Depression is among the most common problems encountered in clinical practice, yet most psychotherapists still accept the cultural assumption that it’s primarily a problem of the individual. Myopically focusing on the individual has become a habit of mind. Best estimates are that about 35 million American adults will, at one time or another, struggle with depression. That’s nearly 1 in 5 people, so it’s no hyperbole to say that we’re the midst of a depression epidemic.
According to worldwide projections from the World Health Organization (WHO), by 2030, the amount of disability and life lost from depression will surpass that from war, accidents, cancer, stroke, and heart disease. In fact, WHO reports that for youth aged 10 to 19, depression is already the number-one cause of illness and disability. And according to the Centers for Disease Control, antidepressant use has increased 400 percent since 1988 in America.
A paradox about depression is that, while more research and treatment resources have been poured into combating it than ever before, its personal and economic toll has actually grown. How can it be that—despite all the efforts aimed at understanding, treating, and educating the public about this condition—rates of depression continue to rise? Why have our treatments plateaued in their effectiveness, and why does the stigma associated with this condition remain very much with us?
The Rise of Mood Science
Depression has clearly been a tough nut to crack, but we haven’t focused much on what’s at the center of that nut: mood. The main approaches to depression have instead focused on other domains, such as cognition, biology, or social functioning. Diagnostically, though, the defining feature of depression is persistent low mood, and the typically depressed person reports moods that are excessively dull, empty, and sad, as well as lacking joy, excitement, or cheer.
A problem throughout most of the 20th century was that researchers doubted that something as evanescent as mood could be studied with precision or objectivity. Fortunately, this has changed. Just as CAT scans and functional magnetic imaging allowed physicians to see the innermost recesses of the body, so, too, in the last 30 years, has an increasingly sophisticated assessment methodology enabled us to measure mood and emotion. The emerging field known as affective science now benefits from a wealth of measurement tools, with techniques for measuring the moods that people report, systems for measuring behavior in the lab and in the field, and ways to monitor the physiology of mood and emotion, from functional brain scans to miniature sensors that monitor the body as people go about their everyday lives. The result has been a wealth of insights about “normal moods” that we can use to understand why we have a depression epidemic—an important first step in bringing it under control.Depression in Context
Although low mood is a primitive adaptation built into our very makeup, the conditions of modern life can set it into overdrive, creating a perfect storm for mood. In just a few hundred generations, humans colonized the planet, built cities, and invented technologies beyond the wildest dreams of earlier times. Today, the dizzying speed of change in our physical and cultural environment has outmatched the pace of evolution of our nervous systems to keep up. What was once a perfectly good adaptation to a less revved-up and stimulating world is out of step with the demands of modern life.
Our unattainable cultural imperative for happiness, combined with the basic principle of hedonic adaptation, is a cruel combination. When people fall outside the zone of their desired mood, as they inevitably do, they consider this a personal failure. An increasing percentage of the population reports itself as being chronically dissatisfied and chronically overacting to low mood. When many of the same people engage in mood-punishing routines that feature too little sleep, light, and physical activity, you have the seedbeds of the depression epidemic.Psychotherapy and Mood Science
It’s important for therapists to become more systematic in assessing the factors that shape mood. An inventory of a client’s mood environment would include lifestyle choices, sleep regimen, light exposure, physical-activity levels, stressors, and progress toward major goals. But it would also include a client’s expectations for mood and how he or she reacts to and copes with negative feeling states.
The right goals should be applied to therapy too. Therapy for depression should set the bar higher than just reducing symptoms, which is the standard goal of the disease model of depression. Rather, the mood science approach takes seriously the aspiration for wellness. This is because wellness and thriving are more robust and clinically meaningful endpoints than reducing symptoms. Epidemiological research shows that people who achieve full symptomatic relief for a significant amount of time are less vulnerable to subsequent relapse. This isn’t a vision of lives without any moments of low mood. Rather, achieving a period of wellness, one that lasts at least a few months, allows a person to rebuild critical resources—friendships, coping skills, and life purpose—that buffer the person against the shocks they’ll inevitably face. Without such a wellness period, improvement collapses like a house of cards.
Understanding the forces that are seeding low mood in the depression epidemic can help us better understand how to achieve better therapeutic outcomes. We know that mood is the great integrator: we can alter it in an upward direction by changing how we think, the events around us, our goals, our relationships, what’s happening in our bodies (by exercising or sleeping better), and, yes, our brains (through medications or diet). Mood science, at its core, advises resourceful experimentation. Most therapeutic approaches pull only one lever: brain change, relationship change, cognitive change. A mood science approach urges us to look to a broad array of levers that may be used to influence mood.