A. Medication & Genetics
I have procrastinated writing about depression. It is such a monumental field: How do I cover this vast field in a few short essays? Here is a short piece about the most often heard untruth as well as the most honest route to ‘cure’.
The most frequently overheard misunderstanding:
1. It is a genetically transferred illness. My father had it; my grandmother had it, so now I have it. We have to take pills for the rest of our lives, and that is all there is to it. It is an illness, just like diabetes. You don’t feel ashamed if you have diabetes, so why should you feel bad about having depression? You can’t help it.
This type of reasoning is understandable. It takes the personal out of the particular, and makes it easy to engage with: We all understand about a clearly defined illness (diabetes, high blood pressure, epilepsy). Medication is simple to administer (if not that simple to adhere to). This helps family members to take themselves out of the equation (it is inside the person after all) – providing a protective shield that quarantines against personal, familial and social liability.
I suffer from depression myself. Many of my family members do. It is not a crippling depression; we function fairly well in spite of it, some even becoming high achievers, despite the chronic dysthymia that runs through our family line (dysthymia is the old-fashioned term for low-grade depression. It stems from Hippocrates, meaning despondency /or a tendency to be despondent/despair – literally, bad soul. In current medical terms it is known as Persistent depressive disorder).
Well then, it must be genetic. Yes and No. Yes, but No.
So is it genetic? Probably. Somewhat. This one is tricky to pinpoint, as we know that genes respond to an environment. We know, for example, that rat mothers who are trained to be anxious (by consistently evoking anxiety in them), not only have anxious pups, but that their pups also have anxious pups. So here we have something that did not exist before, being trained into the genes. But it is not as simple as that either, because anxious mothers react differently to their offspring than non-anxious mothers do, so that their reactions are also transferred through learning, and learning gets wired into our brains. Thus it is not that easy to discern genetics and learning, given genes also get triggered in specific environments. Taking this argument into consideration, unlearning and not triggering a gene could therefore also happen. In other words, we could reverse the anxiety in the rat pups – and in their pups.
The most truthful answer is that depression is most probably genetic and environmental: In other words, a gene to be triggered needed to pre-exist, but it also required an environment to trigger it. As the trigger usually happens early, the environment is most usually familial as well as societal.
A. Typical familial triggers: A loss that cannot be properly grieved, nor restored.
This can be a real loss (death, stable & secure environment, disability, etc) or a psychological one: power, spontaneity, emotional stability, love.
B. A wider loss: It can also be the loss of something more abstract, but equally vital: meaning, true connectedness, authenticity, truth, depth, spirituality, creativity, and engagement.
C. And more modern/societal: The loss of childhood, the loss of security, of certainty, of community, and of time spent in nature.
2. The most ineffective way to treat it: With medicine.
No, this is not my personal opinion because I am anti-medicine. I do not tell people with diabetes or high blood pressure not to take their pills. But, as any medical practitioner will tell you – with exasperation, or resignation, depending on how long they have been in practice – the problem is that many people with diabetes continue with their unhealthy lifestyles, even when they become blind, or a foot has to be amputated. That persons will high blood pressure will not exercise, or keep their weight down, despite being told to do so repeatedly.
Research has conclusively shown by now that a) anti-depressants on their own will not –cannot – cure you of depression, and that b) at least one third of people do not respond to anti-depressants positively, and a significant percentage will respond negatively, that is, become more depressed. The long and the short of it: Anti-depressants can help in the short term, and may even be vital for that initial kick-start that you need, but if you do not make the necessary lifestyle changes, you will become depressed again. This I can guarantee you. The same goes with anxiolytics (anti-anxiety meds). Depression and anxiety, by the way, are twins.
3. The best cure is the hardest one. Its name is truth.
To be objective about ourselves is probably thé most difficult task that we can undertake. I had a wonderful friend who died prematurely of cancer. I still miss him. One day he said, “All life is based on a white lie. Without it we could not function.” This may be true, but for a person with depression, the only way out is through the gates of honesty. If we are not honest about own lives, we will not overcome it. In our family for example, we have generations of unloving stepmothers. How could this not have impacted on us? (Small wonder that is such a prominent feature in fairy tales). But, important as this is, and it is, it is still only á backdrop. There are many more: You have to go through the entire ABC above, and unpack them one by one.
The most efficient way to begin: Ask your best friends, your family, and then your colleagues. Ask them to be honest. Grin and bear it.
Much of depression is rooted in an overcompensation that had you compromise the very essence of your being. It is disempowerment combined with grief. The greatest grief: The loss of your vital, authentic self. The loss of the connection to that which is vital. No amount of pills or the distraction of your choice will extinguish the longing for something more vital.
You have to put up a fight to get yourself back. Don’t give it up.
To read: “Depression as a Social Disease”, by Michael Bader in Psychology Today
To watch: John Hari on you tube: “Why disconnection is at the center of depression and anxiety today”
To research: The research on medication consists of a host of contradictory findings, opposing each other. Even reliable websites can contain directly contradictory research papers.
Here is a cautious reaction from the World Health Organization (WHO)
There are effective treatments for moderate and severe depression. Health-care providers may offer psychological treatments (such as behavioural activation, cognitive behavioural therapy [CBT], and interpersonal psychotherapy [IPT]) or antidepressant medication (such as selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). Health-care providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists.
Psychosocial treatments are also effective for mild depression. Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with extra caution.