"Depression/anxiety is not a malfunction but a symptom of unmet needs." Thoughts?

In My Humble Opinion
1

This is very interesting article on a book calling for a new approach to depression: Is everything you think you know about depression wrong? | Depression | The Guardian

I recommend the whole article but am interested in takes particularly on two excerpts.

One excerpt:

And another:

I do not mean to stack my anecdotes up against someone else’s data, but while reading this article I thought “These statements weren’t true for me.” Or at least I don’t recognize them as true, which may be a failing of mine rather than the author’s.

My only depression seemed to occur randomly. It lasted a couple of months. I don’t remember anything changing to start it, and I didn’t do anything to treat it. It just went away.

On the flip side, when I was widowed, I didn’t become depressed. I was sad, but I didn’t have the helpless/hopeless feeling I felt during my depression (not to claim that it never surfaced, but it would surface for an hour, not a week or a month or a year).

Do these quotes ring true or false for you?

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Can’t make blanket statements about whether or not it is. For some people, anxiety and depression are indeed symptoms, even useful signals and motivators that something is wrong and needs to be addressed. As an example, if a large dog seems angry with me and I’m within its reach, having an initial anxious reaction is perfectly fine. It would be a failure of my survival instinct if no anxiety were felt.

On the other hand, there are times when anxiety and depression are not so much symptoms of something needing to be addressed/unmet needs but more like infections from past wounds. Even after the wound is closed up, you still need to deal with the infection qua infection, not qua wound. To continue the dog analogy, if someone has panic attacks when they see a dog because a dog bit them decades ago as a kid, that’s not a symptom of their current situation needing to be addressed or needs being unmet, it’s the mind having a runaway reaction and needs to be addressed as an anxiety problem, not an angry dog problem.

And just like it’s possible for someone to be anemic, not produce enough insulin or have some other biochemical imbalance, some people just have an imbalance of serotonin or dopamine or some other neurotransmitter. That needs to be addressed on a chemical basis.
Now, is there overreliance on meds? Probably, because it’s simple for healthcare workers, insurance and people to understand, manage and apply. Delving into your social situation, your psyche or existential issues is a lot more difficult and intricate. Getting into a program of proper sleep, nutrition, exercise and meditation/yoga also requires far more dedication than taking a pill each day.

I’m reminded of Addyi, the so-called “women’s Viagra” which was non-sense as for women, sexual problems typically stem not from insufficient bloodflow but unsatisfying relationships. You can’t pop a pill for that.

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I think it’s way more complicated that either of the binary positions. I think it’s likely that many cases of depression *are *caused by unmet needs–sometimes as simple as poor diet or too little fresh air and sunshine, but also by poverty, poor expectations, toxic people, tragedy, etc.

But sometimes depression just happens. Brain serotonin levels go wrong, and it’s no one’s fault and behavior therapy isn’t going to help it.

Twenty years ago when I took psych 101 (crikey, I’m not young anymore) they told us that schizophrenia was really a myriad of different disorders lumped under one heading. I’m pretty sure depression is the same.

4

Dunno. I guess if I had everything I “needed”, at least in my mind, I don’t suppose I’d be depressed.

5

That rings true for me, but of course I am very much just knee jerking from my own experiences.

It’s interesting that when I was grieving my first husband, many resources made a very big point of distinguishing between sadness and depression. The article I referred to seems to bundle them back together. Should we think of them as something separate?

6

This ends up as almost a philosophical or axiomatic point. If we have everything we need, we can’t be depressed because we would also have the right chemistry, etc.

But I do know that when I had my bout of depression, one of the most frustrating things was my inability to identify anything that was actually wrong with my life. I had what felt like everything I needed.

7

In many ways, the linked article is a crock of hog drippings.

The business about “unmet psychological needs” being the basis of depression sounds like a hearkening back to the bad old days before we had a decent understanding about neurotransmitters and chemical dysfunction in the brain, and people’s supposedly bad attitudes were held to be responsible for their depression.

I’m not impressed by bogus blanket statements like “Now, if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away.”

It is a gross exaggeration to claim that physicians’ sole response to symptoms of depression is to start drugging patients, or that other, non-pharmacologic measures are not employed.

The answer to over-medicating the population is not to address someone’s severe, life-threatening depression with advice about how they should find a more fulfilling career.

Yes.

Antidepressants literally save lives. Trashing them wholesale as the author of this article does, puts lives in danger.

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My impression is that there are two types of Depression. Those that are caused purely by a brain chemistry imbalance and those that are caused by events in ones life. My wife has the latter, she only suffers from depression and suicidal thoughts when her pain is particularly bad, or when she dwells on trouble with her family or her past history of abuse. Her anti-depressant takes the edge off but its clear that there is something beyond a chemical imbalance that is going on. On the other hand there are certainly some people for whom there is absolutely no reason for them to feel depressed other than their brain turning against them making it impossible to get out of bed, and who after having this corrected make miraculous improvement.

