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Charlie Rose Brain Series 2: Depression with Eric Kandel of Columbia University, Peter Whybrow of UCLA, author Andrew Solomon, Frederick Goodwin of George Washington University and Helen Mayberg of Emory University
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arlenefn 11/15/2012 02:32 PM Report
Very enlightening information on experiencing depression from the p.o.v. of the sufferer. Helpful and encouraging. The experts here really care.
jpke 08/21/2012 03:36 PM Report
Mr (Charlie)Rose,
You've had a series on the brain, brain "science" and psychiatry with various guests discussing developments and "discoveries" in their field(s). How about doing a show (or even a series) on a growing number of groups and activists in the field of "mental health" and psychiatric reform? I (and a growing number of others) believe it would be of great public service to broadcast in the "mainstream" media the views and work of individuals such as Peter Breggin, MD(author,psychiatrist), Jim Gottstein (atty, mental health activist), Robert Whitaker(psychiatric researcher and author), David Healy MD (author, psychiatrist), Ann Blake-Tracy(International Coalition for Drug Awareness), and others.
There is increasing, documented evidence on the harm done by the use of psychotropic drugs which should be made more "public".
There are also mental health/ psychiatric consumer (and "insider expert") voices rising on issues related to: Informed consent, coercion, disclosure, misrepresentation, false claims, conflict of interest, corruption, ghostwriting, fraudulent practice, physical/mental abuse, and professional ethics and standards issues in the psychiatric and mental health field.
Your response would be appreciated.
Sincerely, Jim Keiser
PS: I'm adding the following statements (by others) for your consideration and comment:
RE. DIFFERENTIAL DIAGNOSIS: "The thing that bothers me the most about psychiatry (outside of the harm done by its so-called "treatments") is the fact that psychiatrists almost NEVER look for underlying medical disorders. They just use their "Bible," the DSM, which is merely a collection of symptoms that could be caused by MANY THINGS. By not using differential diagnosis, psychiatrists are failing to practice actual medicine. Joe Blow off the street, with no medical training, could come up with a diagnosis after listening to someone describe their symptoms once he has flipped through the pages of the DSM. If I can accomplish one thing (and I have no idea of how to do this), I would like to create a standard that forces psychiatrists to do a thorough battery of medical tests before any medications are prescribed or labels given."~unk
___________________________________
STANDARD PRACTICE IN PSYCHIATRIC "DIAGNOSIS" AND TREATMENT (valid from my, and others' experiences):
"...Most people would agree that people need to (be) told accurate information about the validity of a diagnosis; including whether or not it is Biological in nature; or if this is a belief based on nothing more than a yet to be validated Hypothesis. Saying that a psychiatric diagnosis is a disease/chemical imbalance/neuro-biological in nature is a story told to 'bust the stigma' and to get people to take their meds; not because it is based on fact.
...Fraud is a crime, and also a civil law violation. Defrauding people or entities of money or valuables is a common purpose of fraud, but there have also been fraudulent 'discoveries', e.g., in science, to gain prestige rather than immediate monetary gain. ...
...Most people would agree that people need to given accurate, unbiased information about the drugs prescribed to them and their children. Most of us would agree it would be wrong to tell people that they in fact have a disease/chemical imbalance or a neuro-biological condition requiring drugs to treat it; when no imbalance, disease, defect or neuro-biological condition has been identified. These claims are being made without any physical, neurological or medical examination taking place. A conversation with the person and gathering information from others about their personal opinions and subjective observation of the patient or 'client' is not an examination; and even a consensus of informed opinions does not make the weakest of 'evidence' scientific or valid; it does not make the psychiatric diagnosis a medical condition either. ...
The fact is: no genetic condition, chemical imbalance, or neuro-biological pathology has been identified ever--in any human being alive or dead; that causes any mental illness, or psychiatric diagnosis. ...
...Failing to give people the very information which is necessary to protect their children and themselves is particularly heinous; despicable really, all things considered. ...
...For professionals to ignore their ethical duty to fully inform patients and parents of children about the nature of psychiatric diagnoses, about the potential for harm involved in taking psychiatric drugs is criminal; not just 'unethical.' It is, in reality fraud...
...This being the case, it is an unethical claim for any psychiatrist or mental health professional to make. It is dishonest, it is disrespectful and it is evidence of an utter lack of professional integrity. ...
...Many believe the drugs are treating a disease, because of the erroneous belief that doctors don't lie to patients. People take neurotoxic drugs believing that the drugs treat a brain disease they have. The drugs cause iatrogenic, or 'physician caused' diseases, neurological impairments, and can disable them; and even cause their untimely death. ...
...It is fraud. It is Standard Practice. It is criminal. "~from article in Systems of Care Yakima
jpke 08/21/2012 03:35 PM Report
Mr (Charlie)Rose,
You've had a series on the brain, brain "science" and psychiatry with various guests discussing developments and "discoveries" in their field(s). How about doing a show (or even a series) on a growing number of groups and activists in the field of "mental health" and psychiatric reform? I (and a growing number of others) believe it would be of great public service to broadcast in the "mainstream" media the views and work of individuals such as Peter Breggin, MD(author,psychiatrist), Jim Gottstein (atty, mental health activist), Robert Whitaker(psychiatric researcher and author), David Healy MD (author, psychiatrist), Ann Blake-Tracy(International Coalition for Drug Awareness), and others.
There is increasing, documented evidence on the harm done by the use of psychotropic drugs which should be made more "public".
There are also mental health/ psychiatric consumer (and "insider expert") voices rising on issues related to: Informed consent, coercion, disclosure, misrepresentation, false claims, conflict of interest, corruption, ghostwriting, fraudulent practice, physical/mental abuse, and professional ethics and standards issues in the psychiatric and mental health field.
Your response would be appreciated.
Sincerely, Jim Keiser
PS: I'm adding the following statements (by others) for your consideration and comment:
RE. DIFFERENTIAL DIAGNOSIS: "The thing that bothers me the most about psychiatry (outside of the harm done by its so-called "treatments") is the fact that psychiatrists almost NEVER look for underlying medical disorders. They just use their "Bible," the DSM, which is merely a collection of symptoms that could be caused by MANY THINGS. By not using differential diagnosis, psychiatrists are failing to practice actual medicine. Joe Blow off the street, with no medical training, could come up with a diagnosis after listening to someone describe their symptoms once he has flipped through the pages of the DSM. If I can accomplish one thing (and I have no idea of how to do this), I would like to create a standard that forces psychiatrists to do a thorough battery of medical tests before any medications are prescribed or labels given."~unk
___________________________________
STANDARD PRACTICE IN PSYCHIATRIC "DIAGNOSIS" AND TREATMENT (valid from my, and others' experiences):
"...Most people would agree that people need to (be) told accurate information about the validity of a diagnosis; including whether or not it is Biological in nature; or if this is a belief based on nothing more than a yet to be validated Hypothesis. Saying that a psychiatric diagnosis is a disease/chemical imbalance/neuro-biological in nature is a story told to 'bust the stigma' and to get people to take their meds; not because it is based on fact.
