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[P]
Demystifying Depression - Part II

By Name of Feather in Science
Tue May 17, 2005 at 04:15:20 PM EST
Tags: Science (all tags)
Science

This is the second and final part of this series. In this instalment I will cover a range of miscellaneous topics surrounding depression. Special attention will be given to the controversy about antidepressants and the role that sports play in depression. Also noteworthy is an attempt to quantify depression in objective terms.

Each topic is fairly independent, but on the whole, the contents of this document are better understood if one carefully reads Part I beforehand.


1. THE CONTROVERSY ABOUT ANTIDEPRESSANTS

This is largely country-dependent: in some countries their use is widespread and generates little discussion; in others, many factors contribute to making them practically taboo words. The country where I live, the Netherlands, tends towards the taboo end of the spectrum. The reason has a lot to do with the prevalent (and backwards if you ask me) Calvinist mentality. I know that in other places, such as most of North America and Southern Europe they are much more readily accepted. Your mileage may vary.

The controversy is typically framed in the following ways: doctors nowadays over-prescribe antidepressants, instead of following the psychotherapy route; antidepressants are just a ploy from the evil pharmaceutical multinationals; our societies are drifting towards a "Brave New World" scenario where drugs are used to keep the populace happy and unable to rebel. Well, my personal opinion is that there is some substance to some of these worries, but they are largely exaggerated and fail to acknowledge one very important fact: antidepressants are very effective in treating clinical depression. This is not a matter of opinion: it has been demonstrated in several double-blind clinical trials.

First, on the issue of over-prescription. I would say that they are both over-prescribed and under-prescribed. The problem is that most doctors do not understand depression well, and will prescribe drugs to people whose brains are healthy, and fail to provide them to people who could actually benefit from them. Take people who are mourning, for example. In most cases, these people do not have a depression. Grief is something perfectly normal, and its onset is all too sudden to cause a depression (remember that a depression typically takes years to develop). Likewise, consider giving antidepressants to very young people: the brain of a child or even a teenager has such a fantastic ability to repair itself that it takes quite a pounding for a depression to develop. In these cases, antidepressants and all their unavoidable side effects are more likely to hurt than to help. On the other hand, there are people who have minor problems with stress and anxiety, or whose blood pressure is above normal for no apparent reason. They are often simply told that they should watch out for salt in their diets, or to take up yoga or meditation. This advice might help, but only to a certain degree. I suspect that a course of an antidepressant would have a stronger and more lasting effect.

Moving on to the subject of side-effects. Modern antidepressants are generally well-tolerated and safe to use. They do have side-effects, which depending on the drug and the person can be significant enough that people discontinue taking the medication. However, this is yet another issue where proper handling by a competent professional will make a huge difference. What one often finds is that people are given the wrong drug for their case. Imagine for example an overweight patient being given an antidepressant which increases appetite, or someone who has a satisfactory sex life and is given a drug which upsets their libido. What is required is matching the profile of the patient with the expected side-effects of the drug. Granted, there is plenty of variation among individuals, but the overall pattern is still strong enough that we can categorically say what will be the most likely side-effects of a given antidepressant. A straightforward discussion with a good professional will go a long way towards finding a drug tuned to your particular case, thus minimising the negative side-effects and decreasing the chances of premature discontinuation.

Finally on to the subject of psychotherapy. As someone who had a depression, I can assure you that there is nothing more patronising and irritating than people who bring up the "psychological help". A depressed person will definitely need professional help, but mostly for a proper explanation of the problem, to learn relaxation techniques, to know how to listen to their bodies, and to be coached in the lifestyle changes required for giving their brains a chance to recover. Once they are recovered, perhaps some therapy might be needed to make sure that whatever behavioural patterns which contributed to the development of the illness will not recur. However, and I cannot stress this enough, therapy is not a substitute for medication, and "psychological help" is a misunderstanding.

2. SUICIDE

Suicide is an unavoidable part of depression, and one which better than no other embodies all the prejudice, the misunderstandings, and the narrow-minded attitudes towards the illness. How often does not one hear pompous proclamations about the cowardice of suicide? Or the patronising and delusive belief that with the proper arguments one can convince a depressed person that life is worth living?

Here I speak only of suicide in the context of a clinical depression. Obviously, non-depressed people can also commit suicide (think of a suddenly dispossessed rich man, or a politician irreparably stained by scandal), but the point I will try to carry across is that suicide associated with depression is a different beast altogether. Again, forget psychology and try to understand the problem from a physiological perspective.

Remember that a depression affects the part of the brain responsible, among other tasks, for planning. During the critical stage of a depression, the brain is in such a condition that a person cannot even visualise a future without the despair and the suffering. They cannot even plan their way out of bed, for that matter. And remember that the reason is entirely endogenous and physiological: there is no amount of well-intentioned arguments which will change that [1]. Also, do not think that you can imagine what it feels like. You cannot. I have been there and I can no longer imagine it.

Bear also in mind that during the critical stage of a depression, people experience anxiety crises of such magnitude that they often resort to self-mutilation to try to quench the suffering. Again, do not think that you can imagine what it feels like. It is most likely that you cannot. An anxiety crisis alone can drive a person to commit suicide.

"Suicide is a permanent solution to a temporary problem". There is much wisdom to this sentence, and it is probably the best advice you can give a depressed person. Unfortunately, during that critical stage is difficult for them to visualise the temporary nature of the problem, and suicide is not uncommon. If you a have a friend or a loved one going through that stage of a depression, do take the possibility seriously and do what you can to prevent it from happening. In particular, make sure they are being handled by a competent professional. Fortunately, especially if people are young, this stage will not last very long, typically just a few days or weeks.

To conclude, if you never had a depression, and should you feel inclined to make grandiose pronouncements on suicide, bear in mind that you have no clue whatsoever of what you are talking about.

3. THE ROLE OF SPORTS

The role played by sports and physical exercise in depression is far more complex than either the "sports good" and "sports bad" mantras would lead one to assume. Moreover, I would say that this is one area where our current understanding of depression is sorely incomplete. Consequently, beware that much of the material in this section is conjectural. I am well aware that most people's gut reaction will be to dismiss my conjectures as pure rubbish, since "everyone knows that sports are good for you". A couple of years ago I would have whole-heartedly agreed with them, but I have learnt otherwise in the meantime. Furthermore, read carefully and you will see that I do not deny that sports can be good for you. I simply add a poignant "however" to the issue of sports and depression.

This issue is complex enough to warrant a number of subsections. I will first make a distinction between the temporary improvement of mood brought by sports, versus the long-term actual improvement of the depression. Second, I will put forth the tentative mechanism of why moderate amounts of exercise can help to recover from depression. Third, I will describe the caveats of doing exercise to recover from a depression. At last, I will describe a real-world example of how sports can be used to make people be more active during a depression, with the drawback that recovery takes longer.

3.1. Feeling Good vs. Actual Improvement

"Sports alone can lift up a depression", says one of the most common advice about the illness. Unfortunately, this statement is grossly incomplete, often tragically so. If you have properly understood the roles played by adrenaline and cortisol (take a look again at Section 2.2 of the first part of this series to refresh your memory), you already have a glimpse of why this is such misleading advice. Exercise can indeed momentarily lift up the subjective feeling of a depressed person, but that is all caused by adrenaline. It is therefore critical to make the distinction between the momentary mood improvement caused by exercise (which is undisputed), and whether it translates into an actual improvement of the underlying depression.

Please refer back to Section 2.2 of Part I. There I have speculated on recent findings which indicate that a process known as neurogenesis ("neuron birth") is implicated in recovery from depression. This process takes about three weeks to occur, which also happens to be the average time required for antidepressants to have an effect. This coincidence has led some to hypothesise that antidepressants work by stimulating neurogenesis [7]. The point of this digression is to emphasise that anything which has a positive effect on recovery from depression is likely to require the same three weeks to work. One should therefore be a bit suspicious of any cure which seems to work instantly, as is the case of exercise.

Now the question is: does exercise also have a long-term positive effect on depression, or is it all a short-term illusion?

3.2. Why Moderate Exercise May Sometimes Help

I will now speculate on two hypotheses why moderate amounts of aerobic exercise seem to help mildly depressed or healthy individuals. (To be more precise, what is usually prescribed is a moderate aerobic exercise lasting for about 45 minutes, and taking place 3/4 times per week. By moderate it is implied that the heart rate never rises past 100-120 beats per minute, depending on the age).

To understand the first hypothesis, you must first take a look at what aerobic exercise really is. If you consider the body's response to exercise, it looks exactly like the effects of an extreme, short-lived stressor: heart rate goes up, senses become sharper, sweat is intense, etc. How can an intense stress prevent stress? The answer may lie in a phenomenon called hormesis [2]. In brief, short-lived stressors might trigger the repair mechanisms of the body to overcompensate.

This phenomenon has also been reported in other contexts. We all know about the health damage caused by radiation. However, people subjected to artificial zero radiation environments will get sick. Since our bodies have evolved in an environment with naturally occurring low-levels of radiation, our cellular repair mechanisms are used to that soft but constant radiation damage.

          ^
          |
          |    ___
          |   /   \
          |  /     \
          | /       \
Benefit   |/---------\--------->
          |           \
          |            \
          |             \
          |              \
          |               \
          v

        Amount of stressor

Figure 1: The hormetic response curve. Note how small amounts of the stressor event have a positive effect, but which decreases rapidly as the amount increases. Large amounts will actually have a negative effect on the body. (The stressor event can be exercise, radiation, or any other agent for which there is a hormetic response).

Figure 1 illustrates the benefit one can expect from exercise. The most important thing to realise is that even though a bit of exercise helps a bit, that does not translate into a lot exercise helping a lot. Quite on the contrary.

At this point you might be wondering about the location of two very important points in the graph: the first is the amount of exercise which provides the highest benefit; the second is the amount where the transition from positive to negative effect happens. Well, the truth is that these points are not fixed and depend (among other factors) on how serious the depression is. To understand why, you must take a look at Figure 3 from Part I, and remember that the more serious the depression, the longer it takes for the body to recover from any influx of adrenaline. For a person with a serious depression, even exercise which a healthy individual would describe as "moderate" will require a long recovery time. So long in fact that it would have a negative effect on sleep. In a sense, the more depressed you are, the more compressed on the x-axis is the graph in Figure 1.

^                            ^
|                            |
|    ___                     |       ______
|   /   \                    |     _/      \_
|  /     \                   |   _/          \_
| /       \                  | _/              \_
|/---------\--------->       |/------------------\_------------>
|           \                |                     \_
|            \               |                       \_
|             \              |                         \_
|              \             |                           \_
|               \            |                             \
v                            v

     Severe                             Healthy

Figure 2: The hormetic response curve for a severely depressed individual and for a healthy one.

