Jonathan Rottenberg

But it was a gradual process.

The prevailing model that we have of depression is that depression reflects some fundamental defect that is inside the depressed person.

That defect might be in the person's mind, like the way that the person thinks.

Or that defect might be in the person's brain, like in the chemicals that are circulating.

between the neurons, or that defect might be in how the person is interacting with other people.

But in the final analysis, the reason that people are depressed is that they have some fundamental defect or defects inside themselves that explain why they are subject to episode or repeated episodes of depression.

People have been studying the biological contributions to depression for 50, 60, 70 years.

And I do believe that part of depression involves biological factors, but that's very different from saying that there is a biological cause, a single cause in the brain.

And

The search for antidepressants has led to a large number of therapies.

There's over 20 different antidepressants, but none of them could be called a cure.

And I do think it's a bit misleading, this metaphor that's often used to talk about a chemical imbalance.

Because that imbalance has never been isolated.

It's never been fully characterized.

It can't be measured.

And so what you have are treatments which are useful for many people, but it relies on a metaphor.

The patient comes in and wants help.

The physician or psychiatrist might tell them that they have a chemical imbalance, but the problem is you can't present to them their number, and you can't show that the treatment is changing that number.

So you're really engaging in hand-waving.

And I don't think that's doing a full service to our level of knowledge and being fully candid with people who are really struggling.