A flurry of articles has set me to pondering again the meaning of how we think about depression. Let me share them with you.
First, take a look at "How Prozac sent the science of depression in the wrong direction" in the Boston Globe. Now no one seems to have told the drug companies about this, or at least not their marketing divisions because the commercials for Cymbalta and the like are still running telling us that "depression hurts" and pushing the chemical imbalance theory of depression, though it is discredited now. Interesting that there have been researchers saying for years that there was no evidence to support that theory but only now is there reluctant yielding to that reality.
Now the sharp-eyed reader of that article will notice that Lehrer puts forward another theory for depression and mirabile dictu, now it is brain cells --
"In recent years, scientists have developed a novel theory of what falters in the depressed brain. Instead of seeing the disease as the result of a chemical imbalance, these researchers argue that the brain’s cells are shrinking and dying. This theory has gained momentum in the past few months, with the publication of several high profile scientific papers. The effectiveness of Prozac, these scientists say, has little to do with the amount of serotonin in the brain. Rather, the drug works because it helps heal our neurons, allowing them to grow and thrive again."
Which might make you think that the only treatment for depression, for these dying brain cells is medication. But what about the studies that show that other treatments are as effective if not more so -- like regular exercise or psychotherapy? Could it be that they also revise neurons? Is anybody looking to see?
But what about this, from Furious Seasons:
"Anti-Depressants Don't Work In 40 Percent Of People Due To Four Genes
File this under "well now they tell us": Mayo Clinic psychiatrists announced last week at a conference in Britain that 40 percent of people who take an anti-depressant cannot respond to the medication owing to a genetic "abnormality."
Uh-oh.
As John Grohol points out, this is part of a narrative that has seized the media and, from where I sit, psychiatry as well. The trumpet of mental disorders as medical in nature and best treated medically continues to play despite the accumulating evidence against it. The chemical imbalance theory fails? Okay, try this dying neuron theory.
"This would be true if mental disorders were pure medical diseases. But they are not and have never been. They are human constructs of aberrant behavior or emotions. They are by no means universal (although some of the big ones, like depression, can be found in most human societies)."
Lehrer reports: "Castren says that patients must still work to cement these connections in place, perhaps with therapy. He compares antidepressants with anabolic steroids, which increase muscle mass only when subjects also go to the gym."
To which Grohol replies:
"You need some encouragement for a drug to take effect? This is nonsense. Drugs either work or do not, they do not need to be “cemented” to the brain through therapy."
So as I was in the shower this morning, I got to thinking about how persistent this effort is to make depression, and there are other instances as well of course, a medical illness. Because it seems to have taken over and become the dominant paradigm at least in the US. Even in the face of reports of potentially serious side effects like GI bleeding
And I wonder if it has something to do with a kind of puritanical underpinning to our culture, one which sees problems which are not medical as so much whining. So a person who is depressed and isn't considered medically ill -- you know, that fuzzy term "clinically depressed" which only means that a clinician says the problem seems to be depression, because there is no way to definitively establish such a diagnosis -- might be expected by those around him to "pull up his socks and get over it" or just get n with things. Whereas someone who is ill and needs medication, well, it's not his fault; it's his brain chemicals or dying neurons or something. Is it maybe underneath it all about blame? Blame and an all but irresistible American attraction to the promised quick fix.
Certainly money plays a part. And turf guarding. But there is more.
