Essays June 2010

“Is Depression a Disease”? An Open Letter to the Editor of the Globe and Mail

Neil Seeman

On the occasion of Father’s Day, I took the opportunity to ask my father, Philip Seeman, about his impressions of an article on depression in the Globe and Mail (June 18) by columnist and feature writer Leah McClaren. Ms. McLaren posed the question: “Is depression a disease?”

As of the time of writing, there were 118 online comments concerning Ms. McLaren’s article. She had interviewed psychotherapist and writer Gary Greenberg, author of Manufacturing Depression, which, she writes, “debunks the prevailing notion that depression is a disease and anti-depressants the long-awaited cure.” The print edition of the newspaper published one critical letter. Ms. McLaren’s article contained no Web links to research on depression by Dr. Greenberg; this research is hard to find.

Contrary to the premise of Ms. McLaren’s article, the official Simon & Schuster description of the book says: “Rather than asking whether or not depression is a disease, or whether or not we should take drugs to ease our pain, Greenberg asks what we gain and lose by taking this approach, and who benefits when we do. Manufacturing Depression allows readers to think of depression not just as an illness, but as a story about our suffering, its source, and its relief.”

Independent reviews of Manufacturing Depression have described it as a withering attack on psycho-pharmacology and cognitive-behavioral therapy (CBT). Although Toronto researchers were global pioneers in both of these fields (notably, Zindel Segal in CBT), Ms. McLaren’s article makes no references to this research. It so happens that my father is one such pioneer (in psychopharmacology), whose lab’s work at the University of Toronto between 1964 and 1974 on the membrane actions of drugs led him to the discovery of the antipsychotic receptor, now re-named the dopamine D2 receptor.

Ms. McLaren’s article singles out one chemical, serotonin, as the brain chemical that anti-depressants are supposed to regulate. This is only partly so. Many antidepressants also regulate dopamine release. Peer-reviewed research – led by Canadian researchers – on the power of CBT and dopamine regulation to alleviate the human health burden of mental illness count among the most heavily cited research in the world. Although Ms. McLaren’s article refers to the number and associated cost of annual prescription drugs in Canada for antidepressants, she does not reference the human health, stigma and cost burden of mental illness, or to the fact that every person in Canada will (either themselves or via a family member) be affected. 

Ms. McLaren thinks that Mr. Greenberg “is part of a growing number of psychiatric professionals who have begun to publicly question the underpinnings of popular thinking on depression.” The purpose of my response here is not to state resolutely that Mr. Greenberg’s position is wrong; rather it is to present what Ms. McLaren’s article in the Globe and Mail does not: her approach needs balance. Balance is what the World Wide Web and real-time intelligence promise. In my own research, I have tried to demonstrate that the medical relevance of health information published in popular health blogs now exceeds that of Canadian newspapers. The superior quality of the best online health media will only escalate, thanks to better online trust certificates for health sites, and due to the growing power and reach of specialized ‘micro-media’, an observation made in a Longwoods Breakfast with the Chiefs presentation by the Globe’s public health reporter, André Picard.

The definitive portal for all health information today is Google™, and, as such, I hope that, with time, people who are in need of help and are searching for information on depression online will also land on this article or articles like it at the same time as they find Ms. McLaren’s. This is in large part thanks to Google’s increasingly sophisticated PageRank™ algorithm. Not so long ago, when journalists would write articles on health issues of controversy, the only recourse for dissenters was to fax or mail in print letters to the editor, which were then chosen selectively and stripped to a minimum length – and thereafter nobody but journalists could access them. Not so today. Controversial ideas live like a living tree on Google, rich with exponentially expanding information fractals flourishing on the Web.

“Is depression a disease?”

I posed this question to my father, who has devoted 45 years to neuropsychiatric research – as have many excellent Canadian neuroscientists – studying this difficult question. Here is his answer:

“The question, ‘Is depression a disease?’ is a non-question, because it all depends on the extent of your depression. When it’s severe and the individual is totally non-functional, then it’s a disease. When it’s moderate and the person has no obvious major limitations, then it may not be a disease. The severe form is likely treatable by admission to hospital with or without antidepressant treatment. The moderate or mild form of depression may or may not respond to the antidepressant drugs no better than a placebo.

“Most clinical studies on depressed patients predominantly enroll subjects that are moderately depressed, almost guaranteeing results that are marginally better than placebo. After all, it should be noted that there are several non-drug methods to relieve moderate depression, including staying up all night or intense daylight exposure, which are about as effective as antidepressant medication.

“Most clinical studies over the past 40 years have shown that about 60 percent of those admitted to hospital improve relatively well within two or three weeks. Of those who take antidepressants, about 70 percent improve. The extra 10 percent of people improved by the antidepressants is a modest but statistically significant effect if sufficient numbers of patients are studied.  Does this mean that an antidepressant will always alleviate the depression of a loved one? Of course not, but it might.

“McGill university pioneer psychopharmacologist Heinz Lehmann taught me that ‘the antidepressants don’t do much most of the time, but when they do, they save a life’.”

 

About the Author

Neil Seeman is a writer, and Director and Primary Investigator of the Health Strategy Innovation Cell at Massey College at the University of Toronto.

 


Comments

Jennifer Jilks wrote:

Posted 2010/12/24 at 08:58 AM EST

Well said. McLaren, again, fails to do her due diligence.

Having suffered depression after the death of both parents, job loss, moving, caregiver burnout and stress, she shows disrespect to victims of this tragic disorder.
For many women, caregiving has a social, emotional, physical and financial impact on us.

 

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