People are dumb; there’s nothing new about that. Public ignorance about depression in particular was on display recently in a news article I came across, and it annoyed me, so I thought I’d write about it.
First, let’s start with some background. The news related to the findings of an article published last month in the journal Molecular Psychiatry titled The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence. The authors concluded that there wasn’t evidence to support the serotonin hypothesis, which was put forward back in the 1960s as a potential explanation for why antidepressants that affect serotonin are helpful for people with depression. The review looked specifically at the serotonin hypothesis; it didn’t evaluate whether or how well antidepressants work.
I’ve written before about the serotonin hypothesis, the idea of a chemical imbalance, the efficacy of antidepressants, and what we know about how antidepressants work, so I won’t reiterate all of that here; there are links to those posts at the bottom of the page. Basically, though, it’s been recognized for years that depression is not a matter of a lack of serotonin, but antidepressants, including those that affect serotonergic neurotransmission, do work better than placebo.
A misleading headline
One of the news outlets that reported these research findings was CBC News, in an article from August 13, 2022, titled Have We Been Treating Depression the Wrong Way for Decades? The article included a couple of subheadings (“Are antidepressants effective against depression?” and “Research calls antidepressants into question”) that were also misleading, suggesting that the paper was about antidepressant effectiveness despite the fact that it was not. The article itself wasn’t misleading, but it seems like it probably fell victim to an editor who prioritized clickbait value over accuracy.
What really stood out for me, though, was the level of ignorance in the comments that were left on the article. As much as we might like to hope that there’s been progress in how well people understand mental illness, there’s clearly a very long way to go.
What people thought causes depression
Quite a few comments blamed depression on modern society, including unattainable standards, politics, entitlement, financial issues, neoliberal capitalism, the news, and social media.
Here are a couple of examples (all quoted text includes original spelling/grammar):
“Funny how people growing up in the first half of the 20th century, with 2 worls wars, the depression, dirty 30s, working 80 hours a week on the farm or 60 hours a week in factories werent so much into ‘navel gazing’ about ‘depression’, and the like.”
“Every one is depressed now, studies show the saturation of news reporting in people’s daily lives couple with television entertainment is overwhelmingly negative and produces the expected depressive condition. Unplugging is the best solution.”
More comments on depression
In response to a comment about it being hard for people who haven’t been depressed to understand it, one person wrote: “I have been through it..after you reach a certain age you realize it is just a crutch…if you are in good health , and dont have a real mental condition like Scitzophrenia, and can be productive, whether physically, intelectually or artistically, there is no reason to be depressed.” I just don’t even know where to start with that.
Someone else wrote, “Everyone gets depressed at some point. Reflection of those times make the happy times that much more enjoyable.” Everyone gets sad at some point, but no, everyone does not get mentally ill at some point, and no, depression is not some gift to make you appreciate life more.
How people thought depression should be treated
People had assorted suggestions for things that they thought would be most effective for depression. The most commonly mentioned were exercise, a healthy diet, getting outside, and sunshine. One person got very specific about the supposed effectiveness of exercising, saying that it “would solve 90 percent of all cases.”
Some people thought the answer to depression was keeping busy, while others thought it was being less busy.
One person wrote, “I have always meds are not a solution to depression. People are depressed because of problems. So, the only way to cure them of depression is for them to solve the problems. How would meds help them?” Someone else pointed out that even rich people with apparently great lives can get depressed, to which the original commenter responded that those people don’t have enough problems. I guess it’s sort of like the whole keep-busy-but-not-too-busy thing.
Some people thought finding a friend was the answer:
“What lonely people who are depressed need is people, not entirely drugs. When we companion those afflicted with others perhaps via media means, to others who are similarly affected, we are at step one. Love of one another.”
“It’s likely that many people suffering depression just need a friend, a true friend.”
Then there was someone with a suck it up, buttercup attitude: “Just a general observation but if the placebo affect works for some people as stated in this article, so to would the attitude of just buck up and keep on, keepin on.”
The idea that meds mask symptoms
Aside from all the ranting about Big Pharma, the most common concern people expressed about antidepressants was that they mask symptoms rather than correct the underlying problem. Okey dokey, but given that the underlying problem is probably pretty complex and no one actually knows what it is, treating symptoms is what we’re left with.
People may assume that therapy is what can actually correct the underlying problem, but that’s not necessarily true. It seems like people hear that the serotonin hypothesis was wrong and jump to the conclusion that biology isn’t involved at all, which is not actually a logical conclusion to arrive at. If nothing else, there is a heritable element to many mental illnesses, including depression, which means there is some degree of biological element. Medications that exert a biological effect have a therapeutic effect, and that would not happen if there wasn’t a biological component to the illness. The fact that the brain is really complex and science hasn’t pinned it down yet doesn’t mean that biology can’t be involved and depression is purely psychological.
There are plenty of medical conditions that are treated symptomatically rather than by resolving the underlying pathophysiology. Chronic illnesses are chronic because the underlying problem sticks around. We don’t tell most people with chronic illnesses to just suck it up rather than treating the symptoms, although unfortunately, people with fibromyalgia and ME/CFS (chronic fatigue syndrome) get told that far too often.
Use what works
Meds don’t work for everybody, and they’re not tolerable for everybody, but when they do work, they can be game-changing. Just because science hasn’t figured out why they work isn’t a reason to stop using them when they are effective.
As for people’s ignorance about depression, I think there will always be people who will happily choose ignorance if they haven’t been directly affected by a health condition. And if anyone tells me that I just need to exercise more and get more sunshine and do some gardening, I will quite happily tell them where they can shove it.