As a young adult I had what one might term a major depressive episode. I couldn’t focus at work, sleep, or find much joy in anything. Close to losing my job, I finally turned to my incredibly sensitive and supportive manager for help. He saved me by listening to me and giving me increasingly harder assignments that I could succeed in. No meds. And I began to thrive once again at work.
Several years later I found myself in a loveless marriage (he had his own problems, chiefly addiction to alcohol and gambling) with a job I disliked and was failing in. This time I used the medical profession for help and with the aid of a competent psychologist finally found some relief from the depression that had taken over my life. But I was on Zoloft and hated it. I slowly began to realize that my depressive episodes were situational and that I just might be able to overcome them. With the help of a psychiatrist I weaned off the medication despite being warned I would need it for the rest of my life. Now, some 35 years later I have remained depression and medication free.
Lesson? I believe many cases of depression are situational. And many people today are falling to feelings of victim hood and searching for easy answers. Life has never been easy but it seems harder today than ever. But walloping doses of frequently unnecessary meds are not the answer. But Big Pharma thinks so.
the lesson is that people need to take responsibility for their own wellbeing vs ‘lazy’ dependency attitudes – sure it is hard work educating yourself, but all the info is out there. Figure out what you need/want for a measure of contentedness and make that happen – dont overestimate your abilities, assess all the propaganda being constantly fired at you – in short WAKE UP !!!!
Tom Lewis
1 year ago
How depressing, maybe I’ll go and eat a bar of chocolate to cheer me up !
Dermot O'Sullivan
1 year ago
‘Time, and finding ways to change one’s environment, regularly lead to a spontaneous remission of depressive feelings.’
That’s a good takeaway from that article. I’ve no doubt that the pharma industry is not shy in promoting its interests and one hopes that there is oversight. I’m also pretty sure that anti-depressants may not be a perfect solution but they are a help in many cases.
Absolutely. I suffered from ‘depression’ for decades after my mother destroyed my education as a musician. Eventually, I recognised that what I was actually suffering from was grief. Rather than trying to make it go away, I prioritised spending on singing lessons and, after a number of years, obtained a diploma and a place in the region’s top amateur choir. Lockdowns were a major setback, of course, but allowing myself to do the thing that I had been grieving for was the answer, not mind and voice-numbing drugs.
This article is worth my subscription to Unherd alone. Whittaker lays bare the neurochemical shift that is debilitating and creating dependency, debilitation and death. The story of how professional self-interest and drug company opportunism fused to create this situation is one of the scandals of our time. Sadly though in a world where marginal gains are worshipped as major advances, the 15% will probably be held up as “crisis averting treatment outcomes” .that’s why I empathise with Krishna below when he feels helped. I also get his well made point about social isolation and obsessiveness. The real story though that this cynical fix was the wrong approach, needs to be more widely known. I dispute the narrative that the left and progressives are not in favour of these neurochemical approaches. They used to be critics of big Pharma but with some exceptions such as Johan Hari have become supporters and enablers, especially by their uncritical acceptance of vaccine narratives and alignment with the chemical castration inherent in transgenderism. I’ll buy Whitaker’s book so I can review his sources properly but this is a very important piece.
John Callender
1 year ago
I began psychiatric training in 1979 and continue to practise on a part-time, semi-retired basis. I agree with much of what is said in this article. I do think however that it is based on a concept of depression that does not reflect the complexity of clinical or human reality. This is not to criticise the author as this inadequate thinking pervades much of clinical research and practice.
Depression is a capacious term that embraces a wide range of negative states of mind. In patients with severe clinical depression (formerly known as melancholia), depression denotes a condition that is a clear break from normal feeling and thinking, and which has a distinctive clinical picture. People with this condition have a pervasive depression of mood that does not respond to changes in circumstances. Sleep and appetite are impaired. Thinking may be disturbed and, in severe cases, frankly delusional. There is a loss of motivation and concentration. The risk of suicide is high.
The level of suffering and disability is out of proportion to any adverse events in the person’s life. The course of the condition is one of relapses and remissions. Family studies show clear evidence of genetic vulnerability. These conditions do not respond to psychotherapy. For these and other reasons, I think the medical or illness model is the appropriate one to apply.
The other big group of depressed patients that come the way of psychiatrists are those who have experienced early traumatisation, neglect or other adversity, such as childhood sexual abuse. People in this group are often depressed but the quality of this is quite different from the first group. Suicidal thinking is common but completed suicide is rare.
