We critically review evolutionary theories of major depressive disorder (MDD). Because most instances of MDD appear to be caused by adversity, evolutionary theories of MDD generally propose that sadness and low mood evolved as beneficial responses to adversity, and that MDD is dysfunctional sadness and low mood. If so, MDD research should focus much more heavily on understanding the healthy functions of sadness and low mood to better understand how they dysfunction. A debate about the boundary between healthy sadness and MDD is then reviewed. In part, this debate turns on whether MDD's costliest symptoms could provide unknown benefits. Therefore, the review concludes by discussing 2 theories that explore possible benefits of prolonged anhedonia and suicidality.Can J Psychiatry. 2011;56(12):716-726.
Clinical Implications⢠The clinical implications depend on which, if any, of these evolutionary theories of MDD is correct. In general, if MDD is dysfunctional sadness or low mood, then the primary goal of psycho-or chemotherapy would be to restore healthy sadness and low mood, and not simply to reduce MDD symptoms. Conversely, if MDD is functional, then therapy would aim to solve the social problem that triggered the MDD.⢠In particular, if MDD is an involuntary subordinate strategy, then therapy should involve encouraging patients to let go of important but seemingly unobtainable life goals that involve conflicts with higher-status people. However, if the analytical rumination hypothesis is correct, then therapy should instead focus on identifying and solving the complex life problem that triggered the MDD. In some patients, and contrary to the involuntary subordinate strategy hypothesis, this may involve redoubling efforts to achieve a seemingly unobtainable life goal.⢠Finally, all psychosocial theories of MDD imply that it may be possible to prevent MDD by identifying and avoiding social risk factors. For instance, the credible signalling hypothesis highlights the potent MDD risk posed by the confluence of social conflict, powerlessness, and adversity, each of which, in principle, could be reduced with appropriate interventions.
Limitation⢠The primary limitation of all evolutionary theories of MDD is that, although each is a reasonably parsimonious account of known facts about MDD, few of their novel predictions have been explored. In other words, these theories are largely untested.