In early January I published an article entitled Understanding Depression. Since then, I’ve continued to think about and read the latest science about depression. I realize that I got something wrong and so wanted to publish this post to set the record straight.

I said in my article is that “…depression is not a sign of personal weakness but an illness (like kidney failure, high blood pressure, or cardiovascular disease) in which the brain lacks chemicals like serotonin and norepinephrine that regulate happiness, motivation and self-esteem. Although the causes vary, there is something real going on in the mind and brain that needs to be treated.”

It is certainly true that depression is not a sign of personal weakness. However, it’s not as simple as a lack of chemicals in the brain that regulate happiness.

The Case Against Brain Chemistry

The case for and against the role of brain chemistry has played out in research on antidepressants which are designed to inhibit or promote certain chemicals in the brain. In 1993, Dr. Peter Kramer published a book entitled Listening to Prozac which popularized taking medicine to treat depression and strengthened the argument that depression is a result of low levels of serotonin. In his book, Kramer claimed that people who took antidepressants not only improved but developed more resilience and energy than the average person.

Other scientists, however, disagreed with such claims and believed the scientific evidence in favor of antidepressants was based on poorly controlled studies and biased in favor of the large pharmaceutical companies funding many of these studies.

One critic of antidepressants was an associate professor at Harvard University by the name of Irving Kirsch. He and a graduate student (Guy Sapirstein) devised an experiment to test the effectiveness of antidepressants by forming three groups. The first group were told they were being given an antidepressant but were actually given a placebo. The second group were given an antidepressant and the third group were given nothing. The results of their research showed that 25 percent of the effects of an antidepressant were due to natural recovery, 50 percent were due to the story they had been told about the drugs (placebo), and 25 percent were due to the actual chemicals. Think about it, 75 percent of the improvement was due either to a placebo or natural recovery.

Then in the late 1990s a group of scientists set up what they called the Star-D Trial, the largest study ever about the effects of antidepressants. The bottom line of this research was that some 65 to 80 percent of depressed patients were still depressed a number of months later. Quoting from the National Institute of Health: “Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and (show) profound publication bias that inflates their apparent efficacy.” (https://www.ncbi.nlm.nih.gov/pubmed/20616621/)

Where does that leave us?

In my opinion, many doctors—general practitioners, gynecologists and even psychiatrists—continue to over-prescribe antidepressants because they seem to be a quick and easy solution to a complex problem. And don’t get me wrong. This is a complex topic and the science is still evolving. However, it seems that drugs are not measuring up to the hopes that some have promised. Perhaps treating depression is not as simple as altering brain chemistry, at least by drugs.

I should point out that there are other methods of stimulating that brain that have been shown to be effective in treating depression for many people. These are electroconvulsive therapy and transcranial magnetic stimulation. I appreciate one reader pointing this out to me because these methods are worth looking into by many who have been chronically depressed.

A New Definition of Depression

But for many people, it makes sense to look at their life situation as well as brain chemistry. In fact, here is my new favorite definition of depression–depression is a personal grieving about a life that is not working out as one had hoped. It can be thought of as grief–grief for oneself. In my article entitled Strategies to Overcome Depression I point out that a holistic approach that that includes a number of strategies which affect mind, body and spirit is most effective for most people in the treatment of depression.

Lost Connections

Here’s another thought. I recently read the book Lost Connections by Johann Hari, who interviewed dozens of scientists who have studied depression for decades. The conclusion Hari comes to from these interviews is that depression is about disconnection from what brings meaning and fulfillment—disconnection from meaningful work, disconnection from meaningful values, disconnection from other people, disconnection from status and respect, disconnection from the natural world, disconnection from a hopeful and secure future, and disconnection from childhood trauma. Disconnection is loss. Loss gives rise to grief and, therefore, depression.

I like this spin. It creates a coherent narrative for understanding and also treating depression. Perhaps understanding disconnection and learning to reconnect to what brings fulfillment and meaning is a new kind of antidepressant.