...Fraud is a crime, and also a civil law violation. Defrauding people or entities of money or valuables is a common purpose of fraud, but there have also been fraudulent 'discoveries', e.g., in science, to gain prestige rather than immediate monetary gain. ...
...Most people would agree that people need to given accurate, unbiased information about the drugs prescribed to them and their children. Most of us would agree it would be wrong to tell people that they in fact have a disease/chemical imbalance or a neuro-biological condition requiring drugs to treat it; when no imbalance, disease, defect or neuro-biological condition has been identified. These claims are being made without any physical, neurological or medical examination taking place. A conversation with the person and gathering information from others about their personal opinions and subjective observation of the patient or 'client' is not an examination; and even a consensus of informed opinions does not make the weakest of 'evidence' scientific or valid; it does not make the psychiatric diagnosis a medical condition either. ...
The fact is: no genetic condition, chemical imbalance, or neuro-biological pathology has been identified ever--in any human being alive or dead; that causes any mental illness, or psychiatric diagnosis. ...
...Failing to give people the very information which is necessary to protect their children and themselves is particularly heinous; despicable really, all things considered. ...
...For professionals to ignore their ethical duty to fully inform patients and parents of children about the nature of psychiatric diagnoses, about the potential for harm involved in taking psychiatric drugs is criminal; not just 'unethical.' It is, in reality fraud...
...This being the case, it is an unethical claim for any psychiatrist or mental health professional to make. It is dishonest, it is disrespectful and it is evidence of an utter lack of professional integrity. ...
...Many believe the drugs are treating a disease, because of the erroneous belief that doctors don't lie to patients. People take neurotoxic drugs believing that the drugs treat a brain disease they have. The drugs cause iatrogenic, or 'physician caused' diseases, neurological impairments, and can disable them; and even cause their untimely death. ...
...It is fraud. It is Standard Practice. It is criminal. "~from article in Systems of Care Yakima
Biosublime 07/16/2012 05:40 PM Report
Re: Charlie Rose Series on the Brain: Depression
Thanks to Eric and Charlie, for the valuable symposium on depression in one short hour. Yet, for me it was painful to watch, because everyone seems so close to the answer and I’m the frustrated Monday morning quarterback, thinking he knows something that would unleash these practiced minds. I’ll save my comments for one guest, though all were greatly appreciated. Dr. Mayberg’s research indicates that the subcortical network she identified can be tweaked different ways to help different kinds of depression. As it happens, this is the same neural network (mine) that was taken out with the powerful cholinergic antagonist, scopolamine, given to my mother in her labor to produce amnesia of her birthing ordeal, in a procedure called, Twilight Sleep. I stood on the shoulders of Eric Kandel, among others, in my attempts to interpret the rare effects of this birth on myself, one of which was a hidden sub-cerebral memory that holds trauma, but erases itself, once activated. This hidden memory is of a different kind from the broad cerebral memory networks defined by Dr. Kandel; this one has Pavlovian elements (Thompson), it’s localized within the cerebellum and can be viewed simply as being “opened” or “closed”, depending on the presence of agonists to a widespread receptor within the brain, the 5-HT1a. OK, what does this have to do with depression?
This sub-cerebral memory, uncluttered by cerebral memory, can erase itself spontaneously. This is compelling evidence for a natural ongoing process for healing accumulated noxious memory, somewhat analogous to the healing of a cut. The erasure begins with the secretion of these agonists, all derived from melatonin. They are most likely secreted during REM sleep, whose onset during the night requires the same 5-HT1a receptor. Their “opening” of this hidden memory releases hurtful impulses from the memory substrate into cortical interpretation as flashbacks, indicating partial or complete erasure the memory. Some of these flashbacks could appear as bad dreams, which are known to be typical of REM sleep. McNamarra and others report ongoing depressive states in the aftermath of REM nightmares and Rebecca Spencer has reported trauma absorbed during sleep, consistent with this notion. Yes, everyone becomes an “acid head” each night of our lives, my take for the source of the famous fairy tales before artificial lighting when Europeans retired at sunset to awaken at midnight for a creative time in the waning land of REM.
Can this erasure mechanism be counted as another approach to the treatment of depression? How many depressions are related to incomplete healing of trauma, i.e., PTSD? Notably, SSRIs and other known treatments for depression are not effective in postpartum depression, closely associated with the trauma of hospital births and mine in particular.
SharkswithfrikingLazers 06/25/2012 03:40 AM Report
Charlie, you did an interview with a Harvard brain scientist, Jill Bolte Taylor, who had a stroke and took 8 years to recover.
http://www.charlierose.com/view/interview/10580
Her left brain was damaged but it allowed her to be in a great state of bliss. She had impaired linear thinking and she thought herself to be more fluid than solid.
Perhaps Area 25 does not need to be stimulated but rather slowed down if that is what happened with Jill Bolte Taylor's brain.
Perhaps brain studies of those who have been effected by stroke in Area 25. This may help even more with our understanding of depression.
grposey 06/22/2012 06:29 PM Report
This was a wonderful program. Thank you for presenting it.
MichaelKorsonMFT 06/20/2012 03:06 PM Report
On the Usefulness of Psychotherapy Treatment When Dealing with Depression: Some More Thoughts on Charlie Rose Brain Series 2: Depression
As a psychotherapist, I very much appreciated that there was a focus in the Charlie Rose program on depression on the usefulness of psychotherapy when treating depression. I appreciated that the panelists emphasized that the latest research suggests that a combination of psychotherapy and medication management is the most effective strategy in the treatment of more severe situations. There was not a lot said, however, about psychotherapy. And what was said seemed to allude to one form of treatment: CBT (Cognitive Behavioral Therapy). There is a lot of talk these days, when there is talk about psychotherapy, about CBT and its effectiveness. Although I am not strictly a CBT psychotherapist, but rather someone who takes an eclectic approach so as to be able to provide my clients with what is helpful to them, I know there is much good to be gained in focusing on some of the essential aspects of CBT therapy. I often reflect on cognition (the “C” part of “CBT” – the thoughts that someone has) and behavior (the “B” part of “CBT” -- the particular patterns of behavior someone is trying to change). And from my years of experience, I also know that that there is more to focus on in order to promote effective and true change.
