FIGHTING CHANCE

A thorough tour of the science of depression, including its causes and its treatment.

Motivated to understand the suicidal depression that plagued a close friend, debut author Zabel, a retired major general in the U.S. Air Force, delved deeply into the constantly evolving research, hoping to find answers. The result is this remarkably comprehensive assessment of the competing theories regarding the reasons for depression, and of its therapeutic treatment. The author lucidly chronicles the shifting expert consensus on depression, from its interpretation as a trauma response to its acknowledgement as a biologically based illness. The candidate causes, however, are many. Is it the result of a chemical deficiency, or an excess of inflammation, or is it a function of cellular energy metabolism? One promising theory, the author notes, views depression as a stultification of neuroplasticity; a brain is in the continuous throes of “abrasion” and repair, and depression may result when the effects of the former surpass the latter’s. Zabel’s study is breathtakingly expansive—she looks at epidemiological surveys of a range of demographics, and provides a rigorous but accessible synopsis of the brain’s general functioning. The book is a combination of highly technical research and anecdotal accounts, as the author interviews many sufferers of depression, endowing the work with a sensitively handled human element. There are times when a lay reader may feel overwhelmed by the large amount of minute detail. However, Zabel never strays too far from the big picture and resists the allure of facile answers: “At my core, I am reductionist—I want to find the simple solution, the fundamental biological problem that is depression...but depression doesn’t support that. It is hugely complex; an emergent outcome of a brain under attack.”

A meticulous and thoughtful scientific exploration.