DR MAX PEMBERTON: Too often, the way we treat depression is wrong

Last week a study showed that people who walk briskly for two and a half hours a week have a 25 per cent lower risk of depression. I’m always interested in research like this, because it flies in the face of the medical model of depression. 

This would have us believe that depression is caused by an imbalance of ‘happy chemicals’ in our brains. If this were the case though, then simply going for a walk wouldn’t change that imbalance; not by any currently understood mechanism in the brain, anyway. 

Rather, it suggests that our understanding of depression is wrong — or, at the very least, that it’s far more complex than we currently accept. 

The way we understand depression has been dominated in recent years by what has been termed a ‘biological model’. 

Dr Max Pemberton says the way we understand depression has been dominated in recent years by what has been termed a ‘biological model’

A large part of this has been fuelled by the pharmaceutical industry who, with the development of SSRIs — a group of antidepressants which includes Prozac and are now the most commonly prescribed antidepressants — has propagated the idea that depression is a biological phenomenon which can be treated with pills.

But while neurotransmitters in the brain are no doubt involved in depression, clearly social and cultural factors play a part, too. 

Personally, I think depression is an umbrella term — a symptom rather than a medical condition on its own — and there are many different causes. 

There is no doubt that there are some patients for whom depression seems to come out of nowhere. Inexplicably this black cloud descends and it seems that nothing and no one can shift it. 

It seems perplexing and baffling because people with objectively pleasant and stable lives are suddenly incapacitated for no apparent reason. 

Then there are others — many of whom I’ve seen in my clinic. Patients whose depression, despite it being crippling and debilitating, seems to make sense. 

I remember being asked to see a middle-aged woman who had come into A&E because she was so depressed she had stopped eating and drinking. She was a shell of a human being, absolutely exhausted and utterly devastated. She had previously been admitted for her depression but little seemed to make it better. 

She was so low she could hardly be bothered to look up and answer my questions. 

Dr Max Pemberton (pictured) says that we cannot put depression down to a chemical mishap in the brain. We need to appreciate how complex the factors and causes of depression are

It transpired we were meeting on the anniversary of the death of her husband and two children. She had been driving the car they were in when she momentarily fell asleep at the wheel. They died, she survived. Is what she was experiencing a problem with her brain chemistry? Was she just in need of a little bit more serotonin? 

Because as I sat and listened to her tell the story, her eyes dead and hollow, her voice thin and distant, I asked myself, given what had happened, what other possible response could there be? Wasn’t her depression a normal, rational response to so -me-thing unimaginably horrendous? 

I have thought the same when I’ve worked with patients who have survived genocides, witnessed their relatives murdered in front of them and all sorts of other atrocities and who are then diagnosed with depression. Can we really say their despair is a chemical imbalance? 

Similarly, a friend was telling me about taking in a ­Ukrainian family. 

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He had been slightly surprised that they seemed a little distant and detached, and it wasn’t until he started talking to them he realised they were profoundly depressed. 

Now, is this a surprise? You’ve watched your country being devastated, your life turned upside down, family and friends slaughtered. And then you find yourself in a foreign country, full of uncertainty and unknowns. 

Can we really say that being depressed by that is simply down to a chemical mishap in the brain; a random, unfortunate imbalance of ‘happy’ chemicals? Of course not. 

But until we start to appreciate how complex the factors and causes of depression are, what hope do we have of providing truly effective treatment?

That’s not to say that antidepressants don’t work or that they’re not helpful in treating those who are depressed. 

Rather, it’s that we do those with depression a disservice if we insist that the biological model of depression is the only one that is relevant. 

It means we fail to see people holistically and take into account what has happened in their lives and the wider world they live in.

Why I’ve fallen for Bennifer

Dr Max says that there is something sweet about Ben Affleck and Jennifer Lopez getting engaged 20 years after they split 

There’s something so heartwarming and sweet about Ben Affleck and Jennifer Lopez getting engaged 20 years after they split. I like to think it shows how a few years can change us. Time mellows us, allows us to see things in perspective and to appreciate people in a different way. We learn to stop focusing on the small irritations and to see the person in a more sympathetic, understanding and rounded light. We stop expecting other people to be perfect and realise we are just as flawed, irritating and frustrating as everyone else. And that we all deserve to love, and be loved, in return.

No more LGBT woke-washing

More and more companies are offering to pay for gender reassignment surgery for their employees. While this sounds compassionate, it’s easy to see this as a cynical attempt at positioning a brand as a caring, woke organisation while doing very little. The reality is, the number of people that will take this up is minuscule. It’s pure ‘woke-washing’ if you will. 

If these massive corporates really cared about LGBT people, they would ensure they did not do business with countries where it is illegal to be gay or with oppressive legislation. 

It’s the same with companies that insist employees put their pronouns on the end of emails. Disney has announced it won’t be using gendered pronouns and language — such as ladies and gentlemen or boys and girls — in its theme parks. 

Yet its eponymous streaming service has just expanded into nearly a dozen countries with strict anti-LGBT laws. To all these corporates I say: We don’t want your empty gestures. Focus on running your business ethically and spare us your hypocrisy. 

Until now, it was unknown whether years gained from healthy habits would be overshadowed by memory loss. But results show that by 65, women with a healthy lifestyle could expect to live until 89 and men until 88, compared to 86 and 82 for the unhealthy. Critically, the extra years were not eaten up by dementia.

Dr Max prescribes…

Rewarding yourself for walking

Dr Max advises the new app WeWard, which uses your smartphone’s step counter to convert the steps you take into gifts or charity donations

For walking If you are out and about this Bank Holiday, how about using new app WeWard (en. weward.fr) which uses your smartphone’s step counter to convert the steps you take into gifts or, even better, charity donations so you can improve your health while helping a good cause.