Is depression an illness?

[An Infinite Ocean]

Hi all,

Everyone says depression is an illness. Just like heart disease and diabetes. Obviously, with depression there are various symptoms, both mental and physical.

However, what actual evidence is there that it's a fully-fledged illness, rather than simply an unfortunate state of mind that has negative effects upon the body? For instance, I've been severely depressed for many, many months at a time. And yet I wouldn't feel happy saying that I was 'ill'.

Presumably lots of studies must exist somewhere, but I'm not a scientist and I don't understand much in the way of medical jargon - could someone please fill me in?

I hope this is the appropriate category. If not, then... sorry!

 

[Rolfe]

There are degrees, and perhaps at the milder end the question is rather moot. Look at Winston Churchill's "black dog" - was he ill? He certainly functioned.

But if you'd ever seen my friend Andrew's wife in the throes of post-natal depression so severe I think they called it "puerpural psychosis", you wouldn't need to ask. Sadly, Andrew is now bringing up two little girls alone, after his wife's suicide. At the funeral, the vicar referred to the "illness" which had taken her life.

Rolfe.

 

[EdipisReks]

depression is often caused by chemical imbalances in the brain. that is by definition an illness. depression drugs operate by attempting to correct these imbalances.

 

[TruthSeeker]

There is some discussion of depression that might interest you in this thread

 

[epepke]

Hi all,

Everyone says depression is an illness. Just like heart disease and diabetes. Obviously, with depression there are various symptoms, both mental and physical.

However, what actual evidence is there that it's a fully-fledged illness, rather than simply an unfortunate state of mind that has negative effects upon the body?

At least in the US, depression is carefully called a disorder. Actually, depression itself is a symptom; the disorders are unipolar mood disorder, bipolar mood disorder, and others. But "depression" is often used as shorthand for "chronic unipolar mood disorder." Also, a disorder, like a syndrome, is little more than a collection of symptoms that usually go together.

Whether it's an illness or not, well, "illness" isn't particularly well defined. Mood disorders are like illnesses in that they can debilitate and can be related to other symptoms (severe depression can precipitate schizoaffective features). Most depression does result in some thought disorder; depressed people tend to think poorly of themselves as well as feel poorly.

There's no clear etiology, so it would be a stretch to call it a disease.

Beware of the notion that there are "chemical imbalances." This is purely a folk medicine concept, notwithstanding the fact that many psychiatrists use it.

It is known to be related to the neurotransmitter serotonin in the following way. If one tinkers with serotonin levels, either with MAOIs, which inhibit monoamineoxidase, the enzyme that breaks down serotonin, or SSRI, which selectively reduce the uptake of serotonin, increasing the average time a serotonin receptor has serotonin stuck to it. However, this does not mean that depression is caused by a chemical imbalance, any more than headaches are caused by an aspirin deficiency. There is no known "normal level" for serotonin in the brain and no way of testing for it anyway (except for taking the brain out and putting it in a blender, which is what they do with rats when developing new drugs, and that would make most people really depressed). The closest that one can come is checking for breakdown products in the CS fluid, but that's so indirect as to be pretty useless with respect to an etiology, though it might tell you if a MAOI is doing what it's supposed to be doing.

A few years ago, there was some evidence based on autopsies that chronically depressed people had more serotonin receptors than other people, but that these receptors were considerably smaller. However, the evidence is far from solid, and even if it were, it is not known whether this is a cause of or a result of depression or both, or whether they're both caused by something else, or whatever. It seems more likely that an anatomical property should cause a psychological disorder than the other way around, but that's all it is: something that seems likely. It could easily be that more and smaller serotonin receptors are a developmental adaptation to chronic depression.

 

[An Infinite Ocean]

Cheers folks. It's this stuff about 'chemical imbalances' that gets to me. I'm curious as to how people know that the chemical changes cause the depression, rather than the depression causing the chemical changes.

I know three people that are very severely depressed (and each is on strong medication). In each of these cases, the depression appears to have situational roots, rather than medical ones.

I just find it quite difficult to see how this depression can be described as an illness per-se. I get quite frustrated when these friends tell me they have an illness, as it seems like an attempt to shift responsibility. Firstly, this makes it 'not their fault' (when I feel that everyone must take a little responsibility for themselves), and secondly it allows them to claim that they can't 'just get better' because 'it's an illness'.

I don't wish to sound ignorant or insensitive, but I think the original question was a valid one. Also, I felt I owed it to my friends to do my research (or get others to do it for me )

Thanks.

 

[MRC_Hans]

We know that the chemical changes cause the depression, and not vice versa, because when we correct the chemical changes with medication, the depression goes away (more or less).

However, there is a whole scale here; depression is also situation, or trauma induced. I think it is proper to say that it is a disease that is situation induced (there must be a better expression).

You will meet people who have been through literally hell, still come out on the other side without any depression, and others who really ought to be happy, but who stagger from one deep depresion to the next.

