Etiopathogenic Theories and Models in Depression

344 Pages·2022·4.493 MB·English

by  Juan Pablo Jiménez, Alberto Botto, Peter Fonagy

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
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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