Etiopathogenic Theories and Models in Depression PDF
Preview Etiopathogenic Theories and Models in Depression
Depression and Personality Juan Pablo Jiménez Alberto Botto Peter Fonagy Editors Etiopathogenic Theories and Models in Depression Depression and Personality Series Editors Mariane Krause Millennium Institute for Research in Depression and Personality; School of Psychology Pontificia Universidad Católica de Chile, Santiago RM-Santiago, Chile Guillermo de la Parra Millennium Institute for Research in Depression and Personality; Department of Psychiatry Pontifical Catholic University of Chile Santiago, RM - Santiago, Chile Alemka Tomicic Millennium Institute for Research in Depression and Personality; Faculty of Psychology Universidad Diego Portales Santiago, RM - Santiago, Chile The Depression and Personality book series presents cutting edge knowledge regarding the causes, treatment, and prevention of depression from a perspective that takes into account the interaction between depression and personality and the influences of multiple dimensions that contribute to the development, maintenance, and exacerbation of depression in different populations. The series is published in collaboration with the Millennium Institute for Research in Depression and Personality (MIDAP), a scientific center of excellence in Chile made up of psychologists, psychiatrists and professionals from various areas of social sciences and health, who seek to generate knowledge based on a multidimensional understanding of depression. MIDAP’s characteristic multidimensional and multidisciplinary approach implies the development of an empirically-based model that takes into account the etiology, prevention, intervention, and rehabilitation of depression. This multidimensional and multidisciplinary model is evidenced in the titles of the series, which cover, individually or in combination, the following topics: 1. Basic bio-psycho-social structures and processes involved in depression and its interaction with the personality. 2. Health promotion and psychosocial intervention strategies that would prevent early conditions associated with the development of depression and personality dysfunction. 3. Psychotherapeutic interventions and mechanisms involved in symptomatic relief and change processes in diverse types of depressive patients. 4. Rehabilitation and reintegration interventions oriented to reduce the chronicity of depression and to maintain gains after treatment, as well as, topics regarding early- life maltreatment and co-morbid personality dysfunction as risk factors of chronic or recurrent courses of depression. More information about this series at http://www.springer.com/series/16388 Juan Pablo Jiménez • Alberto Botto Peter Fonagy Editors Etiopathogenic Theories and Models in Depression Editors Juan Pablo Jiménez Alberto Botto Department of Psychiatry and Department of Psychiatry and Mental Health East Mental Health East Faculty of Medicine Faculty of Medicine University of Chile University of Chile Millennium Institute for Research Millennium Institute for Research in Depression and Personality (MIDAP) in Depression and Personality (MIDAP) Santiago, RM, Chile Santiago, RM, Chile Peter Fonagy Research Department of Clinical Educational and Health Psychology University College London London, UK ISSN 2662-3587 ISSN 2662-3595 (electronic) Depression and Personality ISBN 978-3-030-77328-1 ISBN 978-3-030-77329-8 (eBook) https://doi.org/10.1007/978-3-030-77329-8 © Springer Nature Switzerland AG 2021 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface We would like to begin this preface by recalling the parable of the wise blind men and the elephant, which is very well suited to introducing a book of this nature. This well-known story, which originated in ancient times in India, is often used to high- light the difficulties of dialogue between different perspectives in the face of reality. In the various versions of the story, a group of blind men who have never come across an elephant before are invited to touch the body of the animal to grasp what it looks like. Each of them touches a different part, but only one part, such as a leg or a tusk. Then, they compare their observations and realize that they do not agree at all. The blind men argue heatedly trying to impose their own version, until the king who summons them says, “You are all right. The reason each of you is saying different things is that each of you touched a different part of the elephant. Therefore, the elephant has all the characteristics you mentioned”. Grasping our point, the sagacious reader will already have substituted the word “elephant” with “depression”. Indeed, depression is a polymorphous heterogeneous condition, with varied clin- ical presentations. Moreover, there is a broad scientific consensus about the fact that what we call depression probably includes very different groups in terms of aetiol- ogy and mechanisms of production. To further complicate