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The dynamic nature of depression: a new micro-level perspective of mental disorder that meets current challenges

Published online by Cambridge University Press:  14 August 2013

M. Wichers
M. Wichers*
Affiliation:
Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
*
* Address for correspondence: M. Wichers, Ph.D., Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616 (location VIJV), 6200 MD Maastricht, The Netherlands. (Email: [email protected])
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Abstract

The examination of moment-to-moment, ‘micro-level’ patterns of experience and behaviour using experience sampling methodology has contributed to our understanding of the ‘macro-level’ development of full-blown symptoms and disorders. This paper argues that the micro-level perspective can be used to identify the smallest building blocks underlying the onset and course of mental ill-health. Psychopathology may be the result of the continuous dynamic interplay between micro-level moment-to-moment experiences and behavioural patterns over time. Reinforcing loops between momentary states may alter the course of mental health towards either a more or less healthy state. An example with observed data, from a population of individuals with depressive symptoms, supports the validity of a dynamic network model of psychopathology and shows that together and over time, this continuous interplay between momentary states may result in the cluster of symptoms we call major depressive disorder. This approach may help conceptualize the nature of mental disorders, and generate individualized insights useful for diagnosis and treatment in psychiatry.

Keywords

Ecological momentary assessmentexperience sampling methodologymajor depressive disordermechanismsnetworkspersonalized medicine
Type
Review Article
Information
Psychological Medicine , Volume 44 , Issue 7 , May 2014 , pp. 1349 - 1360
Copyright
Copyright © Cambridge University Press 2013 

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References

Borckardt, JJ, Nash, MR, Murphy, MD, Moore, M, Shaw, D, O'Neil, P (2008). Clinical practice as natural laboratory for psychotherapy research: a guide to case-based time-series analysis. American Psychologist 63, 77–95.CrossRefGoogle ScholarPubMed
Borsboom, D, Cramer, AO (2013). Network analysis: an integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology 9, 91–121.CrossRefGoogle Scholar
Borsboom, D, Cramer, AO, Schmittmann, VD, Epskamp, S, Waldorp, LJ (2011). The small world of psychopathology. PLoS ONE 6, e27407.CrossRefGoogle ScholarPubMed
Bringmann, LF, Vissers, N, Wichers, M, Geschwind, N, Kuppens, P, Peeters, F, Borsboom, D, Tuerlinckx, F (2013). A network approach to psychopathology: new insights into clinical longitudinal data. PLoS ONE 8, e60188.Google Scholar
Brown, GW, Ban, M, Craig, TK, Harris, TO, Herbert, J, Uher, R (2013). Serotonin transporter length polymorphism, childhood maltreatment, and chronic depression: a specific gene–environment interaction. Depression and Anxiety 30, 5–13.Google Scholar
Cramer, AO, Borsboom, D, Aggen, SH, Kendler, KS (2012 a). The pathoplasticity of dysphoric episodes: differential impact of stressful life events on the pattern of depressive symptom inter-correlations. Psychological Medicine 42, 957–965.Google Scholar
Cramer, AOJ, Van der Sluis, S, Noordhof, A, Wichers, M, Geschwind, N, Aggen, SH, Kendler, KS, Borsboom, D (2012 b). Dimensions of normal personality as networks in search of equilibrium: you can't like parties if you don't like people. European Journal of Personality 26, 414–431.CrossRefGoogle Scholar