You may now begin to understand why I advise caution in regard with depression and exercise. For a severely depressed individual, the graph is so skewed towards the left that any exercise beyond a 30 minute gentle walk in the mornings is discouraged. As the recovery progresses, the graph expands on the x-axis (see Figure 2), meaning that people are able to safely do more physical activity and for longer. In the case of a healthy individual or one with a mild depression, the graph is significantly expanded on the x-axis, meaning that moderate exercise as a way of treating depression is a viable option. (Again, moderation is the key!)

The second hypothesis is more straightforward. Regular exercise improves the condition of the cardiovascular system, thus making it less likely to go into emergency mode whenever physical requirements increase, and therefore reducing the amount of adrenaline that needs to be put into the system. However, and in similarity with hormesis, the advantages from exercise probably only outweigh its disadvantages for healthy individuals or mildly depressed ones.

At last, a word of advice. If you think you have a depression, you should seek professional help. It might be tempting for some people to try to exercise their way out of a depression, but chances are you might actually be making your condition worse. See next section for details.

3.3. Caveats of Treating Depression With Exercise

Looking back on Figure 2 from Part I, some people might suggest that a person with a severe depression could avoid the crashing down simply by exercising every single day. In a sense, as soon as your body begins to crash, you simply do more exercise to rev it up again. You could therefore rip the positive temporary effects of exercise, and hopefully avoid the negative side. This routine "sort of" works, but is also extremely dangerous, as I will proceed to explain.

The major problem is that having too many stress hormones flowing through veins has a negative effect on sleep. And sleep is crucial for recovery. So people with more severe depressions who exercise every day will not sleep as much as they should, and the recovery will therefore take longer (see next section for a real world example). More seriously, if the amount of exercise is too high, they might even regress. Even more seriously, if the underlying depression worsens, people might be tempted to increase the amount of exercise to compensate, which will quickly lead them into a very dangerous downwards spiral. In a sense, advising a seriously depressed person to exercise is like telling a drunken individual that the best way to avoid a hangover is to keep drinking; or advising a heroin addict that the best way to avoid the withdrawal symptoms is to keep injecting the drug.

This is unfortunately not widely known, but even healthy individuals who exercise too much can develop the symptoms of a depression. This is sometimes referred to as the athletic overtraining syndrome [8], and by now you should have understood the basic mechanism of why it arises.

3.4. A Real World Example

At last I will provide you a real world example which illustrates the caveats of doing sports during depression. Some companies here in the Netherlands rely on a sports-intensive routine to put people back to work sooner. In basic terms, the routine involves running every single morning for a period between one hour and one hour and a half. The running is performed under controlled conditions, to prevent the heart rate from ever going over 130 beats per minute. If you understood the role of sports in depression, you will also realise just how this scheme works: it basically gets their brains running on adrenaline. This is not entirely harmless, as during the recovery period the people will have elevated heart rate and stress hormones flowing through their veins. Also, with all that adrenaline in their systems, they will not sleep as much as they could, which makes a full recovery last much longer, up to three years. The advantage of this scheme? Well, they do begin working (part-time of course) much sooner than otherwise.

At this point you might be wondering how they do not realise what is really happening. Remember that adrenaline is an insidious hormone, which makes one feel good even as it revs up the body, and this scheme requires them to exercise every single day without exception. Obviously, the idea is to keep them from crashing down from all that adrenaline, and therefore to prevent them from realising their true status. Also, there is widespread ignorance about depression among dutch GPs, which makes it all the more unlikely that someone will realise that there is something fishy going on. Personally, I find this scheme to be utterly mad. But then, I am not a Calvinist.

Should you be thinking that this scheme is also a perfectly viable alternative way of curing a depression---one which takes longer, is potentially harmful to the general health, but does allow one to become active sooner rather than later---I would even be tempted to agree with you. However, I still think that the ultimate choice should reside with each individual person. It is their health we are talking about, after all. These people should be properly informed of all possible alternatives and the implications of each one. This is currently not happening.

4. DEPRESSION AND AGEING

You do not see 60-year olds having the same lifestyle as 20-year olds. Even a 40 or a 30-year old probably would not be able to accommodate for a long time all the intense living and partying of their youth. We naturally accept that our physical abilities decrease slowly with age, and our brains are no different. Mind you, in this context I will speak only of the brain's endurance, not of the general cognitive abilities. Therefore, do not interpret the graph in Figure 3 as "getting dumber with age". (Though it is most likely that cognitive abilities also decrease with age. Luckily, the added experience can in large part compensate for that).

^
|=========
|         =========
|                  ==========
|                            =========
|
|
|
|
|
|
|
|
|
--------------------------------------->
                Age

Figure 3: The maximum normal capacity naturally decreases with age.

Bear in mind that I am largely speculating here, but I would not be surprised if the reason why depression tends to strike first towards the mid 20s (and this is a fact) is related to a dip in the maximum normal capacity which happens after adolescence. Many people simply fail to accommodate for the necessary changes in their lifestyle, and thus find themselves constantly going over their (now slightly diminished) limits.

Still on the speculation front, consider the fact that people tend to sleep less as they get older. Could it be related with the graph in Figure 3? If sleep is indeed fundamental for the brain to repair itself, and if age cuts down the requirements for the maximum normal capacity, it is not too far-fetched to imagine that people would therefore require less sleep as they get older.

Speculations aside, do not look with gloom at the graph. Ageing is not a death sentence as far as feeling well is concerned. People do generally accommodate by making changes to their lifestyle, and remember that depression only arises should you constantly go over your limits. Furthermore, in percentage terms, the natural decrease might not even be large. (Unfortunately, our current understanding of depression does not yet allow us to make precise quantifications. See Section 7 for details).

5. THE GENETIC LINK

I have not brought up the genetic link up till now, but it is without doubt one of the primary risk factors. Depression seems to run in families, and even after the environmental effects are taken into account, the genetic link is still clearly there [3]. Some studies have shown that approximately one out of every three people have a genetic predisposition to develop a depression. However, like in many other cases, the interplay between genes and environment is also relevant for depression: only about half of those with the genetic predisposition will actually develop the illness. In any case, should you have cases of depression among close blood relatives, do take it as a warning that you too might be at risk.

Note: A person is most closely related to their siblings, their parents, and their children. In either case, you share with them approximately 50% of your genes (for which there is variance among the breeding population). Grandparents, grandchildren, aunts, uncles, nephews, and nieces are next: the shared portion is approximately 25%. In these cases, the conditional probability of having a depression knowing that your relative had a depression is higher than the above mentioned absolute probability of about one third. For relatives farther beyond the genetic proximity measure (cousins, etc), the conditional probability approaches the absolute probability for the general population, and is therefore not quite as relevant as an indicator.

6. IS DEPRESSION ON THE RISE?

Is the incidence of depression really on the rise? Statistics seem to point that way [4], and considering the risk factors, that should not be altogether surprising. The truth is that many modern hobbies are actually very demanding on the brain. Should a person pull long hours at work and then come home to face an equally demanding hobby, there is a very good chance that they are pushing the brain past its limit.

This is likely to strike a chord with the Kuro5hin crowd: surfing the web and blogging should be seen as work as far as the brain is concerned. In a similar note, information overload is not just a fancy buzzword: it is a factor contributing to the development of depression. The list is long: mobile phones, news tickers, instant messaging, etc. We seem to be very good at devising ways to overload our brains.

On a more positive note, if one considers the current understanding of the problem, plus the available means to treat it, making serious clinical depression a thing of the past is well within our reach. What is required? Just getting the message across! Sadly, it may prove difficult to overcome centuries of prejudice surrounding mental illness.

7. QUANTIFYING DEPRESSION

You will certainly have noticed the lack of scale in all the graphs herein shown. The truth is that research into depression has not yet reached the quantification stage. This is a pity, as much of the prejudice (especially in getting official recognition for the problem) could be avoided if there were tests which could estimate the seriousness of a depression. Which is not to say that such tests are not possible. In fact, in this section I intend to propose the means by which they could be developed.

At this point you might be thinking that blood pressure already provides a fine estimation. This is only partially true. Foremost, several factors other than stress levels have an effect on blood pressure. Furthermore, blood pressure is a static measure, unable to differentiate between the state of deep depression / low activity and the state of mild depression / high activity. This is an especially crucial distinction in the recovery phase of a depression. (Blood pressure is more reliable during the buildup phase towards a depression precisely because the activity variable tends to be always high, as people struggle to maintain a normal lifestyle).

My suggested test also relies on blood pressure, but adds a dynamic measure of that variable. In short, the idea is to build a graph showing how blood pressure progresses with time as the test subject performs a high-concentration activity. Figure 4 shows what one would be likely to expect from a healthy individual, a mildly depressed one, and one more deeply depressed.

          ^                        ^                        ^               __
          |                        |                        |            __/
          |                        |                        |         __/
          |                        |                        |      __/
Blood     |                        |               ____     |   __/
Pressure  |                        |          ____/         |__/
          |                        |     ____/              |
          |             _____      |____/                   |
          |____________/           |                        |
          |                        |                        |
          -------------------->    -------------------->    -------------------->
               Healthy                   Mild                     Severe

Figure 4: The blood pressure response curve for three individuals with varying degrees of a depression.

Note that a depressed individual will typically not only have a higher blood pressure at rest, but more importantly, a steeper response curve. This could be the basis for developing an objective test of the seriousness of a depression. It would also be extremely valuable for tracking the progress of the illness.

The test activity is an open question. I would suggest a test which would require both high concentration and short-term memory. In my personal experience, I noticed that the simple game "Concentration" (the one where you are supposed to pick pairs of cards out of a large set of unturned cards [5]) provokes an almost immediate response. It might be a good candidate for the test.

Obviously, there is a fair amount of noise which makes a precise measurement harder. How well the test subject slept the night before is one variable hard to control. Likewise for the degree to which they are enjoying the activity. Furthermore, other variables such as current medication and time of day would also interfere.

Another advantage of an objective test would be an estimation of how much time would be required until the test subject could be considered cured. I realise that there are several factors interfering with the progress of the illness, but given a large population of test subjects, one could compensate for factors such as age. It is only a matter of statistics, after all. In any case, a rough estimation is a lot better than no estimation at all.

At last, one small note of hope: there is research underway which uses imaging techniques such as fMRI to look directly into the brain and see the changes caused by depression [6]. Unfortunately, it might take quite a long time before such research is put into practical use. The test I proposed is low-tech, potentially a lot cheaper, and could be developed immediately.

8. THE BURNOUT SYNDROME

There is much talk (at least in the Netherlands) about the so-called burnout syndrome. And as is often the case, there is more noise than signal in this discussion. First of all, in medical terms, there is no such thing as a burnout. There are depressions, period. A burnout is just a depression whose causes are mostly work related. Remember that the person's attitude towards the task at hand plays an important role in the biochemistry of the brain. Should you have a job that you find boring and repetitive, or should the surrounding circumstances (overbearing boss, bad corridor atmosphere) make you feel uncomfortable about going to work every day, a depression is likely to develop.

