Why Me?

Those of us who suffer from depression often ask the question – “Why me?” Depression is very common and sometimes does not need any external help to attack. Many times, however, there are external stressors that trigger episodes. The list of potential stressors is quite long, and can include positive stress such as a new partner, job, or house, these are in addition to those things we normally consider: life incidents such as illness, loss of a job, death of a loved one, end of a relationship, bullying, accidents, and other traumatic events.

But, why do some people shrug these off, or react with  as if these stressors are minor speedbumps, while others collapse? Geoff Watts in BBC News Magazine takes a look at a different approach to this question.

A person who goes through experiences like that and does not get depressed has a measure of what in the psychiatric trade is known as “resilience”.

According to Manchester University psychologist Dr Rebecca Elliott, we are all situated somewhere on a slidling scale.

“At one end you have people who are very vulnerable. In the face of quite low stress, or none at all, they’ll develop a mental health problem,” she says.

“At the other end, you have people who life has dealt a quite appalling hand with all sorts of stressful experiences, and yet they remain positive and optimistic.” Most of us, she thinks, are somewhere in the middle.

Defining something does not necessarily make it any easier to pin down. Is resilience inherited or developed from environment factors or some combination of the two?  Most importantly, how can we increase resilience? The answer is ‘sometimes’. The treatments so far involve talk therapy, drugs, and electro-shock therapy. Watts reports that new research in the UK is looking into this subject.

With the support of the Medical Research Council, Bill Deakin, Rebecca Elliott and their colleagues are peering into the brain, trying to fathom the origins and nature of resilience. They think that a better understanding of it might pay dividends in helping those who lack it.

The subjects of their study are a mixed bunch – intentionally so. Some have suffered bouts of depression, others have not. Some have had more than their share of adverse life events, while others have had an easier time of it.

In knowing where to start looking for the differences that might underpin resilience to depression the Manchester group has the advantage of being able to draw on previous work that has investigated resilience to post-traumatic stress disorder.

This, says Bill Deakin, has pointed them to several relevant features of brain function. They include cognitive flexibility – our capacity to adapt our thinking to different situations – and also the extent to which our brains concentrate on processing and remembering happy, as opposed to sad, information.

Each subject in the Manchester study has been allocated to one of four groups based on the four possible combinations of high and low life stress, with or without depression. All have given saliva samples from which their stress hormone levels can be measured, and many of them will undergo a brain scan.

The researchers are using the technique of exposing subjects to emotionally charged visual stimuli and recording reactions and memory of the images with a MRI scan.

The research is not yet complete, so Rebecca Elliott can’t say whether there are distinct differences in brain function between the groups. But there are encouraging hints, such as the correlations she’s finding between the psychological measurements of her subjects’ resilience and how they perform on some of the tests.

“For example, our early data suggest that people who are more resilient are more likely to recognise happy faces and less likely to recognise sad or fearful faces. The more resilient someone is, the better they remember positive words and pictures.”

I didn’t see the article whether or not they included people before and after treatment courses, or the inclusion of people who suffer from severe depression. One of the recent discoveries in anti-depressant treatments is that they are not very different from placebo for mild depression, but can be very effective for severe depression.

Resilience may function as a concept of unipolar depression, but I’m not sure how it fits with the depressive aspect of bipolar disorder.

I’m also not sure what sort of difference there would be between teaching resilience and and behaviour modifications such as Cognitive Behaviour or Dialectical Behaviour Therapy.

Resilience is a new idea in the battle against depression, and it remains to be seen just how useful it will be.  In any case, additional weapons and approaches to fighting mental illness are always welcome.




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