Is depression an illness?

[Luke T.]

My personal experience with depression revealed that when doctors start considering what antidepressant to give you, they are totally shooting in the dark. Here, try this one. A couple weeks go by. How do you feel now? Worse? Okay. Try this one. And so on. One of the antidepressants made me so much worse, I had to be hospitalized.

I can understand what epepke is trying to say. It would be like if I had a bad headache and a doctor gave me some ground up tree bark and waited to see if my headache went away. If that didn't work, then he gives me some alum to mix with my Pepsi. And so on.

If ground up tree bark was successful at removing a lot of people's headaches, it would only be natural to try to figure out what the mechanism behind that is. But where it gets tricky is that we might assume the mechanism is related to the cause of the problem.

Put another way, if a door is locked (which is what it feels like when you are trapped in depression), and someone trys to open the door with a screwdriver and that doesn't work, and then they try a crowbar and it works, we can study what that crowbar did to open the door, but we shouldn't assume or conclude that a locked door is caused by a lack of leverage. Just because a crowbar is extremely successful at opening a lot of locked doors doesn't mean a "leverage imbalance" is the key (no pun intended) behind the cause of locked doors.

 

[Luke T.]

To stretch the analogy really, really far, ( ) one could say that chasing after "leverage imbalances" will never reveal the true cause of locked doors being a reaction to thieves and the resultant fear and not having a key to the lock.

Locked doors have a conceptual, spiritual and mechanical explanation. I have the feeling that depression is the same. Sorting out cause and effect can have a sort of snake-swallowing-its-tail feeling to it.

I have edited this post about six times. Apologies to anyone who read it during that process.

 

[Luke T.]

I've heard it can go both ways. Post partum depression...caused by imbalance?

In my case stress led to the imbalance.

You can get better, if you make it happen. You won't get better sitting around moping about it.

You can't heal a bone properly without getting it set. You won't beat diabetes without insulin.

It's an illness, but not an excuse to stay ill.

I know all about post partum depression. My wife suffered from it, big time, after our twins were born.

And you forgot PMS.

Definitely some hormone action involved. (edited to add: ) But I'm not so sure that they are related to serontonin re-uptakes.

 

[Luke T.]

Right. Then diabetes is not caused by insulin imbalances. Schizophrenia has nothing to do with dopamine. Lack of iron has no effect on blood cells.

Folk medicine? This isn't woo wooism here. We're talking modern science and medicine, not folk medicine.

How do you explain depression?

I don't see how diabetes being caused by insulin imbalances is proof that depression is caused by a "chemical imbalance."

I used that kind of argument in my satirical Case for Blue Fairies on Claus' web site.

All they can do is attack me with personal slanders because their holy Science is unable to deal with reality. They once said the Earth was flat, and they were wrong. Now they say there are no Blue Fairies. Wrong again!

 

[Eos of the Eons]

I don't see how diabetes being caused by insulin imbalances is proof that depression is caused by a "chemical imbalance."

I used that kind of argument in my satirical Case for Blue Fairies on Claus' web site.

Yes, anecdotes are not proof. It's just an example to help give a clear picture.

I can't put everything my and my son's psychiatrists said here because it's not down on paper, and will be rejected.

My son's psychiatrist was great with anecdotes because he deals with parents every day that need to understand what is going on in their child's brain.

The reasons people have to find drugs that work for them? Everyone is different when it comes to our brains. You can't gear one drug to everyone's imbalance because not every imbalance is the same.

You also then have to work with dosage. This is where balance is worked out over time.

That is why some people will reject the whole process. They feel it is hit and miss instead of zeroing in. That's fair enough.

I simply asked you to show me wherein it is written that mental disorders are certainly caused by chemical imbalances.

As far as I can tell, there are three possible answers to this question:

1) A page number and paragraph wherein it is written.

2) An admission that it is not so written.

3) A nolo contendere approach in which you do not admit that it is not so written but neither do you point out where it is so written.

It is written, and I already showed where. Apparently you missed my post, so here it is again:


A good layman's term site



quote:
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The treatment of depression is the same whether or not it was triggered by stress. If the chemical imbalance is present, it can be treated regardless of the cause. Think of it this way. If someone breaks their leg, they will need a cast. It doesn't matter if it was caused by a fall or a car accident, the treatment of the resulting disability is the same.