Second, when a person is said to be burned out, what they have is a lingering depression from which they have not yet fully recovered. Also, there are plenty of mildly burned out individuals who have never received any kind of treatment. They often drone through life for years before the problem is diagnosed.

I made a section out of this issue precisely because the general attitude in this country is to dismiss burnout as just a psychological problem, thus being handled with a lot of complacency, or just ignored. This is all the more tragic if one considers the statistics which show the Netherlands to have some of the highest percentages of people affected by this problem. There is indisputably also a psychological component to burnout, but it goes far deeper than that.

9. HAPPINESS

This section is dedicated to my nihilist friends who thought I have been exaggerating by equating a healthy brain with happiness. In truth, having a healthy brain and no symptoms of a physical depression does not mean your life will be a carnival of constant bliss. There are people who are unhappy their entire lives and yet never develop a depression. They have a general discontent with life, a permanent feeling that the present is not satisfactory enough, and frequent bouts of the blues. However, given that their brains are healthy, they are capable of feeling happiness when circumstances are favourable. In comparison, a clinically depressed person will not feel happy even if all their problems were magically resolved. If you have not done so before, you will now understand how critical it is to make a distinction between the psychological feeling which could be described as "depressed", and the physical illness which affects the brain---clinical depression. Many a prejudice would be overcome if healthy individuals could be made to experience, even if just for just five minutes, what the fire and the desperation of depression feel like.

10. FACING THE PREJUDICE

Most of the advice contained in both instalments of this document is based on one very important assumption: society will give you the means to recover. Unfortunately, this is still far from being the case. A seriously depressed person cannot constantly go over their limits if their brains are to be given any chance of recovering. Take the practical example of restarting work: one has to build up the activity slowly, in accordance with the increase of the maximum capacity of the brain (remember Figure 6 from Part I). Obviously, this requires some sort of official recognition of the particularities of depression. In theory, this is part of the law and recognised in most civilised countries. In practise, things can be very different.

Do not assume that because you live in an otherwise tolerant and socially-minded society, depression will also be well understood. Bear in mind that other factors come into play, most importantly the fact that cure takes a long time, which means it is also very expensive for an employer. Also, the overall stance towards mental illness might be biased by the prevailing religious substrate, influencing attitudes even of non-religious people: take the example of Calvinism here in the Netherlands. All in all, when depression is the subject, do not be surprised when society shows its ugly side. The good old advice of stashing away some six-months worth of salary for a rainy day is very much applicable in the case of depression: you will need it.

Interestingly enough, I see no reason---other than prejudice and bad will---why the state of affairs should remain like this. Take again a look at Section 7: it is well within our means to devise reliable objective tests to assess the seriousness of a depression and/or to determine when a person is again fit enough to work. Depression itself provides more than enough misery. It is inhumane and cruel that the problem should be compounded by lack of recognition.

REFERENCES

[1] Why? The Neuroscience of Suicide

[2] Nietzsche's Toxicology

[3] Taming Stress

[4] Wikipedia: Clinical depression

[5] Wikipedia: Concentration (game)

[6] Wikipedia: Functional magnetic resonance imaging

[7] Depression and the Birth and Death of Brain Cells

[8] Overtraining

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Related Links
o Kuro5hin
o Part I
o Why? The Neuroscience of Suicide
o Nietzsche' s Toxicology
o Taming Stress
o Wikipedia: Clinical depression
o Wikipedia: Concentration (game)
o Wikipedia: Functional magnetic resonance imaging
o Depression and the Birth and Death of Brain Cells
o Overtraini ng
o Also by Name of Feather


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Demystifying Depression - Part II | 96 comments (75 topical, 21 editorial, 0 hidden)
What about Diet? (none / 1) (#3)
by mberteig on Mon May 16, 2005 at 10:55:06 AM EST

In my personal life, I have seen strong evidence that diet plays a huge role in mood and emotional quality of life.  My children go crazy on sugar.  My wife goes crazy when she eats popcorn.  Some friends of mine had huge learning and emotional problems as children until they got off of milk.

There are lots of books about the relationship between diet, allergies and health.  One that I have read is called Eating Alive by John Matsen.  My wife has read the sequal (Eating Alive II) and says it is also excellent.

There are a few people in my family who have been diagnosed with depression (I am not one of them).  I would be interested to hear if others have treated depression successfully, or failed to treat depression, through the use of dietary changes.


Agile Advice - How and Why to Work Agile

Helps a bit, yes (none / 1) (#5)
by Name of Feather on Mon May 16, 2005 at 11:06:30 AM EST

I have alluded to diet in a comment posted in the first instalment. I reproduce it here verbatim:

Concerning diet, I had some extra advice which I have not included in the article because I didn't want to give people the impression they could diet their way out of a depression. A good diet might help a little, but the other lifestyle changes are much more important. Having said that, the advice is very straightforward:

  • Avoid coffee and all substances with caffeine (tea, coke, etc).
  • Avoid spicy food, especially at night.
  • Beware of alcohol, especially at night. It might make you feel sleepy, but the sleep will be of less quality.
  • Get all your nutrients: don't embark on diets which limit one particular class, be it carbohydrates, proteins, or fat.
  • Avoid sugar. Prefer complex carbohydrates.


[ Parent ]
Just curious... (none / 0) (#6)
by mberteig on Mon May 16, 2005 at 11:28:02 AM EST

That list is presented very definitively... do you have some specific resources to which I could refer people?

It also doesn't completely jibe with my (very limited) experience: diet can make a huge difference in emotional and mental health.  My family members who have been diagnosed with depression have not tried diet changes so I can't say specifically with depression.  However, to be more specific, my wife had huge problems controlling her temper.  After a few very simple dietary changes (eliminating corn being the major one) her ability to control her temper improved immediately (within days) and to a degree that not only noticable, but blatant.  It is hard for me to imagine that careful (not one-size-fits-all) dietary changes could make a huge difference for people with depression.  After all, diet does affect overall body chemistry, so why not brain chemistry?


Agile Advice - How and Why to Work Agile
[ Parent ]

Diet (none / 0) (#7)
by Name of Feather on Mon May 16, 2005 at 11:56:20 AM EST

Well, I reckon that if a person's diet is seriously unhealthy anyway, that could also have bad effect on mental health. However, if your diet is already relatively healthy then don't expect a miraculous improvement to your mental well-being if you plan to make additional changes to what you eat. This is a case of diminishing returns.

[ Parent ]
Specific resources (none / 0) (#22)
by krkrbt on Tue May 17, 2005 at 01:21:40 AM EST

I refer you to my post in Part I of this series, titled malnutrition and mental illness.  It has a link to a magazine article called "vitamin cure".  I'm missing my copy of the article at the present, but it covers the emerging science of studying brain chemistry (and if I had it handy I'd use their fancy word - psycho-somethingorother).

A first step that I'd take in modifying my diet to help with mental illness would be to remove all nutrient-poor foods.  This would include all refined sugars (especially "soda", in all its forms), all refined flours, and most processed foods (especially the ones that include ingredients I don't recognize on the label).  I'd stick to organic veggies, or locally grown produce.  Just some first steps.

I thought the article was really good - if you can still find a copy of the May issue of Discover magazine pick it up, otherwise I guess they only charge $1 for web access.


[ Parent ]

Thanks for the links. (none / 0) (#24)
by mberteig on Tue May 17, 2005 at 02:23:02 AM EST

I forwarded them to my family members who are suffering from depression.  Maybe it will help :-)


Agile Advice - How and Why to Work Agile
[ Parent ]
Tea :-( (none / 1) (#20)
by unknownlamer on Mon May 16, 2005 at 06:09:38 PM EST

Tea is liquid life!

What if you do the quick steep, throw the water away, and then resteep to get less caffeine method?

And what about the tannins that reduce counteract the effects of the caffeine and increase one's calmness?



--
<vladl> I am reading the making of the atomic bong - modern science
[ Parent ]
Tea (none / 0) (#27)
by Name of Feather on Tue May 17, 2005 at 05:29:49 AM EST

Tea usually has less caffeine than coffee anyway, so it's not as bad.

Also, having a nice cup of tea in the mornings should pose no problem. Just avoid it at night.

[ Parent ]

And yet... (none / 0) (#33)
by rusty on Tue May 17, 2005 at 10:35:20 AM EST

I'm a two or three cup of coffee a day person, but caffeinated tea just ruins me. It gives me a headache, dehydrates the crap out of me, and sometimes gives me a racing heartbeat and "feelings of impending doom" -- in short, essentially the symptoms of caffeine overdose. One cup with plenty of milk and sugar won't usually do it. But any more than that and I'm in trouble.

It's generally well known that the effects of the caffeine in different drinks is affected by all the other stuff in those drinks. Tea apparently has something in it that makes the caffeine affect me much more than coffee does.

So I guess the point is just that people should know their own reactions and act accordingly. If I were depressed, I think tea would probably be just about the worst thing I could have.

____
Not the real rusty
[ Parent ]

YMMV apparently (none / 0) (#39)
by tetsuwan on Tue May 17, 2005 at 12:00:54 PM EST

I'm a total tea guy. Coffee really races me up. If I have one (1) cup of coffee for three days in a row I'm addicted in so far I experience withdrawal (drowsiness and headaches) if I don't drink some the forth day.

I didn't quite realize this until a summer i Tokyo when I had two cups a day at work every day and none for the weekends. Needless to say, I wondered why I so many saturdays and sundays in the zombie state.

Now I save my coffee shocks for late night lab work. And neverending dinner parties.

Njal's Saga: Just like Romeo & Juliet without the romance
[ Parent ]

Interesting (none / 0) (#68)
by unknownlamer on Wed May 18, 2005 at 07:50:05 PM EST

I drink a pot of four (6 oz) cups of tea at a time usually. It's just because I have a 24oz mug and I make it in that (yeah, I use a little tea ball and don't let the tea leaves float loose, I'm going to tea Hell).

I don't get dehydrated from it because I tend to drink way more than eight cups of water a day. I picked up the habit when I was in a band that was recording/touring to keep my vocal cords hydrated.

The buzz that a pot of tea gives me is way better than that of coffee. Coffee would hit all at once and then I would crash hard. Tea gives me a slightly elevated energy levels for a few hours. Supposedly it's because of the tannins slow the absorption rate of the caffeine, but it's all just theory with very little scientific testing done (yet people still claim it as if it were absolute truth). That aside, tea tastes way better ;-)



--
<vladl> I am reading the making of the atomic bong - modern science
[ Parent ]
Re. caffeine/exercise/alcohol/diet (none / 1) (#49)
by The Voice of Reason on Wed May 18, 2005 at 12:50:23 AM EST

If I can't have caffeine, then what the hell do I do when I've only had 4 hours sleep because my body-clock is completely fucked-up by shift-working and I've got another 20 hours before I can go to bed again? If it wasn't for coffee I probably wouldn't even manage to get to work, and so I'd get sacked and have to live on the streets.

