Depression or 'normal sadness?'
Making a distinction between ordinary sadness and clinical depression doesn't help patients, a Tufts professor of psychiatry says in an essay in today's New York Times.
Dr. Ronald Pies of Tufts University School of Medicine debates criticism that says psychiatry in recent years has medicalized normal sadness, increasing depression diagnoses and prescriptions for drugs to treat it. He says it's not so simple. The incidence of depression hasn't changed very much in recent decades, isolating the cause of depression isn't easy, and deciding when sadness crosses the line into a disorder hasn't become clear, he says.
"Most psychiatrists believe that undertreatment of severe depression is a more pressing problem than overtreatment of 'normal sadness,' " he writes.
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Elizabeth Cooney is a former
health reporter for the Worcester Telegram & Gazette, where she also was a
business reporter and an editor. Earlier in her career, she edited medical
books and journals at Little, Brown, and worked for Boston magazine.Boston Globe Health and Science staff:
- Gideon Gil, Health and Science Editor
- Ishani Ganguli, Short White Coat blogger
Dear Ms. Cooney:
I appreciate your coverage of my article on depression in the New York Times. Several of the points you summarized were accurate. However, I did not say, in my article--nor do I believe--that "Making a distinction between ordinary sadness and clinical depression doesn't help patients..."
On the contrary, it is very important to distinguish "ordinary sadness" from clinical depression. My point was that in certain cases, there is a very fine line between severe grief that may resolve on its own, and clinical depression that may require treatment. My other main point was that merely identifying an "understandable cause" for someone's depression does not mean that the depression should be dismissed, or taken as unworthy of clinical care and attention.
Some readers of my NY Times piece also took away the mistaken impression that I believe grief to be a "disease", or that all grieving individuals should be started on an antidepressant--not at all! The hypothetical patient I described, however, was talking in a way that might have indicated suicidal
intentions; he had lost interest in nearly all his usual activities, was sleeping poorly, and eating poorly.
This was an individual who may have had a clinically-serious depression--and the fact that we can identify a possible precipitant for it (his being jilted by his fiancee) does not mean that this person is going to
do fine without some professional help. That might or might not merit an antidepressant--I merely indicated that I would provide the treatment he "needs" to get better.
No, grief is not a disease. But it is complicated, and sometimes veers very close to clinical depression.
I hope you will convey these ideas to your readers. Thanks very much. --Sincerely, Ronald Pies MD
,
You wrote in the NYTimes "Until solid research persuades me otherwise, I will most likely see people like my jilted patient as clinically depressed, not just “normally sad” — and I will provide him with whatever psychiatric treatment he needs to feel better."
And I write: and you, as most midless quacks, are driven by greed, and you have no credibility, sorcerer.
This blogger might want to review your comment before posting it.