Whenever Richard Cory went down town,
We people on the pavement looked at him:
He was a gentleman from sole to crown,
Clean favored, and imperially slim.
And he was always quietly arrayed,
And he was always human when he talked;
But still he fluttered pulses when he said,
"Good-morning," and he glittered when he walked.
And he was rich—yes, richer than a king—
And admirably schooled in every grace:
In fine, we thought that he was everything
To make us wish that we were in his place.
So on we worked, and waited for the light,
And went without the meat, and cursed the bread;
And Richard Cory, one calm summer night,
Went home and put a bullet through his head.
Sometimes an awesome life can actually make it harder.
It's easy to justify being depressed when you have a crappy life. (even though your depression probably doesn't have some cause like that)
"I am depressed because I am living in a bad apartment in a bad part of town, working a bad job. If I get a better job and can afford a better apartment, I'll be happy."
Assuming you have some hope for that happening, that can keep you going. At the very least, you have something you think is a cause and things are easier to deal with when we at least think we know why they're happening.
"I have everything I could ever want, and I'm still depressed." Pretty easy to let that spiral you into thinking you're never going to get better and that there isn't any hope.
> "I have everything I could ever want, and I'm still depressed."
Not only that, but it becomes very easy to tell yourself that you don't deserve success. It's easy to look at your life and say "I haven't really worked that much harder, lived that much more virtuously. I don't deserve this, this should be someone else..."
"I should’ve died in my 20s. I became successful in my 40s. I became a dad in my 50s. I feel like I’ve stolen a car — a really nice car — and I keep looking in the rearview mirror for flashing lights."
I remember reading about a very successful female model's suicide few years ago - didn't know who she was and can't remember her name now. What I do remember was that she was quite successful materially and jumped from 20th floor (according to the news article).
But what hit me the most was her age - she was just 20 :(
Every person is different and we may never understand what bothers them, even if they appear successful and happy on the outside.
Most cases of depression do care how awesome your life is. Depression rates aren't spiking because people's brains have suddenly stopped working properly, it's because society has gotten progressively more dehumanizing.
It is also a mistake to think that being a celebrity is necessarily awesome. The loss of privacy and the barrier celebrity presents to having genuine interactions can literally be a killer.
Chemical imbalances may possibly play some role in depression, but we have no idea of which chemicals or what the "correct" balance is.
Antidepressant drugs do work, but we don't really know why. Selective serotonin reuptake inhibitors appear to work. So do monoamine oxidase inhibitors. So do selective norepinephrine and dopamine reuptake inhibitors. We used to think that tianeptine was a serotonin reuptake enhancer, but we now think it's a mu-opioid agonist; either way, it seems to work as an antidepressant. Opipramol is a stone cold whodunnit of a drug.
Nobody really knows what causes depression. We know that there are certain risk factors, we know that there are useful treatments, but we don't really have a clue what's going on inside the brain.
The chemical imbalance hypothesis isn't particularly accurate or particularly helpful. Psychiatrists see some patients who are severely depressed for no apparent reason, but most see far more patients who just have lives that would make anyone miserable. Depression is emphatically not randomly distributed - prevalence rates are vastly higher in certain groups, for reasons that can only plausibly be psychosocial. The chemical imbalance hypothesis lets society abrogate responsibility for the fact that a lot of people are justifiably downtrodden, despondent and hopeless.
We need to recognise depression as a complex, multifaceted disorder with neurological, cognitive and social components. Antidepressant drugs have life-changing effects for some patients, but psychotherapy and lifestyle interventions are also enormously valuable. Some patients achieve complete remission within weeks of starting antidepressant drug treatment; others have tried four or five drugs with no noticeable benefit. If you're suffering from depression, you'd be foolish not to try drug treatments, but you'd be equally foolish to only try drugs.
1. We know that the symptoms of many different varieties of mental illness have been helped by the administration of SSRIs and other drugs that alter brain chemistry.
2. But what we most assuredly do not know is that mental illness patients have detectably different brain chemistry from baseline.
We assume from (1) that (2) follows, but we have no actual evidence of (2). Herein lies the problem. We cannot make a scientific statement on (2) predicated only on (1).
In this specific sense, OP is correct. And the downvotes are unfair. And more research is needed.
I think there a difference between saying what you have said, which admits the possibility of real chemical imbalance based on surrounding contexts, even if more research and evidence is necessary to fully understand or prove it, vs, outright saying that it is a "myth," as the OP did, which is both dismissive and inaccurate.
Yes. I’m not a neurologist and my views shouldn’t be taken as medical. But many issues are classified by the nature of their remediation. Also, it’s my understanding that treating depression with just medicine and no counseling is frowned upon.
