The Antidepressants Wars and the Uncertainty of Depression

My recent PLoS guest post generated a lot of interest.

Here are a few follow-up thoughts jotted down in the aftermath of the comments I've been getting  on the post.

It is abundantly clear that depression is not an easy topic to handle.

First, there are those who claim that mental illness does not exist. Period.

Secondly, there are those who concede that some mental illness might exist but contend that depression, especially the so-called garden-variety (meaning mild to moderate depression) does not exist as “it is all in your head” and you only need to will yourself out of it.

Thirdly, there are those who concede that depression might exist but argue that the way we make our diagnosis is all messed up as we keep changing a set of “subjective” diagnostic criteria.

Fourthly, there are those who accept the diagnosis but debate the way our research has chosen its animal models or neuro-molecular targets.

Lastly, there are those who don’t care what the reason is, but became invested in demonstrating that approved treatments are effectively ineffective, or at least, no better than placebo.

Sum it up and chance is that if you are a patient with depression you will end up fairly confused. To make matter worse, chance is that if you are a busy doctor (not only a psychiatrist but also a primary care doc, as primary care doctors treat the vast majority of the depressed population) you are going to be almost as confused. The news are non-informative or even misleading when it comes to the topic of depression, and the research literature is too many times too complex to be understood by straightforward clinicians.

So, here we are, with a problem in search of a solution.

A complex problem, a true biopsychosocial Hydra, depression cannot be tacked with simple solutions. I believe this realization of complexity is the first step in successfully fighting it.

By accepting the complexity of the depression construct all the above perspectives can change from being plainly wrong to being, each one, partially true. Similar to the famed blind men disagreeing on what on elephant was for as long as they kept their findings separated instead of summing them up, a “together” perspective will allow us to not only better define depression but attack it on multiple fronts.

There is no end of fight in sight if biology will hold to its guns against psychology which in turn will hold to its guns against biology etc. only a catch-22 that will hurt those suffering.

Instead, working toward a model where the nature-nurture relationship is truly bidirectional (as when we understand how inherited genes express preferentially in different epigenetic contexts) is the path to follow if we are to see the light at the end of the tunnel.

© Copyright Adrian Preda, M.D.