De Wild-Hartmann, JA, Wichers, M, Van Bemmel, AL, Derom, C, Thiery, E, Jacobs, N, van Os, J, Simons, CJP (2013). Directions of daily associations between subjective sleep and affect in relation to future depressive symptoms in a population-based female sample. British Journal of Psychiatry. Published online 9 05 2013 . doi:10.1192/bjp.bp.112.123794.CrossRefGoogle Scholar
Donohue, JM, Pincus, HA (2007). Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment. Pharmacoeconomics 25, 7–24.CrossRefGoogle ScholarPubMed
Fisher, HL, Cohen-Woods, S, Hosang, GM, Uher, R, Powell-Smith, G, Keers, R, Tropeano, M, Korszun, A, Jones, L, Jones, I, Owen, M, Craddock, N, Craig, IW, Farmer, AE, McGuffin, P (2012). Stressful life events and the serotonin transporter gene (5-HTT) in recurrent clinical depression. Journal of Affective Disorders 136, 189–193.Google Scholar
Fredrickson, BL, Branigan, C (2005). Positive emotions broaden the scope of attention and thought-action repertoires. Cognition and Emotion 19, 313–332.CrossRefGoogle ScholarPubMed
Fredrickson, BL, Cohn, MA, Coffey, KA, Pek, J, Finkel, SM (2008). Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of Personality and Social Psychology 95, 1045–1062.Google Scholar
Garland, EL, Fredrickson, B, Kring, AM, Johnson, DP, Meyer, PS, Penn, DL (2010). Upward spirals of positive emotions counter downward spirals of negativity: insights from the broaden-and-build theory and affective neuroscience on the treatment of emotion dysfunctions and deficits in psychopathology. Clinical Psychology Review 30, 849–864.CrossRefGoogle ScholarPubMed
Geschwind, N, Peeters, F, Drukker, M, van Os, J, Wichers, M (2011). Mindfulness training increases momentary positive emotions and reward experience in adults vulnerable to depression: a randomized controlled trial. Journal of Consulting and Clinical Psychology 79, 618–628.CrossRefGoogle ScholarPubMed
Geschwind, N, Peeters, F, Jacobs, N, Delespaul, P, Derom, C, Thiery, E, van Os, J, Wichers, M (2010). Meeting risk with resilience: high daily life reward experience preserves mental health. Acta Psychiatrica Scandinavica 122, 129–138.CrossRefGoogle ScholarPubMed
Greening, SG, Osuch, EA, Williamson, PC, Mitchell, DG (2013). The neural correlates of regulating positive and negative emotions in medication-free major depression. Social Cognitive and Affective Neuroscience. Published online 11 03 2013 . doi:10.1093/scan/nst027.Google Scholar
Hankin, BL, Fraley, RC, Lahey, BB, Waldman, ID (2005). Is depression best viewed as a continuum or discrete category? A taxometric analysis of childhood and adolescent depression in a population-based sample. Journal of Abnormal Psychology 114, 96–110.Google Scholar
Hasler, BP, Dahl, RE, Holm, SM, Jakubcak, JL, Ryan, ND, Silk, JS, Phillips, ML, Forbes, EE (2012). Weekend–weekday advances in sleep timing are associated with altered reward-related brain function in healthy adolescents. Biological Psychology 91, 334–341.CrossRefGoogle ScholarPubMed
Hoenders, HJ, Bos, EH, de Jong, JT, de Jonge, P (2012). Temporal dynamics of symptom and treatment variables in a lifestyle-oriented approach to anxiety disorder: a single-subject time-series analysis. Psychotherapy and Psychosomatics 81, 253–255.CrossRefGoogle Scholar
Jacobs, N, van Os, J, Derom, C, Thiery, E, Delespaul, P, Wichers, M (2011). Neuroticism explained? From a non-informative vulnerability marker to informative person-context interactions in the realm of daily life. British Journal of Clinical Psychology 50, 19–32.CrossRefGoogle ScholarPubMed
