Woe be gone: Why it might not be healthy to medicate away sadness

Misery is inconvenient, unpleasant, and in a society where personal happiness is prized above all else, there's little tolerance for wallowing in despair.

Especially now that we've got drugs for it.

Antidepressants can help banish sad feelings - not just the life-sapping black dog of clinical depression, but the rough patches most people go through sometimes, whether it's after losing a job, the break-up of a relationship or the death of a loved one. So it's no surprise that more and more people are taking them.

But is this really such a good idea? A growing number of cautionary voices from the world of mental health research are saying it isn't. They fear that the increasing tendency to treat normal sadness as if it were a disease is playing fast and loose with a crucial part of our biology. Sadness, they argue, serves an evolutionary purpose - and if we lose it, we lose out.

"When you find something this deeply in us biologically, you presume that it was selected because it had some advantage, otherwise we wouldn't have been burdened with it," says Jerome Wakefield, a clinical social worker at New York University and co-author of "The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder" (with Allan Horwitz, Oxford University Press, 2007). "We're fooling around with part of our biological make-up."

Perhaps, then, it's time to embrace our miserable side. Yet many psychiatrists insist not. Sadness has a nasty habit of turning into depression, they warn. Even when people are sad for good reason, they should be allowed to take drugs to make themselves feel better if that's what they want.

So who's right? Is sadness something we can live without or is it a crucial part of the human condition?

Hard evidence for the importance of sadness in humans is difficult to come by, but there are lots of ideas about why our propensity to feel sad might have evolved. It may be a self-protection strategy, as it seems to be among other primates that show signs of sadness. An ape that doesn't obviously slink off after it loses status may be seen as continuing to challenge the dominant ape - and that could be fatal.

Wakefield believes that in humans sadness has a further function: it helps us learn from our mistakes.

"One of the functions of intense negative emotions is to stop our normal functioning, to make us focus on something else for a while," Wakefield says. It might act as a psychological deterrent to prevent us from making those mistakes in the first place. The risk of sadness may deter us from being too cavalier in relationships or with other things we value, for example.

We may have evolved to display sadness as a form of communication, says Paul Keedwell, a psychiatrist at Cardiff University in the UK. By acting sad, we tell other community members that we need support.

Don't be happy, worry

There's certainly nothing wrong with an abundance of happiness, but it can be bad for your career. Ed Diener, a psychologist at the University of Illinois in Urbana-Champaign, and his colleagues found that people who scored 8 out of 10 on a happiness scale were more successful in terms of income and education than 9s or 10s - although the 9s and 10s seemed to have more successful close relationships.

This could simply demonstrate that the happiest people are those who cherish close relationships over power and success, but it could also signal that people who are "too happy" lose their willingness to make changes to their lives that may benefit them.

Medicating sadness, Keedwell suggests, could do the same - blunting the consequences of unfortunate situations and removing people's motivation to improve their lives. Giving antidepressants to people whose real problem is something else - a bad relationship, for instance - might allow the person to continue in an unhealthy situation instead of addressing the underlying problem.

Whether or not a little sadness is useful, everyone agrees that clinical depression is not. Unfortunately it's not clear exactly where to draw the line between the two. So which is more dangerous: to over-medicate normal sadness, a feeling which may lead us to re-evaluate our lives after the loss of a job or the end of a relationship, or under-medicate clinical depression?

Ian Hickie of the Brain and Mind Research Institute at the University of Sydney, Australia, insists that depression is not overdiagnosed but would rather it were than see seriously depressed people left out in the cold. He points out that there is evidence to suggest that the number of suicides has declined as more cases of depression have been diagnosed. It's important to take borderline diagnoses of depression seriously, he says, because "most of the suicides do not occur in the most severely depressed."

Wakefield, however is uneasy about prescribing pills where there is no certainty that they are needed. After all, he points out, antidepressants have side effects, some of them serious.