“Rather than some embarrassingly reductionist, one-deficiency-one-illness-one-pill model of mental illness, contemporary exploration of human behavior has demonstrated that we may know less than we ever thought we did. And that what we do know about root causes of mental illness seems to have more to do with the concept of evolutionary mismatch than with genes and chemical deficiencies.”
I’m also wary of accepting controversial opinions at face value, and fully support your skepticism here. She’s not my favorite messenger, either. I don’t think ad-hominem attacks are fair, though.
The article is full of references to evidence outlining her position. Do you have any critique of her arguments you can share?
Yup. Just to get rich selling pills that barely make a difference. As someone who’s probably had a prescription for every major anti-depressant, the only difference I never noticed from taking them is that my dick didn’t work.
Not saying that depression isn’t a serious issue and that it can just be “thought away” though. But the drugs are really only helpful to some people, and there’s not much evidence to substantiate that this is just a chemical problem. There may be a chemical element, but IMO this is being exaggerated for profit. Meanwhile we aren’t dealing with any of the underlying social problems that probably play a much larger part.
I recently read the book "Lost Connections" by Johann Hari which covers this issue. In fact, it's a really a book about some deeper problems of Western society (where depression, anxiety, etc. has been on the rise for a long time), so the pharmaceutical pill-pushing and the fairly debunked "chemical imbalance" explanation of depression really just sets the backdrop of the story. He emphasizes - like you mention - social changes in modern Western societies as major causes of depression.
I really recommend the book. If you're not convinced or just want an audio version, then I recommend the episode of the Ezra Klein Show podcast where Johann Hari is a guest - that's what convinced me to read the book.
I am obliged to point out that Johann Hari has a distinctly chequered reputation. He lost his job as a columnist at The Independent in 2011 due to multiple substantiated allegations of plagiarism; it later transpired that he had vandalised the Wikipedia articles of journalists who had criticised his conduct.
His book Lost Connections has been strongly criticised for misrepresenting the mainstream scientific position, cherry-picking data and making unreferenced and unsupported claims.
Thanks for your post, I was not aware of the controversy around Hari.
That said, I found his book "Chasing the Scream: the first and last days of the war on drugs" [1] an informative resource that in some places touches on this thread's topic.
I’m curious, if depression doesn’t have some basis in chemical roots, then why is it often hereditary? Like other forms of mental illness which are chemical and hereditary, depression also exhibits these characteristics.
It's entirely plausible that some people have hereditary character traits that make them less resilient to stress. They're not necessarily depressed because of their genes, but their genes make them more vulnerable to depression.
We observe a similar phenomenon with diseases like type 2 diabetes. People of south Asian origin have significantly higher risk of developing type 2 diabetes, even after controlling for diet and lifestyle factors. We have identified a cluster of genes that don't directly cause diabetes, but seem to increase the risk of developing the disease. You aren't doomed to develop diabetes if you have these genes, but you do need to be more careful about your diet and lifestyle.
The current mainstream view is that depression is partly physical, so you're not wrong.
(edited for clarity) Some say that depression is a chemical imbalance, but this is not a mainstream view any longer (I think, although it's often mentioned in comments on the Internet), although treatment is still very much based on chemicals like SSRI drugs, which have very little proven effect, require constant upping of dosages to gain the small effect they provide, and also having several undesirable side-effects.
I first felt the genuine desire to seek out and socialize with strangers after a dose of kava. I now can’t take it as it conflicts with other medication. But before then and after then, I genuinely experience discomfort around all people.
It’s just my opinion based on personal experience, from my own struggles and those of people that I’ve known. It seems to make a lot of sense that we like the chemical imbalance narrative because it allows us as a society to wash our hands of this and pretend it has nothing to do with us.
While I don't directly agree with jrs95, the fact is that the pills just plain don't work a lot of the time. Google the medical term "treatment-resistant depression". The very first link says "Despite advances in the understanding of the psychopharmacology and biomarkers of major depression and the introduction of several novel classes of antidepressants, only 60%–70% of patients with depression respond to antidepressant therapy." (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363299/) Presumably, the odds were worse before.
Consider, too, that that probably doesn't even include those that develop tolerance effects afterward; with that, the numbers likely climb much closer to 50%-50% or worse.
Physiology and “chemical imbalance” aren’t exactly the same thing. Just because you’re physiologically predisposed to depression doesn’t mean that you can fix that by ingesting chemicals, which is usually what’s implied by that phrase.
Most people would tell me his life is their dream.
Rest in peace.