What causes sadness and depression?

[smc]

https://www.nytimes.com/2016/07/10/books...pe=article

I bookmarked this link a long while ago... it's an interesting article and speaks to a deeper assessment of anti-depressants...

conclusions: they're over prescribed

they should be used only for clinical and severe depression

they should be used as a last resort and prescribed conservatively (low starting dose)

...his decades of clinical work with patients, antidepressants work more often than not and that, most of the time, prescribing an antidepressant is not about making somebody “better than well” but rather helping to relieve a patient’s acute suffering enough that she can resume a semblance of normal life.

Kramer evinces such humility that no one could accuse him of being a pro-­medication ideologue. (He has never taken money from a drug company.) In fact, late in the book, after 200 pages of arguing that antidepressants work effectively, Kramer reveals that he himself is conservative in, if not hesitant about, prescribing antidepressants. “I rely heavily on psychotherapy, often postponing prescribing until I hit a roadblock,” he writes. “Even then, I tend, relative to the literature, to undermedicate patients, in every way — lower doses at shorter duration.”

Kramer tells three stories that are especially convincing. The first is about Osheroff v. Chestnut Lodge, a court case from the early 1980s. Raphael Osheroff, a kidney doctor who had been felled by anxiety and depression, ended up in a psychoanalytically oriented inpatient facility in Maryland, Chestnut Lodge, that eschewed medication. He deteriorated so dramatically there that a friend moved him to a different facility, which medicated him, allowing him to promptly recover. The ensuing court case — based on the failure of Chestnut Lodge to prescribe medication — played out over a number of years and was ultimately settled in Osheroff’s favor. It changed how the field approached prescribing; from that point on, the failure to prescribe antidepressants or other psychotropic medications could be grounds for a malpractice suit.

The second example involves Robert Liberman, who, as a medical student in 1961, published one of the first influential papers questioning the efficacy of psychiatric medication, “A Criticism of Drug Therapy in Psychiatry,” which argued (to oversimplify) that antidepressants like imipramine didn’t work — and to the extent that they did, it was due to the placebo effect. Liberman ended up as a psychiatrist at Johns Hopkins, where he became depressed. Talk therapy didn’t relieve his woes — but taking an antidepressant did.

The final story may be the most dispositive. When Kramer began visiting psychiatric wards in the 1970s, they were filled with miserable, hollowed out people who were in what was then known as “end-state depression”; the only thing that differentiated these patients from psychotically catatonic patients is that these depressed patients would wring their hands. Kramer — and everyone he’s talked to — have not seen such patients in decades, a development he attributes to the advent of aggressive antidepressant prescription to forestall such dire outcomes.

Kramer is out to win the “antidepressant wars” in favor of the antidepressants. Is he right? I can’t say definitively that he is. Nobody could, or these drug debates would already have ended. But in my judgment he is. One can question whether I’m qualified to make that judgment. I’m neither a psychiatrist nor a statistician. But as the author of a book on mental illness, I’ve read deeply in the scientific and historical literature, including all the books attacking Big Pharma. Perhaps more relevantly, I have copious experience with taking antidepressants. Can I say with 100 percent certitude that they’ve worked? No. In fact, some of those drugs definitively did not work for me, and sometimes made my anxiety worse, or created inconvenient and, at times, intolerable side effects. But I’m pretty sure that without the tricyclic antidepressants of the 1980s I wouldn’t have made it through middle school without inpatient hospitalization. And Paxil gave me the closest I’ve ever had to full remission from anxiety and depression symptoms for about eight months in 1997 before it lost its effectiveness. Could this all have been placebo effect? Coincidence? Or even something as ineffable as the quality of my personal interactions with my psychopharmacologists, which some studies have shown can have a significant effect on a patient’s response? Perhaps. But I don’t think so. And, as Kramer amply demonstrates, reams of clinical anecdote, as well as a proper reading of the statistical research data, suggest otherwise.