[6] The best we can do is to humbly accept the limitations we have in striving for a more precise description of depression that may respond to medication.
DSM 5 gives a clinical picture that defines a depressive condition that would be appropriate to treat with medication. In one example, this includes a somewhat arbitrary time limit: If grief in bereavement is prolonged more than a certain number of days, then we deem it a pathological state. And, with that diagnosis, comes the implied appropriateness of trying some pharmaceutical intervention.
If a genuine therapeutic alliance has been established with the patient, I would have a clearer sense of the likelihood of early childhood trauma, or an assessment of potential ongoing trauma in the patient’s current life. Being able to identify trauma leads to one treatment path. Absence of trauma would lead to a different treatment path.
My approach is to look at a person’s depression. If it is there most of the time, when he wakes up, when he does not get cheered up seeing his loved ones, when he is socially withdrawn, when he cannot shake it off, that would satisfy my criterion of a form of depression where I might try antidepressant. But, that would only be as an adjunct to psychotherapy.
Depression that responds to drugs usually has a different quality than depression connected to trauma. It is more like someone who has lost interest in things that used to generate a positive experience, a positive response. A common description is of a patient that no longer enjoys his favorite foods.
Psychiatric text books describe true depressive symptoms in different ways. The term “True depressive symptoms” refers to depression as a syndrome, a disorder; in other words a mental illness that prevents one from living one’s life in a way that accommodates the ups and downs of ordinary existence.
[7] There is a dangerous pattern in psychiatry to quickly conclude that a depressed patients should be on medication.
This kind of presumption is illogical, dangerous, and based on an inflated sense of one’s insight. But, it is inflated by the promotional materials of the pharmaceutical industry and the money that flows from it. I have heard this kind of nonsense from the press as well as from many of my peers. What is missing? It is empathy that is missing. It is the warmth of genuine compassion that is missing. Both of those should be tested before anyone is given a license to be a therapist – whether it is a license as a psychiatrist, a psychologist, a clinical social worker or perhaps even just an ordinary human being that deals with other human beings in trouble.
For the sake of billions of dollars of sales, pharmaceutical companies invest heavily in propaganda and brain-washing to promote the use of drugs as the exclusive means in solving the mental health problems.
Be aware of the erroneous assumption that depression is a disease curable by antidepressants. This is, at best, a half truth. We need to be alert to identify patients with depression that is amenable to psychotherapeutic intervention.
