The term "depression" is a misleading catch-all. Two people diagnosed with it can have completely opposite symptoms, such as oversleeping versus insomnia or overeating versus appetite loss. These are not points on a spectrum but discrete experiences, and lumping them together hinders effective, personalized treatment.
The history of depression treatment shows a recurring pattern: a new therapy (from psychoanalysis to Prozac) is overhyped as a cure-all, only for disappointment to set in as its limitations and side effects become clear. This cycle of idealization then devaluation prevents a realistic assessment of a treatment's specific uses and downsides.
While lifestyle changes like diet and exercise are effective for mental health, their utility is primarily preventative. During an acute depressive episode, a person often lacks the motivation to implement them. Framing these interventions as a way to maintain stability during periods of wellness is a more realistic and sustainable approach.
Social inequalities are a major risk factor for depression, making it a political problem. However, this is not a reason to deny medical treatment. Like other diseases of inequality such as AIDS or COVID-19, individuals need medical help now and cannot wait for underlying societal issues to be resolved.
In its rush for the next breakthrough, the field of psychiatry often discards older, effective treatments due to historical stigma. For instance, MAO inhibitors and modern, safer Electroconvulsive Therapy (ECT) are highly effective for specific depression types but are underutilized because of past negative associations, a phenomenon driven more by politics than science.
Contrary to the colonial-era view that depression was a "Western" disease, community-based psychotherapy models are now flowing from low-income countries to high-income ones. For example, a successful Zimbabwean program using grandmothers as therapists to address social issues like poverty and abuse is now inspiring similar community healthcare initiatives in the US.