Depression is often referred to as the “the common cold” of mental illness. Indeed, rates of depression have been consistently on the rise for each successive decade since 1915. Despite the growth in prevalence rates of this mental illness—or perhaps because of it—pervasive misinformation regarding depression continues to persist in our culture. I have identified what I have found to be some of the most pervasive—and damaging—myths about depression:
(1) Depression is the result of a “chemical imbalance”. The idea that a chemical imbalance, or, more specifically, that depression can be reduced down to levels of serotonin has completely distorted the relationship between brain chemistry and depression. This simple way of reducing a complex mental illness into a series of neurotransmissions (or lack thereof) in the brain has been perpetuated by pharmaceutical companies that tout their products as the ultimate “quick fix” for depression. Psychiatrists and researchers of depression have yet to isolate specifically the relationship between all the different neural connections and firings of our brains and depression. In fact, the notion of serotonin being the chief biological basis or the underlying root for the illness is, “a reductionistic oversimplification of a very complex biological state” (Greenberg, 2010, p. 197).
(2) Medication is the most effective treatment. The above myth serves as the catalyst for the next one—namely, the notion that meds are the most effective intervention to date in treating clinical depression. In fact, the standard the FDA requires for psychiatric meds to be approved and sold to consumers is not a high one: only two independent studies that yield significant results in favor of drugs is required, regardless of how many trials may be required to render such findings. In other words, “so long as research eventually yields evidence of efficacy, the failures would remain off the books. This is why antidepressants have been approved even though so many studies have shown them to be ineffective” (Greenberg, 2010, p. 216). Moreover, research suggests that the reduction of depressive symptoms seen with antidepressant use may be more indicative of a placebo effect than the merits of the drug itself. For instance, some sources contend that up to 80% of the effectiveness of antidepressants is due to placebo effects (see Greenberg, 2010). This comes at a high cost, given the documented (and not so documented) side effects—chief among them that in some cases, ironically, use of antidepressants actually increases suicidal ideation (particularly among adolescents).
(3) Depression is a disease. Alas, both of the above myths serve as the basis of this next one—namely, the old, “depression is a disease” refrain, implying that this very complex mental illness operates similar to purely medical conditions. For instance, psychiatrists oftentimes use the parallel of the diabetic who takes insulin to treat his condition; so, too, must the depressive take his or her meds, they claim. This is a wildly inaccurate parallel for a number of reasons. Firstly, one can definitively diagnose and validate diabetes as a medical condition. One can also identify with certainty the underlying medical reasons behind the diabetic’s condition. Lastly, one can also identify with certainty the extent to which the disease can be controlled/treated with the administration of insulin (in the case of type I diabetes in particular). There is no definitive blood test or otherwise physical examination that can determine a depression diagnosis. In fact, contrary to the entire medical paradigm, the symptoms of the illness actually serve as the basis of the diagnosis in the case of depression. Moreover, there is not a clear intervention, medical or otherwise, that can be implemented for a depressed individual that will work in all cases.
(4) If you experience symptoms, you have depression. The strikingly high rising rates of depression not just in the U.S. but across the globe begs the question of whether we have become better at identifying and diagnosing when people are clinically depressed, or, quite frankly, if we are starting to pathologize normal human experiences. The relentless pursuit of perfection and the ubiquity of ads for anti-depressants everywhere we turn may be compelling individuals who are dealing with the regular struggles that come with being human to falsely perceive they are depressed just because they aren’t happy all of the time. As I try to convey to my students, mental illness is just an exaggeration of regular human experiences. So just because a person may have difficulty sleeping on occasion, or experience a loss of focus or concentration (both symptoms consistent with depression) this doesn’t mean that the person is clinically depressed. One needs to consider whether or not what they are experiencing is leading to dysfunction or impairment, and remember that no life or experience is ever perfect.
(5) Men don’t get depressed. There is a common presumption that depression is a female affliction. This is not entirely without merit, as two times more women than men are diagnosed with depression, a striking figure that actually holds up across the globe. However, the disparity between the sexes does not mean that men are immune from depression. In fact, some researchers contend that men may be equally vulnerable to depression, but less likely to seek help or treatment because this goes against the rigid constructions of masculinity. Moreover, males who are experiencing depression may manifest symptoms in less emotional ways and more covert means such as through acting out, aggression, and/or alcohol or substance use, which may not be properly identified as manifestations of depression. In other words, there may be gendered patterns to expression of depressive symptoms that make the mental illness more likely to be identified and observed in women as compared to men.
The bottom line is that depression is a complex mental illness that is oftentimes misrepresented and misunderstood within our culture. Just as no two snowflakes are alike, as the saying goes, every case of depression comes with its own nuisances and complexities. We need to become more holistic in how we recognize and treat this condition, and less reliant on quick fixes or seemingly easy (but often erroneous) answers.
Greenberg, G. (2010). Manufacturing Depression: The Secret History of a Modern Disease. Simon & Shuster: New York.
Copyright 2013 Azadeh Aalai