The discussion of medication, specifically anti-depressants, has made its way back into the blogosphere. Kactus posted on December 20 at Feministe about her relief at finding a good anti-anxiety medication. More than 120 comments followed, many critical of the pharmaceutical industry — and others questioning the usefulness of medication for depression or anxiety.
Responding to Kactus, my fellow vegan feminist Elaine Vigneault takes a fairly strong anti-medication tack, largely rooted in her own experience.
Yesterday, Daisy summed up the whole kerfuffle at her place.
I was on one form or another of psychotropic drugs (all prescribed, though at times abused) from 1987 to 1998. After my first hospitalization at age 19, I was put on Elavil, an old-fashioned anti-depressant that left me teary and sleeping 12 hours a day. I was a first-generation Prozac kid (from 1989-1992). As micro-psychotic episodes began to appear, I was put on lithium as well — and spent eighteen months on that drug. Others followed, from Anafranil to Wellbutrin to Klonopin. I became seriously addicted to the last of these; of all the substances I ever put in my body, none was as compelling and intoxicating as Klonopin.
Some of these medications were useless. One, Klonopin, ended up being worse than useless. But a few of these medications worked, and worked well. For many years, particularly in my twenties, my anxiety and depression were so debilitating and absorbing that they left me nearly incapacitated. Eventually, three things turned my life around: an excellent psychiatrist, a commitment to work and live a Twelve Step program, and a spiritual conversion. Therapy, AA, and God became the three-legged stool of my transformation.
But here’s the crucial thing: though eventually, I was able to live without any medication, initially medication was vital. The pills quieted the self-loathing, the anxiety, and the pain long enough for the therapy, the Twelve Steps, and God to start working. Medication, in other words, wasn’t the basis of my recovery — but it made me available to begin recovering.
Some folks may need to be on medication for a lifetime, others only for a season, others not at all. Yes, the drug companies ruthlessly and recklessly promote pharmacological solutions to spiritual and emotional problems. Sometimes, saying “my kid has a problem with the receptors in her brain and she needs anti-depressants” is easier to say than “our family is fucked up and it’s taking a toll on my child’s sanity.” No question, some folks use substances (prescribed or otherwise) to avoid doing the painful work of uncovering the emotional trauma that caused their pain or anxiety. But other folks genuinely have organic issues that can best be addressed by medication — in combination with counseling of some sort. There’s no harm in admitting that.
I’m so grateful I haven’t needed pills in nine years. I am so grateful that the pills were there when I did need them. The right medications quieted the rushing, intrusive thoughts that tormented me for so long — and it was in that pharmacologically-induced quiet that I was able truly to listen to the voice of my shrink, to the voice of my sponsor — and finally, to the still small voice of the Spirit.
many, many people would be dead if not for psychotropic medications.
many people’s day-to-day existence is sustained by them. one missed dose of one drug on one day can tip some over the edge—not just mentally—but physically.
due to the severity of some illnesses, some will take meds their whole life long.
it is not just “in their head,” as ill-informed people are wont to say in regards to mental illness. mental illness is very much in the body. for the record, the brain is connected to the rest of the structure that houses us.
brain chemistry is quite mysterious and quite misunderstood—and the effects of meds differ from person to person. many people feel like lab rats, going through numerous drugs, numerous doses, and an infinite number of combinations. some people suffer from symptoms that are “off the books” and baffle doctors. the wrong meds can ravage the body. it can take years for doctors to arrive at the right recipe. psychiatry is an evolving science.
indeed, pharmaceuticals are quite corrupt and drug reps are in bed with doctors. but people still need drugs.
absolutely, people abuse anti-depressants and the like. (they are not for everybody.) but people abuse any number of drugs. vicodin, for instance. this doesn’t eliminate the need.
for some, like hugo, they are useful to keep one from drowning. for some it gets their head above water until they are able to tread on their own.
the cliche is true for those of us that truly need psychotropics: it’s like insulin for the diabetic.
ignorance of the basic science of mental illness, as well as the associated and perpetuated stigma have cost too many people their lives.
i lost a very dear friend this last week because he could not get adequate care or the psychotropics he very much needed. to deny people the possibility of a miracle is criminal. my friend’s death was an unnecessary tragedy.
