Welcome to From Insults to Respect. As this post’s title indicates, today I take up the question, “Is depression really so bad?” In doing so, I imagine many will conclude I must be out of my head or a complete numbskull. My challenging task for today is to see if I can convert such insults to at least a modest degree of respect.
As a start, let me be clear that I recognize and empathize with what I imagine the insulters’ position is likely to be:
Depression is every bit as bad as a majority of folks think it is, and even a whole bunch worse. Depression, these people are likely to point out, leads to some folks ending up committing suicide, or attempting it. Other sufferers of depression will end up being hospitalized at great societal cost, including costs to U.S. employers that has been estimated at $187.8 billion a year. This includes $134 billion in health care (health and mental health combined), $20.9 billion in absenteeism, and $32.9 billion in lost productivity. Finally, the anguish that comes from depression is nothing to make light of.
My case about the degree of badness of depression is worth considering is three pronged: 1. Repeatedly, the evidence indicates people who take antidepressants leads to more suicides and hospitalizations. 2. The available evidence indicates the consequences of using the arguments about suicide and hospitalization to convince people to take antidepressants leads to worse long term suffering of those folks experiencing depression. 3. When the nature of depression is clearly understood as a natural, potentially healthy process for dealing with stressful situations, it leads to less harm than believing that it really is so bad.
Evidence that Suicides and Hospitalizations Increase with Antidepressant Treatment
Convincing folks that depression is so serious because some people who experience it end up committing suicide or are hospitalized for suicidal thoughts is counterproductive. People who become convinced by this type of argument are more likely to get treatment with so called antidepressants when they find themselves becoming depressed. Moreover, such people, using the same argument will urge others who are depressed to get such treatment. This would be fine if the treatment sought would be just counseling/psychotherapy, but in modern countries, such as the United States and Great Britain, the first-line treatment is either antidepressant medication or a combination of antidepressant medication plus psychotherapy.
Despite this, according to a November 15, 2023 study appearing in Psychological Medicine by Harvard University researcher Nur Hani Zainal, such approaches can have dire consequences. Treatments that included antidepressant medications, either as a stand alone treatment, or in combination with psychotherapy, had significantly worse outcomes than psychotherapy alone for suicide deaths, suicide attempts, psychiatric emergency department visits, and psychiatric hospitalizations. This is a consistent finding that included 34 random controlled trials.
More specifically, the researcher wrote:
Forty-seven out of 1273 (3.7%) in the combined treatment arm and 24 out of 1240 (1.9%) in the psychotherapy-only arm had suicide attempts and other serious psychiatric adverse events, and this difference was statistically significant (OR 1.96 [1.20–3.20], p = 0.012)…
Thirty-one out of 1030 (3.0%) in the psychotherapy-only arm, and 67 out of 1192 (5.6%) in the ADM [antidepressant medication]-arm had suicide attempts and other serious psychiatric adverse events. This difference was statistically significant.
This analysis, along with others, suggests regardless of the treatment, over 94% of those going for treatment are unlikely to end up having one of the very serious consequences of depression. Framing the need for treatment by raising the prospect that very serious consequences are likely to occur without treatment, rather than being helpful, too often leads to antidepressant treatment, which the best science we have indicates this will increase the risk of such serious consequences.
The Effects of Antidepressants On Suffering
The available research findings indicate so called “antidepressants’ can increase the likelihood of strokes, heart attacks, falls and even death. Antidepressants can cause side effects, including nausea, agitation, weight gain, lower sex drive and indigestion. Research also suggests that people often experience unpleasant withdrawal symptoms, known as antidepressant discontinuation syndrome, when they stop taking antidepressants, sometimes for weeks or months. Thus, people seeking relief from a challenging emotional experience who turn to the most frequent prescribed treatment–antidepressants–are actually increasing their risks of suffering from these various negative consequences.
A very recent study titled “The impact of antidepressants and human development measures on the prevalence of sadness, worry and unhappiness: cross-national comparison,” the researchers conclude,
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In this study, we examine the relationship among individual symptoms (sadness, worry and unhappiness), human development factors and antidepressant use in 29 OECD [Organisation for Economic Co-operation and Development ] countries. We report that increased antidepressant prescribing is not associated with decreased prevalence of sadness, worry or unhappiness. However, income, education and life expectancy (measured using the Human Development Index) are associated with lower prevalence of all these symptoms. This suggests that increasing spending on depression treatment may not be as effective as general public health interventions at reducing depression in communities.”
An estimated 18 billion dollars a year is being spent on these drugs, (approximately 100 billion dollars spent every six years). This amount does not include the cost of appointment hours of psychiatrists and other prescribing doctors that is part of the required process of people getting access to these drugs. This appears to be a lot of wasted money that can be used more productively in other ways. Given this cost, along with the drugs’ side-effects, and negative health outcomes, framing depression as being so bad so that it ends up encouraging people to take “antidepressants” may be unwise.
So, why do so many who are taking these drugs come to believe they are enormously helpful? There are three major guesses about this.
Many people who become depressed start to feel better after a few months without taking this type of drug. If they do take the drug when they become depressed, and begin to feel better, they attribute it to the drug rather than the natural course of the experience.- If they start to feel better while taking the drug, they may try to stop taking it. Because of the withdrawal effects that feel awful, they are likely to think these awful feelings are due to their depression returning, so they quickly return to taking the drug while now more convinced that the drug is helpful.
