A Maverick Redefines Depression

Is depression one disease or many? And can most depressives treat themselves with home remedies?

Currently, psychiatry is in a lumping, not a splitting, phase. The idea is that if you have the syndrome of depression - problems with mood, concentration, sleep, appetite, and the rest -and if you have it long and severely enough, then you have the disease. The most troubling individual feature, be it apathy or lack of energy, is of secondary importance. It's the cluster of symptoms that suggests what's going on in the brain and body, as well as what may go on in your life over time.

But, as regards the lumping trend, there are dissenters. One of the most interesting is Bruce Charlton, a psychiatrist who teaches evolutionary psychology at the University of Newcastle, in the UK. Charlton is a maverick (no, really) and a creative thinker. In Against Depression, I referred to his notion that the core symptom of depression is malaise and that the cause is inflammation.

Today, in a blog related to the journal he edits, Medical Hypotheses, Charlton presents a more varied array of theories. Effectively, he splits depression into five conditions. The least common of these is severe melancholia, the classic illness at the core of the contemporary disorder. But Charlton sees more widespread forms that, by his account should not be called depression. These include:

• neuroticism, an emotionally unstable disposition that, Charlton says, responds to classical antidepressants, St. John's Wort, and, perhaps, over-the-counter antihistamines;

• malaise, a cluster of aches, pains, and fatigue that signal immune system activation, responsive to drugs like aspirin;

• demotivation, or low energy and loss of pleasure, treatable with stimulants;

• and seasonal affective disorder, which bright lights ameliorate.

About this last variant, few disagree, although it may be that the effects of light are fairly general. Many people with depression will do better in a season of long, bright days. Overall, the lumpers (I'm one) would say that depression, the disease, is characterized by a loss of resilience in both mind and brain, a condition and that responds to events and interventions that restore the capacity to grow and change. When light (or exercise or psychotherapy) does the trick, then it's treating depression.

Taking the same problem from the reverse direction, my impression is that a good percentage of depression includes low energy but that only a handful of patients do well on amphetamines, never mind the milder stimulants that Charlton recommends, such as caffeine. Also, I've seen patients who are apathetic in one episode and despairing in another. In my view, the categories Charlton defines meld at their edges to compose a disease that is, finally, difficult to treat over time.

Still, among the dissenters, I have always admired Charlton. In his blog, he responds to patients' common wish to avoid professional help - to do without either medication or psychotherapy and instead rely on such remedies as non-prescription drugs. At the same time, Charlton sees the whole spectrum of mood disorders as worthy of attention. And he has the prudence to list all the right precautions, including checking results, acknowledging failure when it occurs — and, then, when necessary, changing course.