Major Depressive Disorders Have an Enormous Economic Impact
scientificamerican.com
scientificamerican.com
Take a simple example: Look at how many times waiters get sick with the flu, say a million hours per year, and then multiply by the average amount of money a waiter earns - say 20 bucks an hour -- and conclude that the flu costs the restaurant economy 20 million dollars.
Well that assumes that if the waiters didn't call in sick, that an extra 20 million dollars of tips/earnings would have been available. Yet that amount is determined by the demand for meals, not availability of waiters, and when one waiter is sick, others cover for them so all the meals get served. But then the extra labor of waiters needed to cover for each other is a cost, no? Well, again no, as collectively the pool of waiters that cover for sick waiters is the same pool that call in sick -- it is some extra volatility in hours worked, but total hours worked is unchanged. So at the end of the day, it's hard to determine how much damage to the economy is created by waiters calling in sick and covering for each other. It's certainly much, much lower than what you get by multiplying hourly wages by time spent sick.
Now come to depression. Depression may be just the mental price of brains capable of risk assessment or deep thought. Like sleep is not a dead weight cost, but just the price of having a developed brain. It's not clear that Depression is "costing" us anything anymore than sleep is costing us lost labor, and it could be that a world without depression would also be a world without genius, realism, and creativity.
There are plenty of very smart people who aren't depressed, but I don't know of any smart people who don't sleep.
Depression is at worst a lethal malady that creates suffering not only in the depressed but for their families as well.
Plenty of things appeared in humans for no positive reason. Its not like smallpox was valuable it some point.
Its possible that depression has some positive function, but its just as possible it does not.
So if you didn't mean the usual metaphorical notion of, "was selected for by natural selection because it increased evolutionary fitness", what did you mean?
I think the prior poster may have been making a point more along the lines that depression is a downside of having benefits like neural plasticity or something, not that this disease state is necessarily beneficial in itself. More like how the downside of having high-performance tires is poor rain traction or something.
The trait is passed on because it benefits the species. You have to consider more than individuals in the evolution of social animals. In various circumstances some organisms will eat their own offspring. Obviously the "infanticide gene" if considered alone, would not make evolutionary sense, yet there it is.
Group selection is a possible mechanism in social animals, but it requires the group to be strongly interrelated relative to the rest of the species, and it relies on the group being able to expand at the expense of the rest of the species.
Infanticide makes perfect sense; offspring are only related 50% to the parent, so if resources are less than 2x as effective in the bodies of offspring compared to once they have been digested by the parent, of course they should be consumed. The genes of the offspring won't agree, of course; for them the calculation is reversed.
Literal survivor's bias. If you are depressed but not resilient, you kill yourself.
> learning to overcome adversity, learning to overcome yourself
Overcoming adversity requires doing something. Depression prevents that.
> learning to be self-aware
I wish.
> thinking "differently".
In what way?
These sort of ideas are hard to evaluate definitively, but I do think it is plausible that mild depression had/to some extent may still have benefits. Of course certain traits can be taken too far though, and when viewed through that lens it is hard to understand how they could be beneficial at all. One could say a similar thing about Autism-like traits.
I dont know, IANAD, but it sounds mildly plausible.
> Another reason depression is thought to be a pathology is that key symptoms, such as loss of interest in virtually all activities, are extremely costly to the sufferer. Biologists and economists have proposed, however, that signals with inherent costs can credibly signal information when there are conflicts of interest. In the wake of a serious negative life event, such as those that have been implicated in depression (e.g., death, divorce), "cheap" signals of need, such as crying, might not be believed when social partners have conflicts of interest.
https://en.wikipedia.org/wiki/Evolutionary_approaches_to_dep...
Where did you get that absurd idea from?
I don't agree with that and I don't agree with how it is stated. It's an absolutist statement (poster is not an expert) and it is dismissive via "silly".
I don't understand your objection. I don't understand the pedantry across this entire thread over like two or three words that aren't even wrong. Just read the extra sentence in the post.
I know this sounds rude, but how many arguments are we going to have over bikeshedding? It's like yall are looking for things to jump on and bully people about without any empathy.
I don't personally care but I don't understand why you do it.
This is what I'm talking about.
You guys can't imagine any way in which depressions might provide benefits? That's how multiple people in this thread have acted. But maybe, just maybe, people that are depressed have a different perspective on life and maybe feel differently.
What is the issue?
