This week's column has been prompted by some phone calls from people with depression. The calls came through to us shortly after the Tonight with Vincent Browne show on RT╔ Radio 1 dealt with the topic.
I contributed to the show - one of three doctors to do so - so the observations I am about to make reflect the concerns of the listeners rather than any objective analysis on my part.
The most striking reaction we received was from a male caller who was extremely upset at the marginalisation he felt after the programme. As someone who was on long term anti-depressant medication, which he credited with giving him a quality of life he would otherwise not have, he now felt a fraud and somewhat of a social outcast.
Tonight with Vincent Browne was discussing whether there was a biological basis for depression. Both Ivor Browne and Terry Lynch, the other two doctors who contributed, would tend towards a position which would be sceptical of demonstrable biochemical changes in people who suffer from depression.
However I have no problem with the evidence which suggests that there is indeed a biochemical basis for the disease, in which the levels of so-called neurotransmitters drop as the disease worsens. A corollary is that anti-depressant medication will boost the levels of noradrenaline, serotonin and other chemicals in the brain and the person with depression will begin to improve.
But I do not have an evangelical view of these matters and I am happy to acknowledge that other treatment methods, such as cognitive behavioural therapy, work equally well as anti-depressant medication in cases of mild and moderate depression.
I did express a strong view that patients with severe depressive illness - those who are bed bound by the disease and who lose weight and rapidly become physically unwell as result of a psychological condition - should not be denied medication.
However, I am disappointed that listeners to the programme, who take anti-depressants as a means of staying well, felt marginalised by it. There should be no question of anyone with a defined illness feeling they are a second-class citizen. And if people do, I have two points for them to consider. One is for them to realise that depression, in my view, is no different from diabetes. In one you take insulin and in the other you take Prozac or some other anti-depressant. Both substances are simply designed to replace natural chemicals missing from the body.
The second is that there is a "re-balancing" taking place within the field of psychological medicine at present. Psychiatry has enjoyed a "biological phase" in which a considerable number of practitioners have followed the chemical route to curing their patients. If there is a trend at present, it is towards the psychotherapeutic approach favoured by the other contributors to the radio programme.
But it appears that even those of a confirmed biochemical persuasion wish to see a re-definition taking place. Prof Patricia Casey, professor of adult psychiatry at UCD and the Mater Hospital, has written an editorial in the current edition of the British Journal of Psychiatry, in which she criticises the over-rigid diagnostic criteria for depression contained in international classifications of disease.
"As psychiatry focuses more and more on 'serious mental illness' and increasingly allies itself with the biological sciences, psychiatrists understandably tend to view 'depression' as a biological entity. Thus, transient depressive responses to stressful events are increasingly regarded as illness," she says. Her editorial is titled: 'Adjustment Disorders - Faultline in the Psychiatric Glossary' and is a lament for the lost art of psychiatric diagnosis in which the various nuances of different patients' presentations were synthesised on a case-by-case basis by the doctor. By adopting a cookbook approach, there is a danger that psychiatrists will over-diagnose major depressive illness and underdiagnose adjustment reactions or transient illnesses related to stress.
But back to our distressed caller. My advice is to ignore all evangelical approaches to this subject, from whichever end of the spectrum they come. Absolutism is rarely a good medical bed fellow. A wise old professor once told us that you should "never say never in medicine". In other words, today's dogma will very likely become tomorrow's well-diluted theory.
You can e-mail Dr Muiris Houston, Medical Correspondent, at mhouston@irish-times.ie or leave a message on 01-6707711. He regrets he cannot reply to individual medical problems