by Ed Bullmore
We all know depression. It touches every family on the planet. Yet we understand surprisingly little about it.
This dawned on me in an acutely embarrassing way one day in my first few years of training as a psychiatrist, when I was interviewing a man in the outpatient clinic at the Maudsley Hospital in London. In response to my textbook-drilled questioning, he told me that his mood was low, he wasn’t finding any pleasure in life, he was waking up in the small hours and unable to get back to sleep, he wasn’t eating well and had lost a bit of weight, he was guilty about the past and pessimistic about the future. “I think you’re depressed,” I told him. “I already know that,” the patient told me, patiently. “That’s why I asked my GP to refer me to this clinic. What I want to know is why am I depressed and what can you do about it?”
I tried to explain about anti-depressant drugs, like selective serotonin reuptake inhibitors (SSRIs) and how they worked.
What we had for depression in 1990 — serotonin-tweaking drugs, like Prozac, and psychotherapy — is pretty much still all that we’ve got therapeutically. And that’s evidently not good enough, otherwise depression wouldn’t be on track to become the biggest single cause of disability in the world by 2030.
We must dare to think differently.
One day in 1989, when I was training as a physician, just before I started to specialize in psychiatry, I saw a woman in her late fifties with an inflammatory disease called rheumatoid arthritis. I’ll call her Mrs. P. She had been arthritic for many years. The joints in her hands were painfully swollen and disfigured by scarring. The collagen and bone in her knees had been destroyed so that the joints no longer worked smoothly and she found it difficult to walk. Together, we talked through the long list of physical signs and symptoms that are diagnostic of rheumatoid arthritis. She ticked all the boxes. Then I asked her a few questions that weren’t on the standard checklist. I asked about her state of mind, her mood, and over the course of the next 10 minutes or so, she quietly but clearly told me that she had very low levels of energy, nothing gave her pleasure anymore, her sleep was disturbed, and she was preoccupied by pessimistic and guilty thoughts. She was depressed.