Is Depression an Illness? Or Part of the Human Condition?

Double exposure with woman sitting on floor and city in the backgroundRecently, I’ve found myself somewhat annoyed at the Pinterest mental health community. I know some may consider it taboo to disagree with other mental health professionals or, worse, to challenge the beliefs of people who live with mental health conditions, but I feel strongly that many in my profession do a great disservice to the people we serve and our culture by perpetuating the belief mental health issues are mostly biological and always require treatment. What irks me even more is that in a well-intentioned effort to reduce stigma, we may suggest there is relatively little individual choice or personal power in creating an emotionally healthful life for oneself.

I saw a pin on Pinterest recently that read, “Depression is an Illness, not a Choice,” and it made me angry. While a temporary state of depression can sometimes be caused by biological or hormonal factors, such as in the case of premenstrual dysphoria, most forms of depression are not caused by biological factors but rather by social factors, learned thinking styles, and ineffective behavioral choices. The desire to reduce mental health stigma is well-intentioned, but our efforts can be misguided at times, and we have gone overboard.

Here’s why.

First, feelings of depression and anxiety, among other unpleasant experiences, are a normal part of the human condition. Most of us, at one time or another, have avoided doing something because it made us nervous. Are we all disordered? Do we all need medication? By discounting the fact ups, downs, and difficult emotions can be part of normal human growth and development experiences, we fail to give people the knowledge, support, and tools they need to move past those difficult periods. We label these feelings “disorders,” which can affect how people view themselves and can become a permanent part of their identity and self-concept.

Second, the medical model of labeling feelings as “illnesses” limits recovery options. In American culture, we have been conditioned to believe illnesses require medication. So that’s how we treat them. In other cultures, even some medical illnesses do not necessarily dictate the use of medication. There is an Ayurvedic saying about illness: “When diet is wrong, medicine is of no use. When diet is right, medicine is of no need.” Although diet isn’t the only factor at play, this ancient wisdom underscores the importance of a healthy lifestyle in avoiding illness.

I believe this notion extends to mental health as well. A healthy emotional lifestyle includes learning how to communicate in relationships to increase closeness and social support; it means learning how to believe in your abilities, conquer your fears, and try new things; and it means practicing mind-calming techniques, such as meditation and yoga, and having the courage to heal old wounds while learning how to create your own happiness.

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I recently interviewed Dr. Barry Duncan, author of What’s Right With You: Debunking Dysfunction and Changing Your Life. He struck a chord with me when he said, “As crazy as it sounds, problems, like depression, also provide possibilities for living our lives differently, for reaching new conclusions. Depression is obviously painful, and it brings attention to the fact we are not happy with some aspect of our lives. The depression, therefore, can be a life-transformation vehicle.”

I agree wholeheartedly. I have experienced severe depression myself—several episodes, in fact. I have felt suicidal on occasion. Yet, those difficult times helped me. They helped me learn about myself, to seek out support and build relationships, and to have more empathy for others who go through similar challenges. Suffering can be a tool for growth, and personal growth, in turn, can lead to more happiness and inner peace.

As Dr. Duncan puts it, “Depression represents a profound crisis—it calls into question our very identity and how we are conducting our lives. It is at once a crisis point, a real danger and an opportunity for incredible change.”

By perpetuating the belief depression is an illness, we encourage people to take medication—that in many cases may not help them and can, in some cases, make them worse—without looking at the entire picture of why an individual is depressed and what is truly the best form of help for that person’s unique set of circumstances.

Third, by perpetuating the belief depression is an illness, we encourage people to take medication—that in many cases may not help them and can, in some cases, make them worse (Sparks, J., Duncan, B., Cohen, D., & Antonuccio, D., 2010; Valentstein, E., 1998)—without looking at the entire picture of why an individual is depressed and what is truly the best form of help for that person’s unique set of circumstances. My view is that in a limited number of cases, medication can be beneficial in the short term but only in combination with psychotherapy. Without therapy, the underlying cause of the depression goes unresolved and the person does not acquire the tools to prevent further episodes.

Dr. Duncan makes an excellent point when he talks about how we, in mental health professions, have contributed to perpetuating myths about a biological basis for depression and, in the process, helped pharmaceutical companies create learned helplessness in people. Many people have bought into the notions life should not include struggle and most individuals do not have the strength or creativity to navigate their challenges. We are empathic and do not enjoy seeing the people we serve suffer, so we often suggest medication. The use of antidepressants has consequently skyrocketed over the past two decades, yet two-thirds of Americans still report not being “very happy.” Something isn’t working.

Dr. Duncan surprised me with his next comment, and it gave me pause. He suggested that, perhaps unwittingly, mental health practitioners have bought into the illness model of mental health in part because it sustains our work and income. I had never thought of this before, but it’s a perspective worth examining. I don’t remember ever saying to a person after an intake session: “I think what you are going through is normal. You don’t really need therapy for this.” Hmm …

The Science of Depression

There are many theories about a possible neurological cause of depression, but very little evidence. In spite of advances in research technologies and neuroimaging studies, a biological cause or marker for depression has yet to be found (Duncan, B., 2005).

Further, meta-analytic reviews of medication treatment for depression found the difference between taking medication and a placebo was less than two points on a popular depression scale (Kirsh, I., 2014). One study found that a psychiatrist with a positive therapeutic alliance with his patients was more effective in improving depression symptoms with a placebo than was a psychiatrist with a poor therapeutic alliance administering a real antidepressant drug (Krupnick, J., Sotsky, S. M., Simmens, S., Moyer, J., Elkin, I., Watkins, J., & Pilkonis, P.A., 1996). In other words, relationships may heal more effectively than medication. In its totality, the research shows that except for a small percentage of people with severe depression, medication does not work well to remit most depressions and, in many cases, has adverse effects.