They are often treated with antidepressants but these are not usually effective. They generally do much better with various forms of psychotherapy. The medical model has a role in patients whose nervous systems have been dysregulated by severe traumatisation, and medications such as alpha adrenergic blocking drugs can often be of great help.
Finally, there is depression as part of the normal repertoire of emotional responses to all that life throws at us. As the author states, this nearly always gets better in time and recovery can be helped along by self-efficacy, and informal care and support.
It was DSM-III in 1980 that began the process of placing depression on a single spectrum, sub-divided on the basis of severity. This is one factor that allowed the medical model to expand its application from conditions where it is clearly appropriate to those in which it has little to offer, or where it may cause harm. If we are to make progress we have to recognise that depression not a single entity, that it embraces a range of emotional states, and that there is no model or approach to treatment that will be applicable to all of these.
I’m a little skeptical of the benefits of the medical profession. Undoubtedly, medicine can help us; can save us sometimes. The trouble is, it seems to me, that people are complicated and medics get enthused by science and are tempted to fix things that they cannot fix.
krishna sampath
1 year ago
have issues with the piece here. Such narratives actually add to the misery and agony of those battling personal crisis – family, relationships, professional, financial, health that unendingly inflict and pile agony & misery on helpless souls who then lose their capacity to navigate a life that is stressful, complex and unrelentingly assaulting by default.
Something has to give. If not circumstances that repeatedly badger you, incapacitate you, then at least to make sure your brain is wired enough to keep you functional. In such a respect psychiatric medications do help. I’m telling my experience and divulging this fact to some of you here in trust and faith. Most battling depression, grief, trauma don’t get support of friends & kins. To express your failures, inadequacies & vulnerabilities is seen to be shameful and embarrassing in times when success, status and proclaiming your state of bliss, joy & happiness in social media is de jure. For this reason many battling such problems don’t even reveal matters to the world and even if they do, the onus for the misery is put on them, which only compounds matters for the already broken and shamed. One can certainly agree that social support , emotional support, empathy are useful and can be the most effective therapy needed, but in the kind of narcissistic world that worships mamon and colonised by anxieties of work & family, such support is unlikely to come from even trusted friends and kins. When completely isolated, in despair and agony, what does one do? For often when the objective conditions are so extrinsic to such folks and are unrelenting, you want them to kill themselves ? To that extent psychiatric medications do help. It is what has kept me alive (so far)
I’m from India. The bogey of pharma industry orchestrating a mental health crisis is again a narrative of the wokes left-liberals. What do they know of mental/emotional suffering that only the disease and the diseased know? The same indeed is often the template for many diseases including pandemics particularly respiratory, gastrointestinal. No intervention, medicines, vaccines, are required. All such is ‘manufactured’, ‘invented’ by antibiotic, analgesic & antipyretic lobby! Disease itself is an construction ! Of course ensuring better societal hygiene, environmental safeguards that improve the quality of air, water and habitation conditions are certainly the long term solution. But till that happens and till folks can truly learn to be empathetic and have capacities to extend emotional support to the distressed, leave the psychiatrists, the allegedly venal pharma companies, the medical profession itself and more importantly the depressed, grieving lot alone!
There is nothing alleged about the venality of pharmaceutical companies or, for that matter, the psychiatric “profession”, and the author lays it out quite clearly.
I am sorry for your troubles and wish you the very best. I can say from long and bitter experience that my husband’s family offered all the love, emotional, and financial support to his now institutionalized younger brother, who was “diagnosed” as depressed when he was a young college student and immediately put on antidepressants. He has spent 40+ years going through every psych and drug fad, tried to kill himself countless times (usually just dramatic enough to get him re-admitted to his favorite hospital ward), and had his life ruined because “doctors” told him there was only a pharmaceutical and psychiatric answer to his perfectly normal freshman year anxiety.
I would think, after just the last two years, we’d all have learned by now what pharmaceutical companies priorities are. And it sure as h*ll isn’t our wellness.
James Tutton M.D.
