We have all heard the concept melancholy includes a chemical imbalance within the mind. Maybe it comes from a deficiency within the neurotransmitter serotonin. We have additionally been instructed that antidepressants work by reversing this deficiency.
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For instance, Medline, an informational web site hosted by the Nationwide Institutes of Psychological Well being, tells us that the drug imipramine works by “rising the quantities of sure pure substances within the mind which might be wanted to take care of psychological stability.”
If that is true, depressed individuals should take antidepressants in the identical means that diabetics should take insulin. What could possibly be extra pure than to take a drug that reverses a dysfunction?
But latest analysis has proven that there is virtually no proof that melancholy stems from a serotonin deficiency. Some research even counsel that, besides in essentially the most extreme circumstances, antidepressants scarcely outperform placebos. Maybe it is time for a special method.
A therapeutic sign
On a more moderen view related to the college of thought often called evolutionary psychiatry, melancholy is not often a “dysfunction” or “illness” in any respect. It is a therapeutic mechanism in its personal proper.
Think about fever. Earlier than the 1700s, medical doctors thought fever – the warmth related to an infection – was a horrible illness. They tried to combat it with medicine, bleeding, and vomiting.
Round 1700, they got here to know that fever, removed from being a illness, was really a designed mechanism of the human physique. We now know that fever exists to assist us combat infections.
For that matter, think about bodily ache – say, the ache of a stubbed toe. No person likes being in ache. From evolution’s perspective, nonetheless, ache serves an necessary operate. It is there to alert us that one thing’s gone fallacious with our physique tissues or inside organs.
Evolutionary psychiatrists assume that melancholy, too, is commonly a therapeutic mechanism relatively than a dysfunction. They’ve completely different theories about what, exactly, its objective is. However on the most common stage, they assume the aim of melancholy is to indicate us that one thing in our lives is just not going properly and must be modified.
It could possibly be a job path, a life aim, or a relationship. Melancholy is there to inform us that our lives have taken a fallacious flip and we should always reevaluate our selections.
I’ve written fairly extensively about this idea on this weblog, for instance, right here, right here, and right here. Now, I need to discover a barely completely different subject: What does this imply for antidepressants?
Ought to we take antidepressants?
Even when melancholy is not a “illness” or “dysfunction,” you would possibly assume they’re nonetheless helpful to take. For instance, they will help us handle our feelings to the purpose the place we’re in a position to go to a therapist and get the assistance that we want, similar to painkillers assist handle ache till we get to a health care provider.
However I need to think about a extra radical proposal. What if antidepressants, by blunting our damaging feelings, generally stop us from getting higher? What in the event that they extend our struggling by stopping us from listening to what melancholy is making an attempt to say?
The evolutionary psychologist Paul Andrews and colleagues proposed this concept about 10 years in the past in an necessary paper entitled “Primum non nocere: An evolutionary evaluation of whether or not antidepressants do extra hurt than good.”
Andrews holds that the aim of melancholy is to mobilize our cognitive sources to assist resolve critical life issues. Meaning generally, antidepressants would possibly extend melancholy by stopping it from reaching its pure finish. (Primum non nocere refers back to the central tenet of the Hippocratic Oath, “First, do no hurt.”)
The Vanderbilt psychologist Steven Hollon has additionally superior this perspective. In a latest paper, he and his co-authors give the next evaluation: “[Antidepressant medications] could also be palliative at greatest: they suppress signs for less than so long as they’re taken however do nothing to shorten the course of the underlying (biologic) episode. It is usually potential that they…could [prolong] the underlying episode by interfering with the conventional homeostatic mechanisms that may in any other case trigger the underlying episode to spontaneously remit.”
Subsequent steps
This doesn’t imply that no one ought to ever take antidepressants. It doesn’t imply that individuals who take them ought to cease taking them. (Given stories of withdrawal issues, individuals ought to keep away from stopping antidepressants abruptly with out medical steering.) However it does imply that as a society, we have to severely rethink our method to psychological well being.
Presently, almost one in 5 American faculty college students are on antidepressants. About one-seventh of the grownup inhabitants of the UK are on them, too. Clearly, we have now a significant issue with overprescription. Medical doctors are far too liable to prescribe these medicine with out even contemplating whether or not the melancholy may need therapeutic worth in its personal proper.
The evolutionary view additionally suggests a extra central function for a sure form of remedy – one which takes severely the concept melancholy is nature’s sign that’s meant to information us. Maybe earlier than instantly searching for a prescription, it may be extra helpful to speak with a therapist who will help us uncover what our melancholy is making an attempt to say.
