An Integrated Theory of Depression

Douglas Watt and Jaak Panksepp's elegant, comprehensive, and thought-provoking essay provides not only an up-to-date review of neurobiological systems involved in depression, and a clear and convincing relationship between these mechanisms and those involved in the panic/separation-distress system, but convincing evidence throughout the painstaking analysis of the interaction of the various neurobiological systems involved that strengthens their overall thesis—namely, “that depression is an evolutionarily conserved mechanism in mammalian brains, selected as a shutdown mechanism to terminate protracted separation distress (a prototype mammalian emotional state), which, if sustained, would be dangerous for infant mammals.” Following Bowlby's (1980) terminology, the separation/distress syndrome is described as a series of psychological responses to social loss on a continuum from protest to despair and, finally, to detachment. The broad spectrum of depressive syndromes results from an exaggerated activation and persistence of this mechanism, particularly the transition phase between protest and despair. A genetic predisposition to an excessive activation of this biological constellation, particularly a genetically determined hypersensitivity combined with excessive negative affect in response to the loss of social support—abandonment by essential sources of physical and psychic security—would reflect the biologically determined vulnerability to depression. This vulnerability becomes reinforced by psychological experiences that further augment the threat of social loss or psychological abandonment and constitute the psychodynamic disposition to depression.

In my view, the authors' thesis fits harmoniously with contemporary psychodynamic thinking regarding depression, particularly with respect to the intrapsychic mechanisms that determine the experience of loss of support not only from external objects, but also as a consequence of pathological internalization of early ob