While CBT has gained a lot of attention as an effective psychotherapy to ameliorate people’s problems, recent research reveals that it does not work any more effectively than other forms of psychotherapy. One such form, with its focus on healing one’s emotional challenges from the past by focusing on that past and by observing how relational patterns from the past emerge in the present, is referred to as psychoanalytic psychotherapy. This is a form of psychotherapy that I practice (while being eclectic and borrowing from other approaches when I believe they will be helpful to my client). An article published in 2010 in the American Psychologist by Jonathan Shedler provides a strong argument for the effectiveness of psychoanalytic psychotherapy. And a study published in 2009 in the Harvard Review of Psychiatry used several well-designed treatment outcome studies that found psychoanalytic psychotherapy was considerably more effective than other forms of treatment.
When working with clients to address the issues that are causing them suffering, I typically take what I like to call a “two-prong approach.” Together, the client and I focus on what changes can be made now in the present. This focus usually involves looking at the client’s thoughts and beliefs. A central tenet found in CBT is that there is an intimate connection between thoughts and feelings. The particular approach, then, is to see what changes can be made in thinking so as to change feelings, particularly distressing feelings.
And inevitably change does mean changing one’s behaviors. Often behaviors, such as those involved in addictions or compulsions, or others such as isolating and social withdrawal, have a long history over many years. Changing those behaviors means instituting new habits. A client and I will talk about those new behaviors and how, with the support of therapy, to instill them as new habits.
The second prong in the approach, however, has to do with healing the wounds of the past. I have found that it is not enough to simply reframe thoughts and begin to practice new habits. While that may be effective for symptom relief, it does not address the underlying problems producing the symptoms. There are experiences in a person’s past which, although they cannot be changed nor redone, need attention and healing. Often it has been the case that in someone’s past there was not sufficient help in addressing these events. Healing is an interpersonal process. It takes a relationship with another human being in order to initiate the healing process, which often involves grieving some sort of loss in the presence of a compassionate other person.
A person, for example, struggling with depression, may have feelings of hopelessness and despair. He may feel inept in managing or charting the course of his life. Through the work that we do in psychotherapy, we may see that these feelings originated in the person’s prior experience, often in his family of origin. Perhaps in that person’s childhood, he was not encouraged to grow towards autonomy. Perhaps there were a lot of experiences causing guilt feelings and an overriding sense of obligation. A person’s earlier experiences, particularly with significant others, form core beliefs about the world and oneself. In this way, the earlier experiences continue to influence the present day – often it’s as if the earlier experiences repeat themselves. It is not enough to point to these beliefs as “distortions” or to help “reframe” newer thoughts. Rather, there is a good deal of work to be done talking about these experiences, grieving them, in order to help the person renounce these beliefs and replace them with healthy new ones. True and meaningful change requires getting to the sources of the symptoms, not just relieving them.
http://www.nvpp.nl/JonathanShedlerStudy20100202.pdf
http://dspace.ubvu.vu.nl/bitstream/1871/17141/2/Maat,%20de_Harvard%20Review%20of%20Psychiatry_17%281% 29_2009_u.pdf
RuthDeming 06/07/2012 04:22 PM Report
Fascinating show, which I shared with New Directions, my support group for people with mood disorders and their loved ones here in the Philadelphia area.
Very interesting that the brain changes after episodes of depression and mania. I had bipolar disorder one - both true mania and depression - for 20 years - then went off lithium because it damaged my kidneys (had a transplant last year)- but when I went off the lithium, my bipolar disorder never returned.
I am 66 years old and episode-free for 8 years and believe me I've had lots of stress since then.
Any comments? RuthDeming@comcast.net
KLoewe 06/05/2012 04:30 AM Report
You start the presentation by saying you will be "examining one of the most widespread disorders, depression". That's contributing to the problem, because when you go on to describe depression as "a group of conditions…", you describe "clinical depression", not depression. The result is that doctors and psychiatrists today are treating people for depression who are depressed, often with good reason, not just people who are "clinically depressed".
One of your experts says "Area 25…seems to always show itself whenever there is an intense negative experience". That can be measured, so it can be presented as fact, assuming it applies to everyone. However, the next statement, "Area 25 is the negative mood regulator", is an unwarranted assumption not unlike the one that gave the common cold its name. What controls the behavior of Area 25, and how?
In the presentation, your experts repeatedly talk about depression as a brain disorder. That assumes that the brain is the seat of perception/consciousness/awareness, and that life is a purely physical phenomenon. Anyone who believes that doesn't understand college physics. Your experts think they know a lot of things that they don't, because they aren't checking their assumptions about the nature of life and consciousness. That's not uncommon in science, but the problem is that they are leading people to believe they know what they're doing.
Your experts talk a lot about treatments, but not about cures. Since these "illnesses" are increasing, but cures are not being found, how long will it be before the entire GDP is consumed by treatments for all the things we would rather live with because we don't want to find or correct the causes?
Regarding the comment made at the very end of the presentation, I did read that one of the risk factors for dementia and Alzheimer's is depression. Perhaps we should be studying the possibility that it is not depression, but chemical treatment for depression that is the real risk factor. I have already read that some people are beginning to wonder if the plaques that are blamed for Alzheimer's are not causes, but the brain's attempt to defend itself against something else. I've also read enough about Namenda to suspect its affect is possibly attributable to the placebo effect of its many psychoactive properties.
Too bad no-one will ever get an opportunity to ask this group of "experts" some questions that come to mind when looking through the clinical trials of an antidepressant:
If the placebo, the control, and the drug being tested in a clinical trial do not have identical side effects for every patient, there is no way to determine whether a perceived improvement in a patient's symptoms is due to one or more of the designed effects of the drug (DRI, SSRI, NSRI, etc.), to a side effect, or to a combination of effects and/or side effects. Furthermore, if designed effects or side effects are different from patient to patient, then there is no way to determine whether a perceived improvement in one patient has the same cause as a perceived improvement in another patient. Therefore, how is it possible to create a valid clinical test for efficacy of a psychoactive drug? Statistics cannot correct for an invalid test.
