This article makes some good points. Most people would agree that labels shouldn't be thrown around carelessly, and that talking is preferable to medication, which should be a last resort not a first. Where things get slightly muddled, though, is in trying to precisely differentiate the two. It is not the nature of someone's misfortune that determines whether someone needs help, it is the degree to which it affects an individual's ability to function. That degree will vary from person to person, spanning a whole spectrum from those you might call "normal" to something requiring intervention.

MFR, London,

I'm sorry to say it, but Sickness is "Big Business", especially in the United States of America, where the ethical drug culture is mega, as are the profits.
India, you mention £291 million being spent by the NHS, in 2006 - for these 2 drugs alone.
"Something for Nothing" and that is what the NHS has become, has bred an "I Want" attitude and doctors find themselves inundated with "Well " people who have read in some magazine - or heard from some chat show on TV - that they are displaying symptoms.
In another article, the behaviour of NHS nurses has attracted 166 hits & rising daily.
The NHS may have been necessary in 1950, when standards in hospitals were high; when doctors cured the sick; before America flooded the market with expensive placebos.
But that was then and it must surely be time to stand back & review this Monster NHS.
In Cuba, they have found a cure for meningitis, using herbal sources.
The FDA in the USA refuse to licence this cure.
Why?
It says it all.

MR. MYLES STANISTREET, NERAC, FRANCE 47

Food was your drug. You did not take Prozac, but managed to become 16 stone

elena, milan, italy

I agree with you India, but my question is, why the people in this 21st century, can´t talk about their feelings openly? maybe is because our relationships are based only in the appearance and the benefits they could bring us. Maybe is time to look to each other and take the time to tell what we really want to say , not what we have to say in order to be cool with others.

Luis Aylwin, Valparaíso, Chile

Good thinking.
Replace possibly ineffective but cheap drugs with expensive and largely useless counselling.

BrummyDoug, Birmingham, England

I completely agree with this article. Drugs are not the solution to life situations. They just create addiction and even if they seem to "help" people to cope watch out for the long term effects they can create. At present I've got a Petition on-line regarding side effects of psychotropic drugs. If you would like more info, read about this on http://petitions.pm.gov.uk/Drug-Warnings/ I found very important to raise public awareness of what these drugs can cause. When facing difficult situations about yourself, family, work, etc. don't take the road of no eating and feeling down. In moments like that your body needs proper diet, vitamins and exercise so your mind can be in a much better condition to find solutions rather than getting overwhelmed with the problems.

Yolanda Fletcher-Buitrago, London,

prozac and the like are life saving drugs! the British attitude of having a stiff upper lip is old and tired! mental illness is a diease and you can not talk your way threw it! some people are on anti-deppresents without cause but, that is not true of the majority of users! maybe as many people would not be drunks if they were not ashamed to deal with their menatl illness! when the meta analysis comes out on cognitive therapy one day you will see it is a placebo effect at best!! in the mean time stop giving out advice to those suffering from clinical depression, anxiety etc.. and I will agree not to dispense advice on diabetes and parkinson's!!.

cain greec, opa locka, florida usa

Spot the article written by a person who has never suffered from clinical depression.
I always considered myself one of life's "copers". I come from the "buck up - don't be pathetic" school. However, years of exhaustion - two small children, one with aspergers, a busy job, a difficult husband, his affair, my redundancy, a divorce, a 6 month search for a job & I was worn into depression.
I had no option but to keep going, as the sole carer of two very small children. However, I was in the darkest, bleakest mental place I have ever known. I had no idea what was wrong with me. I couldn't understand why I felt so apathetic and unable to cope. I kept giving myself mental talking tos - but one day when I found myself genuinely contemplating suicide I knew that something was very wrong with me.
Anti-depressants gave me my cope back. They enabled me to get through the most awful 3 years of my life and hold my children & family together. That has to be good.

Fiona, London, UK

My little sister desperately needs counselling. My Mum left when she was just 14 and she came to live with me aged 16 (I was 18). She's now 22 and additcted to prescribed anti-depressants. Friends and family cannot help her, as people with depression often push those closest to them away. I'm so angry with the irresponsible GP who thoughtlessly doled out medication after a 4 minute consultation, when she was only 17. Anyone, medically trained or not, should have seen that all she needed was a good chat and some reassurance. If anyone can offer any advice I would be grateful. Her life is a constant downward spiral.

