Psychological Medicine

Review Article

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

M. Wichers 

Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands

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.

(Received April 27 2013)

(Revised July 10 2013)

(Accepted July 12 2013)

(Online publication August 14 2013)

Key words

  • Ecological momentary assessment;
  • experience sampling methodology;
  • major depressive disorder;
  • mechanisms;
  • networks;
  • personalized medicine

Correspondence

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)

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