Hans

 

[bug_girl]

well, there seems to be quite a bit of molecular evidence accumulating that depression, or a tendancy for it, is heritable.
one of my favorite journals is molecular psychiatry i just scan it because i think it's cool what we learn each day about brains & ourselves.

ultimately, i think it's an illness because it clearly inhibits my student's ability to function. this recent paper in science shows that peple can have a genetic predisposition to depression:
"Among people who suffered multiple stressful life events over 5 years, 43 percent with one version of a gene developed depression, compared to only 17 percent with another version of the gene" (the actual paper is subscription only) this would partly explain why some people can experience trauma, and emerge unscathed.

"illness" is also a legal term, in some ways. and that is a whole other can of worms

 

[TeaBag420]

Depression also occurs as a symptom of a vitamin deficiency called pellagra, which is based on a lack of niacin or poor niacin metabolism. Treatment? Niacin, either as a supplement (pill) or by improving the diet.

To the poster who wrote about measuring the amount of serotonin in the brain, it's not the amount, it's the way it moves around that's important.

 

[epepke]

To the poster who wrote about measuring the amount of serotonin in the brain, it's not the amount, it's the way it moves around that's important.

Are you talking about me?

You're probably right, which further shows how the "chemical imbalance" is just a folk concept.

 

[epepke]

We know that the chemical changes cause the depression, and not vice versa, because when we correct the chemical changes with medication, the depression goes away (more or less).

Likewise, "we know that chemical changes cause bipolar mood disorder, because when we correct the chemical changes with lithium carbonate, the bipolar mood disorder goes away (more or less)."

Except that this is both wrong and stupid. The normal human body contains essentially no lithium. The lithium ions replace sodium ions which reduces the action potential of some neurons. This is well understood, and it doesn't have jack to do with a "lithium imbalance."

To reiterate:

The fact that aspirin and acetominophen cure headaches does not mean that headaches are causes by an aspirin deficiency.

The fact that aspirin lowers fever says nothing about the source of the fever.

The fact that nitroglycerin is useful for heart disease does not mean that heart disease is caused by not eating enough dynamite.

The fact that digitalis is useful for heart disease does not mean that heart disease is caused by not eating enough foxglove.

And so on, and so forth.

The "chemical imbalance" concept is folk medicine, pure and simple.

People believe in it because there is a stigma attached to mental disorders, and they think that having a scientific-sounding explanation will somehow erase the stigma. But it's bogus.

 

[Eos of the Eons]

Cheers folks. It's this stuff about 'chemical imbalances' that gets to me. I'm curious as to how people know that the chemical changes cause the depression, rather than the depression causing the chemical changes.

I know three people that are very severely depressed (and each is on strong medication). In each of these cases, the depression appears to have situational roots, rather than medical ones.

I just find it quite difficult to see how this depression can be described as an illness per-se. I get quite frustrated when these friends tell me they have an illness, as it seems like an attempt to shift responsibility. Firstly, this makes it 'not their fault' (when I feel that everyone must take a little responsibility for themselves), and secondly it allows them to claim that they can't 'just get better' because 'it's an illness'.

I don't wish to sound ignorant or insensitive, but I think the original question was a valid one. Also, I felt I owed it to my friends to do my research (or get others to do it for me )

Thanks.

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.

 

[Eos of the Eons]

The "chemical imbalance" concept is folk medicine, pure and simple.

People believe in it because there is a stigma attached to mental disorders, and they think that having a scientific-sounding explanation will somehow erase the stigma. But it's bogus..

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?

 

[epepke]

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.

This is dissapointing. I was building up some respect for you. Oh well. At least it's demonstrating something that has bothered me with respect to skeptics for some time, and it inspires me to put together an essay which I'll write later.

Let me try to explain, using simple words. First of all, you will look long and hard before you will find a physician or a medical researcher who will call the cause of diabetes an "insulin imbalance." What you will find is some good research about how the level of insulin in the body relates to the processing of sugar. You will also find some good, simple blood tests for the level of insulin in the blood.

None of these exists with respect to depression. If you doubt me, go to any psychiatrist of your choice on the planet and ask to get a blood test for depression. There is one.

Now, this will require some imagination, and you may try, if you are up to it. It is entirely possible that people with depression respond positively to levels of serotonin that are significantly higher than those of normal people. I am not saying that this is true; we do not know. But if you have some scientific reason that it must necessarily be false, present it.

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

The idea that cream diets were really good for ulcers was also a product of modern science and medicine, and it was wrong. Totally, completely, blatantly wrong. And stupidly, as it's been known for a long time that fats increase stomach acid, and cream has a lot of fats.

[/b]How do you explain depression? [/B]

I don't.

I assert that at the present time there is not enough information to produce an explanation for depression. I support more research. What I do not support is a jumping to conclusions based on a small amount of data.

 

[Eos of the Eons]

Where in the world do you get your information from? I've built up 5 years of books, therapy, and yes, psychiatrist visits. They ALL talk about brain chemical imbalances.

