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[P]
Demystifying Depression - Part I

By Name of Feather in Science
Tue May 10, 2005 at 12:44:11 PM EST
Tags: Science (all tags)
Science

"Depression is a mood disorder", so start many descriptions of the illness. That is a gross understatement. Depression does indeed seriously affect your mood, but that is just the tip of the iceberg. A clinical depression is an incapacitating illness, affecting your ability to perform tasks that require concentration and rendering you unable to work.

I had a depression. By writing this document I hope to provide you with the knowledge I wish I had when I was younger. Because you see, depression is not an unavoidable fate. It is essentially a physical illness which takes years to develop, and whose symptoms provide ample advance warning if you know how to identify them.

The good news is that you can recover, lead a normal life again, and yes, even learn to be happier than you have ever been before. It takes time, a long time, but it is possible, especially if you are young and physically healthy. However, it is necessary that you throw away most of the myths and the prejudice that surround depression and mental illness in general. I will do my best to assist you in this task.

This is the first of a two part series. This instalment will introduce clinical depression, covering the factors which lead to its development and the typical symptoms people experience at each stage. Furthermore, it also includes my personal experience with the recovery process.


1. INTRODUCTION

Statistics point out that approximately one out of every six people will have a depression (with varying degrees of seriousness) at least once in their lifetimes. The magnitude of this number is all the more shocking if one confronts it with the general ignorance about the problem. Even people well-informed about other health issues will often be caught totally by surprise by a depression. I know, I was one of them. Since our early school years we get tons of information about healthy eating, on the perils of smoking and heavy drinking, on avoiding sunburn, etc, etc. But mental health, largely because of the prejudice surrounding any kind of mental illness, is to a large extent ignored. This is more of a tragedy if one realises how far-reaching are the implications for a person's life and productivity, and most importantly, how depression could be avoided altogether if only people knew how to recognise the early symptoms.

First of all, forget purely psychological explanations of the illness. Clinical depression is a physical illness which so happens to affect the brain. In this respect, it is fundamentally different from momentary bouts of the blues or melancholy. As you read through this document, please always bare in mind that whenever I mention "depression", I am specifically referring to the physical illness more properly described as "clinical depression". One also finds the very same word "depression" used in the context of other mental disorders (such as manic-depression[11]) of which I will not speak. It is very important to keep this distinction in mind. As an example, consider the people who suffer from bouts of melancholy all through their lives. They often describe their subjective feeling as that of being "depressed". However, when one takes a closer look at more objective indicators, they do not show the symptoms of a clinical depression. This document does not apply to them.

There are many reasons why the psychology myth still lingers. At the core, this myth probably stems from the ghost in the shell view of human cognition [1]. Since many people still believe that there is an immaterial soul separate from the physical body, the thought that the soul can be affected by a physical illness clashes violently with their worldview.

One of the enduring myths about clinical depression is that you can suddenly lift it up simply by convincing a depressed person that life is good and worth living. Likewise, a depressed person will not be magically cured if all their problems are suddenly solved. In fact, it was my experience (and that of many others) that the factors which contributed to the depression were long past and resolved. But they had their physical toll in the brain, and that could not be suddenly undone.

Our use of language compounds the problem. All too often will a perfectly healthy person (brain-wise, of course) say that they feel depressed, when all they have is a momentary case of the blues. It is far from my intention to dictate how people should use language, but this example illustrates my case. Curiously, one of the tell-tale symptoms of a depression is an inability to have strong emotions, including sadness and the blues.

Another important aspect to retain about depression is that it is not an on/off condition. There is a continuum between a perfectly healthy brain and one from a severely depressed person. My estimate is that in a modern society, those who could be classified as perfectly healthy are a minority. Moreover, just like physical fitness goes through ups and downs throughout a lifetime, the brain health of a typical individual will also fluctuate. It is only when the fluctuation deeps significantly low for an extended period that the diagnosis of a depression is typically made. Elaborating further on this note, the good news is that a very large number of people who strictly speaking are not depressed and have largely satisfactory lives, could still feel better and happier if they took better care of their brains. The advice herein contained is also for them.

At this point you might be wondering about my qualifications for providing what could be considered medical advice. You are very right in questioning anything you find on the Internet, even more so should health be the subject. The information contained in this document stems largely from the counselling and the discussions I had with the professionals who treated me. As far as I am aware, both the model explaining depression and the description of my recovery treatment represent the current state-of-the-art. Furthermore, I tried as much as possible to separate between what is largely consensual among the medical community, and what is controversial or just speculation. Read the text carefully: you will see that conjectures are clearly indicated as such.

However, and I cannot stress this enough, if you have a depression you should be treated by a professional anyway. You will encounter this advice several times in this document. Do not read it simply as a disclaimer. If I could choose the one thing that people should remember from this document, it would be the importance of being treated by a competent professional. And by competent, I do mean competent. In many countries, depressions are sometimes handled by GPs or even psychologists. In my experience, many are not properly qualified. Try to find a good clinical psychiatrist instead. Remember that you are putting your health and well-being in their hands.

You may raise the question of why have I bothered to write such a lengthy description of depression if I advise people to seek professional help anyway. In a sense, you are asking for a rationale for this document. Well, I would not have written it if I thought it was irrelevant, dangerous, or simply superfluous. Quite on the contrary: I see good reasons that justify it, as follows.

  • The focus of the document is an objective description of clinical depression, explaining the physical illness which progressively takes it toll on the brain. If more people were aware of this fact, they would not be as complacent when the first symptoms appear. Moreover, they would feel less stigmatised and reluctant about seeking professional help.
  • By being better informed, people would realise the importance of seeking competent help. Many GPs and even psychologists are not properly informed about depression, and they can even inadvertently give their patients plenty of bad advice. Worst of all, the situation can worsen dramatically before the patient even realises what is wrong with the advise they are being told. This happens frequently, believe it or not. The only solution is for people to be better informed and able to spot whether or not their GP is competent enough to treat them.
  • The enormous cost of health care in affluent societies often translates into health insurers pressuring for the cheaper solution of relying solely on antidepressants. In countries where the GP stands as the "gate-keeper" for specialised treatment, people may find it difficult to convince their GP to send them to a specialist. The result is treatment based largely on medication, with little or no coaching.
  • Lifestyle plays a large role in the development of depression. Again, by better understanding the problem from an objective perspective, people will more easily assimilate the need to take good care of their sleep and to avoid overloading their brains.

The remainder of this instalment is structured as follows. I will begin by explaining what exactly is a depression and how the problem develops in the first place. Special attention will be given to a description of the most typical symptoms which accompany each stage of the illness. The next step is more personal: it describes the lifestyle changes I had to take to make my brain recover instead of sinking deeper into the illness. The resulting table of contents is printed below.

  • Part I
    • 1. Introduction
    • 2. What is Depression?
      • 2.1. Normal Neuron Communication: the Role of Serotonin
      • 2.2. The Stress System: Adrenaline and Cortisol
      • 2.3. The Buildup to a Depression
    • 3. Giving your Brain a Chance: a Personal Tale
      • 3.1. General Lifestyle Advice
      • 3.2. Daily Routine
      • 3.3. Tips for Good Sleep
    • 4. The Recovery Process
    • 5. Conclusion
The next instalment will cover a range of miscellaneous topics concerning depression:
  • Part II
    • 1. The Controversy about Antidepressants
    • 2. Suicide
    • 3. The Role of Sports
    • 4. Depression and Ageing
    • 5. The Genetic Link
    • 6. Is Depression on the Rise?
    • 7. Quantifying Depression
    • 8. The Burnout Syndrome
    • 9. Happiness
    • 10. Facing the Prejudice

2. WHAT IS DEPRESSION?

If I were asked to come up with an alternative wording for what we call depression, I would say it's a problem of chronic brain overload. The key is to understand that the brain---just like all the other organs in the body---has a limited processing capacity, and if you constantly exceed it, disease will ensue.

Consider the liver. Most people know that alcohol is broken up by this organ. It is also known that even a healthy liver has a limited throughput measured by the amount of alcohol it can process by unit of time. Should a person constantly overflood their liver with alcohol, as typically happens with alcoholics, the organ has very little chance of recovering from the abuse. Over the course of many years, disease such as cirrhosis is likely to develop [2].

Similar examples could be given for the kidneys, the gall-bladder, and many other organs in the body. Occasional excess (particularly if you are young) is well tolerated, as long as there is enough of a rest period for the organ to recover. The brain is no different.

So, what does the brain process? In short, information. Our cognitive functions are realised by the neurons in the brain, which communicate with each other by means of neurotransmitters. When you perform a task that requires concentration, this requires heavy processing by the neurons in some specific parts of the brain, forcing them to dispense their precious supplies of neurotransmitters to get the job done. And what happens when that supply runs out? Well, evolution has provided us with a system which can compensate in case of an emergency. This is the stress system, and its constant abuse is what leads to a depression.

Note: I will not elaborate into what is actually happening and in which parts of the brain. Rather, I will simply present a model which abstracts from the physical details. Neuroscientists are likely to disapprove of the simplifications, especially concerning the myriad of other involved neurotransmitters which I will not mention. However, I personally think that it is still a valid model for the purpose of understanding the behavioural patterns which cause the illness. For a detailed description of the physiology of depression, the reader is referred to [3].

2.1. Normal Neuron Communication: the Role of Serotonin

Communication between neurons relies on molecules called neurotransmitters. Without going into the details of this process, it suffices to say that for a neuron to transmit information to another neuron, it must release a neurotransmitter in the small gap between the two neurons, called a synapse. More than 300 different neurotransmitters are known to be used in one role or another by the human brain. One of them in particular, serotonin, has been identified as playing a major part in the physiology of clinical depression.

Depression affects the area of the brain responsible among others for memory, learning, and tasks that require concentration and organisation [3]. When the neurons in this area are using it, you typically feel good and restful. In this sense, one can say that reliance on serotonin is the hallmark of a healthy brain.

Given that serotonin must be released into the synapse in order for communication to occur, one can imagine that neurons might spend it at a higher rate than they are able to produce it. This does indeed occur, and sleep plays a vital role in replenishing the supply of serotonin. It is also the reason why towards the end of a hard day's work we do feel more tired and sleepy. In a sense, it is your brain warning you that it is time to stop.

It is fundamental to realise that different activities will exhaust your supply of serotonin at different rates. High concentration activities, such as reading, writing, or engaging in intense conversation, are very demanding on the brain. Likewise are activities where learning a new task is involved, or which require planning and organisation. On the other hand, watching some silly things on television is a lot less demanding, while sitting in the park watching the flight of birds is not demanding at all.

It is now time to bring psychology into the picture. You might have been wandering if my description of depression would be a purely mechanical one, without any role for psychology whatsoever. In my experience, psychology (as far as depression is concerned!) is overrated, but that does not mean that it is irrelevant. In the above example, psychology is important when another variable is included: your attitude towards the activity plays a large role in the rates at which serotonin is spent and replenished. Basically, performing an activity with pleasure will be much less demanding than otherwise. This is an important factor in the so-called burnout syndrome, one of the primary causes of depression, and one which I will address in Section 8 of the second instalment of this series.

Crucial to my goal of demystifying depression is being able to visualise the problem. Being a scientist, I found that charts and graphs helped a lot in my understanding, and I reckon that even those averse to anything vaguely reminiscent of mathematics will probably benefit from seeing a few pictures illustrating the text. I will do my best to overcome the limitations of ASCII art, but bear in mind that these graphs are much more intelligible when you can show them in colour.

Figure 1 shows the progression of an individual's maximum normal capacity (in effect how large is the supply of serotonin), and the actual used capacity (how much serotonin is effectively used), during the course of an extended period. Notice that there moments when the demand is higher, perhaps because of extra work, but that the maximum capacity was never breached.

^
|
|========================================
|                   _________
|       ___________/         \___________
|______/
|
|
|
|
|
|
|
----------------------------------------->

Figure 1: The double line "=" at the top indicates the maximum normal capacity of a healthy individual. The single line "-" below represents the actual used capacity. Note how the maximum normal capacity was never exceeded.

2.2. The Stress System: Adrenaline and Cortisol

What would happen if the used capacity in Figure 1 were to approach the maximum limit? Obviously your brain would not just shut down. When this happens, evolution has provided us with an emergency mechanism which can compensate for the lack of serotonin: the stress system.

The stress system relies on two key hormones: adrenaline and cortisol. In short, adrenaline works in the short term, while cortisol has large momentum and works in the long term. (Adrenaline is also known as epinephrine in North America. To be exact, the terms noradrenaline and norepinephrine are used to refer specifically to the neurotransmitter as opposed to the hormone, since they are different molecules. Moreover, there are many other neurotransmitters involved: check reference [3] for details. The purists will excuse my exclusive use of the word adrenaline throughout the text).

It is important to realise that the stress system can also be activated if your brain perceives danger or any kind of threat. In the first stage, this triggers the release of adrenaline into the bloodstream to prepare the body for action. As a result, your heart beats faster, you begin to sweat, your breath becomes shallower, and your senses become more acute [4]. This is the so-called fight or flight response to the stressor event, and was quite adequate during most of our evolution, when these events were quite specific and usually short-term: escaping from a lion, chasing away a rival gang, or facing up to the impudent adolescent trying to woo your mate [5]. Problems with chronic stress arise because in a modern society we cannot escape easily from the stressor, be it an overbearing boss, crowded cities, or traffic jams. Furthermore, no matter how hard we try to delude ourselves with the pretence of civilisation, at heart we are still primates, and consequently, factors such as social status also play an important role as sources of stress. Moreover, primates have evolved the capacity to stress up the body in anticipation of a possible danger [3]. Again, this was an advantageous adaptation in the context where it evolved, but nothing but trouble for the modern human.

The effect of the stress hormones on the brain is curious and not what you might expect. The initial surge of adrenaline will make you feel good, though not quite in the same way as with serotonin. The difference is that adrenaline will make you feel euphoric and accelerated, whereas serotonin produces a state which could be described as that of quiet bliss. However, as far as the communication between neurons is concerned, adrenaline can compensate for low levels of serotonin. There is, alas, a serious drawback of adrenaline: together with it comes cortisol, the yang of the stress hormones.

Just as your levels of adrenaline start coming down, so rises the amount of cortisol flowing through your veins. Moreover, cortisol has a much larger momentum than adrenaline, which means that even though it builds up slowly, it also takes a long time to go back to normal. And should you constantly be engaging in activities which require adrenaline, so will your levels of cortisol slowly increase. In a sense, you can think of cortisol as a measure of the weighted average of your recent levels of adrenaline. I have tried to capture this feature in Figure 2.

^
|          @@@@@@                                   @@@@@@@
|         @      @                                 @
|        @        @                               @
|       @          @                             @
|      @            @                           @
|     @              @                         @
|    @                @                       @         ####
|   @                  ############          @##########
|  @        ########### @          ###########
| @#########             @@@@@@@@@@@@@@@@@@@
------------------------------------------------------------>

Figure 2: The interplay between adrenaline ("@") and cortisol ("#").

Together with the rise of cortisol and the decrease of adrenaline, come the nasty side-effects of the stress hormones. It is at this moment that you feel bad, anxious, and having lots of negative thoughts. And this is perhaps one of the critical features of stress which flies against common sense: you only feel its bad aspects when your body is stressing down and progressing towards a more relaxed state. When you are building up on adrenaline, in effect stressing up, you might even be feeling good! This explains what is popularly known as the adrenaline rush and the consequent adrenaline crash.

Having too much cortisol flowing through your veins has another nasty side-effect: the recovery time from any adrenaline surge increases. In a sense, the relation between adrenaline and cortisol goes both ways: the adrenaline curve influences the cortisol curve, and vice-versa. Figure 3 tries to capture this reaction effect by showing the adrenaline response curve for three individuals subjected to the same physical exercise. Notice how the more serious the depression (which translates into higher levels of cortisol, as you will soon understand), the longer it takes for the body to go back to normal.

^                         ^                           ^
|                         |                           |
|       @@@               |      @@@                  |     @@@
|      @   @              |     @   @@                |    @   @@@
|     @     @             |    @      @               |   @       @@@
|    @       @            |   @        @@             |  @           @@@
|   @         @           |  @           @            | @               @@@
|  @           @          | @             @@          |@                   @@@
| @             @         |@                @         |
|@               @        |                           |
--------------------->    ----------------------->    --------------------------->
     Healthy                      Mild                          Severe 

Figure 3: The adrenaline response curve for respectively: a healthy individual, a mildly depressed, and a more seriously depressed one.

Now, a healthy brain will never require too much adrenaline, even in emergency situations, and therefore the occasional crashes will be too minute to be noticed. A healthy person will therefore hardly feel stressed, if ever. Moreover, since the measure of how good you feel is related to the total amount of neurotransmitters available, a healthy brain with plenty of serotonin will feel ecstatic if adrenaline is added to the mixture. This can be achieved with aerobic exercise, and explains what is commonly known as the runner's high. In a sense, it is as if the brain were overflooded with neurotransmitters. (A depressed person will not experience the runner's high. In fact, they should be extremely careful with exercise, as I will explain later in more detail).

To complete the picture of how chronic stress causes depression, there remains one critical factor to be explained: high-levels of stress hormones will over time diminish your brain's ability to produce serotonin. Looking at Figure 4, you can see that chronic stress will diminish your maximum normal capacity. The exact mechanism by which this happens is still subject to discussion, but the general consensus is that sleep is the key. The reason is that higher levels of stress hormones mean less sleep, which is fundamental for the brain to restore its ability to produce serotonin.

On the speculation front, recent findings have implicated neuron death as the physical underpinning of depression. Furthermore, it seems that the opposite process, termed neurogenesis, is crucial for the recovery, and happens naturally in healthy individuals [3,6]. Furthermore, evidence indicates that sleep is fundamental for neurogenesis to take place. If indeed so, then depression would arise because elevated stress levels cause people to sleep less, which then leads the brain to fall behind on its natural regenerative processes.

^
|                               _________
|                       _______/
|                      /
|======================
|        ______/       ========
|_______/                      ==========
|
|
|
|
|
|                             @@@@@@@@@@@
|                     @@@@@@@@
------------------------------------------->

Figure 4: Whenever the energy requirements ("-") go over the maximum normal capacity ("="), the body compensates by resorting to the stress system (here represented by adrenaline "@"). The problem is that the stress hormones have a negative effect on the maximum capacity.

2.3. The Buildup to a Depression

At this stage you are in possession of all the ingredients necessary to understand how depression develops. The negative effect of the stress hormones on the maximum normal capacity is the key to comprehend the buildup process that makes a depression feed on itself, like a positive feedback mechanism.

