Human Emotion Is Not A Disease

One of the things one tends to do when in another city is use public transport. And so it was that I was waiting for a train at Sydney Town Hall Station when the billboard caught my eye.”7 out of 10 Australians will suffer a mental health illness” was the headline. Below the headline was a diverse looking group of people with thought bubbles above their heads.

Amongst the thought bubbles were things like, I am stressed at work, I am grieving for my mother who died, I have mortgage stress and I feel anxious at times. The billboard was promoting a charity, which amongst other things provides support for people with “mental health problems”.

There is an increasing tendency for a variety of medical groups, patient support groups and charities to make problems look bigger than they are so that they can get attention or raise money. To do so however, they reclassify normal parts of human emotion as an illness to boos the numbers and create a sense of crisis. In turn those who create the crisis stand ready to solve it with donations from the public.

If it is not a mental health illness to feel happy when you win a lottery why is it an illness to feel sad when a loved one dies. If it is not an illness to feel nervous before performing on a stage, why is it an illness to feel anxious sometimes? Stress in relation to work or finance is a normal response depending on the circumstances and is not an illness.

In a similar vein eating disorder “experts” are warning that anorexia nervosa is more prevalent than being reported. Part of the basis for this is that ninety per cent of teenage girls have allegedly been on a diet. The experts warned of an “alarming” number of young people developing eating disorders as they battle obesity.

Being on a diet is not the same as anorexia and people “battling” obesity are unlikely candidates for anorexia which in fact has nothing to do with food and is all about control issues. However “alarming numbers” and “experts” makes for great headlines, as did the claim that one in 10 women will develop an eating disorder.

One question though. How did they define eating disorder? Depending on the definition you could widen it to nine or even ten out of ten women.

Meanwhile it has been shown that Australians are being prescribed antidepressant medication for reasons other than those for which the drugs have marketing approval. This is particularly the case in the elderly. In the USA increasing prescribing rates for antidepressants over the last decade has not improved the overall mental health of the populace.

So here is the problem. Feeling stressed or down or a bit anxious is not the same as a mental illness. Conditions like anxiety and depression represent one end of a spectrum of human emotion and behavior. Labeling every emotion as a disease is good for sales of medications, for groups seeking to raise funds and for academics pushing research agendas.

It is not good for people. Reclassifying normal human emotion and experience as a disease portrays people as victims in need of the support offered by those raising the monies or selling the medication. As soon as you are not a victim you are in control of your own destiny and may not need the “support”.

None of this is to deny that some people have genuine mental health illness and need support and in some instances medication. It is to say that it is easy to reclassify human emotion and behavior as an illness and that doing so can be very profitable.

Depression-Alternatives to Antidepressants in Managing and Avoiding Depression

Once again a large question mark has been thrown over antidepressants. A major analysis of previous studies shows that the effect of Selective serotonin reuptake inhibitors (SSRI’s) is no more than placebo (a non active sugar tablet) in mid and moderate depression. It is only in severe depression where the drugs do more than placebo.

This backs up a previous large analysis in 2008, which showed the same result. These analyses have looked at both published studies and also unpublished data submitted to the FDA. Their have also at times been allegations that studies, which showed little benefit from the medications, were at best not published and at worst suppressed.

What is interesting is that, of course most people who take antidepressants feel better, but in mild and moderate depression, it is the taking of the tablet rather than the tablet itself, which has the effect.

The rates of diagnosis of depression have increased considerably over the last two decades. Between 1995 and 2005 the number of Americans prescribed an antidepressant doubled and those being treated took more tablets. Some say this comes from better recognition of the problem. Others feel that it reflects a medicalizing of normal human emotion. However there is no data at all to show that the population is better off for taking all these pills. Around US$1billion is spent on promoting SSRI”s each year with the proportion devoted to direct consumer advertising quadrupling between 1999 and 2005.

