I have to admit that clinical psychiatry is not my field. My information on the subject comes mainly from the work of Francis Mondimore, " a psychiatrist and a member of the clinical faculty of the Johns Hopkins University School of Medicine. His books include Bipolar Disorder and A Natural History of Homosexuality, both available from Johns Hopkins" - who also happens to be openly gay. http://www.press.jhu.edu/press/books/titles/f95/f95mode.htm. Hardly a spokesman for the "big pharma."
Dr. Mondimore does not deny the role of cognitive factors in triggering affective disorders (and hence recommend cognitive therapy in treating it, in conjunction with medication). But he presents quite a convincing argument that such disorders are produced in changes in brain chemistry.
Mondimore makes a very useful distinction between "ordinary" depression and affective disorders. The former is usually a normal and expected response to life circumstances, while affective (mood) disorders are usually unrelated to such circumstances. Mood swings, esp. in bipolar disorders, often occur without any circumstances (such as a personal loss) that are normally associated with sadness or grief, although such circumstances may sometimes trigger mood swings. Therefore, treating the underlying causes of affective disorders does require changing brain chemistry, whereas cognitive therapy, counseling, and support group can only help (many of them quite effectively) coping with the symptoms and their social consequences.
This of course does not mean that the big pharma and its propaganda are not trying to push their pills beyond their legitimate applications. But over prescription of SSRI drugs (i.e. to treat "ordinary" depression caused by life circumstances), should not overshadow the fact that they can be very useful in treating affective disorders.
What surprises me is that otherwise intelligent people fall for the anti-science and anti-intellectual bullshit that is so popular in this country and reflected in sentiments that renounce "big science", "big government", "big corporations" "big pharma", "big cities", "worldliness" etc. and favor escapism to the idyllic "small town and country" and folksy simplicity. Examples include the popularity of the "lefty" quack Gary Null whose anti-science rant is highly reminiscent of the 1950s right wing paranoia about water fluoridation (http://www.garynull.com/Issues/Fluoridation.htm).
Wojtek