Let us go back to Figure 4. Imagine that you would chronically go over your limits, thus forcing your body to constantly rely on the stress hormones to compensate for the lack of serotonin. On the long term, your maximum capacity would therefore be reduced, making it much more likely that you would have to resort to the stress system to compensate. And thus the feedback begins: your maximum capacity is diminished, forcing you to use the stress system all the time; and because of all the stress hormones flowing through your veins, your brain has no chance of recovering, and your maximum capacity diminishes even further.

This may sound very mechanical, but I would say that it is the key element that leads to the development of a full-blown clinical depression. Alas, it is also something that most doctors fail to realise. And if you are still clinging to "psychological" notions about the illness, it is time you put them into perspective. Psychology plays a role in the factors that lead to the initial dip of your work capacity, but after a certain stage the problem just feeds on itself, and it is crucial to understand that to avoid falling prey of this downward spiral.

Even though the graphs might give the impression that this is a phenomenon that happens very quickly, in reality the process typically takes many years to develop. Moreover, the progressive increase of the levels of stress hormones in your body provide a very good advance warning, if only you know how to read them. I will now provide a basic description of what to expect (and what to do!) at each stage of the process. Beware that different people have different symptoms, so your mileage may vary.

  • In the very early stages, a depression will not feel like a depression at all. The small amounts of stress hormones could in theory be measured---your blood pressure would be slightly higher than otherwise---but in practise it would be difficult "to extract the signal from the noise". Subjectively, you might feel a bit down and tired, especially during those periods when you are crashing down from the adrenaline, but most people would still not say that they feel depressed. Also, you would start sleeping a bit less than usual, and not feeling quite as fresh when you wake up.

    The problem is not very serious yet, and I think that most people could recover on their own if they were to simply take a long holiday and to make sure that they sleep well. There is some evidence that if done properly moderate amounts of aerobic exercise might help at this stage. However, be sure to read Section 3 of Part II before you decide to embark on any exercise routine. In fact, I would rather advise people not to begin exercising than to risk having them over do it and making their condition worse. I know this flies against some commonly held beliefs, but sports alone can worsen a depression. If you do not believe now, read carefully both instalments of this document and you might understand what I mean.

  • As the amount of stress hormones increases, you will start feeling some of their nasty side-effects. This is largely person-dependent, but most people start having problems with their digestive system, headaches, and having more frequent nightmares. Since stress depresses the immune system, people also tend to fall sick with infections more often [7]. Only a minority of people suffer from sleep paralysis [8], but it is also a good indicator of elevated stress hormones. An objective measure such as blood pressure should be controlled: it will definitely be higher than normal, and a good doctor would not fail to recognise it. At this stage you are very clearly sleeping less than normal, waking up early in the morning, feeling tired and "lazy" about getting up. Subjectively, you should notice that you do not feel things quite as intensively as you used to: you feel empty, morose, and definitely "depressed" most of the time. Other subjective indicators include loss of appetite and sex-drive, feelings of guilt, lowered self-esteem, and detachment from hobbies or friends [9].

    At this stage you should not be complacent about the problem. The best thing you can do is to go see your doctor. Take also into consideration that you have been putting too much pressure on your brain. Really do give it a rest: take a long holiday, make sure you sleep well, and be careful not to get any extra responsibilities. Antidepressants are very effective at this stage, especially if combined with minor lifestyle changes. (And yet another reason why you should see your doctor!)

  • As the buildup towards a depression continues, you get to the point where it is impossible not to notice that there is something definitely wrong. At this point, most people start having serious problems with anxiety, stress, panic attacks, hyperventilation, bouts of psychosis, etc. Your sleep will definitely be a mess, your blood pressure will be high, and your ability to focus at work seriously compromised.

    If should definitely seek professional help at this stage. In particular, do not make the assumption that your GP will be qualified to treat you. They may, or they may not. Unfortunately, many doctors still do not quite understand what is going on. My experience in this area was quite bad: I spent more than one year jumping from doctor to doctor, with the problem constantly aggravating, and getting all kinds of bad advice. In short, you need to stop. Your maximum capacity will probably be so low that you cannot even work full time. Also, specifically ask your doctor for antidepressants. In the country where I live, the Netherlands, this is bit of a taboo subject, so depending on where you live, you might need to convince your doctor not to be stingy and stubborn. Should they suggest that you start exercising, just ignore that advice. It is a very good indicator that they do not have a clue of what is going on. Also, you will need to make changes to your lifestyle. Section 3 describes my personal experience in that regard.

  • In the last stages, the maximum capacity is practically nil, and the level of stress hormones so high that people cease to be able to function. The stage of a clinical depression is very difficult to describe in words, but I will do my best. The anxiety transforms itself into a "fire" which constantly burns inside your head; you will feel desperate, much more than you ever felt in your life, as if you could never be happy again; and you will definitely be suicidal, to the point of actually planning suicide or even attempting it (with success in many cases, tragically). During this stage, people can barely sleep, if at all.

    To an outsider, the fact that a clinically depressed person is pretty much confined to bed is often misinterpreted. People often think that a clinical depression is a simply a state of apathy. Quite on the contrary: remember that the blood pressure and heart rate of a depressed person are extremely high. Rather than apathy, depression is an overwhelming fire which will not subside and burns you from the inside.

    Unfortunately, it is only at this stage that many people finally concede that they need professional help to treat them. Needless to say, you will need to make drastic changes to your lifestyle if you want to recover. You should also be very patient: it will take a long time before things go back to normal. Most important of all, a clinical psychiatrist is the proper specialist to accompany you during this period.

^
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|                                        @@@@@
|                                   @@@@@
|=====                         @@@@@
|     =====               @@@@@
|          =====     @@@@@
|               =====
|          @@@@@     =====
|     @@@@@               =====
|@@@@@                         =====
|                                   =====
|                                        =====
------------------------------------------------>

Figure 5: The buildup towards a full-blown depression: as the levels of adrenaline rise, the maximum capacity diminishes, forcing the body to rely increasingly more on adrenaline, thus beginning a downwards spiral.

3. GIVING YOUR BRAIN A CHANCE: A PERSONAL TALE

I saw "Sideways" a few weeks ago. If you have not seen it yet, give it a try: it is a good film and tells an interesting story. For the purpose of this discussion, the relevance comes from the fact that one of the main characters had been chronically depressed for a few years. While watching the film I could not help but to think that he would probably continue depressed for many more years (happy ending notwithstanding), since depression-wise his lifestyle was appalling!

The point of this digression is that plenty of people with depression are not being properly treated. Antidepressants revolutionised medicine's approach to the treatment of depression, and even though they are generally effective and an indispensable tool, sole reliance on drugs neglects valuable lifestyle advice. This is an especially important consideration for the more severe depressions, where drugs alone may not suffice to bring the illness into remission.

In the following sections I will describe the lifestyle changes I had to follow to recover from my depression. Before you proceed, take heed of two very important observations:

  • You must be mad if you are relying on the Internet as a substitute for a doctor. If you have a depression you should be treated by a specialist! Only they will be able to provide you with the coaching most appropriate for your case.
  • The advice was meant for people with severe depressions, and is overkill for a mildly depressed individual. If you had a mild depression in the past, you are therefore likely to find this guide to be too strict. Concerning mild depressions, you are absolutely right.
In order to recover from a depression, one must first understand the problem. If I have been successful in carrying my message across, by now you should have understood the critical aspects: avoiding raising your adrenaline levels, and make sure you sleep well and a lot. In practise, achieving these goals can be much more difficult than it seems. It takes some time before a person learns how to properly listen to their bodies; moreover, it is easy to fall victim of the "adrenaline trap", since people get fooled by the immediate positive reward (the adrenaline rush), but fail to associate it with the delayed negative effect (the adrenaline crash). The following three sections cover the different aspects of the lifestyle changes. The first category deals with general advise which one should always have present. It was for me the hardest to assimilate, especially since I had to overthrow some long held misconceptions about the nature of physical exercise. (And one which I am sure will raise controversy amongst the audience). The next section deals with the daily routine. Even though more flexible in nature, I quickly realised that there were good reasons behind my counsellor's insistence that I followed its guidelines. At last, the third section focuses on tips for good sleep. These are by no means specific to a clinical depression, but especially important for someone with the illness.

3.1. General Lifestyle Advice

These are just the general tips that one should have always present going through the day. It might take a while to get used to them, but in time they will become second nature. Moreover, remember that depression is not an on/off condition: this same advice is also useful for healthy people who wish to remain that way. Obviously, a healthy person does not need to follow them very strictly, but they remain nevertheless good lifestyle advice.
  • Avoid excitement like the plague!

    This is perhaps the most important. Excitement means adrenaline, and by now you must have realised how important it is to cut down on the release of this hormone. Beware that activities which might make you feel temporarily good are often exciting and laden with adrenaline, and will thus make you feel worse afterwards!

    This particular example also illustrates how plenty of so-called professionals will often be totally clueless about depression and likely to provide their patients with bad advice. I refer in particular to many naive psychologists who base their counselling on platitudes such as "you must do whatever makes you feel good" (obviously reminiscent of the myth of psychology). It is true that pleasure is very important, and finding activities which make you feel good is fundamental. However, care should be taken that this subjective feeling good is not caused simply by an adrenaline rush. A good professional will be able to tell the difference, and with time so will you.

  • Do not hurry

    Hurry means adrenaline: see above example. In practise, it may be difficult to avoid hurrying, but you can do your best to plan your activities in such a way as minimise the chances of it happening. If you need to catch a bus or a train, don't do it at the last minute; it is better to wait five minutes than to rush. Switch off the telephone: it avoids running towards it; make use of voice-mail instead. Also, do not be afraid to let the world turn without you for a while!

  • Beware of sports

    This was probably the hardest one for me to understand. Sports made me feel good, and I thought I could "sport my way" out of the depression. Now I know better. The problem is that sports do indeed give you an immediate good feeling, and we interpret this short-term positive response as if sports improved the depression. However, that good feeling is caused mainly by adrenaline, which is just an illusion. Moreover, since the crashing down can take a long time, people fail to associate that delayed negative response with the physical activity they had some days before. And thus the myth endures. (There are however circumstances in which sports can indeed help with depression. Please read Section 3 of Part II for details).

  • Listen to your body, not to your brain

    The rationale is of course that adrenaline can make your brain feel good, even as it revs up the body. In practise, most people have difficulties in learning to read what their bodies are telling them: in the first stage, help from a good physiotherapist might be required.

  • Rest after every activity

    Rest is important for the adrenaline levels to come down. However, remember that it is when your body is stressing down that you feel the nasty side effects of stress. Therefore, in the early stages it will be very difficult to rest: in serious cases, people will have such anxiety crises that they will want to devour their own flesh. In spite of this, you must resist the temptation to get up and do sports or physical activity! The withdrawal symptoms are very tough to endure, but you must go through this stage if you are to cleanse your body from all the adrenaline.

    Thankfully, after this critical initial stage you will not have anxiety crises anymore when you start resting. In any case, do make sure that you rest a few times during the day, especially after lunch (the good old siesta), and after any physical activity.

    If you are thinking that the kind of language I am using is reminiscent of that used to refer to drug addiction, then you are right on spot. Adrenaline might be a natural drug produced by the brain, but the effects of its excessive use are not unlike those of cocaine or heroin. I cannot make more precise comparisons, but perhaps someone in the audience who has the experience of both depression and drug addiction will be kind enough to report on the similarities/differences.

  • Do not perform multiple activities simultaneously

    Be especially aware that your whole life you might have been doing this, so it will take time before you realise all the parallel tasks that you have been imposing on your brain! A few examples to get you started: listening to music while doing housework, having a television on in the background, and reading the newspaper while having breakfast.

    Multitasking is very demanding on the brain. Do not think that since you are doing two things simultaneously, you will be finished quicker and therefore stress your brain a bit less. Quite on the contrary. Consider E(a), E(b), E(a+b) to be respectively the amount of effort required to perform activities a, b, and a plus b simultaneously. Bear in mind that E(a+b) > E(a) + E(b).

  • Practise relaxation exercises

    Yes, I am referring to stuff like meditation and yoga. They actually work, despite all the silly new-age nonsense that surrounds them. If you cannot stand the airy-fairy aspects, try to find a good expert who does not preach them.

    Personally, I found that one of the most relaxing things you can do is to lie in the sunshine. This might no be an option if it is winter and/or you happen to live in a cold country, but if you can, do it as much as is safely possible. (But take into account the usual advice concerning the dangers of catching too much sun, obviously! Like in all things, moderation is the key).

  • Make a conscious effort to do things with pleasure

    This could take a fair amount of brainwashing, but the idea is that before each activity, no matter how small, you think I love doing this. For best results, say it loudly. Also, only do things when you really feel pleasure in doing them, and do them only for as long as that pleasure remains. Should you lose interest or feel tired, then stop.

  • Take appropriate medication

    If your gut reaction is that antidepressants are evil, consider informing yourself properly. The truth is that modern drugs are quite effective and generally safe (I am referring in particular to SSRIs and more recent classes [10]). They do have side-effects, but these are usually mild and quite bearable compared with the illness itself. For best results, have a clinical psychiatrist prescribe them to you: they are generally well informed of the different side-effects and can choose the drug best suited to your case. Also, remember that antidepressants usually require around three weeks before they have an effect. Three weeks are an eternity for someone with a depression, but do not stop taking them just because you do not see an immediate result.

3.2. Daily Routine

I will now make a brief description of the typical daily routine. This advice assumes that the person is in a serious condition, but there are still a few good pointers to extract even for mildly depressed individuals. Also, as the condition improves, one does not need to be as rigorous as in the early stages.
  • Take your time to do the morning activities

    You surely do not want to rev up your body immediately after waking up! Take your time to get up, to shower, to get dressed, and to breakfast. If it takes you less than one hour and a half to perform these activities, then you are doing them too quickly.

  • Take a walk in the morning

    The idea is to have a qualitative walk. Pay attention to the colours around you, to the smells, the sounds, the shapes, the people, etc. This will help to diffuse your thoughts, and to avoid the obsessive thinking that accompanies depression. Also, since you must limit physical activity, walking every morning is important for your body to burn excess sugar. Walk for about half an hour, and do not forget: lie down for another half an hour afterwards! (Remember Figure 3: your body will take longer than usual to get back to normal).

  • Find an activity that gives you pleasure

    Remember that depression affects the part of the brain responsible for high concentration activities, planning, and organisation. For this reason, you must find an activity which does not demand too much of these abilities. This could prove difficult, as often people who have depressions are those whose hobbies are concentration-intensive. Forget reading, writing, and the Internet. What you need is something like gardening, painting, or bird-watching. Just make sure it is not physically demanding either!

    Towards later stages, you will be able to watch some things on television. Just avoid excitement. In fact, you should probably stay way from cinema altogether, not to mention the news! Instead, watch some documentaries or silly sitcoms.

  • Eat properly and avoid heavy meals

    Digestion is also quite demanding on your body, and therefore it is better to have more meals rather than bigger meals. Also, a depression is really a bad time to be thinking of diets. Eat well and make sure you get all your nutrients.

    Some people also swear by the importance of drinking water regularly during the day. The rationale is that dehydration is a stressor event, thus triggering the physiological reaction we aim to avoid.

  • Have a siesta

    Even if you cannot sleep, it is important that you lie down for a while until your body is (relatively) rested. We all have a natural dip after lunch, and it is a pity that in modern societies people have lost the siesta habit.

3.3. Tips for Good Sleep

To conclude, I will present just a few tips on how to get a good night's sleep. These are especially important during a depression, but again, they also apply to anyone.
  • No activities before going to sleep

    You must avoid at all cost any adrenaline coming into your system before sleep time. Be especially careful of anything exciting or stressful. Yes, this includes most of television and even reading! Avoid also any physical exercise before going to sleep. Always have in mind that a person with a depression will need longer than normal for the body to recover from any physical effort. Even healthy individuals should avoid doing sports at least a couple of hours before going to bed.

  • Follow a steady sleep routine

    Try going to bed always at the same time everyday. We all know how working in shifts and jet-lag affect sleep: do not emulate them by going to bed at random times each day!

  • Give your body time to crash down

    You cannot fall asleep while there is too much adrenaline running through your veins. It can take a while (even hours) before you crash down, and often people lie awake in bed waiting for sleep to come. The problem is that after a while it is very easy to start obsessing about not sleeping, which is a sure way of keeping yourself awake.

    The idea is to only get ready for sleep once you have crashed down and feel tired. Before you actually get into bed, just lie there for a while (even with your clothes on), until you feel rested and tired.

  • Go to bed early

    There are several reasons why this is a good practise: foremost to be able to wake naturally rather than with an alarm clock; but also to avoid being out of synch with the solar cycle, and to give your body time to crash down.

  • Make your bedroom your sanctuary

    Do not have an office in the same room as where you sleep. Dedicate one room simply for sleeping, and make it as uncluttered as possible.

4. THE RECOVERY PROCESS

Depending on your age, your general health status, how serious the depression was, and how well the recovery progresses, it typically takes between two months and two years before you can be fully recovered. Do not despair, however, because this certainly does not mean that during all this period you will feel as bad as in the beginning. The first few months are the hardest, but after that things will slowly improve, and little by little you will get your happiness and normality back. Moreover, remember that you only feel the nasty aspects of a depression when you go over your limits: you just have to be patient and to realise that your limits will indeed be very short during an extended period.

In the buildup towards a depression, you probably spent years sleeping less than normal. During the critical stage of a clinical depression, you probably will not be sleeping much if at all. Since it is during sleep that the brain recovers, it should not come as a surprise that the huge sleep deficit must be compensated for with unusual amounts of sleep. This does indeed happen. It can take several weeks or months for the body to crash down, but when it does, you will feel as tired as you have never felt in your life. And you will start sleeping like you have not slept since you were a baby: it is not unusual for people to spend several weeks sleeping 10, 12, or even 14 hours a day. Do not fight against it!

Your sleep will slowly go back to normal after this period. However, during the entire recovery you will still sleep a bit more than the proverbial 7-8 hours. Again, it is crucial that you do not fight against it. Furthermore, try as much as possible not to cut your sleep short: it is better to wake up naturally rather than with an alarm clock. It is mainly for this reason that I strongly suggest that you go to bed early every night.

Figure 6 shows how the recovery should progress as far as your maximum capacity is concerned: from an initial state of practically nought, it will slowly start increasing. Also notice that the amount of activity that you perform during the day must also slowly rise. You need to push your brain a little so it continues recovering. As an analogy, think of physiotherapy on an injured limb: one needs to slowly and progressively increase its activity, always careful not to go over the limit. The same thing happens with the brain.

When you go to sleep at night, you should feel sufficiently tired, but not anxious. If you do not sleep much, and feel stressed an unrested when you wake up, you have probably done too much activity in the day before. However, do not fall for the opposite trap of doing too little. You have to push your brain a bit, remember.