I get really, really heated up when this subject comes up. I think that I am even more passionate about it than abortion. I get quite defensive when people write off all anti-depressants and anti-anxiety medication. You are somewhat familiar with my family history. Those people who aren’t probably wouldn’t understand my position. Both of my parents are on lots of medication, including anti-depressants. My mother has a rare mental condition. She suffers from delusional thinking (including seeing things that are not there) as well as chronic depression. When I was a kid, she spent most of her day in bed because she could not function whatsoever. It took her doctors years before they could find the right drugs for her. Since my mother has a hormonal imbalance, she needs certain psychotropic drugs in order to function. It is not about curing emotional depression — she was born with a chemical imbalance, and it got even more out of whack immediately after my brother and I were born. If she misses her drugs for one day, everything seems to fall apart. Is my mother dependent? Yes. But in her case, she needs to be on meds, otherwise I probably would not have much of a mother at all.
I am critical of the idea that one needs to be on anti-depressants for extended periods of time because they suffer from emotional depression. I do believe that they are useful for a short period of time, but ultimately, it is up to the person taking them to decide for themselves whether or not they want to be happy and do important emotional work. My mother also had to do serious emotional work as well in order to merely admit that she has a problem (the craziest people do not know they are crazy) To me, this is not back and white. Her case is one of the exceptions because it is so extreme. Certain, but not most, people may need to be on such drugs for life because they were born with a chemical/hormonal imbalance in addition to doing emotional work. And then, there are those who need it for a short period of time. It’s complicated. I just get somewhat defensive when people who are born healthier than, say, my mom, write off all psychotropic drugs as unnecessary.
/end rant. Sorry. I was responding to the topic, and not specifically Hugo’s analysis, which I agree with.
BTW — I am changing my blogging name from “Mermade” to “Melusine.” I think it sounds better.
As one of the lab rabbits they worked out methylphenidate (Ritalin et al) on, as well as a survivor of a nasty encounter with trycyclates (Anafranil), I have a peculiar perspective on psychiatric drugs. I approve of the use of drugs to remedy organic brain illness or imbalance, which we ought to cure, but I do not approve of using drugs to erase differences, which we have an obligation to accommodate. The difficulty lies in distinguishing between those two things.
Right on! I might not be here today if it weren’t for psychiatric medication, and I certainly wouldn’t be as functional. Also, I second your support of talk therapy — I suspect that even those with purely physical mental illness can sometimes benefit from counseling, because the thought patterns people develop to deal with depression, anxiety disorders, etc. are destructive and don’t necessarily go away with medication alone. From what I can tell, my obsessive-compulsive disorder seems to be simply a flaw in my brain — I’ve been tormented by a succession of all-consuming obsessive fears, with only a few “quiet periods”, since I was six or seven years old — but it’s left me with a crapload of maladaptive thought processes that do not simply “go away” when I’m medicated. The medication just gives me the mental space to hold them at arms length and think about things more sensibly.
Even then it’s not easy. I finally found medication that worked for me about seven years ago, and I thought I had it all figured out. Then two years ago my meds crapped out on me, but it took me most of a year to realize it. From there it took six months and two doctors to find new meds, and now I’m unraveling the OCD thought loops all over again. Sometimes I grieve, because I remember what it was like to be okay, and now I’m not. But I have learned that the voice inside me that whispers, “Do you REALLY have OCD? Are you sure you NEED medication? Are you sure you aren’t just screwed up in a unique way that means you can never recover?” isn’t the Voice of Truth, but in fact, part of the OCD. It boils down to this — when I listen to that voice, things get worse. When I listen to my counselor, when I try to think and behave with something resembling reason instead of as a reaction to the core of anxiety that constantly screams, “Are you SURE? You have to be SURE!”, things get better. Can’t argue with results.
The right medications quieted the rushing, intrusive thoughts that tormented me for so long — and it was in that pharmacologically-induced quiet that I was able truly to listen to the voice of my shrink, to the voice of my sponsor — and finally, to the still small voice of the Spirit.
I’m glad you were finally able to get to a place where you could hear that still, small voice. I’ve lived with my OCD (which has sometimes manifested itself as scrupulosity) for so long that I’m not sure I could trust the voice of God if I did hear it. All I can do is pray for mercy and hope He hears me… but it’s lonely.
Since I’ve only been seriously reading since last summer, it seems more personal stuff has come to my attention here. I appreciate that.
