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Sadowsky: First, not many of the books about depression are histories. Take The Noonday Demon: An Atlas of Depression by Andrew Solomon, PhD.1 I think it is great, but it only has a single chapter on history, and it is a brief account. With a few exceptions, most of the history books are focused on antidepressants, and many other treatments have important histories—psychodynamic psychotherapy, cognitive behavioral therapy (CBT),electroconvulsive therapy (ECT), and the many approaches that preceded the 20th century, for example.A couple of long, detailed histories of depression barely mention ECT. This is weird. I know opinions about ECT are divided—my book about ECT is also a book about controversy—but whatever you think about ECT, many psychiatrists consider it among the best treatments psychiatry has for serious affective disorder. Imagine for a moment a historian of medicine in another specialty writing a long history of a particular ailment and skipping briefly over a treatment many doctors say is among the most effective! Previous histories of depression have also been a bit weak on psychoanalysis, which is a strong interest of mine.
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Sadowsky: Many individuals look at the high numbers of individuals with a depression diagnosis compared to previous times and take it as self-evident that we are over-diagnosing. It is not. Rising diagnosis rates is a valid reason to be concerned about over-diagnosis, but it is not proof. In 1950, much of psychiatry was concerned that we were under-diagnosing depression, so from that perspective, we may be finding a lot that we had been missing. We should at least consider the upside: More diagnosis means that more individuals who could use professional help are getting it.As for medicating the normal pain of living, we should keep in mind that getting treatment for depression, whether in psychotherapy or with antidepressants, does not protect anyone from suffering, though one hopes it is reduced. Life remains hard. And many patients with depression welcome sadness as a relief from feelings of deadness or numbness inside.
