Thanks for your very interesting comment.  You raise lots of interesting issues.

1.  You say that feeling blue is not depression.  Well I disagree.  People use various words to describe a feeling of sadness: depression, melancholy, blue, morose, downcast, troubled, discouraged, etc.. Words mean what people use them to mean, and that is the way people use these words.  The words blue and depressed have essentially the same connotation.  Merriam Webster gives the following meaning for blue:  low in spirits; melancholy… marked by low spirits; depressing….  The notion that the depression described in DSM is not the same as “ordinary” depression has become an accepted part of the bio-psychiatric model.  But there is no evidence to support this notion.

2.  You mention correlations between depression and neurological activity.  I’ve discussed this issue in considerable detail in some of my responses to the comments above, but essentially my position is this. All behavior has neural correlates in the sense that every movement of a muscle is triggered (i.e. caused) by the action of a neuron.  Neurons are also involved in feelings.  Sadness or depression or blues or whatever you want to call it is a combination of feelings and behaviors.  Typically a person experiencing depression is experiencing certain feelings and is also behaving in certain ways.  (Sitting morosely on the couch; casting his gaze downwards; speaking slowly and quietly; saying things like “woe is me,” etc.) And meanwhile the brain and the rest of the neuron system are functioning in a characteristic manner.  So when researchers find neural correlates with depression, this is not surprising.  It would be surprising if they didn’t.

These correlates, however, do not establish the notion that depression is an illness.  There are almost certainly specific neural activities associated with long distance bicycle
racing.  But you wouldn’t conclude from this that long distance bicycle racing is an illness.  Even 105,000 such correlates wouldn’t convince you of this.  Well the same logic applies to the phenomenon we call depression.

3.  It doesn’t matter how often an erroneous statement is repeated. It is still false.

4.  As to an “alternative diagnostic tool,” I fear that you have missed the point.  My point is hat there are better ways to conceptualize unusual/disturbing behavior than the illness theory.  It is the illness theory that requires diagnoses.  Here in the United States a physician who prescribes a pill must also assign a diagnosis.  It was this regulation that initially drove the creation of these spurious diagnoses and continues to drive the expansion of the system.  The problems involved in unusual/disturbing behavior are not suited to a medical model and the population presenting these problems has not been served well by this model.  I would certainly not be cranking out another diagnostic system.
 
In this context, however, it is interesting to note that the APA themselves in 1994 with the publication of DSM IV had this to say:

“It was suggested that the DSM-IV Classification be organized following a dimensional model rather than the categorical model used in DSM-III-R.  A dimensional system classifies clinical presentations based on quantification of attributes rather than the assignment to categories and works best in describing phenomena that are distributed continuously and that do not have clear boundaries.  Although dimensional systems increase reliability and communicate more clinical information (because they report clinical attributes that might be subthreshold in a categorical system), they also have serious limitations and thus far have been less useful than categorical systems in clinical practice and in stimulating research.  Numerical dimensional descriptions are much less familiar and vivid than are the categorical names for mental disorders.” (p xxii)

In other words, the APA is conceding that a dimensional quantification of attributes would be a better (more informative) system than the so-called diagnoses.  But they went
with the latter because the “diagnoses” are more vivid and familiar. In my view, vividity and familiarity are poor criteria for choosing a conceptual framework, and I believe that their primary agenda in this decision was the same primary agenda that they have emonstrated consistently for the past 60 years – the expansion of psychiatric business!

5.  With regards to your personal situations, I don’t know you and so can draw few conclusions.  You suggest that if I had had your life “…(Young, fit, decent wages, attractive young women everywhere, dozens of good mates, running around playing enemy and cleaning rifles” I would have been happy.  I’m not sure I could agree with that.  I think I might have been pretty miserable.  We’re all different!

6.  With regards to the efficacy of anti-depressants, studies consistently show that on average they are only very marginally more effective than placeboes!  See Irving Kirsch’s book The Emperor’s New Drugs. Don’t misunderstand me – I’m not encouraging you to stop taking the drugs.  That’s your own business.  I merely encourage people to study the side effects and make informed decisions.

7.  You express skepticism concerning my notion that depression is an adaptive mechanism – a “message,” as it were, from the organism, calling for change.  You ask me to justify this position, and I think this is a very good point.  I have some difficulty with it, however, because in my view the notion is almost self-evident.  Here’s how I see it.

Humans and other mammals and many other species have evolved to their present state of development with an emotional apparatus.  It seems unlikely that such a widespread
mechanism would have no adaptive value.  

In common with these other species, we are motivated to pursue good feelings (i.e. feelings that feel good) and to avoid unpleasant feelings.  So a feeling of hunger
motivates me to seek food; a feeling of thirst to seek water.  These are very specific feelings with very specific targets.  If I am attacked by an enemy or a predator, I might experience anger, which will encourage me to fight back, or fear, which will motivate me to run. Again, very specific.

