First, the bad news. The biggest cause of ill health and disability in the world – that’s depression for you. It affects more than 300 million people directly, and each one of those struck down in turn affects those around them. In Australia, it’s on the rise in the young, and it’s calculated that more than a million of us in this country suffer depression each year.
According to the highly respected Mayo Clinic, there’s a treatment: selective serotonin reuptake inhibitors (SSRIs), which ease depression by increasing levels of the neurotransmitter serotonin in the brain.
But hang on! I haven’t said we’d got to the good news yet (and we will). Because there’s a problem with the serotonin imbalance model – two problems, actually.
Firstly, according to international expert Dr Michael Yapko, there’s little evidence to support the serotonin theory, and what there is isn’t bearing up very well to close scrutiny: “The suggestion that depression is caused by a chemical imbalance in the brain – a shortage of serotonin – has been popular since the development of the newer generation of antidepressants about 30 years ago. That hypothesis has suffered badly in the research and many neuroscientists and depression experts now consider it entirely obsolete and misleading,” he says. In fact, there's an entire class of anti-depressants that work in precisely the opposite way to SSRIs - they actually enhance reuptake! So it's hard to see how the prevailing model can be the whole story.
There’s a second problem, too, which is that relying on a pill to ‘cure’ depression just doesn’t work. In fact, of all treatments, those relying on medication alone have the highest rates of relapse.
OK, now for the good news! And there is good news – two lots, indeed. First, it’s that there’s a better solution than medication: psychological treatment is highly successful, with a lower relapse rate than medication and without undesirable side-effects.
Psychological treatment can address a person’s adverse life experiences, their style for dealing with life stressors, problem-solving abilities, thinking patterns and decision-making strategies to help them deal with and prevent depression. Psychologists have even been able to devise prevention programs with high success rates.
The second piece of good news is that there are ways to prevent depression before it strikes. “The evidence has grown to a level too great to ignore that depression is much more a social condition than a medical one,” Dr Yapko says. And the implication is that addressing the social drivers, both at an individual and at a wider level, can reduce the risk of depression.
Dr Yapko says: “In this terribly overcrowded world, loneliness is on the rise and depression is rising right along with it. Many of the triggers for depression are the painful things that happen in our relationships – the betrayals, humiliations, rejections, and abandonments. The skills necessary to build and maintain healthy, enduring relationships are on the decline.
“It’s critically important that people who are depressed or vulnerable to depression recognise that much of what it takes to live well and to minimise the likelihood of suffering are specific life skills. These include coping skills, problem solving skills, and social skills that can help build enduring and positive relationships, and these can be learned with the help of a good psychologist.”
He says: “Just as there are many pathways into depression, fortunately there are also many pathways out. Each person has to discover his or her own path.”
Recently, Dr Yapko was invited by the Australian Psychological Society to share his knowledge at a public lecture in Melbourne, and the lecture was filmed. Click on the video above (or here) to watch the whole thing, absolutely free. It's a terrific initiative by the APS to bring up-to-date knowledge to a general audience, and it's really very well worth your time - particularly if you or someone you know is dealing with depression.
What next? Why not make a free appointment to talk to me about it and I’ll explain how therapy can help you to develop coping skills.