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Transcript: Stanford’s Robert Sapolsky on Depression in U.S. (Full Lecture)

Robert Sapolsky

Stanford Professor Robert Sapolsky discusses Depression in U.S. In this lecture, the entertaining Stanford lecturer dives into the biological and psychological aspect of the ‘most damaging disease’. Below is the full transcript.

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Okay. There are all sorts of interesting diseases out there and lots of them are quite exotic. You’ve got elephant man syndrome. And you’ve got Progeria, which is a disease where you basically die of old age when you’re about 10 years old. And then you’ve got cannibals eating brains and getting prion diseases. And those are very exciting and they’re great, and great, junior high school papers about disease and such.

Oh no, okay, come up to the front. There’s lots of room up here. I see a couple more seats up here.

So there are all sorts of these great made for TV movie diseases out there. But when you want to come to basic meat and potatoes of human medical misery, there is nothing out there like depression. Depression is absolutely crippling. Depression is incredibly pervasive, and thus important to talk about.

I’ll make the argument here today, a number of things, but one critical thing being that basically depression is like the worst disease you can get. And I’ll make the argument for that in a bit. It is devastating. It is wildly common. Current estimate are 15% of us in this room will have a major depression at some point or other in our lives. So that is not good.

What is also clear is it is worldwide. Currently, World Health Organization says depression is the number four cause of disability on this planet. And by the year 2025 it’s going to number two, after obesity, diabetes-related disorders. So it is bad news. And it is becoming more common.

Okay. So what I’m going to talk about today are seemingly two very, very different topics, and tie them together at the end. And what the main is, is if you live inside only one of those topics, you’re not going to understand this disease at all: First topic being what does biology have to do with depression? Second topic being, what does psychology have to do with it?

Okay. So starting off, first giving a sense of symptoms. And right off the bat, we’ve got a sematic problem, which is we all use the word depression in an everyday sense. You get some bad news about something. You now have to replace the transmission in your car. Somebody disappoints you enormously. And you feel bummed. You feel depressed. You are down for a few days. That’s not the version of depression I’ll be talking about.

Next version, you do have some sort of large, legitimate loss, setback, whatever, losing a job, unemployment, death of a loved one. And you are extremely impaired by a sense of malaise for weeks afterward. And then you come out the other end. That’s sort of what I’ll be talking about.

But even more so what I’ll focus on is the subset of individuals who, when something like that occurs, falls into this depressive state. And weeks and months later, they still have not come out the other end.

Terminology. The everyday depression that we all have now and then, that sort of version. The second one, the something awful happens and you feel terrible for a while, and then come out the other end, a reactive depression. The third version, where you are flattened by it for long periods afterward, a major depression. And what you also see with people with major depression after a while is it doesn’t take something awful externally to trigger one of those again.

Okay. So what are the symptoms about? If I had to define major depression in one sentence, I would say, it’s a lot biochemical disorder with a genetic component, and early experience influences, where somebody can’t appreciate sunsets. And that’s what this disease is about.

And when you think about it, that is a very sad thing. You look at some of our major diseases, somebody with cancer, somebody crippled by heart disease, and you see the most unlikely things out there. You see somebody saying, well, obviously I’m not glad I’m dying of cancer. But without this disease, I never would have realized the importance of friends. I never would have reconciled with my family members. I never would have found my God. On a completely weird level, I’m almost glad this has happened to me. Humans have this astonishing capacity to derive pleasure out of the most unlikely domains. What could possibly be worse than a disease whose defining symptom is the inability to feel pleasure?

Thus, at the top of the list, anhedonia — hedonism, the pursuit of pleasure, anhedonia the inability to feel pleasure. That is what a depression is about. And you get someone who has just had some enormous good luck, a long-sought relationship works out well, whatever. And they feel nothing, an inability to feel pleasure, way at the top of the list.

What else? Grief, guilt, and that’s where we’ve got the sematic problem again, which is the everyday sort of depression. Something happens, bums us out, and by definition we are feeling some version of grief. Often, we started obsessing at that point over some miserable thing we did to somebody 12 years ago and sort of despair in that. When you’re talking about major depression, the grief and the guilt can be so severe that it actually takes on a delusional quality.

Okay, not delusional in the sense of a schizophrenic with delusions hearing voices, thought disorder, but a certain style with extreme depression. Let me give you an example. You have late middle aged guy, perfectly healthy, and suddenly out of nowhere he has a major heart attack. He is lying there in a hospital. And the reality is, he’s going to recover. He’s going to have to make some changes in his lifestyle. But he’s going to recover. He, instead, falls into a major depression. This has transformed his sense of who he is. Suddenly, he’s an old man. Suddenly there’s all these things he can’t do. He falls into a major depression. Yet, he’s recovering.

Every day, his family is in there, saying, look, you’re just depressed. You’re getting stronger. The doctors are saying you’re getting stronger. You’re just depressed. It happens the hospital is circular. It has a corridor that forms a circle in it. And one day, the family is in there saying, you’re getting stronger. Look, the nurses said yesterday you did one loop around the hospital. And today you did two loops. You’re getting better. You’re getting stronger. And the person says, no, no, you don’t understand. They’re doing some construction. Last night, they closed down the outer corridor. And they opened up a new little. So the two versions of this one, two loops there is shorter than the large one. I’m getting weaker. I’m getting weaker. I’m going to die. I’m hopeless.

This is like someone expecting to believe that last night there were beavers digging through the walls there making this new – this was the father of an acquaintance of mine, a structural engineer. This is what a structural engineer looks like when they’re delusional to the point of saying that this is a world in which everything is inevitably getting worse, depression built around that.

Next, of course, one of the most dramatic and one of the most awful symptoms of depression: self injury. Depressives mutilating themselves at a high rate, and of course most notoriously, suicide, risks of suicide. And that is absolutely tragic. And teenagers, early adults, that along with accidents is the leading cause of death — major bad news.

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