As the recovery progresses, you will feel not only that you can perform more concentration intensive activities and during longer periods, but also that your subjective mood improves. At some point you will be able to start working again, only for a couple of hours each day in the beginning, but increasingly more until you can work full time again. Finally, your mood should start approaching normality towards the later stages of the recovery: you should regain the feelings of fullness, vibrancy, and what is sometimes called the elan vital.

Concerning physical activity, you will notice that the amount of time required for the body to go back to normal slowly becomes shorter and shorter, as illustrated by Figure 3. You will also feel that you can do more intense physical activity (such as walking faster) without your heart racing abnormally. This means that towards the end you will be able to increase the amount of physical activity, and even to start doing some gentle sports. Just be careful not to start too early: if it affects your sleep, then cut down on the amount of sports. Also, be sure to read Section 3 of Part II before you decide to start exercising again.

One last note: towards the final period of recovery, small amounts of adrenaline will make you feel really good, as if you were "as good as new". Do make sure that you are not fooled by this. Have your doctor measure your blood pressure to make sure it is really normal. Also, spend a few days trying to crash down: avoid major intellectual activities or any physical exercise. If you do not get the nasty side effects of a crash down, then the feeling good was genuine and there was not too much adrenaline on your system. At last, remember that you are supposed to continue taking your medication for a while even after you think you are cured. Beware that if you stop the treatment before you have reached your maximum normal capacity, there is the danger of a relapse some years down the road.

^
|
|
|                              =====
|                        ====== ____
|                  ====== _____/
|            ====== _____/
|      ====== _____/
|====== _____/
|______/
--------------------------------------->

Figure 6: As the recovery progresses, the maximum capacity ("=") will increase, and should be accompanied by corresponding increases of the daily activity ("-"). Be careful not go over your limits!

5. CONCLUSION

The moral of the story is fairly straightforward: depression is a physical illness which should be taken seriously and be treated as soon as the first symptoms arise. Like most other ailments, it feeds on ignorance and complacency, which is all the more tragic if one considers that we have the medical knowledge and the means to make it a thing of the past. Humanity has been tormented too much already.

REFERENCES

[1] Wikipedia: Dualism (philosophy of mind)

[2] Wikipedia: Cirrhosis

[3] Taming Stress

[4] Wikipedia: Stress (medicine)

[5] Wikipedia: Fight-or-flight response

[6] Neurogenesis in the Human Brain: Fact or Fiction?

[7] Stress and the Immune System

[8] Sleep Paralysis Page

[9] NIMH: Depression

[10] Wikipedia: Selective serotonin reuptake inhibitor

[11] NIMH: Bipolar Disorder

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Related Links
o Wikipedia: Dualism (philosophy of mind)
o Wikipedia: Cirrhosis
o Taming Stress
o Wikipedia: Stress (medicine)
o Wikipedia: Fight-or-flight response
o Neurogenes is in the Human Brain: Fact or Fiction?
o Stress and the Immune System
o Sleep Paralysis Page
o NIMH: Depression
o Wikipedia: Selective serotonin reuptake inhibitor
o NIMH: Bipolar Disorder
o Also by Name of Feather


Display: Sort:
Demystifying Depression - Part I | 130 comments (100 topical, 30 editorial, 0 hidden)
ANtidepressents (2.25 / 4) (#2)
by Blarney on Mon May 09, 2005 at 09:33:11 AM EST

I dig what you're saying about the overuse of antidepressants - it has been my experience that they are oft overused for ill, are handed out like candy to any young man or woman whose well-off parents cannot figure out their lack of direction and success in life, are often pushed more than prescribed to the point where a patient is encouraged to take some of the red pill to get up and some of the blue pill to chill out and some of the green to concentrate and some of the yellow to ward off side effects from all the others - I've seen some sad side effects, too, like violent suicide attempts and forgetting of the most normal things and relationships.

I may well be depressed myself, but I'm damned if I'll take any of that stuff. I see what it does to other people.

But talk therapy doesn't work either. I've had it when I was very young, it's sure pretty lame. It never works, never has been shown to work, even Freud was rather unique as a medical scientist in seemingly never caring about the outcomes of his treatments, not tweaking results as many researchers do, but simply not presenting them at all!

My opinion (none / 0) (#6)
by Name of Feather on Mon May 09, 2005 at 12:25:12 PM EST

Well, don't be complacent: if you think you have a depression, don't give up on finding proper treatment just because your first experience was bad.

Personally, I also had a bad experience with a psychologist. (Basically, that woman had no freaking clue whatsoever of what a depression is). That is why I specifically advise people to seek a clinical psychiatrist if they can.

As for medication, there is no need to be paranoid about it. Talk with your doctor about it. If you do have a depression, they will probably recommend it. And more likely than not, it will help you.

[ Parent ]

Therapy (3.00 / 2) (#10)
by tallest on Mon May 09, 2005 at 02:46:51 PM EST

I agree that a psychiatrist is the person anyone with a mental health issue should see, as they are trained to make proper diagnoses and figure out the best medication regimen for you.

It may also be true that for simple depression (i.e. single episode, no comorditity, etc. ) that therapy is not required. However, I think you are being a little harsh in dismissing it all together. Many people with depression experience it along with a number of other disorders. Therapy can be very useful for people with chronic and early-onset illnesses who need support discovering better coping strategies and dealing with what can be a life long illness. To say that therapy is useless for depression is to ignore a large group of depressed patients who benefit greatly from therapy due to the complexity of their therapeutic picture. For some people medication alone just isn't going to cut it.

[ Parent ]

clinical psychiatrist (2.50 / 2) (#62)
by Delirium on Tue May 10, 2005 at 05:56:52 PM EST

"Clinical psychiatrist" is a nice way of saying "pill-pusher". Studies have also consistently shown that their patients have very poor prognoses.

[ Parent ]
I needed both (none / 0) (#75)
by Thought Assassin on Wed May 11, 2005 at 01:58:21 AM EST

There are definitely the neurological and psychological sides to long-term depression. If treated early enough, maybe just medication or just therapy will be enough, but if the depression goes on for too long, both sides will be far enough out of whack that they won't self-correct. It took me a long time to find a drug regime that held me steady, and although it wasn't enough to get me back to full health, it was only when the neurological side was off my back that I could cope with the therapy side - and most psyches I've been to have been utterly useless, I've been very fortunate to finally find one smart enough to guide me to an understanding of my own thinking. On a side note: I find that after 2 or 3 days _without_ excercise, I start to get lethargic, disengaged, and spiral very quickly into misery.

[ Parent ]
I call bullshit. (none / 1) (#85)
by tentonnun on Wed May 11, 2005 at 05:35:04 PM EST

Firstly, the plural of anecdote is note data. Everyone goes on and on about how doctors hand out happy pills to whomever wants them and how therapy is a buch of crap. Guess what? This isn't an exact science. These are mind altering drugs. These is a frelling complex system that we have very little knowledge of. What makes it even harder is that, for each person, their depression is different from that of other people. It might be more genetically based, or stress, or messed up childhood... whatever. On top of that, the medicines do NOT work the same with everyone! Everyone has things in their life that could be helped (even slightly) by talking to the right psychologist. That doesn't mean they're depressed. It just means that being screwed in the head is not the sole domain of depressed people. It's all a mixture of genetic susceptibility, psychological health, and life choices. You can become depressed from any one of these falling to unhealthy levels (and when that happens it brings the others down with it), but where people are most vulnerable is where those areas meet. If you have some history of depression in your family, and you don't excersize or go to bed on time or socialize, then your mental health will go downhill. Simpe as that. What gets me is that some people dont realize that it can be the case where the mental health is the thing that starts to go first. Plus, sometimes people are just so far along that therapy along doesn't fix things. They need help. Why should you criticize them for that? Any good psychoatrist will know when is a good time for antidepressants. They are not "happy pills." They do not help you if you are not depressed. They have side effects that you have to deal with (is loss in sexual interest worth energy, concentration, motivation, loss of sadness, etc?). Not every drug will work for you, so it may take time. Depression itself usually doesn't take more than 1 (maybe 2) drugs at once. But, those drugs need to be chosen correctly by someone who has experience. Your account is evidence of stigma associated with depression. You do not understand the situation. You do not understand the treatment. You do not understand the problem

[ Parent ]
+1FP (3.00 / 5) (#3)
by jhoderd on Mon May 09, 2005 at 09:52:37 AM EST

This is very good. I had a depression 3 years ago. I don't think it was as serious as the one you describe, but it was still a depression and I felt like shit during many months. I was stupid not to go see my doctor right away, but I was also lucky that a good friend of mine had the same problem and she convince me to go. It was very different from what you see in the movies: he didn't care about my "problems" or any of that shit. He just wanted to know how I spend my days. He gave me some pills (Remeron) which made me sleep a lot better, and explained me the thing about serotonin and adrenaline. He didn't give me any detailed lifestyle advise like yours, but he forbid me from doing anything exciting, to avoid rushing around, and to always go to bed early. I had started doing jogging when I started feeling stress, but he also told me to avoid running very fast or for very long. At the time I thought he was a bit old-fashioned, but now I understand better why.

When will you send the second part?

Second instalment (none / 0) (#8)
by Name of Feather on Mon May 09, 2005 at 02:06:35 PM EST

If the first part gets accepted, one week from now.

[ Parent ]
Isn't that the difference btwn (none / 1) (#21)
by shinnin on Mon May 09, 2005 at 05:13:52 PM EST

psychiatry and psychology?

[ Parent ]
+1FP (2.80 / 5) (#4)
by OlympicSmoker on Mon May 09, 2005 at 11:43:24 AM EST

ascii graphs make me feel pretty when i'm depressed...

Diet .... (2.50 / 2) (#11)
by levsen on Mon May 09, 2005 at 02:56:09 PM EST

I'm not sure whether any diet is so wrong for you in any moment. If you're trying to lose weight by starvation or any other way that puts great stress on your body, that's probably wrong. However, I've been for a long time been a fan of the books by Michel Montignac (see your favorite online book retailer for copies) who advocates a moderate low-carb diet that has a lot of health benefits in addition to losing weight, including better mental fitness.

In that context it would also be interesting to know the effects of cocoa and caffeine on the serotonine levels in the brain and whether these things are recommended or not.

This comment is printed on 100% recycled electrons.

My SO did some volunteer work (2.12 / 8) (#12)
by Sesquipundalian on Mon May 09, 2005 at 03:08:30 PM EST

for a mental health organization in Canada, and I don't mean to diminish anyone's suffering here but I always got the impression that all of the depressed people she worked with were losers (God I sound like such an asshat).

After meeting more than a few of them, I came to the conclusion that most of them would have been a lot more happy if someone had shown them how to "win" at life, rather than just trying to pacify them.

The thing that gets me is this; Our brains store "how-to" information by myelinating response patterns into our cortex (myelinating is a fancy psychiatrist word for pattern - hardening). First we try out a pattern to see if it's any good, (for example when I was first learning to do sales, I had to practice how to shake hands with people). Then if we get happy results whenever we activate that new pattern, our brains decide "hey - that's a good pattern" and the pattern becomes permanent via the process of myelination (after the happy reinforcement I got from closing a lot of sales, a firm positive handshake has become second nature to me).

I believe that everything in life has a purpose (or can be used for a purpose, if you prefer). Could it not be the case that depression is the feeling you get when your brain triggers a big de-myelination session after it notices that the patterns that you have trained into it aren't getting you the results that you want?

Think about it. Most of the depressed people I've met are always bitching about the meanlessness of their lives and how unfair everything is, could it not be that their brains are actually trying to reject years and years of indoctrination at the hands of school teachers and Big Media? I mean, most of the stuff I was exposed to in school and on television sounds great on paper, gets pretty heavily reinforced, and absolutely does not work in competitive "real life" situations. Maybe these people are just trying to take back their frontal lobes and it hurts like hell because they have to demyelinate so much tissue, all at once.


Did you know that gullible is not actually an english word?
Thinking about it (2.66 / 3) (#19)
by shinnin on Mon May 09, 2005 at 05:10:39 PM EST

Most of the depressed people I've met are always bitching about the meanlessness of their lives

Interesting. If I remove the indoctrination bit - do you mean the brain wants to create a feeling of meaninglessness w/r to certain activities so that you stop doing them?

[ Parent ]

Yes, that's what I meant; (2.66 / 3) (#24)
by Sesquipundalian on Mon May 09, 2005 at 06:00:18 PM EST

and then, when you're feeling numb and un-activated (AKA:depressed), some chemical process can perhaps dissolve the "wrong" myelination (which if you happen to be a neural enzyme, is probably being activated in a certain way that smells like "DELETE ME").

The feeling of depression actually makes a lot of sense to me (sort of like a mental bandage), because I think demyelination might work much better if you aren't enthusiasticly using the demyelinating tissue at the time. Later you might feel renewed and optimistic so that then you can re-train that "freshly washed" tissue to encode a more effective behavior.


Did you know that gullible is not actually an english word?
[ Parent ]
Far too technical explanation for me (2.50 / 2) (#25)
by shinnin on Mon May 09, 2005 at 06:13:48 PM EST

and I'm no psychiatrist, but certainly, as I'm quite convinced that most disorders are functional in that they attempt to correct behaviour, I tend to think that's a very interesting slant on the topic.

But if depression becomes chronic that life itself appears meaningless - it's not a rational option to stop "doing life". That would mean we should be more aware of situations in which we lose the sense in certain activities? I fear western society is too fast-paced for most ppl to be aware of that. In that sense, I'd agree with your comment about indoctrination - we are indoctrinated to be deaf to such subtle mental messages.

[ Parent ]

you're suggesting (3.00 / 3) (#26)
by lostincali on Mon May 09, 2005 at 08:06:56 PM EST

that depressed people actually have something to be depressed about. In my experience, that kind of thinking is strictly frowned upon in the medical world.

Treating depression seems to be mostly about telling people that their depressions are irrational assessments of their life with no basis in reality. Try telling a medical professional that you're depressed because your life (or, perhaps, skill-set) actually sucks, well, it's time for some re-education.

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

It's the other way around (none / 0) (#39)
by Dievs on Tue May 10, 2005 at 09:43:33 AM EST

The way I feel about this, is that once you start getting a clinical depression, you become a 'loser' - you are unable to focus, compete and win - since if you put a short-term effort to really achieve something, then very soon the stress and 'crash' will leave you basically unable to do anything much - you will spend more time worrying about things to be done that actually doing anything. Many such people are quite the 'winners' after they recover from this mental issue which has their hands tied up.

 

[ Parent ]

A whole world of asshats aplenty (none / 0) (#52)
by JohnFrum on Tue May 10, 2005 at 02:43:06 PM EST

You're correct on both accounts.  People with depression come off as losers and you sound like an asshat.  I suffer from depression and I've thought the same thing about depression sufferers when I wasn't in the middle of it.  Talk about your asshats.  There are times when I have worked with big-name musicians, have successfully managed businesses, have learned multiple talents, donated my time to charity, had a positive attitude and was in every since of the word a winner.  There are times when I can not manage to bathe myself, look someone in the eye or stop crying.  Let's settle on temporary losers.

This has been one of the hardest things to deal with...  The fact that my family and the people who see me in those times just think I am a loser.  It makes me sink deeper into myself and only prolongs the possibility of healing.  If I were to kill myself, I am sure that would be the main reason.  The things is that they are only seeing the outside of me with no clue what is precipitating that physical manifestation of the battle in my mind.  If they knew what I dealt with they would see me as one tough motherfucker.

Some times I don't think that depression is a 'real' disease.  If I were able to still work in the midst of it would they call it a disease?  Mine is very existential.  You're right.  We are fed a lot of meaningless bullshit and then thrown into the world.  What our society holds dear is horrible.  Some times I think it is a reaction to something so much greater.  I don't have the answer and neither do the doctors.  We live in a time of leeches when it comes to SSRIs and modern psychiatry.  Psychiatry really is just a new religion.  The drugs are profit-making guesses by scientist who do as much harm as good with them.

If it is existential then the only thing that could help us as a whole is more education, understanding, empathy, tolerance, reaching out and ,oh yeah, completely razing everything Western culture holds dear.  Hah!

Kudos to the article writer.  I definitely have come across the cortisol/adrenal connection with my depression.  I'm not sure if what you said about exercise is correct or not but it sure is soemthing to think about.  As little as is known, you might be one of the leading researchers into this.  Don't know

 

[ Parent ]

here here! (none / 0) (#56)
by ited on Tue May 10, 2005 at 03:22:17 PM EST

(i hope i format this time. i'm a new poster, love K5.)

i'm a musician, Berklee School of Music 72, Univ. of Miami, FL for a stint, then back to Berklee.  i'm from Virginia.

you're so right.  i needed a letter the other day from a doctor i saw in 72 and who wrote a letter for me in 78 to get in the service since i had a prior stay in a mental hospital... long story... (if your interested in my story let me know, i have it all on a website).  i learned as a footnote in his recent [yesterday] letter that the DSM1 was not in existence in 1972, wow.  we are still in the dark ages if you ask me.

i once, in the early 90's, had a doctor say to me, "there are thousands of these medications and there is no guarantee any of them will work."  i understand that, you could probably say that about anything, but it's scary because there is no pathology, no bloodtest.  i'm BP (manic depressive), or so they --i don;t know what to believe, but i've settled in to keep on trying.  i'm 51 today!  

i tried to end it for the first time when i was 18, the last time, last fall.

i joined the service to play guitar in the jazz band.  it was great because it was structure  and I did very very well, i was the best in my grade, in my field in the entire army --that's on paper;  but something bad, something terrible happened.  

the VA (Veterans Administration), everywhere i've ever lived since Dec 82 doesn't have 1 on 1 counseling which is what i need weekly.  it takes months to see the psych and all that's for is to monitor medication.  i have no health insurance.

i guess i'm a loser?  i was the number graduate in boot camp and won soldier contest after that which of course they used me for because of the first win.  i went back to college at 41 and graduated with a 3.9.x GPA, 5 honor societies and i volunteer teaching english to non english speaking peoples --but i can't get hired so i have to go around trying to sue people everywhere in m wake for discrimination --long story, why?  because like the other poster apparently they think i'm a loser who shouldn't be around kids.

anyone who doubts that there is any reason that i should not be hired i will gladly show you otherwise for the asking.  i will keep your address if you send it to me until my current litigations are over, then, win or lose, i will let you see my information including that of the other side.

but to this poster that i am replying to, i thank you.

