San José, Costa Rica, since 1956

On the cause and cure of depression

From the print edition

Depression is a well-known and universal mood disorder characterized by a wide range of negative sensations including pessimism, anxiety, insecurity, despair, self-loathing and, in extreme cases, suicide or catatonia. The literature is signally unhelpful concerning the etiology of depression, so first let me roundly assert that it is a disorder of the “fight or flight” mechanism (FOFUM) which every organism requires for continued existence.

To assist understanding, it is convenient to adopt the viewpoint of a Designer contemplating the introduction of a new species. The first requirement is a sense of self, of “me” (or “us”) as distinct from “them.” The second is self-replication; our creation cannot expect us to stick around to recreate every time a part wears out.

Then because our world is already teeming with other organisms which to exist must destroy us, the next most important requirement is FOFUM. In order for this to work, following every challenge FOFUM must first create a series of hypothetical mental scenarios ranging from ‘attack and destroy’ through less aggressive solutions to “run for your life.”

FOFUM must then examine and compare each scenario and decide which is most appropriate in the circumstances, taking into account the attendant risks. Although no muscular action has yet occurred, the consequences of acting on each scenario must be assessed. Finally, FOFUM must select the optimum scenario and initiate muscular action, while remaining alert to countermand the order if the situation deteriorates, and not forgetting to delete the unselected scenarios. This review of response options takes place before any conscious activity, from lifting a finger to killing an enemy.

Any activity, mental or physical, is mediated by neurotransmitters and inhibitors, more than forty of them according to location.

Obviously, they must be easily broken down to do a proper job and so are synthesized as needed in minuscule amounts, and consequently are rapidly depleted following excessive use, such as in high stress situations like armed combat, overwork, domestic strife, unemployment, sickness or forced immobility.

In particular FOFUM, in selecting a “flight” scenario, may be unable to delete the unwanted “fight” scenario, so that both become activated together, resulting in self-loathing, suicide or catatonia. Thus every one of the symptoms characterizing depression may be attributed to faulty operation of FOFUM, and, ultimately, to the basic design of the nervous system.

The cure for depression follows from recognizing the cause. For irregular bouts, if you have a serotonin reuptake inhibitor handy, use it. Otherwise a bar of milk chocolate or a couple of brownies followed by a brisk walk and hyperventilation may be helpful. But for long-term depression, furious physical activity with a total, and I emphasize total, change of environment is essential. 

Jack O’Brien

Jack O’Brien

Unfortunately, this is often what the patient will not accept, but it is prerequisite to recovery. Of course, removal of the proximate cause, such as depletion of a particular neurotransmitter, should not preclude attention to the distal cause, being challenges too numerous or overwhelming to be easily handled. But that calls for the advice of your travel agent, not mine.

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