Exercise is also vital, I don't believe that about it depressing you, my depression is equally bad no matter how much exercise I do. Years ago when I didn't do any exercise I was no worse off mentally than I am now when I exercise regularly. Also you need exercise to look after your body properly, humans aren't supposed to be sedentary, and I don't think obesity will do much to help depression. My mind might be slowly decaying and falling to pieces but I'm not going to let my body go the same way.

Alcohol is also a good way to temporarily relieve the misery, although these days it just sends me to sleep. I don't know whether that's just my lack of sleep or the alcohol-intolerance because of the chemicals at work. Spicy food also provides pleasure. Do you aim to reduce depression by cutting out things which bring pleasure?

I don't think diet has anything to do with it. My diet has vastly improved over the last year or so, but I'm still depressed, it doesn't make a difference.

[ Parent ]

Diet has "Vastly Improved" (none / 0) (#64)
by mberteig on Wed May 18, 2005 at 03:44:30 PM EST

That may be true from an overall nutrients perspective, but it may not be true from the perspective of food sensitivities or allergies.  Not all food allergies manifest as physical symptoms - sometimes they manifest as emotional or mental symptoms.  A balanced diet may still include many foods that are having a negative emotional effect...

On the other hand, maybe not.  Depends on your personal body and brain chemistry.


Agile Advice - How and Why to Work Agile
[ Parent ]

Food allergies (none / 0) (#88)
by The Voice of Reason on Fri May 20, 2005 at 12:38:30 PM EST

In that case, how do you find out which foods you are sensitive to or allergic to?

[ Parent ]
Diet (none / 0) (#16)
by Anonymous Lemming on Mon May 16, 2005 at 03:11:29 PM EST

You are what you eat. Right?

I believe that bodies are very excelent self-repair machines. You get them the right stuff and they take care of themselves. My wife saw noticible improvement with an improved diet.

[ Parent ]

Your require 150 grams of sugar per day to simply (none / 0) (#90)
by benzapp on Sat May 21, 2005 at 01:29:52 AM EST

maintain basic life.  

Sugar is literally the fuel your body burns to stay alive.  Now, is it arguable that certain foods which contain sugar are bad? Yes, absolutely.  There can be no doubt that opioids affect mood, and those found in wheat products can affect people to varying degrees.  The same is true for "flavor enhancers" in most candy which are mixtures of treated casein derived opioid peptides and beta carbolines which seem to have an affinity for the GABA complex.  Then of course there is chocolate which also contains opioid peptides and caffeine.    

But, eating apples is not going to cause depression. What is even more amusing is that while most candy is certainly "sweet", most calories in fact come from fat.  

The simple point is DRUGS interfere with mood. Sugar is as necessary for your survival as oxygen or water.  

[ Parent ]

Psychotherapy vs. meds (3.00 / 2) (#12)
by Psychopath on Mon May 16, 2005 at 01:24:01 PM EST

The idea that every illness - including depression - can simply be healed by taking some medicine might appeal to a "technical" readership like on k5. But I believe that in many cases of depression psychotherapy actually can be more than a substitution of medication (not in severe cases though).
--
The only antidote to mental suffering is physical pain. -- Karl Marx
Medication (none / 1) (#13)
by Name of Feather on Mon May 16, 2005 at 01:29:33 PM EST

Well, if you have read both instalments of this article, you will see that I do not advocate a medication-only treatment. Medication does help (though some readers will disagree), but is only half of the equation. Lifestyle changes and therapy are the other half.

[ Parent ]
Are you going to write about therapy? [NT] (none / 1) (#23)
by richarj on Tue May 17, 2005 at 01:42:09 AM EST



"if you are uncool, don't worry, K5 is still the place for you!" -- rusty
[ Parent ]
This is the second and last part (none / 1) (#26)
by Name of Feather on Tue May 17, 2005 at 05:26:48 AM EST

No, I'll leave therapy to the professionals...

[ Parent ]
Wait (none / 1) (#35)
by Friedrich Dionysus on Tue May 17, 2005 at 11:02:00 AM EST

Does that mean you're a professional in the topics you're writing about?

[ Parent ]
Recently Google News... (3.00 / 2) (#14)
by mberteig on Mon May 16, 2005 at 01:32:28 PM EST

was featuring stories about a study that showed that therapy is just as effective as medication.  Unfortunately I can't find any references... anyone?


Agile Advice - How and Why to Work Agile
[ Parent ]
+1 FP legitimizes sex with cousins. (1.40 / 5) (#21)
by communistpoet on Mon May 16, 2005 at 07:37:20 PM EST

For relatives farther beyond the genetic proximity measure (cousins, etc), the conditional probability approaches the absolute probability for the general population, and is therefore not quite as relevant as an indicator.

We must become better men to make a better world.
-1, legitimizes sex with cousins. (1.11 / 9) (#28)
by the ghost of rmg on Tue May 17, 2005 at 08:51:55 AM EST

you sick freak! why don't you take this back to incestdot?


rmg: comments better than yours.
Change title (1.16 / 6) (#29)
by ant0n on Tue May 17, 2005 at 10:00:16 AM EST

Suggestion: The Quack Doctors Handbook of Depression, Part II


-- Does the shortest thing the tallest pyramid's support supports support anything green?
Patrick H. Winston, Artificial Intelligence
About medication (3.00 / 2) (#30)
by Name of Feather on Tue May 17, 2005 at 10:01:16 AM EST

Many people have posted (either here, on Part 1, or in my diary) comments arguing against my stance on antidepressants.

Obviously one has to maintain an open mind and take a good look at the data. If the data is flawed in any way, then new studies will be required. We all know how the scientific process works (or is supposed to work, anyway).

In my personal experience, antidepressants do work. I am well aware that many will say it was just a placebo effect, so I will not go further into that subject.

However, I also think that it is a bit dangerous for people to make bold pronouncements denouncing medication as a sham. I imagine that at least some of the people reading this article (and the associated comments) probably have the symptoms of a depression but have not yet sought professional help. Don't you think they might feel a bit discouraged about seeing their doctors should they see so much negativity concerning the primary means of treatment available nowadays?

Think about it.

it's not necessarily the primary means (none / 0) (#67)
by Delirium on Wed May 18, 2005 at 06:45:41 PM EST

It's the primary medical means of treatment, but if indeed depression is not primarily a medical problem, it may well be the case that medical treatment is using a hammer for something that's not a nail.

[ Parent ]
I doubt it's a placebo effect. (none / 0) (#78)
by Fon2d2 on Thu May 19, 2005 at 03:03:10 PM EST

Or else someone could say marijauna is a placebo effect. Or cocaine is a placebo effect. And I seriously doubt that.

I am in fact one of those people with a number of the symptoms described in your article that has never sought professional help. I am also one of those people with a very healthy distrust of anti-depressants. This comes from a number of sources: the reactions of people I've known on anti-depressants, literature, and having known for a significant period of my life who were drug users in one way or another.

The average person from the drug use community is right in line with your description of depressed and overly stressed people. But you also get a lot of distrust of the medical community there. In that type of crowd there are a lot of people who have been through the system in one way or another and may have been pushed around, abused, or neglected in the process. Although I have lost most of the respect for any of the people I knew then, it still leaves me guarded as to the role and motivations of health care providers in this area.

Another major source of my distrust is a book called Prozac Backlash. Having checked it out on a whim I actually read the whole way through it, which is a rare occurence for something that didn't start as a serious consideration. Perhaps it's my desire to find fault with the world. The author there finds a lot of problems with anti-depressants as well as a lot of ulterior motives and unethical practices on the parts of the drug companies. He does not rule out the use of anti-depressants however. He merely says that their use needs to be much more controlled. Only after long consultation with a psychiatrist who understands your problem should they be perscribed. Never should they be perscribed by GPs.

[ Parent ]

+1, but... depressing. :-) n/t (none / 0) (#36)
by fyngyrz on Tue May 17, 2005 at 11:06:29 AM EST


Blog, Photos.

Therapy Just As Good As Drugs For Depression (none / 1) (#41)
by Drog on Tue May 17, 2005 at 03:21:04 PM EST

However, and I cannot stress this enough, therapy is not a substitute for medication, and "psychological help" is a misunderstanding.

A new study published in the April archives of General Psychiatry challenged the widely accepted idea that drugs are the only effective, initial treatment for major depression. I wrote about this awhile back, here.

What are your thoughts on this study?

Looking for political forums? Check out "The World Forum". News feed available here on K5.

A bit of everything (none / 0) (#42)
by Name of Feather on Tue May 17, 2005 at 03:41:32 PM EST

Facing the risk of sounding like a politician, I would say that the best way to treat depression is to take a holistic approach. That means medication + lifestyle advice + therapy. All of them are important, though I will not go as far as saying that they are equally important. (The exact quantification is likely to be person dependent).

From my experience, lifestyle advice makes a huge difference. And mind you, it is not quite the same thing as therapy.

[ Parent ]

lifestyle as evidence against a disease (none / 0) (#47)
by Delirium on Tue May 17, 2005 at 06:08:28 PM EST

One might suggest that if lifestyle is a major component, depression is more a "problem of living" than a "disease" properly so called. That is, the "chemical imbalances" you discuss are not the cause of depression, but rather caused by depression, which is itself caused by lifestyle issues.

[ Parent ]
But of course (none / 0) (#55)
by Name of Feather on Wed May 18, 2005 at 04:59:21 AM EST

Wasn't explaining that the whole point of the article?

[ Parent ]
Medication. (none / 0) (#51)
by The Voice of Reason on Wed May 18, 2005 at 12:58:08 AM EST

What sort of medication would you recommend, and where can I buy it? How much does it cost? I've had depression for a few years and nothing I do cures it, I think I need some drugs.

[ Parent ]
Careful there (none / 1) (#54)
by Name of Feather on Wed May 18, 2005 at 04:57:27 AM EST

Take a good look at your own nickname and listen to "the voice of reason": you should not be medicating yourself. That is quite dangerous! Instead, go see your doctor and try to find a good specialist. Have a chat with them. If you could really benefit from medication, they will give it to you.

(Unless of course you live in a country like the Netherlands where many doctors think that "real men" should live with depression without complaining).