Gemma, Worcestershire, UK

I picked up a copy of the Sunday Times yesterday and enclosed was aCD_ROM games of scrabble.

I have tried several times to load it into my computer but it will not let me play.

Is it possible to send me a replacement.

Mrs J Eames, Southend on Sea, Essex

SJP, you would have done well to read Kate Lee's post below yours, and indeed to have actually read the entire article. India Knight is clearly drawing a distinction between genuine depression (whose existence she fully acknowledges) and 'unhappiness'. You have read in this article only the parts you want to read, and ignored what she is actually arguing.

Nick, London,

I usually enjoy India's articles, but this made me think India has been very fortunate. Real depression isn't just fixed by pulling yourself together. It is a black hole where if you desire anything at all it is probably death. Being told to buck up just makes you feel more useless, because maybe that is just another of the list of things you feel incapable of doing.

SJP, London, UK

I do rather worry about the reading comprehension of people here. The article is clearly seeking to differentiate between normal, human sadness, and clinical illness. The latter can be helped by medication, the former cannot. Having suffered from depression so severe I was hospitalised and needed three kinds of medication to avoid suicide, I was very able to distinguish the difference when my mother's cancer diagnosis made me very unhappy indeed. I refused medication then, because I was not ill; I was miserable.

India is right. Mental illness is a scary, bleak and frightening thing, but it isn't anything like the sorrow we experience when the slings and arrows of outrageous fortune manage a particularly direct hit - for a start, depressed people don't feel much, other than fear and hopelessness. Drugs are a useful way of lifting mood in clinically unwell people. They are not a one-size-fits-all panacea for the human condition, and personally, I wouldn't want one.

Kate Lee, London, UK

I agree with Clive. Serious depression - clinical, inexplicable, or linked to catastrophic adverse circumstances is one thing, but sometimes the solids just hit the air-con and we all get depressed and we need to respect this and tough it out. Just listen to the lyrics of 'Rehab' by Amy Winehouse. None of us is immune from the slings and arrows of outrageous fortune and nor should we expect to be. We are an exceptionally lucky, pampered society and have grown spolied. In the words of the inestimable author Cynthia Heimel - "Heartbreak is horrible, but we dancing girls must keep on dancing!"

Sally , New York, USA

id like to suggest another factor here - hormones .... we are still chock full of them after we have given birth - we also have a 6 week period to cope with that no one ever bothers mentioning - surely the loss of the pregnancy hormones and the bodies readjustment to non pregnancy have a part to play ? When teens are depressed it is recognised that this is due to adjusting to the rush of hormones that carry the body from childhood to adulthood - same goes for the reduction of hormones in men and women in their 30's and 40's . Unfortunately there is no real benchmark for these changes on either aa general or individual basis so as its not cureable its dismissed as a solution - in fact woe betide anyone that mentions it to the "hormonally challanged" maybe we should see more life is a journey of ups and downs including physical ones and recognise the damage done by trying to control the changes the ageing process brings at all ages

f clarke , newcastle upon tyne , uk

I went to my local NHS surgery feeling out of sorts a while back (insomnia, lack of motivation, low energy, etc...) and was expecting to have blood tests tell me I was anaemic. Instead the GP referred me to a psychiatrist who diagnosed me with what he called "moderate to severe clinical depression."

The label was not in the slightest bit reassuring; it frankly scared the he|| out of me.

I should point out (to the doctor's credit) he told me flat out that he didn't want to put me on any sort of pills and that he doubted the efficacy of SSRI's anyway. I was put on various cognitive and behavioural therapies, spent some more time talking to said doctor, and I got well.

Point of the story: in my experience, the NHS was extremely reluctant to feed me Prozac and Seroxat. The doctor used very carefully engineered psychiatric techniques combined with an excellent bedside manner; I was only on the wait-list for 3 weeks. Not bad for our under-funded over-criticized institution.

PK, Borough, London,

"real life intrudes. Landlords/lenders, the taxman, and power companies demand payment; employers demand product; family and friends demand presence that resembles cheer. ...
Ellen, London"

Sorry, Ellen, that's not depression -that's just normal life.

