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It’s time to rethink how we approach depression

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Depression is an epidemic, and more complex than we've been treating it.

It’s probably not news to anyone that suicide is an epidemic. These days, it’s rare to find someone who hasn’t lost a friend or family member to suicide, often after a long struggle with depression or other mental illness.

For those of us who are left behind, struggling to make sense of why often seems overwhelming. Even if we’ve experienced depression or despair ourselves, it’s hard not to try and find an answer that makes sense of it all. We tend to second guess every conversation, ever interaction, playing them back with the clarity of hindsight. Why didn’t I catch that? we ask ourselves. Why didn’t I do more, do it differently, try harder? Why didn’t they know how loved they were, how wonderful, how necessary, how irreplaceable they were in this world? 

Sometimes it’s easier to place the blame elsewhere — on the counselors that failed them, the doctors that prescribed the wrong drug, or the wrong dose. The pharmaceutical companies that didn’t disclose the risks of a medication. When we frame depression as a nothing more than a chemical imbalance, some wiring gone wrong somewhere that the right medication can magically fix, this temptation grows stronger. So, too, does the risk that those struggling with depression will give up in despair if their medication doesn’t help lift them out of the mire.

The truth is that depression is a complex affliction, one that can be helped by medication but usually not solved by it. The World Health Organization began a year-long campaign in 2017 to raise awareness of depression as the leading cause of ill health and disability worldwide, and to urge countries to re-think their approaches to mental health and treat it with the appropriate urgency. Treating depression as an inexplicable imbalance of brain chemicals, unrelated to one’s past or present, disconnects a person from what they are experiencing, ignoring the validity of their suffering and stripping them of their agency to confront it.

Johann Hari spent three years researching the real causes of depression and anxiety after he graduated from Cambridge University and found that there are nine major causes of depression and anxiety, of which only two are biological. He was so shocked by his findings that he wrote a book about it, recently explaining in the Huffington Post that his researched prompted him to revise the way we should understand and approach depression.

And that led me to the scientific evidence that we have to try to solve our depression and anxiety crises in a very different way (alongside chemical anti-depressants, which should of course remain on the table).

To do that, we need to stop seeing depression and anxiety as an irrational pathology, or a weird misfiring of brain chemicals. They are terribly painful – but they make sense. Your pain is not an irrational spasm. It is a response to what is happening to you. To deal with depression, you need to deal with its underlying causes. On my long journey, I learned about seven different kinds of anti-depressants – ones that are about stripping out the causes, rather than blunting the symptoms. Releasing your shame is only the start.

The most powerful cause of depression for Hari was also the most difficult to deal with: childhood trauma. It’s well-known that childhood trauma significantly increases the risk for adult depression and everything that goes with it, from drug use to suicide.  And while anti-depressants can help those suffering from depression as a result of a childhood trauma, only dealing with the trauma itself can bring actual healing.

Unfortunately, access to mental health services like long-term counseling can be prohibitively expensive. Although there are initiatives that have begun to focusing on increasing access to counseling and decreasing the stigma surrounding depression, it will take while for those to see wide-spread success. For now, the best way to help friends and family who struggle with depression might be to take a suggestion made by one of Hari’s colleagues, Dr. Robert Anda, and change the narrative.

“When people are behaving in apparently self-destructive ways, ‘it’s time to stop asking what’s wrong with them,’ he said, ‘and time to start asking what happened to them.'”

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