I have worked in poverty/high crime areas most of my 35+ career in psychiatry. Good practitioners know the difference between grief, situational and chemical depression and treat accordingly.

I don't just give someone a pill if depressed, we both process severity of depression, reasons for such and ways to make it better. I find Professor McGorry's assumptions insulting. Most patients see a psychiatric provider and a thearpist as well as a case manager. I am a therapist but consider myself a brain chemist but I do know the difference between depression/grief, etc. which should be treated with medication and what should not be treated/won't respond to medication even if taken. I usually say, "I wish I had a pill for the sadness and stress that you are going through, but if it gets too severe or you get thoughts of harming yourself or others, we can try medication." I let the patient decide from there and usually they agree that it is situational and they can get through it.

In Professor McGorry's defense, I find that about 50% of people are incompetent in their jobs and sadly that includes medicine and psychiatry.

Remember too that if someone has prolonged stress it can cause chemical depression and medication may be able to help the person get through troubling times if too severe i.e suicidal thoughts, aggression to others, not able to function at work, etc. Now days, no one can afford to take time off of work to heal.

In regard to drug companies PR campaigns, maybe there would be less suicides if people knew that treatment was available. I like when my patients ask me about medications seen on TV, we discuss the pros and cons of that one and others in the same category and the patient choses which one (if indicated) i.e. some cause weight gain, some help with sleep, increase in blood sugar, etc.

Most of my patient's stress is around not having money, housing, and in limbo waiting on a "disability" decision in order to get money.

PTSD is also common due to terrible childhood traumas and adult traumas as well (the stories I hear would make you sick).

Genetic loading is a big factor in my patients with mental illnes on both sides of the family. I find a lot of patients coming to me with depression who failed multiple antidepressants because he or she acutally has Bipolar II whcih is bipolar depression (often misdiagnosed for 15 years).

Malnutrition can also play a role which is why my patients get a B complex and Vitamin D3 daily from me.

Substance abuse is another factor.

I hope you find this helpful i.e. it isn't just one way or the other, a good clinician knows the difference between situational/transient/manageable depression and something that only time, lifestyle changes, therapy can heal. Continued monitoring for need of medication is also important.

Dr. Kelly Gardiner PhD, PMHNP, CNS, BC

Board Certified Psychaitric Clinical Nurse Specialist

Psychiatric Mental Health Nurse Practitioner

PhD Public Health: Community Health and Education

It is a fallacy to believe that there must always be environmental triggers for anxiety or depression. There often are for headache, for example, but if you go to doctors they will simple give you some (partially) effective treatments for the symptom. For psychological disorders, there is an unfortunate tendency for therapists to bully the patient into generating some plausible external 'explanations' for such troubles when these may not exist.

In my reading of the literature, there is really no evidence supporting the contention that depression and anxiety disorders are, in any significant way, due to physiologically predetermined unbalances or flaws in the brain of those afflicted as such. Rather, the so called imbalances that are "corrected" by medications appear to be the organism's (and the brain's) natural responses to the individual's uniquely patterned exposure to untoward conditions of life/living and the accumulation of disruptive/stressful/harmful experiences. I do believe that current and coming research into social, economic, and status inequality and its effects on the psychological well being of individuals will enlighten us a great deal as to how such experiences bring about the various states and traits constituting mental disorders according to currently dominant definitions.

Ashkan, as to PA being an ideology: your notion is interesting, but in 25 years of reading and practising psychotherapy I don’t think I’ve ever seen a psychoanalysis paper that wasn’t an N=1 case study, which is an in-depth scientific study of the development of an individual in therapy. Both participants are continually hypothesising, intervening, and observing. It’s science.

Poverty, vulnerability, economic crises, social disconnection, to say some.

In the light of the research from 40% to 50% of depression is caused by genetic factors and their mechanism is not fully understood.

The non-genetic factors of depression include, e.g. stress, trauma, viral infections (e.g. Borna disease virus) -

- lifestyle: alcohol abuse, sleeping problems, improper diet, low physical activity ,

- psychological: low level of positive well-being , low self-esteem , negative life experience

- social: low socioeconomic status , stressful environment, social isolation

- environmental e.g.: catastrophic disasters, pollution of water, air, food and noise pollution.

The truth is- that depression means inbalans of some neurotransmitters like serotonin- but it might be caused by many factors- genetic and non-genetic . According to the new study- upon roleplays inflammatory processes.