Yes, my own experiences with depression in those around me (thankfully not in myself) have left me seeing no way in which depression provides benefits. It is a terrible debilitating disease (or symptom, or whatever it is) that literally saps people of their will to do anything regardless of external stimuli. I find it very hard to imagine something so maladaptive being presented as possibly useful.
I would guess that sentiments like this are the main reason behind the powerful response to your thread. It is almost like claiming that "there is a reason for cancer".
Edit: I would also note that it's possible that we're simply talking past each other, as the term "depression" actually covers some quite different disorders; it's possible that what you're thinking of when you use this word is different from what I'm thinking of - to me, it mostly refers to a disorder where people feel either deeply sad or deeply anxious, but either way they are lacking almost entirely in motivation, finding it hard to even get out of bed sometimes; and all this with little relation to external stimuli.
This is all unsettled science. I've suffered depression for a decade. In my experience you learn to live with it and you learn from it even if you never fully get used to it.
This might just be a semantic quibble, but I don't think the term "costing" necessarily implies that the burden has no use. For example, I might say something like "the garbage collector is costing us 20% of the clock cycles". That doesn't mean that I think we can just shut off the garbage collector off. It just as an attempt to account for how much its spending critical resources.
Historians have long puzzled over the apparent mental instability of great and terrible leaders alike: Napoleon, Lincoln, Churchill, Hitler, and others. In A First-Rate Madness, Nassir Ghaemi, director of the Mood Disorders Program at Tufts Medical Center, offers a myth-shattering exploration of the powerful connections between mental illness and leadership and sets forth a controversial, compelling thesis: The very qualities that mark those with mood disorders also make for the best leaders in times of crisis. From the importance of Lincoln's "depressive realism" to the lackluster leadership of exceedingly sane men as Neville Chamberlain, A First-Rate Madness overturns many of our most cherished perceptions about greatness and the mind.
I find these comparisons deeply suspicious. If there indeed were a strong link between leadership ability and mental illness, there cannot be a very big difference between Lincoln and Chamberlain for the reason that both men were surely at the very tails of the relevant distributions. One does not become a British Prime minister by being average. I fully expect the book to be full of cherry-picked data supporting narratives built largely on popular stereotypes about successful and unsuccessful leaders of dubious accuracy.
But if waiters called in sick less would there be less waiters, and some of the waiters would instead be doing something else productive?
> Depression may be just the mental price of brains capable of risk assessment or deep thought
Isn't inability to accurately asses situations objectively and difficulty focusing both symptoms of depression? That seems the opposite of risk assesment/deep thought.
This review is kinda old, but written by the psychiatrist behind CBT, so it's probably worth a read if anyone is interested in an intro to the topic: https://www.sciencedirect.com/science/article/abs/pii/000579...!
That is because people who make accurate risk analysis and talk about it get punished. So you learn to shut up about negatives.
Or unemployed.
Well that's macabre. I really don't think that grinding to an emotional halt is a natural consequence of attentiveness. It's the opposite, if anything.
Waiters can cover for each other, what about those working full time? Ceteris paribus, a rise in depression that leads to the inability to work which will reduce the the size of the labour force and consequently output.
Your last point on it being the "cost of genius" is pure conjecture. A rise in depression (tripling according to the article) has definite costs in terms of the economy (tangible) and human well-being (the intangible). It is in public interest to reduce the incidence of depression.
But how do you get the energy and motivation for constant learning and self-development when you struggle to get out of bed every day, or are burnt out on tech altogether?
Even if, against all odds, a depressed person manages to get a job, it's likely that doing it will feel meaningless and overwhelming, leading to a struggle not to quit, poor performance, and possibly firing.
If you screw up at work because of depression, of course you're not going to make a good impression on your colleagues, making getting hired or recommended by them in the future even less likely.
If one is out of work for extended periods of time, not only is that a drain on your savings, but also an economic drain on whoever helps you (whether that's family, friends, or society).
Then there are the secondary economic effects of all that lost productivity that the depressed person could have contributed to the economy but didn't because of their depression. All of the deals that could have happened, all of the innovation that was missed, the people that they might have inspired, etc, have economic consequences that are difficult to quantify but that are real nevertheless.
This doesn't even go in to the potentially drastic economic consequences of suicide, both to the family of the person who takes their life who might have been relying on them for sustenance, and because of the knock-on economic effects of depression and trauma of those affected.
