My take on depression treatment is this: there are a number of different forms of depression that individuals can suffer from. And this is not merely to make the distinction between traditional depression and manic depression, which is the antiquated term for bipolar disorder.
Many people like to talk about their theories of depression, saying that depression is anger turned inward, or that depression is a biochemical disorder, a shortage of neurotransmitters, or a way of coping with hopeless situations. It seems like everyone has a pet theory of depression, but my opinion is that treatments for depression have to match the symptoms of depression. Because depression itself is too broad a category to simply assign one treatment for or to even say it's just one disorder. Diagnostically you can break it down into specifiers and similar disorders such as dysthymia. There used to even be a depressive personality disorder but this disorder is no longer acknowledged in the current diagnostic manual.
In fact I would say that the entire diagnostic model of current psychiatry and psychology is largely a failure because it tells us much less about the treatments that we should be giving patients than any other medical diagnostic model. In fact, the treatment is the only important thing that we really need to be paying attention to. How is it that we can make the patient feel better and function better in society?
And so it is with a diagnosis of depression, because if you say a patient is depressed, there are really only a couple of things that you can assume. There are wide range of symptoms. Sometimes conflicting symptoms, which can indicate depression can also indicate other things.
For example, there is little difference between a classical case of clinical depression and perfectly ordinary grief. Grieving is differentiated only by the length of time over which it is expressed, and also by the circumstances under which it is expressed. So you would not attempt to treat depression following the loss of a loved one if it were less than six months, because you would call it grief even though it looked identical.
However, clinically, this doesn't make a lot of difference. The important thing with depression is always going to be to help the patient to come to terms with whatever it is that they're having difficulty coming to terms with. And so the important thing when seeking treatments for depression is to seek treatments for the individual character structure and individual symptoms of the patient before you, rather than trying to find a treatment for some generic category that someone has decided to call depression.
Because depression doesn't really exist. None of the disorders listed in the diagnostic and statistical manual of psychiatric disorders actually exists. Those individuals who would claim that depression is a medical disorder brought about by an imbalance of neurotransmitters are speaking gibberish. I will believe that depression is caused by an improper level of neurotransmitter as soon as you can tell me what a proper level of neurotransmitter is. There is no such measure. We can do studies to see the differences in chemical makeup in the brains or the bloodstreams of depressed people vs. people who are not depressed, but all that gives us is a correlation between a certain chemical level and a certain expression of the individual. It does not tell us that the treatment for depression is a correction of this neurotransmitter imbalance. It does not tell us that the neurotransmitter levels are incorrect. For all we know the body could be trying to naturally adjust for some other factors that we haven't thought of yet. In fact, that's probably the more likely case.
So when we consider depression treatment, we should not simply look at the symptoms, or the blood levels of neurotransmitters, or the circumstances of an individual's life. Rather we should look at all of these factors and try to draw a complete picture of where they're at to the extent that we are able as psychologists. From there, we can help the individual to explore these factors in a way that naturally facilitates them changing their thoughts and feelings. There are plenty of excellent approaches to doing this, but do not necessarily assume that depression as an entity exists. These include cognitive interventions, psychodynamic interventions, psychoanalytic interventions, humanistic interventions, and a number of more specialized approaches.
In this blog I will be exploring a number of these approaches in greater depth. I will also go into detail about the various specifiers and diagnostic criteria for depression, as well as the psychodynamic considerations in working with depressed patients. We will therefore be able to develop a better sense of what are appropriate treatments for depression and how the clinician can go about treating depression in the individual rather than in the abstract.
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