I am a retired emergency medicine physician who graduated from med school in 1973. I was privy to most of the grotesque carnival that has been the entanglement of big pharma with psychiatry. Whitaker is spot on in his article! I have seen so many patients in my line of work who decades ago would have just considered themselves simply unhappy now find themselves medicated and worse off all to fill the coffers of predatory pharmaceutical companies. Sadly many us in the medical profession join the dance because it is easier to write a prescription than to take the time to help someone realize as Schopenhauer put it “fate is cruel and men wretched”.
Please don’t throw the baby out with the bathwater. I don’t doubt big pharma promoted depression drugs way beyond actual need, but pay attention to the cases where antidepressants were essential, as for krishna sampath, and myself. Regardless of the reason for the onset of severe depression (cruel fate and wretchedness included), they helped me stay alive long enough to be able to address contributing factors. (And let me add, I was opposed to taking psychoactive drugs initially.) They are not effective for everyone. But they are very effective for some and can be the difference between life and death.
It is undeniable — some people like their psychiatric drugs. (If you don’t like them, perhaps you should take a good look at what benefit you actually do get from them.)
Last edited 1 year ago by Adele Framer
Ian Stewart
1 year ago
Jeez, after spending the first 20 years of my adult life thinking in old fashioned terms that most depression can be cured pretty quickly by action by the individual – change job; divorce; exercise; etc; and then the latter 20 years accepting that depression is a much more serious and long term health condition that can require drugs and years of treatment; and now I’m being told my original view was correct.
Why do humans have to make life so much more complicated than it already is?
laurence scaduto
1 year ago
I’ve often wondered how many of the stories we hear of people doing weird, stupid things are the result of medications they’re on. Not just SRIs.
Getting too close to dangerous wildlife, leaving the trail and falling into super hot thermal springs in Yellowstone NP, bone-headed boating accidents, etc. Internet trolling. Maybe even mass shootings.
I’m pretty sure that no one is even trying to keep track.
William McKinney
1 year ago
If they really believe in ESG, first on the banned list has to be Big Pharma. They’re truly vile.
Leejon 0
1 year ago
That’s that then (thankfully) what is the next idiocy we all need to rush into like lemmings (yes! I know! Lemmings aren’t as stupid as us.).
Simon James
1 year ago
We all in the developed and developing nations need to take a long hard look at ourselves and wonder why we have bought so deeply into the narrative of endless progress, and the belief that there will always be a tech solution to every problem. Big Pharma is giving us what we apparently want.
‘Trauma’ is the new kid on the block in this area, now being promoted heavily in the training and practice of psych professionals. If your parents divorced or your pet died or you lost your job, you can now join the ranks of the officially unwell and wait for help to arrive. And on it goes.
Ethniciodo Rodenydo
1 year ago
“A society that wants to promote good “mental health” should strive first to create more nurturing environments — improving access to housing and childcare, and working toward a more equal distribution of financial resources.” This statement is just nonsense. If you grind your political axes in your writing you deserve to lose all credibility
I was thinking the same thing. “More equal distribution of financial resources” sounds like socialism as a cure for depression. As for “childcare”, what on earth does that have to do with depression?
I think that the first part of the quoted statement (up to ‘environments’) actually makes some sense, but the rest is simply inadequate, and ignores a huge factor in the current upsurge in mental health ‘issues’ especially amongst the young, namely family breakdown. That is something for which there is no quick state-engineered fix.
Barry Murphy
1 year ago
Interesting article. Based on my own personal expierence, I believe that “depression” (however one chooses to define it) can be a result of difficult circumstances (being unhappy at work and loneliness, to name but two factors) but also because of a person’s personality. Some people are naturally more melancholic than others. Having said that, the medications can still work! Anytime I go off my antidepressant medication, I feel like rubbish. It’s not that I always feel great when I’m on them, but when I’m off them I feel so angry and irritable I could explode. As for behavioural therapy: the less said about that, the better. A depressed person could possibly get more out of talking to their dog or cat that talking to those money grabbers who oftentimes don’t have a clue and who rigidly apply their dubious theory (that thoughts influence mood and that said thoughts can be controlled) to every depressed patient.
Yersinia pestis
1 year ago
I can’t take anything screaming about the imaginary ‘Big Pharma’ bogeyman seriously.
As for depression – I agree, the best treatment for most cases of so-called depression is exercise, fulfilling hobbies and a good diet. The fact that it’s not recommended by doctors is not due to some great conspiracy by drug manufacturers, as the psychotically minded imagine – it’s because people seek a diagnosis of depression primarily to avoid being held accountable for their behavior. So called ‘Big Pharma’ is simply responding to a market need.
