Watchful Waiting and Depathologization Effective First Line Approach to Depression

A new study highlights the benefits of a partial watchful waiting approach as a first-line treatment to non-suicidal depressive symptoms.


A new study published in the Journal of Affective Disorders Reports attempts to address the issue of antidepressant overuse by offering a solution: adopting a partial watchful watching approach to depressive symptoms. Researchers found that this multifaceted approach led to the majority of patients experiencing significant improvement in symptoms without drugs or psychotherapy.

The researchers, led by Milutin Kostic of the Institute of Mental Health in Belgrade, Serbia, write:

“Considering Ads [antidepressants], one should keep in mind that they have (1) modest short-term effectiveness; (2) questionable long-term effectiveness, with hypothesized and somewhat supported possible negative long-term effects; and (3) potential for withdrawal symptoms. Further caution has been based on observations that ADs themselves might chronify depression. Also, even time-consuming and expensive psychotherapy can pathologize and potentially evoke adverse effects.”

A partial watchful waiting (WW) approach has traditionally been used as a medical intervention where time is allowed to pass before treatment is administered. When applied to depression, WW involves educating the patient about the diagnosis and the potential risks and benefits of medication and psychotherapy.

When biological explanations of depression are connected to diagnosis, patients tend to become more pessimistic about their ability to get better, which, unsurprisingly, leads to worse outcomes. In fact, there is no evidence that low serotonin causes depression, pointing to the lack of evidence to support biological theories of depression. Additionally, the reliance on biological narratives  contributes to the pathologization and potential misdiagnosis of normal sadness – as seen in the psychiatrization of grief in “prolonged grief disorder.”

In the current study, researchers used a WW approach, which includes psychosocial education on depression, including an explanation of the flaws associated with a depression diagnosis, depathologization of sadness, and shared decision-making with non-suicidal patients experiencing depressive symptoms. It is the first known study of its kind to apply WW to depressive symptoms.

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  1. Still more misuse of medicalized language (depressive “symptoms”) that only perpetuates the fallacious notion that patterns of thinking, feeling, and behavior without a verifiable physical cause can be legitimately defined in terms of pathology.
    Is a non-binary teenager, for example, who feels depressed, perhaps suicidal, because of bullying, rejection, even physical assault at the hands of intolerant peers suffering from a genuine medical illness? To me, his/her/their distress is totally appropriate and reasonable under such painful circumstances and does not require psychiatric labeling and treatment (be in chemical or so-called talk therapy) but rather a non-judgmental, caring support group.

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  2. Foregoing a wait-and-see approach is the reason why so many people these days are inappropriately labeled as “mentally ill” — and is why consulting an medical doctor or psy-professional could end up being a mistake.

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