The hypothalamic axis that regulates responses to stress is also a focus of study.6 But other theories suggest that the mechanism of depression is more of a widespread process than being isolated in specific brain areas. Neuroplasticity, the ability to form new physical connections between neurons, underpins learning and much of the brain’s general functioning, and has been shown to be impaired in people with depression.7 This arguably prevents the brain from responding or adapting to aversive stimuli and stress. Something bad happens, and the impaired plasticity means the brain is more “fixed,” like a cake left out too long, preventing moving on or escaping the negative mind-set. Thus, depression happens and endures. This might explain why depression is so persistent and pervasive; impaired neuroplasticity prevents a coping response. Antidepressants which increase neurotransmitters often increase neuroplasticity, too, so this may be actually why they work as they do, long after transmitter levels are raised. It’s not like refueling a car, it’s more like fertilising plants; it takes time for the helpful elements to be absorbed into the system.
All of these theories may contribute to, or may be consequences rather than causes of, depression. Research is ongoing. What is clear is that it’s a very real, often extremely debilitating condition. Aside from cripplingly awful moods, depression also impairs cognitive ability. Many medical practitioners are taught how to differentiate between depression and dementia, as on cognitive tests serious memory problems and being genuinely unable to muster up any motivation to complete a test look the same, as far as the results are concerned. It’s important to differentiate; the treatment for depression and dementia vary considerably, although often a diagnosis of dementia leads to depression,8 which just complicates matters further.
Other tests show that people with depression pay more attention to negative stimuli.9 If shown a list of words, they’ll focus far more on those with unpleasant meanings (“murder,” for example) than neutral ones (“grass”). We’ve discussed the brain’s egocentric bias, meaning we focus on things that make us feel good about ourselves and ignore things that don’t. Depression flips this: anything positive is ignored or downplayed; anything negative is perceived as 100 percent accurate. As a result, once depression occurs, it can be extremely hard to get rid of.
While some people do seem to develop depression “out of the blue,” for many it’s a consequence of too much time being hammered by life. Depression often occurs in conjunction with other serious conditions, including cancer, dementia and paralysis. There’s also the famous “downward spiral,” where people’s problems mount up over time. Losing your job is unpleasant, but if then your partner leaves you soon after, then a relative dies and you get mugged while heading home from the funeral, this can be just too much to deal with. The comfortable biases and assumptions our brains maintain to keep us motivated (that the world is fair, that nothing bad will happen to us) are shattered. We’ve no control over events, which makes matters worse. We stop seeing friends and pursuing interests, maybe turn to alcohol and drugs. All this, despite providing fleeting relief, taxes the brain further. The spiral continues.
These are risk factors for depression, which increase the likelihood of it occurring. Having a successful and public lifestyle, where money is no object and millions admire you, will have fewer risk factors than living in a deprived high-crime area, earning barely enough to survive and with no family support. If depression were like lightning, some people are indoors while others are stuck outside near trees and flagpoles; the latter are more likely to get struck.
A successful lifestyle doesn’t provide immunity. If someone rich and famous admits they suffer from depression, saying, “How can they be depressed? They’ve got everything going for them,” makes no sense. Being a smoker means you’re more likely to develop lung cancer, but it doesn’t affect only smokers. The brain’s complexity means many risk factors for depression aren’t linked to your situation. Some have personality traits (such as a tendency to be self-critical) or even genes (depression is known to have a heritable component10) that make depression more likely.
What if the constant struggle against depression is what spurred someone to be successful? Staving off and/or overcoming depression often requires considerable willpower and effort, which can be channeled in interesting directions. The “tears of a clown” cliché about successful comics whose skills stem from fighting internal torment is a perfect example, as are many famous creatives who endured the condition (Van Gogh, for instance). Far from a preventative, success may result from depression.
Also, unless you’re born to it, achieving wealth and fame is hard work. Who knows what sacrifices a person made to obtain their success? And what if they eventually realize it wasn’t worth it? Achieving something you’ve worked for for years can rip the purpose and drive from your life, leaving you adrift. Or, if you’ve lost the people you value on your determined upward career path, this can eventually be seen as too high a price. Being successful in other people’s eyes is no defence. A healthy bank balance does not overrule the processes underlying depression. Even if it did, where’s the cut-off point? Who would be “too successful” to be ill? If you can’t be depressed because you’re better off than others, logically only the most unfortunate person on earth should be depressed.
This isn’t to say many rich and successful people aren’t very happy; it’s just not a guarantee. The workings of your brain don’t drastically change because you have a film career.
Depression is not logical. Those describing suicide and depression as selfish apparently struggle with this concept, as if those with depression make a table or chart with the pros and cons of suicide and, despite there being more cons, selfishly opt for suicide anyway.
This is nonsensical. A big problem with depression, perhaps the problem, is that it prevents you from behaving or thinking “normally.” A person with depression is not thinking like a non-sufferer, in the same way that someone who’s drowning is not “breathing air” like someone on land. Everything we perceive and experience is processed and filtered through our brain, and if our brain has determined that everything is absolutely awful, that’ll impact on everything else in our lives. From a depressed person’s perspective, their self-worth may be so low, their outlook so bleak, that they genuinely believe their families/friends/fans would be better off without them in the world, that their suicide is actually an act of generosity. It’s a very upsetting conclusion, but not one arrived at by a mind that’s thinking “straight.”
Accusations of selfishness also often imply people with depression are somehow choosing their situation, that they could enjoy life and be happy but consider it more convenient not to. Exactly how or why they’d do this is rarely explained. In instances of suicide, you get people saying it’s the “easy way out.” There are many ways to describe the sort of suffering that overrides millions-of-years-old survival instincts, but “easy” isn’t an obvious one. Perhaps none of it makes sense from a logical perspective, but insisting on logical thinking from someone in the grip of mental illness is like insisting that someone with a broken leg walks normally.