Repost - Ten Depression Myths Busted

Patient Expert

My original Dec 1 post vanished without a trace. Here is my repost:

Depression is one giant myth begging to be busted. Let's get started:

Myth One: Depression is a mental illness caused by a chemical imbalance of the brain.

This is true only if you believe a runny nose is a physical illness caused by a chemical imbalance of the mucous. Closer to the truth is the likelihood that what we we call depression refers to many different (and perhaps overlapping) illnesses and conditions whose causes and effects we have not firmly pinned down.

Myth Two: If you have depression, it follows that an antidepressant will make you better.

Maybe, maybe not. Let's go to the runny nose analogy again. If the cause is bacterial, an antibiotic may work. If the cause is viral, the antibiotic will not work. If clinical trials have one thing to tell us, it's that an antidepressant is not a one-size-fits-all drug. For some people, antidepressants may work wonders. For others, antidepressants may have no effect or even worsen the condition. The problem is we have no way of knowing in advance who is likely to benefit.

Myth Three: Depression is treatable.

Not if you think you can passively sit back and let an antidepressant do all the work. The truth is that antidepressants have a limited success rate and relapses are high. Typically, we need to implement our own recovery strategies - very difficult when you are depressed. But an antidepressant may provide that vital leg up.

Myth Four: Depression is about feeling sad.

Perhaps. But maybe you are lacking energy or feeling unmotivated or totally overwhelmed or stressed out. Maybe you are agitated and angry. Maybe there is a sense of psychic unease or distress. Maybe you are experiencing an existential crisis. Maybe it's all of the above. One one hand, depression can be about too much emotion, on the other not enough. You may feel wound up, you may feel completely dead. You may think too much - or too little. Your senses may be heightened, they may be dulled. Your affect may be animated - or it may be flat. Yet we call all of it depression. May as well call it broken brain disease.

Myth Five: Depression is all your fault.

Wrong, dead wrong. There is a lot we don't know about depression, but one thing comes in loud and clear: There is a clear biological basis to depression, one that physically affects a particular organ in the body (the brain), and every organ system tied into the brain (the whole rest of the body). Physical damage occurs to the neurons, entire neural systems are compromised. The effect is that of the brain shutting down. Booting the brain back up is a major challenge.

Myth Six: Depression is not your fault.

This may appear to contradict Myth Five. Why don't we bring in another medical analogy? If you have a chronic physical illness such as diabetes, you don't push your luck by indulging in sweets. Knowing that we have a predisposition to depression challenges us to lead more disciplined lives. We may not always prevent a depression from occurring, but we can learn to get smart about reducing our risks.

Myth Seven: Depression is not "normal."

Prepare for another contradiction. In one sense, depression is so far from normal that we think and feel and do things we would never in a million years dream of. But then there is the matter of "temperament." Many of us are downbeat by nature - our true "normal" - which is not necessarily a bad thing. Deep-thinkers thrive in this state. Not all of us have to be the life of the party.

Myth Eight: Depression is not "normal" (again).

Let's think this through. How did you feel after you lost a loved one or received some very bad news? Evolutionary biology supports the proposition that depression is a defense mechanism, an adaptive reaction, to terrible events. In essence, our brains need to shut down, at least for a short while. Or, our psychic pain may be telling us something the way that physical pain tells us something. There are no easy answers, here. The challenge is to ask intelligent questions.

Myth Nine: Modern psychiatry represents a quantum leap over Freudian psychiatry.

Get ready: Recent brain science, in fact, has exposed modern psychiatry as overly simplistic to the point of obsolescence. At the same time, it is validating quite a bit of ancient Freudian wisdom. Both Freudian psychiatry and modern psychiatry struggled mightily with the "mind-brain" distinction. The Freudians laid emphasis on environmental stressors and trauma, but naively assumed that the biology of the brain had little to do with the behavioral outcome. Modern psychiatry laid great emphasis on the biology of the brain, but tended to ignore the environmental stressors and trauma that interacts with this biology. One of the great achievements of brain science and related disciplines has been to link environment and biology via stress and trauma. This appears to be the key to picking the lock to the door that represents depression.

Myth Ten: We are victims of our genes and biology.

Wrong, big time. The other great accomplishment of brain science is the discovery that we can literally change our own brains. The brain is plastic. Over time, with effort, we can lay down new neural roadwork. At the same time, we can also change our environment. And - very mind-boggling - by changing our environment we may change our genes. No, we can not exchange the genes we were born with for difference genes. But by changing the circumstances around us, we may prevent some of these bad genes from getting switched on in the first place. Take home message: Even in depression there is hope.

I have presented these myths in the spirit of raising talking points. I look forward in future posts to pursuing these issues in far greater depth. In the meantime, I am looking to hear from you. Comments below ...