Judd, LL, Schettler, PJ, Akiskal, HS (2002). The prevalence, clinical relevance, and public health significance of subthreshold depressions. Psychiatric Clinics of North America 25, 685–698.CrossRefGoogle Scholar
Kanter, JW, Puspitasari, AJ, Santos, MM, Nagy, GA (2012). Behavioural activation: history, evidence and promise. British Journal of Psychiatry 200, 361–363.Google Scholar
Kapur, S, Mizrahi, R, Li, M (2005). From dopamine to salience to psychosis – linking biology, pharmacology and phenomenology of psychosis. Schizophrenia Research 79, 59–68.CrossRefGoogle ScholarPubMed
Kendler, KS (2005). “A gene for…”: the nature of gene action in psychiatric disorders. American Journal of Psychiatry 162, 1243–1252.Google Scholar
Kendler, KS (2012). The dappled nature of causes of psychiatric illness: replacing the organic–functional/hardware–software dichotomy with empirically based pluralism. Molecular Psychiatry 17, 377–388.CrossRefGoogle ScholarPubMed
Kendler, KS, Gardner, CO Jr (1998). Boundaries of major depression: an evaluation of DSM-IV criteria. American Journal of Psychiatry 155, 172–177.CrossRefGoogle ScholarPubMed
Kendler, KS, Zachar, P, Craver, C (2011). What kinds of things are psychiatric disorders? Psychological Medicine 41, 1143–1150.Google Scholar
Koval, P, Kuppens, P, Allen, NB, Sheeber, L (2012). Getting stuck in depression: the roles of rumination and emotional inertia. Cognition and Emotion 26, 1412–1427.Google Scholar
Kramer, I, Simons, CJ, Wigman, JT, Collip, D, Jacobs, N, Derom, C, Thiery, E, van Os, J, Myin-Germeys, I, Wichers, M (2013). Time-lagged moment-to-moment interplay between negative affect and paranoia: new insights in the affective pathway to psychosis. Schizophrenia Bulletin. Published online 13 02 2013 . doi:10.1093/schbul/sbs194.Google ScholarPubMed
Kuppens, P, Sheeber, LB, Yap, MB, Whittle, S, Simmons, JG, Allen, NB (2012). Emotional inertia prospectively predicts the onset of depressive disorder in adolescence. Emotion 12, 283–289.Google Scholar
Lardinois, M, Lataster, T, Mengelers, R, Van Os, J, Myin-Germeys, I (2011). Childhood trauma and increased stress sensitivity in psychosis. Acta Psychiatrica Scandinavica 123, 28–35.CrossRefGoogle ScholarPubMed
Lemos, JC, Wanat, MJ, Smith, JS, Reyes, BA, Hollon, NG, Van Bockstaele, EJ, Chavkin, C, Phillips, PE (2012). Severe stress switches CRF action in the nucleus accumbens from appetitive to aversive. Nature 490, 402–426.Google Scholar
Mata, J, Thompson, RJ, Jaeggi, SM, Buschkuehl, M, Jonides, J, Gotlib, IH (2012). Walk on the bright side: physical activity and affect in major depressive disorder. Journal of Abnormal Psychology 121, 297–308.Google Scholar
Mathers, CD, Loncar, D (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine 3, e442.Google Scholar
Myin-Germeys, I, Oorschot, M, Collip, D, Lataster, J, Delespaul, P, van Os, J (2009). Experience sampling research in psychopathology: opening the black box of daily life. Psychological Medicine 39, 1533–1547.CrossRefGoogle ScholarPubMed
Oorschot, M, Lataster, T, Thewissen, V, Wichers, M, Myin-Germeys, I (2012). Mobile assessment in schizophrenia: a data-driven momentary approach. Schizophrenia Bulletin 38, 405–413.CrossRefGoogle ScholarPubMed
Pae, CU, Chiesa, A, Porcelli, S, Han, C, Patkar, AA, Lee, SJ, Park, MH, Serretti, A, De Ronchi, D (2012). Influence of BDNF variants on diagnosis and response to treatment in patients with major depression, bipolar disorder and schizophrenia. Neuropsychobiology 65, 1–11.Google Scholar