IMHO the author of this is right in his conclusion that a significant number of people whose depression may not be chemically based, but then he makes that logical fallacy of excluded middle by tilting all the way to the other extreme by claiming that no depression is chemically based. His study seems to be mostly anecdotal, and may suffer from reversed causality. Is it the lack of work satisfaction that make people depressed, or is it that a chemical imbalance that makes you think that nothing is worthwhile will extend to your opinion of your work life as well?

I have no doubt that the author is earnest in his belief and that his depression was probably not caused by a chemical imbalance, but like many self help guru’s they overplay their hand from “This helped me” to “This will help everyone”, and is very dangerous if it prevents those who suffer from chemical based depression from getting the help they need.

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A past theory, I think largely discredited, is that chronic depression is the result of a lack of ‘rose colored glasses’ to view the world with. While depression is clearly not simply the result of a poor attitude there should still be consideration for the potential for the mind and body to heal itself. But that is just a generality.

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It’s true that sometimes depression and stress and anxiety are caused by circumstances, and those circumstances may resolve with time. Medication may still have a role to play in working through that. For example, work is stressful. Not everyone has the option to tell the boss to sod off, and walk out. Stress causes chemical changes. You might have to stick it out which you work out another job, or a move, or pay off some large bills. Medication might help you hold things together while you master other tools to deal with the stress, or just make it through a short patch of time when things until you can change your circumstances.

In other words, I think circumstances and/or brain imbalances can play a role in causing depression or other issues, and so a wide variety of treatments can help, potentially including medication. People aren’t cookies and treatments can’t be cookie cutter.

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Both true and false.

There are many biological causes of depression and anxiety. Many. Lots of hormonal imbalances can cause these issues.

I know for me, when my blood sugar gets low I get anxiety. Low blood sugar means adrenaline is released to bring sugar levels back up.

I’ve also had severe anxiety from using an anti-snoring device. I’m not sure why, maybe I was choking in my sleep. But that wasn’t psychological.

Basically, yes and no.

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Spanish psychiatrists differentiate between exogenic depression (caused by external triggers, heals by itself when the triggers are removed unless they last long enough for the depression to become encysted; encysted exogenic depression responds to non-chemical approaches) and endogenic depression (caused by a problem with internal chemistry, remember to take your pills; non-chemical approaches do not work).

Feeling bad because your cat died is normal. Feeling bad because your cat died six years ago is not. Feeling bad because your serotonin receptors have a mis-synthethized bit is, again, not.

13

This seems about right to me. I think rather than depression being caused by unmet needs, it may actually be that unmet needs and the woes of modern life can produce temporary symptoms that in some ways resemble those of clinical depression.

I’m not sure I want to lump all of those different, but similar-looking things into one bucket - lest we make the grave error of assuming ‘people with depression are just sad’, or worse, ‘they just need to snap out of it’.

14

There are plenty of rich people who are depressed. Shrinks in NY don’t live on treating the poor. Now depression might cause someone to never feel they get what they need, or need new things once they do get them.

15

It seems to me that the article uses a very loose definition of depression. Bad jobs cause stress, sure, but not everyone working a shit job is depressed. The loss of a loved one makes you sad, but some people snap out of it quickly and some, who are depressed anyway, may grieve for excessive periods.
She also accuses drug companies of violating the most basic rule of reporting a study, which is reporting on all the subjects. In a press release, maybe, but in a published paper - unlikely. It sounds like what an anti-vaxxer would accuse a drug company of.
I’ve seen people snap out of depressed states immediately upon taking an anti-depressant. They may be over-prescribed, sure, but they do work.
If what she says is true, levels of depression would decrease with rising incomes and power. I’d love to see evidence of this. Clearly people in similar situations have widely varying degrees of depression. And no one who is retired with a reasonable amount of money would be depressed in her model.
Sure sounds like she is trying to blame society for everything. And she over-simplifies the problem, claiming that people say depression is caused by one hormone. Seems unlikely to me - nothing about the brain is claimed to be that simple.
Lots of strawmen too. How many psychiatrists diagnose depression solely because of a loss?

I wonder if she is selling some sort of self-help solution in her book. It smells like it.

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I agree with the overall point, that situational factors are the primary cause of why a person manifests as being in a depressive state at a specific time and place. Biological factors may play a role in why this person and not someone else in a similar situation is manifesting as depressed, but our mental states are not “caused by a chemical imbalance” or by our genetics — treating them as specifically biological diseases has not proven to be a very useful approach.