The organism needs to be relatively active in order to stay in optimal condition.  So if we sit
around vegetating for lengthy periods, we get a message from our bodies.  The message comes in the form of a feeling: a feeling of depression.  We might use different words – “bored,” “fed up,” etc.. But it’s the same feeling – depression.

(In talking about messages being sent and received, I’m not subscribing to any kind of dualism.  I realize that what we are dealing with is different parts of an organism
interacting.)

And this feeling of depression is what motivates us to get up and get going.  Now the feeling of depression is a stimulus, and the natural response to this stimulus is to get
up and get going – to do something different.  But responses that are not reinforced, for whatever reason, tend towards extinction, and this is what has happened in the case of people who are habitually depressed.

Once again, thanks for coming in.  Please feel free to come back if there are any other points you would like to pursue further.

Obviously ‘feeling blue’ or upset because of a particular traceable event (or for a short period of time) is not depression, obviously someone who lacks self-esteem by attribute of their lifestyle is not necessarily depressed.  

With that out of the way, there are hundreds of papers publish showing a correlation between neurochemical imbalances and depression, (a cursory search on google scholar came up with about 105 000 results).  As an example ”The authors performed dexamethasone suppression tests (DST), TRH infusions, 72-hour urine collections, and lumbar punctures on a group of male depressed patients. Approximately 60% of the patients were DST positive and 33% had a blunted TSH response. Two biologic variables, the 8 a.m. postdexamethasone cortisol and the postprobenecid CSF 5-hydroxyindoleacetic acid (5-HIAA), accounted for over half of the variance in the behavioral measure, the Hamilton score. Plasma cortisol elevation was associated with high 3-methoxy-4-hydroxyphenyl glycol (MHPG) excretion; TSH blunting was associated with low urinary MHPG excretion. Comprehensive biologic measures showed certain significant interrelationships and correlations with the severity of depression.” (http://ukpmc.ac.uk/abstract/MED/6171169/reload=0;jsessionid=5TSqoLdimwZZfdDM5oKw.96 ) 

The fact that every bio/biochem/behaviouralbio course i have ever attended (and the various lectures i have watched on the topic from other universities) acknowledges this fact seems to imply that depression is indeed an illness and not purely environmental.  The view that severe, diagnosed depression is “… an instance of something going right.  Depression is a message from the organism calling for change.”  is totally unfounded.  Do you have any real references or mechanistic explanations to corroborate this view or is it purely opinion?  Off the top of my head i can think of several reasons this is an untenable position (the most obvious being the prevalence of suicidal ideation in severely depressed people).  

As for “The purpose of the DSM is to promote the false notion that depression is really an illness, and to legitimize the prescription of mood-altering drugs.”  I am assuming you propose an alternate diagnostic tool which can be applied consistently throughout the field?  

I personally have suffered from depression (I am an extremely fit, healthy 23 year old male; i eat extremely well and spent 4 years in RAINF; excluding me from all of your causative factors for depression) and it took me years to figure out the best approach in combating the problem.  

Eventually i picked an SNRI (with mild dopaminergic RI).  The irony of course, is that if you were to take the exact same drug (at the same dosage -minimum recommended), it would have little or no effect (barring the mild sleepiness and increase in appetite a few hours after taking it) however, in me, the drug is a virtually miraculous; dysphoria is gone, sleeplessness is gone, suicidal ideations are gone etc.  

Nothing has changed in my environment whatsoever (prior to taking the drug that is, obviously my QOL has seen a huge improvement since) and yet i finally feel ‘normal’ again.  Oh and by the way, if you had my life when i was severely depressed (Young, fit, decent wages, attractive young women everywhere, dozens of good mates, running around playing enemy and cleaning rifles) I could pretty safely say you would not have felt as i did.

You continue to reiterate your view that people who are talking about being in a poor mood for a short period of time constitute the majority of those suffering disorders such as MDD “The fact is that people sometimes get depressed”.  This is just blatantly incorrect.  The whole issue with MDD (As Aqua and others have stated) is that it is CONTINUOUS REGARDLESS OF LIFESTYLE CHANGES.  
In a nutshell: First you try CBT/lifestyle changes, if this fails totally; totally overhaul your environment/lifestyle.  If this has no results whatsoever and (>6 months later) your mood has been consistently depressed you need to look into another avenue – this is where drugs that imitate/alter the activity of neurotransmitters come in extremely handy.  P.S. Even though i feel as though it would be ironic (and god knows i love irony) if you were to suffer from (real) depression, i would never wish such an awful illness on anyone (I do however, hope you stub your toe every day for the next week).

You came in by quoting Amanda. But the quotation was considerably longer than Amanda’s comment. So I’m not sure what’s going on.

Please clarify.

Thanks for coming in. Sorry for the delay in getting back to you – I’ve been a little under the weather.

As I stated in the post, in my view depression is not an illness. Rather it is a message from our bodies to make some changes. If you attempt to walk into a burning building, the heat will almost literally push you back. Similarly if your life is plodding along in a certain direction and you feel really rotten about everything – well that’s your body telling you to change direction – do something different!

