Why Does Depression Exist at All? Practical Implications of an Evolutionary Explanation for Mood By Randolph M. Nesse, M.D.

EMOTIONS - special states shaped by selection to cope with Important situations Usual Q: what ls the function of fear, anger, happiness, etc? Better Q: In what situation is fear, anger, happiness, etc useful? CLINICAL IMPLICATIONS Of knowing when low mood is useful - What to ask: Review of Social Systems - Formulation: The Motivational Structure - Treatment planning: Inividualized - Psychotherapy: Dealing with desires that cannot be fulfilled To understand an individual, find out what the person... -HAS Current resources/sources/security - Wants Goals (to get or to avoid) - PLANS decisions, strategies, enterprises - EXPECTS opportunities, obstacles - REPRESSES (defenses) - CURRENT CONCERNS - EXPERIENCES EMOTIONALLY ROS: Review of Systems - Generaal - Cardiovascular - CNS - Respiratory - Renal - GI - GU - Etc. ROSS: Review of Social Systems - Does this person have secure sources of sufficient: - Personal resources: health, appearance, aabilities - Work & money

- Love & sex - Childern & family - Friends & groups - Status & recognition BEHAVIOARAL ECOLOGY 101 RESOURCE CATEGORIES Effort Somatic Social Reproductive Personal Material Allies Status Mate Offspring Full ROSS: MOP SO FAST, AHA! Money Occupation Partner Sex Offspring Family Allies Status Time Appearance Health Abilities Short ROSS - Are there any very important things you are trying to get or do that are not going very well? Clinician Instruments - Life Situation Assesment - Graphical presentations of motivational structure - More needed Soma: (todos relacionados) Personal Status Material Allies Mate Offspring Motivational Structure Wants Has Expects

Patient Completed Instruments - The Michigan Extremely Difficult Life Situations Inventory - Life Situation Assessment -[More and better needed] ROSS for Mr. B. - Personal resources are intact. Stable although not fully satisfying marriage. Recently laid off from his car sales job, and efforts to get another job are failing, and he is losing his house in a month. Two children doing OK, but one may be addicted to alcohol, and another may have lo leave college. He has friends and is a valued member of a church group, but he gets little social recognition. - Assessment: Ordinary goals, but major deficits in availability of money work and status are having big effects on family and self-esteem. TREATMENT PLANNING Three things combine to cause depression - The Situation - How the person views the situation - The Brain - We can intervene for each one Psychotehrapy - How can ... recognize that he cant succeed in this goal? Not always best (cartel) - Is the person distorting the situation? - Why is reaching the goal dificult? - What alternative strategies are there? - hy cant this person give up the goal? - Whay alternative goals are possible? Is it best to give up or persist? Poor quesion (cartel) - No general answer - It depends on the person x situation - Optimal strategy is flexible -Persist when it is worth it -Quit when efforts will be wasted A nomotetic framework for scientific study of idiographic causes - Nomothetic sata miss crucial variables - A ROSS gets idiographic data on goals that fits in a nomothetic framework - The experienced clinician is a subtle and essential instrument.

- As for well-meaning amateurs... New Variables - Pursuing an unreachable goal or not? - What resource is at issue? - Nature of problem - Obstacle - No strategy - Strategy failing - Conflict with other life goals - Grand goals - All eggs in one basket Specific studies - Is dex nonsuppression higher in those facng conflicts? - Is irritable depression especially common in those facing obstales? - Is anxious depression more common when the goal is to prevent something? - Is retarded depression more common when there is no available strategy? Brain studies - What activates the amygdala msot? - Threat? - Loss? - Obstacles? - Failing eforts? - No knowing what to do? - Goals crucial ato personal identity? Remission - How often is remission initiated by finding a new route to a goal? - How often is it initiatd by giving up a goal? - How often is it initiated by changing cognition or defenses?