Sadness is the normal reaction to unfortunate events. It resolves in time and with new ways of seeing things.
Depression is an involutional melancholia: a sense of inner emptiness that has no external cause. It comes from nowhere. It simply exists and won't go away.
It is important to distinguish between sadness and depression. Sadness does not need treatment; depression does.
Doctors who fail to make this distinction will tend to prescribe antidepressants for everything. How else can we account for 31m prescriptions for Prozac and similar pharmaceutical drugs being given out each year? There may sometimes be an unthinking exchange between doctor and patient:
'I am depressed.'
'You suffer from depression. Here is an antidepressant.'
The intention on both sides is that the patient will feel better and function more effectively. Yet vast numbers of controlled studies reveal that antidepressants are only 20% more effective than placebo - dummy tablets that have no active chemical ingredient. Even so, antidepressants can lead to a dependency, they are dangerous in overdose and they can be used in suicide. Paradoxically, they may even lead to suicide by distorting reality, rather than by helping them to face it appropriately, with non-chemical support. Clinical depression, due to chemical imbalance in neuro-transmission systems in the mood centres of the brain, does not inevitably require chemical treatment. There are many alternatives.
Doctors whose training leads them to believe in pharmaceutical drugs as the solution to many of life's emotional, as well as physical, problems will tend to prescribe even more when told that an initial drug has not helped. They may increase the dose of the first antidepressant, add in another and then consider prescribing a mood-stabiliser as well. The doctor's greatest fear is that the patient will commit suicide and that he or she will be blamed for not providing the appropriate clinical treatment. This tends to be judged on what other doctors generally do. Consequently there is a solid inertia: the status quo continues and is unchallenged, regardless of the mounting evidence of serious risks associated with these drugs.
From the perspective of the patient, the sombre feeling and clouded mind make it very difficult to function effectively when faced with very real challenges such as unemployment, bereavement, inadequate housing, family problems and money worries. The doctor's suggestion is often that an antidepressant will 'take the edge off' or 'put the mind in a splint' and thereby enable the patient to be able to function more effectively and even resolve some of the issues. There is very little evidence that this is what happens in practice. It is more probable that the patient becomes dependent on the drug and the problems persist as before.
Patients will often try to lift their depressed moods on their own by using alcohol, recreational drugs, nicotine, caffeine, sugar and white flour. All these substances have mood-altering effects: they act on the mood centres of the brain. Therefore it is very easy to become habituated to them. People who have addictive natures will then become addicted to them, often to several at the same time.
Withdrawal symptoms occur when the individual tries to stop using these substances by 'going cold turkey'. These symptoms are resolved by taking more of the habit-forming drug - and so the rot sets in. Progressive decay is inevitable in physical, emotional, mental, social and every other aspect of life.
It can be argued that depression and a tendency towards addiction are the same thing. The depression exists before the use of mood-altering substances and processes. The addiction to them occurs afterwards. Some people may be born with an addictive nature. This then becomes activated by traumatic events that set up a craving for mood-alteration. Full blown addiction then occurs when the individual discovers the mood-altering properties of one substance or another - or many.
A responsible rehab will focus on helping the patient to become abstinent from all mood-altering substances and processes. Prescription medications will be used in an effective rehab only to cover short-term withdrawal symptoms. Otherwise a disastrous long-term pharmaceutical drug addiction can follow.
The centrepiece of rehab should be trauma resolution, as well as giving insight into the specific nature of addictive disease and recovery.
The appropriate on-going treatment for the underlying depression is through daily working of the Twelve Step programme, first formulated by Alcoholics Anonymous. This is at times an unpopular suggestion - but the process works and there are no damaging side-effects.
Years of misery can be set aside. Gloom and doom become features of the past, not of the present. A fresh outlook on life opens up new visions and presents new opportunities.
People who resist surrendering to a higher power than self in a spiritual (but non-religious) programme can have their previous wretchedness again - any time they want to return to it.