[ Parent ]

i'm interested... (none / 0) (#55)
by ited on Tue May 10, 2005 at 02:54:46 PM EST

...in your ideas. i'd like to talk offline. contact me xxxx at hotmail dot com how about the "up" side though, for instance of Bipolar depression? particularly i'd like to point you to as study on stress events as they relate to BP, not so much the depression side but the manic aspect. i have this information online, but it's protected access right now. i could spin it off to another location quite easily so anyone could read it. this is important to me as it is describing "me." and also that i am currently using this information to pursue various legal matters. in fact, matters that have plagued me, not of my control, for over two decades and continuing. i think this information is important to what you see as the development and evolution of memory schema and how we grow, learn and evolve. yes, i invite you to review my information before you call me a "loser." no on second thought... you were right in your sentence. like my situation, you have no idea of my history, and it seems you have your information of other's histories second hand... so yes your are definitely and by your own words as "asshat." i take back my offer to educate you. i have deleted my email address that was above. it was a nice try, though. now please go donate to your nearest mental health agency.

[ Parent ]
Psychotherapy (2.50 / 2) (#67)
by frankwork on Tue May 10, 2005 at 08:43:23 PM EST

I recently read a synopsis of a psychotherapy textbook, the gist of which is that people develop most of their personal strategies for dealing with life when they're 13 to 18 years old. In other words, high school. How fucked up is that?

Furthermore, (according to the synopsis) the purpose of psychotherapy is to coach people into a) seeing that some of the strategies they've developed may no longer be appropriate and b) seeing how to modify their strategies to work in the present-day real world.

I'm aware that I'm over-generalizing a probably already over-generalized synopsis of a book that can't hope to cover every situation, but there may be a grain of truth to the parent post that psych textbooks would agree with.

A natural question to ask is that if all you're doing is re-strategizing, why do you need some dude with an MA to charge you $100 to listen to you bullshit for an hour?

Well one proof by example I can come up with is that as a programmer trying to explain to someone why your code isn't working the way you want it to, you often figure out the answer without the person doing much more than nodding and appearing concerned. So if your life isn't working out the way you want it to, it stands to reason that the presence of a trained professional, even if you're doing all the talking, can help.



[ Parent ]
why do they need to be a trained professional? (none / 0) (#71)
by Delirium on Tue May 10, 2005 at 10:31:10 PM EST

If, as you're arguing, all you really need to do is talk a bit, then isn't that one of the major purposes of friendships? Of course, this may be the root of the problem—modern-day psychology serves, in large part, a a friend-for-hire.

[ Parent ]
A slant on this. (none / 0) (#115)
by sophacles on Sun May 15, 2005 at 04:11:59 PM EST

I do some work at a place that does drug and alcohol addiction counselling.  Many of the people there are just coming out of prison, or are there to prevent being imprisoned.  One of the things we try to teach these people is how to use their 'old skills' effectively in non-destructive ways.

For example a person who was good at dealing drugs has a high probability of being good at commission based sales.  Many of the required skills are the same. Similarly running a store of some sort can use many of these skills (markups, bulk discounts, keeping customers, etc. Actually a lot of people who sold drugs at one point have good business sense, they just chose an illegal business).

The counsellors explained to me they do this to keep people feeling good about their lives, so they don't go into deep depression.  A lot of these folks are depressed because everything they have known got them in trouble, so by helping them see a lot of what they know is NOT wrong or bad, the chances of them giving up are reduced. (Hence the chance of relapse, repeat offending, etc are reduced).

Combining this with your comment makes a lot of sense. I think the difference between severe depression and a mild depression/this isn't right feeling is, in this light, an overloaded brain. This also explains why a mild depression can be caught and cured early as described in the article. Overloading the brain while it is repairing itself intuitively feels like a recipe for trouble.

Of course I'm not very qualified to claim that the above reasoning is anything other than a semi-educated guess.

[ Parent ]

Those folks are not really depressed, then (none / 0) (#127)
by CptPicard on Wed May 18, 2005 at 01:23:38 PM EST

I dig part what you're saying because a part of my own depression pattern is getting stuck into such a hopeless mindset that I just want to totally give up because genuinely, nothing matters. My life becomes just this huge slow-motion train wreck happening that I don't even want to stop. When I recover, I end up spending months and months fixing what I have fucked up while I wasn't capable of much anything. Turns life into a bit of roller-coaster.

The difference between active losers and depressed people is that some people are just simply lazy by behaviour and seek scapegoats for not bothering to try in the world outside them by claiming that nothing matters. They choose their state.

A depressed person doesn't, and he really means it when he says nothing matters. There is a huge difference. Nobody is in such a state voluntarily.. it is the most godawful state of mind because you're not "there" in any capacity to control where your life is going because you don't WANT anything. Complete, absolute lack of desire and interest in anything is totally different and far more sick than just choosing to be a couch potato all day long.

An important sign in recovery from a bout of depression is the return of thoughts along the lines of me "wanting" to do something -- anything! It is important to support your recovery when those thoughts start to occur by slowly picking up an activity... it should probably be something completely different from what you usually do, just to get your interest in life back up. For me it was just driving around aimlessly, enjoying the scenery...

[ Parent ]

Thoughtworthy (none / 0) (#133)
by Rutegaard on Tue Sep 20, 2005 at 02:46:57 PM EST

Indeed. I resent being labeled a loser, though. :-) On the other hand, my troubles are primarily of anxious nature, I'd say, with resulting secondary depressive symtoms.

[ Parent ]
Depression (none / 0) (#134)
by Rutegaard on Tue Sep 20, 2005 at 03:20:48 PM EST

Replying to myself, since I can't find a way to edit comments, I'd like to add that depression might result from any discrepancy between demands and performance. High-performing as well as low-performing people may enter depressive states as a result of perceivingly performing less than demanded (by self, which might be a function of what is demanded by others).

[ Parent ]
Sports: adrenaline or endorphins? (2.60 / 5) (#20)
by enthalpyX on Mon May 09, 2005 at 05:12:20 PM EST

I always thought it was endorphins (i.e. "runners high") that made you feel good post-exercising.

Anyone care to elaborate?

Exercise (2.75 / 4) (#28)
by iLurk on Mon May 09, 2005 at 11:28:46 PM EST

What you say about exercise is crap. Hundreds of studies have found that the positive effects of exercise on depressed people is enduring and large. In studies comparing different treatments and therapies for depression, exercise usually comes out near the top in quantitated positive effects.

Exercise (3.00 / 2) (#31)
by Name of Feather on Tue May 10, 2005 at 04:41:44 AM EST

I do not deny that exercise can help with depression. Read again Section 2.3 of this instalment, and Section 3 of Part II (which you can find on my diary).

The critical point is that one has to be careful with exercise. Most people simply get the advise to exercise, without the extra warnings. If done the wrong way, exercise can make your condition worse!

[ Parent ]

Too much of a good thing (none / 0) (#48)
by Noexit on Tue May 10, 2005 at 01:33:08 PM EST

Exercising incorrectly during a major depression can indeed be a bad thing. Several years ago I was going through a major depression and part of my ill-advised self-treatment plan was exercise. Lots of it and very intense activities. I always felt GREAT while doing the exercise, then lousy a few hours later. The dip and the letdown after the initial "rush" were just too powerful. In my last episode, which I'm still coming out of, I started practicing yoga. Good benefits for my terribly out of shape body, but not so intense that I get all jacked up afterwards. Also, a word about the medications. If it weren't for 200mg of Zoloft a day I wouldn't be typing this right now. YMMV.

[ Parent ]
Exercise (none / 0) (#74)
by oddity on Wed May 11, 2005 at 12:22:37 AM EST

I've had the opposite experience with exercise. Really intense aerobic exercise would make me feel much worse while I was doing the exercise. Shortly after finishing I would feel better than when I started exercising.

Since this seems to be exactly opposite expectations from reading the article and I've heard repeatedly that exercise is good for those who are depressed, I am hesitant to put any trust in the article's claims.

The article really should have provided some support to this exercise/adrenaline connection. I would love to see links to scientific studies regarding this connection but my impression from the article is that this is just the author's fantasy.

[ Parent ]

Careful (none / 0) (#78)
by Name of Feather on Wed May 11, 2005 at 05:45:20 AM EST

I think the confusion lies in what is meant by "after the exercise". I also felt good immediately after exercising: everyone does. Hence the commonly held belief that exercise is good for depression. What you have to understand is that the inevitable crash can take a long time to happen, even days! Therefore people fail to recognise it as a consequence of the exercise they did the day or days before.

As for lack of references concerning the serotonin/adrenaline/cortisol model, well my apologies, but like I stated, most of that information stems from the discussions I had with the professionals who were handling me. Which is not to say that the information is not out there.

[ Parent ]

Days? (none / 1) (#83)
by oddity on Wed May 11, 2005 at 02:03:15 PM EST

I find it hard to believe that the biochemical effects of exercise take so long to manifest. One would expect adrenaline to reach its maximum level during exercise, not afterwards. So if this is what is the cause of good/bad feelings, one would expect an emotional peak during exercise and a gradual decrease over time. Claiming an adrenaline crash can occur days after exercise sounds more like your desire to believe this theory despite the evidence rather than a reasonable explanation. I would posit that the benefits of exercise are more along the lines of giving one a feeling of accomplishment rather than a purely chemical effect. Especially since a common form of treatment is to get depressed people out and accomplishing things again. This also more easily explains the varying (and long) timeframes involved for a return to depressive feelings after exercise.

I'm not saying you're necessarily wrong, but my experience is contrary to your description and you provide no supporting evidence. In fact, it appears that you yourself have never been given any hard evidence, just other people's opinions. Although these people may be professionals whom you have reason to believe, it's been pointed out that studies have been done that disagree with a negative link between exercise and depression. I see no reason why I or anyone else should believe your second hand account of this connection over more immediate and well-supported information sources.

If you presented this as purely your personal experience with depression without broad claims of the bad effects of exercise and adrenaline, I would look upon it much more favorably. As it is, it reminds me of the evolution/creationism arguments. One side presents evidence, the other wants us to take things on faith with a few weakly supported arguments but no attempt to prove the assumptions made in those arguments. If the information truly is out there, I would think you'd be able to provide at least one link to a study showing a connection (and not just hypothesizing one).

[ Parent ]

Exercise (none / 0) (#89)
by Name of Feather on Thu May 12, 2005 at 08:10:28 AM EST

Well, please read Section 3 of Part II for my complete opinion on exercise. (you can find it here in my diary. I will post it next week as a story).

"One would expect adrenaline to reach its maximum level during exercise, not afterwards."

But of course! It peaks during the exercise, but it can take a long time to subside after the exercise is finished. This is precisely what the article states. If you read it carefully, you will see that nowhere it is stated that "adrenaline reaches its maximum level after exercise". That is nonsense.

I suspect that you are either a healthy individual or have at most a mild depression. As such, exercise can indeed help you, but do not extrapolate that for people with more serious depressions! (Again, read Section 3 of Part II).

[ Parent ]

Psychiatry (3.00 / 4) (#38)
by oneiromancer on Tue May 10, 2005 at 09:00:32 AM EST

This is drawing somewhat from personal experience and also some case studies gained from working in the field of mental health, but I take great exception to your dismissal of the 'psychology myth'.

I posted this in comments while this story was still a diary, but, nevertheless, Peter Breggin's book 'Toxic Psychiatry' is quite a damning indictment of modern psychiatric doctrine; understanding of mental health issues and their precise effect upon brain chemistry is still sketchy, and to pretend that we have a complete understanding of such a complex problem is dangerous. Things that may have been effective in the treatment of your own condition may not be so effacious when applied to myself or another sufferer.

Also, I feel that mention could be made of the role of CBT and similar therapeutic techniques in combatting depression. Even exercise, as another comment mentioned, can be helpful -- one study (apologies, I don't have the precise citation to hand) found that exercise had the same effect as antidepressants in lifting the mood of depressive patients over a period of 2 years.

In summary -- nice article, and +1FP from me. I appreciate the effort you put into it, and applaud your contribution to this site, though I may not agree with every word. ;)

'You are a heartless bastard.......' -- K5 hate mail
Treatment (none / 0) (#40)
by Name of Feather on Tue May 10, 2005 at 09:56:51 AM EST

From my experience, part of the problem is sole reliance on medication without the associated supervision. Medication does help, and it might suffice for mild depressions, but for more serious cases, it is not enough.

The reason for this state of affairs? Partly ignorance, but I reckon that the high costs of specialised treatment also play a role. It is a lot cheaper to give someone pills than to send them to a psychiatrist.

[ Parent ]

Some small annoyance (none / 0) (#58)
by levesque on Tue May 10, 2005 at 04:57:36 PM EST

Another way of putting my comment titled "psychology does not equal "mind only"" in the diary version of your article: The quality of psychiatrists is not uniform and neither is the quality of psychologists.

A little biased but I liked the general angle and feel.

[ Parent ]

Thank you! (none / 1) (#45)
by Scott L on Tue May 10, 2005 at 11:29:51 AM EST

Thank you very much for writing this - I myself suffer greatly from Major Depression. Medication has only been partially effective in my treatment up until now. I'm taking a new drug that is more than just an SSRI, it's an SNRI, and it's finally providing me with some relief. For the first time in a long time, I feel like I'm in control of my head, not my emotions. Finally, that process of getting better isn't a 'two steps forward, one step back' situation for me anylonger.

--
I'm on new meds, it's ok, really.
Depression has many causes (3.00 / 4) (#47)
by jd on Tue May 10, 2005 at 12:46:32 PM EST

And therefore many cures, but a cure for one cause won't necessarily be a cure for a different cause. This is "obvious", but it needs stating, as many treatment programs for depression are based on symptoms, not the underlying mechanisms.

Untreated, depression is guaranteed to get worse. The brain's chemistry and structure will change in semi-permanent ways, in response to the depression. This is why the two typical American responses - ignore it or use pills to conceal it - are potentially deadly.

Sometimes medications are essential for a person to actually get other treatment. In those cases, that is exactly what the person should do. They should get that other treatment. A person may also have a form of depression which requires lifelong treatment, in order to maintain the chemical balance in the brain. When that happens, that should absolutely be the response. But it should never be the ONLY step taken.

There are many myths surrounding depression, and it can be hard to seperate fact from fiction, but there are a few things that seem to be generally true.

  • Depressed people tend to either over-isolate or over-compensate. Their sense of perspective is usually a little distorted.
  • Depression tends to suppress the immune system while encouraging the depressed person to take risks that increase the risk of exposure to pathogens.
  • Self-medicating can lead a depressed person into addictive and self-destructive patterns of behaviour.

Part of the problem with the current knowledge of depression is that it is symptomatic (eg: the DSM-IV description) rather than mechanical, for the most part, which means that treatments usually take the form of guesswork and trial-and-error.

The other part of the problem is that because depressed people isolate and because they have a hard time staying employed (and because mental health care is often not covered by insurance policies), depressed people often don't get seen by specialists. This means that they don't get treated, and the limited body of knowledge that does exist is self-selecting.

That last bit is possibly the most important. Our knowledge of ALL mental illnesses is self-selecting. We have virtually no truly random samples, no broad range of conditions to learn from, no verifiable control group. We know some things - you can do a lot with chemical tracers, EEGs, CAT scans and other diagnostics - and those things we do know we do have considerable control over.

With virtually no good, high-quality studies on the kind of scale needed to truly nail this subject down once and for all, all any doctor can do is take out the list of meds and try them one at a time, noting the consequences and hoping the patient won't die from them before reaching the one that works.

not necessarily (none / 1) (#49)
by khallow on Tue May 10, 2005 at 01:49:02 PM EST

Untreated, depression is guaranteed to get worse.

No it's not. This is an partially untrue blanket statement that serves to undermine your argument. First, I'll mention that virtually everyone will experience the symptoms of depression at some point during their lives (and the symptoms may be severe enough to harm their health). And for most people these symptoms will go away on their own. And there are people who recover from the genuine article (clinical depression) without explicit treatment for the condition. I base this observation on the historical biographies of various people who lived before the era of modern medicine. There are a number of cases of people who endured servere bouts of depression in their youth or middle age and yet become rather stable perhaps even happy in their old age (two off the top of my head, Isaac Newton and Thomas Aquinas).

Perhaps a better example (from the 19th century) is Abraham Lincoln (who became President of the US from 1861-1865) and his wife, Mary Todd. It appears that Lincoln overcame severe depression prior to when he married Mary Todd (around 1842) and later showed remarkable resilience under the extraordinary pressure of the Civil War. His wife, particularly after Lincoln's assassination in 1865, got worse until she was commited to an asylum in 1875. Afterward a few months (of what I presume was the best treatment of the time), she recovered enough that she could live with her sister for the rest of her life.

Having said that, I don't see a reason to delay treatment just because you might be one of the luckier ones who either through change of life style or brain chemistry as they grow older could recover from this disease on their own some indefinite number of years down the road.

Stating the obvious since 1969.
[ Parent ]

All your examples show is... (none / 0) (#57)
by Russell Dovey on Tue May 10, 2005 at 03:41:58 PM EST

...that you have to be some kind of genius (Newton, Aquinas and Lincoln, and I'd add Spike Milligan if he'd actually gotten over it) to get through depression without treatment.

Of course, depression requires life-style changes as part of any treatment, so perhaps it's meaningless to say that someone prevailed against their depression "without treatment", since they may, if they are lucky enough, make the right choices to save themselves.

This article is an illuminating and truly valuable guide, by the way, and I thank the author for it. Some of the details may yet prove wrong, but the important thing is that they're interesting enough to follow up.

The description of how depression progresses, and sound practical advice on what to do to avoid it, is the best bit. Well done.

"Blessed are the cracked, for they let in the light." - Spike Milligan
[ Parent ]

not surprising (none / 0) (#64)
by khallow on Tue May 10, 2005 at 06:42:12 PM EST

...that you have to be some kind of genius (Newton, Aquinas and Lincoln, and I'd add Spike Milligan if he'd actually gotten over it) to get through depression without treatment.

Well, that's not surprising. After all, that's classic selection bias in action. After all, how did I hear about them? Answer because of their impact on history which in part would be driven by their intellect.

Stating the obvious since 1969.
[ Parent ]

Abraham Lincoln (none / 0) (#61)
by jd on Tue May 10, 2005 at 05:35:24 PM EST

First, it is very difficult to make any kind of meaningful "historic" diagnosis when in a different century and without any access to the person in question. In consequence, any conclusions a person comes to must be highly speculative.

Second, the fact that he "seemed" to get better is not quite the same as him actually getting better. Apparent improvement is not really indicitive of actual change. It would be just as valid to suppose that he developed methods of coping, methods of hiding it, or even methods of drawing from it. Sir Winston Churchill was certainly depressed, and commented on it often, but used those throes of depression to drive him on as one of the most successful wartime leaders Britain has ever known.

Third, we don't know that Lincoln was NOT treated. He would have access to herbs, such as St. Johns Wort. As a politician, though, he would not have been keen on making it public knowledge that he was receiving such treatment, as any mental problems in those days were deemed evidence of Evil.

