Dorothy Rowe

Misconceptions about Depression

If you've been depressed and you consulted a GP or a psychiatrist very likely you were told that your depression was caused by a chemical imbalance in your brain. If the doctor prescribed an antidepressant like Prozac or Zoloft he'd have told you that the drug would replace the missing serotonin in your brain, and this would cure your depression. Many doctors would still say the same thing, not because they're right, but because they don't read the research, they don't consult the depression website beyondblue (www.beyondblue.org.au ), and they hate having to change their mind. However, if you become depressed and you consult a doctor who does keep up with the research, you'll find that the doctor doesn't mention "chemical imbalance". Instead, they'll ask you about the stressful events in your life and how you've interpreted these events. Do you see these events as challenges which you'll master, or another defeat in a long line of defeats, or the punishment you deserve for being such a bad person.

Psychiatrists have always known that there has never been any scientific evidence for the theory that depression is caused by a chemical imbalance in the brain. The imbalance is supposed to be in the neurotransmitters noradrenalin and serotonin, usually referred to as monoamines. In her book The Myth of the Chemical Cure, Joanna Moncreiff, senior lecturer in psychiatry at University College London, wrote, 'Despite decades of research, there is no evidence to support the monoamine theory of depression. Eminent mainstream pharmacologists admin that there is no evidence of serotonin dysfunction in depression. It is as if the psychiatric community cannot bear to acknowledge its own findings.'[i]

In recent years the medical profession has set as their standard what they call "evidence-based medicine". Diagnosis and treatment have to be based on the research. Hence the words "chemical imbalance" have vanished from the beyondblue website. Under the heading 'What puts a person at risk?' is a long list, beginning 'stressful events' like divorce or bereavement followed by 'long term risk factors'. The first is that depression can run in families, just as voting Labor or gambling on the pokies can run in families. There's no depression gene, just as there's no 'voting Labor gene' or a 'gambling gene'. Younger generations learn from older generations. More factors are chronic illness, substance abuse, the age you are, what gender, living in a rural area, and being an indigenous Australian. It's not these things in themselves that leads to depression but the way the individual interprets these things. If you say, 'My mother and grandmother got depressed therefore I'll get depressed,' you are making sure that not only you'll get depressed but that you'll never stop being depressed. If you say to yourself, 'I was born a horrible person and I can't change,' you're stopping yourself from changing.

Some people argue that, because the antidepressant drugs have helped them when they were depressed, this proves that depression is caused by a lack of serotonin in the brain. Aspirin undoubtedly cures a headache. Can we conclude from this that headaches are caused by a lack of aspirin? Being depressed always comes to an end, with or without antidepressants. Follow-up studies show that people who don't take antidepressants have a better outcome than people who do.[ii] This is probably because the people who didn't take drugs had to work out what in their outlook on life led to them being depressed.

Some people reject the idea that their depression comes from the way they see themselves and their world because they don't want to think about these matters. They fear reawakening painful memories, or they don't want to acknowledge, for example, that theirs is a very unhappy marriage. They prefer to see their depression as being a chronic illness for which they're not responsible. If they believe they'll never get better, and, if they work out the conditions under which their depression returns or deepens, they'll strive to avoid these conditions and they might think they can make a reasonable life for themselves. However, a danger remains. There's a great deal of research which shows that the emotional stress of being depressed causes physical changes which can lead to major physical illnesses such as heart disease and cancer.

Accepting that your depression is a result of the way you see yourself and your world means that you've taken responsibility for yourself. You can talk to a friend or a therapist, and you can consult a doctor about a taking an antidepressant which will ease your mental pain, but you're responsible for choosing what medication you take, just as you're responsible for thinking carefully and truthfully about your life and deciding to change.

Taking responsibility for yourself means becoming your own best friend. Instead of constantly criticising yourself, you give yourself praise and encouragement, and do nice things for yourself. You work out what really matters to you. You become a much wiser and stronger person. You might find that the people around you don't want you to be depressed but they don't want you to change. Now you're strong enough to resist them.

You'll need to confront the events that occurred just before you became depressed which showed you that life was not what you thought it was This discovery was absolutely terrifying. You might have grown up believing that, 'If I'm good nothing bad will happen to me or to my loved ones', and then something bad happened. In an attempt to hold yourself together you blamed yourself for the disaster, and in doing this you inadvertently created the prison of depression.

But there is a key to the prison of depression: valuing and accepting yourself, and accepting the natural uncertainty of life. Once you have this key, you know how to prevent yourself from becoming depressed ever again. 

Dorothy Rowe Depression: The Way Out of the Your Prison third edition, Routledge (distributed in Australia by Palgrave Macmillan).