[ Parent ]

I'm not sure the US is much better (none / 0) (#66)
by Delirium on Wed May 18, 2005 at 06:43:54 PM EST

Many general practitioners will prescribe antidepressants, but most of them don't have any more knowledge of what they're doing than a layperson who spent a few weeks reading up on journal articles would (in fact, they may have less, because they typically have't kept up with recent developments). Clinical psychiatrists may be better, but especially in the U.S. there's a bit of a holy war on, so I'd take what they say with a grain of salt too. Psychiatrists are allowed to prescribe antidepressants, while psychologists aren't, which leads to psychiatrists tending to talk up their importance and usefulness (and psychologists tending to talk down the same). Historically, psychiatry has also not been the specialty into which the brightest people go—if you're a promising med-school student at the top of his class, few people will counsel you to go into psychiatry, and even if you indicate an interest in doing so, many people will counsel against it. It isn't considered among the more prestigious occupations for an M.D. That doesn't mean all psychiatrists are the bottom of the med-school barrel, but it does decrease the average quality.

[ Parent ]
Fresh Air (none / 1) (#45)
by DrJonesAC2 on Tue May 17, 2005 at 04:24:12 PM EST

Does this have any connection with today's "Fresh Air" on NPR?
My crappy site
Heard that too (none / 0) (#46)
by solstice on Tue May 17, 2005 at 04:30:14 PM EST

Caught the tail end of this driving home from work this afternoon. From what I heard, it didn't sound like Peter Kramer (author of this book "Against Depression") mentioned the real cause of depression even once, although he does advocate treating it as a disease. I even heard them discussing that depression may be a good thing for some, and that melancholy people are very creative? With real depression, don't you lack all motivation to do anything, let alone something creative? Admittedly, I haven't heard the whole thing yet. Anyway, you can stream the interview on NPR's website.

[ Parent ]
Right on (3.00 / 5) (#48)
by ubu on Tue May 17, 2005 at 06:59:52 PM EST

After reading the first of these two articles, I went out and bought Undoing Perpetual Stress. It's excellent.

The message here, I think, is that we're all in for serious, unhealthy stress. Modern life practically guarantees it, and it causes horrible degradation of quality of life.

I'm one of the worst stress-cases I know. I want desperately to change that, and for the first time, between O'Connor's book and these two K5 articles, I feel like I finally have information and advice that can actually help.

I spent years and years chasing down the psychological roots of my problems. I made great progress, and I don't regret any of that effort. But you cannot outthink your stress. If there's one thing that I found most important about my quest to alleviate stress (and its effects) it is that you have to stop looking for the one specific cause of your stress. Stress is all around you, and it perpetuates itself in a vicious cycle.

If you're suffering from stress — and you almost certainly are — I urge you to stop looking for the cause, because you won't find it in any one thing (or even any hundred things).

  • It's not your fault
  • Humans didn't evolve to live this way
  • Almost everybody suffers from stress
  • Making mistakes is always acceptable
  • Your life is worthwhile because you live it, not because you avoid tragedy and error
  • There is nothing, nowhere, and nobody that you have to achieve
  • Your life belongs to you
  • You are not in competition with anybody for anything
  • Authority and punishment are the products of convention, there is no "natural law"

One last piece of advice: make a habit of saying "fuck it", "fuck you", "go fuck yourself", and "i couldn't possibly fucking care" whenever and wherever you can get away with it. Nobody has a moral imperative over your life.


--
As good old software hats say - "You are in very safe hands, if you are using CVS !!!"
Stress (none / 0) (#50)
by The Voice of Reason on Wed May 18, 2005 at 12:55:41 AM EST

If you're suffering from stress -- and you almost certainly are

Certainly? I'm not suffering from stress, I have a completely stress-free existence. What makes you so sure about that? What sort of things cause stress?

[ Parent ]

Lots of Things (3.00 / 5) (#62)
by ubu on Wed May 18, 2005 at 12:06:08 PM EST

Most of them can be considered the causes of what O'Connor calls "21st Century Illness". He likens the constant stress response of modern living to an impala chained to a tree with a cheetah chained to another tree nearby. The impala cannot escape the neurological cause of its stress response — the presence of a predator — so it will suffer exhaustion and eventually permanent physiological damage.

Similarly, modern people are in a state of constant response to stressful conditions they cannot escape. These include traffic, irritating neighbors, noise pollution, financial woes, ubiquitous advertisement, highly authoritarian workplaces, and many more. For the most part, individuals feel they are subject to stressful influences from some or all of these causes, and for the most part they feel they can't escape them in fulfillment of their stress response.

The result, as Name of Feather's article explains, is that the part of the brain involved in planning becomes less and less effective. Therefore the escape routes become more and more difficult to exploit, and the individual eventually surrenders to its deteriorating physical and mental condition.


--
As good old software hats say - "You are in very safe hands, if you are using CVS !!!"
[ Parent ]
Unipolaire and Bipolaire Depression (3.00 / 2) (#52)
by MonsieurMerdique on Wed May 18, 2005 at 03:20:56 AM EST

It is very important to distinguish between unipolar and bipolaire depression because the psychopharmaceuticals can be differents. Atypical depression (cf. melancholic depression) is commoner in bipolaire patients than in unipolaire patients. With bipolaire patients, there is also the risk that the mood will become maniac. An other risk for bipolaire patients is that the depression and the mania will cohabit as a mix episode ; those are very fun. Psychotic depression is also commoner in bipolaire patients.

When I went to visit the psychiatrist, she was careful to analyze my history to reach her final diagnosis. She searched a possibility of a maniac episode and she determined that schizophrenia was not the cause of my symptoms.

After taking the SSRI, she probed my mood to verifie that I was not maniac because there is the possibility that a patient who was diagnosed with unipolaire depression is truly bipolaire.

Major Depressive Episode

  • Extreme dejection or void feelings
  • Sleep troubles
  • Changes in level of activity
  • Fatigue
  • Inferiority and culpability feelings
  • Decreased cognitive abilities
  • Suicidal ideation

Melancholic Features

  • No interest in life
  • Depression worst in morning
  • Wake up early in morning
  • Culpability

Atypical Features

  • Reactive mood: Patient can be made to feel a little happier
  • Weight gain/Increased appetite
  • Excessive sleep
  • Pre-existing sensitivity to social rejection

Psychotic Features

  • Delusional beliefs
  • Hallucinations

Maniac Episode

  • Less sleep
  • Feeling very happy and energetic AND/OR godlike powerful and aware AND/OR irritable
  • Talkative
  • Rapid movement of thinking
  • Prone to distraction
  • Impulsive gratification

Mix Episode

  • Maniac
  • Depressed
  • Same time!
  • HIGH chance of suicide or violent behavior

No, merdique is not French for shitty!


Effectiveness of psychotherapy / diagnostic tests (none / 0) (#53)
by Vaughan on Wed May 18, 2005 at 04:18:40 AM EST

The article is very interesting but you seem slightly misinformed in some areas. Cognitive therapy (a form of psychotherapy) has been found to be an effective long-term treatment for depression. There are already reliable psychometric scales for measuring depression such as the Becks Depression Inventory and the Hamilton Depression Rating Scale. There are no objective or physical tests for measuring depression because no reliable brain or body abnormalities have been found in people with depression (the abnormalities reported in the literature have only been found when comparing depressed individuals as a group, and therefore are not diagnostic).

Way too subjective... (none / 0) (#87)
by Name of Feather on Fri May 20, 2005 at 09:04:25 AM EST

Good that you mention the existing scales for assessing depression. I intended to make a reference to them in Section 7, but in the end I thought I would only be starting a flame-war. Because you see, I don't think very highly of them, as I will proceed to explain.

First of all, they tend to be overly subjective. In Section 9, I mentioned that in practise people with depressions can be made to go through hell to get any kind of recognition of their problem. I know that some societies are more enlightened than others, but the truth is that the denial exists. Now, if all you have is a subjective test, people can claim that you simply "cheated" on the answers.

Second, and just like blood pressure, they fail to make the distinction between the states of severe depression + low activity and mild depression + high activity. This is especially important in the later stages of recovery. I perfectly remember that towards the end, I could almost lead a normal life with "a bit" of adrenaline. Of course this also meant that I suffered again the nasty side effects, which would translate into a diagnosis of (mild) depression if I took, for instance, the Hamilton test. However, if I didn't go over my limits, I would feel quite okay. Of course my routine would be quite different from that of a healthy person, but if I were to take the Hamilton test again, my score would not indicate depression. Do you understand now why existing tests are grossly incomplete?

Now, I am sure that sooner or later, objective tests based on brain scans will be developed. In the meantime, I am sure that it is also possible to devise objective tests which rely on the cognitive impairments associated with depression. Section 7 is my own personal speculation on how such a test could be made.

[ Parent ]

Exercise (none / 0) (#56)
by jhoderd on Wed May 18, 2005 at 08:13:32 AM EST

Very interesting again. I posted on part 1 about my depression. What you say about sports is very interesting, and I remember that the psychiatrist I went told me to be careful for too much exercise. Now I understand better why.

Funny that nobody has commented on that scheme used in Holland by some companies. I think that if the people following the scheme found out the truth they would be furious. Is that even legal?

Funny indeed (none / 0) (#60)
by Name of Feather on Wed May 18, 2005 at 10:06:19 AM EST

It freaked me out when I found out about this. But you have to take a closer look at dutch society to understand how this kind of thing can go unnoticed.

First of all, there is widespread ignorance about depression among dutch GPs; something so basic like measuring the patient's blood pressure is almost never done.

Second, remember that there is a stigma associated with burnouts and depression (not only here, of course). People affected by this problem are not likely to discuss it beyond their inner circle of family/friends, and thus will get all their information from the company doctors and counsellors.

Third, do not underestimate the power of adrenaline. If you exercise every morning, you do indeed feel well, and by yourself it's very difficult to discover what is wrong with this scheme.

Combine all these things and you can begin to understand why this is the "perfect crime".

[ Parent ]

Calvinist? (none / 1) (#57)
by dimaq on Wed May 18, 2005 at 08:22:12 AM EST

Having just read up the definition of Calvinism on wikipedia, I fail to see any connection between "Calvinist mindset" and "failure to recognise depression" or "failure to treat depression properly". Would you enlighten me please?

Calvinist attitudes (3.00 / 2) (#59)
by Name of Feather on Wed May 18, 2005 at 10:03:20 AM EST

This comment from Low End Dan explains it very well.

[ Parent ]
Also a Dutch Calvinist (none / 1) (#61)
by ubu on Wed May 18, 2005 at 11:58:55 AM EST

And I would say that Calvinism is a very rich and complicated tradition involved that you cannot grasp simply from a Wikipedia entry. I'm in agreement with Name of Feather and Low End Dan that my Calvinist upbringing contributed a great deal to my depression.


--
As good old software hats say - "You are in very safe hands, if you are using CVS !!!"
[ Parent ]
Depression a Complex Issue (3.00 / 4) (#58)
by Low End Dan on Wed May 18, 2005 at 09:34:36 AM EST

Thank you for a very thoughtful pair of articles on a difficult subject. I've been through depression myself and understand how it makes you feel more and more powerless.

