Most of us can point to recent losses and disappointments in our lives, but it is not always clear that they are causally related to our becoming depressed. For example, a patient who had a stroke a month ago may appear tearful, lethargic and depressed. To critics, the so-called depression is just “normal sadness” in reaction to a terrible psychological blow. But strokes are also known to disrupt chemical pathways in the brain that directly affect mood.

What is the “real” trigger for this patient’s depression? Perhaps it is a combination of psychological and neurological factors. In short, the notion of “reacting” to adverse life events is complex and problematic.

Third, and perhaps most troubling, is the implication that a recent major loss makes it more likely that the person’s depressive symptoms will follow a benign and limited course, and therefore do not need medical treatment. This has never been demonstrated, to my knowledge, in any well-designed studies. And what has been demonstrated, in a study by Dr. Sidney Zisook, is that antidepressants may help patients with major depressive symptoms occurring just after the death of a loved one.

Yes, most psychiatrists would concede that in the space of a brief “managed care” appointment, it’s very hard to understand much about the context of the patient’s depressive complaints. And yes, under such conditions, some doctors are tempted to write that prescription for Prozac or Zoloft and move on to the next patient.

But the vexing issue of when bereavement or sadness becomes a disorder, and how it should be treated, requires much more study. Most psychiatrists believe that undertreatment of severe depression is a more pressing problem than overtreatment of “normal sadness.” Until solid research persuades me otherwise, I will most likely see people like my jilted patient as clinically depressed, not just “normally sad”  and I will provide him with whatever psychiatric treatment he needs to feel better.