On the Medicalization of Depression

As a therapeutic boarding school that hosts students with an array of psychological issues, we wanted to comment on Johann Hari’s recent book regarding the medicalization of depression. For any of you who are aware of Hari’s new book, Lost Connections: Uncovering the Real Causes of Depression—and the Unexpected Solutions, the author argues that the biological explanation of depression is erroneous in some ways and oversimplified, and the key to treating depression is more-so a psycho-social approach, then a pharmacological one. He researched depression and spoke to experts all over the world, and drew on his own experience to make these conclusions. Ron Gray, LMFT at Newport Academy agrees but cautions that the medical explanation and approach are still appropriate at times and perhaps Hari’s assessment is oversimplified.


The medicalization of depression

We agree with both Hari and Gray at Newport. However, we emphasize that offering to treat depression, in our case teen and young adult depression, without the use of psychotropics is like swimming upstream in the U.S. today. For over 30 years we have found that youngsters can over come life long sadness, anxiety, low self-worth, feelings of incompetence and the like by fixing their life- becoming engaged in their future, a community and hard work? Themselves?

Robert Whitaker wrote Anatomy of an Epidemic, in 2011, Alan Schwartz published ADHD Nation in 2016, and now Johann Hari’s book. Additionally, the oversimplified synaptic explanation of how anti-depressants work (“more serotonin in your synapse equals feeling better”) has been questioned for a very long time (for example, in Initiation and adaptation: A paradigm for understanding psychotropic drug action.   Hyman, Steven ENestler, Eric JThe American Journal of Psychiatry; Washington Vol. 153, Iss. 2,  (Feb 1996):  And despite this “press” we at JD regularly come across parents, professionals and sometimes students that can’t imagine a sane approach to teens with the use of psychotropic meds.

To be very clear, the therapeutic team at The John Dewey Academy is not anti-medication. In my own career spanning almost three decades I have seen psychotropics used effectively for a whole range of mental health issues in people of all ages, shapes and sizes. But what we have seen much more of are folks maintained on cocktails of meds with little efficacy, getting higher and higher doses of meds and more and more add ons. Additionally, often a great deal of resistance to a trial of complete medication holiday. All of this despite hard evidence – both from our own work, and cross cultural findings in Hari’s discussion. We have no desire to throw the baby out with the bath water, but, what will it take for the tide to shift and psychotropics treatment being the last resort, or even not the first go-to?

— Andrea Nathans, Psy.D.
Executive Director, Admissions