Fisher's Exact Test is a statistical technique used to analyze the probability of relationships between groups of clearly measurable, absolute/binary data (true/false, black/white, heads/tails, male/female, etc.); whereas, the data collected in clinical trials consists of averages of subjective "measurements" of analog data using arbitrary scales, and requiring corrections between groups of patients to place them in comparable ranges, as part of the process of evaluation. Therefore, doesn't using Fisher's Exact Test to analyze clinical trial data implicitly assume that every patient in the trial was absolutely and equally ill at the start of the trial, and that every patient that showed improvement at the end of the trial was not just equally healthy, but no longer ill?
The results of clinical trials are supposedly statistically analyzed to determine the probability of the results being random, the assumption being that if the probability of them being random is low enough, the results are statistically significant (which is actually not quite true). However, a company need only produce two clinical trials that demonstrate efficacy to support approval of a drug; without calculating the probability of the number of successful trials in the number of total trials being a random result (for example, in 6 trials of random binary outcomes of improved/not improved, the probability of exactly 2 trials having outcomes of improved is 23.4%, and the probability of 2 or more trials having outcomes of improved is 89.1%). Therefore, isn't allowing as many clinical trials as necessary to get two trials that "show" efficacy, essentially guaranteeing success, even if the trials are invalid and the results meaningless?
In clinical trials, patients are screened to eliminate those known to have adverse events in response to antidepressants, the control, or the placebo, before the individual trials begin. After trials begin, patients are dropped from testing when adverse events occur, and the data for those dropped patients are excluded from trial evaluations. Individual trials that show no efficacy are declared failed trials and the data are not used in determining the overall success of the trials. These practices make the trials no longer random or blind, but skewed (rigged) to favor success; therefore, why are so many trials still required to show efficacy, and why is the efficacy shown by still typically insignificant?
Based on the above, how can clinical trials that show efficacy of antidepressants be considered valid, let alone that benefits shown are the result of the drug and not the result of the placebo effect or the patient simply getting better?
Antidepressants that target a specific excitatory receptor may cause more of the amino acid to be released (releasers), may inhibit reuptake of the amino acid that has already been released (reuptake inhibitors), or may increase the sensitivity of the receptors for that amino acid (receptor agonists). Recreational drugs work exactly the same way (MDMA/ecstasy is a releaser, LSD & mescaline are receptor agonists, and cocaine & amphetamine are reuptake inhibitors). In other words, antidepressants are drugs, not medicine. Like recreational drugs, all they do is change chemical balances normally maintained by the brain to alter perception; and like recreational drugs, how and how much they change perception varies from person to person. That's why some people feel better when they first take a recreational drug or an antidepressant, some feel terrible, and some respond with anxiety; and these differences are why clinically depressed patients often end up taking many different drugs over relatively short periods of time while their doctor or psychiatrist experiments on them looking for a drug that makes them feel better. Because of this, why would anyone expect antidepressants to work for everyone?
Unfortunately, some people don't feel better on any drug (many people like the feeling they get from alcohol; some hate it) or antidepressant, but the brain still interprets drugs as an imbalance, and reacts by decreasing its receptors as necessary to restore what the brain considered a balance – in the case of antidepressants, by decreasing its own excitatory ability associated with any of the amino acids targeted by the drugs being used. That means that if the drugs in use targeted the amino acid that was causing the symptoms, the treatment made the patient worse, and if a different amino acid was targeted, something that was not out of balance has been thrown out of balance, adding a problem. So, even if the drug helps initially, it eventually stops working, and the brain becomes dependent on the dose it has adjusted to. One "solution" is to increase the dose, but once the maximum dose is reached and adjusted to; the "solution" becomes to change to a drug that affects a different amino acid or combination thereof, so that eventually, the patient's brain has multiple problems and there's no way of knowing what drug is causing what symptom or side (or withdrawal) effect. Why would anyone think causing more imbalances in someone's brain and making them dependent on drugs will cure depression?
The science says that, through the mechanism of neuroplasticity, antidepressants will cause the brain of someone who is depressed (whether they are clinically depressed or not) to change itself so that it will be more depressed in the absence of the drug. Therefore, why does anyone expect antidepressants to provide anything but short term improvement, followed by dependence or worse?
Dependence is what leads to withdrawal symptoms when someone stops taking a drug. An Internet search easily confirms that for many people, withdrawal from antidepressants is "hell". Why are patients encouraged to continue taking antidepressants if they don't feel better, or if they do, when all antidepressants create dependence?
If functional imaging of the brain of someone with clinical depression identifies an area of the brain with abnormal activity, there is no way to determine if the abnormal activity is the cause of the depression or if the depression is the cause of the abnormal activity. Why do researchers simply assume the former in their approach to treating depression, instead of trying to find out the cause of the abnormal activity?
The like all organisms, the human organism has developed all its metabolic abilities through evolution. It is therefore impossible for the human body (or the environment) to have developed the ability to safely metabolize drugs that exist no-where in nature. Why are doctors and psychiatrists assuming that modern antidepressants are safe for intermediate and long-term use, when clinical trials typically last less than a year, and don't include physically and mentally healthy patients?
A 2009 comprehensive study of literature available on ECT concluded that ECT has a very powerful placebo effect, and that studies do not show evidence of efficacy that justifies the risk inherent in the procedure. An Internet search easily confirms that many people suffer permanent damage from ECT, so why are we still using and experimenting with it?
Every antidepressant comes with a warning against operating dangerous equipment, including motor vehicles, while taking antidepressants, until they know they can do so safely. Imagine that warning on beer or whiskey. What is the difference between the physical and mental impairment of an antidepressant and alcohol, and what are the safe limits for taking antidepressants, considering the fact that the ability to drive safely of someone who is depressed is undoubtedly also impaired?
Has it ever occurred to anyone that the association between suicide, depression and antidepressants might have something to do with the fact that all psychoactive drugs affect thinking and judgment?
MichaelKorsonMFT 06/03/2012 04:04 PM Report
As a psychotherapist, it was with great interest that I watched the Charlie Rose show on the brain and depression. This show in particular focused on the clinical situation of depression. Mr. Rose’s panel of guests, comprised mostly of scientific researchers and academics, provided informed and useful information about depression in its unipolar (Major Depressive Disorder) and bipolar (Bipolar Affective Disorder) manifestations. They made clear that they were not addressing more ordinary experiences of sadness or “the blues.” The show is educational especially for someone minimally aware of depression, One guest in particular, Andrew Solomon, the author of a well-researched as well as intimate memoir on depression, The Noonday Demon, spoke eloquently from his experience of depression. The guests talked about research on the brain that now reveals the areas that are implicated with depression.