How to Heal Depression

There are many options to consider in treating your depression. Here are a few:

  1. Make life changes. Sometimes medication allows you to tolerate an intolerable situation. For example, if you have to take medication to cope with your stressful life, it may be time to reevaluate how you live life and perhaps make major changes. One person I work with in therapy decided she would stop being angry and verbally abusive, would learn to have healthy boundaries and say no when appropriate, and discontinue living with a husband who is addicted to alcohol and has a girlfriend on the side. Although this was a difficult time for her, she is much happier now and no longer reports depression symptoms.
  2. Give it some time. Some episodes of depression spontaneously remit with time. Improvement without treatment ranges from 20% to 60% for a given episode of depression (Duncan, B. 2005).
  3. Seek psychotherapy. Studies show psychotherapy is more beneficial than medication in the long run. Therapy maintains a positive effect over time, while medication does not. Psychotherapy can help you identify the causes of your depression and develop a more personalized plan for how you can get better. Therapy teaches the skills you need to manage your mood and difficult emotions. Most people report a lasting benefit when they participate in therapy for at least three to six months.

While medication may be the best option in some cases, research tells us psychotherapy is generally a more effective treatment for depression. The effects can last beyond the treatment, and there are few, if any, unwanted side effects. Therefore, in my view, it should be our first line of defense.

References:

  1. Duncan, B. (2005). What’s Right With You: Debunking Dysfunction and Changing Your Life. Deerfield Beach, FL: Health Communications, Inc.
  2. Kirsch, I. (2014). Antidepressants and the Placebo Effect. Zeitschrift Fur Psychologie, 222(3), 128–134. http://doi.org/10.1027/2151-2604/a000176
  3. Krupnick, J. L., Sotsky, S. M., Simmens, S., Moyer, J., Elkin, I., Watkins, J., & Pilkonis, P. A. (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 64(3), 532-539. doi:10.1037/0022-006x.64.3.532
  4. Sparks, J., Duncan, B., Cohen, D., & Antonuccio, D. (2010). Psychiatric drugs and common factors: An evaluation of risks and benefits for clinical practice. In B. Duncan, S. Miller, B. Wampold, & M. Hubble (Eds.), The heart and soul of change: Delivering what works in therapy (199-236). Washington, DC: American Psychological Association.
  5. Valenstein, E. S. Blaming the Brain: The Truth About Drugs and Mental Health. Free Press, 1998.

© Copyright 2016 GoodTherapy.org. All rights reserved. Permission to publish granted by Chantal Marie Gagnon, PhD, LMHC, CAP, SAP, therapist in Plantation, Florida

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Dawn

    May 13th, 2016 at 10:09 AM

    So I guess that overall I believe a little bit of both.
    I do believe that for many of us depression is not anything that can be warded off or controlled. I think that there is something biological in us that makes this a part of who we are and that genetically we can’t fight some of those tendencies.
    But on the other hand I think that there are definitely things that we can do for ourselves that would help alleviate the symptoms a bit and maybe even make us a little less likely to have to struggle with it quite as much as we do.
    Yes I believe that there are parts of it that can’t be controlled and then there are parts that could be. Too much of a fence straddler there?

  • James L.

    May 13th, 2016 at 10:13 AM

    Very interesting take on depression. I’ve always seen it as a mix of biological, cultural, societal, and individual factors too. I think we put way too much stake in the medical model (which can be useful for treatment, but aligns way too much with what drug companies want) for treating mental health. Very interesting perspective!

  • Hanna

    May 13th, 2016 at 11:55 AM

    Many of us with this would beg to differ. It is a medical condition and we deserve for it to be treated as such.

  • Mike

    May 13th, 2016 at 2:55 PM

    The author suggests that when someone comes to therapy with a distressing experience that is within the normal range, it might be correct to tell them “you don’t need therapy.” Wait a minute here… therapy is not just for restoring people to a “normal” condition. The “normal” condition in the U.S. is high levels of self-aversion, shame, and low levels of self-compassion. I agree that medication is not the answer to this, but let’s not forget we can do much better, we can raise emotionally healthy children, we can encourage compassion and a feeling of being connected, but it will take a lot of work to rise above “normal.” That work could be therapy, mindfulness meditation, or the ripple effect from people who do the work on themselves.

  • Brigid Sboto, LMFT

    May 14th, 2016 at 5:17 AM

    Depression is a state of mind that perpetuates the feeling of hopelessness and inertia. The most difficult part is the belief that the state of mind or situation that triggers it won’t or can’t change so the motivation to move towards change is hard and sometimes feels impossible to find. Although the discussion of its cause is interesting, to really help a depressed individual is to recognize the paralysis they feel and not to blame them for having these feelings. It is also important to use every helpful tool available to help. Taking sides on the debate of whose responsible is alienating.

  • Dr. Chantal Gagnon

    May 14th, 2016 at 9:22 AM

    What grabs my attention in Dawn’s comment is the word “believe”. Dawn believes that ” for many of us depression is not anything that can be warded off or controlled”. Belief is not fact. The fact is, the research strongly tells us that depression is ABSOLUTELY something that we can prevent or change. There’s no dispute in the scientific literature about that. But it’s easier to tell ourselves that we have no control, because then we can avoid the responsibility to step outside of our comfort zone to take the actions needed to prevent or eliminate depression. To this day, there is no scientific evidence that proves (or even strongly suggests) that depression is a biological illness. -Dr.Chantal, article author

  • Helen M

    May 24th, 2016 at 12:12 PM

    I have always thought that depression can be helped with therapy to change the way we think, but my own experience tells me that it is biological too. Good health always involves both life choices and medicine–depression is no different. I know, as someone who did anything she could do to maintain any sanity in life without medication, that sometimes you need them to help your depression. I agree that antidepressants are over-prescribed and people can sometimes “blame the illness” rather than help themselves, but don’t discount those that live for decades with a depression that without medication makes us hopeless and totally unproductive.