Psych drugs certainly are a hot button issue. My stance is the same as yours, I suppose. There are people with purely organic brain diseases. There are people whose brains go “poof” without outside stimuli. There’s always someone with such a story. But, the vast majority of people on psych meds are not these people. Reminds me of the porn argument, and countless other arguments, that are derailed by calling up extreme examples or minority populations when the group being discussed is obviously not the individuals often brought up in anecdotal evidence. That being said, it is clear at this point that pills are pushed on people to suppress the symptoms of emotional problems. Therapy is expensive and time consuming and a lot of people (especially ones with the most emotional problems) are not equipped in childhood with the basic (healthy) coping mechanism to even begin healing. Therapy is nearly impossible to obtain for the working class because of time constraints and financial reasons. Healing from emotional wounds is hard, it’s real hard, and doing this is just not put at a priority in this country.
I was in the same position. I was medicated with anti-depressants and mood stabilizers to anti-psychotics to lithium all through adolescence. Through what was probably causing my emotional problems was the fact I was being molested by two adult men at the time, but the doctors didn’t deem it necessary to see if there was an external cause to my emotional instability. Anyway, after it stopped, the medicine was helpful in stabilizing me artificially long enough to allow me to mature a little and see that I wasn’t going to get better crawling into a bottle or getting high, I had to fight if things were ever going to be bearable for more than a moment. Unlike most poor people I was raised with, I still had the hope of scholarships and college ahead of me. It really doesn’t help recovery when you feel you have nothing to lose.
So, I understand medicine. It is really important when people need it. I just don’t think people should see it as a solution, but more of a tool for the more permanent inner work to be done. A lot of drugging is to alleviate symptoms of an emotional problem that mostly likely could be eliminated over time with therapy. I won’t go into how the majority of my extended family is on psych drugs because they “can’t sleep”.
Sigh. Too much hurt in the world.
I am not anti medication. I’m not even anti antidepressants.
sorry, Elaine, I read this out of context:
“I hate anti-depressants for various reasons, including that a) THEY DON’T FUCKING WORK and b) they have unbearable side-effects.”
You can see how that might be construed as an anti anti-depressant tack…
Yes, I know.
The key word in that statement is “I”. I hate antidepressants. I hate olives. I hate Bush.
Those statements are not the same as saying “I hate people who take antidepressants” or “I want to ban antidepressants”.
I said many things that were taken out of context and misunderstood. That’s why I tried to clarify with multiple blog posts on the issues. Here’s the best easily digestible round-up of my current thoughts:
http://www.elainevigneault.com/bullet-points-on-depression-round-two.html
Medication, in other words, wasn’t the basis of my recovery — but it made me available to begin recovering.
I couldn’t agree more. I am one of those people who would be dead without antidepressants. These drugs are often derided as “crutches”, which is exactly what they are designed to be! You use crutches to walk when you are unable to do so unaided, while you heal. If you tried to walk around on a broken leg, you wouldn’t get anywhere very quickly and you would never heal because you’d keep damaging the break.
I believe talk therapy (or a substitute like conversation with clergy, family, or close friends) is essential for true recovery from depression. You have to get to the core issues that led to the depression if you want to avoid recurrence. But for someone deep in depression, talk therapy is slow at best and useless at worst. When I was at my lowest points, you couldn’t talk to me at all. The words went in and out, but nothing even touched my unshakable belief that I was a worthless person and there was no possible solution for my misery. Antidepressants consistently lift me just enough from this state that I can find the initiative to undertake real therapy - which is hard, hard work, and impossibly daunting without first picking up the crutch.
scienceiscool wrote:
Good metaphor. Note that a crutch, like most other things, can have a positive and a negative use. To the extent that we use crutches to make healing compatible with normal, positive activities, we use them n a positive way. But if we use crutches to push our bodies to destructive ends, then we use them in a negative way.
Using anti-depressants to live with a destructive situation or intolerable pressure make healing unlikely and abuses you. Everyone who uses a crutch, whether chemical or physical, faces the challenge of discerning whether their use of the crutch aids healing, or just lets them live with the harm.
Those statements are not the same as saying “I hate people who take antidepressants” or “I want to ban antidepressants”.
