In its January 23 Morning Edition segment on depression, Alix Spiegel of National Public Radio (NPR) made two statements which are not supported by scientific evidence and which are harmful to people. The two statements are:
“Everybody agrees that depression is caused by biology to some extent.”
“Researchers don’t know what causes depression.”
The first statement is not supported by scientific evidence. Clearly, depression is biological as is everything that goes on in the human body. But there is no evidence that depression is caused by biological dynamics. It is more likely that depression is caused by psychological dynamics. If we use the scientific principle of parsimony, i.e. when developing hypotheses we should be informed by what is already clearly established, our hypothesis would be that depression is caused by the reaction of a person to a life situation. After all, that is what happens with the stress response, the mind-body dynamic which has been most widely and deeply studied.
The stress response is a profound physiological dynamic. The heart begins beating more rapidly; the blood carries more oxygen; adrenalin and other hormones which increase strength and quickness are secreted; blood flow to the extremities is reduced; the pain threshold increases; blood goes to the heart, brain and muscles and not to the digestive organs; the immune system is compromised.
But the stress response doesn’t come out of the blue. Rather, it is triggered by a perception that something is threatening the person or the person is going to have to do something that is very difficult and demanding and a cognition that the threat and the demand are real.
If this is true of the stress response, why wouldn’t we think it is true of depression and other mind-body dynamics?
And there is plenty of reason to believe that it is true of depression. It is clearly established, for example, that depression is triggered by the loss of something precious to a person: a spouse, a child, a parent, a friend, a job, financial security, a sense of self-worth and adequacy, a sense of certainty and security in the world. This view is supported by the following research findings:
People with the following characteristics are more likely to become depressed than other people:
- People who derive their sense of self-worth from social relationships and who have suffered an interpersonal loss.
- People who score low on self-esteem and high on stress.
- People who score high on a Self-Defeating Personality Scale.
- People who had poor social functioning as adolescents.
People who have high levels of emotional strength and resiliency and a higher level of ego control are more likely to be able to handle being depressed than others would be.
This is evidence that depression is a reaction to life situations that are troubling, stressful, difficult, discouraging and even tragic. So the statement that researchers don’t know what causes depression is untrue. Of course, some people are more vulnerable to depression than others because they have a more difficult time dealing with stress, because they react more strongly to “hard times”, because they lack a support system that can help them weather the storm, perhaps because they are not as resilient as other people.
Ms. Spiegel and others may respond by saying that NPR was referring to “clinical” depression, not the kind of depression that is caused by loss or difficulties in dealing with troublesome and scary life issues. That is an invalid distinction. There is only one way that depression is diagnosed by psychiatrists and psychologists. The person is asked the following questions:
During the past two weeks, have you experienced the following?
- Depressed mood most of the day, nearly every day;
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day;
- Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day;
- Insomnia or hypersomnia nearly every day;
- Psychomotor agitation or retardation nearly every day;
- Fatigue or loss of energy nearly every day;
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day;
- Diminished ability to think or concentrate or indecisiveness nearly every day;
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan or a suicide attempt or a specific plan for committing suicide.
If the person answers “Yes” to five or more of those questions, the person is diagnosed with “clinical depression”. There are no laboratory tests or physiological markers. And there is no difference between the diagnosing of the so-called “garden variety” of depression and “clinical” depression.
Thinking that depression is caused by chemical dynamics is like thinking a home run is caused by a bat. It is confusing a mediative variable with a causative one. Just as focusing on the bat is a mistake with homeruns, focusing on chemistry is a mistake with depression. The important variable in a home run is the batter. The important variable in depression is how the person is reacting to hard times, loss and deep concerns about his or her life. To focus on the bat is to lose sight of the most important variable, the batter. To focus on chemistry is to lose sight of the most important variable in depression, what is going on with the person who is experiencing it.
To say that nobody knows what causes depressed mood is just as ludicrous as saying that nobody knows what causes good mood.
The statements made by Ms. Spiegel are damaging to people for the following reasons.
They reinforce the belief that depression is caused by some unknown biological dynamic and that belief dissuades people from realizing that depression is caused by a life situation they are facing, by difficulties with spouses, bosses, jobs, parents, children; by significant loss; by deep concerns over whether one is going to be able to live the life one wants to live. And since it has to do with their life situation and how they are reacting to it, depression is an opportunity for people to learn some valuable lessons, i.e. what is precious to them and worthy of being nurtured and protected in the future, what is missing from their life and what they want to do about it, how to use the stress response to recognize and deal with threat, how to manage their thoughts, feelings, intentions and perceptions in ways that will enable them to live more the way they want to live.
They make it more likely that people will opt for taking psychotropic drugs instead of seeking help in learning how to manage their thoughts, feelings, intentions and perceptions, in learning about what makes them tick so they can manage themselves more effectively. Psychotropic drugs are harmful to people for the following reasons:
They impair the very faculties that people need to use in facing their depression and learning from it, i.e. the ability to experience and learn from emotions and the ability to think clearly.
They don’t address the causes of depressions. They only address the symptoms of depression.
They have serious side effects – mania, akathisia, sexual dysfunction, suicidal ideation, violence and suicide.
They cause the brain to compensate for increased levels of neurotransmitters thereby reducing the density of receptors, thereby causing serious withdrawal effects.
They send a cynical message: when you are feeling bad, take a pill. In fact, antidepressants work in the same way that cocaine does. Whereas Selective Serotonin Reuptake Inhibitors (SSRI’s) inhibit the reuptake of only serotonin, cocaine inhibits the reuptake of a whole host of neurotransmitters. That is the only difference.
There is a very high relapse with people who are treated with drugs. When they stop taking the drugs, the symptoms of depression return. That is not true with people who are treated with non-drug psychotherapy.
To believe that depression is caused by chemistry is to hold a cynical view of human beings. It turns them into bunches of neurons, neurotransmitters and synapses that operate in some kind of random, unfathomable fashion rather than meaning-making, desiring organisms who suffer when they are not able to live the way they want to live, when they are not able to love the way they want to love and work (express themselves) the way they want to work. And the suffering is potentially useful because it induces people to take stock of their lives, realize what is precious to them and needs to be protected and learn how to mange their thoughts, feelings, intentions and perceptions so they can live more the way they want to live.
The widely held belief that depression is caused by a chemical imbalance in the brain has not been supported by scientific evidence. Doctors are not able use laboratory findings to diagnose depression. Researchers have not been able to induce complaints of depression by directly altering neurochemistry in ways consistent with the chemical imbalance theory. The “normal balance of neurotransmitters” has never been established. So how can we know what an imbalance is?
National Public Radio is looked upon by many Americans as a source of accurate reporting, as a spokesman for the truth. This is especially important when it comes to the truth about health issues. By making the two erroneous statements about depression, NPR has let down its listeners in a way that is harmful to them.
Al Galves is a retired psychologist who lives in Las Cruces, New Mexico. He is Executive Director of the International Society for Ethical Psychology and Psychiatry.