"Medicine Is Awesome": A Critical Look at the Factors That Shape Thinking About Depression and Its Treatment.

No longer are prolonged sadness and despondency, with their effects on day-to-day functioning, conceived of as a response to someone's internal world or external environment. Instead, the syndrome has been elevated to a medical disorder-depression-explained as a chemical imbalance in the nervous system that requires medication to rebalance these chemicals. How did we arrive at this modern state of affairs? While the answer to this question is complex and has been hotly debated, one thing is certain: This relatively new explanation of depression as a neurochemical imbalance leads to the current privileging of pharmacotherapy over other approaches to treatment. However, the pharmacologic effect of these treatments is still speculative. Numerous studies have failed to show a benefit to active treatment greater than that seen with placebo, and most patients will not achieve remission of symptoms despite treatment. This overreliance on medication may reflect a "medicine is awesome" stance that biases clinicians toward medical interventions. A more expansive understanding of depressed mood, one that can and should be discussed with patients, is to understand it as a reaction to one's psychosocial, political, economic, and physical environment. This more expansive understanding includes the neurobiological basis of mood, but it also allows for discussions of non-pharmaceutical treatments, ones that can be aligned with each patient's agenda. Medications may be an eventual option after a thorough explanation of limited benefit and possible harms. However, this reframing of depression facilitates a valuable, satisfying means of developing trust and helping people with depressed mood.