Please. If antidepressants don’t work and are, at the very least, a money-sucking placebo, why *wouldn’t* anyone with half a conscience want to ban them? Own your words instead of trying to whitewash them.
mythago, because some people might like them, that’s why. Even if they aren’t effective for treating depression they might still be fun to use, for people who like that kind of thing. I don’t want to ban them for the same reason that I don’t want to ban marijuanna.
I’m not interested in telling other people how to live their lives and whether or not they can do destructive things to themselves.
I’m not trying to whitewash anything. I’m trying to be very clear, yet it’s such a touchy subject for so many people that everything I say ends up being misunderstood and misinterpreted.
The statement….
“I hate anti-depressants for various reasons, including that a) THEY DON’T FUCKING WORK and b) they have unbearable side-effects.”
is pretty ambiguous if you don’t intend to communicate that you think anti-depressants are a big scam and don’t work, etc, etc. You could probably get across the same ideas, intensity included, while clearing up your meaning so that you’d be less prone to being misunderstood.
Elaine, come on. People can read. At feministe, you said
I hate anti-depressants and I think they’re dangerous. I think they make people stupid/ cause a type of brain damage. i think they’re also tending to pacify a public who is reasonably depressed and angry. Justified anger and depression, in my opinion, should not be medicated except in very rare circumstances.
Lots of drugs work for some people and not others. You’ve declared, repeatedl that a whole class of drugs that dramatically improve quality of life for many and save peoples lives are depolititicing and effectively lobotomizing, based on your own hazy theorizing. You’re obviously not merely saying anti-depressants didn’t work for you. If that’s your story now, you’ve changed it considerably. Mythago’s right, own your words or repudiate them.
djw -
I’m posting more on this today. Check out my blog for more.
But till then, do you see how your interpretation of my statement is different than Hugo’s unedited statement?
Hugo said I was anti-medication.
You say I claim antidepressants don’t work.
Those are very different claims.
You /= Hugo /= mythago /= me.
In order to have a fair and productive discussion about depression and antidepressants, we all must begin with similar definitions and language use. If you define mental illness one way and I define it another, we will just keep talking past each other.
Moreover, my quotes are taken out of context. If you really want to understand me, you really DO have to try. You have to do more than rely on other’s quotations of me.
At this point, we have such overwhelming evidence for a genetic link to certain brain disorders (schizophrenia, as I understand, and bipolar from personal experience), that I really find it hard to imagine how anyone can argue against it. Whether or not drugs can cure these illnesses, to treat them as weaknesses or spiritual problems, something the “right” diet or attitude can fix, simply insults the sufferers.
I would affirm that anti-depressants can have dangerous side effects (I would hardly call any drug that affects such a critical part of the body as neuro-transmitters particularly safe). However, I would point out that the rise of the suicide rate by the users of anti-depressants does not necessarily mean the drugs cause suicide. Last time I checked, sufferers in the deepest part of a depression had a relatively low risk of suicide, because deeply depressed people lack the energy to plan and execute a suicide. The risk generally increases as the sufferer begins recovery, and regains energy. So blaming anti-depressants may misrepresent the cause of suicide in these cases.
So everyone who says they weren’t suicidal before taking the pills and they were afterwards is lying?
And what about withdrawals? Are you suggesting people don’t become addicted to these drugs and that they don’t suffer withdrawal symptoms that can lead to suicidal thoughts and actions?
And why would the FDA issue the blackbox warning of increased risk of suicide if studies didn’t suggest there was a link?
But to treat them with ineffective drugs that can increase the risk of suicide and that are likely very addictive is a good idea? Something’s missing in your analysis.
There are some gray areas here you’re ignoring, like treating with placebos and cognitive therapy - no potential for side effects there and studies show the placebos are almost or just as effective as the antidepressants.
See these recent articles for more on antidepressant effectiveness:
http://www.theglobeandmail.com/servlet/story/RTGAM.20080116.wpharma1701/BNStory/specialScienceandHealth/home
http://www.nytimes.com/2008/01/17/health/17depress.html
I said what I said; no more, no less. I certainly didn’t accuse anyone of lying. I stated that a known risk of remission from depressive illness can account for increased suicides among people taking anti-depressants, and that risk (that as patients recover from deep depression they have more energy, which makes them more capable of self harm) makes measuring the risks of anti-depressants more difficult and uncertain. If you have the facts to refute my statement, feel free to do so. If you don’t, I see no reason for you to suggest I said something I did not, particularly since, if you read what I wrote with any care, you will see that I don’t endorse he use of anti-depressants.