I come from a Dutch Calvinist background, and to the reader who asked about Calvinism and medication: This has more to do with mindset than with theology. Calvinism has very much been associated with a negative self-image and self-reliance. Using anything other than your will to overcome depression could be viewed by some as akin to using illicit drugs or alcohol to make you feel better (or at least minimize the pain).

Fortunately that attitude is less common here in the States. I fell into a long period of growing depression, never recognizing what was happening until my wife divorced me and the depression became so severe that I had anxiety attacks, didn't want to get our of bed, and seriously considered suicide as the only way to make the heartbreak go away. It's not rational, but depression doesn't make you thing rationally. It does make you think negatively. Life has defeated you and will continue to do so.

There are many aspects to depression - chemical, emotional, and spiritual, and I believe they all interact. (I am not a materialist.) After having a severe anxiety attack during a therapy session, I was whisked to the psychiatrist's office. I have been on Wellbutrin for over a year, and from the first day I could see how it lifted my mood. I could also tell exactly when it wore off. After four days, I could see differences in my focus (I also have ADHD). I believe medication was essential at that point in my life. Between the depression, anxiety, and suicidal thoughts, it helped keep me alive, and it gave me the strength to move out of the depression.

Not every case of depression is clinical depression, but if you are depressed, it's something you need to check out. As Name of Feather says, find a competent psychiatrist who knows the medications, knows depression, and will work with you to find the right solution - it may be meds, it may be talk therapy, it may be a change in your diet or activity level. It's likely to be a combination.

You get one shot at life. Don't waste it depressed. And don't commit suicide - it's a terrible legacy for your family and friends to deal with. Recognize when you need help and get it. There is life after depression, and although the whole mechanism is not well understood, there are ways of dealing with depression.

What works for me or Name of Feather may not work for you. Everyone's personality and biochemistry is unique. My psychiatrist is amazed at how well I do with the lowest dosage of Wellbutrin while others need much higher levels or don't benefit from it at all. Your situation is unique. The more you learn, the more you can participate in healing yourself.

Don't rule out diet, exercise, medication, therapy, self-help books, support groups, or religion based on your prejudices. Human beings are more complex than most theories would have you believe, and your worldview might lead you away from the treatment that will work best for you.

Dan Knight, LowEndMac.com

teenaged depression (3.00 / 4) (#63)
by pyramid termite on Wed May 18, 2005 at 02:06:43 PM EST

the brain of a child or even a teenager has such a fantastic ability to repair itself that it takes quite a pounding for a depression to develop.

the problem with this is that teenaged depression seems to be a widespread problem ... so, the question is ... are you being overoptimistic about a young mind's ability to repair itself? ... or are many of today's teenagers taking "quite a pounding?"

even though i agree that anti-depressants are necessary in many cases, it's my experience that there are people who are using them to mask their unhappiness and problems with the lives they lead ... the talk about brain chemistry is accurate and fine ... but is this the disease itself, or simply a symptom of the disease? ... naturally, with clinically depressed people, it's best to medicate first and ask questions later ... but i often get the feeling, especially with less severe cases that the questions are never asked at all

considering that depression is rising, i really have to ask why these questions aren't being asked


On the Internet, anyone can accuse you of being a dog.

agreed facts not in evidence (1.50 / 2) (#65)
by massivefubar on Wed May 18, 2005 at 06:03:28 PM EST

Teen-aged depression is supposedly a very wide-spread problem, and I just googled a health link that claimed that the average age at onset of clinical depression was the mid-20s. There have been several studies showing that older people, especially people over 60, are happier with their lives than people in their teens and 20s. Yet I don't think anyone can reasonably argue that the average 60 year old has the brain health as far as circulation, ability to form new memories, and so on of a young child or teen.

Teens have always had churning hormones, and twentysomethings have always had to struggle to establish themselves in the world, but now it's a disease because our big pharmaceutical companies have medicines to sell. If I were asked to find out why clinical depression is increasing, I would look first to the marketing of this disease. Only a couple of hundred years ago, it was only the occasional oddball who was melancholic. Now if you're not depressed, you're an insensitive weirdo.

I find it hard to believe that brain chemistry has changed so radically in that span of time.

[ Parent ]

They are taking a pounding. (none / 0) (#73)
by Fon2d2 on Thu May 19, 2005 at 11:06:18 AM EST

In my honest opinion. School, and life in general, is very demanding in teenage years. There can be all kinds of stressors and complications. Harsh parents, tough teachers, mistreatment at school. Often times the teenager has no recourse for many of these stressors. If the conditions have persisted since middle school or earlier, then the kid really has spent multiple years in an overstressing environment.

I believe this may be the case with myself and may explain why I'm so prone to anxiety. As I look around I see the signs in much of today's youth.

There's another stereotype that may be revealing here. If we divide high school up into the typical social groups: jock, nerd, geek, whatever, it's interesting to note that the group we'd think of as having the least amount of stress and being the most socially well rounded (the jocks) are also the group we'd think of as most likely skirting the responsibilities of school (thus avoiding that stress).

[ Parent ]

my story (1.33 / 3) (#69)
by User 61482 on Wed May 18, 2005 at 10:07:03 PM EST

I actually made an account on kuro5hin.org just now, so I could post this. Here's my summarized story: Computer geek since 8 years old. Had a verbally abusive father, and needed counseling to learn to ignore him. Almost shot him one day, then went to a counselor. Started smoking weed at 14, smoked on daily basis by age 16. The weed kept me isolated, didnt get a girlfriend for many years, didnt want to get too close to people. Got a good job in computers, made good money, worked tons of hours, bought a home, bought a big screen tv, a jet ski, new truck, etc etc. Had money and possessions, but not happyness. Mom went onto prozac when she entered menopause. Same with her 2 sisters. I figured that depression runs in the family, because I definately have the symptoms. Stopped smoking weed for about a month, nothing changed, assumed I had a chemical imbalance. Started taking 2 anti depressants that were recommended a prescribed to me. At first they made me feel really good even at half dosage. Then the ffects wore off. So I upped it to full dosage. Some hair fell out, gained some weight, but felt good. Then I started to change. I started to smoke even more than I did. Was late for work, too 2 hours lunches, and basically "wouldnt take shit from anybody anymore". I wouldnt hesitate to tell people to fuck off, but since I was always a nice guy, I thought I was finally normal. Started drinking lost of alchohol, and surprisingly the hangover effect didnt happen because of the medications. Always drunk and high, my judgement started to slip. I quit my job, and started taking more of the medications than what was prescribed. Started to hallucinate. Police got involved, I got committed. while in the mental hospital I obeserverd some very very fucked up people. The hospital kept my medication going but lowered the dosage. They said I was bipolar. Got released for hospital, and had to go to a different shrink because my original guy lost his license because he had sex with a patient. Turns out he was taking the same meds as he prescribed to me. The original couselor who sent me to him got divorced because he cheated on his wife too, turned out he was taking the same cocktail of medications. Not lying, this is the truth. I was smart enough to know that I've never had bipolar symptoms until i started taking the medications. The current doctor would ask me the same questions every time I saw him, I warned him this was pissing me off, told him to pay attention to his notes. he didnt stop, so I told him to fuck off and ordered the medications off the internet. Decided to quit the medications cold turkey. This is NOT recommended. Had ALL TYPES of weird problems, especially with bodily functions. Even felt electrical charges going thru my brain as if electrodes were hooked up to my head. Recovered from the effects of quitting the medications. Most of my hair grew back, weight wasw lost, but still have some strech marks around my crotch and thighs. Parents would not leave me alone, told them to either stop asking me the same questions and calling every day or else I would stop talking to them. they didnt stop, so I moved and changed my phone number. also quit smoking weed. 6 months passed and I felt different. Decided to not smoke for 6 more months. Got a girlfriend (finally), even though she was a whore (nice body though). Normally women would get to me, but during this time of my life I didnt worry about anything. no signs of anxiety, no worrying about what other thought of me. I had confidence, but it wasent because of her but it was because of not smoking weed. Started smoking weed again. Told girlfriend to get lost. Depression and anxiety symptoms returned. stopped smoking weed, this time for good. Moral of the story: marijuana is not harmless and took years to cause me problems, and beware of the medications because if you DONT have a chemical imbalance they will cause one adding chemicals to your brain which are already at the correct level. I love getting high, but I cant do it anymore. Also, now I get more pussy than I ever dreamed of, even hot women (i'm decent looking). When women sense confidence and think that you dont really care if they want you or not, they are then attracted to you. The must be genetically programmed to be attracted to confidence, I figure its an evolutionary advantage and thats why I consider this to be a fact. If / when I have kids, I will teach them my story and explain why smoking weed can be dangerous and take years to cause a problem. The antidepressants absolutly kicked my ass, and my guard was down because they were legal drugs. I've done LSD and mushrooms and coke and GHB and others, and thought that if something was presribed to me it would be ok. Beware, that stuff is soo potent that you cant really see yourself going wrong, you must be observed by people that know you, and you must trust their judgement. Imaging a failing computer with corrupt memory, it cant be trusted to diagnose itself. A separate computer is needed to do so, because by defintion the failing computer is already bad. Also, marijuana affects the same part of the brain as antidepressants, so mixing them is a very bad idea. Since then I've found studies done in europe that tie marijuana to mental problems later in life. I've always thought weed was harmeless, I was wrong. I learned this the hard way.

Too much (none / 1) (#70)
by Jebediah on Thu May 19, 2005 at 12:42:22 AM EST

It sounds like you were on way too much to know what was affecting what.

[ Parent ]
I agree (none / 0) (#75)
by DissidentPhoenix on Thu May 19, 2005 at 11:44:03 AM EST

I'm inclined to agree with this.

Additionally, your mood changes are in line with those that can be experienced by long term users.

[ Parent ]

What 2 types... (none / 0) (#79)
by parrillada on Thu May 19, 2005 at 03:18:47 PM EST

of antidepressant were you using?

[ Parent ]
on the other hand (none / 0) (#89)
by lostincali on Fri May 20, 2005 at 04:11:06 PM EST

for a lot of people, marijuana acts as a mood stabilizer. I know some pot smokers like to smoke all the time just to get high -- this isn't what i'm talking about. I'm talking about a valid medicinal use.

For many people, smoking at the end of a rough day, when they're done interacting with people, murdering innocents, or whatever bullshit they do for a living -- when you're vegging out on the couch getting ready to go to bed with your wife or whatever -- it's very relaxing.

Of course, it isn't viewed as good medicine by government addled minds, but fuck those people. Since Prop 215 passed 9 years ago, more and more people are realizing that cannabis is good medicine for a variety of ills, including the stresses, anxieties, and minor depressions found in every day life.