"Sufferers" should do what everyone else does
-take a day or two off work
-go out with friends
-get drunk
-whatever

but DON'T take anti-depression pills simply for that (life), 'cos it ain't ever going to go away

Clive, Surrey,

..Is this possibly a valid but not very eloquently writen article? Some of the points raised seem valid (e.g. "GPs handing out Prozac like sweeties"), but the reader is, most likely wrongly, led to conclude that India lacks understanding of depression as a psycological condition, especially when statements like "I also think that people need to buck up and understand that life isn’t a serene horizontal line but one that is interspersed with a series of zigzags" are made. Perhaps, however, these statements were intentional to provoke debate...

Kyri, Kingston, UK

brilliant. your attitude to depression is basically "cheer up". oh thats helpful. useful and so very much what comes from the neurotypical when they think they can talk about mental illnesses and disorders.

Catherine, Newcastle,

After suffering bereavement, work place bullying and having to resign from my dream job( all in a space of 2 years), my body and mind could not take any more. I'd 'bucked up' and trudged through it all because what had happened to me was not unique to me - 'everyone has highs and lows' they said.

Granted I never told a soul what was really going on in my life, because 'everyone goes through rough patches', but my friends and family were aware that I'd changed and was not the same as before.

My moment of truth came after engaging in some uncharacteristically risky behaviour, I decided to go to my GP. He prescribed Seroxat and after a few weeks, I'm feeling like I'm able to function like an ordinary person. The need to hide and sleep every waking moment has gone, I even manage to walk for 50 mins a day. Looking after myself is now easier, and even though I am broke, I don't feel despondent like before. And I'm still on the NHS therapy waiting list.

But I have hope...

Vicky, London,

At the risk of further offending the depressed, I would say two great treatments have not yet been mentioned - 1) aerobic exercise and 2) doing something to help someone else.

In my experience, a combination of talking plus positive action such as the above can help release stuck emotions such as grief, guilt and anger that are often at the root of depression.

Yes I've been depressed. Yes it's not fun walking around a pretty village on a sunny day with tears pouring down your face, not even knowing why you are crying. But do this every day and one day you will have no tears left, only insight.

Rachel, Bath,

I remember my cousin having a baby and I asked her how she was and she said, not too good. She was the first mother I heard actually say that. And to me it was reassuring and honest. Who wouldn't be scared, feeling slightly overwhelmed at having responsibility for a little person.....
I am from the Caribbean and after birth, new mom's parents, sister or cousin would often stay with new mom (who in any event may be living in an extended family situation) for a couple of weeks/months after the birth. When fathers are allowed only two weeks paternity leave and there is no support network, how do we expect mothers not to feel some element of being overwhelmed.

Kim , Paris,

India once again speaks total sense. I'm a mental health patient and a bit of a campaginer as well to boot. I take a cocktail of medication, including anti-depresants because without them, I simply do not function like a 'normal' person.

I have a lot of friends, women especially, who have had SSRIs thrown at them by overworked GPs, to treat what is essentially, situational depression. If you were not depressed after loosing a parent/partner/job then I would be more concerned. These times are undenyably hard to endure, but the only way to overcome them, is to endure them.

Depression is a cruel thing, it comes for no reason and it can last as long as it wants to. Being depressed when you've just given birth is normal - being depressed in the middle of a happy, joyful, party situation surronded by loved ones - that's true depression.

Martyn Illingworth, Nottingham,

India, I am a huge fan of your brand of British stiff-upper-lipness, but you are a bit off-base with this one. Depression is not necessarily linked to a life event. Picture a Venn diagram of two overlapping circles - Traumatic events, and people who are Depressed. Yes, there are those who are in both categories, notably post-natal depression. But for those of us who suffer from a totally "irrational" depression - ie sobbing uncontrollably and wanting to die on a lovely spring day when you are perfectly healthy with a great job - SSRIs have been a life-saver, quite literally.

Jessica, London,

It would be lovely if those who suffered from depression - especially of the seasonal or "life bogged down right now" sort - could simply hibernate or vacation for a couple of months until recovery.

