More Than a Chemical Imbalance
Why depression cannot be cured by medication alone.
Posted Oct 27, 2015
A few months ago a friend asked me for some advice about his father, who was suffering from depression. After finding out that his father spent most of his time indoors, watching television, I told my friend about ecotherapy, which investigates the therapeutic effects of contact with nature. As I informed my friend, there is a great deal of research showing that regular contact with nature — such as a daily walk in the park or countryside — can have a very beneficial effect on well-being. The research suggests that this can be just as effective against depression as medication or other forms of psychotherapy. So I asked my friend to encourage his father to get out of his house and go for a walk in his local park every day — or better still, go for walks in the countryside.
A couple of weeks later, my friend got back into contact to say that he had told his father’s doctor about my advice. The doctor had gotten angry and told my friend, “Your father has an illness! Would you tell a cancer patient to go for a walk in the countryside? Would that help their condition? Depression is an illness that has to be treated medically.”
It seems to me that this attitude to depression — or to any psychological condition — is simplistic, misleading and possibly even dangerous. This is not to say that brain chemistry isn't involved in depression. But it’s certainly not the only factor.
All of the main fields in psychology interpret depression in different ways, and recommend different kinds of treatment or therapy, based on those interpretations. For example, while in psychobiology depression might be seen as a problem with brain’s serotonin reuptake system, in behaviourist terms, it might be seen as a habitual emotional response to negative events, perhaps learned from our parents. A humanistic psychologist might interpret it as the result of the frustration of basic human needs, and a blocking of the urge for development, or self-actualisation. A positive psychologist (or a cognitive therapist) might see it as the result of faulty thinking styles, a "script" of negative thoughts manifesting themselves as negative emotions. A social psychologist might see depression in environmental terms, as a reaction to an unfair society, to inequality and oppression. An ecopsychologist would see it as the result of lack of contact with our natural environment, while a transpersonal psychologist might see it as the result of a false identification with our superficial ego-selves, and the result of a sense of separateness from reality.
As in so many areas, the problem here is that some adherents to these fields fall prey to what I call “justism.” They proclaim that depression is just the result of brain chemistry, or just the result of faulty thinking styles. Of course, it’s much more likely, and much more sensible, to argue that all of the above are factors in depression, operating in different combinations and proportions in different people.
If a person lives in a deprived urban environment, is unemployed and in an abusive relationship with a partner, how helpful is it to prescribe them medication to increase their brain’s reuptake of serotonin? How helpful are such drugs for a person who is naturally highly creative and intelligent but intensely frustrated because they are stuck in a dreary low paid job with long hours and don’t have enough money to free themselves from their predicament? How helpful are drugs for a person whose main issue is that they have low self-esteem, and habitually think that they don’t deserve to be happy, and expect things to go wrong for them?
It could be argued that medication is actually unhelpful in these circumstances, because it makes people less likely to deal with the real causes of their depression. Even if (and that if is in itself very controversial) such drugs might bring short-term benefits, their long term effect may be counterproductive.
Of course, there are other conditions where these problems apply. For example, a condition such as ADHD may be viewed as a psychiatric problem which can be “treated” with drugs. But this ignores the social and environmental factors which may generate restlessness, impulsivity and an inability to concentrate in children. These characteristics may be the effect of a lack of “concentrative training” provided by parents, who allow their children to spend too much time passively staring at screens, or they may perhaps be due to an intrinsic nature of restless spontaneity and creativity, which makes it difficult for some children to sit still and focus. Perhaps, for some children, it simply may not be “natural” to spend several hours a day in a classroom, staring at books, screens and pieces of paper. (This is similar to the “hunter vs. farmer hypothesis” of ADHD, that the condition may be an adaptive ability left over from the early human hunter-gatherer phase.) So again, to treat alleged ADHD as a medical problem may mean ignoring its underlying causes.
But what about the research suggesting that depression is associated with disturbances in the brain’s serotonin system, or that ADHD is associated with impairment in the brain’s neurotransmitter system (dopamine and norepinephrine in particular)?
These associations are by no means proven. Research has found that the best known “selective serotonin-reuptake inhibitors’” do not alleviate the symptoms of depression for 60-70% patients. Some neuroscientists question whether serotonin is associated with depression at all. But even if there is some truth in these associations, perhaps it makes more sense to reverse the conventional causal direction, and suggest that it may be a state of depression itself which generates changes in neurological functioning. In other words, the psychological state of “feeling low” may produce changes in the brain’s serotonin system. In the same way, perhaps the characteristics associated with ADHD themselves affect the brain’s neurotransmitter system. Or perhaps — more likely — psychological and neurological states interact in a more nuanced way.
This “reverse view” of depression entails the philosophical assumption that the “mind” is not entirely a product of the brain, and may in some sense be independent of it, and so be able to affect the brain. This view would explain why depression is associated with so many different factors. After all, a whole range of different issues (e.g. a lack of contact with nature, frustrated creativity, negative thought patterns) could generate similar neurological patterns of activity. And this also emphasises the importance of dealing with depression in a holistic way, treating a range of factors rather than “just” one.
To someone who is schooled in the biopsychological model of the mind, this may seem absurd. But perhaps it is even more absurd to try to cure depression by “fixing” the brain, when neurological activity does not itself cause depression. If you were walking through a jungle and a lion stepped out in front of you, it would produce all kinds of biological and neurological changes associated with the state of fear, such as a cascade of hormones like norepinephrine and epinephrine. To take medication to reduce the levels of those hormones would not fix the problem — in fact, it may make it worse, because you might be less likely to make the necessary changes to your situation e.g. to try to escape or pacify the lion. The real cause of your fear would still be there, just as the real causes of depression will still be there, with or without medication.
Steve Taylor Ph.D. is senior lecturer in psychology at Leeds Beckett University, UK. www.stevenmtaylor.com