How Understanding Depression Goes Beyond The Scientific Method

SHAHLA FARZAN: This is Science Friday. I’m Shahla Farzan.

JOHN DANKOSKY: And I’m John Dankosky. This week, we’re continuing our conversation about depression. Last month, we dug into the science behind antidepressants. We heard about the latest research using genetic testing to better match patients with medications, and we heard about emerging new treatment options like ketamine and psychedelics.

Science has yet to pinpoint exactly why some people experience depression and others don’t. And it may never be able to get to a fully satisfying answer. While people with depression may have similar symptoms, each person’s story is just a bit different. And there’s no one-size-fits-all treatment.

My next guest has spent a lot of time thinking about the nuances of depression. Jon Moe is the host and creator of the podcast Depresh Mode, and he’s the author of a book called The Hilarious World of Depression that is just out in paperback. He joins us now from Saint Paul, Minnesota. John, welcome to Science Friday.

JOHN MOE: Thanks, John. Glad to be here.

JOHN DANKOSKY: So let’s start off with the simple question here. What does the word “depression” really mean? I mean, people toss it around a lot. What does it mean to you?

JOHN MOE: Oh, if only it were such a simple question. That would be really great. The problem with the word “depression” is that it describes a mood and a disorder both. And those are different things.

So people can be sad about something, and they’ll use the word “depression.” I follow the Seattle Mariners, so I could have said, oh, I’m so depressed that after finally getting to the playoffs, they get swept by the Astros. And that’s OK.

But a depressive disorder is a different kind of thing because it can sometimes be sadness. It can sometimes be despair. It’s famous for being immobilizing in some cases. But in my case, it never was. I’ve always been able to get out of bed.

And my depression didn’t often manifest as just being bummed out. It was things like road rage incidents. It was the inability to focus. It was crying for no reason and physically not being able to stop or to isolate what the reason was that might have caused some of this. So it can mean a whole lot of different things. But generally, the disorder part of it is when those conditions, those symptoms make it harder to live your life.

JOHN DANKOSKY: How have you thought about it differently? Over the course of the last few years since you started a podcast about this, and you started talking to a wide range of people, have your ideas about what depression is changed a lot in just the last few years?

JOHN MOE: Yeah, I mean, I was a lot more doctrinaire about it when I started out. I thought, well, unless you have had a psychiatrist tell you you have major depressive disorder or dysthymic depression or something, a term that a practitioner would use, then it’s not real. Then it’s not a real thing.

But I’ve softened a lot because I talked to the comedian and monologuist Mike Birbiglia. He talked about never being diagnosed with depression, but he said, you know, I do have this kind of darkness that kind of envelops me– I’m paraphrasing– and it kind of gets in the way of a lot of things. And I’ve got to try to figure out how I can work my way around it. But I’ve never been diagnosed with depression.

And you know, I’m not a psychiatrist. I’m not a therapist. And I’m like, god, that sounds like depression to me. But at some point, you know, who cares? It’s a darkness. It’s an obstacle that we all need to deal with. And so whether you’ve walked into a doctor’s office and had them write something down on a notepad that assigns you this particular disorder feels kind of immaterial to me.

And then the other thing that has evolved in my thinking is I always assumed that it was about a 50-50 setup of how you might have come to have this condition, between trauma that you faced or just genetics. And I think much more around, like, 85-15 on the trauma side now. Most people I know who have really dealt with something, it’s at least been exacerbated or had the flames fanned by a traumatic incident that, by definition, they have not resolved in their own thinking. And it’s really throwing a wrench into the works.

JOHN DANKOSKY: So let’s talk a bit about trauma. There is a clinical definition, which also tends to be pretty rigid. You know, it’s really reserved for people who’ve been exposed to natural disasters or violence, other life-threatening events. But we hear, just like the word “depression,” John, people throw around “traumatic” an awful lot. So how exactly is trauma defined?

JOHN MOE: Well, I think they throw it around a lot because there’s a lot of trauma in our world, too.

JOHN DANKOSKY: Yeah. Fair enough.