"The least busy day [at McDonalds] is Monday, and then sales increase throughout the week, I guess as enthusiasm for life dwindles."
[ Parent ]

Please tell me (none / 1) (#71)
by auraslip on Thu May 19, 2005 at 04:49:55 AM EST

the affect of nicotine. Smoking seems to be a very arenilene like experiance. The rush, then the slow down. Then waking up the next morning feeling like shit.
I think i should quit smoking for that reason alone.
124
Nicotine (none / 0) (#72)
by Name of Feather on Thu May 19, 2005 at 09:57:25 AM EST

Yes, you should. Interesting enough, antidepressants also seem to help people who quit smoking deal with the physical withdrawal symptoms of nicotine, making it a lot easier.

[ Parent ]
PLEASE learn real facts about psychotherapy! (3.00 / 2) (#74)
by DissidentPhoenix on Thu May 19, 2005 at 11:34:13 AM EST

I think that while some of your points are interesting, you seem to be vastly misinformed about psychotherapy. Go and read up on your research and get a clue please! Discounting something that is shown to be effective in the research is stupid, particularly since you are aiming to demystify depression.

Medication is effective to at least some extent in a number of clients - however, in others it is not. It is certainly a viable option for many people, but not the be-all and end-all.

From what you've said about psychotherapy, it is pretty clear that you have little or no idea about what it actually IS. What the hell do you think psychotherapy actually is? Psychotherapy should include explanations of the problem as well as teaching relaxation techniques, listening to bodies and talking about lifestyle changes that may be helpful in dealing with their depression. In fact, the most popular long term treatment for depression by psychotherapists in many countries (including my own) is cognitive behaviour therapy. This involves the client working towards goals that they have decided they can work for, in steps that they feel that they can handle. An example for a very depressed client is that they'll find getting out of bed sometimes too difficult. So, a short term goal that they could aim for might be that they could get out of bed for at least half an hour and go outside in the sunshine.
Psychotherapy is NOT insight therapy or psychoanalysis and I am offended that you are writing an article about 'demystifying depression' while showing so little understanding of what a major course of action regarding it should entail.
Research has shown that therapy is INDEED a substitute for medication. Go read some journal articles. Research has shown that therapy like CBT has similar sucess rates to drug therapies. Additionally, depression tends to come back when drug therapies are halted, whereas the effects of therapy tend to be more long lasting.
Finally, the most effective treatment according to the research literature is a combination of drug therapy and psychotherapy.

On suicide:
I've been there. The most important thing in my own personal experience is social support. It's not so much saying 'no, don't kill yourself!' or arguing, but simply being there, letting the person know that you care and if you feel that their situation is serious, you could try alerting the police. They can take people to hospital against their will if they are evaluated as being of serious suicide risk (in australia anyways).

On sport:
I won't comment too much, but I will say that gentle outdoors exercise is definitely GOOD, even if it's only for the sunlight (and there's a fair bit of evidence to support that sunlight can be helful for depression although some of it is circumstantial).

On depression and ageing:
I don't agree with your speculation. Your theory doesn't pay a great deal to individual differences where depression strikes in the teenage years or even earlier. Additionally, it doesn't take into account the genetic basis for depression. In order for your theory to be tested, there'd have to be a longitudinal study that looked at intergenerational lifestyle changes and their correlations with depression.

Depression stats:
You raised an interesting point. Something very important if you suffer from depression or are at risk of it is to work hard towards pacing yourself well.

On burnout:
NO! No, no and NO!
Burnout and depression are NOT the same thing! Read the diagnostic criteria for depression. When people are burned out, they don't have that many actual symptons of depression at all. Burnout could be maybe borderline depression at best. I'm not saying that it's not serious - and I do think that severe burnout can spiral into depression. However, I do think that they are two different things. As with depression, learning to maintain a good routine and pacing oneself are very important - not just for helping with feelings of being burned out, but with depression as well.

I have an issue with your use of the term 'psychological problem'
What the hell do you define as a 'psychological problem'? Psychology has a great deal to do with physiology, so your distintion is splitting hairs.

On happiness:
I know a number of people who are general pessimists and nihilists. They might not suffer from depression, but I feel that chances are that they are at risk. Statistically, pessimists are more likely to develop PTSD after a trauma. I don't have stats for depression, but I suspect that they may not be all that different6.On the other hand, there are plenty of people who generally are happy who go through depression and return to being their usual happy selves when they have recovered.

On your comments about prejudice:
My own experiences with depression and organisations/work/university have been extremely positive. That may be due to the fact that most of my lecturers etc are clinical psychologists (yes, that career for which you seem to have so much contempt for in your ignorance) and thus have a greater understanding of mental illness than the general population.
In my country, there is a lot of help out there for people with depression issues. This is certainly not the case in many other countries and even in Australia, we are not getting the amount of funding that we should be.
Mental health equates for around 20% of the health burden in my country and there are a lot of information in the media, as well as programs aimed at promoting good mental health in our public school system.

RTFA (none / 1) (#81)
by Name of Feather on Fri May 20, 2005 at 04:28:01 AM EST

For goodness sake, I wish that people would bother to actually read the article (and both instalments, please) before they started posting long rants criticising it.

I agree with most of what you say in your comment. However, it seems that you are criticising some fictional article rather than the one that was posted here on kuro5hin!

Let us go step by step:

"Medication is effective to at least some extent in a number of clients - however, in others it is not. It is certainly a viable option for many people, but not the be-all and end-all."

I have already commented way too much on this issue. Neither me nor anyone else here has ever advocated a single approach to treating depression. Where did you get that impression?

"From what you've said about psychotherapy, it is pretty clear that you have little or no idea about what it actually IS."

Funny, I didn't say anything about what psychotherapy is or what it isn't! I will quote the article verbatim:

<quote>"A depressed person will definitely need professional help, but mostly for a proper explanation of the problem, to learn relaxation techniques, to know how to listen to their bodies, and to be coached in the lifestyle changes required for giving their brains a chance to recover. Once they are recovered, perhaps some therapy might be needed to make sure that whatever behavioural patterns which contributed to the development of the illness will not recur."</quote>

Now tell me, how does this contradict what you have said about therapy? Do you understand now why I wonder if you have read the same article?

"I won't comment too much, but I will say that gentle outdoors exercise is definitely GOOD, even if it's only for the sunlight (and there's a fair bit of evidence to support that sunlight can be helful for depression although some of it is circumstantial)."

I agree that sunlight is very good. If you read again Section 3.1 of Part I you will see it explicitly mentioned. As for sports, I believe I have already provided a very thorough explanation of why they can be good, as long as one is careful.

"I don't agree with your speculation."

Fine. I called it speculation precisely because it is just a conjecture. But still, one that I think deserves further investigation. In any case, have a chat with someone over their 70s and ask them about their daily routine.

"Burnout and depression are NOT the same thing!"

I am referring to serious cases of burnout, where they do indeed spiral into a severe depression.

"What the hell do you define as a 'psychological problem'"

This will actually be the second time I am answering this question. Please read all the comments before you post!

The exact expression used in the article is "psychological help". Notice the quotation marks: they are not there simply for decoration. I thought it would be clear for everyone that I am quoting the common misconception about therapy. The average lay-person assumes that therapy involves laying on the couch talking with an old man named Freud about their childhood experiences. And they assume that this is all that there is to therapy, or "psychological help" as most people put it. Putting "psychological help" under quotes expresses my dislike for this expression. Sorry if that was not clear enough.

"In my country, there is a lot of help out there for people with depression issues."

You are not the first to say good things about mental health attitudes in Australia. And again, cheers for that! However, note that I specifically talked about my experience in the Netherlands, where the reality is quite different. Your mileage may vary.

[ Parent ]

heh (none / 0) (#95)
by DissidentPhoenix on Sun May 29, 2005 at 06:57:39 AM EST

I certainly did read the article. In full. Twice. And part one as well. I also read the comments but posted my own because they were relevent even if they have been repeated elsewhere. If someone reads an article twice and still has this much to say, then obviously there MUST be some miscommunication issue or bias on one or both peoples parts.

I got the impression that you advocated a fairly single and/or narrow approach to treating depression by what you had to say about different people who are (in your opinion) 'qualified' to treat depression. You basically implied that anyone who is not a medical doctor is not going to be qualified to help people with depression. That is untrue. You stated a lot of things that are a big part of psychotherapy and implied that they were a medical intervention, which also is not exclusively the case. This again led me to believe that your knowledge of psychotherapy was very lacking.

I still don't think that you have any idea about psychotherapy from the way you wrote it. It seems clear that you share many of the same stereotypes of others in your country (that you've stated. I don't know anyone elses attitudes to mental health over there). My main point of dispute is that your article in general seems very biased against psychological interventions. This doesn't help to demystify depression at all. Saying that it's a physical problem is bullshit. Yes. It IS a physical issue - but then so is every bloody thought anyone ever has in their heads. It's all neurotransmittors. So what?
Your article didn't do anything to dispel the notion that psychotherapy is all about freudian 'its all my mothers fault and i wanted to kill my father' pseudo-psychology. You didn't talk about therapy until after depression was in remission to help to prevent it from happening again. Thats an issue that I have with what you wrote. I know from my own experiences as well as those of others that therapy should probably be the first port of call. Therapy and then medical intervention if necessay and/or drug therapy. In Australia (again, I can't comment on your country) the most common way of people being diagnosed with depression is by seeing their GP, BUT the average appointment time for a GP is about 15 minutes. There's not much explanation of problems possible in such a brief period of time! Most people never get anything more intensive than this and it doesn't teach them any coping skills. Even with psychiatrists, there are common/similar problems.
A common complaint about them in Australia is that they tend to lack empathy and just give out drugs while showing little understanding of the actual problem and an inability to respect the clients reality. While this stereotype certainly can't always be true, it shouldn't be discounted either! Traditionally, psychiatrists tend to deal with more 'serious' disorders like schitzophrenia. Depression is considered in mental health circles as the 'common cold' of mental disorders. I know of one story about a guy with severe agoraphobia whose psychiatrist demanded that he take a bus to his appointment. The guy found this very distressing and it set his progress back a great deal. The flooding like that was completely inappropriate and demonstrated a real misunderstanding of how CBT works on the part of the psychiatrist.

On your talk about burnout etcetc.
You seem to be assuming that I don't know what I'm talking about.
I've suffered from depression as well as chronic stress and burnout for quite some time and have qualifications in psychology as well as work in the mental health industy. I know. Believe me, I know.

Yes, burnout can spiral into depression. I've been there. But that doesn't mean that burnout IS depression or even that severe cases of burnout WILL spiral into depression. Thats like saying, for example... that a car crash IS a broken leg or that it WILL be a broken leg. It's a simple issue of causation versus correlation. Sometimes burnout can lead to depression but sometimes it doesn't.