The need for sad

So where does this leave the notion of human sadness? Should we accept that major life events may make us so sad that we are temporarily disabled? Or should we head to the doctor in the hope that pills will speed up our emotional journey back to happiness?

Ken Kendler, a psychiatrist at Virginia Commonwealth University, Richmond, points out that for some people, sadness is definitely something they're better off without. He recalls a mother in her late 20s who came to him because she had an inoperable defect in her aorta that would rupture at some undeterminable time in the future, killing her instantly. This knowledge had made her depressed - certainly with reasonable cause - but she didn't want to live the rest of her days that way, unable to function for her family.

"That seemed to me to be an irreproachable logic on her part," Kendler says. "I started her on antidepressants. She came back much brighter. The idea that I was depriving this woman of the proper grieving experience and preventing her from experiencing deeply the meaning of this rang very hollow in this particular case."

For those of us not faced with such an extreme problem, Terence Ketter, a psychiatrist at Stanford University in California, is more cautious. "The cost of happiness is complacency," he says. Sadness is still something useful: "Discontent can drive change. Certainly, you don't want to stifle or blunt emotion - emotion is information."

Keedwell agrees. "Clearly, if we didn't feel sad when we were unsuccessful at achieving certain goals, we would not stand back from that goal and introspect and perhaps try to change our strategies," he says. "Being enthusiastic and jubilant, we would probably go blindly on."

So is there some middle ground? Both sides agree that there are ways to lift the gloom without pills. "An alternative would be thinking about what is making you unhappy," says Wakefield. "Another possibility is watchful waiting. A more nuanced view of the situation will help people think about their options better."

Diener also suggests we stop obsessing about being happy all the time. "One of the things we want to do is disabuse people of the notion that they're not happy enough," he says. He cites a study that used emotion-recognition software to work out the Mona Lisa's inner feelings. It concluded that she is 83 percent happy. The rest is a mix of negative emotions like fear and anger. That, it seems, is just about right.

<p class="factboxheadblack">Sad or depressed?</p> <p class="News">If you've experienced five of the symptoms below for two weeks or more, including at least one of the first two, you meet the diagnostic criteria for major depressive disorder:</p> <p class="News">• Depressed mood</p> <p class="News">• Reduced interest or enjoyment in normal activities</p> <p class="News">• Loss or gain of weight or appetite</p> <p class="News">• Insomnia or excessive sleep</p> <p class="News">• Fatigue or loss of energy</p> <p class="News">• Feelings of worthlessness, or excessive or inappropriate guilt • •Indecisiveness or reduced ability to concentrate</p> <p class="News">• Agitated motion like pacing or hand-wringing, or physical slowing down</p> <p class="News">• Thoughts of death or suicide</p> <p class="News">This definition, introduced in the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders in 1980, changed the definition of depression from something that depended on the context of an individual's life circumstances to a more objective list of symptoms.</p> <p class="News">There is one notable caveat. According to the criteria, if you have these symptoms after the death of a loved one you are not considered to be depressed, but suffering a normal reaction to bereavement.</p> <p class="News">Some say that bereavement isn't the only type of grief that should be left out of a diagnosis of depression. Jerome Wakefield of New York University is one of them. He says that other losses, like divorce, illness or loss of a job should also exempt people from a diagnosis of depression because these unhappy but commonplace events can trigger similar symptoms.</p> <p class="News">"It does make one worry that any negative emotion (except the grief of bereavement) that disrupts your ability to function in a happy manner could be classified as a disorder," he says.</p> <p class="News">Other researchers, though, feel the opposite is true: that far from being excluded, anything that creates depressive symptoms - grief included - should be diagnosed as clinical depression and treated accordingly.</p> <div class="infoBox"> <h1>More Coverage</h1> <div class="infoBoxContent"> <div class="infoArea"> <h2>Stories</h2> <ul class="links"> <li><a href="/story/?id=335803">A pill for every ill</a></li> </ul> </div> </div> </div>