Wednesday, November 24, 2010

Depressed? Maybe you’re just sad - Part 2


With the advent of modern diagnostic criteria, these authors argue, doctors were directed to ignore the context of the patient’s complaints and focus only on symptoms — poor appetite, insomnia, low energy, hopelessness and so on. The current criteria for major depression, they say, largely fail to distinguish between “abnormal” reactions caused by “internal dysfunction” and “normal sadness” brought on by external circumstances. And they blame vested interests — doctors, researchers, pharmaceutical companies — for fostering this bloated concept of depression.


It may seem easy to determine that someone with depressive complaints is reacting to a loss that touched off the depression. Experienced clinicians know this is rarely the case.


Most of us can point to recent losses and disappointments in our lives, but it is not always clear that they are causally related to our becoming depressed. For example, a patient who had a stroke a month ago may appear tearful, lethargic and depressed. To critics, the so-called depression is just “normal sadness” in reaction to a terrible psychological blow. But strokes are also known to disrupt chemical pathways in the brain that directly affect mood. What is the “real” trigger for this patient’s depression? Perhaps it is a combination of psychological and neurological factors. In short, the notion of “reacting” to adverse life events is complex and problematic.


Yes, most psychiatrists would concede that in the space of a brief “managed care” appointment, it’s very hard to understand much about the context of the patient’s depressive complaints. And yes, under such conditions, some doctors are tempted to write that prescription for Prozac or Zoloft and move on to the next patient.


But the vexing issue of when bereavement or sadness becomes a disorder, and how it should be treated, requires much more research. Most psychiatrists believe that undertreatment of severe depression is a more pressing problem than overtreatment of “normal sadness.” NYT NEWS SERVICE

 
Concluded