matters, in the last few decades, social scientists have pointed out that the term “depression” is used collo- quially, at least in the Western world, to refer to the social malaise derived mainly from the model of society that governs us. Thus, we understand depression as a heterogeneous and complex phenomenon that needs to be addressed not only by the natural and medical sciences but also by the social sciences and the hermeneutics of cultural manifestations. In this book on theories and etiopathogenic models in depression, we have invited different authors from various disciplines of brain/mind research to collabo- rate so that, as in the parable of the elephant and the blind wise men, they can share what they understand, from their particular disciplinary point of view, about the depressive condition. In a twist on the ending of the parable, we want the blind men (and women) to continue talking to each other, with the aim of finding, among all of them, certain invariant qualities common to their multiple perspectives, beyond the incommensurabilities. The authors of the chapters were asked to critically review v vi Preface the state of the art in their field of expertise and to present their views without losing sight of the fact that depression is a complex phenomenon, that is, one where no single theory or model can offer a fully comprehensive explanation and, eventually, to explain the weak points of their own theories and their possible openness or attachment to alternative theories or models. This was intended to reinforce the interdisciplinary perspective of the book. We think that such an integrated perspec- tive is of great translational value for clinical practice and for the construction of public policies that can be applied by government agencies. This is an ambitious book in the sense that it aims not only to juxtapose theories with variable degrees of incommensurability between them, but to go further, collaborating in the construc- tion of a pluralistic and integrated model that can be used by clinicians and policy makers in the design of public policies. Certainly, the book that readers have in their hands falls short of this goal, but we expect it to be a step in the right direction. We subscribe to the idea that the present and future of Mental Health research should be guided by the principles of explanatory pluralism. In Chap. 1, we address the diffi- culties that impede this integration. As a matter of fact, in our work we face a general scientific problem of our times, namely the realization that the relevant problems afflicting humanity are complex in their presentation and causes and must be tackled in a transdisciplinary way. The current crisis caused by anthropogenic climate change teaches us that the various scientific disciplines, the natural and the social sciences, must work together, because if a complex phenomenon is addressed in a partial manner, without simul- taneously considering the multi-level interaction of the various concurrent etiologi- cal factors, it is not unlikely for the problem being addressed to end up getting worse, i.e. to produce what in medicine we call iatrogenesis. This book, then, is also an exercise in inter- and transdisciplinary collaboration. Various studies, using different methodologies, confirm that Chile has around 20% more depressive disorders than the world average. Even more shocking is the fact that, according to the latest National Health Survey (2017), Chilean women report 5 times more depressive symptoms than Chilean men, while in the rest of the world the female/male ratio is between 2:1 and 3:1. This is a striking difference that needs further scientific explanation. In 2014, a group of researchers from 6 Chilean universities, coming from a vari- ety of disciplines such as Psychiatry and Public Health, Psychology, Sociology, Genetics, and Anthropology, got together to apply for funding from the Millennium Scientific Initiative, which the Chilean State makes available to natural and social scientists to investigate problems relevant to the development of the country and the welfare of its population, and to propose public policies that can be subsequently implemented. After an international competition, our group was awarded funding in 2015, and in 2019 the funds were renewed for five more years. This is not the place to report the numerous goals accomplished in these years by some 160 researchers from every level within MIDAP’s hierarchy, together with undergraduate and postgraduate students, global collaboration network members, and visiting foreign researchers. However, given that MIDAP’s multiple research projects –which have so far yielded over 200 publications in indexed journals– have Preface vii enabled us to delineate several central features of depression, we feel that it is worth mentioning a few of them. Our studies confirm that depression is a clinical condition of heterogeneous pre- sentation and complex aetiology. Although this is