StayOnTop: Depression

A while ago, when I got angry about one of those dangerous people peddling a magic depression cure, I promised I would get back to this often-heard fallacy of “When dealing with depression, we should fight the cause instead of the symptoms”. Fallacy? Yes. While sounding logical and reasonable, this is in fact an extreme simplification based on tunnel vision or a lack of understanding.

    First of all, what is a “cause”? What we call “cause” is one arbitrary link in a longer chain-of-events; it can be any link that connects to the next links in the chain. Exactly which one in a string of connected events we call the “cause” will always be disputable. For a simple example, imagine the following scenario. The morning after a warm summer night, you wake up itching all over from mosquito bites:

The itching is the symptom, and the biting by those pesky mosquitoes is the cause, right? But we might just as well label a different link from the chain-of-events as “cause”. Like: the cause you got bitten by those mosquitoes, was that you stupidly left your sleeping room window wide open. Or: you got bitten by mosquitoes because the last few nights were so very warm and humid. Or for yet another variation, a doctor may tell you that the mosquito’s bite is by itself not the cause of the itching: that itch is caused by your own body’s allergic reaction to some mosquito saliva left behind in the bite spot.

    Whatever you would like to label as the real cause of your itch, it’s all fine with me. But you still find yourself scratching those itchy spots. Luckily you have something like calamine lotion in your medicine cabinet: rubbing it on the bite spots will make the itching less acute. Uh… wait, aren’t we fighting a symptom here instead of the cause? Yes we are! We are fighting symptoms, for the cause is something that cannot be undone anymore. We cannot flash back into the previous night and close our bedroom window to un-bite ourselves; we cannot prevent our body from having a natural allergic reaction to mosquito bites; and so on. Once you have been bitten by mosquitoes, fighting the symptoms is all you can do.

    Now let’s move to a more serious example: diabetes. As you know, diabetes is an illness that (although infections can sometimes trigger it) is basically caused by a not-yet-fully-understood genetic defect. As a result of that defect, your body is unable to produce or process the insulin that is needed to control your blood sugar level. This inadequate body chemistry will cause symptoms such as blurry vision and can eventually also cause life-threatening effects such as a heart attack. Once you have diabetes, you can never be fully cured: there is no way to repair the underlying genetic defect.

    Fortunately, many diabetes patients can still have a fairly normal life by regularly injecting themselves with a dose of insulin. Of course this is a kind of clumsy workaround, but one that saves many lives. Now suppose you are a diabetes patient. Someone tells you “Those injections are stupid, for they only cure the symptoms, do you really want to keep injecting yourself for the rest of your life? You should do something about the cause of your diabetes!” How would you react? I think that’s obvious. You would just ignore that dumbass.

    Before I get to depression (by the way, it happens that depression can be one of the symptoms of diabetes) I want to simplify things a little by showing a cause-and-symptoms cure-and-action flowchart. In the diagram below, the countless possible cause-and-symptoms scenarios have been reduced to four main ones. Each row represents, for whatever health problem, one of these four basic possibilities:

    As you see, the case of diabetes belongs in row (2) here. And depression? Most magic-depression-cure peddlers want to make you believe that depression is a really straightforward case that belongs in row (1). This would mean there is only one simple obvious cause, for example your unbalanced diet, or a lack of restfulness and daily meditation, or rather a lack of daily jogging and physical exercise, or the stress of a bad marriage or frustrating job, or your wrongly conditioned mind, or… whatever. Each magic cure peddler will pull his own Favorite Cause from his hat. Just tackle that Favorite Cause, and your depression – with all its symptoms – will be gone for good. If these magicians were right, then it would indeed be stupid to fight the symptoms instead of the cause.

    But is it really that simple? I cannot keep you from believing whatever fairy tale you would like to believe, but my own years of experience with real depression and real therapies (my own and those of fellow patients) tell a very different story. Just take a look around at fellow depression patients in a psychiatry ward, and ask yourself: if things really were that simple, how come those patients are still there muddling along in that ward? Is there some kind of evil conspiracy that keeps them from getting the simple miracle cure that will send them back to home happily? Well, I cannot keep you from believing in evil conspiracies either…

    But maybe curing depression is often so difficult and complicated just because there is no single easily-remedied cause. Take a brief look at the same flowchart again.

    Depression, in my experience, is so complicated it doesn’t even fit clearly in one of the four rows. If I had to put depression somewhere in this diagram, I would say depression is a mix of case (3) and case (4). We know some but not all causes, and not all of the known contributing causes can be remedied. For example, we do know that our lifestyle (changeable) may play a role, but our genetic disposition (not changeable) may be a cause too. Due to this complexity, fighting the symptoms of depression – by whatever therapies – will sometimes be the best option left to us.

    There is much more to say about possible causes and symptoms of depression, about what we can and cannot do, and about how to fight symptoms in an effective way. So I will get back to this topic.

    I want to make one more thing clear for now: sometimes, one of the ways to effectively reduce the symptoms of depression is medication. In my view, pills are not intrinsically bad or good. I know that medication can be used and over-used in many wrong ways. I know that medication should not be used at all when there are better alternatives. I know that medication can have unpleasant side-effects. I know that medication should be kept to an effective minimum (which may differ for different people). But I also do know that in serious cases of suicidal depression, some little pills can make the difference between death or life. This may be an unpleasant and unwelcome truth, but still it is a truth.

• tip: If someone tries to tell you that your antidepressants are a devious invention of the pharmaceutical industry that only alleviate symptoms instead of going for the real cause, just ask him if he would tell a diabetes patient the same thing about his insulin injections.

 
Author: Henk van Setten