The de-stigmatizing of mental health has been a good thing. Mental health issues are no less real than any other. However, it has also led people to feel that having a bad hair day is somehow the same as having depression. I am staggered by the number of people who feel that because they are facing challenges in their life, they feel like they have got “a bit of depression”.

So what are some simple things that can we do to reduce the likelihood of feeling depressed and improve our mood if we are low?

1 Exercise. Regular exercise can reduce depression by around one third. Even regular housework (20 minutes per week) has reduced depression by 20%.

2 Eat real food. Higher rates of depression are found in people who eat lots of processed food whereas those who eat “whole” foods (fruits, vegetables, fish, nuts etc) had lower rates.

3 Get enough Vitamin D. This can be from a bit of sunshine eating oily fish (e.g. salmon or tuna) or supplements.

4 Drink Green tea.

5 Manage your stress. For example take a walk in the park or listen to music. Meditation or yoga is also good.

For those seeking a natural option instead of tablets, the herb St Johns Wort has been consistently shown to be as effective as drugs and has minimal if any side effects.

When “bad” things happen it is as normal to feel down, as it is to feel happy when “good” things happen. To feel down after a relationship breakdown or job loss is no more abnormal than to feel happy after winning a lottery. There is a range of human emotion and feeling-all of which are valid.

Life has its ups and downs. Often when you are feeling down there is some lesson in life to learn. It is from the hardest times that comes the greatest growth. Some people may need an antidepressant for severe depression. For most of the rest the answer will lie in resolving the issue(s) that trouble you rather than in a pill.

Depressed, or a bit Down - There is a difference

It has been said that depression is the epidemic of the 21st century. Certainly the rates of diagnosis have increased over the last 10-15 years. Some claim that this is due to better recognition of the issue and that actual rates are unchanged. Others feel that we are collectively more depressed than in years gone by.

Figures from the USA (link 1) show that the number of Americans prescribed an antidepressant doubled between 1996 and 2005 and that those being treated took more tablets. Yet there is nothing to show that the population is better off. In fact the suicide rate has risen.

It is interesting to note hat $1 billion is spent each year on promoting anti depressants. Between 1999 and 2005 the amount spent on direct to consumer advertising nearly quadrupled.

When one looks at the definition of depression in the DSM4 (the psychiatry reference manual) there are a number of criteria, which need to meet for a diagnosis of depression. Some of these like a 5% change in weight are measurable; others like reduced concentration are subjective. There are 9 criteria 5 need to be present for at least 2 weeks and their needs to be an impact on the person’s ability to function either at work or socially.

This area is a touchy one. There are many people who feel bad, who have stress, who have issues that trouble them. These people may need help or assistance to get through a difficult time. There seems to be a tendency to label many of this group as being depressed. The rise in prescriptions in part represents a reclassification of stress as depression. The two may overlap but are not the same.

The de-stigmatizing of mental health has been a good thing. Mental health issues are no less real than any other. However, it has also led people to feel that having a bad hair day is somehow the same as having depression. I am staggered by the number of people who feel that because they are facing challenges in their life feel that they have got “a bit of depression”.

When “bad” things happen it is as normal to feel down as it is to feel happy when “good” things happen. To feel down after a relationship breakdown or job loss is no more abnormal than to feel happy after winning a lottery. There is a range of human emotion and feeling-all of which are valid.

We need to be careful about medicalizing the human condition. The idea that 3 year olds can have depression (link2) demonstrates this tendency. Children can have emotional and behavioral problems and those problems need help. This is not the same as saying they have a medical illness requiring a drug.

Without the dark we could not understand light. We all have lessons to learn in our lives. It is from the hardest times that the greatest growth and learning’s come. Some people will need medication to get them through or at least started. For a reasonable number of people who are experiencing life’s “downs” the answer is more likely to lie in confronting and resolving the issues rather than in a tablet.

1 http://www.msnbc.msn.com/id/32274077/ns/health-mental_health/?ocid=twitter

2 http://www.msnbc.msn.com/id/32271786/ns/health-kids_and_parenting/?ocid=twitter