The Depression Trap

This year Depression Awareness Week will be 21 to 26 April. This is an annual campaign to raise awareness about depression organised by the Depression Alliance. You can find out more about the campaign and how to get involved on their website.

During the week I will be offering a free copy of my Ebook to visitors to this website. Just return to this website during that week for information about how to claim your copy. I will also be raising money for the Depression Alliance by doubling my usual donation for each book sold during that week.

This morning I woke up and the sun was shining. I immediately felt more positive than I had yesterday, a dull, overcast day. This reminded me that a number of my clients have also commented on how they feel better on a sunny day. You may be familiar with Seasonal Affective Disorder (SAD), a type of depression triggered by the lack of sunlight in the winter months, but it may be that exposure to sunlight also has an impact on those suffering from more traditional forms of depression.

No one is sure why sunlight should have an impact on our mood. Some theorise that it has an impact on our levels of serotonin and other mood related hormones. This may be because our body clock gets out of balance during the short winter days and therefore too much melatonin is produced. It may also be that we have positive associations to sunlight e.g. summer holidays, long lazy days in childhood etc. This could be why just waking up and seeing a blue sky with the sun shining can help us to feel in a more positive mood.

Whatever the reason, it’s worth taking note of whether or not your depression is effected by sunshine. With spring upon us this is s a good time to take note of your reaction to the sun. You could keep a sun-mood diary, writing down each day how you feel on a scale of 1 to 10 and making a note of whether it’s cloudy, sunny, etc. If you find you are effected by sunlight then its worth taking some steps to increase your exposure. Consider the following:

1. Spend 20minutes outside each day. This can be especially important in the winter when there is less sunshine. An excellent approach is to take a 20 minute walk, as this also ensures that you get some exercise. Why not experiment with what works for you? Try a 20 minute walk each day for a few weeks and see how you feel.
2. Gardening is an excellent way of spending time in natural light all year round and is good exercise too.
3. In the summer you may choose to sit outside and read, chat to friends, or just lie down and relax. (Though do be careful to use sun tan lotion if you are going to be outside for any length of time.)
4. Actively think about how you can spend more time outside. If its warm enough to sit outside then all kinds of tasks can be taken outside – sewing, reading a magazine, writing letters, even peeling vegetables.
5. If you find you are really affected by sunlight then you may want to invest in a full spectrum lamp (SAD lamp). These lamps mimic the effect of sunlight and by spending time under one in the winter months you can help to lift your mood. There have been a number of studies showing that such lamps can be very effective in treating SAD and there is some evidence that they may help with other forms of depression too.

A Recent study by Researchers from the University of Illinois highlights some of the problems with trying to study depression using the biological model. In this study they compared the brains of depressed people who had committed suicide to those of non depressed people who had committed suicide. They found differences and suggest that these differences could be used to diagnose depression and measure the effectiveness of anti-depressants.

Studying the biological basis for depression is always going to be difficult as we can’t just cut up the brains of sufferers to see what’s happening. There are certain tests that can be done with a live patient, but they are limited.

However, reading about this study left me with a number of concerns.

Firstly, most depressed people do not actually commit suicide, so can we take this small sample as representative of all those with depression? Clearly not and to be fair the team do intend to do further research. Secondly, how do we know for certain that the control group were not depressed? Had they been tested in some way? Or is it just that they hadn’t told anyone they were depressed. I tried to find out more by reading the full article published in The Journal of Neuroscience, but couldn’t find it in the issue that was referenced and there was no further information on the UIC website. 

 I was also concerned by one of Dr Mark Rasenick’s (UIC) comments:

 “In simple language — we may be able to tell you if you are depressed..”.  

My immediate reaction was that my clients know they are depressed and don’t need to be told. We currently define depression in accordance with the DSM4 criteria, which is based on how a client/patient feels. It looks at factors such as depressed mood, loss of interest or pleasure, poor concentration, lack of energy etc. All these are based on the subjective experience of the patient. The patient may not know that what they are feeling is depression (although these days increased awareness means that many of them have a good idea), but it is their description of their experience that creates the diagnosis. 

Dr Rasenick seems to be suggesting that in the future we will be able to carry out a test to see if you are depressed or not. If the test is negative, then ‘good news, you’re not depressed’, so all those negative thoughts and emotions you are experiencing must be your imagination. If it’s positive then ‘congratulations you do have depression’, take some antidepressants and you’ll feel fine. I’m sure the study team didn’t intend for their work to be interpreted quite in this way, but there is no attempt made to explain what Dr Rasenick does mean. Is he suggesting that there will be two conditions one where depressed mood etc. occur together with these ‘biomarkers’ and one where the DSM4 criteria are met and there are no biomarkers? This might actually be quite useful as it might indicate whether or not your depression is likely to be helped by antidepressants or similar treatments. However, a test that denied clients experience of depression because there was no physical symptom to detect would be a step backwards. 

Couldn’t we please have a more integrated approach to reporting research and indeed to trying to understand depression? When scientific research throws up biological results like this, why is there never any attempt to integrate them into a more holistic view of depression? Maybe this is down to how the media reports studies, looking for a catchy headline, but I’m sure it would help if the research scientists thought about the wider implications too. It would be so much more helpful to patients and professionals alike if we could start to bring all the information together and try to create a consistent theory. Instead we seem to be stuck with each group working within their own model with little attempt at integration.   

Read the UIC Press Release here.

Media articles stating that depression is caused by chemical imbalances in the brain are not backed up by scientific evidence.  This is the finding of Jeffrey Lacasse and Jonathan Leo who spent about a year monitoring such news items. They contacted the authors of articles to ask for the scientific evidence to back up what they had written. None were able to do so satisfactorily. This is hardly surprising, as there is no definitive evidence to back up the chemical imbalance theory. (click here for the full story).

The idea that depression is caused by chemical imbalances was developed in the 1960’s when it was observed that some people seemed to show an improvement in their symptoms after taking certain drugs. However, there has never been any definitive evidence to show that levels of chemicals such as serotonin are directly related to depression. The use of antidepressants is based on this unproven theory and there is increasing debate as to whether antidepressants actually work (see last week’s blog entry). The reality is that we still don’t know what causes depression. Current theories include serotonin imbalance, genetics, stress, psychological factors, social factors, spiritual crisis and various combinations of these factors. 

So why don’t media articles reflect this situation? Is it just laziness? Could it be that journalists receive press releases from pharmaceutical companies and just assume they are correct, without bothering to check the facts? Those with a vested interest in the chemical imbalance theory have a lot of money and are well placed to saturate the media with their version of reality. Or maybe it’s because headlines such as ‘Depression caused by chemical imbalances’ or ‘Antidepressants don’t work’ are more likely to cell papers than the more accurate or ‘We Still Aren’t Sure What Causes Depression’ or ‘Lack of Evidence of Clinical Effectiveness of Antidepressants Compared to Placebos’.

If our understanding of depression and hence our ability to treat it is to improve then the media need to start presenting a more balanced picture. Perhaps we can all play our part by speaking out and making sure that the media are aware of the alternative views and challenging articles which we know are misleading.  I don’t know what causes depression, but I do know that the truth is best served by open debate and genuine enquiry.