Again, I never said that. In fact, in the very sentence you quote, I clearly alluded to the possibility that anti-depressants (or any other available medication) may not cure physical brain illnesses. Nor (to foreclose other possible misreadings of my statements) did I list depression as a physical brain illness.
Ok, first of all, can we just get over the drug=crutch analogy. Ableist, a little? Offensive, a lot. I don’t mean to get my knickers in a twist, but since I am little miss disabled-activist around here, COME ON!
I posted a little (very, very long) comment on Elaine’s latest, but I’m too tired to link to it (sorry). It’s boring enough. Just details my psychiatric history and how my depression is definately physical (having to do with brain damage and family history).
I think everybody here believes in bodily autonomy. Part of being in charge of your own body is being able to take in substances that help you function without others screaming, crying, ranting, raving, and denigrating you because of it. I also find it just a tad bit offensive when people naturally assume I am too stupid to take an active role in my own healthcare or try the obvious answers (diet, exercise, get out in the sunshine, take a nap, see a counselor).
Elaine, when you said you hated anti-depressants and they don’t work, you were obviously being very inflammatory and derisve to a great number of people. I’ve read your posts (and the feministe posts), so I know the context. Of course people are going to get up in arms. Making excuses for it doesn’t fix it. You said it. People are angry. You could have used better wording (”I distrust antidepressants and doubt their effectiveness” would be easier to swallow), but I actually think you owe people an apology for your overblown reaction to what is really their own personal business and none of yours.
Just a note. Elaine was very kind and respectful toward me on her blog, for which I am grateful. I don’t think Elaine is bad or stupid or any of the other insults that have been leveled at her in the blogosphere. I think the all-enompassing-ness of her remarks is unfortunate, but that’s semantics, and she is as entitled to her opinion as I am to my anti-crazy meds.
Well anti-depressants worked for me and while there is side-effects, I would gladly tolerate them to help alleviate debilitating depression. Who in the world would want to wake up feeling depressed. I’ve had a lot of experience with this, although I do not feel like discussing my personal situation. All I can say is that when help was offered, I gladly took it. I felt what have I got to lose and it was like a heavy weight had been lifted off of my shoulders to know that what was happening to me was organic and due to a chemical imbalance and not because I was “too sensitive,” or had some skewed thought process. I feel thankful and grateful for the help that I received. It is so much better than to feel suicidal. I’m currently not taking any meds. I also believe in talk therapy with a very good psychiatrist or couselor–I’ve had problems here too, so a very good psychiatrist is crucial to managing depression. I’m less inclined to talk to friends as in their well-meaning ignorance they could be part of the problem, adding insult to injury and making situations far worse instead of better. AA (12-steps) and spin-offs didn’t work for me, nor did church due to the nature of the types of people I met, which made things worse.
For the people who have told me antidepressants saved their lives, I’ve responded by explaining how they almost took mine.
I’ve showed examples of other harmed lives as well. But the antidepressant lovers’ callous indifference to my experience makes me think they’re fine with negative consequences of these drugs, so long as those consequences happen to other people.
They’d rather not feel insulted than let me express anger over a drug and system that nearly killed me. That really is the truth of the matter.
So first people who disagreed with you merely misunderstood you; when that tactic didn’t work, you turn to painting them as callous and even malicious, happy for anyone else to suffer and die as long as they get their brain-crutch.
Do you not see how this approach might sabotage your arguments somewhat? Or do you just not give a fuck as long as you can see yourself as Always Right and those who disagree with you as At Best, Sadly Ignorant?
mythago,
My critics are not a monolith. They have various criticisms that are sometimes in conflict with another. Hugo was not attacking me; he was simply mischaraterizinng my point. So I corrected him. Others have more directly attacked me. Those are the people I refer to in my last comment.
I’m sorry I generalized. They haven’t all been callous towards me.
But it does seem like most people who disagree with me on this issue are so bent on getting me to apologize for whatever slight they felt I made against them that they don’t see my points at all. They simply ignore the larger picture.