JOHN MOE: You know, there is the kind of trauma that I’ve always thought of with the word “trauma.” You know, oh, that’s when you get mugged. That’s when you get in a horrible car accident. But trauma can mean complex trauma as well. If you’ve been neglected throughout your childhood, if you’ve had a parent with a substance use disorder, if you’ve been in danger or not had security when you should have had security, when you don’t have safety to rely on as a child or as an adult over a prolonged period of time, that eats away at your ability to ever feel secure because of that complex trauma that you’ve had.

I use more of a loose definition of, if it’s something that happened to you that was too much for your brain to process– like, in seventh grade, I was hit by a car on my way to school. And it took me a long time to say, oh, OK, this led to this dread of going to school in the morning that lasted for many years. And this has led to these other incidents in my life.

And that’s been the benefit of therapy, is I can trace, OK, here’s what I’m going through now. Here’s where it might have come from. Here’s how I can manage that in the future, because with a trauma, complex or simple, the brain keeps trying to loop back and process it. And it’s like turning a car over but not having it start, like something is wrong, but you keep going [MIMICKING ENGINE REVVING] with the engine. And obviously, that means you don’t get very far.

JOHN DANKOSKY: Yeah. One of the things that I think people who have depression struggle to do is explain how it feels to others who haven’t experienced it. So how exactly do you describe it to people, John? How do you tell them, this is what depression feels like to me or to somebody else who is experiencing it?

JOHN MOE: Analogies is all I can really use.

JOHN DANKOSKY: Lots of analogies.

JOHN MOE: Lots of analogies. I mean, I have yet to meet someone who can describe depression in a way that I think is really complete and accurate. And that includes very distinguished authors and psychologists that I’ve met and whose work I’ve read. It defies definition.

I will sometimes talk about the relationship between people who have never experienced depression and people who have as like two cars going over this bridge, right? And in one car are the normies who’ve never had to deal with it. And to them, it’s just a nice glide over a bridge. To people who’ve dealt with depression, the bridge is missing slats, and your car is breaking down, and there’s a big sail over the top of it for some reason so that if it’s a windy day, you know you could go plunging off the side at any time, and you’re not sure if you have parachutes for when you do go over the side.

And then, meanwhile, the people in the fast car, the normies, are saying, you should smile more. You should go for a walk. You’d feel a lot better. What do you have to have your car break down about? Your life is going so well. And you’re like, well, that’s not real helpful.

JOHN DANKOSKY: We’ve talked about the way that people want to be helpful when they say, smile more, just go for a walk. A lot of people will also say, well, just go to therapy. We know that therapy works. But as you’ve outlined, it’s not exactly that simple. You went to a lot of therapists before you found therapy helpful. What changed for you over that process?

JOHN MOE: I was hosting a show about depression for a full year before I finally got serious about therapy. And here’s the insidious part about depression. I thought if I could just help other people through doing a show, then that would redeem me somehow, and then my depression– maybe it would get better because I’d be helping people. But I was avoiding the root cause.

And so I had done a bunch of interviews where people talked about cognitive behavior therapy, which is about finding the thought patterns and redirecting the harmful ones. And I finally said, OK, I’m going to go into therapy this time and not treat it like it’s something that’s being done to me. I’m going to treat it like a collaboration.

So I found a therapist who was of an old enough age that I felt that I could trust them. And they took my insurance. They practice cognitive behavior therapy. They were near my house. And I went in there with the idea that I was going to roll up my sleeves and like, OK, let’s work on this.

And that’s when things really started to change for me because the knock, often, with therapy is, oh, you’re just living in the past. You’re just blaming your mother. You’re just blaming your dad. And it’s not that at all for me.

Like, my dad had a substance use disorder with alcohol, and we all suffered as a result of it. I know that that was a mental health condition that he had. I know that it was probably a result of a lot of trauma in his life. He was a child in Norway during the Nazi occupation. I don’t think he ever recovered from that.

So it’s not about living in the past. It’s not about blaming the past. It’s about saying, OK, clear eyed, here’s what went down. Here’s what made me into who I am. What am I going to do now?

JOHN DANKOSKY: And this cognitive behavioral therapy, which has helped you, has a lot of science backing it up. It seems as though this has been effective for people. But John, just like everything else with this problem, it doesn’t work for everyone. And I guess I’m wondering what the limitations are of relying on scientific backed methods like CBT when you’ve got something as elusive to people as trying to solve their depression.

