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January 25, 2008
Sadness is not always “depression”
What is pathology and what is ordinary suffering? In most cases, a few weeks of intense grief following the death of a loved one is ordinary suffering, according to the handbook psychiatrists use to classify mental illness. But the same grief following, say, the loss of a job or the end of a marriage could be classified as depression, a form of mental illness.
A study published March, 2007 in the Archives of General Psychiatry takes issue with that distinction. “Historical precedent, common sense, and research on loss responses all suggest that many types of losses can trigger intense normal sadness,” the authors write, listing a few garden-variety forms of loss: “not only bereavement but also romantic betrayal and rejection, economic misfortune, severe physical illness, loss of cherished possessions, and failure to attain important goals, among others.”
In the study, researchers looked at data from a national mental-health survey and identified respondents who met the standardized criteria for major depressive disorder (which requires multiple symptoms such as gloomy mood, feelings of guilt, and changed eating or sleep patterns), and whose depressive episodes were triggered by bereavement or other specific forms of loss. They found, perhaps not surprisingly, that the bereavement-triggered group was almost identical to the group whose grief was triggered by other forms of loss.
If the Diagnostic and Statistical Manual of Mental Disorders, were to expand the boundaries of ordinary grief to include forms of loss besides bereavement, it could reduce the number of people classified with major depressive disorder by one quarter. A revision which would hopefully cut down on prescriptions for antidepressants that may do more harm than good. (Sorry big pharma) If someone has a normal grief reaction, you wouldn’t give that person an antidepressant, you would favor psychotherapy. If someone has major depression, medication is more likely to have some utility. Does your psychiatrist appreciate the difference between normal sorrow and “depression”? If he or she only wants to talk meds then probably not…
Citations:
Jerome C. Wakefield, PhD; Michael B. First, MD, et al; Extending the Bereavement Exclusion for Major Depression to Other Losses (Evidence From the National Comorbidity Survey) Arch Gen Psychiatry. 2007;64(4):433-440.
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