Abstract for: Cutting the Loops of Depression: a Systemic Representation of the Feedback Mechanisms Involved in Depression Treatment

Background. Depression is a complex illness that involves the instability of biological and psychological structures in an individual and personalized treatments are needed to efficiently address depression symptoms and diminish relapses probabilities. This paper contributes to treatment personalization of depression by presenting the first comprehensive causal loop diagram (CLD) of the main reinforcing and balancing feedback loops involved in depression, and the ones behind treatment via mindfulness meditation, cognitive behavioral therapy, physical exercise and pharmacotherapy. Method. The paper uses qualitative system dynamics methods to map the feedback mechanisms of depression and behind four specific treatments. Results. The final CLD shows how depression can be explained through the interaction of reinforcing and balancing feedback mechanisms formed by cognitive and biological structures, and how different treatments may affect the development of this disorder. Conclusion. Mapping the mechanisms behind depression and remarking its endogeneity serves to understand how specific treatments may reduce the strength of these mechanisms and how the combination of treatments might generate better results since they may control more reinforcing feedback loops of depression that one single treatment. The paper facilitates further testing of these mechanisms. Moreover, the CLD may serve as a communication tool to increase patient engagement with treatments.