  • Dr. Chantal Gagnon

    May 14th, 2016 at 9:29 AM

    Hanna,
    Thank you for taking the time to read and comment on my article. In your comment, you make the claim that depression is a medical condition. How do you know that? Also, you imply that depressed individuals are mistreated by stating that depression is not a medical condition. How is that the case? Bereavement for example is not a medical condition. It is the experience of intense grief after a deep loss. It is extremely emotionally painful. Yet, we accept and respect that bereavement is part of the human experience. We support and comfort those in grief. We do not judge them. We love and help them. Why couldn’t the same be true of someone experiencing depression? We can respect, love and support them without needing to convince ourselves that depression is a medical illness. -Dr. Chantal, article author

  • Helen M

    May 24th, 2016 at 12:17 PM

    What do you call what people have when they feel 100% improvement when taking an antidepressant? I am curious because I fought taking meds and staying on them for decades. However, if I have a choice of holding down a job, keeping healthy relationships, and not killing myself, then I choose the meds. Some people cannot function without their meds. What is that defined as?

  • Steve M

    May 25th, 2016 at 12:09 PM

    At the risk of sounding insensitive, the fact that antidepressants make someone feel better doesn’t mean they have something wrong with them. Alcohol, for instance, is an excellent anti-anxiety agent, and drinking a shot of tequila at breakfast lunch and dinner will reduce anxiety throughout the day, just like Xanax would. Many people feel much better, reduced depression and/or anxiety, when they smoke marijuana. And I certainly am conveying no judgment against either alcohol or marijuana as a means of ameliorating negative feelings! I’m just saying that substances can and do change our psychological states through physiological impacts on the brain, but that doesn’t mean we have an illness or that our brain is malfunctioning. It just means we find the effects of this substance enhance our mood/behavior.

  • Marcie

    May 14th, 2016 at 10:01 AM

    Couldn’t it simply be viewed as both?
    One does not make it any better or worse than the other

  • Brigid

    May 15th, 2016 at 11:29 AM

    I think the author is taking a very black and white stance on depression. We continue to learn about the causes of depression, so it is not helpful to choose sides to such a degree. There is no doubt we all have some power to change our circumstances, including those circumstances that maintain depression. Yet, there are many who diligently try to climb out of depression, yet have limited or temporary success. It is my experience that people who take the stance that depression is a “pull yourself up by your boot straps” kind of situation really have no idea how powerlessness feels. I also think this view point may originate from a child whose parent or loved one did little to battle his or her own depression. As such, it is hard to empathize and easy to be angry at depressed people for not “taking control” of depression. Depression is a powerful illness. If it was so easy to treat we would not have as many suicides as we do.

  • Helen M

    May 24th, 2016 at 12:19 PM

    Very well said!

  • Steve M

    May 25th, 2016 at 12:22 PM

    I agree with you, and yet nothing you say is incompatible with the author’s statement that depression is not an illness. I also don’t regard it as a “choice” in the sense of “I’m deciding to be depressed.” But as a long-standing sufferer of anxiety and depression, I would take the position that it has resulted from an interaction between my natural skills and challenges and the stresses of the environment I grew up in. Without getting into details, I’d say I’m very sensitive by constitution and grew up with a mom who was rather insensitive – not mean, but just pretty emotionally unavailable and sometimes quite thoughtless. It impacted me differently than my brothers, because I have a different constitution, but it impacted all of us in various negative ways. School was also a very depressing experience for me – I was very bright, way above the norm, and was bored to death most of the time, while lacking the social skills to really develop many long-term meaningful friendships. As a result, I was depressed quite a lot in my childhood and had to get some quality therapy and do a lot of work as an adult to overcome this inauspicious start to life.
    Saying that I have an “illness” would suggest to me that my innate sensitivity is a BAD thing and that I SHOULD have been “less sensitive” (believe me, I was told that many times), and hence my own biology/temperament is at fault rather than the environment being a bad fit for my needs. It also lets my parents and the educational system completely off the hook for requiring me to engage in years of torturous misery that would have been largely preventable if anyone had bothered to notice that it wasn’t working for me. And it would also have felt very disempowering to me as a person to suggest that my brain was the reason I was depressed and that I couldn’t do anything about it.
    I don’t doubt that my innate sensitivity has some kind of genetic underpinnings, and that I was “born with it.” I do NOT want to regard that as a curse, as it has also provided me with the opportunity to have insight into the human condition and to help people that other people are unable to reach. I have used this gift well by going into the field of counseling and advocacy for foster youth. If I had not had this “illness”, I would not have been so tremendously successful at my chosen profession.
    Bottom line, genetics is something we can’t change. We’ve all got it, but it is part of who we are. We’re far better off focusing on changing the things we CAN change while acknowledging that there are strengths and challenges to ANY personality presentation, and trying to build on the strengths. That’s what mental health care should be about. If medication is able to help in that process, that’s awesome, but suggesting that someone has an “illness” just because they find this insane world we live in a challenge to work through and figure out is, in my view, counterproductive to our long-term welfare.

  • Teresa

    October 8th, 2016 at 12:28 PM

    I completely agree with you.
    Saying that a patient isn’t “trying hard enough” therefore will continue to “choose” to suffer from the symptoms of depression is not only incorrect but insensitive.

