Skip to main content Accesibility Help
×
×
Home

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

  • M. Wichers (a1)
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.

Copyright
Corresponding author
* 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: m.wichers@maastrichtuniversity.nl)
References
Hide All
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, 7795.
Borsboom, D, Cramer, AO (2013). Network analysis: an integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology 9, 91121.
Borsboom, D, Cramer, AO, Schmittmann, VD, Epskamp, S, Waldorp, LJ (2011). The small world of psychopathology. PLoS ONE 6, e27407.
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.
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, 513.
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, 957965.
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, 414431.
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.
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, 724.
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, 189193.
Fredrickson, BL, Branigan, C (2005). Positive emotions broaden the scope of attention and thought-action repertoires. Cognition and Emotion 19, 313332.
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, 10451062.
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, 849864.
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, 618628.
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, 129138.
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.
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, 96110.
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, 334341.
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, 253255.
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, 1932.
Judd, LL, Schettler, PJ, Akiskal, HS (2002). The prevalence, clinical relevance, and public health significance of subthreshold depressions. Psychiatric Clinics of North America 25, 685698.
Kanter, JW, Puspitasari, AJ, Santos, MM, Nagy, GA (2012). Behavioural activation: history, evidence and promise. British Journal of Psychiatry 200, 361363.
Kapur, S, Mizrahi, R, Li, M (2005). From dopamine to salience to psychosis – linking biology, pharmacology and phenomenology of psychosis. Schizophrenia Research 79, 5968.
Kendler, KS (2005). “A gene for…”: the nature of gene action in psychiatric disorders. American Journal of Psychiatry 162, 12431252.
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, 377388.
Kendler, KS, Gardner, CO Jr (1998). Boundaries of major depression: an evaluation of DSM-IV criteria. American Journal of Psychiatry 155, 172177.
Kendler, KS, Zachar, P, Craver, C (2011). What kinds of things are psychiatric disorders? Psychological Medicine 41, 11431150.
Koval, P, Kuppens, P, Allen, NB, Sheeber, L (2012). Getting stuck in depression: the roles of rumination and emotional inertia. Cognition and Emotion 26, 14121427.
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.
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, 283289.
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, 2835.
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, 402426.
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, 297308.
Mathers, CD, Loncar, D (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine 3, e442.
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, 15331547.
Oorschot, M, Lataster, T, Thewissen, V, Wichers, M, Myin-Germeys, I (2012). Mobile assessment in schizophrenia: a data-driven momentary approach. Schizophrenia Bulletin 38, 405413.
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, 111.
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, 5563.
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, 497511.
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, 377386.
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, 543554.
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, 403410.
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, 143153.
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, 819829.
Tschacher, W, Ramseyer, F (2009). Modeling psychotherapy process by time-series panel analysis (TSPA). Psychotherapy Research 19, 469481.
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, 30303036.
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, 498503.
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, 402403.
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, 699704.
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, 206222.
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, 218223.
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, 191195.
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, 135144.
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, 10771086.
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, 262272.
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, 93104.
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, 624633.
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, 11071116.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed