Psychiatrist Says, “Depression not a Disease”

National Public Radio devoted its show Science Friday to a debate between a psychiatrist who maintains that depression is not a disease and one who thinks that depression is a medical illness.

The two principals were:

• Harvard trained Dr James Gordon who founded and directs The Center for Mind-Body Medicine in Washington. Dr Gordon is the author of a new book Unstuck which prescribes a holistic program to deal with depression
• and Dr Peter D. Kramer who teaches at psychiatry at Brown University and practices psychiatry in Rhode Island. Dr Kramer is the author of many books including Listening to Prozac and Against Depression. The latter argues that the term depression has many meanings in our culture but most important is the fact that depression is a medical illness.

What is Depression

To Gordon, depression is a signal that something in one’s life is out of balance and can be a beginning to transformational change where a person can become unstuck and move forward.

On the other hand, Kramer sees depression as a cluster of disease traits and symptoms:

• Level of pain;
• Runs in families;
• Disruptions in normal brain activity;
• Co-morbidity with other illnesses such as diabetes and heart disease;
• And tendency to be recurrent and progressive.

So depression looks, smells and acts like a disease to Kramer.

Causes of Depression

Dr Kramer pressed his point that a depressed person’s brain activity and anatomy is abnormal. The head of the Center for Mind-Body Medicine responded that everything in the human body has biological manifestations.

Dr. Gordon believes that the primary response to depression should be a integrated program which includes meditation, relaxation, nutrition and exercise and help for the patient see the world and himself differently. Dr Kramer doesn’t write off these techniques but stresses that depression interferes with the ability to function which impacts careers and relationships and is dangerously associated with strokes, suicide and heart disease.

Depression and Medication

Gordon pointed out that recent antidepressant studies have shown them to be less effective that previously reported. The reason for this, according to Kramer is that the standards of research study have been raised:

• Studies now are based on larger samples of people;
• People are screened more rigorously before they come into to a study;
• And a closer review is conducted on the people who seemed to improve on the drug.

Dr. Kramer also mentioned that the studies of the effectiveness of psychotherapy has shown lesser results recently because the test bar in research studies has been set higher.

Dr Gordon maintains that usually stress is the primary cause of depression and the patient should first be guided through a multidisciplinary program; and that medication is the treatment of last resort for the very small percentage of people don’t respond to holistic treatment.

Morality and Spirit

During one exchange as Dr Gordon was making the point that a person needed to be guided through his program so that the patient could learn to help himself. Dr Kramer reacted by saying that the use of the word “guide” had a moral and spiritual feel to it that made him uncomfortable. Gordon responded by saying that doctors do help to save souls and they have a moral duty to do so. Kramer acknowledged that religion or spirituality can be very important to the patient.

A lot of what Dr Gordon had to say makes sense. In an ideal world, I would agree with his approach. Medications should be the last resort and not the first.

The profession of psychiatry is in a crisis. Efficacy claims for both psychotherapy and medications have been dropping based on new research studies. To be in the position of saying the reason the two treatments looked good a few years ago is due to bad research practices is devastating.

But there are elements of both our culture and the human equation that neither doctor brought up that explains what’s going on:

• Insurance companies have reduced psychiatrists to pill dispensers because it’s cheaper for a patient to spend 15 minutes talking with a doctor who then writes a prescription and sends them out the door. Of course the psychiatrist will prescribe a med, he’s a human being and wants to help is patient.
• Most people don’t have the time, interest or energy to participate in a multidisciplinary holistic program. Dr Gordon has stories in his book about people who have stretched themselves and been successful but they are very much the exception and not the rule. So the idea of taking a pill is probably the most attractive option for people.

Based on what I heard on Science Friday, I understand why we are in the mess that we are in. A healthy life style falls by the wayside when people don’t have the energy or time because they are figuratively running to stay in place economically; it’s difficult to change old habits; and there is big money to be made and time to be saved with drugs,