  • Alice

    May 16th, 2016 at 6:46 AM

    Dr. Gagnon, Thank you for sharing. Your points about therapeutic alliance having a stronger clinical impact on depression than placebo is significant. There is a great deal of power in psychotherapy and the benefits are clear. I support the practice of medication, relaxation and yoga as practices / self interventions that allow the for the opportunity to gain clearness of mind and the ability to seek possible solutions to challenges in social, family and behavioral practices that contribute to depression and anxiety. You have provoked a great discussion.

  • Anna Belle

    May 16th, 2016 at 10:21 AM

    There shouldn’t be anything wrong with admitting that you are depressed. It is a part of the human condition. We wouldn’t be allowed to have these kinds of feelings if it wasn’t.

  • zeke

    May 17th, 2016 at 10:25 AM

    does this even really matter if you are getting help?

  • Dr. Chantal Gagnon

    May 17th, 2016 at 3:23 PM

    Thank you for taking the time to comment on my article Brigid. Interesting theory about children of depressed parents, but neither of my parents suffered from depression. However, I’m glad you bring up the topic: children of depressed parents are more at risk for depression. Many researchers posit that this is because when a parent is depressed, they are more focused inward and are therefore less able to provide developmentally appropriate engagement with their children. It may also be that children eventually imitate their parents mood states. In either case, encouraging depressed parents to seek psychotherapy is a good way to help protect children against the effects of parental depression.

    What’s been most striking to me about some of the comments on this post is that readers perceive that I am either taking a “black and white” approach, or that I am blaming people for experiencing depression. It may surprise you to know that I do actually understand how depression feels, because I have experienced it myself, including feelings of suicide (I have written about this on my own blog). If you re-read my article, I specifically state that some types of depression have a hormonal cause (for example the feelings experienced during “baby blues” or premenstrual dysphoria), but after over 50 years of research, science has not yet been able to find any biological cause for depression. That is significant, and by ignoring this reality, we are in fact prevent ourselves from identifying the actually causes of depression. What it we designed a study where we provided professional social support to pregnant women and new parents, paid job-protected maternity and paternity leave, and gave free therapy to parents so that they could learn to reduce their stress and improve their joy. And what if in this ideal research study we found that the children of those parents had very low rates of depression. Then, we would know how to prevent depression! Wouldn’t that be good for everyone? By insisting that depression “must be biological” in spite of no scientific evidence to support that, we are actually robbing ourselves of finding solutions that work. No one is blaming depressed individuals or suggesting that they should “pull themselves up by the bootstraps”. What Dr. Duncan and I are saying is that depression is not a medical illness over which a person has no control. It is a signal that the mind and body give us to indicate something is amiss. That something varies from one individual to another. But in most cases, it is not a gene or a virus. It is a sign; a sign that we are not sleeping enough, or taking good care of ourselves, that we have not healed a childhood trauma, that we feel miserable at work, or powerless in our marriages. This is why long-term, psychotherapy is a much more effective treatment to depression than medication. Like Anna Belle says above: there should not be anything wrong with admitting that you are depressed. It is perfectly normal to feel depressed in a lot of circumstances. If there was no joy in your home growing up, it is hard to feel joy now; and to feel joy you will need to learn how. Saying that after fifty years of research, science has not yet found a biological cause for depression, does not mean that we are blaming people for being depressed. It simply means that maybe it’s time to look for causes and solutions somewhere other than medicine. -Dr. Chantal, article author

    PS: Thank you for your comment Alice. Yes, indeed, my goal was to spark a discussion. It is time for the mental health profession to have this discussion so that we can serve our clients more effectively!

  • Brigid

    May 17th, 2016 at 7:48 PM

    Although depression can be hard to treat, therapy really works, especially when a client is really open and invested in the process. When I am working with depressed clients, I try to help them describe his or her feelings. This is crucial in determining the most helpful tools to treat depression. If a patient can articulate his or her feelings quite well, it is typically not “depression”, but rather a situation that has generated a variety of feelings that may simply need to be sorted and expressed in words to an empathic listener. I would describe this as “the blues”. “The blues” typically respond well to therapy without an additional need for medication, but not always, each situation is unique.

    On the other hand, if an individual is having great difficulty describing his or her feelings, yet they are clearly negatively impacted by them, I would describe this as “the blahs”. As far as my work with depression is concerned, “the blahs” can be described as an overwhelming state of perpetual powerlessness that has resulted in an inability to describe, process and possibly understand his or her own feelings (alexithymia). There are a great many contributing factors that cause and maintain this type of depression…..OCD, ADHD, Cyclothymia, Aspergers, perfectionism (to name a few). Exploring a client’s relationship with emotional articulation/expression most often reveals the maintaining factors of the depression. The next step of the journey is for the patient to be open and willing to experiment with different tools (including medication) in order to find the tools that work best in fighting his or her depression. It is very satisfying to be present with a client as they learn to survive and thrive despite depressive tendencies!

  • Brigid

    May 17th, 2016 at 8:48 PM

    I must first say that there is so much that I agree with in your article Chantal! On the other hand, it was difficult for me to read without cringing. I reacted rather quickly as I could visualize in my mind’s eye, the painful reaction of a few of my depressed patients…. These are the people who are so deeply removed from his or her own experience that they fail to blink regularly despite your efforts to engage and support them. Maybe it started out environmental ….maybe it became biological (visaversa) ……… I am not sure?
    Research is very helpful, but it can also be misleading, inaccurate, and inconclusive and yet often in this profession we throw it around like it is fact.

    I used to believe depression was completely treatable with the right therapy. I now feel naive for believing that. Depression is so much more complicated than I originally thought. Yet, with a little hope and humility, I am hoping to pick up some more tools here and there to help. Thank you for your article and your response :)

  • Ethan

    May 18th, 2016 at 12:27 AM

    First, I would like to establish that I agree that psychotherapy ought to be the “first line of defense”, as you put it. It’s less costly, less risky, and often more effective than most common antidepressants.

