The recently-declared campaign on depression is reminiscent of the war on cancer that has been waged for the last two decades in the US:- In both cases there is a sharply-focussed goal in the form of a dragon for which we seek a destructive laser-guided missile. No such missile has been found for cancer, but the investment has led to considerable advances in our understanding of cancerís diverse mechanisms as well as a more balanced outlook that gives equal weight to prevention. In the case of depression, perhaps we would do well to heed this parallel and invest in a balanced, diverse, even idiosyncratic, approach to research into depression instead of blindly adopting the US magic bullet metaphor.

The dangers of tunnel vision are illustrated by the continuing controversy over the very popular anti-depressants that work by blocking serotonin reuptake (so called SSRIs such as Prozac, Zoloft, Luvox, Effexor etc). Such a large proportion of the US population is now taking these relatively stable compounds  that there are reports of them turning up in small amounts in the water supply. Two recent books, by Dr. David Healy at the University of Wales and Dr. Joseph Glenmullen at Harvard University, have drawn attention to the dangers of indiscriminate use of these chemicals, in particular suggesting that they increase the risk of suicide and other serious side effects to a larger degree than advertised. There are numerous counterclaims to the two studies, so I do not want to overemphasise these risks, just to point out the dangers of overreliance on magic bullets whose mode of action is still obscure despite the 40 million consumers of them. Some subjects need a mood stabiliser more than they need an anti-depressant, which may even increase their problems, rather than solve them. By increasing the sensitivity of left brain over right brain, SSRIs can cause impulsiveness, for example, with an increased risk of suicide in someone emerging from depression.

My guess is that Virginia Woolf and Winston Churchill would both have been such individuals, suffering severe depressions for which so-called ìanti-depressantsî would have been useless despite their name. Because neither had manic swings that required hospitalisation, but did have severe depressive swings, Woolf and Churchill are celebrated bipolars who are often not recognised as such despite the clear hallmarks of bipolar disorder in their clinical and family history. The term ìbipolar depressionî is used to describe these recurrent swings that have a bias toward the depressive side without obvious manic swings. Once recognised, bipolar depression usually responds well to mood stabilisation. It is underdiagnosed, partly because of the exclusive focus on the dragon of depression rather than on the more subtle concept of mood stabilityÖÖthat natural rhythm of swing between the complementary viewpoints of the brain that seems to be altered in bipolars. Mood stabilisers have an obscure mode of action and can be medications (such as lithium and valproate ions), dietary supplements (e.g. Omega 3 fatty acids from seafood), as well as a variety of life style interventions.

A recent survey showed that self-reported happiness was greatest amongst citizens of the US and India, despite the negligible use of anti-depressants and vastly lower level of material well-being in the latter nation. In searching for an explanation, I suggest that we keep in mind the complex and paradoxical cultural web that constantly exercises and gives muscle to the right brain in India, compared with the more linear goal-oriented right-brain-deprived culture of the US.

 It seems that it may be possible to bewitch the dragon into submission with a diverse strategy, rather than adopting a military strategy that inflates its own target.