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Both true and false. To me, he has highlighted a distinction by choice of examples. Grieving (loss of a spouse) is a case where you have a sudden loss, but given time, most people adjust and recover. Some even remarry. Other cases he quoted contain an element of being trapped: “What if you are stuck in a job that you hate for the next 40 years? What about if you are alone and friendless?” I find it hard to explain, but the latter 2 situations would obviously cause situational depression as opposed to temporary grief because they could plausibly last longer and be much harder to resolve.

On the other hand I know depression absolutely can be purely physical in some cases. Since I swore off alcohol, on the isolate occasions where I cave to temptation, an evening of heavy drinking can make me feel depressed for 10 full days afterward. So I know there are chemicals sloshing around in my brain that can make me depressed when they don’t slosh like they should.

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She is a he, although the name is confusing. He was on RHLSTP this week and turned a normally comic podcast into a massive downer. He never shuts up!

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IMO, the elimination of bereavement was just one of the most bothersome changes in the recent DSM revision.

As others have said, there are countless different causes of mental and emotional distress - whether depression, anxiety, PTSD, or whatever. Moreover, there are countless levels of severity for each of those conditions. And other aspects of an individual’s character and personality affect how they respond to their particular stressor.

My problem with the mental health profession is the eagerness to diagnose, treat, and opine as to severity - after an initial consultation. And I perceive a great many people (CERTAINLY NOT ALL) as eager to rely upon a diagnosis as freeing them from responsibility.

Life is hard. Most people get anxious and depressed at times. Really lousy shit happens - but people get over it. And MOST people continue getting up everyday, going to work, and doing what needs to be done. Hell, I’m all for taking a pill or talking to someone if that makes you feel better. But you’re not all that special. And the fact that something unpleasant happened to you once in your life does not give you a free ride forever.

20

I’ve suffered from depression and anxiety all my life, or at least for as long as I can remember. I’m now 56, and was formally diagnosed probably in my early 40s. I’m still struggling with definitions, causes, and all manner of thoughts about the subject.

The reason I’m writing this post is more of a release, so feel free to ignore it. It probably won’t make much sense outside of my head, and that’s okay with me.

Dinsdale says you’re not that special. I disagree, because while everyone goes through difficulty, be it losing a job, bankruptcy, family tragedies, etc., no one goes through my experience my way, with my thoughts, emotions, reactions, etc. So yes, I am special. But so is everyone else. That’s the paradox: we’re all together, as the same species, but we react to and process experiences (even the same ones) differently.

However, I do agree that if something happened to you once doesn’t give you a free ride forever. Depending on the circumstance(s), you do need to deal with it, and get over it. On the other hand, I, for example, am still dealing with the fallout from decades of toxic work environments (I’ve been describing it as “workplace PTSD,” even if that’s not a recognized diagnosis, it’s an apt description).

You could say the treatment I received at various workplaces was my own fault; that I brought it on myself, and I’d say to a certain extent, that’s true, even if it was unintentional. However, as has been pointed out to me over the years, I can’t be responsible for other people. They react in ways that I can’t control; so if they’re bullies, I can’t stop them. Sure, I can stand up to them, but given my individual temperament, that’s very difficult to do. (Call me weak, a wimp, whatever, I was taught to let it roll off my back and not lower myself to the bully’s level.)

So as far as I can tell, my problem (which simultaneously is and isn’t mine alone) is that it’s a combination of chemical imbalance (or genes, or hormones, or other natural process, since my condition runs in my family) and environment.

It’s not nature vs. nurture, it’s nature and nurture.

The problem I’m seeing with society as a whole is that if I were to compare the status of mental health to breast cancer, we’re in the late 70s to early 80s. (Betty Ford, in the mid-70s, was among the first to talk openly about breast cancer. I remember prior, you could barely say the word “breast,” unless it had to do with chicken. Mental health at the time was still stuck in the Cuckoo’s Nest mentality, as far as the public were concerned. By the 80s, breast cancer was slightly more in the open. Today, of course, it’s not a bit shameful. Compare that to mental health–we’re just beginning to talk about it openly, but it’s still stigmatized. Not as much as just a few years ago, but hopefully, it’ll get better. Too bad it’s taking so long.)

The bottom line is that mental health is complicated, and there’s still much we don’t understand. In some ways, we’re all together, because we share the same brain biology, but at the same time, we are each special snowflakes.

What’s the answer? I don’t know, but I do know there isn’t one–there may be many, but it’s not just one. Discussion and a sincere attempt to understand what someone else is going through is a start. One thing I do know: we have to get away from the “snap out of it” line of thinking (something my wife of 30+ years is just now beginning to understand–so if a person I’ve lived with most of my life is just now starting to understand my condition, it’s even more difficult to people I don’t even know to understand.) But I have to keep trying to get myself to understand it, and share what I’ve learned. Because if I don’t at least try to understand it myself, I may as well give up and give in to the self-destructive thoughts I’ve had over the course of my life. And I know what it would do to my family, even if I didn’t care about myself. I know they care about me.