There are many things about depression that are a mystery, but certain ideas can be dismissed.
Following a publication in El Mundo (digital version) in 2015, various misconceptions about depressive disorder were exposed . Sanz and García-Vera (2017), from the Complutense University of Madrid, have carried out an exhaustive review on this subject in order to shed some light on the veracity of the information contained in that text (and many others that today they can be found on countless psychology websites or blogs). And it is that in many occasions such data seem not to be based on proven scientific knowledge.
The following is a list of the conclusions supposedly accepted and published by the Editorial Board of the DMedicina portal (2015), the same group of specialists that carries out the edition in El Mundo. These ideas refer both to the nature of depressive psychopathology as well as to the efficacy indices of the psychological interventions applied for its treatment.
Misconceptions about Depressive Disorder
When it comes to misconceptions about depression itself, we find the following.
1. When everything in life is going well for you, you can get depressed
Contrary to what is published in the article in El Mundo, according to the scientific literature this statement should be considered partially false, since the findings indicate that the relationship between previous life stressors and depression is stronger than expected. Furthermore, depression is given a connotation of illness, which entails attributing more biological than environmental causality to it. On the latter, science affirms that there is a small number of cases of depression without a previous history of external stressors.
2. Depression is not a chronic illness that never goes away
From the El Mundo article, depression is considered to be a condition that never goes away completely, despite the fact that the arguments that support it are not completely true.
First of all, the wording in question states that the efficacy rate of the pharmacological intervention is 90%, when in many meta-analysis studies carried out in the last decade (Magni et al. 2013; Leutch, Huhn and Leutch 2012; Omari et al. 2010; Cipriani, Santilli et al 2009), an approximate percentage of 50-60% of efficacy is given to psychiatric treatment, depending on the drug used: SSRI or tricyclic antidepressants.
On the other hand, the authors of the review article add that in the conclusions of a recent meta-analysis (Johnsen and Friborg, 2015) on 43 researches analyzed, 57% of patients were in total remission after a cognitive-behavioral intervention, so A similar efficacy index can be established between pharmacological prescription and empirically validated psychotherapeutics.
3. There are no people who fake depression to get sick leave
The wording of the portal states that it is very difficult to deceive the professional by simulating depression, so there are practically no cases of feigned depression. However, Sanz and García-Vera (2017) present the data obtained in various investigations in which the simulation percentages of depression can range between 8 and 30%, the latter result in cases where workers’ compensation is linked.
Thus, despite the fact that it can be considered that in a greater proportion the population that is visited in primary care is not simulating said psychopathology, the statement that there are no cases in which this casuistry does not occur cannot be considered valid.
4. Optimistic and extroverted people get as depressed or more depressed than those who are not.
The article we are talking about defends the idea that due to the greater emotional intensity of optimistic and extroverted people, these are the ones who are most likely to suffer from depression. On the contrary, the list of studies presented by Sanz and García-Vera (2017) in their text affirm precisely the opposite. These authors cite the meta-analysis by Kotov, Gamez, Schmidt and Watson (2010) where lower rates of extraversion were found in patients with unipolar depression and dysthymia.
On the other hand, it has been indicated that optimism becomes a protective factor against depression, as corroborated by studies such as those by Giltay, Zitman and Kromhout (2006) or Vickers and Vogeltanz (2000).
Misconceptions about Depressive Disorder treatment
These are other errors that can be made when thinking about psychotherapeutic treatments applied to depressive disorders.
1. Psychotherapy does not cure depression
According to the article in El Mundo, there is no study that shows that psychological intervention allows depression to subside, although it does assume that it can be effective in the presence of some milder depressive symptoms, such as those that occur in Adjustment Disorder. Thus, he argues that the only effective treatment is pharmacological.
The data obtained in the Cuijpers matanálisi, Berking et al (2013) indicate the opposite to this conclusion, since they found that Cognitive Behavioral Therapy (CBT) was significantly superior to the waiting list or to the usual treatment (consisting of various psychotropic drugs , psychoeducation sessions, etc).
In addition, the data previously provided on the study by Johnsen and Friborg (2015) corroborates the falsehood of this initial statement. In the text, the efficacy proven in studies on Behavioral Activation Therapy and Interpersonal Therapy is also exposed.
2. Psychotherapy is less effective than antidepressant medication
In accordance with the above, there are more than 20 investigations collected in the meta-analysis by Cruijpers, Berking et al (2013), which is cited in the article by Sanz and García-Vera (2017) that proves the absence of difference in efficacy between CBT and antidepressant drugs.
It is partially true that it has not been possible to demonstrate greater efficacy in other types of psychotherapeutic interventions other than CBT, for example in the case of Interpersonal Therapy, but this conclusion cannot be applied to CBT. Therefore, this idea must be considered as false.
3. Treatment of depression is long
In El Mundo it is stated that the treatment of severe depression should be at least one year due to the frequent relapses that are associated with the course of this type of disorder. Although scientific knowledge agrees to establish a high relapse rate (between 60 and 90% according to Eaton et al., 2008), they also show that there is a brief psychological therapy approach (based on CBT) which has a significant efficacy index for depression. These interventions range from 16 to 20 weekly sessions.
The aforementioned meta-analyzes indicate a duration of 15 sessions (Johnsen and Friborg) or between 8-16 sessions (Cruijpers et al.). Therefore, this initial hypothesis should be considered false based on the data presented in the reference article.
4. The psychologist is not the professional who treats depression
According to the editorial group of El Mundo, it is the psychiatrist who carries out the intervention of patients with depression; the psychologist can take care of depressive symptoms, milder than depressive disorder per se. Two conclusions are drawn from this statement that have already been refuted previously : 1) depression is a biological disease that can only be addressed by a psychiatrist and 2) psychological intervention can only be effective in cases of mild or moderate depression, but not in cases of severe depression.
In the original text by Sanz and García-Vera (2017), some more misconceptions than those presented in this text can be consulted. This becomes a clear example of the trend, increasingly common to publish information that is not scientifically proven enough. This can lead to a significant risk since nowadays any type of information is available to the general population, causing a biased or insufficiently validated knowledge. Such danger is even more disturbing when it comes to health issues.
- Sanz J. Y García-Vera, MP (2017) Wrong Ideas about Depression and its Treatment (I and II). Papeles del Psicólogo, 2017. Vol 38 (3), pp 169-184.
- Drafting of CuidatePlus (2016, October 1). Misconceptions about depression. Retrieved from http://www.cuidateplus.com/enfermedades/psiquiatricas/2002/04/02/ideas-equivocadas-depresion-7447.html
- Drafting of DMedicina (2015, September 8). Misconceptions about depression. Retrieved from http://www.dmedicina.com/enfermedades/psiquiatricas/2002/04/02ideas-equivocadas-depresion-7447.html