Redefining Depression as Mere Sadness

[groovedaddy]

Let’s say a patient walks into my office and says he’s been feeling down for the past three weeks. A month ago, his fiancée left him for another man, and he feels there’s no point in going on. He has not been sleeping well, his appetite is poor and he has lost interest in nearly all of his usual activities.

Should I give him a diagnosis of clinical depression? Or is my patient merely experiencing what the 14th-century monk Thomas à Kempis called “the proper sorrows of the soul”? The answer is more complicated than some critics of psychiatric diagnosis think.

To these critics, psychiatry has medicalized normal sadness by failing to consider the social and emotional context in which people develop low mood — for example, after losing a job or experiencing the breakup of an important relationship. This diagnostic failure, the argument goes, has created a bogus epidemic of increasing depression.

In their recent book “The Loss of Sadness” (Oxford, 2007), Allan V. Horwitz and Jerome C. Wakefield assert that for thousands of years, symptoms of sadness that were “with cause” were separated from those that were “without cause.” Only the latter were viewed as mental disorders.

http://www.nytimes.com/2008/09/16/health/views/16mind.html?th&emc=th

[Pab Sungenis]

1. The problem is not that we're redefining "depression" down to "sadness"

it's that we've been elevating all "sadness" to "depression."

"Depression" is a clinical disease, and we've been overprescribing antidepressants designed to treat it for people who don't have it.

[groovedaddy]

2. Hey, depression is good for business. Sadness...who cares!?! n.t

[Sal Minella]

3. Yeah, people bounce back from sadness without buying Pills from Big Pharma! We can't have THAT!!!

[melody]

6. Depression is a very real, crippling disease

It's as real as cancer.

[Pab Sungenis]

7. That's what I said.

Depression is a disease. Sadness is "awwwwwww."

[melody]

8. I was replying to your "depression is business", not the OP

Just making the point.

[groovedaddy]

9. No denying that depression is a serious illness...I've seen it up close and personal

but when treating depression becomes a business, as it has, then people who are sad are all too quickly diagnosed as "depressed."

[LeftishBrit]

11. While I agree that shoving pills at people is sometimes a substitute for finding out what

the real problem is, and that the wrong pills or unnecessary pills can do actual harm - let us not forget that depression is not just a business: it can be fatal. Pills can be a lifesaver. Two of my relatives developed bad depressions before antidepressants were available, and committed suicide. Other relatives had bad depressions once antidepressants were available, and recovered.

As with any medication, antidepressants have their own dangers and can be overused. But when needed, they can save people's lives, and cure or prevent a great deal of pain.

In the UK at least, antidepressants are not usually prescribed for *mild* depression.

[beam me up scottie]

12. Thank you, many of us have lost loved ones to depression.

And not just through death, depressed people don't act like themselves-they are in such pain that many are completely unrecognizable, even to themselves.

I only wish antidepressants had been available when my mom was still alive.

[Jack Rabbit]

4. I don't think you can give someone a diagnosis of clinicla depression based on that

Your patient may very well have it; trust me on this, I have it. However, three weeks may just be a reaction to his fiancee leaving him (that's something that would upset most people). Has he had suicidal thoughts? Is he delusional? Has he felt this way before and what happened to make him feel that way?

Before I was diagnosed with major depression, I was entertaining suicidal thoughts and talking to dead relatives.

[melody]

5. After I was given anti-depressants, I was relieved to feel sadness

Depression is far worse than sadness.

[varkam]

10. AFAIK, Bereavement is a "rule out" factor in the DSM.

Meaning that if someone has suffered a loss, that sadness is normal and to be expected. However, that has a time cap on it of six months as IIRC there is data to show that bereavement that lasts longer than six months is likely to last *much* longer.

[hedgehog]

13. While occasionally depression can be triggered by the stress

of a sad event (divorce, death, loss of job etc), IMO the key marker for depression is the inappropriate response to life's events. Look how often a teenager commits suicide when everything looks to be going perfectly in his or her life - good grades, lots of friends, success in sports etc.

[Fire_Medic_Dave]

14. Great now I get to explain to 500 more people that clinical depression is not mere sadness.

They'll say but I read an article once. A pastor once told me depression was a spiritual problem. I asked him why a pill fixed it then. He didn't have an answer.

David