The Science of Melancholy

Louis Menand is a professor of English at Harvard and “Critic at Large” for the New Yorker. He is also knowledgeable across a wide range of disciplines including psychology and psychiatry. In the March 1st of the New Yorker, he writes about current research on depression, therapy, and antidepressants. His discussion centers around six topics:

Depression
Menand claims there is scarcely any agreement on the causes or most effective treatments for depression. Indeed, it may never be known what the source(s) of depression are, largely because it is almost impossible to distinguish a genuine depressive pathology (if there is one) from a sadness or long-lasting melancholy from naturally occurring events.

Diagnosis
There is also considerable disagreement about the definition of depression and a very low agreement among trained psychiatrists in diagnosing a mental patient who appears to be suffering from depression.

Therapy
Psychotherapy for depression has highly variable results with outcomes that are often not significantly different than no-treatment or placebo conditions. There is also little evidence that “…supplementing antidepressant medication with talk therapy improves outcomes.” Further, patients often get better over the course of time without clinical interventions

Antidepressants
In spite of the advice--“Take the meds.”--of a number of well known individuals (William Styron in Darkness Visible, Andrew Solomon in The Noonday Demon, etc), there is also little evidence that antidepressants lead to enduring recovery or that they are superior to placebos

Drug Companies
While the understanding of depression languishes in uncertainty, the drug companies are thriving. “Between 1988, the year after Prozac was approved by the F.D.A, and 2000, adult use of antidepressants almost tripled. By 2005, one out of every ten Americans had a prescription for an antidepressant.”

Coping
There is a strain of pharmacological and psychotherapeutic Calvinism in this country that underscores the importance of learning how to cope with adversity. “We think that sucking it up and mastering our fears is a sign of character.” Or that we don’t want to be the kind of person who doesn’t experience sorrow or distress. These are questions beyond the scope of research and, for Menand, will forever remain matters for philosophy and literature to grapple with.

If the confusion and disarray among those who study and treat depression wasn’t already clear to you, it surely will be after reading Menand’s review. I believe it gives an accurate account of the current state of depression research and analysis. There is scarcely any certainty about what to do if you become depressed and if you are in some way professionally qualified, how to go about treating it.

As one who has spent much of my life observing and studying depression, as well as spending many long hours thinking about the depressed people I have known and loved, I wonder if we will ever be able to understand and effectively overcome what has become an increasingly common problem for all too many individuals