As a young adult I had what one might term a major depressive episode. I couldn’t focus at work, sleep, or find much joy in anything. Close to losing my job, I finally turned to my incredibly sensitive and supportive manager for help. He saved me by listening to me and giving me increasingly harder assignments that I could succeed in. No meds. And I began to thrive once again at work.
Several years later I found myself in a loveless marriage (he had his own problems, chiefly addiction to alcohol and gambling) with a job I disliked and was failing in. This time I used the medical profession for help and with the aid of a competent psychologist finally found some relief from the depression that had taken over my life. But I was on Zoloft and hated it. I slowly began to realize that my depressive episodes were situational and that I just might be able to overcome them. With the help of a psychiatrist I weaned off the medication despite being warned I would need it for the rest of my life. Now, some 35 years later I have remained depression and medication free.
Lesson? I believe many cases of depression are situational. And many people today are falling to feelings of victim hood and searching for easy answers. Life has never been easy but it seems harder today than ever. But walloping doses of frequently unnecessary meds are not the answer. But Big Pharma thinks so.
the lesson is that people need to take responsibility for their own wellbeing vs ‘lazy’ dependency attitudes – sure it is hard work educating yourself, but all the info is out there. Figure out what you need/want for a measure of contentedness and make that happen – dont overestimate your abilities, assess all the propaganda being constantly fired at you – in short WAKE UP !!!!
How depressing, maybe I’ll go and eat a bar of chocolate to cheer me up !
‘Time, and finding ways to change one’s environment, regularly lead to a spontaneous remission of depressive feelings.’
That’s a good takeaway from that article. I’ve no doubt that the pharma industry is not shy in promoting its interests and one hopes that there is oversight. I’m also pretty sure that anti-depressants may not be a perfect solution but they are a help in many cases.
Absolutely. I suffered from ‘depression’ for decades after my mother destroyed my education as a musician. Eventually, I recognised that what I was actually suffering from was grief. Rather than trying to make it go away, I prioritised spending on singing lessons and, after a number of years, obtained a diploma and a place in the region’s top amateur choir. Lockdowns were a major setback, of course, but allowing myself to do the thing that I had been grieving for was the answer, not mind and voice-numbing drugs.
A most uplifting story
This article is worth my subscription to Unherd alone. Whittaker lays bare the neurochemical shift that is debilitating and creating dependency, debilitation and death. The story of how professional self-interest and drug company opportunism fused to create this situation is one of the scandals of our time. Sadly though in a world where marginal gains are worshipped as major advances, the 15% will probably be held up as “crisis averting treatment outcomes” .that’s why I empathise with Krishna below when he feels helped. I also get his well made point about social isolation and obsessiveness. The real story though that this cynical fix was the wrong approach, needs to be more widely known. I dispute the narrative that the left and progressives are not in favour of these neurochemical approaches. They used to be critics of big Pharma but with some exceptions such as Johan Hari have become supporters and enablers, especially by their uncritical acceptance of vaccine narratives and alignment with the chemical castration inherent in transgenderism. I’ll buy Whitaker’s book so I can review his sources properly but this is a very important piece.
I began psychiatric training in 1979 and continue to practise on a part-time, semi-retired basis. I agree with much of what is said in this article. I do think however that it is based on a concept of depression that does not reflect the complexity of clinical or human reality. This is not to criticise the author as this inadequate thinking pervades much of clinical research and practice.
Depression is a capacious term that embraces a wide range of negative states of mind. In patients with severe clinical depression (formerly known as melancholia), depression denotes a condition that is a clear break from normal feeling and thinking, and which has a distinctive clinical picture. People with this condition have a pervasive depression of mood that does not respond to changes in circumstances. Sleep and appetite are impaired. Thinking may be disturbed and, in severe cases, frankly delusional. There is a loss of motivation and concentration. The risk of suicide is high.
The level of suffering and disability is out of proportion to any adverse events in the person’s life. The course of the condition is one of relapses and remissions. Family studies show clear evidence of genetic vulnerability. These conditions do not respond to psychotherapy. For these and other reasons, I think the medical or illness model is the appropriate one to apply.