Unfortunately, real life intrudes. Landlords/lenders, the taxman, and power companies demand payment; employers demand product; family and friends demand presence that resembles cheer. And all sufferers want to do is sleep - just for a bit, just until the pressures pass.

[sarcasm]Exhortations of "just get over it!" are so much easier to handle - as if real life wasn't hard enough as it is, even under the best of circumstances.[/sarcasm]

Ellen, London,

There's a huge difference between feeling 'down' (which most people say is 'feeling depressed' in the same way that a 'cold' is 'flu' or even 'pneumonia'), SAD (seasonal affective disorder - when you feel like hibernating from November to March like I do) and real depression that comes and lies on you like a leaden blanket and numbs you completely.

I've been through all three states. I've got absolutely no support whatsoever so I have to keep pushing on otherwise I'd not earn the money to pay the rent and get food (I'm freelance). I've managed to smile in front of my students only for the numbed state to come back again as soon as they've gone through the door.

The German doctor tried me on St. John's Wort for six weeks. Nothing. Then he gave me the full-blown tablets and I could feel them working. Unfortunately, I didn't like the side effects of a dry mouth and feeling I was on a rolling ship whenever I walked, but the nine tablets I did take were enough to get me over the worst.

Martina, Duesseldorf, Germany

Post-natal depression is thought to have an evolutionary basis.Forty years ago when I worked with the British government in Malawi , over half the kids died before they reached six months of age.
This was presumably mankind's lot for millennia,
Smarter brains than mine have pointed out the evolutionary basis for the female post-partum depression.
Women expected to lose most of their kids to death from some natural affliction,in the peri-natal period .
Mother nature allowed them to feel depressed until they were sure their offspring would survive.
Most of their kids didn't , So they got over it ,and eventually their depression lifted and they were ready to mate again.
Women's post-partum depression is natural , it allows them to accept the death of their child, or some birth defect which many had. Oxytocin and all the loving hormones made the women love their offspring no matter what, poop and all.
Why turn it into some three ring circus ? It is what it is.

wilfred knight, orange county, usa /ca

....Now in the winter of our discontent.... Depression has been around for a long time. Our hibernation reflex with the long winters with little sunlight, and our wish to sleep in on cloudy rainy days is natural and normal.
Even Churchill had his 'black dog' days-probably depleted his feel -good neurotransmitters, dopamine & serotonin , with all his boozing.
Yet the man made something of his life did he not ?
What happened to the old British stand-bys - Onward and upward, ! Once more unto the breach, ! Hope springs eternal in the human breast ! and all that ?
Grow up and deal with it.
No-one, least of all our mothers, told us life was going to be easy.
Narcissistic self-absorption is a luxury of rich decaying societies.
Ask the Chinese peasant right off the paddy field into some crummy factory if he even has time to be depressed ,working seven days a week.

wilfred knight, orange county, usa /ca

"If there’s one thing I’ve learnt through having a child with special needs, it is not to judge other people in a similar boat "

If personal experience of a problem previously gave you this extra understanding, isn't it doubly unwise to rush into judgement about a different boat? Have you trodden "quite gingerly" enough, India?

There are more, and more intractable, forms of depression than the post-natal on which you primarily base this piece. Yes, this particular problem will usually be self-resolving, and thus a non-problem. But even that may not preclude short-term easing of symptoms to help severe cases to cope.

The other examples you cite: loss of career, love or children, coupled, due to age, etc, with the unlikelihood of ever finding consolation, will likely be far more serious. Yes, counselling may well offer potential breakout from the vicious circle of depression, while the drugs can only relieve symptoms. But if such a service is still unavailable, what then?

David, Bristol, UK

Depression is a normal condition akin to sleep or hibernation. It is helpful in more primitive circumstances when faced with drought and famine. The best thing to be done is to shut down all energy consuming activities including thought until the rains come or the fish start running or whatever. Faulty thinking about normal reverses in our society brings on the condition. To the extent that brain chemistry may be involved. St, John's Wort, an ancient non-prescription remedy seems to be scientifically better documented particularly concerning dangerous side effects than selective serotonin reuptake inhibitors.

Jim Batley, Gaithersburg, Maryland, USA