Mental health is not what you’d call an “exact science.” For example, if two highly trained mental health providers meet privately with the same patient, they will agree 90 percent of the time on diagnosing schizophrenia and 65 to 70 percent of the time on diagnosing a bipolar disorder. But this reliability drops off sharply in cases of depression—our two mental health providers would agree only 28 percent of the time on such a diagnosis. This should not surprise us: Depression, as many can attest, covers a broad spectrum of mood disorders, that span different subtypes, and entail, among other things, different treatment responses and risks.
Still, expert mental health professionals can help people identify ways to recover from depression and become more resilient. Medications certainly can help to treat mental health disorders, particularly those that meet the criteria of chronic medical illness. These include some subtypes of depression, as well as schizophrenia, psychosis, bipolar and their neurodevelopmental disorders. But the number of people medicated on antidepressants in our society is vast: 1 in 12 people in the United States. Antidepressants are arguably being overprescribed. And what’s puzzling is that more than 75 percent of antidepressant drugs are prescribed by a general health practitioner, not a mental health provider, whose standard would have been to offer a psychiatric assessment with treatment to include therapy. A 2015 study, based on data from the Baltimore Epidemiologic Catchment Area, concluded that “antidepressants are commonly used in the absence of clear evidence-based indications.” As a result, many people are receiving medication in order to cope with a broad range of subtypes, as well as symptoms of, depression that do not meet diagnostic criteria—including the ongoing developmental work of adulthood—that can be treated by other means.
When we embrace depression to cultivate an awakened awareness, we are far less likely to be severely depressed in the future.
This troubling trend—I call it “depression doping”—makes me wonder what the consequence of overmedicating the natural, existential struggles of adult development might be. As the founder and director of the Spirituality Mind Body Institute at Columbia University, where I am a professor in clinical psychology, I think about the importance of those struggles to people’s lives a lot. COVID-19, as you might suspect, is deepening this problem: According to a 2020 study that examined the impact of the pandemic on psychological distress globally, young people are the most vulnerable to stress, anxiety and depression. More recent research, from April, shows that reports of anxiety and depression have been on rise for all American adults, but especially for young ones. About a third of US adults reported symptoms of either an anxiety or depressive disorder in August 2020, and that number bumped up to 42 percent in December. This means that many young adults might be seeking relief from feelings of depression through medication when it might be best not to.
I worry that “depression-doping” might be impeding or forestalling important breakthroughs in development that make people more resilient. If we medically insulate, or precipitously shield, emerging adults from introspection and struggle, from the work of figuring out life’s big questions—brought on, perhaps, by an unwanted life event, like illness, death, or another form of loss—it could prevent them from effectively coping with depression later in life. No doubt many will say it is “good medicine” to alleviate suffering whenever possible. Yet research suggests that medicating depression can short-circuit how inclined people naturally are to do the hard work of building a life with meaningful direction. This is represented by the fact that, once patients discontinue their medications, often the same symptoms return—40 percent of people on SSRIs remain so, for over five years, and 20 percent over 10 years.
I’m thinking this moment might be ideal to dig deep, to discover a new way to understand and be with isolation, disappointment, foiled plans, and aspirations—and, yes, chronic uncertainty. Why? Because the world appears increasingly to be given to flux, foiling any illusions of control. A new way of living and being is in order, in which we adopt the role of pilot, who keenly observes and then navigates the changing weather. The old question to ask was, “What do I want out of life?” The new question is, “What is life showing me now?” Perhaps, by adapting a new dialogue with life, we might move from an attitude of making our path to seeking it.
Depression could be the door into a way of being that aligns more truly with the nature of life itself. This is something I’ve learned during my time working as a clinical psychologist. There has always been an alternative to medicating for several subtypes of depression. A decade-long inquiry into what I’ve come to call the “awakened brain” underscores this. Our latest report, recently published in Psychiatry Research: Neuroimaging, suggests that behaving altruistically, and placing a high value on others, offers neuroanatomical protection against a recurrence of depression. We are set free from suffering when we go beyond our concerns to care for other people.
Spirituality is not so much a belief as a capacity for perception.
This research began when a Columbia University Medical School team I was a part of published a paper that reported a remarkable finding, involving people who report possessing a strong personal spirituality. (To be clear, spirituality and religion are two different things. Religion is environmentally transmitted. Our capacity for spiritual awareness, by contrast, is innate, as twin-studies have shown. Spiritual awareness is experienced as a kind of transcendent relationship with a higher power, God, or the universe, and might be felt as a sense of oneness, a two-way relationship, or the presence in and through nature, as told in many indigenous traditions. This heritable endowment of human spirituality is not so much a belief as a capacity for perception, which research shows has great deal to do with recovery from depression.)
In our 2012 study, subjects (at a mean age of 26 years) with a strong personal spirituality were 2.5 times more likely than people who report low levels of personal spirituality to have suffered from depressio