When the chemical imbalance is corrected, the person is then better able to deal with their stresses since their thought control has been restored.

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http://www.drgrantmullen.com/whtcausdeprn.html

Most of the woo sites claim this is not true. Big surprise there.


More technical here:


quote:
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The researchers found that individuals who have a particular variation in the serotonin transporter gene were more likely to develop depression after exposure to stress.
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http://www.brightsurf.com/news/july...ws_071803_c.php


quote:
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Stress causes chemical changes in the body that, left unchecked, can have negative effects on both mental and physical health.
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http://www.stress-and-health.com/



quote:
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Scientists have now identified approximately 45 different hormones that are associated with behaviour such as sleep, fear, peace, pain, obesity, addiction, hunger, depression and stress. So, there is a lot going on because everything is so inter-connected.
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http://www.nlp-romania.ro/en/topics/stress.html



So, now your turn epeke, show us a credible source that "it is written" chemicals have nothing to do with depression or other mental illnesses.

Include examples for

a) schizophrenia
b) Bi-polar
c) depression
d) tourettes syndrome
c) parkinson's disease
etc etc etc.

I will be waiting patiently, don't worry.

I'm also curious. Are you into scientology/dianetics?

 

[roger]

May I humbly suggest that people read my post above? I feel like I'm invisible here! It contains quotes from a very well respected psychiatrist on exactly this issue. Sorry, Eos, but he does discourage the use of "chemical imbalance", not because chemicals don't play a role, not even because a lack of a chemical can cause depression, but because it is far too simplistic and misleading. It's not a matter of too little of chemical A, so we dose with A and patient gets better.

It _really_ is an excellent book, if you want a view into the current thinking about the biochemical basic of depression in general, and bipolar disorder in detail.

 

[bug_girl]

May I humbly suggest that people read my post above? I feel like I'm invisible here!

welcome to my world, roger

 

[roger]

Did somebody say something???

 

[El Greco]

It contains quotes from a very well respected psychiatrist on exactly this issue. Sorry, Eos, but he does discourage the use of "chemical imbalance", not because chemicals don't play a role, not even because a lack of a chemical can cause depression, but because it is far too simplistic and misleading.

I would guess that he just doesn't like the terminology "chemical imbalance", because it implies that we can somehow fix this imbalance by adding something or subtracting something else, without taking into account unmodifiable gene expression.

But this doesn't change anything for us, does it ? I mean, depression is still something that has a molecular / cellular basis.

 

[roger]

I would guess that he just doesn't like the terminology "chemical imbalance", because it implies that we can somehow fix this imbalance by adding something or subtracting something else, without taking into account unmodifiable gene expression.

Well, partially. Also part of the problem is that chemical and psychological causes overlap.

But this doesn't change anything for us, does it ? I mean, depression is still something that has a molecular / cellular basis.

Perhaps to us layman (I hesitate to include you in that category, as if i rmember correctly you are trained in pharmacology) nothing is changed, but doctors are not trying to just adjust chemical levels. They need to look into medical causes - vitamin deficiancy, hormones whacked out, etc., provide psychological counseling (either to help treat the disorder, or at least teach coping skills), etc. Calling it a "chemical imbalance", while correctly identifing the problem as biochemically based, both ignores the complexity of the situation and fails to identify many of the other factors which may be involved.

With that said, I think everyone in this thread pretty much agrees with that, but are just expressing it differently. I could be wrong.

 

[El Greco]

Well, partially. Also part of the problem is that chemical and psychological causes overlap.

I would argue here that "psychological causes" are also "chemical" in their basis. What else could they be ?

And of course it is much more complicated than a "chemical imbalance", but it is also amazing that we have managed with simple molecules to reverse such a complicated disease.

 

[Eos of the Eons]

Well, partially. Also part of the problem is that chemical and psychological causes overlap.

Perhaps to us layman (I hesitate to include you in that category, as if i rmember correctly you are trained in pharmacology) nothing is changed, but doctors are not trying to just adjust chemical levels. They need to look into medical causes - vitamin deficiancy, hormones whacked out, etc., provide psychological counseling (either to help treat the disorder, or at least teach coping skills), etc. Calling it a "chemical imbalance", while correctly identifing the problem as biochemically based, both ignores the complexity of the situation and fails to identify many of the other factors which may be involved.

