I hate shrinks. Shrinks should die. Shrinks are evil. (Thank the commenters (not an individual) for that.) OK I get it, you don’t like psychiatrists. Personally, I would find a more intelligent way to express an argument, but your point is clear nonetheless. You’re ranting. I get that. I rant. We all do. It’s a healthy expression of the frustration seen when dealing with so many things outside of our own control. But at some point you have to stop hating, wishing for murder and committing moral condemnation and actually do something useful.

In my last article on the biological evidence for depression I discussed evidence in genes, hormones, monoamines (like serotonin) and neuroimaging. Today I’ll finish off the research areas for the biological evidence of depression and suggest what I think all this biological evidence means.

Common messages spread by certain special interest groups are that “mental illness doesn’t exist” and “there is no biological evidence for mental illness.” It’s not surprising I take great exception with these claims. So do most doctors. But the brain is an extremely complex organ and refuting the above notions is hard. It’s not a two-word response. So, I’m going to attempt to give a two-part overview, in plain English, of some of the research around the biology of major depressive disorder according to a meta-analysis done in 2010 (see below).

I was recently having lunch with a woman who has a series of medical issues, including pain management. One of the medications she is on is oxycodone. She said she would like to get off of the oxycodone but when she has tried, the pain has been unbearable and no other pain medication would touch her pain. So I asked her, "if this medication is working for you and other medications don’t work, then why are you trying to get off of it?" She said it was because of the stigma attached to that medication. So I told her something important – you can’t let stigma make your treatment decisions.

There is a common refrain that if you looked in the DSM, everyone would have some mental disorder. And in point of fact, many symptoms are fairly generic and can be attributed to many. Fatigue, insomnia, thoughts of death, loss of pleasure and weight loss are part of the depression diagnosis. But the part no one seems to remember is what’s under that, The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Some people believe that being crazy makes you creative (perhaps brilliant) and being creative makes you crazy. Similarly, along this line of logic is that taking medication makes you uncreative and perhaps, un-brilliant. Well, pish-tosh I say.

Last week I waded into Charlie Sheen territory. It was, perhaps, a touch more eel-infested than I had anticipated but life is surprising like that. Yes, I said Sheen is going through a manic episode as part of a mental illness. (And no, I still haven’t become a doctor.) Let’s say for the moment, I’m right. Since I made my case for compassion for Sheen and mental illness, over scorn and ridicule, people have made the case back that it’s the media’s fault Sheen’s behavior is this out of control. I don’t think so.

I know this seems like an odd question, but I was considering it this morning (in my shower). It is a common problem for people with a mental illness. I have a tendency to avoid showering (really) and I know of others with a mental illness have gone weeks without showering. So, if all we’re talking about is standing in some warm water, why don’t we want to shower?

People throw around the word “depression” as if that word means only one thing. This is far from the case, therapeutically speaking. I would suggest there are mild, moderate or severe, relapsing/remitting or chronic depressions. Doing the basic math, that’s six types right there and we haven’t even taken into account treatment-resistant depression, or the depression subtypes noted in the DSM. Depression is not a disease; it’s a cluster of diseases.

I’m not known for my cheery everything’s-going-to-be-OK-puppies-rainbows-lollipops perspective. In fact, I’m against such perspectives. I find them disingenuous, phony, or seriously ill-informed. Save the rose-colored glasses for Sir Elton John, thank-you. I find smiling, being positive and telling people how great everything is to be just another chore on my list of things to do today when I’m already busy just trying to keep breathing and possibly pay rent.