Depression: Failure to Learn
Depression stops you. You can’t start. You can’t think. You want to rest but can’t sleep. Simple acts become unendurable. You retreat, then hide. You can’t burden others with what you are now — stuck.
In previous centuries personality changes so abrupt led depressed people to be burned at the stake. Things are somewhat better now. There are drugs and therapies. But the problem grows. Many millions stay depressed for decades. Others see their families, jobs, and lives wrecked. Treatment is fitful and too often far from successful.
What’s going on?
Perhaps it’s time to try something new.
The Causes of Depression
The causes of depression are legion. People can get depressed sensing the end of love. Losing a job. Breaking a leg. Developing hypothyroidism. Getting a carcinoid tumor. Living through dark winters without sun. Then there's the most common cause of all – unknown.
With depression not just the brain but the whole body shuts down. To the outside world only — internally stress hormones may be sky high. Yet adaptation, resilience, changing with the always changing environment diminishes or disappears. Some liken depression to human hibernation.
It’s probably better just to say we stop learning. We don’t make changes when the environment shifts. We’re stuck.
Conceive of the body as an information system and what depression does starts to make sense. To survive we always need to learn. If someone starts roaming around school with a gun, children learn to get the hell away. If a van weaves wildly through a crowd, we learn to run.
But most of our learning is not conscious. When a new virus like AIDS appears, our immune system learns to fight it. When a new flu attacks, new approaches hit back. Immunity shows how critical unconscious learning is to survival. For all biology works on a simple principle—learn or die.
The same is true of organs and cells. When we walk, our muscles learn to move around obstacles. Our joints modify and strengthen. Our lungs change their patterns of breathing, while the immune system scopes out different pollutants and infective agents. Everything we do teaches us something new.
Except that doesn’t work when we’re depressed.
Failure to Learn and Depression Treatment
Depression is a systemic disease. There are so many derangements that piecemeal treatments inevitably leave many sufferers no better off. But it’s instructive to recognize how depression treatments reset and renew basic biological mechanisms so that learning and adaptation can take place. Here’s a brief historical review:
1. Electroconvulsive therapy is literally shocking. Seizures radically change brain function while leaving us unconscious. Blood pressure can march to extraordinarily high levels without provoking damage. Soon the whole body begins to recover — and reset. Transcranial magnetic stimulation may be working on similar mechanisms of reset and renewal.
2. "Standard" antidepressants, whether affecting serotonergic, cholinergic, noradrenergic, histaminergic or every other neurotransmitter system, all cause a major reset of not just brain but body chemistry (ask bacteria how they feel about serotonergic antidepressants.) They take a long while to help, as all the renewing and rebuilding and reformatting works its way through many different information systems.
3. Light resets biological clocks and systemically activates the body. No wonder recent studies show it as efficacious as the economically more lucrative antidepressants.
4. Cognitive Behavioral Therapy takes as a premise teaching the brain to reset its way of looking and learning about life. CBT directs conscious learning to remake people’s view of living with depression.
5. Exercise activates and rebuilds tissues throughout the body. It’s effectiveness is often ascribed to resetting neurotransmitter levels. That proves more about present poverty of thinking regarding biological information flows than in how exercise truly performs. Moving through the environment makes pretty much every organ actively learn, from immune cells to joints, muscles, bone and brain.
6. Behavioral Activation Therapy works by getting people to get going. To act. To move. With normal adaptive learning diminished or gone, people get their mojo back doing things they once did well, particularly activities achieving social and purposeful ends. Behavioral Activation Therapy forces you to learn anew.
7. Mindfulness. Is rest truly active? When it teaches the brain new ways to think, shifts the way the body responds, and resets people's state of conscious relaxation, sure.
8. Ketamine’s useful functions remain unclear. One recent idea of its efficacy involves increased synaptic plasticity. More resilient, more adaptive brain cells may lead to a more adaptive, more actively learning body and brain.
Depression as a Failure to Learn
Learning is what we do. Every moment of our lives is a teaching moment for the body. Whether we’re sitting or standing, conversing or reading, our brain learns to adapt to a continuously changing environment.
Such learning often goes out the window when we become depressed.
Treatments of depression are generally partially effective. In many people they don’t do much. Combining them usually helps.
But seeing depression as failed learning, learning by all the different information systems of the body, may help treatment get more effective. Putting different information systems back online, adapting and learning together, may help reset information flows from the gut to the brain. Putting together treatments like exercise, light, antidepressants, behavioral activation therapy and CBT either in sequence or conjointly may make it much easier for different information systems to cohere, reset and renew. Similarly, combining physical (exercise) mental (CBT) social (IPT and social engagement) and spiritual, purposeful means of treatment (mindfulness, purpose training, positive psychology) may creatively lead to better results.
Thirty percent of Americans will eventually get depressed. We have to change those numbers, and depression's inadequate treatment.