How Beliefs About Depression Can Harm |
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Biological beliefs about depression can prolong antidepressant use.
Seeing depression as a brain defect reduces agency and optimism.
Viewing depression as a meaningful signal can support better outcomes.
One of the strangest things about depression is that what one believes about its nature and causes can help—or hinder—healing.
Depression is different from, say, hypothyroidism. It doesn’t matter quite so much what you believe about hypothyroidism: If you take your medication, you will keep symptoms under control.
Depression works differently. Do I think of my depression as caused by a chemical imbalance in my brain? Or a reasonable response to adversity? Or a message from the depths of my soul that I should change my life?
Over the last decade, an emerging body of evidence has shown that one’s beliefs about depression are not neutral. They shape treatment outcomes in surprising ways.
How biological beliefs undermine recovery
Most notably, the belief that depression stems from a chemical imbalance in one's brain can hinder treatment in at least three ways:
Biological beliefs can give rise to “prognostic pessimism.” Some form the idea that, if depression is a biological condition, it’s unlikely to change—it’s just part of “who I am.”
Biological beliefs can create the impression that medication is the only useful form of treatment, thereby limiting treatment options.
Biological beliefs can create a sense of a lack of agency, or what psychologists call an external locus of control. This is the idea that I’m helpless to change my depression on my own; I need a doctor to “fix” me.
These beliefs can perpetuate depression by limiting the treatments we pursue and creating a sense of hopelessness about them.
Unfortunately, biological beliefs about depression are quite pervasive in the Western world. Studies conducted around 2010 showed that about 80 percent of the population in such countries believed that depression involves a chemical imbalance in the brain. For years, this view was vigorously promoted by doctors, drug companies, and anti-stigma campaigns.
This is despite the fact that there’s almost no evidence for the claim that depression involves a known brain abnormality.
The harms of biological beliefs
A new study from the United Kingdom has just added to this list of potential harms. The study looked at the connection between biological beliefs and the use of antidepressants.
The study shows that people with biological beliefs about depression—rather than those who see their depression as a meaningful response to life’s challenges—tend to stay on antidepressants for longer than those who do not hold those beliefs. They also tend to think that they cannot cope without their antidepressants. Finally, they are less likely to try to stop them.
This is worrisome because staying on antidepressants for longer than needed can expose people to unnecessary side effects or more severe withdrawal symptoms.
The study was led by Mollie Griffin Williams, a researcher in clinical mental health sciences at University College London. She conducted a survey of nearly 500 people on antidepressants in the United Kingdom. These were individuals who’d enrolled in a public therapy service for depression and anxiety disorders.
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The participants were asked about their beliefs about depression: Is my depression due to a brain abnormality? Or is it a reasonable response to negative life events?
Intriguingly, those who had biological beliefs about depression:
Remained on antidepressant medications for longer
Were more likely to believe that they couldn’t cope without antidepressants
Were less likely to attempt to stop taking antidepressants.
For example, nearly 40 percent of those with biological beliefs had used antidepressants for more than two years, compared to only about 25 percent of those who did not share those beliefs.
Additionally, only about 58 percent of people with biological beliefs had attempted to stop taking antidepressants, compared to about 67 percent of people without those beliefs.
Interestingly, there was no evidence that people with biological beliefs have more severe depression than people without. That rules out the possibility that their prolonged antidepressant use is just the result of having more severe depression, rather than their biological beliefs.
Side effects and withdrawal symptoms
Why is it a problem for people to remain on antidepressants for longer than needed? The problem is that these drugs alter nervous system functioning in ways that can be harmful.
For example, about half of SSRI users experience some dulling of sexual desire and sensation—most characteristically, a reduction in genital sensitivity. For a minority of such users, this dulling can be permanent, even after they stop taking the drugs. This is a poorly understood condition called post-SSRI sexual dysfunction, or PSSD.
Additionally, some patients report distressing withdrawal symptoms when they try to stop, such as insomnia, anxiety, and “brain zaps”—shock-like sensations in the head. Some evidence indicates that withdrawal symptoms may be more severe the longer one takes antidepressants.
Remaining on antidepressant drugs for longer than needed has real harms. In that way, the chemical imbalance theory of depression—the idea that depression can be explained in terms of a biological flaw in the brain—often makes people worse off.
An evolutionary alternative
If we should no longer see depression as a biological abnormality—a chemical imbalance in the brain—how should we see it? What are some more empowering perspectives on depression?
One emerging perspective (see here and here) is that depression may be your brain’s well-designed signal that something in your life is not going well and needs to change. It could be a career path, a relationship, or life goal. Depression can be the impetus to powerful transformation.
This view of depression is associated with a school of thought known as evolutionary psychiatry. Evolutionary psychiatry often sees mental illnesses like depression, anxiety, or attention-deficit/hyperactivity disorder (ADHD), as adaptations that humans use to survive and thrive.
Some theorists have argued that if depression is a designed signal, rather than a brain disorder, then taking antidepressants might make people worse off. That’s because they may prevent them from making the positive life changes needed to heal their depression.
If depression is a designed signal, then one promising way to heal depression would be to consult with a therapist who shares that viewpoint and is willing to help you find out what has gone wrong—and how to change it.
Some intriguing evidence suggests that believing that depression is a “designed signal” may actually improve treatment outcomes. People who believe their depression is a designed signal tend to be more optimistic about treatment, they tend to see their depression as temporary, and they tend to feel less stigma in talking about it.
The biological view of depression is not only scientifically questionable. More worrisome, it can deter people from getting the kind of help that would be most useful to them.
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