The objection that I have with the show, however, is that it takes a unipolar view of what is a complex and multidimensional phenomenon. The panelists understand depression as a disease or, as the moderator, Eric Kandel says, a “disorder.” Their interest is the brain, and their focus is, therefore, on changes in brain chemistry and functioning that result in depression. The thesis behind this model is that something happens, particularly to the neurotransmitters, that impairs the functioning of the brain. They see depression similarly to other diseases with biological etiology, such as diabetes or Parkinson’s disease.
As a psychotherapist who has focused over the years in working with people suffering from depression and anxiety, I have learned that there are other important ways of understanding and working with depression. In my work, I take an eclectic view. While I do not dismiss the notion of depression as a disease, I also remain open to understanding it along more psychological and emotional dimensions.
Depression may be seen more as a symptom, an indicator of something else that is terribly wrong overall. Andrew Solomon says that he believes the opposite of depression is not happiness, but is vitality. I agree with him. From this point of view, depression signals some sort of problem in vitality, in the force that animates one’s life. The focus then in psychotherapy as I practice it is to understand what constricts or obstructs a person’s access to his or her vitality. These obstacles may be many things: specific traumas from the past that are unresolved and drain one’s energy; long-held negative beliefs about oneself and the world; maladaptive and persistent coping strategies for dealing with life’s challenges. The goal of therapy, in addition to understanding what has gone wrong, is to help stimulate a vital engagement in life.
Another view of depression focuses on it as a person’s unconscious attempts to cope. This may seem ironic, of course, given that the suffering associated with depression is often quite severe. Yet it may seem to a person that that suffering is the better of two evils. Clients of mine often speak of the depressed state as one of “numbness.” They see their depression not so much a byproduct of feelings (in that way it is different than say feeling sad); rather it is more the absence of feeling. That numbness is meant (unconsciously) as a coping strategy, a defense against not only painful feelings, but seemingly intolerable ones. The goals of psychotherapy are to provide a safe and trusting process for someone to reopen feeling sectors that have been shut down, to feel and thus work through the emotional issues that seem so intolerable and intractable. In this way, psychotherapy treatment helps the person create better defenses, ones that don’t shut down the emotional ways of responding to life.
The show notes how the recorded human history of depression dates back quite a long time. In our modern era, we see a consideration of depression at the very inception of psychological treatment. At the turn of the last century, Freud wrote in his famous paper “Mourning and Melancholia” about the differences in grief (mourning) and depression (melancholia). As I have learned from my clients suffering from depression, there is often some sort of grief work yet to be done. Often some sort of loss or perhaps an experience of disappointment (which can be viewed as a loss of hope) needs to be processed. Psychotherapy provides a means in which, in the presence of another human being, to grieve. As is the case with the stages of grief, as one moves through the process of grieving, the depression states resolves.
My approach when working with people with depression is to remain open to the various possibilities of viewing depression. It is not uncommon that my clients also work with physicians and take psychotropic medications as part of their treatment. My experience suggests what the panelists confirm: while medications alone cannot resolve depression nor the problems that contribute to the person’s experience of hopelessness and despair, they can assist in ameliorating some of the devastating and paralyzing effects and make it more possible to delve into psychotherapeutic work. With any given treatment, my focus is to understand that particular client, the meaning of his or her depression and therefore how to best address resolving it.
It seems axiomatic to me that in our modern world we are faced with holding seemingly contradictory facts. As science advances, and gives us views into the workings of the brain, it reveals much that was previously hidden and unknown. And it reveals how much remains unknown as well. (In fact a new book by Stuart Firestein called Ignorance argues that science is less about an accumulation of facts and more about embracing what we don't know.) It seems beneficial to me to remain cognizant of this fact: while much is known, say about depression, much remains unknown and subject to inquiry both scientific and personal. Or perhaps I should put it another way: the more we know, the more we know about what we don’t know. Which leads us back almost a hundred years to the conclusion of Freud’s paper:
“As we already know, the interdependence of the complicated problems of the mind forces us to break off every enquiry before it is completed – till the outcome of some other enquiry can come to its assistance” [p. 258].
Perhaps we are wise to heed those words as we gather scientific knowledge about the workings of the human mind (not just the human brain). There is indeed an “interdependence of…complicated problems” and enquiring is never completed. Keeping a diverse, rather than singularly focused, viewpoint seems to me the best way to proceed.
hoosierbooks 06/03/2012 02:10 PM Report
the show about depression was amazing, wish u had more time with this subject. Learned a lot and am sure there is a lot more...love u Charlie Rose, u are always bring us wonderful tv (which is hard to do these days) I have been telling everyone about this show, love that u had Andrew on there to speak for us, I could really relate to him, he was wonderful and brave to speak out on this subject, am making sure my Doctor watches it.
Juls008 06/02/2012 01:17 AM Report
What an excellent program for a novice in the world of major depression. I have only begun to delve into this topic as my mother has been trying various medications since Jan. of this year. I wish the website would list additional resources. I thought the panel was excellent in describing the disorder both scientifically and emotionally. Andrew's description was eye opening for me, as this is exactly how my mother has been feeling yet unable to articulate.
SharkswithfrikingLazers 06/01/2012 03:38 PM Report
Emo Philips: “I used to think that the brain was the most wonderful organ in my body. Then I realized who was telling me this.”
BobFeikema 06/01/2012 02:05 PM Report
Whenever I watch a Brain Series program on mental disorders it’s like watching a group of mechanics sitting around the garage comparing notes on how to diagnose and repair a car that has been damaged in an accident. They have expert knowledge regarding any design and manufacturing faults, how the car’s systems operate, and what needs to be done to repair a particular component or system. But they have only passing interest in environmental factors that may have led to the crack up, e.g., road conditions, the terrain, and atmospheric conditions that may have triggered the accident. They will have less concern with the driver’s driving skills, while knowing that his lack thereof may have caused the accident. They will have no concern with the social context in which driving takes place – traffic laws, congestion, the conduct of other drivers, and what types of vehicles are on the road. And they will find the purpose behind the driver’s use of the vehicle irrelevant, not to mention the kind of society that has been created by making automobility the primary mode of transportation. Thinking about whether there might be fewer accidents if our communities were more walkable and bikeable is outside their field of interest. They are concerned only with fixing the vehicle and getting it back on the road.
