The nature of depression and the biomedical model: ten questions in search of an answer

Papers that dispute the neurobiological basis of depression and the usefulness of antidepressants keep emerging; therefore, a thorough review is necessary to register pro and con arguments. The current paper formulated 10 questions and tried to provide evidence-based answers. Depression is not a functional stress reaction to life events; it is a dysfunction in mood, affect, and emotion regulation, which results in dysfunctional responses. The reductionism of the biomedical model has no alternative if a scientific pathway is to be followed. Psychosocial approaches find it very difficult to meet the falsification criterion, while methodological shortcomings in pharmacological trials leave room for unsubstantiated discussion of the role of non-biological factors in the response to medication. The dispute over the efficacy of antidepressants has long been resolved and the argument that antidepressants exert their efficacy through a generic emotional numbness was rejected. Psychotherapies probably act through a generic pathway, including simple, practical interventions and relationship compassion. Inevitably, the advances promised by neurosciences, biological psychiatry, and psychopharmacology will eventually pave the way for better outcomes. A profound culture change is essential to ensure that our field is ready to embrace new findings as they emerge. However, a strong psychosocial element and psychoeducation techniques will probably be of prime importance in the future; patients and their families need education and persuasion, otherwise any scientific breakthrough would have little effect on their lives.