Another issues is treatment- according to new study: pharmacotherapy, psychotherapy and physical activity are giving the same results.

I have worked in poverty/high crime areas most of my 35+ career in psychiatry. Good practitioners know the difference between grief, situational and chemical depression and treat accordingly.

I don't just give someone a pill if depressed, we both process severity of depression, reasons for such and ways to make it better. I find Professor McGorry's assumptions insulting. Most patients see a psychiatric provider and a thearpist as well as a case manager. I am a therapist but consider myself a brain chemist but I do know the difference between depression/grief, etc. which should be treated with medication and what should not be treated/won't respond to medication even if taken. I usually say, "I wish I had a pill for the sadness and stress that you are going through, but if it gets too severe or you get thoughts of harming yourself or others, we can try medication." I let the patient decide from there and usually they agree that it is situational and they can get through it.

In Professor McGorry's defense, I find that about 50% of people are incompetent in their jobs and sadly that includes medicine and psychiatry.

Remember too that if someone has prolonged stress it can cause chemical depression and medication may be able to help the person get through troubling times if too severe i.e suicidal thoughts, aggression to others, not able to function at work, etc. Now days, no one can afford to take time off of work to heal.

In regard to drug companies PR campaigns, maybe there would be less suicides if people knew that treatment was available. I like when my patients ask me about medications seen on TV, we discuss the pros and cons of that one and others in the same category and the patient choses which one (if indicated) i.e. some cause weight gain, some help with sleep, increase in blood sugar, etc.

Most of my patient's stress is around not having money, housing, and in limbo waiting on a "disability" decision in order to get money.

PTSD is also common due to terrible childhood traumas and adult traumas as well (the stories I hear would make you sick).

Genetic loading is a big factor in my patients with mental illnes on both sides of the family. I find a lot of patients coming to me with depression who failed multiple antidepressants because he or she acutally has Bipolar II whcih is bipolar depression (often misdiagnosed for 15 years).

Malnutrition can also play a role which is why my patients get a B complex and Vitamin D3 daily from me.

Substance abuse is another factor.

I hope you find this helpful i.e. it isn't just one way or the other, a good clinician knows the difference between situational/transient/manageable depression and something that only time, lifestyle changes, therapy can heal. Continued monitoring for need of medication is also important.

Dr. Kelly Gardiner PhD, PMHNP, CNS, BC

Board Certified Psychaitric Clinical Nurse Specialist

Psychiatric Mental Health Nurse Practitioner

PhD Public Health: Community Health and Education

I believe that it is necessary first to understand the clinical depression from the reactive depression. Although the neurotransmitters are directly involved in both types, one may originate with the problem in the neurotransmitters (not enough available, or receptors not sensitive to them, or even both) and the other may originate from external factors, leading to temporary issues with neurotransmitters. One may last a lifetime, other may be a temporary issue. One may not have anything to do with environmental factors, and the other may be with lack of resilience to an external stressors.

So, the issue is to limit yourself to believe that there is only 1 root cause of depression and there is only 1 form of treatment. The truth is that there are so many variables...

Prof Peter Kinderman at the University of Liverpool has published on this issue. Here's one article that may be helpful to you:

https://livrepository.liverpool.ac.uk/3007724/4/Harvard_paper_for_mooc.pdf

Have also a view at this: Article The biomedical model of mental disorder: A critical analysis...

and this:

Article Misuse of Cognitive Neuropsychology in Psychiatry Research: ...

The whole issue of that journal can be freely downloaded. After you have read it, you can only smile scornfully at those with biomedical prtensions.

Depression is a disease state. the definition of disease is a disorder of structure or function in a human especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of a physical injury. It is no different than cancer. There is a genetic predisposition, there is situational depression, depression related to PTSD or chronic pain and chemical imbalances brought on by other drug use or disease of the body and hormone imbalance, exposure to toxins, etc. I believe you must first address the physical causes then you can address the social and environmental factors that add to depression.

Many times it goes back to Maslow's hierarchy of needs, basic human needs must be met before you can begin to address the root cause of anxiety or depression. The basic physical needs, security, and socialization are things I see on a daily basis as an inpatient psychiatric nurse. Homelessness, loneliness, and food insecurity are two big issues that contribute to depression, anxiety and drug use.

You might be interested in different scenarios of social interaction and significant social/environmental factors that influence these scenarios in Chapter Scenarios of Social Interaction