Read2022 - Depression, why drugs and electricity are not the answer

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Key takeaways

  • They refute the idea that biological dysfunctions underlie depression
  • They argue that, because patients notice a change in their normal functioning when taking antidepressants, they have an enhanced placebo response which drives the effect.
    • More like alcohol for social anxiety than insulin for diabetes
  • Later on very similar argument relating to ECT. Lots of quotes from the 1940s-1960s which I don’t find convincing.
    • but it seems like there are very few RCTs on ECT versus sham. And the published ones are typically small (average n = 37).
  • What do the authors suggest as alternatives?
    • More long-term studies
    • “Brain disorder” -> pessimistic views of recovery & discourages from taking active steps to improve their situation
    • They are proposing psychotherapy, but also steady income and rewarding employment, housing etc.
    • “People who feel severely depressed for a long time may simply need to be cared for, reassured with kindness and hope, reminded of times when they have felt good, and kept safe until they feel better, which they often do with time.” Suuuper naive…
  • One core idea is that antidepressants mask other causes of poor mental health. So rather than fixing the cause, it’s just hiding the truth which is some other (often social) cause.

Hence viewing depression as a medical disorder that somehow originates in the brain and responds to brain-based interventions is fundamentally inconsistent with understanding it as a ‘normal’ human emotion, albeit sometimes extreme and disproportionate – that is as a meaningful reaction to depressing events and circumstances. page 1402

Understanding depression and anxiety as emotional reactions to life circumstances, rather than the manifestations of supposed brain pathology, demands a combination of political action and common sense. page 1407