A newly published article is reigniting debate around the roots of depression, presenting fresh analysis and decades of scientific evidence that question the long-standing view that depression is primarily a biological illness requiring medical treatment. The piece asserts that psychological, not biological, factors may lie at the heart of depression—a claim with profound implications for how the disorder is diagnosed and treated globally and in Thailand.
For years, the mainstream belief—widely propagated by medical authorities and reinforced by pharmaceutical marketing—has been that depression is caused by chemical imbalances in the brain and should be approached like other physical illnesses. This perspective shifted in the 1980s, coinciding with the publication of the American Psychiatric Association’s DSM-III manual and the widespread introduction of antidepressant medications, especially selective serotonin reuptake inhibitors (SSRIs). However, the article cautions that this medicalization of depression is not firmly founded on scientific evidence and may be failing patients worldwide (madinamerica.com).
Historically, depression was once considered rare and generally psychological in nature. According to archival research, authoritative sources in the mid-20th century—like the then-head of the US National Institute of Mental Health’s (NIMH) Depression Section—viewed depression as typically self-limiting, with patients usually recovering fully, often without any formal intervention. At that time, fewer than 6% of Americans were diagnosed with depression across their lifetimes (Silverman, C., 1968, The Epidemiology of Depression).
Modern clinical practice, especially since the 1980s, has pursued a different path: psychiatric authorities have promoted the view that depression is a biologically rooted disorder best treated with medications. This culminated in research efforts to pinpoint genetic or neurophysiological causes for depression, as well as widespread prescriptions of antidepressant drugs. Yet, according to the article, after billions of dollars and half a century of research, robust biological evidence for most mental disorders—including depression—remains elusive.
One of the article’s central critiques is the lack of proven biological markers for depression. Even ambitious studies—such as the US NIMH’s STAR*D project, a multi-year, multimillion-dollar study intended to verify the biological basis of depression and the effectiveness of drug treatment—failed to find significant long-term benefits for antidepressant use over placebos. The results, the article claims, have been misrepresented by some psychiatric authorities and pharmaceutical interests, heavily influencing global treatment patterns and public beliefs (STAR*D study referenced in Mad in America).
Short-term benefits of SSRIs, when measured, barely exceeded placebo effects. Long-term results were more concerning: remission rates after a year on medication dropped to just 3%, and patients taking antidepressants actually experienced more relapses and less time free from symptoms compared with those given placebos or no treatment at all (Kirsch I., et al., Placebo effects in antidepressant clinical trials; UK and Swiss health studies corroborating these findings).
A widely cited rationale for medications—the “chemical imbalance” theory, positing that low serotonin causes depression and that SSRIs “fix” this—has itself been brought into question. Recent meta-analyses and biological research, such as the work led by UK psychiatrist Joanna Moncrieff, have found little evidence to support such a simplistic chemical model (Moncrieff J., et al., The serotonin theory of depression).
The article also contrasts the scientific standards of psychiatric practice with those of physical medicine. While many physical diseases have identifiable biological causes and clear medical treatments, the same is not true for most mental disorders, depression included. The result, as noted by behavioral researchers, is a paradox: despite improved recognition and vastly expanded use of psychiatric medications, rates of depression diagnosis, disability due to depression, and relapse have all climbed, particularly among women.
Against this background, the article champions a return to psychological origins and treatments. It details how, in decades past, depression was meaningfully alleviated through psychological methods—relaxation and exercise foremost among them—without the cascade of negative side effects associated with long-term medicinal use. Instead of lingering on speculative psychoanalytic theories or unsubstantiated biological models, the article highlights decades of empirical research in behavioral psychology.
Classical conditioning (Pavlov) and operant conditioning (Skinner), foundational learning theories established through rigorous scientific investigation, have shown that dysfunctional, depressive behaviors are learned in response to adverse environments, loss, and trauma. Critically, such patterns can also be unlearned and replaced—forming the scientific core of behavioral therapies used today (Pavlov, Skinner studies in psychology).
The article details the successes of various psychological therapies: systematic desensitization for phobias, exposure and response prevention for obsessive-compulsive disorder (OCD), dialectical behavior therapy for borderline personality disorder, and cognitive-behavioral therapy (CBT) for depression. Numerous controlled trials and meta-analyses have found these approaches reliably more effective than medication, with their effects often strengthening over time as patients continue to apply learned strategies after therapy ends (meta-analysis of CBT effectiveness).
For Thailand, these findings raise compelling questions. Thai public health strategy has often mirrored global trends, with antidepressant usage and pharmacological spending rising steadily over the past two decades (World Health Organization Thailand country profile). As the public increasingly seeks biomedical explanations—and medicalized solutions—for mental health, access to medication is expanding in both urban and rural settings.
However, the report suggests that policy-makers, hospital administrators, and mental health professionals here may benefit from reevaluating the emphasis on pharmacological interventions for depression. While medication is not entirely dismissed—it can still play a role for select patients or in severe cases—the article’s argument is for a fundamental recalibration: prioritizing evidence-based psychological treatments, empowering behavioral therapists, and educating the public on the environmental and learning-based roots of depressive disorders.
This perspective is consistent with Thailand’s rich tradition of self-care, community support, and mindfulness practices rooted in Buddhism. Concepts of “sabai” (a sense of wellness or being at ease), “santiphap” (peace), and the central Thai value of collective support align with many precepts of behavioral therapy—using consistent, supportive actions to rebuild functional daily patterns and coping skills. Mindfulness-based cognitive therapies have already established a research-backed presence in both Thailand and overseas, making them especially accessible and culturally resonant for Thai patients (Thai studies on mindfulness and mental health).
The enduring success of behavioral psychology in other fields—from sports coaching to political campaigns to technology design—further demonstrates the flexibility and potency of these principles for modifying human behavior. The article warns, however, that behavioral therapy research has historically lagged behind drug studies in receiving financial and institutional support from major health organizations. The author calls for expanded funding, local research, and training to further tailor behavioral interventions for diverse populations, including here in Thailand.
Looking ahead, mental health policy in Thailand and other Southeast Asian countries may move toward a more integrated system—bringing together the strengths of biological and psychological science, individual and societal insight, and traditional and modern health wisdom. Practically, readers are encouraged to seek out psychological therapy as a first-line treatment if diagnosed with depression, to remain informed about both the potential limits and benefits of medications, and to advocate for a mental health system that offers a broad continuum of care—beyond the prescription pad.
For those currently coping with depressive symptoms, making use of reputable Thai counseling services, participating in community-based mindfulness or behavioral therapy programs, and engaging in regular exercise remain effective, evidence-based steps toward recovery. Awareness campaigns and medical education should likewise prioritize these approaches, ensuring that mental health care in Thailand is not only scientifically grounded, but also equitable and sensitive to the fabric of Thai society.
In summary, new scientific scrutiny continues to cast doubt on the biological model of depression, instead affirming decades of research that psychological factors—and the treatments targeting them—should be at the heart of tackling this complex, pervasive disorder. As Thailand faces rising rates of depression, especially among younger generations, recalibrating treatment priorities could set a precedent for holistic, effective, and compassionate mental health care in the years to come.