The other big group of depressed patients that come the way of psychiatrists are those who have experienced early traumatisation, neglect or other adversity, such as childhood sexual abuse. People in this group are often depressed but the quality of this is quite different from the first group. Suicidal thinking is common but completed suicide is rare.
They are often treated with antidepressants but these are not usually effective. They generally do much better with various forms of psychotherapy. The medical model has a role in patients whose nervous systems have been dysregulated by severe traumatisation, and medications such as alpha adrenergic blocking drugs can often be of great help.
Finally, there is depression as part of the normal repertoire of emotional responses to all that life throws at us. As the author states, this nearly always gets better in time and recovery can be helped along by self-efficacy, and informal care and support.
It was DSM-III in 1980 that began the process of placing depression on a single spectrum, sub-divided on the basis of severity. This is one factor that allowed the medical model to expand its application from conditions where it is clearly appropriate to those in which it has little to offer, or where it may cause harm. If we are to make progress we have to recognise that depression not a single entity, that it embraces a range of emotional states, and that there is no model or approach to treatment that will be applicable to all of these.
This is very clear, thank you.
I’m a little skeptical of the benefits of the medical profession. Undoubtedly, medicine can help us; can save us sometimes. The trouble is, it seems to me, that people are complicated and medics get enthused by science and are tempted to fix things that they cannot fix.
have issues with the piece here. Such narratives actually add to the misery and agony of those battling personal crisis – family, relationships, professional, financial, health that unendingly inflict and pile agony & misery on helpless souls who then lose their capacity to navigate a life that is stressful, complex and unrelentingly assaulting by default.
Something has to give. If not circumstances that repeatedly badger you, incapacitate you, then at least to make sure your brain is wired enough to keep you functional. In such a respect psychiatric medications do help. I’m telling my experience and divulging this fact to some of you here in trust and faith. Most battling depression, grief, trauma don’t get support of friends & kins. To express your failures, inadequacies & vulnerabilities is seen to be shameful and embarrassing in times when success, status and proclaiming your state of bliss, joy & happiness in social media is de jure. For this reason many battling such problems don’t even reveal matters to the world and even if they do, the onus for the misery is put on them, which only compounds matters for the already broken and shamed. One can certainly agree that social support , emotional support, empathy are useful and can be the most effective therapy needed, but in the kind of narcissistic world that worships mamon and colonised by anxieties of work & family, such support is unlikely to come from even trusted friends and kins. When completely isolated, in despair and agony, what does one do? For often when the objective conditions are so extrinsic to such folks and are unrelenting, you want them to kill themselves ? To that extent psychiatric medications do help. It is what has kept me alive (so far)
I’m from India. The bogey of pharma industry orchestrating a mental health crisis is again a narrative of the wokes left-liberals. What do they know of mental/emotional suffering that only the disease and the diseased know? The same indeed is often the template for many diseases including pandemics particularly respiratory, gastrointestinal. No intervention, medicines, vaccines, are required. All such is ‘manufactured’, ‘invented’ by antibiotic, analgesic & antipyretic lobby! Disease itself is an construction ! Of course ensuring better societal hygiene, environmental safeguards that improve the quality of air, water and habitation conditions are certainly the long term solution. But till that happens and till folks can truly learn to be empathetic and have capacities to extend emotional support to the distressed, leave the psychiatrists, the allegedly venal pharma companies, the medical profession itself and more importantly the depressed, grieving lot alone!
There is nothing alleged about the venality of pharmaceutical companies or, for that matter, the psychiatric “profession”, and the author lays it out quite clearly.
I am sorry for your troubles and wish you the very best. I can say from long and bitter experience that my husband’s family offered all the love, emotional, and financial support to his now institutionalized younger brother, who was “diagnosed” as depressed when he was a young college student and immediately put on antidepressants. He has spent 40+ years going through every psych and drug fad, tried to kill himself countless times (usually just dramatic enough to get him re-admitted to his favorite hospital ward), and had his life ruined because “doctors” told him there was only a pharmaceutical and psychiatric answer to his perfectly normal freshman year anxiety.
I would think, after just the last two years, we’d all have learned by now what pharmaceutical companies priorities are. And it sure as h*ll isn’t our wellness.
James Tutton M.D.
