Jonathan Rottenberg, PhD

Jonathan Rottenberg Ph.D.

Charting the Depths


Is Depression a Disease? -- Part I

Time to rethink the disease model of depression?

Posted Oct 12, 2009

The symptoms of depression --despondency, lethargy, nightly insomnia, an inability to concentrate--are bewildering. The person with depression wonders, "What is wrong with me?...Why do I feel this way?" and if the symptoms persist, he or she will pose these questions to a doctor or therapist. Mainstream approaches to depression say that these symptoms reflect a defect or disease. While this model of depression is intuitive and virtually inescapable, it may be time to reconsider its clinical and scientific usefulness.

For example, mainstream psychiatry presents the idea of a correctible biological defect, a ‘chemical imbalance.' With 27 million people taking antidepressant medicines in the US, the media, patient groups, and mental health professionals have widely embraced this comforting and optimistic notion. Sadly, the efficacy of antidepressants is often overstated: Two-thirds of those who are treated with antidepressants continue to be burdened with some degree of depressive symptoms. In fact, current antidepressant treatments are no more effective than those developed 60 years ago. Even diehard biological psychiatrists acknowledge that the quest for a physical cause for all cases of depression has proven elusive. Without a clear target of what is being treated, the search for a magic pharmacological bullet for depression verges on the quixotic.

Likewise, cognitive approaches answer the depressed person in the same terms-your symptoms reflect a defect. This time, it is faulty thinking that is to blame. This approach, too, has spawned an influential therapy, one that corrects thought. But the evidence that one or more of these cognitive defects causes depression is modest, and the resulting therapy is only about as effective as treatment with antidepressants-beneficial for many, but far from a cure.

In fact, just about anywhere a depressed patient turns in contemporary society, the answer remains much the same: Your symptoms signal a deficiency. That deficiency may lie in the person's childhood (says the psychoanalyst), in the person's soul or relationship with god (says the priest, pastor, or rabbi), or in the person's relationships with significant others (says the marital or family therapist). While each idea may capture a part of why some people become depressed, for most these will not be final answers that lead to fully effective treatment.

In the end, the depressed person all too often faces a triple indignity. (1) You experience distressing and crippling symptoms; (2) treatments deliver you less relief than is promised; and (3) professionals interpret the failure of a treatment as a sign that your defect is more serious than initially thought.

If results are this frustrating, why do we cling to the idea that depression is a disease or defect?

Dear Blog Readers, this very question has been on my mind lately.

More to come...


I believe there is an untold story, that when experts overreach, the depressed person can end up in a worse place than if he/she had been more self-reliant. I am interested in  the human costs of these intellectual misunderstandings of depression, the stories of how people gradually came to grips with the real causes of their depression often in the face of other people's misunderstandings.

If you are comfortable sharing your story via email or are interested in being interviewed for a book I am writing please email me at