clinical and situational depression

NLG commenting to mentalblog.com: Ma look, no depression!

Most commenters on this phenomenon get two things confused: there is clinical depression, and then there is situational depression. The former is a serious medical disorder, characterized most typically by the person's inability to lift out of the depression even when everything in their life is going fine. For those, medications can be a necessary (though as more and more research is demonstrating, not sufficient alone) part of a broad therapy regimen.

The latter group, however, is according to a growing body of evidence medicated too quickly and too much. For such people, behavioral therapies, changes in diet, nutritional supplementation, exercise, sunshine, and spiritual work are really all that is required. Resort to medication in such instances is most often a quick-fix that over time turns out to not be such a fix; by altering their neurochemistry under less than necessary circumstances, they may be permanently creating a need for medication simply to remain in balance.

Sadly, such a nuanced approach to the issue doesn't make for grabbing headlines, so the public remains terribly misinformed. And that leads to truly ill people being stigmatized and made to feel they are somehow morally deficient for having sought out treatment in the first place.

Unfortunately, a solution is going to require a complex approach. Though the medical establishment and the pharmaceutical companies contribute to this problem, the roots run far deeper. For example, most insurance companies impose severe restrictions on coverage for therapy -- often no more than 15 or 20 visits per year. So doctors, who understand that getting into a therapy relationship with a patient in order to really get at the root of their problems and work with them to implement non-medication approaches to resolving the depression, feel that they have no choice: medication does lift depression, even in people who are not technically clinically depressed. If a doctor is faced with a patient who is truly depressed, with the depression causing other health problems and contributing to a downward spiral in his or her life, but knows that insurance will not cover nearly enough visits or time to properly set up a complete program to help the person get out of the depression and stay out, the doctor may feel the compassionate thing to do is to prescribe medication. Medication that insurance will cover, and that only requires occasional visits to monitor the patient.

It's a terrible situation. I honestly don't know how we're going to get out of it.