Is It Time to Change How Society Views Depression?

depression_by_ajgiel-d7l4ewu“CAN WE EXPECT a cure for depression in the next few years?”

That was the first question on everyone’s lips after a study released last week claimed depression might be linked to high inflammation in the body. We’re a cure-obsessed culture, so it’s understandable, although it perhaps reveals much about how we collectively behave towards those that do suffer from this mental health issue and how we feel about our own mental stability. A cure for depression seems, if you really think about it, as outlandish an idea as a cure for cancer.

The idea that high inflammation can cause mood changes is not entirely new. An inflammation-causing drug or vaccine can, for some people, cause a change in emotional state. What is termed “sickness behavior” — basically how miserable you feel when you are sick — is seen as an example of the body ruling the mind as a part of physical illness. And, conversely, depressive feelings are thought to weaken the immune system.

Yet, only about 20-30% of people suffering with depression also actually experience inflammation symptoms, although this percentage is higher in those who don’t respond well to the usual medications (but it’s still only 45%). Not only that, but anti-inflammatory drugs like ibuprofen have been shown to hinder the helpfulness of anti-depressants in those not suffering with high inflammation.

So, would this “cure” be prescribing a probably-lifelong regimen anti-inflammatory medication to at least that percentage of depression sufferers who might benefit? What could help is identifying, through routine blood tests, those that are experiencing high inflammation prior to embarking on the Russian roulette of prescribing them selective serotonin reuptake inhibitors (SSRIs bring a host of potential side-effects). That way, someone could be prescribed anti-inflammatory drugs plus an antidepressant when needed and probably experience good results.

However, the issue is that a whole range of issues that can cause inflammation to go from the “good” kind to the “bad” — inflammation is the body’s protective system so, at a normal level, it is essential. These include factors ranging from poor diet to too much stress to lack of sleep. None of which are especially easy to avoid in contemporary society and all of which can be both causes and symptoms of depression.

Saying that how we feel mentally is somewhat rooted in our physical well-being is not the same as saying that poor physical health is the only reason people can feel chronically low. Perhaps what we need to take from this is that there are lots of different kinds of depression and it’s different for each individual. That’s not particularly useful as a mindset for a one-size-fits-all medical industry or for the sale of popular medications, but it might be the answer.

The common way we have understood depression is that it’s a chemical imbalance in the brain. Another kind of physical health issue, then, and one that can be alleviated with medications. If depression were not thought to be a physical illness of some sort, then we would not prescribe drugs at all. Unless we are doing so only in the hope that they will impact the mind purely via the suggestion that drugs can fix mental issues (AKA how placebos are documented to work). In fact, some studies have shown placebos can, in certain cases, be as effective as a SSRI, for some people.

Which brings me to my TV show segue — in this season’s premiere of Shameless on Showtime, Mickey comments that his boyfriend Ian’s depressive phases could be explained by their living situation, which involves residing in an impoverished suburb and having to make money via crime and prostitution. He doesn’t want to admit it could be a physical illness — in this case, the bipolar disorder genetically passed down from Ian’s mother. Mickey also suffers with — similarly contextualized — anger issues. He chooses to believe the depression is a logical reaction to exterior forces rather than a problem that could not be resolved by a change in circumstances. According to this outlook, exterior forces might well play a part in whichever kind of depression a person might have.

And so, what if depression is situational for some? Why isn’t the ability to deal with unbearable situations seen as an indicator of poor mental health of another kind?

That depressed people cannot help but be depressed has only really become acceptable in recent years. Yet, still, depression sufferers are often seen as incapable or weak in one way or another for how they feel or for not knowing how to change how they feel. As illustrated by the storyline in Shameless — and that show should really get more praise for how it deals with mental health issues, by the way — this is all, at base, about the problem of blaming the depressed for their own depression. It’s never acceptable, but we still keep doing it. Even if the cause is high inflammation, we might well see the depressed blamed for the poor diet/lack of sleep/whatever-cause-you-can-think-of that is decided to have led to that inflammation.

In the end, it will be made to be about personal responsibility. Which, to my mind, is an attitude we really need to address and counteract. Because the other thing that causes inflammation and depression is isolation and social exclusion. As we look ever inwards for reasons, we ignore the causes all around us. We should be careful that what we discover in our search isn’t just another way to avoid the harder questions.

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