What’s Wrong With “Evidence Based” Depression Treatments?

With all our medical advances, why is it that the incidence of depression and anxiety is skyrocketing. The World Health Organization says that depression is the most disabling disease in the Western World today, yet all mental healthcare specialists seem to talk about is “evidence based” treatments such as counseling and anti depressants. Whilst these strategies have been shown to be helpful for some people, if this was really cutting edge advice, why aren’t we seeing the incidence of depression declining or at the very least plateauing. This in no way seeks to imply that medication and psychological counseling don’t have their place in treating depression, just that we are not exploring all the variables

Having interviewed thousands of people who have battled with depression, I am convinced that there are some serious issues with the “evidence based” approach to treating depression. These can be summarized as follows:

1. The “evidence” is where the money is
Unfortunately clinical trials are very expensive to run so private funding will only be directed towards those areas where “investors” can see a return on investment. In the world of depression treatments, this means that the vast majority of funds are directed towards medication and psychological counseling interventions. This means that important lifestyle strategies such as exercise, emotional support,nutrition, relaxation, and fulfilling work are relatively ignored. Ironically these less discussed strategies can be much less costly to implement.

2. When you’re holding a hammer everything looks like a nail
The vast majority of depression treatment studies are undertaken by doctors or psychologists. Whilst there is nothing wrong with this per se, most of these studies are evaluating areas where they have expertise (which makes sense). This means that the comparisons are often looking in isolation at one drug verses another (or a placebo) or one psychological intervention verses another. Quite often meaningful advancements in areas can come from someone outside the established “paradigms”. I love the story of the little boy who came across rescue workers who had been struggling for 3 hours with sophisticated hydraulic equipment trying to dislodge a truck which had been tightly wedged under an overhead bridge. After being encouraged to leave the site he quietly said “Why don’t you let down the tyres?”.

3. We are not just DNA
As human beings our bodies and minds are intricately linked. Depression treatments that focus purely on a “biological illness” are seriously limited. Much of the despair that exists in the western world today can be linked to loneliness, family breakdowns, excessive and unfulfilled work, and financial crises. Saying that depression is caused by low levels of serotonin is like saying teen pregnancies are caused by a sperm fertilizing an egg – yes, but…. Depression treatments that fail to reconnect us with our passions and purpose are ultimately going to be short lived solutions.

What are the right depression treatments?
To find out what works best in managing or overcoming depression, we must ask the people who are living with depression what works best for them. In 2007 I asked just that, and their answers were (in order) exercise, support of family and friends, psychological counseling, fulfilling work, relaxation/meditation, nutrition and medication.
Coincidentally, the Black Dog Institute (BDI) -one of the pre-eminent mood disorder units in the world – also undertook a study directly asking those with depression what helped them most. Although there were some differences in the studies, lifestyle strategies were also shown to be extremely important. One of the authors of the published study, Professor Gordon Parker, who has been practicing psychiatry for over 30 years, has now started advising General Practitioners and their patients to exercise regularly to aid recovery.

If Professor Parker, who has published over 600 clinical papers and book chapters regarding mood disorders, can learn something from these results, perhaps we all can.