    However, I think you could have made that point without rhetorically (if not substantively) dismissing biological depression to the extent that you did. Phrases such as “perpetuating the belief that depression is an illness”, “perpetuating myths about a biological basis for depression”, “Is Depression an Illness? Or Part of the Human Condition?”, etc., both cloud the most meaningful parts of your post, and read as insulting to the hundreds of thousands of us with severe depression, chronic depression, and other forms of mental illness with very real biological components. Even appealing to effect size to demonstrate psychotherapy’s clinical superiority over common antidepressants in the cases of mild or moderate depression is in a sense overly reductionistic; that psychotherapy is generally more effective in such cases does not make it uniformly so, and it in no way disproves a link between less severe depression and biology.

    Again, I do agree that psychotherapy is underutilized. But as someone who developed dysthymia before they could walk, and for whom a single injection of ketamine proved more efficacious than over a decade of psychotherapy, it admittedly pained me to read parts of your post, and I don’t think it necessarily had to.
    (Also, I apologize if this post came off as overly hostile; I really did find your article worthwhile.)

  • Sara

    May 18th, 2016 at 9:53 AM

    As a therapist I would totally agree in a holistic approach to depression. We are all individual and context is paramount. How about a both and approach instead of an either or.2zkA

  • Ian

    May 18th, 2016 at 10:29 AM

    My fear is that to say that it is not an illness gives the implication that it can just be turned on and off and that a person should be able to handle this on their own.

    While that would be great the reality is that for some of us even though this may be a part of our makeup there is no way to shake it off without a little help.

    I just wouldn’t want someone to believe that it is something that they are doing wrong which is causing this to happen to them.

  • Ashley

    May 19th, 2016 at 3:33 AM

    I really like this article for a couple reasons. The first one being that several of my family members suffer from mental illness, especially my grandmother who is schizophrenic. The idea that mental illnesses are completely biological or genetic always left me with a feeling that I was “doomed” to experience mental health issues throughout my life. The idea that positive life changes can keep these at bay is definitely more encouraging and hopeful.
    The second reason being that I did start having mental health problems when I was 13, ten years ago. I left my issues untreated for years, until I became suicidal. When I was seventeen I started therapy and taking medication. I hated talking to people and therefore I let myself rely heavily on the medications. I tried seven different anti depressants and anti anxiety medications in less than two years. I always felt like they weren’t working. I was in an abusive relationship and had no close relationships other than my partner. Life changes were what I needed, not medication.
    I eventually stopped taking the medications and stopped going to therapy, and I decided to take on the situation myself (which was stupid and dangerous, because I stopped everything by myself, without my doctor). I left my partner, I got a new job, I made changes and I haven’t been on medication since.
    That’s not to say I’m 100% perfect all the time. I stil have days where I lay in bed and cry for no other reason than that I’m alive, I still get stressed and lose motivation to do anything at all, I still have days that getting out of bed is emotionally painful. But I stop crying, I go to work, I get out of my bed, I force myself to get up and be alive. I do my best not to enable myself. It’s extremely difficult but it’s undoubtedly something that you must do.
    I fully understand that some people get in so deep that they may temporarily need medication to get to the point where they’re able to stop enabling themselves, but the majority of people don’t need to rely on medication forever.

  • Steve M

    May 25th, 2016 at 12:27 PM

    Awesome post! Thanks for sharing your story!

  • David

    May 19th, 2016 at 12:32 PM

    I spent many years in third world countries and I never saw one case of chronic depression. I deducted it was because those people didn’t have the luxury of being depressed. They had to survive. They couldn’t sit in bed all day or take pills to make symptoms go away. I think sadness, anxiety and lethargy are made chronic when they are treated with drugs. Brain chemistry can be changed through other means than pharmaceuticals. Recent studies have proven that meditation is far more effective than drugs for PTSD patients. Of course, there is no money in meditation so it will never become part of the treatment protocol for mental health.

  • Mary

    May 20th, 2016 at 11:14 AM

    I call part of what you are talking about “situational depression”. However, not all of us can discard a spouse or child that easily based on our value system. Also, I have SAD very bad and have a very hard time of keeping my Vit D up and sunshine exposure in the winter. I have heart disease from heart attack that was stress related earlier in life, now disabled with joint dysfunction. I try to read all I can about natural health and take supplements in addition to medications I think are at least 50% necessary. The medical profession beats us down every time we refuse to take a STATIN or other that they think is valuable, even though it is our body. It is a hard time, the world is stressful just living. My mother lived to 96…her body was healthier, her outlook more positive. My father passed at 50, less healthy and nervous. Be careful what you say, for you never know where you will be as your get older because of all kinds of life experiences. You do make some good points, and I tapered down my anti-depressant by counting granules so that I could take a natural anti-inflammatory. I suffered HUGE SAD this winter because of it.

  • Anne

    May 20th, 2016 at 1:02 PM

    This article made me mad. I have suffered with depression for at least 40 years. It is not a choice. I’ve spent a lot of time in therapy trying to undo that belief. It took years for me to accept that it is an illness for me. With medication (Parnate) and therapy, my life is pretty good. Being free from so much of the symptoms of depression has allowed me to make healthy changes. Therapy helped me so much but until the addition of the Parnate, I really never had long periods of relief. It is rare for me to have sustained periods of severe depression today but I am not, nor would my doctor recommend, me going off the Parnate. I agree with some of the article. I certainly believe that therapy is the best starting place but this is not a choice for me.