a well-known fact, we have been struck by the enormous aetiological weight that environmental variables have in the onset and maintenance of depressive symptoms and disorders. In contrast to the biomedical model that continues to predominate in psychiatry, we have been sur- prised by the weight of what have been called the “social determinants of mental health”. One factor that stands out in multiple studies is the importance of early trauma for the onset and course of adult depression. The association between depression and social malaise, which reflects the huge inequality gap in Chilean society (like in all the Latin-American region), and which led to a social and politi- cal explosion at the end of 2019, has been confirmed by many scientific studies. The Covid-19 pandemic has highlighted structural social inequality and the weight of social determinants in epidemiological figures. The chapters of the book are grouped according to a thematic logic. The first four chapters are introductory and touch on epistemological, methodological, diagnostic (clinical), and sociological problems of the scientific study of depression. These are followed by two chapters devoted to the field of psychological aetiology. Chapters 7, 8, 9, and 10 are devoted to the genetics, neurobiology, and psychophysiology of depression. Chapter 11 deals with the influence of labour laws and psychiatric cul- ture on the diagnosis of depression. Chapter 12 looks directly at the impact of pov- erty and social inequality on depression. Chapter 13 approaches depression from the perspective of developmental psychopathology. Chapter 14 explores the com- plex relationship between personality and depression. Chapter 15 looks at the hot topic of women, transgender, and gender non-conforming depression. The book ends with a chapter that asks how different etiopathogenic models can be applied in the diagnosis and treatment of a particular patient. Santiago, Chile Juan Pablo Jiménez Alberto Botto London, UK Peter Fonagy Contents Part I Epistemology, Epidemiology, Psychopathology and History of Depression 1 The Study of Depression in the Frame of the New Research Paradigm in Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Juan Pablo Jiménez, Alberto Botto, and Peter Fonagy 2 Psychopathology of Depression in the Spectrum of Mood Disorders 31 Paul A. Vöhringer, Pablo Martinez, and José Manuel Arancibia 3 Epidemiology of Depression: Burden of Disease, Trends, and the Contributions of Social Epidemiology to the Study of Its Causes . . . 47 Rubén Alvarado and María Soledad Burrone 4 Idioms of Depression in Contemporary Individualistic Societies: The United States and Chile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Claudio Maino Orrego Part II E tiopathogenic Theories and Models 5 Contemporary Psychodynamic Theories on Depression . . . . . . . . . . . 91 Marianne Leuzinger-Bohleber 6 Theory and Interventions in Cognitive Behavioral Therapy for Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Andrés Beltrán-Gabrie, Daniela Lira, Vanetza E. Quezada-Scholz, and Tomas Arriaza 7 Genetic and Epigenetic Determinants of Depression: From Basic Research to Translational Medicine . . . . . . . . . . . . . . . . . . . . . . 141 Luis A. Salazar and Tomás Zambrano ix x Contents 8 Neurobiology of Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Hernán Silva 9 A Dimensional and Dynamic Approach to the Neurobiology of Mood Disorders: On Intermediate Phenotypes and Their Interaction with Early Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Ulises Ríos 10 Psychophysiology and Psychoneuroendocrinology of Stress and Reward in Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Jaime R. Silva, Franco Medina, and Manuel S. Ortiz 11 Depression and (Expert) Culture: Psychiatric, Regulatory and Moral Frameworks Underpinning the Absence of Depression in Occupational Health in Chile . . . . . . . . . . . . . . . . . . 201 Sofía Bowen 12 Poverty, Social Inequity, and Depression . . . . . . . . . . . . . . . . . . . . . . . 223 Alvaro Vergés Part III E volution and Development as an Integrating Framework 13 An Integrative Developmental Psychopathology Approach to Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245 Patrick Luyten and Peter Fonagy 14 Depression and Personality Dysfunction: Moving from Descriptive Comorbidity to the Identification of Common Intermediate Phenotypes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Alex Behn and Mariane Krause 15 Gender and Depression: Women, Transgender, and Gender Nonconforming Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281 Caroline Leighton and Claudio Martínez Part IV C linical Practice as a Meeting Place for Etiopathogenic Models 16 Models in Depression and Clinical Judgment, or How to Use Different Etiopathogenic Models with a Particular Patient . . . . . . . . 315 Juan Pablo Jiménez and Alberto Botto Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
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