LEAH MCLAREN From Saturday's Globe and MailPublished Friday, Jun. 18, 2010 2:19PM EDTLast updated Friday, Jun. 18, 2010 3:14PM EDT
It's all in your head” isn't something a chronically depressed person likes to hear. In the age of Prozac, when adjusting your serotonin level is as normal as checking the oil in your car, it seems unhelpful to suggest that someone might think their way into – or out of – a disease of the mind.
And yet depression is all in our heads. Where else would it be? The real question, still hotly debated in the scientific community, is whether its cause is chemical and ultimately curable (good news for Big Pharma) or something far more complex (good news for poets and pot-smoking students of existential philosophy).
There is no doubt that depression exists. Inexplicable sadness – or “melancholia,” as it was historically known – has been with us since Hippocrates conceived his famous oath. But a groundbreaking new study has found that not only is depression affected by the way we think about it, so too is its cure.
Last week Irving Kirsch, a professor at the University of Hull in the U.K., presented a study that found Prozac and its ilk are no more effective than placebos in treating depression. In his view, there is no substantial link between serotonin – the brain chemical that antidepressants are supposed to regulate – and chronic depression.
It's a controversial study – one that many members of the psychiatric community reject out of hand – but it also raises a nagging question about depression: How did it come to be recognized as a disease in the first place?
Like Hirsch, psychologist and writer Gary Greenberg is part of a growing number of psychiatric professionals who have begun to publicly question the underpinnings of popular thinking on depression.
His recent book, Manufacturing Depression, debunks the prevailing notion that depression isa disease and anti-depressants the long-awaited cure.
In his view, the game is rigged. As he told me in a phone interview, “the disease was invented to justify the cure.”
Greenberg sums up the history of modern depression like this: In the 1950s, doctors researching drugs for unrelated illnesses discovered that certain substances made people feel high. They didn't know why or how, just that they'd struck oil. These psychoactive drugs were marketed as mood enhancers and by the 1960s minor tranquilizers like Valium and Librium were routinely prescribed to people who these days would likely be classified as clinically depressed. Once the market was established, the race was on to develop the perfect mood-elevating pill. At the same time, pharmaceutical companies began to search for a way to increase the market share. An executive at the U.S. drug company Merck had a brilliant idea – why not broaden the diagnostic criteria for depression in order to sell more people the drugs? They recruited a doctor to write a book entitled Recognizing the Depressed Patient, which was then distributed to some 50,000 doctors around the country. The strategy was a resounding success and stands as an early triumph of viral marketing. And the script in that book is the same criteria doctors today use to determine whether a patient qualifies for anti-depressants and is, by extension, “chemically imbalanced.”
In his own book, Greenberg participates in a clinical trial himself, signing up first as a minor depressive (for which he believes himself qualified) and later getting upgraded to major depressive simply by answering the questions honestly.
As a clinician he takes issue with the methodology used to determine depression. He points out that answering “yes” to questions like “Have you been feeling depressed lately?” and “Do you ever wonder if life is worth living?” may be evidence that you are a Prozac candidate or simply a natural response to watching the latest news on the BP oilspill
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