The Brain Series presents the viewpoint of mainstream neuroscience regarding how the brain causes various mental, emotional, and behavioral conditions. It downplays the serious limitations of that knowledge. For example, the diagnostic categories for mental disorders are descriptive, “scientific hypotheses that are intended to be tested and disproved if the evidence isn't found to support them,” according to Darrel A. Regier, director of research for the American Psychiatric Association and vice-chair of the DSM-5 Task Force. In contrast to diseases like diabetes and cancer, a diagnosis of depression is entirely dependent on the interpretation of the patient’s account of her mental/emotional state and behavior. Images of activity in Area 25 are not comparable to a blood test or a biopsy.
The Brain Series ignores any research that counters the brain-centric, chemical imbalance theory of mental disorders. Eric Kandel’s glib dismissal of the idea that antidepressants are no more efficacious than the placebo effect is, in fact, highly contested as anyone who has read Irving Kirsch’s "The Emperor’s New Drugs" will appreciate.
Finally, the neuroscientific perspective of the brain mechanics provides an unsophisticated, reductionist understanding of the brain-body-world unity. Yes, they will concede, there may be environmental triggers that set the depression in motion, but once underway it has a mind of its own and every brain that that particular type of depression will have it in the same way. The unique circumstances of your suffering in relation to your personal life and prevailing societal conditions are relevant only to the extent that psychotherapy can help you manage them. And talk therapy, too, is all in your head since we are told that it changes brain functioning just like a drug.
By treating depression as a disease to be studied and eliminated, the brain mechanics distract our attention from what depression and other mental and addictive disorders can tell us about the world in which we live. Exploration of the relationship between a disordered, disturbed, maddening world and the disorders of the body, brain, mind, and (dare I say?) spirit are off the table.
Over fifty years ago Michael Foucault traced the evolution of Western society’s characterization of mental illness in "A History of Madness." He recounted how those considered to be afflicted were treated (in the broader sense) over the centuries since the Middle Ages. He views the definition of madness as an exclusionary tool by which society establishes an idea of itself as sane. The medicalization of insanity – turning it into an illness – is seen as a crowning achievement of modernity, rendering madness into pathology subject to scientific observation and medical control.
In the half-century since Foucault’s study medical science has further delimited the locus of madness by confining it to the brain. Once the brain slips its gears, what's out in the world has little to do with it. Welcome to the age of “madness without meaning” accomplished by the transposition of the world’s insanity into the circuitry of the brain. Be certain, you will find it there. But no matter how many brains the mechanics may fix, once you leave the biopsychiatric garage loaded with pharmacological additives, you return to a deteriorating world in which more and more people are bringing their battered brains into the garage for repair.
SharkswithfrikingLazers 06/01/2012 02:01 AM Report
Loved Helen Mayberg at 31:20:
'Area 25 is the ring leader and the negative mood regulator. It is found deep in the frontal lobe.
Amygdala is for emotion, stress, anything novel and it has a big relationship with Area 25.
Hypothalamus is the core for drives, sleep, appetite, libido. Direct link.
Hippocampus for memory, it is online to say if something is familiar and have I been there?
Pre-frontal cortex will have to synthesize it all.
Yes this system is a constellation and there is a circuit disorder. You need to know the anatomic infrastructure to understand the illness. Connections are very important. The brain is not a single organ. The brain is like a great city with sub-centers.
You can see the points of disconnection and see that the emotional system is highjacked.
The circuit diagram is big here and A MAJOR ADVANCE with depression but not with schizophrenia yet.'
-------------------------------------------------------
With citalopram/SSRIs--at only $3 a month--you can see this circuit in action. It effects the circuit by slowing or stopping the negative thoughts from Area 25 and limits the stress from the amygdala. However, over in the Hypothalamus it can effect appetite (weight gain) and reduce sex drive (great for prisoners) but helps restore a full sleep cycle (critical to health). Then over in the Hippocampus it can reduce short term memory so you aren't pounded with the thoughts that cause anxiety but then again it reduces short term memory (you can't have everything).
Yes, this circuit diagram is BIG! Perhaps treatment will finally hit the problem areas with just the right tweaking and no significant side effects.
jhope 05/31/2012 11:05 PM Report
This was a wonderful panel, so thanks. I have read works and appreciated the contributions of each of them. Like Dr Goodwin, and many others, i wish there
were another word for Depression. My experience with "major depression" for
30years never felt like depression/sadness. Sad I have it. So hard to describe. Terrible pain,retarded movement, most of all nameless Dread, Fear, as Andrew mentioned. As to "sleep regulation" in many people that is impossible, as it is the TYPE of abnormal sleep which happens with depression; it isn't "getting to bed on time." "Circadian rhythm" may be thrown off . I, and many others have a "lift" in the evening. I almost feel like myself. That has saved my life, though I have "rapid cycling'' i.e. depression for about 3 weeks and then "jumpiness' then level: not typical, but as with so many illnesses, how many are "typical." I imagine the further away from typical, the harder to treat. Bipolar 1 seems to be among treatable. Important for people to remember that all depressions end; unfortunate when become repetitive. Just wish DSM would mention "Fear,Dread" along with "Sad." AFter all, it is the stress hormone which is in overdrive. My sadness for all who do
not have the advantages I've had: education, support, finally finding right DR.
ntherese4990 05/31/2012 07:52 PM Report
Thank you Mr. Rose for reporting on such an important topic. It's one of the diseases that makes you feel like you are on a rough road trip all by yourself. Alone. Separate and different than everyone else. This is great! Thanks!
Gelles 05/31/2012 11:31 AM Report
Individual mood depression and collective economic depression are maladies we fear for good reason. Cures have always come -- but sometimes only in association with great change.
Last night I watched Defense Secretary (retired) Rumsfeld refuse re-entry into political combat suggested by our own Charlie. I'm past 80 -- said Donald.
I'm now six years older than Don. Luck keeps depression at bay. I would love to be Secretary of Defense. I'd end economic depression over night. We need energy and war-prevention assets. I'd spend enough to have them -- even it meant impeachment and going to jail.
Charlie seems betwixt and between. He wanted the President given full credit for foreign policy and anti-terror war success. Charlie is right. Donald Rumsfeld would not admit it.
As to individual mood disease, we also must spend a huge sum of money to fight it.
After Rumsfeld, last night, a Muslim voice for Muslim embrace of capitalism with all its uncertainties was heard. The speaker now sits at the London School of Economics and sees hope for a world lees under of the spell of Washington and Wall Street.
