Why is it that when we supposedly know the cause of depression, and its treatment with appropriate drugs, that we still have an epidemic of depression? Surely we have got it wrong, so let’s take a tour through depression and its causes to re-evaluate how we manage it, because obviously anti-depressants are only part of the answer… if at all. Houston, we have a problem. But the solution is not to go down the same track of trying to find better drugs, surely?
The way we are looking at depression contains a fundamental flaw right at the very beginning; what we are saying is that the brain and the mind are the same thing, but they are not. Let’s get one thing right at the onset: The brain is an organ in the body, it has physical presence, but the mind is neither of these things. The brain and mind may be connected, but maybe the mind is like the TV stations and the brain like the TV. If the TV malfunctions you won’t see the stations properly or at all, but that is not the same as saying there is a problem with the stations. Yet modern western medicine (MWM), in spite of most disciplines seeing the difference, does not. It believes that by correcting brain chemistry it corrects problems in the mind. Certainly changing brain chemistry can affect the mind – ask anyone with a hangover – but this is different to when someone has a primary mood problem.
MWM, backed by the pharmaceutical industry, sees that boosting the natural chemical serotonin in the brain corrects a low mood, or depression, which it does; but it does not deal with the cause or triggering factors to the initial mood change. And this is what anti-depressants do, they boost serotonin. It the short term, this may be effective, but in the long-term maybe not… because the way they boost depression causes a loss of serotonin reserves, so that after a while the dose doesn’t work as well. Then there is the habit of either increasing the dose or changing the brand, because the belief is that the problem is chemical – probably genetic – and so you “need to be on them for life”. Added to that are that the drugs are not ‘natural’ and hence the chemical concern regarding toxicity becomes an issue, leading to an addictive situation, which is one reason people have such difficulty coming off them.
If you think this is self-serving, you may be right. Also, don’t believe that different classes of drugs that maybe work on other chemicals are much different, they are not in principle. And, if you concerned about the association between MWM and the pharmaceutical industry, you may be right here too; but this is too big a topic to explore here… don’t be concerned, it will be though! Experience amongst clinicians, who work with depression and take a broader and more holistic view of depression, is that this is a very limited way of looking at the problem and dealing with it. In the short term these drugs can be very effective, but should be part of a longer term and broader management strategy. In other words, we need to look at the TV stations as well, so let’s kick on to this area.
There are other models that better describe depression. One, even acceptable in some areas of MWM, is what is called the biopsychosocial model, or BPS. BPS gets beyond the TV stations and TV set division as mind and body, to connect them together with the ‘social’ sphere; this is, of course, inclusive of other factors, such as occupation, family, and even religious belief. Then there is the psychoneuroimmunological model, or PNI, that sees the profound interconnection but also differentiation between the mind (psych) and brain (neuro), as we have already noted. But PNI goes further and recognises the role of hormones and the immune system in the overall picture.
Personally, I like a blending of these two models. I also prefer an even more expanding view that includes the creative and spiritual dimensions. When we look at these we don’t see depression as a fixed and inevitable state, but as a stage in our personal growth, a transition or even a transformation. This view also sees that depression is also an almost inevitable part of personal growth and spiritual development; one to be negotiated or ‘gone through’, rather than denied or avoided.
Unfortunately, MWM does not take this view, because it has a very poor appreciation of these other influences. Added to this is that a lot of depression that is diagnosed may not be actually the mood of depression in the first place, but other mental disturbances, such as anxiety. Also, the almost inevitable triggers, or ‘stressors’, are not usually taken into full account, nor are diet and exercise issues considered.
So, we may come to the conclusion that anti-depressants may have a place, but much more limited than seen to date. What alternatives do we have? Well, firstly, how about other ways to make sure that the serotonin levels are OK, such as eating foods that are rich in them? You may appreciate the Christmas turkey a bit more, but there are also more readily available alternatives, such as nuts and eggs. Too many bad carbohydrates lowers them, and because serotonin and the other major chemicals in the brain are made from protein, your diet should be sound here. Ideally, tryptophan, a foodstuff and precursor, could be used as a supplement, but because of a curious and antiquated anomaly it requires prescription. However, there are alternatives such as 5-HTP, the next biochemical in line to making serotonin from protein sources.
It is obvious that diet and supplements have a big place, so is there anything else? Well, the brain is a big lump of fat, so good fat intake is important. There are also other supplements to support brain biochemistry, although good naturopathic support may be helpful here. However, there are a lot of quality supplemental ranges that can guide you in any self management process. And, surprise surprise, exercise helps considerably.
If we go back to the models, then the social factor should be considered: are the support mechanisms positive and creative? Avoid people who don’t support you, or those who might give you well-meaning advice, but of the sort that is not part of your belief system and self-management strategy. Ditto with engaging professionals, as there are holistically-oriented doctors who have some additional tricks up their sleeves. If people engage with you out of fear or for self-serving reasons, they are not for you.
Good quality psychotherapy deals more directly with the mind. Limited psychological approaches, such as the popular cognitive behavioural therapy or CBT, can be limited and temporary. Ultimately, depression is connected to stress, anxiety, and our whole emotional and instinctual worlds. Any counselling or therapeutic approach should be with someone skilled and experienced, and not as a simple ‘tack on’ to drugs.
It’s a big field, which is why many opt for the drug ‘fix’. But it is failing, we have the drugs and an epidemic still. There are alternative paths, as outlined briefly here, but they ultimately rest on taking self-responsibility, being empowered and getting the right support and advice. For most, it is also a temporary state, a transition; learning to handle it is a growing experience and can be creatively and spiritually rewarding.