To the Editor:

Contrary to most diseases (a tissue diagnosis for cancer, an angiogram for artery disease, etc.), there is now no clear biological marker for depression (July 27). The diagnosis is subjective. Unfortunately, the word depression has lost its specificity, has become synonymous with a variety of separate emotional states including grief, disappointment, frustration, despair and loneliness. All have different origins. Some are situational, others biological, yet others are character traits.

Studies on identical twins raised apart suggest that some patients are more likely to be happy on a biological and perhaps genetic basis. Common experience tells us that some people have greater biological capacity for enjoyment than others.

Depression is quite dissimilar from lack of happiness. Lack of enthusiasm can be seen with depression, but can also be nothing but a character trait without any major emotional connotation. But if the patient without enthusiasm or joie de vivre describes himself as being depressed?

Medical advances occur by understanding disease mechanisms. Depression has become a grab-bag word and has lost much of its usefulness as a diagnosis. Disappointment does not respond to Prozac. Lack of enthusiasm won't be affected by psychoanalysis. Lack of talent can't be overcome with encouragement.

Isn't it about time that we stop using the word depression to describe whatever ails us, then blame medicine/psychiatry if they cannot help?


San Francisco