In the second half of the last century, transcultural psychiatrist Ari Kiev traveled the world literally like a patchwork blanket, and everywhere, regardless of any conditions (ethnic, economic, geographic, social, or religious), he found 1 % of people suffering from schizophrenia and 6.5 % of people suffering from severe depression, which at that time was called melancholia.
Neurotic disorders, which were the focus of interest of other psychiatrists oriented toward cross-cultural studies, he labeled as folklore. It was truly a colourful mix; at home, hysteria, in Asia for example koro, in Greenland windigo, on Haiti spells, and there were also zombies there.
To severe depressions we must also add part of the milder ones, as well as those that were then called reactive and considered to be caused by life events. When, according to the latest valid classification systems, we put everything into one basket labeled “major depressive disorder” (F32) with varying intensity, we get a prevalence of around 16 %, which in plain language means that every eighth person will encounter depression at least once in life that would merit professional care. It does not always happen, however.
Regarding the causes of depression, we currently know only that they are multiple, ranging from hereditary influences, through an unfortunate childhood, head injuries, to life events; more recently, gut microbes have also entered the picture. Treatment of patients with depression is varied, but antidepressants clearly lead the way, and their aim is to improve the metabolism of “brain chemistry,” especially the famous serotonin. Antidepressants are NOT addictive, because they do not replace anything the brain produces on its own, they only regulate certain neurochemical processes in the brain in a partly known way.
While the number of depressions is probably still stable (depression is not a “drug problem,” but a serious disorder), the use of antidepressants is progressively increasing. Over the last fifteen years, it has doubled. The fact that antidepressants are non-addictive does not mean they cannot have other adverse effects. A freshly published article by Andrade C., Genes as unmeasured and unknown confounds in studies of neurodevelopmental outcomes after antidepressant prescription during pregnancy. J Clin Psychiatry. 2020;81(3):20f13463, raises reflections on the possibility of affecting the fetus when they are taken during pregnancy.
There is a certain association: children of mothers who took antidepressants more often suffer from autism spectrum disorders and restless child syndrome (ADHD) than children whose mothers did not take these medicines. The author states that we cannot unequivocally attribute these facts only to antidepressants, that there is equally valid suspicion that “depressive genes,” of which there are several, may be responsible, depending on how they combine in the offspring.
My rule in my early medical years was: no medicine for anything, not even vitamins! On the other hand, we know that a depressed mother is “unavailable” for a newborn, infant and later toddler, and therefore does not allow full development of their sense of safety and security. In truth, we do not know which is the greater risk.
Therefore, the smartest solution is probably to improve mutual relationships, strengthen them and give each adult a sense of a safe background, which is one of the preventive procedures against depression. Let us stop producing for Instagram and Facebook and take each other by the hand and talk to each other!
Author: MUDr. Radkin Honzák psychiatrist Author's blog: http://blog.aktualne.cz/blogy/radkin-honzak.php