JOHN MOE: Yeah, it’s a real drag because if– I wish there was one thing that worked for everybody. I wish there was, like, an antibiotic, a penicillin of mental health. But unfortunately, it’s not that way. People respond differently to different medications. What I take, I know that somebody I know took the same thing and was in horrible shape as a result. But for me, it helps me get through the day.

And same with different approaches to therapy. Some people need more of a dialectical-based therapy or some other form. It’s such a bummer that the people least equipped to go trial and error on different methods for addressing depression are the people who have to keep trying things, keep throwing the spaghetti against a wall and see what sticks.

Even something like Transcranial Magnetic Stimulation, TMS, which is this relatively new treatment that feels like a sort of magnetic woodpecker that pecks at your head for several days in a row, and people aren’t quite sure why it works, but it often does– even in that scenario, a third of people are completely, evidently, cured of their depression. A third of people feel a lot better for a certain amount of time. A third of people have no effect whatsoever.

And so it is– unfortunately, it’s just this long slog of trying things. And then sometimes something works, and then it stops working because it’s the price we pay for having interesting brains.

JOHN DANKOSKY: Yeah. They are interesting indeed. I’m John Dankosky. This is Science Friday from WNYC Studios. We’re talking with John Moe. He’s host and creator of the podcasts Depresh Mode and The Hilarious World of Depression. The book Hilarious World of Depression is just now out in paperback.

A few weeks ago on this show, we talked about the science behind antidepressants and how they’re not just simply fixing a chemical imbalance in the brain. There’s a lot more going on here. How exactly have antidepressants worked or not worked for you?

JOHN MOE: When I got diagnosed for the first time with a major depressive disorder, it wasn’t until I was in my 30s because of a lot of shame and a lot of denial and a lot of not really understanding that this weirdness that I knew that I had actually wasn’t all that weird. It had a name. It was something that millions of people deal with.

And so when I went into and was given this diagnosis, being told that I’ve had this chronic mental illness my entire life and would probably have to manage it the rest of my life, I was elated. I was so happy that it wasn’t– that I wasn’t alone, that there was a doctor there who could treat it or could at least attempt to treat it. And one of the first things he did was say, OK, we’re going to put you on Zoloft because we want you to feel more functional as quickly as possible.

And it worked for a little bit, and then it stopped working. And I said to the doctor, oh my gosh, I guess meds don’t work. He’s like, no, no, no, this med isn’t working right now. Let’s try something else.

And he did, and it’s like the sun came out. And I became more myself. And that’s the other thought that a lot of people have, is that it’s going to make them into someone else. It’s really just a matter of cleaning a windshield so you could see the world more accurately.

JOHN DANKOSKY: Why do you think that humor is so important when talking about this really, I don’t know, depressing topic?

JOHN MOE: Well, I think it’s kind of funny that there’s this thing that’s invisible and in your head that just wants to ruin everything. Like, there’s no evolutionary purpose to this. There’s no organic parasite in your head causing this to happen. It’s just a drag. I think that’s– I think that’s kind of funny.

I mean, to me, I’ve always been a comedy nerd. And I’ve done a lot of comedy stuff in my career because it has the benefit of looking at the world in a different way. Like, if you listen to a brilliant comedian– Maria Bamford or Mitch Hedberg– it forces you to look at the world in a different way than you normally would, to see kind of the ridiculousness, to see the humor that’s baked into unusual situations.

And I feel like if you can look at the world and have a sense of humor and find the jokes and find what’s odd, then it’s empowering, you know? Because then you’re not stuck with just the traditional, narrow way of thinking. And I think that kind of mind expansion can only help in dealing with something like depression.

JOHN DANKOSKY: John Moe is host and creator of the podcasts Depresh Mode and The Hilarious World of Depression. His book called The Hilarious World of Depression is now out in paperback. John, thanks so much for joining us. I really appreciate it.

JOHN MOE: John, thank you for having me.

JOHN DANKOSKY: If you want to find more of our reporting on depression and mental health, you can go to sciencefriday.com/mentalhealth. Once again, that’s sciencefriday.com/mentalhealth.

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