The heart of depression

Chris,
I have enjoyed reading your posts. I certainly don’t agree with your use of some of the citations as they are taken out of context, but nonetheless I think you raise some very good points. I am wondering if you have ever been diagnosed with depression? This statement at the beginning of this post
“As a result, a large percentage of the population has been convinced to take drugs in order to deal with the problems of daily life.”

@Mark:

Thanks for your comment, Mark. I’m curious to know which references you think are out of context. I’d like to address them and respond.

Regarding your question, at one time in my life I struggled with very severe depression. At that point I knew little about antidepressants, but intuitively I knew they weren’t the answer for me. I was able to recover completely without antidepressant drugs.

It wasn’t until several years later that I began researching antidepressants extensively. But this research grew out of personal experience with depression – my own and that of others close to me – rather than a purely academic or political interest.

I think research is very clear that the definition of what constitutes “depression” has been continually expanded over the past decade to include milder and milder cases which could indeed be equivalent to “the problems of daily life”. However, as I pointed out in this article, they are specifically equivalent to “the problems of daily life in a society in which social support structures have broken down”. That’s an important distinction.

Some authors suggest there is a difference between “normal sadness”, which is sadness “in proportion to” life circumstances. For example, if a loved one passes away a certain amount of grief is expected, for a certain period of time. But – according to this model – if the person is still grieving after a given period, they are no longer sad. They’re now depressed.

There are several problems with this model. First, who defines how long the “appropriate” period is? In our society, the people who write the DSM define it. And that period is getting shorter and shorter. In DSM-IV, it is now two months! Which is to say that if your partner or mother or daughter passed away, you’d be allowed two months of “sadness” before you were labeled “clinically depressed”. In my opinion this is a thinly veiled PR campaign for antidepressant drugs.

The other problem with that model is this: just because there may not be an obvious “trigger” for depression in someone’s life, that doesn’t mean there isn’t one. Someone might “have it all” on the surface: nice house, good job, attractive partner, two kids, etc. but perhaps they have lived a life that is not their own. Perhaps they are suffering from the loss of community in modern society, from the disconnection from nature that is now so prevalent, or from a lack of meaning and purpose in their lives.

I think there is always a “reason” for depression, however subtle it may be. And we do ourselves and our patients (if we are clinicians) a disservice by first turning to antidepressant drugs rather than exploring the true causes of our discontent and addressing our depression on that level.