As for the learning part. Yes, finding motivation for self development is not easy when you're depressed or burned out. I'm not going to talk about dealing or treating depression since I'm not an expert. One thing I found helpful is developing different interests of mine since it solves the motivation problem. For example, recently I got into the world of investing and I'm learning a lot. This doesn't solve the problem of finding motivation for self development for work, but it helps in making me more productive and overall more excited about learning and doing.
Not that it's necessarily completely hopeless, and it varies from person to person, but people tend to underestimate how difficult ordinary, "easy" things are for people who are severely depressed.
Slight tangent, but I hear this all the time and I think it's total BS. Yes, if you're working at a big tech company and are gunning to continually move up the ladder, it's true for a while (eventually soft skills become more important for most), but I know plenty of developers who make a competitive salary, even in HCOL areas, and don't look at code outside of their 9-5 jobs.
Sure, they're not making FAANG salaries, but they're making more than enough to live comfortably on. I can name three different ex-colleagues at three different companies all making well over 100k a year and they're all still writing JQuery.
If you're not striving for the top, there are plenty of development jobs where you can make an above average salary and keep work at work.
If you have severe depression, you are probably going to be missing out on years (or even decades) of work, and not learning nearly as much either on or off the job... or at most learning a bit on the rebound from your depression (as it's often cyclical, and even severely depressed people tend to have better days when they feel at least somewhat motivated or at least manage to keep it together).
Such severely depressed people are just not going to be competitive with people who manage to keep on working 9-5 for most of their career, even if the latter put in zero extra effort to learn outside of work.
And when they next apply for a job the recruiters will hang up because they don't have x years of $hotNewTech. Sure they'll probably land a job sooner or later anyway or may be able to rely on word of mouth, but it does give you less opportunities. The jobs they're being rejected for are run of the mill ones too, nothing to do with "striving for the top".
Of course this is stupid and anyone with experience should be able to pick up $hotNewtech easily, but it's how things currently work.
This is absolutely not true and you're just perpetuating the myth.
One of them was the head of another project at the company I worked at pre-covid. He liked the company we were at, but had to move across the country because of some family issues and wasn't sure if the company we were at would let him work remote full time, so he started interviewing so he could have a fall back if they said no. It took him about 6 weeks of interviewing to get 2 different offers. Both interviews were from companies you've probably heard of, but neither were companies I would classify as "tech companies".
If you've got more than a few years experience and are looking in the right places, there are tons of people who don't care that you aren't writing what ever the latest technology is.
Big cities that aren't traditionally "tech cities" have tons of these jobs. Also, like I mentioned above, big companies that aren't tech companies, but have internal tools that need to be maintained have these positions as well (regional banks, large school districts/colleges).
And how many rejections did they get for not having $hotNewTech on their resume? That they got a job doesn't demonstrate that they had fewer opportunities, which was the point I was making.
Two caveats I would put is: we can do self-development and learning during our job hours, I'd argue it's a right that is usually understood and well supported by our workplaces.
A somewhat darker point: in 20 years there will still be devs writing jQuery, but it will only be a super small fraction of the devs that were in it 10 years ago.
The same way we have devs writing new COBOL code now, and there will still be some 50 years from now, but you can't expect 20% of our field to be leading a successful career in COBOL for the next decades. It will be a selected few that get to keep doing that job for that length of time, the rest will have to move to something else either way.
Yeah, I agree, that was kind of my point.
I see a lot of people who talk about software development as if FAANG is the only game in town, but like you said, our industry is big and only getting bigger. If you know where to look there are tons of laid back tech jobs that don't expect you to eat, sleep, and breath code.
I disagree with you though that there are only a select few who will be able to get these jobs. I think as time goes on, were only going to have more legacy systems that will require knowledge of older languages. Also as tech continues to infiltrate every other aspect of our lives, more and more companies will start to need one or two in house developers to do random tasks where no one cares whether you're using the latest and greatest technology.
The key is finding them and giving them a chance.
When I was young I hadn't heard much of Lisp, and what I did hear didn't sound that great (Lisp was old and maybe it was great back then, but technology has advanced so much, I thought, that it's probably not worth bothering about)... but when I did finally learn it I fell in love and wished I'd learned it much, much earlier.
And it wasn't just a copy of something I'd learned before, as were many other technologies that I'd learned.