Finally, we don't know if he self-medicated. Drugs of all kinds were available at that time, which were mood alterants. It would not have been hard for him to get some chemical relief, if he had wanted to.

We need a more solid example, if you're to successfully show that depression isn't always a progressive disease.

[ Parent ]

hrmmm (none / 1) (#65)
by khallow on Tue May 10, 2005 at 07:11:11 PM EST

Here's Wikipedia's take on clinical depression:

Untreated depression is typically characterized by progressively worsening episodes separated by plateaus of temporary stability or remission. If left untreated it will generally resolve within six months to two years although occasionally depression becomes chronic and lasts for many years or indefinitely.

So they're saying here that clinical depression usually isn't progressive (ok, they are, but then they say it usually resolves in time) and chronic.

Stating the obvious since 1969.
[ Parent ]

Bullshit. (1.14 / 7) (#50)
by V on Tue May 10, 2005 at 01:50:08 PM EST

I didn't RTFA but come on, this is k5.

This all brain chemistry seems like bullshit to me. I went with two p-docs that were just trying to guess which happy pill would be right for me. The only thing that those things did was make me feel extremely tired for months, they killed my concentration and was unable to do any work at all.

Before I always felt pretty bad but at least I could do enough bullshit work, with the pills even getting out of bed was a challenge.

I noticed during those years that I had a very acute perception. I was always right. It was like I could read minds. Every asshole I met was so transparent that it was boring. But if you say that to your p-doc he thinks your are phsychotic and gives you more pills to dull your mind.

P-docs are quacks and should not even be doctors at all.
---
What my fans are saying:
"That, and the fact that V is a total, utter scumbag." VZAMaZ.
"well look up little troll" cts.
"I think you're a worthless little cuntmonkey but you made me lol, so I sigged you." re
"goodness gracious you're an idiot" mariahkillschickens

repost: malnutrition & mental illnes (2.50 / 2) (#51)
by krkrbt on Tue May 10, 2005 at 02:42:48 PM EST

I originally made this comment first time this article came through the voting queue.  

I came across an magazine article a couple of weeks ago about a pig farmer and his acquaintance who formulated a vitamin/mineral/nutrient supplement to treat two of the acquaitance's kids for mental illness (depression/bi-polar).  Pig farmers know that when their pigs are bitting each other's ears off, that signals a nutrient deficiency.  So they started work on formulating something for the daughter, testing it on her as they went along.  One day she looks down at her chest and says, "oh my god, the hole has closed up!" (demons used to fly out of it).  

I look at family members who claim to be depressed (3, that I know of), and I think that the majority of their problem is that they eat poorly.  If it was up to him, my grandfather's sole source of food would be from cans and frozen dinners.  My Aunt prepares ~1 meal/day for her parents, but she's mostly a meat & potatos cook, with a smattering of vegetables on the side.  And she uses conventionally grown veggies, and meat purchased at costco - not exactly the most nutritious of ingredients.

Speaking of the aunt, she doesn't sleep too well, and claims to depression too.  She takes her upper (expresso) in the morning, and has a perscription for a downer at night.

According to the discover magazine article, the brain takes some 40+ nutrients, and if any one of those 40 are missing things start to go haywire.  Consider:  before ~1900, all farming was done organically.  Recent research is showing that organically grown food has more antioxidants and trace minerals than modern factory-farmed foods.  Also consider relatively modern consumables such as Soda (coke, pepsi, sprite, etc) and pre-packaged "foods" (Grandpa's frozen T.V. dinners) which have displaced traditional food & beverage choices.  Human nutrition requirements haven't changed over the last hundred years, but nutritional intakes for most of us have changed dramatically.  

Is it any wonder that so many claim to depression?

Yesterday I searched out the company in that article for an email I wrote, so if anyone's interested:  True Hope



This is a very reductivist view (2.14 / 7) (#53)
by Delirium on Tue May 10, 2005 at 02:44:28 PM EST

I'm not going to dispute that this is a view of depression (and many other mental illnesses, for that matter) held by many people, but it is essentially one radical extreme of the range of viewpoints, and certainly not the only one.

Depression as a "brain disease"

If I'm reading you correctly, you're arguing that depression is essentially a "brain disease" caused entirely by physical factors. This is a very reductivist view that is somewhat implausible from a philosophy of mind standpoint—and it certainly does not require one to be a dualist to think it implausible. Now granted, there may be cases where there is a physically-caused imbalance, but: 1) These are likely a vanishingly small minority of cases; and 2) even in that case, differentiating "personality" and "mental illness" is a tricky issue.

To address the first point first: You seem to be arguing, based on a correlation between various physical observations and depression, that therefore these observed physical properties are a purely physical cause of depression. This is plainly nonsense: Unless, indeed, you take a strong dualist position, it must be the case that any mental activity is accompanied by physical activity, so of course you can observe some correlation.

What this means is much more complex to interpret. For example, if you give a person suffering from depression a placebo, you can observe physical changes in the person's brain [1]. Can we conclude on that basis that sugar pills, as a matter of biochemistry, cause physical changes in the brain? Of course not: We conclude that they have a psychosomatic effect (the "placebo effect"), a mental effect that in turn causes observable physical changes. Likewise, the observed physical correlations (e.g. of neurotransmitter levels) with depression may well be caused by depression, rather than vice-versa—much as my receiving a piece of unexpected good news causes observable chemical changes in the brain, rather than the reverse.

Even if we consider a case where one might argue fairly well that there is a biological basis, what to make of this is quite complex. It's clear that a person's brain essentially is their personality, and this is influenced most likely by a combination of genetics and environment. By some point in their lives, for one reason or another, people will have various temperaments, personalities, likes, dislikes, and so on. I'd consider it dangerous to glibly write these all off as simply medical issues, and de-legitimize personality and opinions based on the justification that there are observable neurological bases. For example, there is clearly a neurological basis for taste: Ought we to conclude, on that evidence, that someone who says they like chocolate doesn't really "like" chocolate in any meaningful sense, but rather merely has a biological condition that causes them to find the consumption of chocolate pleasurable? (One might say the same of people who don't like chocolate; perhaps they have a disease.) I could go on for a while, but the short and long of it is that if we say that anything with a neurological basis is "not part of personality", then personality doesn't exist, since all mental activity has a neurological basis. Neurochemistry, in a very real sense, is part of personality.

Now, one might of course dislike one's personality and wish to change it. But that is a very different proposition, and one people ought to enter into as a voluntary choice with open eyes, not something that ought to be treated as if it were a biological illness properly so called.

Some of the better writing from this viewpoint is by Dr. Thomas Szasz, a maverick psychiatrist who was one of the few in the 1960s to argue that homosexuality wasn't a mental illness [2], at the time a proposition opposed using arguments nearly identical to those you advance here for depression. Among his many books is the classic The Myth of Mental Illness, which advances the following controversial thesis:

<font size=-1>It is customary to define psychiatry as a medical specialty concerned with the study, diagnosis, and treatment of mental illnesses. This is a worthless and misleading definition. Mental illness is a myth. Psychiatrists are not concerned with mental illnesses and their treatments. In actual practice they deal with personal, social, and ethical problems in living. [3]</font>

Treatment of Depression

Now consider the treatment of depression. There are two main currents: Prescribing anti-depressants, which makes sense if you see depression as a biological illness in need of a medical solution; and various forms of therapy, which make sense if you see depression as a "problem in living" in need of sorting out.

Of course, either could also help in the other case: Even if depression is a "problem in living", antidepressants do modify the functioning of the brain, so may change the way a person goes about their daily life. This would not prove that the drugs cured a medical disease however: It may instead mean they treated symptoms of another problem.

Consider a case where we observe a specific chemical pathway A leading to some specific observable mental state B, and also observe that an antidepressant blocks this pathway, thereby preventing B. This does not mean that A was the ultimate cause of B, and that, if B is something we consider bad, A was the cause of the disease and we have cured it. Instead, it may well have been the case that a particular mental state C caused B by means of pathway A, and so by blocking A we have prevented part of the functioning of the brain, thereby preventing C from causing B. For example, someone who shoots up heroin right after hearing of the death of a loved one may not be particularly sad about the death: But this does not mean their sadness was an illness cured by heroin.

Perhaps the most damning bit of evidence against the psychiatrist orthodoxy, regardless of what we might think of their philosophical position, is that their approaches to treatment simply do not work. Despite the considerable increase in drug treatment as of late--including both major advances in the discovery of new drugs and a large increase in prescription--there has been no measurable improvement in patient prognosis over the past 20 years [4].

I will leave out, for the sake of some semblance of brevity, the argument over whether antidepressants actually work better than placebos (there is considerable controversy over whether any of the studies claiming to demonstrate they do were properly conducted), and focus simply on outcome in clinical settings. The fact of the matter is that, as advances in medicine have not improved prognosis, medical-style treatment of depression is not even the best treatment available. Two recent studies have both shown that therapy intended to help people identify and overcome problems in their lives works better, especially in the long term [5,6]. One study in particular [5] lends some circumstantial support to Szasz's hypothesis—it shows that "couple therapy", whereby a depressed person is counselled together with their non-depressed spouse, works much better than any other form of treatment. This would seem to imply that what we're really talking about are "problems in living", which are best solved by getting a depressed person together with their spouse and figuring out how what they might change about either or both of their lives to solve the problem.

In any case, I certainly don't claim that this article misrepresents current psychiatric orthodoxy, but it should be noted that it's merely one view of the matter, not the universally-agreed-upon view. And, indeed, it is increasingly questioned; the current consensus view today is much less strongly in favor of the medical model than was the case ten to twenty years ago (a positive trend, in my view).

References:

[1] Leuchter, A.F., Cook, I.A., Witte, E.A., Morgan, M., and Abrams., M. (2002). Changes in brain function of depressed subjects during treatment with placebo. American Journal of Psychiatry 159(1):122-129.

[2] Szasz, T.S. (1965). Legal and moral aspects of homosexuality. In Marmor, J., editor, Sexual Inversions: The Multiple Roots of Homosexuality, pages 124-139. (The introduction to this volume contains the note: "most of the psychoanalysts in this volume, except Szasz, are of the opinion that homosexuality is definitely an illness to be treated and corrected".)

[3] Szasz, T.S. (1961). The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Harper & Row, New York (p 261).

[4] Kennedy, N., Abbott, R., and Paykel, E. (2003). Remission and recurrence of depression in the maintenance era: Long-term outcome in a Cambridge cohort. Psychological Medicine 33(5): 827-838.

[5] Leff, J., Vearnals, S., Brewin, C.R., Wolff, G., Alexander, B., Asen, E., Dayson, D., Jones, E., Chisholm, D., and Everitt, B. (2000). The London Depression Intervention Trial. Randomised controlled trial of antidepressants v. couple therapy in the treatment and maintenance of people with depression living with a partner: Clinical outcome and costs. British Journal of Psychiatry 177:95-100.

[6] DeRubeis, R.J., Hollon, S.D., Amsterdam, J.D., Shelton, R.C., Young, P.R., Salomon, R.M., O'Reardon, J.P., Lovett, M.L., Gladis, M.M., Brown, L.L., Gallop, R. (2005) Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry 62:409-416.

i love Szasz (2.50 / 2) (#68)
by ited on Tue May 10, 2005 at 09:34:50 PM EST

but you fell for the Myth of Mental Illness?

Szasz is brilliant and i have videos of him, several of his libertarian books i highly recommend. his debates on mental illness are mostly losses, imnsho.

the best i can do is tell you read the book reviews here, especially the last one.

[ Parent ]
I'm quite aware of his critics' views (none / 0) (#70)
by Delirium on Tue May 10, 2005 at 10:26:06 PM EST

I do think he presents a cogent argument in the book, however, and many of his positions—such as the argument that homosexuality is called a "mental illness" by psychiatrists as a value judgment rather than any matter of science—have now become mainstream. I don't agree with every position he has held, but I think the analysis of "mental illness" as "problems in living" is, by and large, correct.

[ Parent ]
Sorry, but it's far more complicated than that... (3.00 / 5) (#54)
by DocJohn on Tue May 10, 2005 at 02:44:38 PM EST

Brain chemistry is just one of many theories that are used to explain the causes of depression. But you have to understand after reading an article like this (or seeing one of the myriad of television commercials hawking the latest antidepressant), it is JUST A THEORY.

The sad truth of the matter is that after hundreds of large-scale studies, we simply do not yet know what causes depression. That is fact.

While serotonin surely plays a role in mood regulation, scientists aren't clear why drugs work to reduce depression for some people and not others. Even less clear is why non-drug therapies, such as psychotherapy, would have the same end-result (alleviation of depressive symptoms) when they have no direct effect on brain chemistries.

The model or theory of a static-state brain chemistry is a little simplistic to begin with. Our brains are in a constant state of change. There is no "balance" of brain chemicals up there, because the chemistry changes when you wake up, when you go to sleep, when you take in food, watch a funny movie, or get angry at someone driving in the car. Furthermore, there is no agred-upn measure of brain chemistries or what a balanced brain would even look like. All those pretty colorful diagrams you see on TV are measures of glucose (sugar) intake in the brain. Certainly an interesting measure, but not necessarily the one that is the most accurate or even the most reliable.

The upshot is this -- while it's good to know that there's a lot one can do to help oneself with depression (or any mental health issue in general!), what this author describes may or may not work for you. Some of this advice is a little suspect, but much of it is common-sensical.

And last, don't get too hung up on the causal thing. There is plenty of research out there to show the treatment for depression is what's important -- combined psychotherapy with medication is what works best for most people. If you're getting just one without the other, you're probably going to be suffering longer than you need to.

DocJohn
--
Psych Central
http://psychcentral.com/
 

whats wrong with depression? antidepressants are e (1.66 / 3) (#60)
by monomood on Tue May 10, 2005 at 05:28:22 PM EST

whats wrong with depression? antidepressants are evil.

Lines of text about depression and only 4 lines of mentioning of antidepressants with a total ignorant comment of "consider informing yourself properly"  ?
ah no, i'm not letting you go there.  I don't know the ratio of depressed patient / prescribed patient for antidepressants but I'm pretty sure psychiatrists give those samples to whoever asks for them.

and it's insane!

Antidepressants and depression go hand in hand. at least here in america. if you are depressed, you take antidepressants. we are living in a country where people would rather not do stuff (exersize, yoga, to get something) than do it if there is a pill alternative. I can't believe you are giving out ways to get out of depression like an amazing diet formula!

a unique individual with unique cases of depression. Billions of possibilities. If your life is shite, problems with job, wife, kids, school,  "Take a walk in the morning" is not a really good advise and antideprressants sure isn't good. not everyone can take a walk but everyone can pop a pill in the morning. especially if their whole body is craving for it. (lexapro)

I've seen , know so many people on antidepressants that I can't help thinking they'd be better off being depressed. I can't believe peoples research into this stupid matter. Trying to define it with all the data related to human chemical reactions they can.

Dude. Have you ever dealt with anyone taking Lexapro? Do we actually understand what "mood-altering" might means? With all this "depression" talk we're turning people into androids by channeling them into accepting stupid medicines which help nothing but make them feel happy. What good does happiness do? It makes you work? is that good?
 Just let them deal with their bad memories by accepting them rather than ignoring them.

This whole article is only as good as the sunscreen speech http://carbon.cudenver.edu/~hgreenbe/sunscreen.html to help any antidepressed person.
hard work, keep it coming.

Give us some more information on SSRI's please. Talk about those side effects. Talk about Lexapro withdrawal. How many medicines do you know that are out there, that healthy people take, and if they don't, if they stop taking suddenly rather than gradually, they have a real high chance of becoming hospitalized. Talk about the emotional ignorance lexapro gives you. The crazy things that people somehow do on SSRI's. But please don't tell me how my life would be better if I took a long walk because the psychiatrists never ever prescribes that. they prescribe Lexapro. and eventually we thank them for it.

we depressed people take antideprressants.

why? we want to be happy, and by doing that they mess up the whole hierarchy of needs.

Once again. The only insanity I've seen so far in my life was because of antidepressants. either i'm too unlucky or 4 years was enough to witness this many "clinically insane" people on antidepressants.

please give the next versions focus on antidepressants there's much more worth reading there.

Excellent article (none / 0) (#63)
by BobTheMighty on Tue May 10, 2005 at 06:41:24 PM EST

A great combination of personal experience and research, with practical suggestions and the theory behind them. Also, the large amount of 'for more information' references that isn't just a list of what Wikipedia has to say on the subject is good.
-
I'll try not to confuse you more than absolutely necessary
optimism (none / 1) (#66)
by synx on Tue May 10, 2005 at 07:34:43 PM EST

I have been reading "Learned Optimism" lately, and it is very interesting. The book puts forward that the reason why people become depressed is because they are pessimistic. More specifically they have a pessimistic explanatory style. That is they talk about bad events in ways like "this always happens to me" and "this will always happen to me." The flip side is pessimists describe good events as isolated incidents, things out of their control, such as "I was lucky" - not "I am talented". The book ties into a field called 'learned helplessness'. Basically what happens is when people and animals learn that nothing they can do affects what happens to them, they stop taking action. The tie in is that pessimists are more likely to become helpless and stay helpless. Someone else said that depressives seemed like losers - in this framework depressives are pessimistic and suffer from helplessness, thus they never _do_ anything which could help them. If you define a loser as someone who doesn't try to better themselves, then this poster was true (and still an asshat ;-)). The book would be useless if it wasn't prescriptive. Lucky you can change your explanatory style from a pessimistic one to an optimistic one. The book says how, but I haven't actually gotten there yet :-) Of course the author is very careful to point out that some depression is chemical in nature, and requires other help, but he believe that the root cause and aggravating factor is the explanatory style. One thing he touches on is the fact that people born before about 1940 have less lifetime long depressive episodes than people born after. Why is this? The conclusion in his opinion (and research) is explanatory style along with a more ruminative style. Thinking and reflecting vs doing.

IMPORTANT RECENT STUDY (none / 0) (#69)
by ited on Tue May 10, 2005 at 09:59:01 PM EST

here

they won't be there but for a few days.

i have spoken to Dr. Amy Arnsten personally after the article appeared in my local paper. she sent me the reports. some additional material i paid to download.

i have a quite a story to tell... i have lot of it online but restricted access. i've just begun working on an autobio. i'm looking for a coauthor.

g7b5 at hotmail dot com this study certainly "described" me. of what ever help that may be. right now it's helping me in some very old, nagging legal matters.

Dealing with depression (1.00 / 5) (#72)
by cronian on Tue May 10, 2005 at 10:48:44 PM EST

Be careful before you go to any psychiatrist. You could end up incerated, tortured, and drugged in a hospital psychiatric ward. You will made crazy to fit the correct psychiatric labels. Drugs only help expedite the proccess.