You and I may see such a world as equally dangerous as the one we have. Washington and Wall Street have given us K Street and lobbyitis - a near fatal disease.
But as bad as depressions are, the mayhem freely inflicted in Syria is worse. We all need a dose of John McCain's morality to be added to our American mission.
ShalomFreedman 05/31/2012 02:46 AM Report
This is another commendable effort at presenting to a broader public an experts' general view of a very difficult and complex subject. I and I am sure most other viewers learned much from it. Andrew Solomon was eloquent and bright and 'on 'in describing his experience with Depression. And this positive manner oddly contradicted the very experience he was trying to describe. The bright talk of everyone involved simply does not give the 'feeling of Depression" Erio Kandel did speak about its 'unendingness' and perhaps the words 'hopelessness, darkness, no way out, sense of uselessness and worthlessness, stale , flat , unprofitable, meaningless, anxious, fearful, were used at one time or another. But the real 'feeling' of depression was not given. No one mentioned that Depression also manifests physically as horrible pain, headaches which are unbearable. Charlie Rose mentioned 'Hamlet' and perhaps that work gives a picture of Depression in the most convincing way. The 'Dark Sonnets' of Hopkins are another candidate. Of course much of great Literature is pervaded by the 'no - way' out' feeling of Depression Samuel Beckett is one long, or perhaps better, one short endless Depression.
I very much appreciated Helen Mayberg's remarks which indicate how mixed and incomplete the treatment of Depression is today for so many people. Though she is responsible as I understand it, for the one major practical advance spoken of on the program, she rightly is aware of present limitations in treatment. One can only pray treatments will improve and the millions suffering from this darkness of darknesses will somehow come to real help and better lives.
finalfantasytown 05/30/2012 11:25 PM Report
The development of science has to keep the same pace of human history advancement. Otherwise, the world is turbulent, even chaos. The most recent example is that everyone has climbed mount Everest. I think this mount climbing is not perfect. They should have teamed up with a monkey or ape, reached the top, and achieved the time travel experience. Is Einstein a prophetical scientist or scientific prophet? Although I did right thing in China, I had wrong desire for United States. That is my own interest. I am obsessed in Greek mythology. It is true because science development is going too far while the whole human history is still stuck in primitive. It is true because of the failure of the second world war. It is true because large amounts of German scientists went to United States and continued forward to Ares without Zeus. At beginning, I believe the world will be better with the advancement of science and technology. But the catastrophe is technology. Time travel of climbing mountain is a good example. Another good example recently happened is that monkey used guns to kill lions, tigers, and leopards in the zoo. I should be punished for my false desire and live in a desolate place for several years.
sugar 05/30/2012 09:55 PM Report
I have watched every CR brain program with great interest. Now 79 yrs old, I have followed the field of psychotherapy and pharmacology since I was a teenager and my beloved brother returned from WWII only to be hospitalized for most of his life in a VA neuro hospital, eventually killing himself in his mid-60s. I am beginning to get overload from all the brain scans and interpretations thereof by the experts -- do any neuro experts ever consider the possibility that the society in which we live, Western version in focus, may not be beneficial to the human creature we all are? We can't all march to the same drummer, and when we get out of step, we need a pill to get us back in line? Andrew lives depending on pharmaceuticals to fit into the role society expects him to play, with a little help from his psychotherapist. Is it time for a new approach to behavior in Western society? I remember being told the only people who are happy all the time are the mentally ill or retarded. Life is suffering and we must learn to accept that. Ben Brantley of NYT in reviewing "Waiting for Godot" wrote, “as this play contends, all life is nothing but passing time that would have passed anyway.” But it must be passed according to a stated, dictated formula, right?
YNHow 05/30/2012 07:56 PM Report
First brain series I was able to catch in a while and it was somewhat instructive. Of course, hats off to this great iniative of a brain series because wich such deep and complex subjects as all of the ones touched by the brain, it is certainly difficult to vulgarize enough and condense in an hour, so great job for all the topics, not only this one. As we look to the past of medicine we realize what?...that the brain is yes, in fact one of the only if not the only region of the human body that required LOTS of technical science in order to properly observe it -that mankind now has or is begginning to have- (i.e: imagery, pills and medication, and of course the invention of psychoanalysis by S. Freud). As it was said few times during the interview, only the fact that for exemple depression is considered an ensemble of complex interdependence malfunction of many brain areas is a breaktrhough... imagine what it will be in let's say 20 yrs...the brain is really left to be reveiled to our understanding for it's most part and more so compared to what we can do with heart transplant, for exemple...fascinating...
It is even more intersting of a topic when articulated around the business aspect of biotechnology and markets. Believe it, if companies conducting experiments find out they is a truly non-placebo treatment against depression, it will be a major hit. At one point, Dr. Kandel said that unfortunately, depression is a life long condition just like diabetes...well i guess that that if talks of cancer vaccines, gene therapy, antibodies treatments and more incredible yet good advances are already in the air, one day, for sure, depression will be cured forever - no I mean prevented...Reaching Fortandrewsman point, do we even know exactly what are the causes of such still opaque disease for our scientists?
SharkswithfrikingLazers 05/30/2012 07:37 PM Report
Charlie/Eric, wonderful, wonderful job.
Andrew Solomon is the perfect poster child and he made the brain scientists shine all the brighter.
Buffalosroam 05/30/2012 06:20 PM Report
I weep to know that someone understands what has happened to me. Thank you Charley for doing this show.
FortAndrewsMan 05/30/2012 04:12 PM Report
I can't say I really understand most of REMant's comment. I find it turgid and strangely incoherent. However, I do agree that the panel presented a somewhat imbalanced portrait of depression. I realize that this series is about the brain and focuses primarily on the neurological manifestation of depression. However, I think we do a disservice to those suffering from depression by not acknowledging that depression is as much a social issue as a personal, biological issue.
That depression has a neurological footprint should surprise no one. Just about every aspect of the human condition will manifest in the brain in some way. However, the question we need to ask is to what extent is the neurological manifestation the CAUSE of depression rather than the SYMPTOM? And, more to the point, will alleviating the neurological manifestation necessarily make depression go away? I would say, no. There are several factors that suggest societal factors are implicated in depression.
Psychologist Bruce Levine wrote a wonderful book called "Surviving America's Depression Epidemic" that dealt with much of these issues. Dr. Stephen Ilardi of the University of Kansas writes of two in his book "The Depression Cure" cites research assessing modern-day hunter-gatherer peoples such as the Kaluli of Papua New Guinea, that reveals significantly lower rates of depression as compared to Westernized peoples. Furthermore, the rate of depression typically increases as nations become more affluent and Westernized, and has been increasing in Westernized nations at an alarming rate. In the United States and France have the highest rates of depression of all nations. In the U.S., rates of depression have increased tenfold since 1950, with an especially troubling rise among in young people.