That said, when you are seriously depressed or burnt out (the two go hand-in-hand), it's tough to find anything interesting, even things that you'd normally be fascinated by.
“I can’t wait to rewrite this legacy software in Rust!” - said not me.
When I have to learn some NIH-based technology that poorly copies something widely used (e.g. the place I currently work at has some custom language to generate "template instantiations in C" and some half-assed hideous clones of protobufs and grpc), I can't bring myself to care or really do my job.
Thank goodness this pandemic has made it easy to spend large portions of my day on leetcode / the CRLS algo book without anyone looking over my shoulder so I can get outta here!
That's not to say i want to do the same thing forever. I want to do different things. Superficial trends dont count.
If about half of young adults suffer from a disorder, it makes me question if it’s a disorder at all. And the noted impact of economic factors and things like Covid highlight the “nurture” aspect of the disorder instead of “nurture” (e.g. the “chemical imbalance” internet myth).
I’ve been diagnosed with MDD, GAD, ADHD, and bipolar type 1 but after I suffered a manic episode while on psych meds , I really dug into the research of psychiatrists and now have the controversial opinion it’s very weak science riding on the coattails of the rest of Western medicine and is obviously influenced by the for profit pharmaceutical companies. The DSM 5 wasn’t even created in the open.
Both as societies and as individuals, we need to introspect on how we can be so relatively wealthy yet so often so fundamentally unhappy. And the idea that half of the population has a brain disorder rather than is in a bad environment and conditioned by circumstances to feel that way seems hard to believe.
I’m very interested in the anti psychiatry movement which includes a small minority of medical professionals, and I’m more open to sane ideas that I used to consider “new age.” But more than anything, I think many aspects of mental health are like losing weight - very simple but difficult especially in the wrong environment. Close family relationships, diet, exercise, time outdoors, a sense of community, less time on social media - we mostly know that this is the key to feeling better but we desperately want an easier answer in pill from someone in a white coat and our profit driven medical system is more than happy to oblige.
The key point he is missing is that psychiatric disease can make those lifestyle changes orders of magnitude harder for someone to make than it would be for a healthy adult. As lifestyle gets worse you get a terrible loop going. Medication helps many break that loop - certainly not all, but it is something to seriously consider with your doctor.
If he was able to make those changes without medication that is great for him, but I think his message is kind of analogous to a rich entrepreneur that grew up poor telling everyone else they should just work harder and they'll move up in life. Is it probably good advice for those people to work harder? Yes, but many of them do not have the talent or luck to actually move up much, so it cheapens the message a lot.
This is a misreading of the (admittedly confusing) statistic
> the proportion of adults with MDD aged 18–34 years increased from 34.6 to 47.5
This is not saying that 47.5% of 18-34 year-olds have MDD, but rather that of adults with MDD, 47.5% are in the 18-34 age range.
https://www.forbes.com/sites/alexledsom/2021/02/07/new-study...
I for one, would be much happier with a less overtly abusive workplace, and oppressive living situation. Money is not everything, but as I cannot afford a better existence, it might as well be the only thing that matters.
Establishing, and garnering respect for, clear boundaries with ones abusers is an exceptionally tough task for teams of social workers working in the context of child protective services who have leverage, and the legally authorized threat of force, over the abusers.
The best alternatives are to "build relationships" with good people and find a "good psychologist" to assist you along the path as you assuredly take detours off your path and lose your way. It's hard, you'll find disappointments, may be revictimized, possibly suffer your own regressions and have to rely on yourself more than anyone should have too. I'm sorry I don't have good answers, but the task at hand is surmountable and everyone deserves a safe, loving, supportive familial-like community to uplift them and be uplifted by them.
I largely agree with you - diet, exercise, close friends, time in the sun and so on are fantastically useful and underrated. They solve a lot of things.
That being said, even when I had lots of close friends and was in fantastic shape, I wanted to kill myself. SSRIs stopped me from thinking about suicide every single day of my life - they literally changed my life. Lithium largely fixed the mania. If there are real, objectively bad things happening and taking a drug can stop them, I'm all for it.
I definitely think that psychiatrists don't know WHY a lot of things work and I think they way they diagnose and treat patients is basically just "try these and see if they work" but I don't think it's worth throwing everything away just because the solution needs a lot of improvement.