Read Szasz. Mental illnesses are not illnesses. When you see a psychologist or psychiatrist, you are submitting to an authoritarian figure. However, if you really do want to be slave, be a slave to god, and find religion.

Humans get stressed out and bummed out, after they get screwed and stressed out by society. Unfortunately, in our society this happens to lots and lots of people.

Don't learn helplessness. Fight man!!

We perfect it; Congress kills it; They make it; We Import it; It must be anti-Americanism
Do you work for the Scientologists? n/t (3.00 / 2) (#76)
by brain in a jar on Wed May 11, 2005 at 03:31:04 AM EST


Life is too important, to be taken entirely seriously.
[ Parent ]

You are describing burnout (2.83 / 6) (#73)
by pnadeau on Tue May 10, 2005 at 11:44:49 PM EST

What you are describing here is what people are calling burnout. A burnout is basically a state of prolonged mental and or physical exhaustion. The depression is a symptom of the burnout and burnout is not the only thing that can cause depression.

So in the case you are describing, which seems to be burnout induced depression, you are right to avoid exercise and excitement.

Remember exercise is the word we use to describe a process whereby a stress is applied to the body followed by rest. It is during the rest that the body adapts to the stress, and becomes stronger. We say that the body supercompensates for the applied stress, which leaves the body prepared to face that same level of stress in the future.

For exercise to work, it has to be a staircase, put some stress on the body, then rest and you move up one step of the staircase. Then from that step apply further stress and you can move up another step, and so on.

Burnout is when a person has not rested enough to compensate for the applied stressors. If you exercise during a burned-out state you will be on a staircase alright, but it will be going down.

And BTW, in case you are thinking that physical exercise is not the same as mental stress because it works muscles and not the brain, think again. If you hook up a muscle and stimulate it electrically it will be able to contract over and over almost indefinitely. The wall that you hit near the end of your weightlifting set is a neurological wall. The brain is no longer able to recruit muscle fibers to do the work. Also a lot of strength gains are essentially neurological, the brain gets better at recruiting muscle fibers to do the work.

One of my theories about depression is that it is not a totally useless mental state. Depression is an immobilising mechanism that is used to keep us from 1) repeatedly trying something and failing at it and getting stuck in an infinite loop 2) being too active when we are physically ill.

If this is true then the depressed 'state' is something that our brains are wired to go into in certain conditions for our own good. Problematic depression starts when this mechanism gets dysregulated and becomes a chronic state.

Then according to this theory burnout can induce depression by causing the body to think it is ill. Your brain is wisely saying, hey if you aren't going to calm down I'm going to make you disinterested, so you will give me the rest I need. This is why burnout (which to me seems very similar to athletic overtraining syndrome ) mainly happens to very motivated individuals, they are the ones who 'suck it up' and ignore the warning signs.

Also, I feel that in a few decades we are going to start to see depression fork into a few dozen related disorders, sort of the way that our understanding of Cancer or Infection has forked into several related diaseases, some more treatable than others. Maybe the burnout induced depression will be one of them alongside others.


"Can't buy what I want because it's free, can't be what they want because I'm..."  Eddie Vedder


Interesting (2.50 / 2) (#77)
by Name of Feather on Wed May 11, 2005 at 05:30:30 AM EST

Very interesting comment. Myself I have wondered if there could be any adaptive advantage to the state of depression. I have reached more or less the same conclusion as yours: it is our brain's way of saying "you need to rest". Even people with mild depressions will report feeling lazy about waking up.

Your comment concerning burnout is right on spot. However, I disagree that burnout and depression are different physical illnesses. The psys describe burnout as a depression whose underlying causes are mostly work-related. And yes, it does tend to happen to overly motivated and hard-working people who either do not rest enough, or find themselves fighting losing and frustrating wars at the workplace. However, and I will stress this again, in physical terms, psys do not describe burnout as a separate illness from depression. (The required therapy might be different, but that is another story).

As for the athletic overtraining syndrome, you are again right on spot. I have alluded to it in the Section 3 of Part II (see it in my diary). This is unfortunately not widely known, but intense sports alone can cause a depression!

[ Parent ]

Burnout not just work related (none / 0) (#90)
by rodentboy on Thu May 12, 2005 at 09:17:34 AM EST

Most books or websites approach the issue of burnout from the perspective of the workplace, but it doesn't really matter where the stress comes from. I guess most people burnout from work related issues in our calvinist society, but there is no reason you couldn't burnout from playing bridge or yoga or chasing the squirrels in your backyard if done to excess.

I personally think that the rise in popularity of 'torture sports' like triathalons and marathons will cause a rise in athletic overtraining, which is basically sports burnout.



[ Parent ]
Agreed! (none / 0) (#123)
by CicelyFex on Tue May 17, 2005 at 09:19:19 AM EST

My self-prescribed recovery from burnout and depression matches much of what's written in this article. I was unable to exercise for over two years, not because it produced adrenaline, but because my immune system was so worn down that I got sick or exhauseted every time I tried to exercise (even mildly). I've only been able to regularly exercise for the last couple of months. I was experiencing a lengthy depressive episode prior to exercising, and exercise now serves to improve and stabilize my mood. I consider it essential.

I take care to get adequate sleep, and I do tend to avoid stress and stimulation. My life is very simple. I work 40 hours a week, and I don't take on new committments. Family, work, exercise and one hobby are all I can handle. I attend church, but my involvement is scaled way back from what it used to be.

Not everyone around me understands my way of life, but it's much easier to live than it used to be.

[ Parent ]

Very Informative (none / 0) (#79)
by tunny on Wed May 11, 2005 at 07:29:50 AM EST

Thanks for taking the time to do this. The thing I like most about this is that it brings the issue to people's attention. I had quite bad depressive period when I was 20 or so. The worst thing about it was that I didn't know what the depression was and why I was feeling this way. I'd never felt anything like that before. There was also a stigma attached to it, I had no intention of going to the doctor. In retrospect it's clear now, I'd failed to deal with a few things and they'd gradually built up to breaking point. Wish I'd had access to material like this at the time, I hope it helps others. Disagreements in the comments about the content are a good thing as at least they get people thinking and talking about it.

great article! (none / 0) (#80)
by murry on Wed May 11, 2005 at 10:07:07 AM EST

Thanks for a great article!
Been suffering from serious depression and anxiety attacks for more than 10years. got treatment for first time about 6weeks ago: SSRI's. This has made a HUGE difference in quality of life for me in a very short time. For first time I've been able to make the lifestyle changes that have been sorely needed. This is but the start and there's a lot further to go still but for the first time in ages i'm making progress in the right direction.
One thing missing in the article is somewhat obvious, but not always to those under the influence. There is a very strong link between folks sufferring from depression to alcohol abuse. I cannot state this strongly enough - stay away from booze if you have/suspect clinical depression. Quitting alchohol does not neccesarily make the problem go away but in conjunction with medication and treatment makes a huge difference. Note that hard drugs and SSRI's do not mix -- negative (emotional and physical) reactions to this mix can be huge and quite possibly fatal.
The side effects of SSRI's are pretty mild (speaking from my experience - other people may have different) as long as they are taken sensibly - no hard drugs, very moderate alcohol use if any and don't stop taking the SSRI's suddenly -- reduce dosage very, very slowly under superivision of doctor.
Depression and it's related diseases are very difficult to handle because they are progressive, and affect your ability to seek treatment before it is too late. Self medication/treatment does not work. The only answer is to seek PROFESSIONAL advise.

I tried to read the whole thing before bedtime... (none / 0) (#81)
by OzJuggler on Wed May 11, 2005 at 11:12:18 AM EST

...but it was getting my adrenaline levels too high. ;-)


"And I will not rest until every year families gather to spend December 25th together
at Osama's homo abortion pot and commie jizzporium." - Jon Stewart's gift to Bill O'Reilly, 7 Dec 2005.

Depression and recovery (3.00 / 4) (#82)
by Rojareyn on Wed May 11, 2005 at 12:32:47 PM EST

I had been suffering from depression for close to 20 years of my life. It wasn't until recently that I've been able to get it under control and actually start to enjoy life.

Background

I'm 32 years old and have been diagnosed with Attention Deficit Hyperactive Disorder, predominantly inattentive type, Dysthyma (which is really a mild depression), and have shown signs of Obsessive-Compulsive Disorder as well.

Generally what I experienced problems with was the following:

  • Generally depressed mood, feelings of hopelessness and dispair.
  • Intense emotional reactions to external events. Basically anything that a "normal" person would feel in response to an event would be increased in me. News that I interpreted as bad (My potential mate dumped me) would get me REALLY down and good news (I won the Lottery!) would have me bouncing off the walls. This is probably attributable to the ADHD.
  • Very difficult to get thoughts out of my head. If someone was rude to me, for example, the same scene would play over and over in my mind as I would unconsciously look for different ways to handle the situation.
  • Bouts of anger, frustration, and anxiety.
  • Thinking with cognitive distortions. This includes jumping to conclusions, thinking in all-or-nothing terms, minimizing the positive, and mind-reading (this is where you think you know another person is thinking bad of you and they're really aren't).
  • Inability to feel pleasure
  • Lack of sleep, motivation
  • Use of addictions to escape depression
  • Neurotic thinking.

Dysthyma isn't as bad as clinical depression but it can get worse in later years if it's left untreated.

Recovery

For me to recover properly, I had to tackle the problem from several ends.

Medications

Getting my medications balanced out properly did me a world of wonder. Remember, not only do the doctors have to treat depression here, but my ADHD as well. I've been on Prozac, Paxil, Ritalin, Concerta, and Effexor. While these drugs helped a bit what I often found was that the ADHD stimulant medications (Ritalin, Concerta, etc) would actually make my anxiety much worse. Sometimes the anti-depressants would work to control this (Paxil did but I had repeated crying spells on it), sometimes they didn't (Effexor did zilcho for anxiety), and sometimes they had me acting erratically (Prozac). What finally worked with me was a combination of the following:

  • Strattera (for ADHD)
  • Zoloft (for Depression)
  • Wellbutrin (for both)

I've found that Strattera gave me a very nice mood stabilizing effect so I'm no longer bouncing off the walls. I concentrate much better now than I used to. Your Milage May Vary.

Coping Strategies

My counselor had me read a couple of books. One of which was Feeling Good: The New Mood Therapy by David Burns. This is basically cognitive behavior therapy which teaches you to listen to your thoughts and recognize when you have what the book calls cognitive distortions. Through this I learned to listen to my thoughts and recognize when my depression is acting up. I use it as a sort of barometer that I need to start doing something constructive to counter it.

Another good book that I read was When I Say No, I Feel Guilty by Manual Smith. Just knowing that I had some tools I could use to push back against those I considered toxic helped immensely.

Exercise

Yes I am aware of the author's stance on exercise. I am only presenting here what's worked for me.

I've taken Tai Chi and Yoga. Yoga especially has proved useful in that it taught me to listen to my body when it's telling me I'm pushing it too hard. It also comes in handy when I'm feeling exceptionally stressed and need to wind down a little.

Back in December, I was determined not to let myself succumb to the "holiday blues" so I started working out 2-3 times a week. This above all else proved beneficial. My mood improved substantially and was significantly more stable. Previously, I'd be okay during the day but when I got tired, my mood crashed significantly. I'm now working out 2-3 times a week so not only do I feel a lot better, I'm also putting on some muscle mass which is always a plus.

Dietary Changes

A little less than a year ago, I had had two glasses of Pepsi along with my lunch. When I returned to work, a co-worker provided me with a piece of bad news and I came very close to snapping his head off (figuratively). After that I realized that the combination of caffine and sugar was really bad for me and I endeavoured to cut caffinated sodas from my diet.

Just recently, I found out that Fanta Grape has caffine in it. Whuuups ...

Another thing I noticed is that every time I drank alcohol, I would be bummed out for the next two days afterwards. The alcohol, being a depressant, would cancel out my medications so I'd feel very down. While I will, on occasion, have a small shot of Southern Comfort, I have, for the most part, removed booze from my diet.

Other little things

I blog on Live Journal under the name of Rojareyn. I've found this to be a very good tool for helping me work out any problems I encounter. It also helps to form a community of friends which can act as a support network.

So, what has this done?

My friends tell me that I'm far more outgoing than I used to be. Furthermore, I'm more active in what I do and have even just started a Master's degree in Computer Science from a local university. Yeah, I may have one or two problems to sort out but in general, I'm doing pretty well for myself.

What is your response to the article above?

I'm not sure about the part on exercise but overall this was a very well-informed and well-researched article and there are even a couple of suggestions in it that I may try and look into such as walking in the morning and making sure I eat healthy.

Obligatory Final Note

Above all else, if you are suffering from any of the symptoms of depression and/or have been feeling down for an extended period of time, please seek the advice of a professional ASAP!

Diet (none / 1) (#88)
by Name of Feather on Thu May 12, 2005 at 07:52:44 AM EST

Very interesting. A good example of why people should not give up immediately just because their first experience with therapy and/or medication did not work out. I wish you all the luck with your recovery!

"Back in December, I was determined not to let myself succumb to the "holiday blues" so I started working out 2-3 times a week. This above all else proved beneficial."

Again, I never denied that exercise can be good for depression. It's just that one has to be careful with it, and do not assume that if a bit of exercise helps a little, then a lot of exercise will help a lot. Quite on the contrary. Please read Section 3 of Part II for more details. (You can find here in my diary. I will submit as a story next week).

As for Yoga and Tai Chi, you do very well in practising them. They are excellent for relaxing the mind and getting rid of stress.

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 ]
Some opinions (1.50 / 2) (#91)
by DissidentPhoenix on Thu May 12, 2005 at 10:12:19 AM EST

First of all, I would like to state that while a lot of your article is quite useful, some of your points are simply incorrect. A bit of background for me I've have suffered from depression, worked in the field of mental health and have qualifications in psychology. I took offense at your statement that psychologists do not have an understanding of depression. Any psychologist worth their salt will have a very detailed understanding of depression. You said "In many countries, depressions are sometimes handled by GPs or even psychologists. In my experience, many are not properly qualified. Try to find a good clinical psychiatrist instead. Remember that you are putting your health and well-being in their hands." That is utter, utter crap. I can only comment on psychologists in my own country (Australia) but here, in order to become a clinical psychologist, we have to do an honors degree of course, as well as a phd or a masters. All up, it requires almost a decade of full time study and research in order to become a registered clinical psychologist and we are expected to expand on our clinical knowledge on a continual basis. Depression is an enormous part of our training. If you think that all we learn is a psychoanalytic 'It's all your mothers fault' approach to depression and other mentall illness, you have been severely misinformed. We know a great deal of the psychophysiology behind depression and remain well aware of the influence of serotonin and other neurochemicals. Simply because psychologists do not prescribe medication does not mean that we aren't aware of exactly how different forms of psychotropic drugs can affect people and how they are structured. We don't come up with airy-fairy theories. We base treatments and understanding on properly conducted empirical research. I suspect from the biased manner in which you have written this article and from your statement that you have gained many of your opinions from talking to the professionals who treated you (as well as your opinion of psychologists) that you were treated by a psychiatrist - and one with little knowledge of what psychologists know and how they work. Within psychology, I know that there are biases against psychiatrist. There is a perception that all they do is hand out medications while not paying much attention to the actual problems that the client faces. While I do not believe that this stereotype is particularly correct, it does illustrate the level of bias between different types of providers of mental health services. Research shows that the best treatment for depression involves a combination of psychotherapy as well as drug therapy at the same time. Psychologists do not provide drug therapy although they can generally advice about side effects and the consequences of the different medications. GPs can of course offer drug therapy, but their training tends not to involve as much psychotherapy as perhaps it should. In this, I'll point to the example of chronic pain and the fact that doctors are trained to take a biomedical approach which is often ineffective. A biopsychosocial approach is the best. The same goes for depression. Medication does generally provide pretty solid benefits, but different medications have different side effect profiles. Additionally, people generally experience relapses if they halt the drug therapy. There is also a slight chance that SSRIs can increase suicidality. Your distinctions between clinical depression (which is rightly termed major depressive disorder since you made the claim that depressive episodes in people with manic depression are somehow different) and other illneses of which depression is a feature make no sense. In terms of feelings, behaviour and neurochemistry, there is little difference between the depressive episode of someone with manic depression and someone with major depressive disorder. You stated: "At this point, most people start having serious problems with anxiety, stress, panic attacks, hyperventilation, bouts of psychosis, etc." Again, this is utter crap. Psychosis and panic attacks aren't features of a depressive episode! Depression is often present when they are, but thats a correlation, not an actual feature of a buildup towards a depressive episode! People with really severe depression should probably be hospitalised and it's unlikely that they'll be able to take your lifestyle advice on their own. Another important source to consider is that depression is an episodic illness. This means that if you've had a depressive episode in the past, it's pretty likely statistically that you'll have one in the future. Also, a lot of the time, peoples depression will recover naturally (although it's not uncommon for it not to - interventions are important!). It is important to understand the episodic nature of the illness. Also, it's not simply a physical illness despite the fact that you are so very keen to state that this is so. Could this perhaps be because of the stereotypes that you have encountered during the course of your experiences within your culture? Depression is a psychological illness. It is physical in the sense that every emotion we go through, every single thing we say and think and feel is physical in nature. It all involves changes in our brain chemistry and structure. Additionally, there is evidence to support the theory that depression is at least in part genetic. That having been said, it is not 100% genetic in basis, as twin studies have shown. Psychotherapy would not be of any real benefit if depression was purely physical in nature. The specific thoughts that people can have about situations, themselves and others also aren't really in line with depression simply being a physical malady like a cold. The sources you have used for your information are pretty dubious. While wikipedia is fantastic, it doesn't substitute for properly researched, recent literature published in peer reviewed publications - preferably well conducted research. If you want to demystify a disorder, please don't include biased and incorrect information! Despite the fact that I know that many GPs don't have as much training as they should in the area of mental illness, they can provide excellent treatment for some cases of depression, at least in my country. They are also quite often the first port of call for someone with a mental illness. Don't discount their ability to help - for all that they seem not to have helped you, they have helped many people.

[ Parent ]
whoa (none / 1) (#96)
by emmons on Thu May 12, 2005 at 06:07:29 PM EST

Formatting, please!

---
In the beginning the universe was created. This has made a lot of people angry and been widely regarded as a bad move.
-Douglas Adams

[ Parent ]
Seeing as I needed it (from the source): (none / 0) (#121)
by ambrosen on Tue May 17, 2005 at 04:28:44 AM EST

First of all, I would like to state that while a lot of your article is quite useful, some of your points are simply incorrect.

A bit of background for me

I've have suffered from depression, worked in the field of mental health and have qualifications in psychology.