- Some people are very susceptible to the placebo effect, and therefore any drug that they are prescribed by a doctor leads to the perception that the drug is effective.
Depression as a Natural, Potentially Healthy Process
Conceptualizing depression as a mental disorder tends to fail to motivate active coping beyond taking a pill. Moreover, it fails to honor the labeled person’s perspective. In contrast, framing these concerns as potentially a healthy functional signal can lead to less self-stigma, and greater self-efficacy in making healthy life-style improvements.
One example of this line of thinking is provided in Joshua Wolf Shenk’s (2005) biography of Abraham Lincoln. There the author makes the case that Lincoln’s depression fueled his greatness. Similarly, David Yaffe (2017) has written a biography about the music legend, Joni Mitchell, titled Reckless Daughter. There, he writes of her frequent bouts of depression and quotes her saying,
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Depression can be the sand that makes the pearl. Most of my best work came out of it. If you get rid of the demons and the disturbing things, then the angels fly off, too. There is the possibility, in that mire, of an epiphany.”
Schroder, et al. (2023), recently carried out a relevant study. As the authors describe it,
“We describe the historical development of popular messages about depression and draw from the fields of evolutionary psychiatry and social cognition to describe the alternative framework that depression is a “signal” that serves a purpose. We then present data from a pre-registered, online randomized-controlled study in which participants with self-reported depression histories viewed a series of videos that explained depression as a “disease like any other” with known biopsychosocial risk factors (BPS condition), or as a signal that serves an adaptive function (Signal condition) …. The Signal condition led to less self-stigma, greater offset efficacy, and more adaptive beliefs about depression.”
In a recent blog post, I describe in far more detail this healthy way to understand the nature of depression (see HERE) and a no financial cost process to maximize its benefits. There the reader learns that transforming one’s belief that depression is a “really so bad” experience, to one that develops a friendship with the experience is doable. Once the transformation is complete, I prefer the term “melancholy” for it becomes a distinctly different experience without all the insults directed at oneself and thoughts of being mentally ill.
For many people, it takes more than reading a few paragraphs about this way of thinking. It typically takes some practice over a few months. By beginning with my very first blog post (see HERE) many will find that for free the practice sessions provided are sufficient. Having a counselor/psychotherapist that reacts to such folks’ depression experiences with kindness and empathy, rather than with insults and seeking to convince them that their experience is so terribly bad, can also be enormously helpful. Such counselors/psychotherapists provide a model that leads one to emulate this way of being supportive of themselves throughout their days even when their therapist is no longer present.
Conclusion
There is a subgroup of people who, upon becoming depressed, end up seriously considering, or even attempting, suicide. I am in no way attempting to make light of the experiences of people who reach this level of desperation. Some kind empathetic support can be very helpful to deal with such situations. What I am seeking to convey is that the vast majority of people experiencing depression don’t go to such extremes. For them, the argument that their experience is so bad they need to rush out and get someone to provide “antidepressant” treatment might not be wise.
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.
The good professor first covers the fact that to most the question of whether or not life is worth living hardly ever comes up, so intent are they to live every moment that they have. Others, spend most of their lives questioning whether it would be better to enter into the peace of being consigned to the earth. And then there are those who drift back and forth. After a poetic discourse of these different types, James delves into what we might say if we meet someone who indeed is questioning whether it would be better just to end it all.
“To breathe the air, how delicious!
“To come immediately to the heart of my theme, then, what I propose is to imagine ourselves reasoning with a fellow-mortal who is on such terms with life that the only comfort left him is to brood on the assurance, ‘You may end it when you will.’ What reasons can we plead that may render such a brother (or sister) willing to take up the burden again?”
At this point, Professor James hastens to confess that nothing he has to say will be able to prevent all suicides. If we make an effort to help and despite this, the person ends his or her life, “cases like these belong to the ultimate mystery of evil, concerning which I can only offer considerations tending toward religious patience at the end of this hour.”
He tells us that certain people who have grown up with a religious background, find that as they get older what they were taught and came to sincerely believe is not meshing well with their personal experiences. They observe that their own actions don’t accord with every teaching of the scriptures, and guilt begins to mount. And they begin to learn in science based teachings that the world was not created a few thousand years ago in six days, the animal kingdom evolved in a manner very differently than their religious stories, and when some of this science stuff seems to make sense to them, they feel they are engaging in blasphemy. They feel confused and fearful. Thus, Professor James tells us,
Once the springs of vitality are let loose in this way, without the burden of infinite responsibility, many experience an immense relief. Meanwhile, whatever is causing the suffering “can be tolerated for another twenty-four hours longer, if only to see what tomorrow’s newspaper will contain, or what the next postman will bring.”
Professor James believed that for some suicidal folks, once they have reached the first stage, it may be possible to incite a fighting spirit within. Identify one or more perceived evil from their perspective, and make appeals to help to overthrow it. Professor James explains,
From these words, James encourages us to use inspiring narratives of those who, through acts of courage, made a real and wonderful difference. In the essay, Professor James’s examples are very dated. Therefore, readers may prefer to turn to my 