Compare the discussion of disorders that manifest themselves physiologically, as opposed to psychologically; say, obesity. In the public discourse on the obesity epidemic, we are quite willing to acknowledge that there are not only personal factors involved (eating and exercise habits and genetic factors), but also societal factors: industrialized agriculture and meat industry, government food subsidies, unwalkable and car-dependent neighborhoods. Many of those selfsame factors have contributed to the depression epidemic.
Among the typical complaints, the American diet is high in processed foods and simple carbohydrates that can cause mood and energy spikes and crashes. Grain-fed poultry and meat have stripped our meat of its nutrient value, resulting in a diet now very low in Omega-3 fatty acids which are implicated in brain health. (Omega-3s are high in grass-fed animals.) American society is also much less socially connected. We are much more isolated than previous generations. Americans have fewer connections with their neighbors than even 20 years ago. The use of computers and cell phones in lieu of personal contact exacerbates this problem.
There is a (now oft-cited) study from 2000 by Duke psychologist James Blumenthal that studied the effect of exercise on those with major depression. One group was assigned exercise as a treatment for depression, another medication, another a combination of exercise and medication. All groups showed improvement. However, the group that had the lowest rate of relapse? Those who were assigned exercise only, at an 8% relapse rate. Those who had taken medication and exercise together had a relapse rate of 31%. (The medication only group had a relapse rate of 38%.)
Even such things as the loss of physical touch in our society is a huge factor. I once started a thread on a depression forum about simply wanting to be hugged. That thread got over 100 replies from people who likewise felt deprived of touch. There is a cute little book called "The Hug Therapy Book" by Kathleen Keating that deals with this. We are primates, after all. We crave contact and feeling connected. It has been a huge factor in our survival as a species throughout our evolutionary history.
There are also existential issues, such as the lack of meaning or purpose in one's life. In our consumer culture in which the only incentive to get from one day to another seems to be to consume something... life can often feel quite empty. Victor Frankl tackled this eloquently in "Man's Search for Meaning" about his struggles to keep morale alive among his fellow inmates at a Nazi concentration camp.
In my experience with depression and talking with many others who have been depressed -- not as a clinician, but as a friend and fellow traveller -- these are often the things that come up, more so than the physiological manifestation of lethargy or anxiety. The loneliness and lack of true friendship, the loss of meaning in one's life, the lack of something to look forward to, the loss of identity and sense of dehumanization engendered by a highly industrialized and corporatized culture, etc. These are things that extend beyond the individual. Depression can serve as a "canary in the coalmine" and serve to awaken us to creating a more enlightened and humane culture.
REMant 05/30/2012 12:06 PM Report
Kandel's history of both disease and drugs is completely inadequate. And the panel was not representative of the very real debate in the profession over this. I would suggest consulting Gary Greenberg's recent "Manufacturing Depression" for an entertaining, if also depressing, account of both, which I cannot do justice to here. (He also provides plenty of references.) Kandel's remark about "placebo effect" was directed at Greenberg, and other such authors, as well as, a plea for the psychopharmacological approach enshrined in DSM-III, the sort of factor analysis begun by Kandel's hero, Kraepelin, which they criticize. IMHO the placebo, or to borrow from social science, the Hawthorne effect, is, as Freud saw, exactly at the heart of this. Greenberg notes that Kandel's associates will not even discuss the subject, considering it akin to "creationism."
Kandel, himself, again denigrated Freud, who, while he may have desired to know more physiology, nevertheless defended psychoanalysis as a "lay" science. As I wrote last time, Freud's animus was directed against 19th c "liberal" anxiety, as much as aristocratic folly. He was not interested in treating symptoms. He did not think symptoms were illnesses. He, in fact, detested Kandel's point of view. In "The Question of Lay Analysis," he wrote medical study burdens the analyst "with too much of which he can never make use, and there is a danger of its diverting his interest and his whole mode of thought from the understanding of psychical phenomena." Doctors are subject to the "temptation to flirt with endocrinology and the autonomic nervous system,...As long as I live, I shall balk at having psychoanalysis swallowed by medicine."
All of these ills are, I think, as Freud believed, reactions. As in a previous installment, the subject here offered some proof of this in his rather manic behavior, illustrating to me that whereas depression is a shame at loss of face, mania reveals hope of acceptance. In "Mourning and Melancholia," Freud said we were all living a lie, and the reaction was to the loss of the illusion. This is why, I think, manic-depressiveness is so deeply entwined in the religious self-abnegation, enthusiasm and fatalism of the unconverted, or improperly analyzed, since it is in essence what Freudian insight aimed at achieving. The depressive is never objective. He can never be certain of where he stands with others. The shortcomings of others are taken for his own. He feels undeserving, and the misfortunes of others make him happy. (Recalls Shimon Peres, no?) Melanie Klein denominated the depressive position a phase in growing up.
Of course, to believe mental illness is behavioral opens the door to reformer notions of moral sanitation, mental hygiene, ego psychology, etc, even eugenics, and entrepreneurship, as much as Big Brother, while belief in the unconscious encourages primitivism. Tho Hippocrates' bile as much as phrenology would seem to offer proof that reductionism is not materially different.
The Becks, founders of the bastard "cognitive behavioral therapy" now practiced, are, in fact, the heirs of Norman Vincent Peale, who inherited the soap box from from legions of Molinists and Pelagians. No doubt they would think Freud, himself, in need of their services.
Many studies have disputed the efficacy of current therapeutic regimes, or shown no difference in outcome among them, suggesting that it is the therapist's interest that matters. Greenberg remarks for instance: "A total of seventy-four trials have been submitted to the Food and Drug Administration for the twelve leading antidepressants. Of those trials, only thirty-eight showed an advantage of drug over placebo. That advantage, when it is there at all, is small: another analysis of clinical trials showed that drugs improved HAM-D scores by an average of ten points, placebos by an average of eight, which means that 80 percent of the effect of the antidepressants is due to placebo effects."
I don't doubt that some ppl are not genetically as strong as others, nor that there aren't physical components, but neither is an argument for "normality." And it certainly shouldn't be the occasion for cures to go looking for diseases to make a buck, which seems clearly what has happened to this branch of medicine as much as any other.