I took offense at your statement that psychologists do not have an understanding of depression. Any psychologist worth their salt will have a very detailed understanding of depression. You said "In many countries, depressions are sometimes handled by GPs or even psychologists. In my experience, many are not properly qualified. Try to find a good clinical psychiatrist instead. Remember that you are putting your health and well-being in their hands."

That is utter, utter crap. I can only comment on psychologists in my own country (Australia) but here, in order to become a clinical psychologist, we have to do an honors degree of course, as well as a phd or a masters. All up, it requires almost a decade of full time study and research in order to become a registered clinical psychologist and we are expected to expand on our clinical knowledge on a continual basis. Depression is an enormous part of our training. If you think that all we learn is a psychoanalytic 'It's all your mothers fault' approach to depression and other mentall illness, you have been severely misinformed. We know a great deal of the psychophysiology behind depression and remain well aware of the influence of serotonin and other neurochemicals. Simply because psychologists do not prescribe medication does not mean that we aren't aware of exactly how different forms of psychotropic drugs can affect people and how they are structured. We don't come up with airy-fairy theories. We base treatments and understanding on properly conducted empirical research.

I suspect from the biased manner in which you have written this article and from your statement that you have gained many of your opinions from talking to the professionals who treated you (as well as your opinion of psychologists) that you were treated by a psychiatrist - and one with little knowledge of what psychologists know and how they work.

Within psychology, I know that there are biases against psychiatrist. There is a perception that all they do is hand out medications while not paying much attention to the actual problems that the client faces. While I do not believe that this stereotype is particularly correct, it does illustrate the level of bias between different types of providers of mental health services.

Research shows that the best treatment for depression involves a combination of psychotherapy as well as drug therapy at the same time. Psychologists do not provide drug therapy although they can generally advice about side effects and the consequences of the different medications. GPs can of course offer drug therapy, but their training tends not to involve as much psychotherapy as perhaps it should. In this, I'll point to the example of chronic pain and the fact that doctors are trained to take a biomedical approach which is often ineffective. A biopsychosocial approach is the best. The same goes for depression.

Medication does generally provide pretty solid benefits, but different medications have different side effect profiles. Additionally, people generally experience relapses if they halt the drug therapy. There is also a slight chance that SSRIs can increase suicidality.

Your distinctions between clinical depression (which is rightly termed major depressive disorder since you made the claim that depressive episodes in people with manic depression are somehow different) and other illneses of which depression is a feature make no sense. In terms of feelings, behaviour and neurochemistry, there is little difference between the depressive episode of someone with manic depression and someone with major depressive disorder.

You stated: "At this point, most people start having serious problems with anxiety, stress, panic attacks, hyperventilation, bouts of psychosis, etc."

Again, this is utter crap. Psychosis and panic attacks aren't features of a depressive episode! Depression is often present when they are, but thats a correlation, not an actual feature of a buildup towards a depressive episode!

People with really severe depression should probably be hospitalised and it's unlikely that they'll be able to take your lifestyle advice on their own.

Another important source to consider is that depression is an episodic illness. This means that if you've had a depressive episode in the past, it's pretty likely statistically that you'll have one in the future. Also, a lot of the time, peoples depression will recover naturally (although it's not uncommon for it not to - interventions are important!). It is important to understand the episodic nature of the illness.

Also, it's not simply a physical illness despite the fact that you are so very keen to state that this is so. Could this perhaps be because of the stereotypes that you have encountered during the course of your experiences within your culture?

Depression is a psychological illness. It is physical in the sense that every emotion we go through, every single thing we say and think and feel is physical in nature. It all involves changes in our brain chemistry and structure. Additionally, there is evidence to support the theory that depression is at least in part genetic. That having been said, it is not 100% genetic in basis, as twin studies have shown.
Psychotherapy would not be of any real benefit if depression was purely physical in nature. The specific thoughts that people can have about situations, themselves and others also aren't really in line with depression simply being a physical malady like a cold.

The sources you have used for your information are pretty dubious. While wikipedia is fantastic, it doesn't substitute for properly researched, recent literature published in peer reviewed publications - preferably well conducted research. If you want to demystify a disorder, please don't include biased and incorrect information! Despite the fact that I know that many GPs don't have as much training as they should in the area of mental illness, they can provide excellent treatment for some cases of depression, at least in my country. They are also quite often the first port of call for someone with a mental illness. Don't discount their ability to help - for all that they seem not to have helped you, they have helped many people.

--
Procrastination does not make you cool. Being cool makes you procrastinate. DesiredUsername.
[ Parent ]

All those psys (none / 0) (#100)
by Name of Feather on Fri May 13, 2005 at 06:17:16 AM EST

This would really be a lot easier to read with proper formatting! Anyway, my comment regarding psychologists stems from my experience here in the Netherlands. Cheers for Australia if psychologists over there are properly trained to recognise and treat depression, but that is generally not the case over here. Around here you are much safer if you go to a psychiatrist rather than to a psychologist.

[ Parent ]
um... (2.50 / 2) (#84)
by transient0 on Wed May 11, 2005 at 05:06:17 PM EST

"First of all, forget purely psychological explanations of the illness. Clinical depression is a physical illness which so happens to affect the brain. In this respect, it is fundamentally different from momentary bouts of the blues or melancholy."

um... all sadness however fleeting is indicative of physical effects in the brain. calling depression an illness is a much grosser mis-statement than is calling it purely psychological. it leads to the dangerous and currently dominant belief that the problem can just be medicated away. penicillin for infection, SSRIs for depression.

THIS IS NOT A VALID ANALOGY.

the brain is a massively complex apparatus and all claims that depression is a chemical imbalance incorrectly presupposes that we have any idea what constitutes an appropriate chemical balance. as far as all current data suggests, depression is equally as physical and equally as psychological as being sad or happy.

the big difference is that depression is a mental state which is damaging and extremely undesirable. drugs CAN help, but you have to understand that all psychopharmacology is basically random shots in the dark.

it is not like we know that depression is related to serotonin and therefore we administer a serotonin-affecting drug to fix it. the causal chain of our knowledge actually goes in the opposite direction. SSRIs have been shown to be helpful in treating depression and therefore we assume that depression must be in some way related to serotonin.

what i am trying to get at here is that when it comes to treating mental disorders with pharmaceuticals we are basically still in the realm of snake oils, leeches and trepanning, not of science. we can see that the drugs help, but we really have no idea why.
---------
lysergically yours

How about improving your health? (none / 0) (#86)
by ultimai on Wed May 11, 2005 at 07:40:14 PM EST

How about cases that you want to improve your health?  Or your mental capacity?  Things that require that kind of challenge and consistant work?  (And you are not depressed or burnt out)

Good article, but... (none / 0) (#92)
by flargx on Thu May 12, 2005 at 10:19:31 AM EST

I liked your article, but I don't really agree with it completely. First of all you call depression a physical disorder. You give a physical explanation for the cause. You do make mention of the brain, but as part of the phsyical system. Surely the brain is a phsyical organ, but at the same time the activity in it (which is physical) also is part of the mental realm, and much of the cause can be there. "I" exist in the mental realm, and personally attach a lot of importance to it. The mind and the body are one and two. Depression occurs in the mind and in the body.

The explanations and treatments discussed may very well apply to your case, but people are complex things. I personally find it hard to believe there is one cause of clinical depression or one certain cure. I know this wasn't claimed, but there wasn't much mention of the many of things going on.

One thing to also note is that uni-polar and bi-polar depression are very different beasts and may require different treatments.

Your lifestyle advice strikes me as horribly incorrect, leading me to believe that maybe my experiences had been much different than yours.

A few comments regarding the given advice:
Avoid excitement like the plague!
I hear what is being said about stress and adrenaline and all that, but I really can't relate at all. In my experience I would say go for excitement. It may help.

Beware of sports
Once again. I found sports to be a temporary relief and found myself no worse in the time afterwards. Maybe there is a difference in the type of depression, but I'd say get involved in as many things as possible, get excitement in your life, and if you are into that type of thing, play sports.

Listen to your body, not to your brain
I would say listen to your body and your brain. Listening to your brain is where I believe the permenant and drug free escape from depression may lie. I would recommend meditation, possibly of the Zen style, as a very good way of learning to permanently control your mental states and eliminate your depression without a dependence on drugs.

Rest after every activity
Depression for me involved months without much activity. I'd say rest as much as it's healthy for a normal person to rest. Maybe a little more, but from my experience your body is often telling you it's exhausted and needs rest when you are depressed, and you probably should be pushing against the urge a little bit.

Do not perform multiple activities simultaneously
Once again, I don't buy into this demand on the brain/stress thing. I'm not saying you didn't have a depression where this was true (or possibly became true through beliefs), but instead that my depressions were nothing like that.

Practise relaxation exercises
I definitely agree here! This is a very important one. Relaxation is always good from time to time and meditation can help everyone, not just depressed people.

Make a conscious effort to do things with pleasure
I agree here too. Smile and laugh a lot. Force yourself to be happy. If you buy into the phsyical side of things you'll have no trouble believing that mental states such as sadness and happiness are somewhat physical states. You can provide feedback into these through your mental activities.

Take appropriate medication<br< A very tricky one. I don't like medication much. SSRIs can take weeks to have an effect, and by then we may be diverging towards the mean already anyway. Bipolar may more often require medication. Either way, if your depression is hurting your life this may be a route to try. There are different medications with different effects, so just because one thing didn't work for you doesn't mean something else won't, For less severe cases you may want to attempt to conquer this on your own, but that's a real touchy area. <br>
Also, Professionals in the world of psychology aren't always very competent, but some are. You may have to try several psychologists before finding one that works for you. Do not believe that the one you like most is the most effective. You don't need a psychologist you enjoy seeing. You need one that can help you.

To skip ahead a bit, as there is much interelated stuff that followed. I do not personally see the need for a regular sleep routine, going to bed early, or avoiding excitement before going to sleep. I personally found that staying up all night seemed to be one way to loosen depression's hold on me. Of course, that's only temporary, but it had provided occasional relief. Personally I see the excitement as a good thing and too much sleep as the enemy. When depressed I would often sleep all the time. When you are in an extreme mental state going to sleep can be kind of like hitting the reset switch, but as a daily routine I don't believe you should sleep any more than most people. Probably 6 to 8 hours, and only at night, with appropriate adjustments for your age and lifestyle.


I guess my main point is that there are different kinds of depression, different causes, and different treatments. In most cases trying to treat depression as purely a physical disorder or purely a psychological disorder is a huge over simplification. This was a very good article, but the reccomendations and thoughts often seem to refer to things that may have been true for you, but are not completely relevant for many other cases. Still, good article!

fuckin' a. (2.33 / 3) (#93)
by coprolalia on Thu May 12, 2005 at 01:29:15 PM EST

wow, i see a great deal of ignorance and douchebaggery in the comments section. Name of Feather, i'd like to commend you for trying to present this information in a layperson-friendly manner. that said, there are some shortcomings of your writeup, i think, and i will attempt to address those directly.

first off, a lot of people appear to be resistant to this reductionist rejection of the old mind/body dualism. i personally would like to reject it and believe that there is something more to our minds than the same biology as governs everything else, and i do believe this. one must realize, however, that the only way we have of building up to sufficiently complex model of internal mental states is through this reductionist model - we may find at some point that the dipshit hippies that produced "what the bleep do we know" were actually on to something, and that quantum events do mediate certain functions of biology and necessarily introduce randomness into the equation, but we're nowhere close to that yet. you wouldnt reject a mathematical description of the acceleration of a mass due to gravity just because it doesnt take into account the strong and weak forces, would you? it's a simplified model, and you need to be able to walk before you can run.

secondly, i think the animosity towards modern american psychiatry is totally justified. my 10-year bout with clinical depression was getting nowhere, and i was locked into the same self-destructive cycle of despair even with the drugs they were giving me, until i went to a psychiatrist who knew what she was doing and wasnt just a shill for the drug companies. the best thing she did for me was take me off the prozac and tell me she thought i was cured. the talking cure, contrary to some assertions here, CAN be effective if employed by a talented psychiatrist. the problem is that most of the psychiatrists out there arent, and years of hearing middle class neurotics bitch and moan about their problems have hardened those "listen and write a scrip" habits to the point where theyre just short of useless.

as for the writeup, i have several suggestions. one is to introduce the concept of the Hypothalamic-Pituitary-Adrenal axis and mention the correlation of dysregulation of the HPA with depressive symptoms. i think it's important to note that the serotonin (5-HT) system directly affects the adrenal hormones, particularly cortisol. also, it should be mentioned that adrenaline and cortisol are produced by different portions of the adrenal gland (one is cortex, one is medulla, but i dont remember which offhand), and the problem with depressives is generally cortisolemic. most of the pharmacotherapies for depression target the 5-ht system, which is upstream of the "problem" but since there is such a glut of antidepressants on the market now, it doesnt seem like any of the experimentals that target other targets like ACTH or the cortisol receptor itself will make much of a splash unles they really are as effective and selective as they should be in theory.

also, as another poster mentioned, regular exercise IS one of the few things that has been shown effective in at least reducing depressive symptoms. part of the problem is that when youre depressed you just want to sit around and cower, which is not conducive to getting off your ass and doing something like exercising on a regular basis.

and also, i think that refusing any sort of treatment (as several have commented, i.e. i dont like big pharma so im not going to take their drugs, and i think psychiatry is full of shit type comments) is in fact a symptom of depression, and a post-hoc rationalization for not wanting to take the time or do the work to get better. it takes work, people, and a lot of it.

one final point, an upthread commenter mentioned that a pessimistic outlook was a "cause" of depression. judging from what we know of the brain, i would be hesitant to mention this as a cause. correlation, certainly, but determining which way that causal arrow is pointing would require a lot more knowledge of the brain than we currently have. i personally think that it's the reverse, that people who are depressed are predisposed to thinking in pessimistic terms.

anyway, rant mode off.

Sleep - understand different patterns (none / 1) (#94)
by 123456789 on Thu May 12, 2005 at 04:10:23 PM EST

Not every body needs the same amount and pattern of sleep. This is greatly variant based on your personal genetic makeup.

In those few times in my life when I have had the luxury to mandate my own schedule, I found that my body naturally tended toward a midnight-to-nine sleep routine, and I would generally feel rested and wake up in the morning without the aide of an alarm quite often.

I knew a man for several years who had an almost opposite sleep schedule from me - he went to bed around 7PM and routinely got up before his alarm at 4AM. This was his natural sleep cycle.

For me, the 12-9 pattern, being the most natural, is probably the most healthy. However for the next person it could be totally unworkable. The point is in order to get healthy sleep you need to understand what that means for you, and then get as close as possible to it while still maintaining your necessary work/life schedule.

---
People demand freedom of speech to make up for the freedom of thought which they avoid.
- Soren Kierkegaard
My doubts. (3.00 / 2) (#95)
by Gluke on Thu May 12, 2005 at 05:16:47 PM EST

This is some of the most sober and levelheaded depression coping advice I've seen. Granted, I haven't looked much but this is good.

In your opinion, how reasonable are your lifestyle adjustment recommendations for someone with a standard 40+ hour work week in the United States? I don't think they are. For example, I cannot imagine a typical worker drone being allowed to wake up on their own as opposed to being woken up by the alarm clock, then spending at least 2 hours and possibly longer to prepare for the day ahead, then having a stress free commute to work and a standard 8+ hour work day, then going to sleep early, all at the same time, all while in the advanced stages of depression. All while tormented by guilt and anxiety of wanting to move along quicker but not being able to. Etc.

Is the answer to change jobs? That may not be an option, at least not immediately. Of course, this is all better than suicide but still seems unmanageable. Is the situation different in countries with more sane health and employment practices? I certainly would hope so.

Jesus Is in the Darkness with You (1.20 / 10) (#97)
by sellison on Thu May 12, 2005 at 07:51:13 PM EST

Recognizing agony in a void that is filled only with darkness and absence calls a depressed person to be present to the Now, even if the Now is darkness. There is a God in that void, the God of Jesus. To be present to this God, to know that Jesus is in the darkness with you and for you as prayer, even were no words or act of love to pass through your heart. God's abiding love is deep within, never forsaking you in darkness. You are alone in the void with the Son of God-both of you keeping silent. Suffering with you is Jesus, the abandoned Son on the cross. When it is impossible to hold on to a thought or to pray, Jesus is praying and contemplating within the one who is suffering from depression. Day by day, moment by moment, groping in the darkness, you are not alone. Jesus is struggling with you. He is there feeling it all. Nothing goes unnoticed by him or his Father. Through Jesus' Spirit who is in you, you can hope for peace.

St. Gregory Nazianzus wrote these words during a time when he found anxiety and depression crowding out any space for prayer in his soul:
The breath of life, O Lord, seems spent. My body is tense, my mind filled with anxiety, yet I have no zest, no energy. I am helpless to allay my fears. I am incapable of relaxing my limbs. Dark thoughts constantly invade my head ....Lord, raise up my soul, revive my body.
If this is happening to you, try these forms of prayer and contemplative love:

  1. Try to find a quiet place. Put on some soothing music. Keep it soft and gentle. Take a few deep breaths, holding each one for a few seconds and then slowly exhaling. Relax. Feel the chair you're sitting on, your feet on the floor. Smell the scents in the room. Imagine Jesus coming toward you with a smile on his face. Tell him how you are feeling right now-anxious, uncomfortable, fidgety, distracted, wanting to focus. Tell him what things are like for you today. Open your heart to him. Feel his presence very close to you. Let his love into your heart. Thank him for this gift.
  2. Go for a walk. Take some pleasant music with you. As you go, notice the sky, feel the season. Recognize what is around you. Feel at home right now. Offer your heart to Jesus, even if your pain is deep. Though you may be alone on your walk, Jesus is in your heart. Tell him what you see ...the beauty around you. Tell him how you feel ...even if it is dark. Remember he wants you to tell him everything in your life ...joys and pains.
  3. Call to mind someone else you know who is hurting or sick. Focus for a few minutes on what that person may be feeling, and on what you would like to say to him or her. Lift this person up by name to Jesus and ask his blessing on them.
  4. Hold a crucifix in your hands. Close your eyes and think of Jesus in agony. Join your sufferings to his in his act of redemption.
  5. If you're feeling low, go to a quiet place and hold your Bible. Read Psalm 130 or focus on a phrase of it. Embrace how you feel, even if it's uncomfortable. Know that God is loving you through these moments of darkness.
  6. When you are unable to focus because your mind is racing, try to remember and pray the words, "My God, I love you." Open yourself to God's love.
  7. Turn on soft music. Read this Bible verse over and over while thinking about it: "My God, my God, why have you forgotten me?" (cf. Mk 15:34). This is Jesus' own prayer of emptiness and abandonment.
  8. When you pass by your local church, stop in for a few minutes. Pause and connect with the One who loves you.
  9. If you can't get up, lie still and repeat the name of Jesus over, and over, and over. His love catches these words and he embraces you with love.
  10. Go to Eucharistic adoration and spend some time in God's presence.
Realize that Jesus is the answer to all things, and get yourself right with the Lord. The drugs and immorality of the modern world, it's distance from God, are the root cause of your problem, and another thing that can help is battling the modern dragons: atheism, drug abuse, materialistic science, and rampant sexuality.