With that said, I think everyone in this thread pretty much agrees with that, but are just expressing it differently. I could be wrong.

Sorry Roger, yeah arguing semantics is missing the point, and you make some really good ones.

I don't know if I used "chemical imbalance", but I did mean that the stress over a prolonged period of time, or hormonal changes during pregnancy, birth, etc, do cause the brain chemicals to be upset (serotonin too low too long affects the receptors, etc...I posted a genetic component as well). If caught soon enough, a person shouldn't even need medication. Some stress management would be in order, and even some therapy. That way the brain gets the break it needs in order to get back to 'normal' for that person.


I didn't try meds until I was at my wit's end (took years for me to try it).


Looking into medical causes first (pregnancy, poor diet, lack of exercise) is definitely the only way to start out. I tried making sure all these things in order to make sure I wasn't lacking in the wellness area physically.

Stress management as well. And yes, coping skills.

Meds are usually a last resort, and are not a quick fix, but a way of managing the illness until a person can get better. It's rare for people to take them longer than 2-6 months.

Then you get folks like me, and that's a little more extreme.
Others with post traumatic stress are also a bit more of a challenge.

Everyone has different levels of stress tolerance. It would be nice if we all had high levels of tolerance, but that is not the case. The saying "what doesn't kill you only makes you stronger" is not always the case. It can cause irreversible damage. Giving yourself a break is not selfish, and can save your sanity.

Roger, Do you mean psychological as in the way a person thinks. That is another area to address with depression. Negative thinking doesn't do a body any good.

It's all complex and everyone is different. There are many ways to help a person who is depressed, it's not like schizophrenia.

Thank you Roger.

 

[roger]

I would argue here that "psychological causes" are also "chemical" in their basis. What else could they be ?

Process, for one. Structural, for another. I'll expand on that in a minute.

But first, let me say I am all for reductionism, but for useful reductionism. One can say, truly, that the computer programs I write all come down to quantum mechanics. But what a completely useless way to try to understand or debug a program.

Likewise, behavior patterns, thinking patterns, etc, while implemented on a substrate of biology and chemicals, are best understood as processes and structure, not as chemical.

A concrete example: say I have sleep aphia (however you spell it) caused by enlarged structures in my throat. I barely get any sleep over a long period of time, and this exacerbates, or even causes a depression. At some point, somewhere, sure, there is biochemistry involved that translates that lack of sleep into a depressive episode, but it may be quite normal biochemistry. Nothing is out of 'balance', and nothing has to be treated at the chemical level. I just need throat surgery.

Similarly, somebody may have low self esteem that stems from a difficult childhood. This leads to negative thinking, which perpetuates and worsens an existing depression. Dealing with these underlying issues, plus education (teach the person that negative thoughts fuel depression, teach them strategies to recognize when it happens and how to change the thinking) will do wonders to fix the depression. Again, is there biochemistry in there? Absolutely. Is the issue poorly adjusted neurotransmitters? Probably not. The therapy in this case may be sufficient to fix the problem.

You may reasonable counter the "probably not" by pointing out that the existing depression was probably caused my neurotransmitters. Well, the jury is out on that one is my understanding, and there are many other factors which can cause depression. For example, genetic factors can cause your brain to be "wired" badly (yes, wild hand waving is going on now ). I'd much rather call that a structural problem rather than chemicals, even though of course chemicals are involved.

So anyway, that's the problem with "chemical imbalance". Yes, drugs are getting much more successful at treating these diseases. But that doesn't mean that is the only treatment modality (which I don't think you were saying anyway), and thus, saying it all comes down to chemistry is, IMO, misleading in it's implications.

Eos, I hope this suffices as an answer to your question to me.

Finally, I wrote the above with more authority than I can claim. I am a layperson, explaining my understanding of what I have read
and also what I have been told in therapy.

 

[epepke]

My personal experience with depression revealed that when doctors start considering what antidepressant to give you, they are totally shooting in the dark. Here, try this one. A couple weeks go by. How do you feel now? Worse? Okay. Try this one. And so on. One of the antidepressants made me so much worse, I had to be hospitalized.

I can understand what epepke is trying to say. It would be like if I had a bad headache and a doctor gave me some ground up tree bark and waited to see if my headache went away. If that didn't work, then he gives me some alum to mix with my Pepsi. And so on.