Please supply your links and reference. I've already provided some links on this forum, and recommended a book by Elaine N. Aron.

 

[roger]

From Dr. Francis Mark Mondimore's book Bipolar Disorder:

Another broad category of "medical" mood disorders are those related to various hormone imalances.

For decades clinical scientists have searched for a way to test for bipolar disorder...has not yet led to reliable test...we have learned how to look for and measure abnormalities of brain chemistry....A number of studies have shown that persons with bipolar disorder have an increased number of unusual MRI findings called T2 hyperintensities.

The most consistent PET scan finding in bipolar disorder is a decrease in metabolic rate in the frontal lobes for the brain during periods of depression.....

This study found that there were decreased levels of inositol in the frontal lobes of both the bipolar patients and the suicide victims compared with the control subjects.

I quoted very selectively from some long passages. The jist was that while there are not yet reliable diagnostic tests for bipolar, the science is advancing rapidly.

As far as it not being called an illness or disease, I quote from the same book:

In this first part...I present all the possible symptoms of the illness.

In Chapter 4, "The Mood Disease," I show how psychiatrists came to realize that bipolar disorder is indeed a disease....It was only with the discovery of effective pharmaceuticals that psychiatry realized that bipolar disorder is indeed a disease - as real as diabetes or hyperthyrodism."

As for "chemical imbalances", he disparages it as misleading and simplistic:

There is a term...that many nonpsychiatrist use that I dislike .. I suppose somebody had to invent a term for psychiatric illnesses as uopposed to purely psychological conditions, but chemical imbalance implies several things...that are very misleading.

The ...human brain is not simply a ...organ bathed in a soup of "chemicals" that can be adjusted by the addition of medications to achive a "balance".

An Infinite Ocean, this book, available in any good sized bookstore, answers a lot of your questions in great detail (for a layperson such as myself). For example, it discusses how depression can be caused by medical conditions, such as hyperthyroidism or stroke, evidence for genetic components, etc. I believe it is a well respected book, it is published by John Hopkins, and was recommended to my bipolar friend by her psychiatrist. It's certainly more informative than these threads that for some reason quickly become filled with personal invective.

edited to add: of course, this book is talking about bipolar disorder, not unipolar depression, to which you are probably referring. The author states that the biochemistry is probably different. Still, the book is a good introduction to how depressive states can be caused by biochemistry.

 

[epepke]

Where in the world do you get your information from? I've built up 5 years of books, therapy, and yes, psychiatrist visits. They ALL talk about brain chemical imbalances.

That authority is sure great! Eat fecal matter. A billion flies can't be wrong.

Well, let's start with the DSM-IV, shall we? Perhaps you can show me the page and paragraph where it describes this.

 

[Eos of the Eons]

A good layman's term site

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.

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

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


More technical here:

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.

http://www.brightsurf.com/news/july_03/EDU_news_071803_c.php

Stress causes chemical changes in the body that, left unchecked, can have negative effects on both mental and physical health.

http://www.stress-and-health.com/

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.

http://www.nlp-romania.ro/en/topics/stress.html


Like it or not, our mental well being is completely connected to physical well being because of the systems our body depends on for feedback.

I'm too tired now to explain much, but I'll try again.

 

[Eos of the Eons]

That authority is sure great! Eat fecal matter. A billion flies can't be wrong.

Well, let's start with the DSM-IV, shall we? Perhaps you can show me the page and paragraph where it describes this.

Get a grip dude, it's called anatomy, feedback systems, and the body. Go learn something and come back with some intelligible arguments.

Why do flies love poo? Go learn, it has to do with their anatomy. Why don't we love poo? Gee, I don't know? Maybe because our system isn't geared that way for obvious reasons. What do you think happens in our brain when we smell or tast something?

That's right, chemical messages. Chemicals in the brain. It's not just dry old nerve cells in there.

Your little "you only think that cause someone said so" won't fly here bub. It's called knowledge, not belief. Why do I know? Because not only did I take anatomy, chemistry, etc in college, but I also happen to have a good twenty years of experience with depression and anxiety, and even schizophrenia and tourettes syndrome.

Dopamine, serotonin (sp?), etc. are not figments of our imagination, they are our imagination.

 

[epepke]

Get a grip dude, it's called anatomy, feedback systems, and the body. Go learn something and come back with some intelligible arguments.

Try and calm yourself for a moment.

You made the assertion that ALL the books in your extensive library talked about "chemical imbalances." I am making the perhaps charitable assumption that any honestly acquired library contains the DSM-IV, which is, after all, the definitive guide for the diagnosis of mental disorders in the United States.

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.

That is all. It is all that I have requested.

However, my interpretation of your reaction is that you have somehow glommed onto me as some sort of enemy. I have experienced this many times before, and while it amuses me, I do not see how it is particularly productive in settling, or even arguing for, any actual issues of fact, or even approximation to reality.

Usually, I ascribe this to some sort of defensive need that overcomes questions of literacy, accuracy, and even open debate. I could always be wrong about this, but I seldom actually am.