Having a depressive episode at some point over the course of a lifetime should be seen as normal IMO. Someone can have a depressive episode and benefit from help at the time just as someone can develop a bacterial infection and require treatment. It does not need to be thought of as a chronic state, even though in a minority of cases that will occur (and is obviously much more debilitating).
Sometimes medication is extremely beneficial, other times it is not, but very few people are just being pumped with/kept on meds. You can see here that only ~6% of people with a diagnosed depressive episode in 2017 were treated with meds alone: https://www.nimh.nih.gov/health/statistics/major-depression
Of course most therapy is going to include work on lifestyle habits like what you've mentioned. While many of the people regularly receiving therapy were also on a medication, it is standard of care to do meds + CBT as they have well-documented and independent impacts on depression recovery.
It is normal to taper off use of antidepressant after a first depressive episode, and I think it's safe to say most people doing combination treatment will have proper oversight of their medication use. Maintenance medication is mainly suggested for those with a history of recurring episodes.
I'll also note I don't think this has anything to do with money grabbing. Prozac remains the most prescribed antidepressant, yet it is not under patent. Therapy on the other hand can cost an arm and a leg. Of course therapy cannot be mass-produced, but from an individual prescriber perspective therapy is more likely to be financially incentivized.
No doubt psychiatry is still operating largely in the dark ages, but that's simply because it is a hard problem (and perhaps some institutional incompetence mixed in). Drug development for psychiatric disease has actually mostly hit a wall, and numerous pharma companies have cut neuroscience research departments, because these clinical trials had a low enough success rate that the R&D costs could no longer be justified.
Further, I agree that lifestyle decisions can have a bigger impact than people think, but this sort of anti-medication attitude and thinly-veiled accusations of laziness only push patients away from good lifestyle changes. Depression can make it harder to do those things you mentioned, and it becomes a very nasty cycle. Medication can help break that cycle if used properly.
It is indeed important to make clear that the meds are a tool and not a magic cure all, and I hate the common sarcastic remarks that get posted in depression groups like "thanks exercise cured me". But I get where some of that defensiveness is coming from. Let's all try to acknowledge that a treatment plan is going to involve multiple pieces, different pieces for different people, and is not going to be easy or perfectly effective.
There's a fine line between helping and enabling, but a lot of people seem to err so far on one side that they either applaud terrible behavior or talk down to people about symptoms that they don't fully understand. Meds can be a lifesaver for some and are not desirable for others, that is something that needs to be determined by the patient and their care team(s).
Their insistence on framing depression as if it were a biological illness (and not a result of the complex and historical interplay between psyche/desire and environment) is repulsive to me. Feels like blatant propaganda to discuss depression as "merely" an economic problem, in "scientific" american no less.
What makes you so sure that it's our economic system (inb4 "let's blame capitalism for everything") and not all the other aspects of modernity that make is isolated, atomized, and nihilistic?
Also, stress alone isn't the issue here at all.
It was. Medieval serfs worked less than us.
http://groups.csail.mit.edu/mac/users/rauch/worktime/hours_w...
I might be wrong here, but I feel that we can endure a repetitive work schedule and high expectations if we feel connected to the work and the fruit of our labour.
Besides, worker alienation and alienation in general is way more than just taking satisfaction in doing things well, it's actually feeling connected to what you are doing and it's purpose, and feeling connected to the social relationships that enable your life instead of seeing them as impersonal exchanges of commodity on the market.
https://briarpatchmagazine.com/articles/view/gabor-mate-how-...
Edit: another good link with Gabor Maté talking about how capitalism harms our mental health.
https://patch.com/california/berkeley/ev--an-evening-with-dr...
Do you know what one of the animal models for depression is? It’s called the “behavioral despair test,” but it’s actually much crueler and more insidious than it sounds.
Put a mouse in an inescapable cylinder filled partly with water. The mouse will initially try to swim and escape, but eventually gives up. Remove the mouse after 15 minutes. Just 24 hours later, the procedure is repeated and the mouse gives up after less than 5 minutes. The mouse has become depressed.
These are the conditions that capitalism knowingly imposes on those at the bottom of the economic ladder. Living paycheck to paycheck just to keep a roof over one’s head, if one is lucky, is what it’s like for a huge swath of America.
And, this is, if not “by design,” working as intended!
Can you honestly tell me that a literal 24/7 struggle to survive isn’t “self evidently mentally distressing?” Because it sounds to me like a recipe for PTSD and depression.