  • Mike

    May 20th, 2016 at 1:21 PM

    David, you say you never saw a case of chronic depression in a third world country. But would they feel free to talk about it? People with depression can force themselves to go through the motions. They can keep quiet about it. Robin Williams was active and was a great comic and actor. People said he was fun and energetic to work with. But every once in a while this look of despair would come across his face, some of his friends reported. They would see a scary depth of despair and suffering for a moment. Then he would master himself and carry on. His friends saw his despair, but on the whole it’s easy to hide such feelings when you need to. This doesn’t mean they aren’t suffering. They are suffering all the more because of keeping it to themselves. Robin Williams took his own life, that’s how much he was suffering. Consider other mental illnesses which are probably genetic, like OCD. There is every reason to think that some people in 3rd world countries suffer from OCD. It’s everywhere. Heck, domestic animals suffer from OCD. Now, when it’s bad, it can be a tremendous amount of suffering. But in some cultures people are not free to talk about it. They suffer silently.

  • Wilma

    May 20th, 2016 at 2:21 PM

    I wonder what Woody Allen would think.

  • Fran E

    May 20th, 2016 at 2:27 PM

    I mostly agree with comments and observations in this article. The DSM-5 has successfully managed to essentially pathologize all of human behavior. I tend to attribute responsibility for this more to insurance companies and other payers than to the practitioners apart from the practitioners needing to be paid for their services. Medical model is a MODEL; the map is not the territory. At the same time, it probably is important to recognize that human experience happens along a continuum of difficulty, and just as I used to be able to see without glasses when I was younger, if I want to see today, I need to wear glasses. So utilization of pertinent and helpful tools – including the right medication at the right time in the right amount for the right reason – also merits consideration. BTW, wearing glasses does not automatically allow me to read. I have2 to learn to read. But in order to learn to read, I have to be able to see. Hence glasses. And medicines.

  • Karen Kochenburg, LCSW, LPCC

    May 20th, 2016 at 2:56 PM

    Great article! Thanks for being brave and putting out an unfamiliar and potentially unpopular opinion (with some research-based evidence). I completely agree and think that increasing people’s sense of responsibility and belief in personal control over changeable circumstances is the definition of empowerment.

  • Wilma

    May 20th, 2016 at 3:09 PM

    PLEASE EXCUSE TYPOS…WRITTEN ON A LITTLE PHONE IN HASTE)
    2ZkASeriously, I kind of do.
    I am someone who lost her father at age 4 and basically became a parentified child, helping my mother, who probably was predesposed to ptsd from living through The Blitz (wwII total bombi g of london, england) as she tried to adjust to New York life, as a single mom of 3. The story goes on. . .
    The first time I recognized that I had depression was when I was 14 (I had physical symptoms though after my father died . . .throwing up that night, and every day I went in the car that drove a few kids to preschool). I asked my mother for help and she got me counselling. It didn’t stop there.
    My point is that I agree to the application of systems theory (I am not a therapist but haven taken courses along the way). But I see it as this: depression is the confluence of many factors and can be experienced to all different degrees on the continuum. Mild depression may be (not “will be”) treatable with non-medicinal therapies, but not without certain other risks such as incompetent therapists or medical staff, abusive treatment providers (yes i did have a psychologist begin telling me how he was lonely . . .his wife was out of town, etc. I walked away but others might not have), and the establiahment of a very expensive dependency (Woody Allen would make a joe here), not to mention becoming overly comfortable speaking in complaint mode.
    On the other hand medicine is given too easily and not by people who have invested hours and hours, and kept up to date regarding factors that influence depression. I am talking about general practitioners who do not do due diligence regarding knowing the risks of long-term use of the medications they provide, who do not ensure their patients give truly informed consent, and who often fail to take into account, themselves, whether an physical addiction may be created and/or whether a patient will be able financially to continue to pay for a particular medication indefinately into the future.
    This article makes it look easy to choose a non-medical path. But easy it may not be. Major depressive disorder is immobilizing (by definition?). When I suffered from it, I had brain fog and could barely pick up the phone to make a call most days. I spoke with a therapist, but that didn’t do it.
    What finally made a huge difference FOR ME was a return to the medication I had been weened off of 9 months earlier (venlafaxin) AND doing what I called a “self-check” whereby I looked myself over and answered the question of “right here, right now, Are you okay?” (To which I found that I actually was okay), reminding myself of that prayer they use in AA (or AAA?) about accepting the things I cannot change . . . . And finally, watching the Connecticut Forum where the speakers discussed how significant depression may literally alters the brain for the worse. The latter was inspirational and gave me new determination.
    I am not “cured” but I have found a way to manage. Now more things are small things that I don’t sweat as much.
    Wheras, for others I suppose religion ( having faith) might do the same thing.
    My point is that system’s theory applied and taken to its logical conclusion would suggest that people with depression, and the depression itself, need to be evaluated for the unique features they present and that qualified professionals should not condemn any reasonable, affordable treatment option because it might be the right one for that individual at that time . . . And therefore being opposed to it (you will be googled!) might cause a client or patient to either distrust it as a possible treatment option, or may not trust the practitioner who has said or written one thing, and later indicates inconsistency by offering that option up.

  • kathleen c

    May 20th, 2016 at 3:26 PM

    The author’s point of view parallels that of the scientologists who abhor the thought of treating depression as a biomedical disorder. I am one of the “few”(as the author would have you believe) who have benefitted from meds alone for years. I am happy and “normal” for having opted to do so when my son was 5 yrs old. He is now 24.

  • Selene Drake-David, LCSW

    May 20th, 2016 at 8:17 PM

    I have often told people they might benefit from psycho-therapy but there are options, such as career counseling when that is the area of their life that needed addressing. Many people do not need analytic therapy, but some short-term behavioral counseling to learn how to take better care of themselves. For example, people who over-function often overcome depression when they set limits with others. -Please do not represent all therapy as being the same.

    And research shows, recovery is best sustained by both medication and therapy; not either/or but both. However, not everyone needs medication for the rest of his life.