I am a retired emergency medicine physician who graduated from med school in 1973. I was privy to most of the grotesque carnival that has been the entanglement of big pharma with psychiatry. Whitaker is spot on in his article! I have seen so many patients in my line of work who decades ago would have just considered themselves simply unhappy now find themselves medicated and worse off all to fill the coffers of predatory pharmaceutical companies. Sadly many us in the medical profession join the dance because it is easier to write a prescription than to take the time to help someone realize as Schopenhauer put it “fate is cruel and men wretched”.
Please don’t throw the baby out with the bathwater. I don’t doubt big pharma promoted depression drugs way beyond actual need, but pay attention to the cases where antidepressants were essential, as for krishna sampath, and myself. Regardless of the reason for the onset of severe depression (cruel fate and wretchedness included), they helped me stay alive long enough to be able to address contributing factors. (And let me add, I was opposed to taking psychoactive drugs initially.) They are not effective for everyone. But they are very effective for some and can be the difference between life and death.
It is undeniable — some people like their psychiatric drugs. (If you don’t like them, perhaps you should take a good look at what benefit you actually do get from them.)
Jeez, after spending the first 20 years of my adult life thinking in old fashioned terms that most depression can be cured pretty quickly by action by the individual – change job; divorce; exercise; etc; and then the latter 20 years accepting that depression is a much more serious and long term health condition that can require drugs and years of treatment; and now I’m being told my original view was correct.
Why do humans have to make life so much more complicated than it already is?
I’ve often wondered how many of the stories we hear of people doing weird, stupid things are the result of medications they’re on. Not just SRIs.
Getting too close to dangerous wildlife, leaving the trail and falling into super hot thermal springs in Yellowstone NP, bone-headed boating accidents, etc. Internet trolling. Maybe even mass shootings.
I’m pretty sure that no one is even trying to keep track.
If they really believe in ESG, first on the banned list has to be Big Pharma. They’re truly vile.
That’s that then (thankfully) what is the next idiocy we all need to rush into like lemmings (yes! I know! Lemmings aren’t as stupid as us.).
We all in the developed and developing nations need to take a long hard look at ourselves and wonder why we have bought so deeply into the narrative of endless progress, and the belief that there will always be a tech solution to every problem. Big Pharma is giving us what we apparently want.
‘Trauma’ is the new kid on the block in this area, now being promoted heavily in the training and practice of psych professionals. If your parents divorced or your pet died or you lost your job, you can now join the ranks of the officially unwell and wait for help to arrive. And on it goes.
“A society that wants to promote good “mental health” should strive first to create more nurturing environments — improving access to housing and childcare, and working toward a more equal distribution of financial resources.”
This statement is just nonsense. If you grind your political axes in your writing you deserve to lose all credibility
I propose you read this: BMJ 2022;379:o2529
and this: https://www.bmj.com/company/newsroom/study-reveals-extensive-network-of-industry-ties-with-healthcare/
You think something published in the BMJ is credible?
I was thinking the same thing. “More equal distribution of financial resources” sounds like socialism as a cure for depression. As for “childcare”, what on earth does that have to do with depression?
I think that the first part of the quoted statement (up to ‘environments’) actually makes some sense, but the rest is simply inadequate, and ignores a huge factor in the current upsurge in mental health ‘issues’ especially amongst the young, namely family breakdown. That is something for which there is no quick state-engineered fix.
Interesting article. Based on my own personal expierence, I believe that “depression” (however one chooses to define it) can be a result of difficult circumstances (being unhappy at work and loneliness, to name but two factors) but also because of a person’s personality. Some people are naturally more melancholic than others. Having said that, the medications can still work! Anytime I go off my antidepressant medication, I feel like rubbish. It’s not that I always feel great when I’m on them, but when I’m off them I feel so angry and irritable I could explode. As for behavioural therapy: the less said about that, the better. A depressed person could possibly get more out of talking to their dog or cat that talking to those money grabbers who oftentimes don’t have a clue and who rigidly apply their dubious theory (that thoughts influence mood and that said thoughts can be controlled) to every depressed patient.
I can’t take anything screaming about the imaginary ‘Big Pharma’ bogeyman seriously.
As for depression – I agree, the best treatment for most cases of so-called depression is exercise, fulfilling hobbies and a good diet. The fact that it’s not recommended by doctors is not due to some great conspiracy by drug manufacturers, as the psychotically minded imagine – it’s because people seek a diagnosis of depression primarily to avoid being held accountable for their behavior. So called ‘Big Pharma’ is simply responding to a market need.