Doesn't this describe nearly all of human history, for the vast majority of humans who have ever lived? For far longer than capitalism was ever the basis for any kind of human society?
Today is today, not “nearly all of human history.” Who cares about “nearly all of human history?”
Who says the increase in depression is "recent?" The article itself mentions the strong upward trend since 1990. You know 1990 is 30 years ago now, right? (Not trying to be condescending here -- I genuinely forget this myself sometime.)
I don't accept your non-acceptance of my contention.
I say 30 years is recent. Particularly given I was referring to evidence on a prehistoric timescale.
I hope that clears everything up for you. Totally not trying to be condescending either.
Instead we make up bullshit jobs and spend hundreds of billions of dollars to convince people people they should be unhappy with what they have, while structuring the necessities for life and social function around extractive institutions.
This is a very simplified version of what goes on in a capitalist economy, but it can be made more rigorous using modern concepts of economics. The end result is still the same, though: a very few control an immense amount of wealth, while many have little, and some have none or nearly none.
Certainly bad financial situations are a risk factor for depression, and we should do more to address these issues so that people working full time jobs can actually make ends meet. But I do also worry that the push on the other side to continually cut back work hours will only make things worse. HN is a total bubble, most people without a career do not know what to do with themselves. Sustaining intrinsic motivation for long periods can be very difficult. Continuing a project without regular feedback can feel impossible. These are big reasons why doing a PhD can be a really tough experience. You might not think it matters if people are productive, but in the long run it is critical to the mental health of many that they feel productive. Work also generally keeps people on a routine schedule, forces some amount of social interaction, etc. These are important for a healthy life.
What makes you think so? It is 100% honest question: what historical evidence makes you guess the rates of depression in early days of US?
Going further back, discussion of a link between modernity/depression is largely speculation, but it is a popular hypothesis and there are some studies that focus on suicide rates for a more data-driven approach. It is harder to find information on US numbers but Scandinavian countries are notorious for access to thorough epidemiological data: https://journals.sagepub.com/doi/abs/10.2307/1389426
You may not be the target audience of this particle piece, in the sense that they don’t have to convince you depression is worth paying attention to. When trying to signal-boost an issue, you often have to play up aspects of it that you yourself might not find to be the most acute, or even the most humane as in this case. If this is the angle that has to be taken to get it taken seriously by some people, I’d rather the argument be made than not.
But instead of admitting that their life simply sucks, they are brainwashed into thinking that there must be something wrong with them.
It's part of the reason why psilocybin is so effective. It makes people actually realize that. That no amount of meds will fix it. That to be happy, you will have to change your life, get unstuck from all the things you don't really need, and prioritize happiness.
It's problematic when you can't make those changes, e.g. you're young and still living with/dependent upon parents, or you feel you'd have to give up too much e.g. being close to your kids, or people are telling you to just take a pill and it will be better.
IDK about psilocybin, never tried it, seems like more snake oil honestly, there are no magic answers here.
That doesn't sound plausible, as one of the main parts of depression is often debilitating lack of motivation (much more than sadness or anxiety). So depressed people are usually the least likely to be able to independently make any kind of significant change in their life - they're already spending most of their "energy" on getting out of bed and following a routine.
Not to mention, establishing clear routines and minor goals is one of the main recommendations (outside medication) for dealing with depression.
I guess part of it depends on what you personally have an issue with. But I can't see trading 40 hours of meaningless work for 80 hours of running my own business, or dropping out and living some nomad life. Or the constant hustle and living near poverty to be in arts or academic research .
Or they'll die of exposure on the streets, or worse. People, in general, can't be expected to solve fundamental problems of the distribution of wealth, opportunity, education, healthcare, food, property, knowledge, power, and comfort in our society by job hopping. The median job in America is a bullshit job for a petty dictator which is a direct result of terrible policy over decades.
The "or figure out something else to do" at the end of your comment is telling of these systemic problems, even if you did not intend it to be such a profound criticism of society and culture.
It's not one or the other. It's both, bio & environmental, like near-everything else.
Agreed, however our economy serves to enrich asset owners, and the health and happiness of everyone else are afterthoughts.
Irreversible or transdermal MAOIs are the answer for first line treatment - > Moclobemide and Emsam They have almost no side effects and are more effective.
This way of thinking is fundamentally responsible for our societies being so suseptible for the spiritual crises which are mainly the cause of depression.
But hey, here's some fucking happy pills, now get back to work.