    As a therapist, I’ve worked with many psychiatrists who told people they did not need medication! Stop implying that psychiatrists “push” medication for their own gain!

    Please do not discourage people who need it from seeking a consultation for medication! It doesn’t necessarily matter what “caused” the depression in terms of physiological manifestations…some people need medication sometimes, to help the body overcome depression. Once someone is depressed, we are treating a body/mind/spirit and any good mental health clinician will take each individual situation to assess what’s needed.

    Maligning a whole profession and confusing people is a disservice. It’s as ridiculous as saying we are all excellent at what we do.

    If you need help, please seek it; and persist until you find answers that work for you.

  • Helen M

    May 24th, 2016 at 12:39 PM

    Thank you for writing this! EXACTLY!

  • Ryan

    May 21st, 2016 at 12:33 AM

    Sounds like this is taken straight out of the pages of the Church of Scientology. Maybe we should return to the good ole days of accusing the mentally ill of being possessed by demons and burning them at the stake. Many environmental factors contribute to mental illness, childhood trauma, abuse, traumatic experiences, but one fact has become clear, mental illness is being more and more linked to nature rather than nurture. It’s a known fact that sociopaths have an underdeveloped frontal lobe. No amount of therapy in the world will ever change that. Just because Tom Cruise plays like a very important person on TV, doesn’t mean people should take medical advice from him.

  • Jay R

    May 21st, 2016 at 5:43 AM

    Depression can be both biological and psychological. Psychological stress triggers biological changes that promote depression. So you can actually address this from both directions.

  • Susan

    May 23rd, 2016 at 11:31 AM

    This is a conceptual framework in which to pose the question, “Am I depressed and anxious because of what I believe about myself, my relationships and the people I associate with, as well as my overall life choices OR is there a medication that will help support me in altering brain chemistry so I can begin making changes in certain areas of my life? Whoever and/or what circumstances created the belief we ought to be happy and comfortable all the time? It’s not a reasonable expectation of being alive to believe we will always be happy and comfortable. Here’s my oversimplified take on this well-thought-out scholarly article: Be mindful of your beliefs, don’t confuse “stories” with “truth,” be accountable to yourself and begin to embrace all aspects of yourself. That’s what I gathered from this rendering. btw, I am a long time user of citalopram to help me maintain a more stable mood, and Xanax prn for anxiety… I also take Ibuprofen to manage pain, occasionally take Tums to manage heartburn, etc. Let’s only pathologize pathology; and not pathologize taking good care of ourselves using medication.

  • Kathy

    May 23rd, 2016 at 2:30 PM

    This is a touchy subject. I went back and forth on being mad at you and understanding where you are coming from. The last paragraph is your saving grace because it CAN be both. So thank you for allowing other possibilities to open our minds to treating depression.

  • RL

    May 23rd, 2016 at 10:21 PM

    To the author, I’m livid. Beyond livid. Rage-filled thoughts raced through my mind as I read the words you wrote.

    First, on fighting stigma. Whether caused by biology, hormones, social factors, learned thinking styles, or ineffective behavioral choices, there should be no stigma attached to mental health issues. Unfortunately, there is stigma attached. Because of that stigma, I hide. I hide my pain and despair from those closest to me. I hide it from those not close to me. How do I explain the horrific scars on my arms? I don’t; I wear long sleeves year round. How do I explain involuntary hospitalizations? I don’t; I never speak of them. I am college-educated and was a marketing professional for ten years. How do I explain I live practically in poverty on disability? I don’t; I tell people I work as a freelance writer. Stigma is real. It is soul crushing. Society tells me it’s not okay to be me. I can not fathom anyone suggesting that anti-stigma campaigns are a bad thing. You are throwing out the baby with the bath water based on your personal bias against what you believe defines “illness.”

    Second, on defining illness. Webster’s defines illness as a condition of being unhealthy in your body or mind, a specific condition that prevents your body or mind from working normally, a sickness or disease. Nowhere in the definition of illness does it mention the use of medication. You are adding medication to the mix. I suffer from mental illness. I have a condition of being unhealthy in my mind. I have specific conditions (depression and anxiety) that prevent my mind from working normally. Illness. Sickness. Disease. Condition. Pickle. Shoe. Palm tree. I don’t care what you call it. It exists. I suffer with it. I seek treatment for it.

    On distinguishing depression and anxiety from depression and anxiety. Cue R.E.M. and “Everybody Hurts.” Yes, everyone feels depressed sometimes. Everyone feels anxious sometimes. However, everyone does not suffer from depression. Everyone does not suffer from anxiety to a level that rises to disorder. I’ve spent my life suffering from and dealing with the affects of depression and anxiety. I was in elementary school when my mom took me to the doctor because I routinely felt like I couldn’t breathe. She feared some sort of asthma. It was anxiety. When I was 14, my pediatrician removed the stitches from my wrist. Today, I am 40 years old. I still suffer. What I suffer from is DEPRESSION and ANXIETY not depression and anxiety.

    Regarding the science of depression. Prove to me it is not caused by some pathogen, virus, bacteria, gene mutation, faulty chromosome, malfunctioning neurotransmitter, systemic inflammation…. You can not say that there is no biological cause just because one has yet to be discovered. That is ignorant. Personally, I’d like to tar and feather the majority of psycho-pharmaceutical company executives and every single drug rep I see walking into my therapist’s office (he shares office space with psychiatrists). The industry angers and sickens me. The current cycle of new drug, promotion, booming sales, patent expiration, slightly altered drug, promotion, booming sales, patent expiration is disgusting! It’s abusive to patients suffering from mental illness. However, just because scientists have yet to find a definitive biological cause does not mean a biological cause does not exist. Did people not get sick before we learned of the existence of germs?

