Depression is contagious

Depression continues to spread around the world and has become the second most debilitating human condition, according to Dr Michael Yapko, an internationally known depression researcher. Interestingly, this was predicted by the WHO to be the case by the year 2020, but was already reached by 2013!

Suicide rates rise by 5% every year. It is time for a change. In this article I’d like to explain the concept of how depression can spread strictly by social means as a social contagion – a concept supported by a great deal of evidence.

Social contagion vs biology

Michael Yapko points out that the rate and nature of depression vary dramatically from culture to culture. This is unlike schizophrenia, where roughly 1 percent of the population is affected, irrespective of the culture sampled. The rise of depression is not resulting from biology gone crazy.

No one has identified a depression “gene” as such, nor a depression ‘virus’ or malicious bacterium. You cannot get depression when you kiss a depressed person or if she sneezes on you. The notion that biology alone is mainly responsible for psychological disorders belongs to the old school paradigm of “nature vs nurture”.

The paradigm of “nature vs nurture” belongs to an inaccurate black and white / all or nothing thinking, which should have long gone. The epigenetic research of the last decade indeed emphasizes the intertwined nature of social, environmental factors and biology factors. This research shows that life experiences in fact shape biology and actually alters genetic expression. This sophisticated research finally farewells the “biology vs environment” dualism to the graveyard of deceased paradigms.

Yet it is still surprising to me how often I hear that “Depression is caused by a bio-chemical imbalance in the brain”, or that depressive symptoms are an expression of a “depressive disease” caused by unspecified biological factors. Subsequently, anti-depressant medication is prescribed, often without referring to a well-trained psychologist. Australia is the second-largest prescriber of anti-depressants in the developed world.

For at least three reasons, prescribing anti-depressants on such a large scale is problematic.

  1. Firstly, research clearly shows that the best treatment for depression is either (1) psychotherapy or (2) a combination of medication and psychotherapy. Medication alone has the highest relapse rate, which is not surprising because medication does not teach you any skills.
  2. Secondly, the implicit message that is sent with the “chemical imbalance in the brain” notion, is that other avenues of treatment are adjacent and less important. So often I have had clients telling me that their doctor had suggested trying medication first for three months, “if it does not work you can still see someone”. Depressed people are often not the most pro-active people and medication reinforces a non pro-active approach.
  3. Also, research makes very clear that medication is neither as safe nor as effective as we are made to believe. Over decades, the effectiveness on average is only a little above the placebo effect (!). Nevertheless, medication can be useful for some people and under certain circumstances. Medication should be reserved for moderate to severe cases only, and in conjunction with psychotherapy, not as stand alone treatment.

Medication can be useful in cases when e.g. very anxious people feel too paralysed to do anything and can do with drug support as a kickstart. Yet, it requires psychological therapy to learn to how to manage their moods, their fears, their life style, how to heal from past hurts, how to be a better partner etc. When depressed people experience (learn!) that they can manage their lives and challenges, it is one of the most important drivers to recovery. When a consistent approach is taken for a while, self-efficacy is built and helplessness is reduced.

The contagious nature of interaction

The rise of depression reflects the cultural values and social conditions, but let’s start with looking at the individual level. How is the social spread of depression achieved by social contagion?

Have you ever entered a room and could feel the mood in an instance? Have you every been exposed to a depressed person displaying distinct negativity? If so, wow do you feel after say 30 minutes?

The following example is taken from Michael Yapko (2012): “It’s exhausting,” says Sarah Paul, 50, manager of records for an insurance company in Seattle. “My husband is depressed much of the time. He can suck the joy out of things faster than anyone I’ve known. It’s hard on me because I feel like I can’t talk about negative things very often; he’s already so down. It’s so frustrating I also deal with depression.”

People suffering from depression deplete your energy, sooner rather than later. They often feel helpless (like victims) and tend to make other people around them feel helpless too. Not surprising then, that people suffering from depression have more marital and family arguments, and have less satisfying relationships.

Children pick up on their parents communication style and develop their own habits in response to the style they are exposed to. They learn from their parents, for a majority of their formative years, because they are exposed to the parents’ style. Parents display a certain style of thinking, a certain style of how to use information, what they consider to be important (what not), their way of problem-solving, their interpretive style, their emotional regulation, their way of managing stress and adversity.
The cognitive, emotional and behavioural characteristics that parents display reverberate in their children again and again. Children are like sponges who soak everything up that comes from the parents which makes the exposure to the parents the most important source of influence. Just for a moment, consider how many times do children hear a parent making a comment on something? How many conversations on the breakfast or dinner table take place that displayed each family member’s cognitive, emotional and behavioural style until the age of 18? Uncountable times! It is impossible to be not affected by it.

Other influences from extended family may play a role too (thank god for that!) but to a much lesser degree.

Therefore it is also not surprising that one of the biggest risk factor for someone is when a parent suffered from depression. The risk to develop a depressive disorder is 3 to 6 fold compared to the risk to develop depression when you don’t have a depressed parent. Just having a depressed parent is one of the strongest risk factors there is.  Long-term epidemiologic studies show that depression intensifies from one generation to the next. We are on average four times more depressed than our parents and ten times more than our grandparents. This is not just a reflection of greater awareness of the disorder.

Psychological reproduction

Feelings of helplessness and hopelessness are core elements of depressive disorders, and one of the cognitive factors. People have a tendency to feel victimised by circumstances (“The government do a shit job”) and have often global expectations “I just want to have a good relationship” but they fail to know what to do. Combine that with a relatively passive approach and it is easy to predict that this “good relationship” is not going to happen.

Even more important is that people suffering from depression victimise themselves. They corroborate helplessness time and time again, creating what we call a self-fulfilling prophecy: “I’m not good enough”, “I cannot do it”, “I don’t have the skills”, “I do it when I feel better”, “Why should I do it when I do not feel like doing it”… Discouraging and even devaluing ourselves is a big one and it often starts – you guessed it – early in childhood when we were exposed to criticism or when we heard parents being self-critical or self-sabotaging in one or another way.

Often, people utter the opinion that someone became depressed because of an incident. Jo became depressed after he was made redundant, Ken became depressed when his father died. Joanna could not get over the passing of her elderly parents and became depressed thereafter. Maria could not cope with her husband leaving and developed a depressive disorder.

Yet, this is only the superficial layer of the chronological order of incidents. In fact, depression does not hit out of the blue. It may often seem that a tragic event can be identified at the onset of the depressive episode but the risk factors had been in place for years. Statistically, most suffer from depression have a co-existing condition, most commonly an anxiety disorder of some sort. The co-existing disorder precedes depression by years. A child who is anxious at age eight or ten is at high risk for becoming a depressed adult, which, to the aware adult, presents an opportunity for preventive intervention.

I hope that by now you have gained some insights into the social passing on of depression, and I have not even discussed the cultural factors, like stigma and other public opinions that influence broader parts of the population.

Yet, it might not be surprising anymore that people suffering from depression often do not ask for help, because they believe there is not much that can be done. Consequently depression remains untreated which reinforces further spreading.

The good news is, you or a relative can do things differently. Be smart. Become active, seek help until you found it. Do your research to find a GP who has a special interest in Mental Health.

If you have a question please ring us, we are happy to assist.

All the best for 2017

Frank Breuer, Clinical Psychologist

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