Unfortunately, this due to the state of the art. The fact that pychs basically have to shoot in the dark to treat depression just shows that we're that much further from having an etiology.

Nobody knows what causes depression. A corrolary of that is that, certainly, nobody knows that there is a single cause for depression. There could be hundreds of diseases, all of which cause depression.

Not too long ago, I had a really bad cold, which still lingers. I find myself sleeping a lot. When I get up, I cannot marshall the mental clarity required to do programming fo my contract jobs. Whether this is due to the effects of the anti-symptom preparations or due to having a head full of snot is a bit of a toss-up. I got depressed. So what's the cause of this one?

Put another way, if a door is locked (which is what it feels like when you are trapped in depression), and someone trys to open the door with a screwdriver and that doesn't work, and then they try a crowbar and it works, we can study what that crowbar did to open the door, but we shouldn't assume or conclude that a locked door is caused by a lack of leverage.

That's a good analogy, but a better one would be the assertion that the door lockage is caused by a crowbar imbalance.

 

[epepke]

May I humbly suggest that people read my post above? I feel like I'm invisible here!

Nah, I heard you, and you make eminent sense, but me-tooism is fairly rare, and as for Eos, I can't even get her to read what I wrote without going off on a something-or-other.

 

[tamiO]

A concrete example: say I have sleep aphia (however you spell it) caused by enlarged structures in my throat. I barely get any sleep over a long period of time, and this exacerbates, or even causes a depression. At some point, somewhere, sure, there is biochemistry involved that translates that lack of sleep into a depressive episode, but it may be quite normal biochemistry. Nothing is out of 'balance', and nothing has to be treated at the chemical level. I just need throat surgery.

I agree that depression brought on by chronic illness and stress can be treated successfully without drugs, but I think a combination of SSRIs and therapy is the best approach. It puts you in a better frame of mind to heal from surgery and/or make attitude/behavioural changes.

 

[epepke]

I agree that depression brought on by chronic illness and stress can be treated successfully without drugs, but I think a combination of SSRIs and therapy is the best approach. It puts you in a better frame of mind to heal from surgery and/or make attitude/behavioural changes.

SSRIs are pretty cool. I think they work best when combined with Buspar or in the combinations that have a Buspar-like end, such as Serzone or Wellbutrin, because you get the anxiolytic effect as well, or combined with a more traditional anxiolytic such as Ativan.

I've seen little evidence that they work so hot over the long term. Still, they can be effective, if even by giving a patient a short-term referent for what it's like not to be depressed.

 

[El Greco]

Similarly, somebody may have low self esteem that stems from a difficult childhood. This leads to negative thinking, which perpetuates and worsens an existing depression. Dealing with these underlying issues, plus education (teach the person that negative thoughts fuel depression, teach them strategies to recognize when it happens and how to change the thinking) will do wonders to fix the depression. Again, is there biochemistry in there? Absolutely. Is the issue poorly adjusted neurotransmitters? Probably not. The therapy in this case may be sufficient to fix the problem.

When major depression diagnosis is (properly) made, considerations like the ones you mention are thoroughly evaluated. From this page, two diagnostic criteria for major depression:

4. The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder.

5. The person's symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down (psychomotor retardation).

My point is that psychiatrists know how to make a differential diagnosis and exclude other medical conditions or socioeconimic problems from the picture. When someone is diagnosed with major depression, we are talking about a serious medical condition that can be aggravated but cannot be caused (as far as we know) by misfortunes in one's life.

Check the site I linked for other types of mood disorders that may be more like what you have in mind.

 

[roger]

My point is that psychiatrists know how to make a differential diagnosis and exclude other medical conditions or socioeconimic problems from the picture. When someone is diagnosed with major depression, we are talking about a serious medical condition that can be aggravated but cannot be caused (as far as we know) by misfortunes in one's life.

I think we agree, and are just talking past each other a bit.

 

[Eos of the Eons]

My point is that psychiatrists know how to make a differential diagnosis and exclude other medical conditions or socioeconimic problems from the picture. When someone is diagnosed with major depression, we are talking about a serious medical condition that can be aggravated but cannot be caused (as far as we know) by misfortunes in one's life.

I'm glad to see someone knows what they are talking about

***pokes epeke with a stick***