Beyond depression: Toward a process‐based approach to research, diagnosis, and treatment.

Abstract

Despite decades of research on the etiology and treatment of depression, a significant proportion of the population is affected by the disorder, fails to respond to treatment and is plagued by relapse. Six prominent scientists, Aaron Beck, Richard Davidson, Fritz Henn, Steven Maier, Helen Mayberg, and Martin Seligman, gathered to discuss the current state of scientific knowledge on depression, and in particular on the basic neurobiological and psychopathological processes at play in the disorder. These general themes were addressed: 1) the relevance of learned helplessness as a basic process involved in the development of depression; 2) the limitations of our current taxonomy of psychological disorders; 3) the need to work towards a psychobiological process-based taxonomy; and 4) the clinical implications of implementing such a process-based taxonomy.

A non-reward attractor theory of depression

“…If an action can be taken, then frustration and anger may arise for the same reinforcement contingency (Rolls, 2014a). This relates the current approach to the learned helplessness approach to depression, in which depression arises because no actions are being taken to restore rewards (Forgeard et al, 2011;Pryce et al, 2011). The sadness or depression may be short lasting if it is a minor non-reward.…”

Neural Implications of Psychotherapy, Pharmacotherapy, and Combined Treatment in Major Depressive Disorder

“…A leading hypothesis is that, by modulating complementary brain regions, PPPT restores informational cross-talk between disrupted or depleted neurocircuits involved in mood regulation (Stahl et al ., 2003[39]; Forgeard et al ., 2011[9]). While both pharmacotherapy and psychotherapy have been shown by fMRI to normalize cortical activity in similar brain regions associated with symptom improvement, evidence suggests that the two modalities may differ in their proximal targets.…”

Chris Peterson’s unfinished masterwork: The real mental illnesses

“…These newly discovered disorders might or might not map onto DSM disorders. I support such an endeavor; promissory and speculative as it is, because it represents theoretical progress beyond the congeries of symptoms in DSM and it coincides with the recommendations in Forgeard et al (2012). Such an endeavor -while years to come to fruition if it ever does, would, like the Peterson disorders, constitutes a viable alternative to DSM.…”

“…The principal granting agency, NIMH, fell into line right away, funding research largely on DSM categories. Because reimbursement was prematurely tied to treating the DSM categories, drugs, and psychotherapies appeared that were tailored to treat the categories -as opposed to treating the underlying biology or the underlying cognitive or emotional basis (Forgeard et al, 2012). The psychological basis and the biological basis turn out to be nonspecific, however, only loosely tied to the categories.…”