Elaine,
When I read your comment after mine, I was unsure who you were responding too, if it was me or just in general and I certainly wouldn’t label myself as an antidepressant lover. I don’t think anyone loves having to take pills (antidepressants). I also don’t feel that I’ve demonstrated callous indifference to your experience, by providing a differing viewpoint, nor would I say that I’m fine with negative consequences of these drugs, so long as they happen to other people. While I’m sorry that you’ve had a negative experience I believe the drugs do help many people and I think that they are worth a try to alleviate suffering. Depression often sneaks up on people and gradually worsens, if left untreated. People who are very ill and in desparate need of help often don’t think they are ill. Sometimes they need intervention. I think intervention is a loving act from relatives who care. It’s unbearable and heartwrenching to watch a loved one change into a barely recongizable–maybe physically and maybe not–version of themselves. It sounds like from what you wrote of your experiences that you were not given a choice. I was given a choice and I gladly accepted as I wanted help. I would also never underestimate the value in parterning with an empathetic and good psychiatrist as I think it is paramount to the process of managing depression.
The thing is, there are no drugs that are universally good for everyone. Antibiotics are some of the most dangerous drugs on the market. Yet, Elaine, you don’t hear about people who had a reaction to, say, Cipro, and then call it a “crutch” and deny the need for it for some people (although I’d fully expect that person to warn others about their experience). Antidepressants work extremely well for some people, not at all for others, somewhere in between for most people, and for some there is a bad outcome. That’s the way it is with every drug, not just antidepressants. Drugs are one avenue that some people can use.
Jodi wrote:
“Antidepressants work extremely well for some people”
The evidence doesn’t support that statement. There is anecdotal evidence only, and given that placebos are just as or nearly as effective, anecdotal evidence of antidepressants effectiveness can be attributed to the placebo effect.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020392&ct=1&SESSID=821757f4b5bbfc6b428042957f1c690a
http://www.elainevigneault.com/drug-marketers-are-liars.html
Moreover, neither scholars nor doctors, nor patients actually all agree on the definition of depression. It’s merely a set of symptoms interpreted differently by different people. The same person with the same symptoms can be diagnosed as having depression, anxiety, or PTSD.
http://www.hms.harvard.edu/news/pressreleases/mcl/0207ptsd.html
People who lack proper nutrition often have depression symptoms and can be wrongly diagnosed as having depression because nutrition isn’t regularly addressed by doctors and therapists. Same goes for exercise, exposure to sunlight, and other basic human needs.
Moreover, sociology is interested the field of depression. Sociologists are abandoning the psychiatry biomedical model of depression and focusing on social factors of the symptom set we call ‘depression’. For example, victims of child abuse and spousal abuse often develop symptoms of depression. It doesn’t make much sense to treat those people as though they have a abnormal brain chemistry. That’s essentially blaming the victim. It makes more sense to address the real, social causes of depressed symptoms. That’s one of many reasons I toss out the biomedical model for these types of “mental illnesses”.
Karen wrote:
“Depression often sneaks up on people and gradually worsens, if left untreated. People who are very ill and in desparate need of help often don’t think they are ill. Sometimes they need intervention.”
That’s not the case. For many, depression does not ‘gradually worsen’ but in fact, gradually disappears. Not all, but many. So please don’t act as though everyone experiences depression in the same way.
And some interventions can cause more harm than help. The biomedical intervention causes harm to some people, hence the warning of increased suicide risk.
Also, telling people it’s not their circumstances or their oppression or the abuse they suffered in the past that’s making them depressed, but rather that it’s something wrong with their brains and then putting these people on medications and/or confining them to hospitals can do SERIOUS damage to real people.
Antidepressants, in general, do not save lives. If they did, there wouldn’t be a suicide risk warning.
The lies drug marketers tell are harmful. And sticking up for them without doing the research is endangering other people.
Elaine wrote:
“That’s not the case. For many, depression does not ‘gradually worsen’ but in fact, gradually disappears. Not all, but many. So please don’t act as though everyone experiences depression in the same way.”
I do not care to get into any personal discussions with you, however I will correct a comment that you made and say that I do not act as if everyone experiences depression in the same way. And yes, some people will eventually cycle out of depression, however it can take a very long time. In other people their clinical depression can get worse and in some cases can lead to a full blown psychosis (delusions). A healthy diet and exercise is very important, however some people can have severe clinical depression despite leading a healthy lifestyle and in these people diet and exercise is not enough. And yes, the real social causes need to be addressed. I’d say find another qualified doctor, psychologist or psychiatrist if they ignore childhood or spousal abuse issues. A good psychiatrist is crucial for managing depression.