Quinn, CR, Dobson-Stone, C, Outhred, T, Harris, A, Kemp, AH (2012). The contribution of BDNF and 5-HTT polymorphisms and early life stress to the heterogeneity of major depressive disorder: a preliminary study. Australian and New Zealand Journal of Psychiatry 46, 55–63.CrossRefGoogle Scholar
Ripke, S, Wray, NR, Lewis, CM, Hamilton, SP, Weissman, MM, Breen, G, Byrne, EM, Blackwood, DH, Boomsma, DI, Cichon, S, Heath, AC, Holsboer, F, Lucae, S, Madden, PA, Martin, NG, McGuffin, P, Muglia, P, Noethen, MM, Penninx, BP, Pergadia, ML, Potash, JB, Rietschel, M, Lin, D, Muller-Myhsok, B, Shi, J, Steinberg, S, Grabe, HJ, Lichtenstein, P, Magnusson, P, Perlis, RH, Preisig, M, Smoller, JW, Stefansson, K, Uher, R, Kutalik, Z, Tansey, KE, Teumer, A, Viktorin, A, Barnes, MR, Bettecken, T, Binder, EB, Breuer, R, Castro, VM, Churchill, SE, Coryell, WH, Craddock, N, Craig, IW, Czamara, D, De Geus, EJ, Degenhardt, F, Farmer, AE, Fava, M, Frank, J, Gainer, VS, Gallagher, PJ, Gordon, SD, Goryachev, S, Gross, M, Guipponi, M, Henders, AK, Herms, S, Hickie, IB, Hoefels, S, Hoogendijk, W, Hottenga, JJ, Iosifescu, DV, Ising, M, Jones, I, Jones, L, Jung-Ying, T, Knowles, JA, Kohane, IS, Kohli, MA, Korszun, A, Landen, M, Lawson, WB, Lewis, G, Macintyre, D, Maier, W, Mattheisen, M, McGrath, PJ, McIntosh, A, McLean, A, Middeldorp, CM, Middleton, L, Montgomery, GM, Murphy, SN, Nauck, M, Nolen, WA, Nyholt, DR, O'Donovan, M, Oskarsson, H, Pedersen, N, Scheftner, WA, Schulz, A, Schulze, TG, Shyn, SI, Sigurdsson, E, Slager, SL, Smit, JH, Stefansson, H, Steffens, M, Thorgeirsson, T, Tozzi, F, Treutlein, J, Uhr, M, van den Oord, EJ, Van Grootheest, G, Volzke, H, Weilburg, JB, Willemsen, G, Zitman, FG, Neale, B, Daly, M, Levinson, DF, Sullivan, PF (2013). A mega-analysis of genome-wide association studies for major depressive disorder. Molecular Psychiatry 18, 497–511.Google ScholarPubMed
Rosmalen, JG, Wenting, AM, Roest, AM, de Jonge, P, Bos, EH (2012). Revealing causal heterogeneity using time series analysis of ambulatory assessments: application to the association between depression and physical activity after myocardial infarction. Psychosomatic Medicine 74, 377–386.Google Scholar
Schneiders, J, Nicolson, NA, Berkhof, J, Feron, FJ, van Os, J, deVries, MW (2006). Mood reactivity to daily negative events in early adolescence: relationship to risk for psychopathology. Developmental Psychology 42, 543–554.Google Scholar
Slade, T (2007). Taxometric investigation of depression: evidence of consistent latent structure across clinical and community samples. Australian and New Zealand Journal of Psychiatry 41, 403–410.Google Scholar
Thewissen, V, Bentall, RP, Lecomte, T, van Os, J, Myin-Germeys, I (2008). Fluctuations in self-esteem and paranoia in the context of daily life. Journal of Abnormal Psychology 117, 143–153.Google Scholar
Thompson, RJ, Mata, J, Jaeggi, SM, Buschkuehl, M, Jonides, J, Gotlib, IH (2012). The everyday emotional experience of adults with major depressive disorder: examining emotional instability, inertia, and reactivity. Journal of Abnormal Psychology 121, 819–829.Google Scholar
Tschacher, W, Ramseyer, F (2009). Modeling psychotherapy process by time-series panel analysis (TSPA). Psychotherapy Research 19, 469–481.Google Scholar
Wichers, M, Aguilera, M, Kenis, G, Krabbendam, L, Myin-Germeys, I, Jacobs, N, Peeters, F, Derom, C, Vlietinck, R, Mengelers, R, Delespaul, P, van Os, J (2008 a). The catechol-O-methyl transferase Val158Met polymorphism and experience of reward in the flow of daily life. Neuropsychopharmacology 33, 3030–3036.Google Scholar