Battle them in yourself and battle them others, as we make the world a more moral and Godly place, we cure ourselves of the accompanying depression atheism casts like a dark wing over the world.

"No, I don't know that atheists should be considered as citizens, nor should they be considered as patriots. This is one nation under God."- George H.W. Bush

Ummm, no. (none / 0) (#111)
by Sesquipundalian on Sat May 14, 2005 at 06:09:17 PM EST

We want to keep vulnerable people away from cults.


Did you know that gullible is not actually an english word?
[ Parent ]
Isn't he just adorable? (none / 0) (#112)
by Mason on Sat May 14, 2005 at 08:09:24 PM EST

Just remember, a puppy is a big responsibility, K5.

[ Parent ]
Affects of Culture on Depression (3.00 / 3) (#98)
by MonsieurMerdique on Thu May 12, 2005 at 11:13:02 PM EST

That which I am going to say can sound a little cliché, but it is true : Americans live to work ; French work to live ! French lycée and university are more rigorous than their American counterparts. The essential difference is that the French system prepares the students for a good life but that the American system prepares the students to enter the force of work.

After receiving my diplome in computer science, I found my job at a development company established. There, an air of leisure was existing despite the complexity of code production. The boss did not dispatch us or utilize excessive criticisms to motivate us.

I come to the United States and experience a culture shock : "The code must be in at next Friday! I want this programme on next Friday!" To my colleagues, this was normal. Overtime, c'est américain !

I had never experienced a depression during my life before, but in America I have. It commenced with some fluctuations of my mood. I was content sometimes, but sometimes I was sad. I started to believe that I was a person inferior to the others. I was obsessing with my problems, and those thoughts made me not sleep. I was listening to the angry or depressing music. I believed that I could not be around the others because I was inadequate. I was crying at night. After a few months, I had need of excessive hours of sleep to fonction. I listened to the advice to do exercises, but I found that I was too fatigued to do even the minimal exercises of running a short distance. Next, my ability to concentrate was absent. Producing code more complicated than "Hello world!" used many tedious hours of my time when it normally used a couple of hours. My emotions were almost nil with the most frequent emotions being ennui, great sadness, flashes of anger and void.

I commenced to eat compulsively, but the relief was transient. I was angry inappropriately. My face revealed nothing ; my voice was monotone. When I talked, I complained. My thinking was deranged. The obsessions took my mind to some strange places ; my own internal ideas were replacing the external reality. My behavior was sometimes bizarre because I followed internal ideas that were the resultat of excessive analysis. I knew I needed some help.

A psychiatrist prescribed me an antidepressant, a serotonin reuptake inhibitor. It succeeded to lift my mood to spontaneous smiling, talking more, and being less reserved. My choice of the music was reflective of this. After a few weeks, the high depleated, and I was at a state moderated. The continuing stresses did not match my sincere essays on positive thoughts. This is where I am now.


No, merdique is not French for shitty!


Being french in America (none / 0) (#108)
by gombeen man on Fri May 13, 2005 at 01:27:36 PM EST

I can understand why a french person working in the USA could become depressed. As a foreigner working in the USA myself, I found the the anti french statements I heard on American TV and radio pretty shocking. When youre not used to hearing that kind of hatred on the public airwaves, it is fairly shocking. If it was directed at me, I think it would have precipitated some serious anxiety also. My advice to you is, if you care about your mental health, work in a different country from the USA, you dont have to live like that.

[ Parent ]
Depression (none / 0) (#129)
by Rutegaard on Thu Sep 01, 2005 at 08:02:41 AM EST

This is most interesting. I myself have suffered quite severe bouts of anxiety and depression and medicated with paroxetine (Paxil in the US) and am now medicating with escitalopram (Lexapro, I believe, in the US). I recognise the many of your symtoms among my own, for example the concentration troubles and the sleeplessness and crying. May I ask what your status is now?

[ Parent ]
A Challenge (none / 0) (#99)
by Name of Feather on Fri May 13, 2005 at 06:12:20 AM EST

Judging from the overall mood of the comments, people still have not properly understood my stance on sports. Moreover, some of the comments give the impression that I said that all sports are bad. For goodness sake, read Section 3 of Part II (which you can find here in my diary. I will post it as a story next week). There you will a more detailed description of why in the right circumstances sports can help with depression, but why in general one has to be careful.

I have a challenge for those still clinging to the notion that sports always help. In Section 3 of Part II I have alluded to a sports intensive scheme that is used by some dutch companies to treat people with burnouts. How do you explain that this scheme requires 2-3 years for full recovery to take place, instead of the 1-2 years of the conventional no-sports method?

Mind you, this is not an anedocte. Plenty of people follow this scheme (dozens? hundreds?), and the way it works is pretty much established. Basically, by exercising every morning, they pump their bodies with adrenaline, makeing them feel better and allowing them to start working sooner. The drawback: all that adrenaline means they sleep less than otherwise, which means that full recovery takes much longer.

sports vs exercise (none / 0) (#106)
by coprolalia on Fri May 13, 2005 at 10:19:52 AM EST

i'm going to need some references on this, because i don't believe it, even recognizing the distinction between sports and exercise.

[ Parent ]
Overtaining (none / 1) (#107)
by rodentboy on Fri May 13, 2005 at 11:46:55 AM EST

About half of the symptoms of overtaining are affective, and sometimes, in severe cases, include depression.

Just google for overtaining and you should get tons of references. (Ignore the weightlifting ones, it's a different thing.)

Most people in north america don't exercise enough so it's inconceivable to them that there could be such a thing as too much exercise. There definitely can be such a thing.

And in a previous comment I speculated that the rise in what I like to call 'torture sports' like triathalon, iron man and marathons are going to lead a lot of people to discover the pure hell that severe overtraining can be.

Exercise is worse than sports because it's more intense, it's training. Sports are mostly self limiting but can lead to the condition as well.

I went through a bout of severe overtraining in 1998 that led to a severe depression. It took about 18 months to recover, and my body has never been the same since. During the subsequent depression I can assure you that excessive exercise (and excessive during that time period was a lot less than a normal, completely unfit person could tolerate) only worsened the condition.

I only disagree with the poster on the point of whether all depressed people should avoid exercise. I think it can help with some forms of depression, but with a depression brought on by overtraining, or burnout or whatever you want to call it he is right on the money. Anything but gentle exercise makes it worse.



[ Parent ]
Recovery (none / 0) (#110)
by Name of Feather on Sat May 14, 2005 at 04:59:01 AM EST

Considering that recent research indicates that neurogenesis is fundamental for recovery to happen, there is a very good chance that stem-cells might be used to treat depression. They could make the recovery faster, and even more importantly, they could finally provide the means for people with chronic depression (which in your case seems to be the result of overtraining) to recover completely. There is yet hope.

(Google for "depression neurogenesis stem cells" or similar)

Just by curiosity: how old were you when this bout of overtraining happened? Age is a very important factor concerning recovery.

[ Parent ]

I was 27 (none / 0) (#119)
by pnadeau on Mon May 16, 2005 at 08:38:56 PM EST

I was nearing elite fitness at the time.

Now my body can't tolerate the same load as it used to, and while I'm in OK shape, I have never managed to get back to what I once was.

The depression, however is gone.


"Can't buy what I want because it's free, can't be what they want because I'm..."  Eddie Vedder


[ Parent ]
Specifics (none / 0) (#128)
by Rutegaard on Thu Sep 01, 2005 at 07:54:11 AM EST

What amount and kind of training and exercise caused your overtraining symtoms, if I may ask? I have personal experiences of both intense training and anxiety and depression and am gathering relevant information on the subjects for the development of a better understanding of myself.

[ Parent ]
Look at - Art of Living courses for happiness (none / 0) (#101)
by grkhetan on Fri May 13, 2005 at 06:42:13 AM EST

Take the Part 1 course (6 days; but held at non-office hours) of Art of Living:

http://artofliving.org/courses.html

This will teach you techniques to relax, and be happy from your inner self.

Apart from a person in depression, even anybody who is not normally happy, will benefit a lot from this course.

I have not read your article fully yet, but I believe that the there are many techniques in ancient Indian philosophies which help people be happy.

Ofcourse, the effect is not as great when you dont have a nice family which supports the cause, and preferably themselves follow the techniques.

Ideally, you and your wife/family should attend art of living together, and then keep practising it together -- this is the ideal condition, and a powerful way to sustained happiness.
-- Ask "Why?" to everything...

oh yeah (none / 0) (#103)
by meatsack on Fri May 13, 2005 at 09:14:08 AM EST

Looks like one of those cults, like the Transcendental Medication group.

[ Parent ]
caffeine (none / 0) (#102)
by meatsack on Fri May 13, 2005 at 09:11:22 AM EST

How does caffeine and nicotine affect this?

stimulants should be avoided in general (none / 0) (#104)
by murry on Fri May 13, 2005 at 09:34:32 AM EST

but really would not recommend trying to quit smoking until you've made a LOT of progress in other areas. Nicotine is a serious addiction and quiting generates a lot of stress. these things like all else affect people differently though and requires advice from a doctor.

[ Parent ]
I don't believe in a soul, but... (1.33 / 3) (#113)
by BJH on Sat May 14, 2005 at 09:36:54 PM EST

...using drugs to correct a mental illness is like trying to change the your PC's screen background by beating on the case with a hammer.

--
Roses are red, violets are blue.
I'm schizophrenic, and so am I.
-- Oscar Levant

Except drugs actually work (none / 0) (#114)
by parrillada on Sun May 15, 2005 at 02:01:35 AM EST



[ Parent ]
Only... (none / 0) (#116)
by BJH on Sun May 15, 2005 at 09:02:50 PM EST

...for definitions of "work" created by the people who make or prescribe the drugs.
--
Roses are red, violets are blue.
I'm schizophrenic, and so am I.
-- Oscar Levant

[ Parent ]
So does the hammer (none / 0) (#126)
by Cro Magnon on Wed May 18, 2005 at 09:26:43 AM EST

But the side-effects are a b!tch.
Information wants to be beer.
[ Parent ]
the role of psychology (none / 0) (#117)
by lazybones on Mon May 16, 2005 at 10:23:36 AM EST

You suggest that you don't put too much faith in psychology but then stress a large section on lifestyle advice.

I have been generally melancholy throughout my life, but in the last 7-8 years (ie. since I transitioned from university to work) it has progressed into full-blown depression and I have been in treatment for 3-4 years.

Your lifestyle advice is dead on.  Proper diet, rest, and stress management are ESSENTIAL to surviving depression.  My issue is that the psychology of depression (ie. the depressive syndrome) makes it INCREDIBLY difficult to maintain a regimen like this.  I have been on various antidepressants which have had some success, but my main issue is that I don't maintain the healthy regimen.  Lethargy and feelings of hopelessness & defeat make it hard to see the positive of eating your veggies and exercise.  I have found dealing with depression much like dealing with an addiction, to the point that I generally use terms like "falling off the wagon" for my episodes.  The energy I have to spend to maintain proper habits is very taxing, and it can take months to recover from a misstep.  I have found cognitive-behavioural therapy to be a big help in combating negative thought patterns and bad habits.  I recommend Burns' "Feeling Good"  for a good self-help application of CBT.

Advice and stuff (none / 0) (#118)
by Anonymous Lemming on Mon May 16, 2005 at 11:59:10 AM EST

Just thought I'd pipe up and throw out a comment. Some good generally good advice is in this article and I'll share some things from my own experience.

My wife was diagnosed with a variety of mental disorders recently and was put on Paxil about 3 years ago (she was not my wife at the time). This all happened a bit after some traumatic spine injuries, she broke her neck doing the high adventure stuff she likes. First problem with the idea of giving medication to her is that no plan was laid out for how long she should be on it, or how she was to improve. It was given to her as "this will fix it" type of plan. Sent her home with the idea she's going to be on some pill the rest of her life because of some "imbalance". If you study out these drugs there is not much behind them. Certainly they appear to help some people, but they make others worse than they originally were. The recent press about increased suicide rates for children on anti-depressants is telling. The school shootings and violence done by children, the first question I ask now is "what was this kid on?". Every story I've dug into has revealed that they were indeed on an anti-depressant. Some might suppose that they were put on them because of their mental state. Yes, this might in fact be true, but the other issues involved indicate marginal effectiveness of the drugs in select people as well as very harsh negative effects in others. This is not fully explained. My wife has indicated that she feels more like a "drone" on paxil and enjoyed life much more before she was put on the drug. I present this as a caution about the drug use, don't let your doctor simply perscribe it without some kind of real plan. How long will you be on the drug? What other courses of action are there? Is the drug a crutch or the solution? (I'd be very suspicious if there is an unspecified length of time and the drug is sold as a "solution"). Something they don't tell you when putting you on the drug is just how incredibly addictive it is, and incredibly hard to get off the drug once you are put on it.

My wife is now at less than 1 mg of Paxil, it has taken her almost a year to wean herself to this ammount from her former 60 mg. She enjoys life much better (of course, she is married to me now after all :-). It might also be interesting to note here that a happy marriage is very good for the mental and physical health of both parties. Generally statistics report this rather overwhelminigly. If you're single and depressed, you may consider this.

It is my experience that depression is the result of an aspect of your life that is rather out of balance. My recent studies of human development have suggested that everyone has a need to be needed. I.E. this is the role that children/family usually fill in most lives. If you're single and really don't want a family in any form - get a pet. They make a good substitute and can be very relaxing. It's hard to ignore the statement made by them in desiring to be around you, it's a nice ego boost. Petting an animal is also good relaxing therapy.

I've experienced burnout from time to time. It doesn't seem directly tied to how hard I'm working, but how well I rest and release focus on those things. I think it's good medicine to take small moments, on the commute home or on a walk, and enjoy the natural beauty that manifests itself everywhere. Take a moment to acknowledge the beauty of the world and how good it is to be in it, to enjoy it. This approach saw me through adolescense and has helped me keep a positive outlook.



Reply on Mind Hacks (none / 0) (#122)
by Vaughan on Tue May 17, 2005 at 06:47:49 AM EST

I've written a reply to this article on MindHacks.com, specifically tackling the claims that depression is a purely 'physical disease' caused by 'low serotonin', both of which are highly problematic. The article is here.

Medication is a life-saver (none / 1) (#124)
by CptPicard on Tue May 17, 2005 at 04:51:18 PM EST

A brilliant text, kudos to you for tackling a subject which for far too many people is still so taboo that they hurt themselves by not seeking help because they are afraid of the stigma.

I have been fighting a depression for some six years straight now, with varying amounts of success. In recent months I have been recovering from an episode that started last fall and lasted throughout the winter, and most probably caused me to all but drop out of my Master's thesis work... I am yet to attempt to make peace with my supervisor and convince him I will bounce back in time.

What broke the spell this time -- as has happened once before -- was a visit to a psychiatrist that got me on  a daily 30mg pill of mirtazapin. It is an SSRI antidepressant -- inhibits the reuptake of serotonin in the synapse.

I must say I can't quite agree with the physical description of depression given in the article, but as my psychiatrist says, people react differently. There is most certainly a psychological component to it, but at some point, the very physique of the brain gets stuck in the "depression gear" and after that, you just won't get out of it through mere talk.

I have found psychologists mostly useless as they do not understand my character or the way my psyche works. I, on the other hand, understand it all too well and actually dwell way too much on the innards of my psyche when I am deeply depressed... I am in general far happier when I do not dwell on my thoughts and feelings too much.

My depression is perhaps closer to the classic "loss of will to live" type of apathy that you find in other descriptions. It is the strangest and most horrible state of mind I can imagine, and a big part of the desperation of it is that you feel so completely powerless in the face of it. I can easily just stare out of the window for days on end without doing much anything, barely bothering to take care of the simplest daily routines.

I guess if I were ever to commit suicide because of depression, it would not be an active act, but something akin to starving myself to death voluntarily. I just feel completely disconnected from the world around me, and in some ways, I fall into an almost buddhist kind of mind-over-matter nirvana, which feels sick but also empowering... it is difficult to put into words how apart from the world I feel at those times. I don't feel anything, and I don't feel that even death would be a big deal for me. It's the sickest feeling you can imagine.

An interesting point here is that I have a very good psychological reason to be depressed, but still, shrinks have never had any effect on me... it is always medication that flips the switch inside my head. See, I am pretty severely disabled, and in pain as well on bad days.

I have managed psychologically for a few reasons, one of them being that fortunately what I lack in body I can compensate with mind. I do not thus have the typical (i.e. trivial) self-esteem issues that most shrinks assume to underlie my problems. My compensating with my mental faculties has of course lead to these "mentally intensive" interests that might be overloading my brain as described in the article... I might actually have to cut back on the programming and reading.

My psychological issues are far more complex than just the standard pattern the shrinks assume. I am actually quite successful in life in some ways... but when the depression strikes, I just start shooting myself in the foot relentlessly... like just running away from my thesis and disappearing off the face of the Earth for the whole winter. Now that I am feeling better again, I do not understand my own behaviour.

It's always the drugs that seem to make the final difference, though. They pull me out of the horrible hole I dig myself into, let me actually feel something again and feel connected to the world around me. When I get a little bit better, I am able to take up interests that drag me further back into the books of the living. This time it was forcing myself to get a driver's license and a car, despite originally feeling that the first thing I will do is crash into a truck. (Over here in this part of the world most wheelchair users use a taxi system to get to places. It works, but you do feel a bit like cargo in comparison to driving yourself)

A month ago I was speeding down the highway in the spring sunshine -- something I have been doing for just a while now, and I'm 26 -- and felt I was getting actual PLEASURE out of an activity that is quite different from anything I've done before. I consider this to be a major win for myself, and it's all thanks to the medication I am on. No amount of psychotherapy could have done this for me, and I have become a firm believer in the connection between our "soul" and the neurons in the process.

Thanks and good luck (none / 0) (#125)
by Name of Feather on Wed May 18, 2005 at 05:06:00 AM EST

Good luck with your recovery! You are still young, so you stand a good chance of making a full recovery.

Just one nitpick: mirtazapine is not an exactly an SSRI. It has an effect on serotonin but also on norepinephrine. And it is known to improve sleep a lot, which explains part of its efficacy.

[ Parent ]

Demystifying Depression - Part I | 130 comments (100 topical, 30 editorial, 0 hidden)
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