    I’ve taken an antidepressant for 20 years. It’s an SSRI. My mom takes a similar medication. Without it, we both can not contain our explosive rage. The SSRI doesn’t do shit for my depression or anxiety. Therapy has helped with those issues. Years and years and years of at times excruciatingly emotionally painful therapy. I started unable to speak during therapy (I could speak just not during therapy). Now, even I’m proud of my accomplishments in therapy. But, I still deal with severe episodes of depression and extreme anxiety. I no longer self injure. Instead I talk. How dare you suggest that those who identify with having a mental “illness” will refuse all avenues of treatment in favor of medication only. I loathe the antidepressant I take. Only the Lord knows what it has done to my body and mind after 20 years. What damage has it done? What will it do? Several years ago, I refused my psychiatrist’s repeated suggestion that I add Abilify, even after talking with my long-time primary care physician and my therapist who both agreed I should try it. The risks were too great, in my opinion.

    Do NOT dismiss my pain and a lifetime of suffering by suggesting I try a little yoga. Do NOT suggest that you know my experience because you’ve suffered episodes of depression and have felt suicidal on occasion. Do some therapists not understand that for some people the depression does not leave? For weeks or months, when I’m lucky, it will lift enough to allow me to function. For weeks and months, when I’m unlucky, it tries to kill me. Year after year after year. My thoughts aren’t entirely my own. My emotions are hijacked. Why can’t people understand that depression is not just feeling depressed? I did NOT choose this. I have desperately fought this for 40 years. Except for medical and psychological professionals, I’ve fought mostly alone. Most family and friends don’t want, nor do they know how, to help those with mental illness. Do NOT undermine my struggle – the struggle of those of us with MENTAL ILLNESS.

    Mental illness is real.

    Just because the psycho-pharmaceutical industry does a better job marketing its product than therapists and psychologists do marketing their service, don’t blame and shame those of us suffering from mental illness.

    I’m afraid to submit this. I’m scared of making people angry. Even worse, I’m afraid of being dismissed. Most of my anger, stirred up reading this piece, has dissipated while writing my reply. I don’t like feeling anger. Now, there are only tears and fear.

  • The GoodTherapy.org Team

    May 24th, 2016 at 9:54 AM

    Hi RL,
    Thank you so much for taking the time to comment and share your experiences! It is so important to continue talking about mental health and therapy to reduce stigma around mental health issues. If you’re interested, we would love to read a full piece about your history, time in therapy, and anything else related you’d like to share. Please consider submitting a piece to our Share Your Story feature—articles may be published anonymously, if you like, or under a pseudonym. You can read more about this feature here: http://www.goodtherapy.org/submit-your-story.html

    Thank you again for your comment!
    Kind regards,
    The GoodTherapy.org Team

  • Steve M

    May 25th, 2016 at 12:39 PM

    I understand your frustration, though I think perhaps you are reading things into the article that are not there. I do have to say, though, that scientifically, it is not correct to say that the fact that a biological cause has not been disproven means that there is a biological cause. It means we don’t know the cause, or even that there is a common cause.
    I think one important reason that researchers have had no luck in finding a cause for “depression” is that it is not always caused by the same thing. Why would we assume that a general state of emotional and physiological distress would automatically always have the same cause? Rashes, knee pain, dizziness, sneezing, vomiting, diarrhea, all can be caused by many different factors, and if we tried to find “the cause of vomiting” and studied all people who vomit and look for one cause, we’ll be SOL pretty fast. That’s what I think is happening, and assuming that all “depression” is biological and looking for a biological cause will ultimately be totally fruitless.
    What should be apparent from the comments above is that many people experience depression for many different reasons, and that each person’s situation should be regarded individually rather than lumping them all together as one “illness.” That way, we could weed out all the folks whose depression is clearly a function of poor diet, or feeling trapped in a dead-end job, or being in a violent relationship, or having been abused as a child, and look at those folks who appear to have no such triggering factor involved and see what THEY have in common. This has rarely or never been done with sufferers of mental illness symptomatology, and I think it’s mostly because it’s more profitable and simpler to just lump everyone into the same category and treat them as if they all needed the same thing. It’s disrespectful and insulting to those of us who view our depressive histories as an expression of conflict between our natural personalities and needs and an environment which didn’t work for us, just as it would be insulting to you if someone said that “no one should ever take antidepressants, they’re just a hoax.” (Which, BTW, the author is most clearly NOT saying.)
    The key is individualizing, and I say this as both a sufferer and a practitioner of the art of therapy. Every person is different, and a good clinician finds out what it is about that specific person that is out of line, rather than considering all depressed people as being the same and treating them as a herd to be managed.
    That’s my take on it. Interested in hearing your response.
    — Steve

  • Dr. Chantal Gagnon

    May 27th, 2016 at 10:53 AM

    Very well put Steve M. ! Thank you for taking the time to write this thoughtful and helpful response. Dr. Chantal, article author

  • Steve

    May 29th, 2016 at 8:00 PM

    Thanks!

  • Panreplicide

    January 14th, 2017 at 1:54 AM

    Life is simply a nightmare dictated by the gene pool. My depression is severe existential angst and there’s no cure except voluntary euthanasia, which is taboo. Thus insult is added to the injury. Please vote for legal euthanasia for those of us who want it as an option!

  • GoodTherapy Admin

    GoodTherapy Admin

    January 14th, 2017 at 12:19 PM

    Dear Panreplicide,

    Thank you for your comment, _. We wanted to provide links to some resources that may be relevant to you here. We have more information about self harm at http://www.goodtherapy.org/therapy-for-self-harm.html and additional information about what to do in a crisis at http://www.goodtherapy.org/in-crisis.html

    Warm regards,
    The GoodTherapy.org Team

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