From Depression

A Letter to the Editor

nyt_logo_transparent_v3A couple of weeks ago, Richard Friedman, a Columbia Medical School psychiatrist wrote an op-ed for the New York Times in which he put forward anti-depressant drugs as the treatment of choice for depressed and suicidal college students who felt themselves under “toxic social pressure.” I was troubled by the article and the authority that appearing in the pages of The Times gave it and wrote a Letter to the Editor. The Times didn’t print it, but I wanted to share it with you. I’d suggest you read Dr. Friedman’s article first and then my letter. I would welcome your sharing your thoughts about the issues raised with others and also with me. This is an important topic. The distress and dilemmas these young people face require a solution that is far more integrative and compassionate than the one they are ordinarily offered.


To the Editor:

Richard Friedman’s plea (Teenagers, Medication and Suicide, August 3, 2015), for mental health services for depressed and potentially suicidal adolescents is appropriate and well intentioned. His focus on psychopharmacological treatment is, however, dangerously narrow and based on a  selective reading of the science. Nor does it recognize and respect the great capacity that all of us, including young people, have to understand and help ourselves.

Comprehensive reviews of the evidence (unpublished as well as published) on antidepressants in The New England Journal of Medicine, The Journal of the American Medical Association, and PLoS Medicine tell a story quite different from Dr. Friedman’s. They reveal that antidepressant drugs, which are burdened with such depressing side effects as weight gain and sexual dysfunction are, at best, only marginally more effective for mild to moderate depression than placebos. Moreover, the FDA data that Dr. Friedman cites clearly indicates that, though the rate of suicidal thinking and behavior was low, it was twice as high in people taking antidepressants as in those receiving placebos (4% vs. 2%).

Even more important, Dr. Friedman completely neglects the various forms of psychotherapy, including cognitive behavioral therapy and interpersonal therapy which appear to work as well as anti-depressants and also make young people active partners in their own care. He also ignores meditation, exercise, and other powerful, evidence-based self-care tools for reducing stress—a primary cause of depression– as well as the small group interventions that may be critical to transforming “toxic social pressure” into life giving social support.

Jim blog response to Friedman
James S. Gordon, a psychiatrist who has worked with adolescents for 45 years, is the author of
Unstuck: Your Guide to the Seven-Stage Journey Out of Depression.


Depression’s Upside: A One-Sided View

By James S. Gordon MD

Some thoughts on Jonah Lehrer’s article from The New York Times Magazine, February 25, 2010.

In his article on the possible evolutionary purpose of sadness, Jonah Lehrer, a talented writer and knowledgeable scientists confuses an adaptive mechanism –the capacity for greater focus that the rumination of depression may afford – with a therapeutic one.  Even more important, he does not address the causes of depression and, in accordance with his emphasis on enhanced problem solving, limits his discussion of therapeutic efforts to cognitive change.

Work with many hundreds of depressed people in my psychiatric practice and tens of thousands more in war, post-war and disaster situations around the world gives me a very different perspective and leads me to different conclusions.  So many of us are depressed because we are living at variance with both our genetic programming and our need for meaning and purpose.  We are affected so dramatically by losses of relationships, jobs, etc. because we are not sustained by the adequate social support that is a hallmark of traditional societies.  We are subject to an unprecedented level of stress and overstimulation in our environment, to toxic food, and sedentary ways of living that are anathema to our evolutionary development and detrimental to our mood.  Many of us lack a sense of purpose in our lives, a connection to something greater than ourselves that gives human life meaning, and can give us hope in difficult times.

The symptoms of depression – both the rumination on what went wrong and why that Lehrer focuses on, and the lethargy, hopelessness, decreased interest in sex and food that go along with it – are best understood and responded to not as an evolutionary advantage but as a wake-up call.  They let us know that it is time to address the conditions that are creating the imbalances in our lives; to use food and exercise, meditation and imagination to improve our biology and enlarge our perspective, and to reach out to others—therapists, clergy, family and friends—who can help us.  The true purpose and challenge of our depression is to wake us up to what is wrong in the way we live, to point us toward ways to become more fully human.