From Joanna Moncrieff: “So if depression is not caused by low serotonin, what is it caused by? I have been asked this question by TV and radio presenters on several occasions over the last few days. Many psychiatrists assume that there must be some brain processes that cause depression that we haven’t fully discovered yet. This might be the case, but at the moment, it is merely speculation. A paper from 2019 reviewed research on all the main biological theories of depression, and concluded that ‘there is a lack of evidence for leading biological theories for onset and maintenance of depression.’

So maybe thinking about depression as a brain disease is the wrong way to think about it. Maybe we need a different sort of framework. Maybe our common-sense understanding of depression is more helpful than a medical one. Although our brain is involved in everything we think and do, of course, our moods and emotions are almost always reactions to events in our lives. We feel good when things go well, and sad, anxious, angry or frustrated when things go badly. Our large human brain is what gives us the capacity to reflect on our circumstances and to evaluate whether we like them or not, and it enables us to experience emotions, but the brain is not the cause of these emotions. In contrast, we know that adverse life events such as poverty, debt, divorce, child abuse, loneliness etc strongly predict whether someone will get depressed or not. This is not to suggest that depression cannot sometimes be very severe and the events that may have caused it hard to identify.

The British Psychological Society’s report on depression published in 2020 argues that ‘depression is best thought of as an experience, or a set of experiences, rather than as a disease. The experience we call depression is a form of distress. The depth of distress itself, as well as the contributing events and circumstances, can be life-changing, and even life-threatening. However, calling it an illness is only one way of thinking about it, with advantages and disadvantages.’

International bodies such as the United Nations and WHO (World Health Organisation) have also expressed concern that thinking about depression and anxiety as medical problems is not appropriate or useful and is leading to ‘an over-reliance on psychotropic drugs to the detriment of psychosocial interventions’ (WHO, 2021).”

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