What's Behind the Modern Depression Epidemic?

Mental health is finally a topic of conversation. Yes, it's still taboo to discuss in many circles. But more and more, people are talking about mental health. With the slow lifting of the taboo, a more reasonable view of mental health issues is forming in the average person's mind.

Whereas extreme mental health issues like psychosis were once written off as demonic possession, today the brain's chemical makeup is being probed. Where chemical interventions are possible, they are being used. More therapeutic options are available, too, as society awakens to the fact of mental illness.

But those types of mental illness that resemble demonic possession aren't even the most pressing issues. Yes, severe issues like psychosis are problematic and tragic. But the more widespread and societally damaging problems plaguing our society are mental illnesses that sometimes don't even look like mental illnesses.

Depression and anxiety impact hundreds of millions of people. These daily internal struggles diminish the quality of life for those who suffer, and all too often result in the most extreme solutions -- suicide.

And popular views on depression and anxiety didn't help, either. Not many thought of a case of depression as demonic possession. But it was believed that the cure to depression was to 'just get over it.' Of course, 'just get over it' is no more helpful advice than a demon-based diagnoses.

Today, we know that depression isn't necessarily something that people can 'just get over.' Sure, there are plenty of times, where otherwise healthy people feel temporary depression. This is a normal, even healthy response to an adverse life event or circumstance. The death of a loved on, or dealing with a health issue can bring on these temporary bouts.

But persistent, clinical depression moves beyond a temporary feeling of sadness and into the realm of permanence. When this happens, the brain changes, developing pathways to a constant state of sadness and despair. 

Understanding and solving depression are vitally important for our society and millions of individuals who believe there's no escape from the difficult terrain of their minds.

How Widespread is Depression?

Depression is a serious public health issue across the entire world, although the United States has significantly more depressed people than most of the rest of the world. In fact:

"It’s estimated that 16.2 million adults in the United States, or 6.7 percent of American adults, have had at least one major depressive episode in a given year." 

Meanwhile the global average is almost 3 percentage points lower at 4%. These numbers mean that 300 million people globally and over 16 million in the US have suffered a major depressive episode in the past year.

This is no small number, especially when you consider that suicide is a major cause of death. In fact, it's the 10th leading cause of death in the US. And, since depression is a major cause of suicide, it's clear that improving depression is an important public health issue.

What is Depression?

First, it's important to note that temporary feelings of sadness are not the same as clinical depression.

Of course, you should immediately seek professional medical help if you think you might have depression. This article is not medical advice. But for information sake, you can turn to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) for a definition of depression:

"at least two weeks of a depressed mood or loss of interest or pleasure in almost all activities, as well as at least five other symptoms, such as:

We tend to think  of depression as simply a mood. In a way this is accurate. But, of course, moods and feelings are temporary.

But getting locked into a depression cycle quickly escalates into other health issues. By looking at those symptoms, it's easy to see how they can quickly become a problem that spirals out of control.

Sleeping too much decreases productivity and feelings of accomplishment. Sleeping too little leads to fatigue. Rapid appetite/weight gain or loss will change personal body image, most likely for the negative. If weight gain or loss becomes severe, many other problems follow. Constant fatigue makes it difficult to succeed or cope in both personal and professional life.

The list could go on and on. Every problem caused by depression is itself a catalyst for a future problem. And each of those future problems speed up an overall decline. This is why it's so important to interrupt depression immediately.

Because, before long sufferers can get stuck in a deep rut. Nothing that normally resets the mind like a good sleep or exercise seems to make a difference. This leads to greater feelings of worthlessness, guilt, and self-hatred.

Thus the sufferer spirals downward, and without a well-defined support system it becomes incredibly difficult to shake these feelings.

What's Causes Depression?

In his recent book How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence, author Micheal Pollan presents a new (to the public) viewpoint on depression.

In the book, he discusses the brain-imaging research of scientist Robin Carhart-Harris. What Carhart-Harris found is that the 'default-mode network' region of the brain actually shuts down when the subject takes psychedelic drugs.

This is part of the brain that is active when we are ruminating, telling ourselves stories about the past and creating new stories about the future. Rumination is like the opposite of a flow state. Most of us have been in flow at least a few times while doing art, playing sports, having sex, or doing any number of things.

In such a state, it's basically impossible to ruminate. To succeed and find enjoyment in these activities, we must be completely present in the moment. In fact, 'over-thinking it' leads immediately to a poor performance and more negative experience. 

Negative emotions are essentially impossible while we're in a state of flow. This is because the default-mode network shuts down.

But the default-mode network is also the part of brain that helps us construct narratives about ourselves. We know that our lives are largely controlled by the stories we tell ourselves. Our brains churn out self-referential stories.

Can you relate to that feeling of a phrase repeating itself in your mind? Or, while distracted, do you ever find your mind playing out scenarios and visions? Many people report having constructed entire arguments and conversations in their minds while showering or doing something else.

These are signs of the subconscious narrative we have about our lives.

Depressed people seem are stuck in negative narrative cycles. Everything good or healthy that they've ever done disappears from the narrative. Only the negative remains. Feelings of guilt and shame about the past rise up. Feelings of anxiety and bleakness about the future dominate. The depressed person remains stuck in a bad story, feeling powerless to change anything. 

This is all thanks to the default mode network. As Pollen states in his book:

"Another type of mental activity that neuroimaging has located in the DMN (and specifically in the posterior cingulate cortex) is the work performed by the so-called autobiographical or experiential self: the mental operation responsible for the narratives that link our first person to the world, and so help define us. 'This is who I am.' 'I don't deserve to be loved.' 'I'm the kind of person without the willpower to break this addiction.' Getting overly attached to these narratives, taking them as fixed truths about ourselves rather than as stories subject to revision, contributes mightily to addiction, depression, and anxiety."

Is Modern Life Making Depression Worse?

Constructing narratives about ourselves and the world around is is something our brains do naturally. Since the dawn of time, humans have lived their entire lives ensconced in a local community. The only narrative that one could feasibly construct was the narrative of the surrounding community.

Storytelling has always been a cultural affair. Groups have a set of stories. Everyone in the group learned the communal story, where they fit into the group, and what was possible. But today, stories are different.

In many ways, human history has been shaped by the storytelling platforms that exist. The written word, the public square, the printing press, the telegram, the radio, the internet, and every new advance in communications leads to new types of storytelling.

Of course, today, we have social media. This has changed every person from a quiet observer of a communal story into a potential storyteller. Much of what we do in the social media era is performative.

Many people today experience the present moment as a future memory. In other words, we frame our actions by how it will look on Instagram not how it will feel when we're there. That's posting online. Then there's consumption of social media content.

People always pay lip service to the idea of not comparing oneself with others. But we're only human. How are we supposed to understand our place in the world without comparison. Of course, not comparing yourself to others is a good idea. But most of us will engage in at least a little bit of comparison.

Consuming social media is steroids for the default-mode network. Whereas comparison might be healthy in a small tribe as we seek to understand our place, it can be downright debilitating to someone predisposed to depression scrolling social media at 2am.

What to Do

Education is the first and most important thing we can do about depression. If you or someone you know are down, despondent, or disconnected for an extended period of time, it could be a sign of depression

Keep in mind that normal periods of sadness follow difficult events or personal tragedy. But if the feeling is persistent, then it's important to take immediate steps. Seek assistance from a mental health professional. The stakes are too high to do nothing.