By Mark Lemstra
July 22, 2010
We could save $2 billion a year on health-care costs in Saskatchewan while actually improving health outcomes if we adopt evidence-based protocols.
To do so, we need to go line by line through budgets to find about $40 million of efficiencies in each of about 50 areas.
This is the second article in a five-part series on depression. The first one discussed how there is no medical test to diagnose depression; the interview scales have no known validity or reliability because there is no comparative gold standard; the varying interview scales result in different diagnostic conclusions; and almost every life reaction is considered a symptom for depression — including things such as indecisiveness, inability to concentrate, changes in weight or sleeping pattern.
None of this is very scientific.
From 1952 to 1980, the Diagnostic Statistical Manual of Mental Disorders (DSM) described mental disorders as reactions to environmental events such as the death of a loved one.
To make depression seem more medical, the editors of the DSM published a revision in 1980, dismissing environmental influences as causative events.
A small group of practitioners voted and agreed that depression should no longer be diagnosed if the symptoms were caused by factors such as bereavement, substance use or other medical conditions.
Although this purely medical concept is obviously good for pharmaceutical companies, it ignores the reality that almost all cases of depression are triggered by stressful life events.
So let’s review the medical or biological basis for depression.
Numerous theories have been suggested, including noradrenalin abnormalities, cortisol excess, hippocampal insufficiency and neurotrophic factor.
All have been dismissed. The latest theory is neurotransmitter deficiency with a focus on serotonin, although norepinephrine and dopamine are also included.
The problem with this latest theory is that it, too, cannot be backed up by data. Molecular Psychiatry published a literature review of all papers that studied what happens when you lower neurotransmitter levels. It found that depletion did not result in depression.
In other words, low levels of serotonin, norepinephrine or dopamine do not cause depression.