[ Parent ]

First port of call? (none / 0) (#96)
by Name of Feather on Mon May 30, 2005 at 05:27:47 AM EST

Well, there is just far too much in your comment that would deserve a lengthy reply. I won't go there though, as it seems that we would only be starting a flame-war without actually achieving anything.

There is one thing though that I cannot let escape:

"I know from my own experiences as well as those of others that therapy should probably be the first port of call."

Therapy as the first port of call?! For mild depressions, perhaps. But for more serious ones, how can "therapy should probably be the first port of call", if people are barely able to speak if at all?

Let us be reasonable for goodness sake!

[ Parent ]

It's meds & therapy, not OR. (3.00 / 2) (#77)
by redelm on Thu May 19, 2005 at 02:37:42 PM EST

I've had 4 bouts of depression in my adult life. All event induced. The first was unmedicated and took 3 years to resolve. For the last 3 I took an SSRI (Zoloft) with therapy and they resolved _much_ quicker (weeks/months). It seemed the quicker I recognized the depression and the sooner I took the SSRI, the better they worked. The cure took about as long as the affliction was pre-treatment.

Essentialy, I feel the drugs gave me breathing space to resolve the underlying causes. Had they not been addressed, I'm sure the drugs would have lost effectiveness. This applies to event-driven depression. I don't know about chronic (stress) causes. And as always, YMMV.

Yes, yes, yes! (none / 0) (#82)
by Name of Feather on Fri May 20, 2005 at 04:31:54 AM EST

Agreed. Meds and therapy (and lifestyle, I would add).

Funny how some people interpreted "medication helps" as "only medication helps". Must be something Freudian... :-)

[ Parent ]

As always, it's a bit more complicated... (none / 1) (#80)
by dcheesi on Thu May 19, 2005 at 06:00:26 PM EST

Interesting rebuttal here (www.mindhacks.com).

IMHO, this article describes a particular form or experience of depression, particularly the "burnout" scenario. Even in this scenario, there are good reasons to seek therapy in addition to treament with medication. For one thing, cognitive-behavioral therapy can teach you how to avoid stressing yourself out with excessive worrying or minor phobias. This kind of self-induced stress can be a major part of the problem.

It would be simpler if people paid attention... (none / 0) (#83)
by Name of Feather on Fri May 20, 2005 at 04:44:44 AM EST

The rebuttal is indeed interesting, though it suffers from the same problem as many of the comments here posted: it is rebutting something which I have never stated! Must be a case of ADD: people merely glance through the article, and then comment on what they thought they read, instead of what was actually written.

The basic point of the rebuttal, that this article claims that depression is merely a (sic) 'physical illness' caused by 'low serotonin', fails to make a very crucial distinction between the factors which lead to the development of depression (namely chronic stress), and the physiological changes in brain which come as a result. In a sense, the author of this rebuttal misinterpreted the causality arrow.

[ Parent ]

That website... (none / 0) (#92)
by Resonant on Sun May 22, 2005 at 08:53:16 PM EST

has one of the most annoying (if technically well done) layouts I have ever seen. You have the whole screen, don't just use 50% of it damnit. Good site, though.

"I answer, 'This is _quantitative_ religious studies.'" - glor
[ Parent ]
ECT (none / 1) (#84)
by CaptainZapp on Fri May 20, 2005 at 06:26:24 AM EST

Why wasn't ECT mentioned? For those who don't want to click the link. That's what's done to McMurphy in One Flew Over The Cockoos Nest when he is naughty. Alas, methods are more refined today and it's certainly no more used to discipline psychiatric patients. At least it's definitely not allowed and considered malpractice of the worst sort. A doctor applying it for any other reason then a severe, clinical depression might wind up in jail nowadays.

It sure is a very controversial form of therapy. In some cases however it's the only way out of a severe clinical depression. As a general rule it is only applied when the only alternative is sucide. Treatment with ECT is the very last resort, after everything else has failed.

I'll probably get flamed and modded into oblivion for only mentioning this definitely most controversial subject, but if you want to learn more here's a book for you: Martha Manning Undercurrents. She is a clinical psychologist that tells the tale of her own depression and her encounter with ECT (which she loathed; who wouldn't?), which saved her life. It's an excellent read.

ECT and others (none / 0) (#85)
by Name of Feather on Fri May 20, 2005 at 07:10:09 AM EST

I considered adding a section on alternative and future treatments, but I thought it would lengthen the article way too much.

Besides ECT, there are other possibilities on the pipeline, such as magnetic stimulation, and even stem-cell research!

If depression is indeed caused by neuron death, then treatments which stimulate the brain to repair itself, either directly or indirectly, are viable options.

[ Parent ]

BTW (none / 1) (#86)
by CaptainZapp on Fri May 20, 2005 at 07:40:26 AM EST

Excellent stories, both of them.

I specifically liked the information about what actually goes on in your brain when you're on the path straight down to hell. It made it to me - as an interested lay person - very transparent what actually happens.

I have a personal interest into the subject, because I started to circle the abyss in '97 and got a glimpse of what it looked like. This was cured with an extended vacation of which most time was spent on a sailing vessel (hey, now I understand even better why this was extra beneficial, you don't have much movie and disco on a small boat, but I digress).

Since it's a horrendous and very frightening sight, even if you only get a glimpse of it, I maintained the interest into the subject and wouldn't hesitate for a heartbeat to seek professional help and do whatever it takes to get out of there, or to avoid going there in the first place.

Congratulations on your recovery and thanks for the courage of writing up your experiences.

[ Parent ]

Thanks for the articles + my own story (none / 1) (#91)
by spacebrain on Sun May 22, 2005 at 06:55:37 PM EST

As a neuroscientist I am quite close to the issue and even though I do not agree with every single bit you wrote I recommended your articles to several people. The comments were worthwhile reading as well.

You wrote in this second article: "...people subjected to artificial zero radiation environments will get sick."
Can you provide a reference for this, please?

---------------------------------------------

I am also struck by depression myself. I was not happy since I was about 12 years old. Before I reached legal adulthood I did not kill myself only because I did not want to hurt my parents. Later I felt "responsible" for the feelings of others as well who would have been hurted by my suicide.
I had some good years in my mid 20's. But then, by far the worst time was 97/98 when I was finishing medical school. It probably was not a severe depression by definition since I still was able to get my ass up and force myself through all those exams. Still, it was absolutely horrible!
Unfortunately I held the strange belief that I have to fight my way out of this myself. Otherwise I'd not be able to look in the mirror anymore feeling like a complete loser. I am not religious (I consider myself being a pantheist) but I was at least partly influenced by the "antipsychiatry" movement.
Another reason was my history in experimenting with all kinds of altered states of consciousness, chemically induced or not. So I felt the urge to "master" that state, as I "mastered" many others before. And I felt highly uncomfortable with the idea of taking a psychoactive drug for extended periods of time. I have no trouble trying whatever chemical to observe its immediate effects on me (of course when I can be reasonably sure that it'll not damage my system irreversibly), because in this case everything is back to normal a few hours later. This is different with antidepressants, there you "live under the influence"! I was also afraid of some undesired side effects, such as sexual malfunction, trouble concentrating, sedation etc.

So I kept suffering... With the years passing it improved slightly. So I was somehow reassured in my decision not to take any medication and not to make any therapy. But then I have seen several people around me taking SSRI's and improving considerably. One of them was my wife in whom I could observe the effects very closely. She said then that she would eat those pills her whole life if necessary. She said they made her feel like a human being again. After about 7 months she stopped taking them and remained feeling well. It still took me more than 2 years to overcome my defensive position concerning antidepressants.

Last autumn I started a therapy, mainly because an almost total erectile disorder developed over the year before. Sex was increasingly unsatisfying for me for several years already, and with time I could only function with the help of Viagra or Cialis. Last year it got unsatisfying for my wife too. The urologist did not find any organic problem. So I started a behavioural psychotherapy. I was willing to give antidepressants a try now. My psychiatrist was reluctant first, but then gave me Cipralex. I am taking it for 8 weeks now and am absolutely convinced about its efficacy! I am actually amazed!
The suicidal thoughts, the deep yearning for an early death, the sensation of life as merely a waiting for death are GONE! And despite sexual problems being described as common side effects of SSRI's I preceive the contrary: my erectile function improved dramatically! The same holds for other expected side effects such as concentration: I can concentrate better than in many years before. In addition to that my long term memory seems to be improving...
Also, my wife told me that I changed a LOT - for the positive. :-)
All in all, now I say the same my wife said more than 2 years ago: if necessary, I'd happily take these pills for the rest of my life! I am sure I will not, but it shows my current feelings about it.

And, despite my very critical position concerning big business in general, and pharmaceutical industry in particular, I can only say now: long live the pharmaceutical industry! Because thanks to one of its products I can finally consider myself being happy now - after more than 20 years of a life which was mostly a waiting for death...

So for me, the case is clear: there simply is a physiological problem inside my brain. I hope that it'll be cured after some time so that I'll be able to discontinue medication, but if not, I'm happy with taking these pills as long as necessary. Life is worth living this way - it's not the other way!

Thanks again for your articles and I hope that they - and maybe also my comment - will help some people suffering from depression to get out of this hell. If only one person blablabla... ;-)

spacenetman

Zero radiation (none / 1) (#94)
by Name of Feather on Thu May 26, 2005 at 07:50:35 AM EST

You wrote in this second article: "...people subjected to artificial zero radiation environments will get sick." Can you provide a reference for this, please?

Check reference 2 for more details on hormesis. I don't have it right here, but I remember that I first read about hormesis (and the anedocte that you enquire about) on a book called "The Case for Mars", by Robert Zubrin.

[ Parent ]

Depression and suicide (none / 1) (#93)
by Orion Blastar Again on Sun May 22, 2005 at 09:44:00 PM EST

I did have an anxious episode in November when all my problems (financial, medical, holidays, anniversary of deaths of relatives, friends trying to manipulate me, heated debates on public forums) and people online urging me to go ahead and commit suicide because I was sucidal in the past, etc.

I guess my brain didn't plan things out, and the best I could do was create an alter-ego to deal with it and do a cyber-death instead of a real death.

People cannot deal with that, and I am still prejudged for it. At the state of mind that I was in, I was not thinking rationally, and all the extra stress from others was too much, and led me to do an abnormal act which I did not want to do.

People are still unable to seperate my behavior when my mental illness is in control, from the real me. I do not want to behave in an abnormal way, but people are feeding my depression with their negativity and stress. I feel sorry for those individuals, because they really do not understand what I was going through, and they are unable to think about how their own actions affect others that are depressed or suicidal.

Learn how to be a liberal.
I can't believe it's not Liberalism!
"Thanks for the pointers on using the internet. You're links to uncylopedia have turned my life around." -zenador

Demystifying Depression - Part II | 96 comments (75 topical, 21 editorial, 0 hidden)
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