WHATEVER ails you 鈥� be it as trivial as a cold or as serious as cancer 鈥� you are likely to attract good wishes and unsolicited advice from well-meaning family, friends and even strangers. But if you have depression, those friends may stay quiet, or even suggest you just 鈥減ull yourself together鈥�. Depression is both stigmatised and denied 鈥� odd for an illness that the World Health Organization places close to the top of its list of burdens on global health 鈥� with people still frequently needing to insist that their condition amounts to more than just being 鈥渄own in the dumps鈥�. How did this state of affairs come about?
Depression鈥檚 reality has been questioned ever since it was , but the emergence of apparently miraculous antidepressants in the 1980s seemed to turn things around, demonstrating conclusively that depression had a firm biological basis. Their supposed success in 鈥渃orrecting鈥� serotonin levels was widely lauded, with their transformative effects described in bestselling books like Elizabeth Wurtzel鈥檚 groundbreaking Prozac Nation.
聯Depression鈥檚 reality has been questioned ever since it was first referred to as melancholia聰
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But over the past decade, it has become clear that up to half of those treated with Prozac and similar drugs do not in fact get better. One response has been to cast such patients as 鈥渢reatment-resistant鈥�, rather than branding the treatments themselves as ineffective 鈥� although a fuller analysis of the clinical trial data suggests such medications may never have been all that effective.
This adds to the confusion over the status of depression 鈥� and has led some big pharmaceutical companies to retreat from drug development, leaving sufferers with even less hope of relief.
But that withdrawal has itself spurred on development of novel treatments 鈥� some of which have succeeded in helping those whose lives have been blighted by otherwise 鈥渦ntreatable鈥� depression (see 鈥�Fixing broken brains: a new understanding of depression鈥�).
These treatments, and the new thinking they prompt, may help refine understanding of the mechanisms that underlie depression 鈥� and so offer hope that goes far beyond their original subjects. A new chapter may be opening in the story of this most misunderstood of illnesses.
