Sapolsky

" So there are all sorts of these great made for TV movie diseases out there. But when you want to come to basic meat and potatoes of human medical misery, there is nothing out there like depression. Depression is absolutely crippling. Depression is incredibly pervasive, and thus important to talk about.

I’ll make the argument here today, a number of things, but one critical thing being that basically depression is like the worst disease you can get. And I’ll make the argument for that in a bit. It is devastating. 

There is a neurotransmitter called Substance P. And what Substance P is about is pain. Jab your finger or your spinal cord and there will be neurons releasing substance P, talking to each other. It’s about pain. It’s about chronic pain syndrome, which is about whole body burns. Everybody knew this.

And then it was discovered that if you get a drug that decreases Substance P signaling, sometimes depressives get better. What does that suggest? It is not just a metaphor that depression is psychic pain. Your body is using the same brain chemistry to feel this sort of pain as it is when it tells you: ooh, I just stubbed my toe''.

The everyday depression that we all have now and then, that sort of version. The second one, the something awful happens and you feel terrible for a while, and then come out the other end, a reactive depression. The third version, where you are flattened by it for long periods afterward, a major depression. And what you also see with people with major depression after a while is it doesn’t take something awful externally to trigger one of those again.

Okay. So what are the symptoms about? If I had to define major depression in one sentence, I would say, it’s a biochemical disorder with a genetic component, and early experience influences, where somebody can’t appreciate sunsets. And that’s what this disease is about.

And when you think about it, that is a very sad thing. You look at some of our major diseases...and you see the most unlikely things out there. You see somebody saying, well, obviously I’m not glad I’m dying...But without this disease, I never would have realized the importance of friends. I never would have reconciled with my family members. I never would have found my God. On a completely weird level, I’m almost glad this has happened to me. Humans have this astonishing capacity to derive pleasure out of the most unlikely domains. What could possibly be worse than a disease whose defining symptom is the inability to feel pleasure?

Thus, at the top of the list, anhedonia — hedonism, the pursuit of pleasure, anhedonia the inability to feel pleasure. That is what a depression is about. And you get someone who has just had some enormous good luck...And they feel nothing, an inability to feel pleasure, way at the top of the list.

It is all around us. And amid it being all around us, there is this weird, corrosive inhibition, embarrassment, discomfort we have with the world of psychiatric diseases. One of the greatest things — if you’re a researcher with a disease, one of the things you pray for is to for some powerful Senator to have their loved one come down with your disease because they’re going to setup a foundation, and get special funding. And there’s advocacy groups and all of that. Not for a psychiatric disorder, that’s the one where people don’t talk about it.

Robert Sapolsky