Now, as I’m sure you realize, I’m very much in a minority in this view. The disease notion is widely accepted, and billions of dollars are spent each year on its promotion. Most physicians accept the disease notion and prescribe drugs accordingly. In my view this is one of the great tragedies of the modern world.

But I’m not in your shoes. You have to do what’s best for you. And if you find the disease concept comforting and if the drugs seems to help you get by – then who am I to argue? I would, however, suggest that you keep an open mind. Look out for areas where you might be able to effect positive changes. Ask yourself what would you prefer to be doing, etc., etc..

You have gotten yourself stuck in the “either it’s an illness or I’m just no good” mindset. There’s another option: You are a normal person who operates in ways that have yielded payoffs in the past. Depressive behavior is frequently rewarded in our culture and we are all capable of succumbing to this kind of enticement, particularly if alternative modes of operating are not high in our repertoires.

Depression is normal. It is a message from the body to “get up and go.”

Once again, thanks for coming in, and please come back if you have other thoughts or concerns.

Lucy :
M

amanda :
Have all my medical certificates from my gp been lies then? My bosses are going to want to know what’s been going on for 6 months and my therapist spent twice that long saying I’m not pathetic and weak wIlled but I have an illness called depression. Maybe the. Suicidal idealisation does make sense after all. Not sick just useless./p>

amanda :
Have all my medical certificates from my gp been lies then? My bosses are going to want to know what’s been going on for 6 months and my therapist spent twice that long saying I’m not pathetic and weak wIlled but I have an illness called depression. Maybe the. Suicidal idealisation does make sense after all. Not sick just useless./p>

Thanks for the comment.

You are raising a very valid and very real issue. Here’s how I think it works.

Depression is a feeling. It has something in common with hunger, in that it drives the organism towards a certain kind of activity. Hunger drives us towards food-seeking. Depression drives us towards novel stimulation – movement – something different. From an evolutionary point of view I can imagine a group of humanoid hunter-gatherers, having worked a certain location for a period of time, becoming bored (i.e. depressed) and being driven by this feeling to move on. This would be advantageous, in that it induces them to abandon a feeding site before they have permanently damaged the vegetation, so plants will still be there to provide food next year. It also ensures that they leave a site before their own feces become hazardous to their health.

So I think that depression as an adaptive drive is very deep-rooted and in this sense “natural.”

But as we know, basic drives are significantly modified by experience and learning. Small babies – as every parent knows – become bored. They want to see new things; they crave novelty. This craving is depression – though we don’t call it that in small babies. But it is the same emotion – the same sense of dissatisfaction with the status quo.

The picture then becomes complicated because what the growing child does about this feeling of dissatisfaction is primarily a function of his experience. If he grows up in a family where the accepted response to these feelings is to get up and go, then he will probably do the same throughout his life. If, on the other hand, he grows up in a family where the response to these feelings is to sit on the couch, watch TV, whine and mope, then – well, you get the picture.

Note that I’m grossly over-simplifying the socialization process. Parental influence is a strong factor in child-rearing outcomes, but it is by no means the only one.

But to get back to your question. In my view, for most people feelings of depression continue to be the adaptive process that evolved in conscious organisms: i.e. an incentive to get up and go, to seek out novel stimuli, to do something different. At the other extreme are individuals in whom this adaptive response has been virtually extinguished through less than optimal training/modeling. So for them depression becomes a sort of morass of self-pity from which it is difficult to extricate oneself. The answer for these individuals, of course, is still the same – get up and go – but they may need the help of a friend to accomplish this. In a very literal sense, that’s what friends are for. And this is how people conceptualized social life for most of human existence.

The first major assault on this supportive social network was television, whereby stimulation was provided through a small window to each individual to the detriment of social supports generally.

The second major assault was, of course, the bio-psychiatric/pharmaceutical assault which created the destructive fiction that depression is an illness.

So to get back to your question. In the situation which you describe, the “natural” response to depression has been extinguished in the same way that the natural response to sexual stimulation is extinguished in the case of a celibate monk; or the natural response to overwhelming danger is extinguished in the case of a soldier; or the natural response to hunger is extinguished in the case of an ascetic who routinely fasts and performs other acts of self-denial.

With regards to the lack of craving to go out in the sunshine and socialize – I think the critical point here is how do you identify craving in another person? The answer, of course, is by his behavior. You will see that he/she is actively pursuing the object in question. But behavior, as we know, is subject to extinction if it is not reinforced and if counter behaviors are reinforced. The extinction of this kind of get up and go behavior doesn’t usually occur overnight, but is rather something that happens gradually over time.

I hope I’ve answered your questions. If not, do come back. Once again, thanks for your interest, and best wishes.

Thank you for “chiming in.” You make good points.

I’ve posted a more detailed response to Type (above) which you might find interesting.

Best wishes.