Wichers, M, Geschwind, N, Jacobs, N, Kenis, G, Peeters, F, Derom, C, Thiery, E, Delespaul, P, van Os, J (2009 a). Transition from stress sensitivity to a depressive state: longitudinal twin study. British Journal of Psychiatry 195, 498–503.Google Scholar
Wichers, M, Hartmann, JA, Kramer, IM, Lothmann, C, Peeters, F, van Bemmel, L, Myin-Germeys, I, Delespaul, P, van Os, J, Simons, CJ (2011 a). Translating assessments of the film of daily life into person-tailored feedback interventions in depression. Acta Psychiatrica Scandinavica 123, 402–403.CrossRefGoogle ScholarPubMed
Wichers, M, Kenis, G, Jacobs, N, Myin-Germeys, I, Schruers, K, Mengelers, R, Delespaul, P, Derom, C, Vlietinck, R, van Os, J (2008 b). The psychology of psychiatric genetics: evidence that positive emotions in females moderate genetic sensitivity to social stress associated with the BDNF Val66Met polymorphism. Journal of Abnormal Psychology 117, 699–704.Google Scholar
Wichers, M, Lothmann, C, Simons, CJ, Nicolson, NA, Peeters, F (2012 a). The dynamic interplay between negative and positive emotions in daily life predicts response to treatment in depression: a momentary assessment study. British Journal of Clinical Psychology 51, 206–222.CrossRefGoogle ScholarPubMed
Wichers, M, Myin-Germeys, I, Jacobs, N, Peeters, F, Kenis, G, Derom, C, Vlietinck, R, Delespaul, P, Van Os, J (2007). Genetic risk of depression and stress-induced negative affect in daily life. British Journal of Psychiatry 191, 218–223.Google Scholar
Wichers, M, Peeters, F, Geschwind, N, Jacobs, N, Simons, CJ, Derom, C, Thiery, E, Delespaul, PH, van Os, J (2010). Unveiling patterns of affective responses in daily life may improve outcome prediction in depression: a momentary assessment study. Journal of Affective Disorders 124, 191–195.CrossRefGoogle ScholarPubMed
Wichers, M, Peeters, F, Rutten, BP, Jacobs, N, Derom, C, Thiery, E, Delespaul, P, van Os, J (2012 b). A time-lagged momentary assessment study on daily life physical activity and affect. Health Psychology 31, 135–144.CrossRefGoogle Scholar
Wichers, M, Schrijvers, D, Geschwind, N, Jacobs, N, Myin-Germeys, I, Thiery, E, Derom, C, Sabbe, B, Peeters, F, Delespaul, P, van Os, J (2009 b). Mechanisms of gene–environment interactions in depression: evidence that genes potentiate multiple sources of adversity. Psychological Medicine 39, 1077–1086.Google Scholar
Wichers, M, Simons, CJ, Kramer, IM, Hartmann, JA, Lothmann, C, Myin-Germeys, I, van Bemmel, AL, Peeters, F, Delespaul, P, van Os, J (2011 b). Momentary assessment technology as a tool to help patients with depression help themselves. Acta Psychiatrica Scandinavica 124, 262–272.Google Scholar
Wilkinson, PO, Trzaskowski, M, Haworth, CM, Eley, TC (2013). The role of gene–environment correlations and interactions in middle childhood depressive symptoms. Development and Psychopathology 25, 93–104.Google Scholar
Wong, ML, Dong, C, Andreev, V, Arcos-Burgos, M, Licinio, J (2012). Prediction of susceptibility to major depression by a model of interactions of multiple functional genetic variants and environmental factors. Molecular Psychiatry 17, 624–633.CrossRefGoogle Scholar
Zimmermann, P, Bruckl, T, Nocon, A, Pfister, H, Binder, EB, Uhr, M, Lieb, R, Moffitt, TE, Caspi, A, Holsboer, F, Ising, M (2011). Interaction of FKBP5 gene variants and adverse life events in predicting depression onset: results from a 10-year prospective community study. American Journal of Psychiatry 168, 1107–1116.CrossRefGoogle ScholarPubMed