Sunday, 21 March 2010

• Is Depression an Autism Spectrum Disorder?

  I was reading this article in the New York Times Magazine about the possible evolutionary upsides of depression (the analytic-rumination hypothesis - that depression may cause an increased ability to focus on problem-solving, resulting in a net mental benefit) that would explain why depression has persisted through so many generations worldwide.  As a person who has dealt with major depression for half my life, I was drawn to the idea that there might be some greater purpose to my cycles of suffering.  But the bit that really caught my attention was this:  
  
  The capacity for intense focus, they note, relies in large part on a brain area called the left ventrolateral prefrontal cortex (VLPFC), which is located a few inches behind the forehead. While this area has been associated with a wide variety of mental talents, like conceptual knowledge and verb conjugation, it seems to be especially important for maintaining attention. Experiments show that neurons in the VLPFC must fire continuously to keep us on task so that we don’t become sidetracked by irrelevant information. Furthermore, deficits in the VLPFC have been associated with attention-deficit disorder.
  
  ...Human attention is a scarce resource — the neural effects of depression make sure the resource is efficiently allocated. Both ADD and depression frequently co-occur with autism, perhaps because of similar misfiring in the brain.  Rumination is certainly a common trait - just last night I was kept awake half the night obsessively ruminating about how I would escape from my bedroom if the rest of the apartment were on fire; my solution involved a Phillips-head screwdriver and a wet towel.  Ryan's ruminations come in the form of scripting and perseverative behavior and language.  He can get so wrapped up in quoting every line of Sesame Street that he is unable to execute simple tasks (like getting undressed), nor is he able to pay attention to my instructions that would guide him through the order of operations involved in taking off his socks.
  
  Further proof of the connection between depression and autism: a study in 2000 concluded that "children with high-functioning autism or Asperger syndrome are at greater risk for anxiety and depression compared with the general population."
  
  Great.  Something to look forward to
  
  I used to wonder if I had somehow caused Ryan's PDD because I used antidepressants during my pregnancy.  It seems more likely that whatever genetic predisposition I have toward depression was passed on to Ryan and has been expressed as an autism spectrum disorder.  I chose not to breastfeed because I didn't want to further expose Ryan to SSRIs; there's still not enough research out there to confirm what the consequences might have been.  I chose to continue my course of SSRIs throughout my pregnancy because I felt the potential dangers of the drugs were outweighed by the tremendous benefit of my being available to my child as a fully-present parent, and not a depressed mommy neglecting her baby.
  
  It's provocative to think of depression as a point on the spectrum.  Our obsessions may be different and our anxieties may express themselves in different ways, but Ryan and I might have more in common than I would like to admit.  One more step on my journey from confusion to empathy.

  
  

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