disclose their own struggles with the disabling disorder. It quickly became acceptable, even chic, to publicly confide vulnerability to depression.
At the same time, the world was being made safe for depression, or at least public revelations of it, by another development, the 1988 advent of the so-called SSRIs—Prozac, Paxil and related drugs believed to specifically combat depression by beefing up serotonin and other neurotransmitters that ferry signals between nerve cells. The wild success of psychiatrist Peter D. Kramer's thoughtful Listening to Prozac generated not only new respect for the effectiveness of Prozac but new appreciation of the disorder it was intended to treat. There followed hundreds of new book titles on depression, over 100 on Prozac alone, surely making it the most heralded drug on the planet. Depression chic cannot be dismissed as a passing fad because, it turns out, how the disorder is defined and popularized deeply shapes what patients are willing to do about it.
Despite the flood of Prozac prose, depression itself has remained, as Styron saw it, a mystery. One of science's cruel ironies is that it can explain bizarre rare conditions, but common afflictions like depression—Western countries' second most disabling ailment (after heart disease) and the world's fourth—elude understanding. That, however, is changing.
Refined imaging techniques have begun providing an unprecedented look into the neurobiology of depression, showing what goes on in the brains of patients as they process positive and negative experiences. The work is forcing a radically revised view of depression, one that promises new treatments for the future. Among the findings:
