We Need To Change How We Look At, Talk About, Depression
I sometimes say to people who sneer at taking medication to alleviate mental problems (like I take Adderall for my ADHD): "If you had a disease, and a drug would make it better, surely you'd take it; you wouldn't say, 'I'll just pull myself up by my bootstraps!'"
Similarly, Gayle Forman writes at the Guardian about depression, starting with two examples:
In the first, a 17-year-old with leukemia has to miss several weeks of school.In the second, a 17-year-old with depression has to miss several weeks of school.
Are you more sympathetic to one than the other? Does one have a real disease, the other, something else - something which, though not quite hysteria, is not quite life-threatening either?
Does it matter that both conditions are disorders, both thought to be caused by something gone haywire on a genetic or biochemical level - leukaemia when blood cells acquire mutations; depression when neurotransmitters are out of balance - as well as environmental factors? Does it matter that both are quite treatable - the five-year survival rate for childhood leukaemia is 85% - and both are potentially lethal? The overwhelming majority of people who take their own lives - 90% or more - have a mental disorder at the time of their deaths, the most common being depression.
Does it matter? Perhaps it should.
In the last few decades, depression has shed some of its stigma. People now talk more openly about it; they are more apt to seek treatment for it. And yet, there is still something to it that causes its sufferers to feel differently about their condition - a mental illness - than they might if they were sick with something more obvious - a physical ailment.
Even that term - mental illness, or mental disorder as it's commonly called - suggests an element of control that sufferers often don't have. Because if it's a mental illness, then it's in your head, right? We control our minds all the time - deciding not to call up an ex, deciding to skip a late-night party because there's work tomorrow - so can't depressed people, just, sort of, get over it?
Sometimes they can. More often they can't. And here's where calling depression a mental illness muddies the water because depression operates much like a physical illness, which is something most of us understand we cannot control. Many of depression's symptoms - exhaustion, insomnia, nausea, headaches, weight loss, weight gain - are physical ailments.
Researchers have shown the link between depression and a lack of neurotransmitters like serotonin, which is responsible for feelings of wellbeing. New research suggests other causes, like one study that looked at a link between inflammation and depression, suggesting that depression might be a response to an infection of some sort.
And yet, it's still thought of as something lesser, a weakness.
via @JonRottenberg, who appeared on my radio show to talk about depression and his excellent, science-based and myth-busting book, The Depths: The Evolutionary Origins of the Depression Epidemic
Some good cartoons about this here:
http://www.huffingtonpost.com/2014/11/13/mental-illness-physical-i_n_6145156.html
Snoopy at January 12, 2015 6:00 AM
Wouldn't it be great if we actually had a drug that worked 85 percent of the time against depression, instead or making you suicidal or crazier?
Some interesting work is being done with research on vitamin D and sunshine, and how,low levels of both might cause, or aggravate depression.
If staying home, curled up into a gelatinous mass actually makes depression worse, instead of better, than shouldn't we discourage depressed people from doing this?
While I am very sympathetic to sufferers, of depression, I am not sure that current treatments aren't the equivalent of medieval blood letting.
I am also extremely wary of doctors who prescribe a certain treatment or drug because *that is what the insurance will pay for.....*
Isab at January 12, 2015 6:59 AM
As a therapist, one of my biggest challenges with my clients was helping them understand that it wasn't "all in their head." Yes, there were things they could do to help manage the depression but it is a serious and debilitating disorder. If someone had diabetes, would we say to them "snap out of it?" Many years ago when I had a serious depression I thought I might open myself up to a family member. I told him how depressed I had been and the response? "I think depressed people are really selfish, don't you?" That was helpful. Sort of like stamping on someones fingers as the cling for dear life to the edge of a cliff. We have such a long way to go in our understanding of depression.
holly at January 12, 2015 7:00 AM
Unfortunately, the symptoms of what I call 'situational' depression ("my parakeet died") and 'medical' depression ("I've been down for years") are very much the same, to the point that the main diagnostic manual lumps them together. I was diagnosed with a permanent condition by six psychiatrists over several years - then was assigned to a psychologist, who at our first session announced he was going to cure me of my drug dependency...
John A at January 12, 2015 7:03 AM
"If someone had diabetes, would we say to them "snap out of it?"
No but if it was type 2 we might suggest dietary and life style changes like a low carb diet, before we went full bore with insulin injections.
I beat a bad case of anxiety by taking B12, getting a lot of carbs out of my diet, and almost eliminating caffeinated beverages.
Not sure which of the three worked. Maybe the combo?
Isab at January 12, 2015 7:17 AM
Isab, in what ways do you think taking anti-depressants is the equivalent of blood-letting or insulin injections?
I take a low dose of Paxil and it definitely increases my quality of life and makes it more likely that I will engage in other healthy activities like getting outside, exercising, etc. Is is working medically to enhance serotonin or is it generating a placebo effect? I have no idea. I go off it every couple of years to see if it is still beneficial. I certainly have more anxiety and depression without it but that's hardly a double-blind test.
Astra at January 12, 2015 7:36 AM
Isab, in what ways do you think taking anti-depressants is the equivalent of blood-letting or insulin injections?
Great Astra. Glad it worked for you... But Paxil doesn't work that way for the majority of people. It is not a cure all.
My daughter was prescribed it for OCD, and it actually caused her to become seriously depressed.
This is what I am referring to. Because *depression* is so difficult to measure, and treat, psychiatrists are pretty much reduced to throwing a lot of dangerous drugs with serious side effects at it, to see what works. And so far, with very poor results overall.
Isab at January 12, 2015 8:00 AM
Yes, actually, Paxil does work well for most people. For most people it is a cure-all. The drug would not be so prolifically prescribed and successfully taken if it was not. I tend to tune Isab out when she talks about all things medicine. She tends to have the approach that what works for her and her family is the gold standard and everyone else should pay attention. Not that there's anything wrong with that. I just have learned to not argue and not care too much about what her experiences have been, because she's really just one person, her experiences are ALWAYS non-mainstream, and she's not the masses.
gooseegg at January 12, 2015 8:07 AM
Understood. I was trying to figure out if you primarily meant the treatments were ignorant, overkill, or non-efficacious.
I knew a woman who suffered a severe head injury who had major depression. Doctors kept trying to put her on SSRIs that didn't work until a neurologist finally diagnosed her with a neurological disorder. I think Spalding Gray's suicide was from a similar source.
Astra at January 12, 2015 8:12 AM
I ever so much loathe to agree with Isab but she's right to a certain extent. SSRIs are poorly understood, over marketed and prescribed. Studies that show they have very poor efficacy and are useless aren't mentioned much. In fact there are other drugs (like ones to treat high blood pressure) that also work as anti-depressants and on anxiety (propranolol is one) and are much cheaper. So yes Paxil works great on people that respond to it and not so great on people that don't. You can't just assume it will work because the truth is..they're just randomly giving you pills hoping they will work and you're supposed to randomly cycle through them until you find the right one. That's psychiatry in a nutshell. I am not anti-medicine and if what you take helps them keep doing it.
I take an anti-epileptic for bipolar disorder and trying to find the additional booster to control my moods. The problem for me is that chemically I don't suffer from "regular" depression. And while I have taken an anti-psychotic specifically designed for my kind of depression if I read the studies it is only confirmed to work for 6-8 weeks. If I take an SSRI I might go hypomanic on your ass and then drop to an even worse depression. An anti-epileptic works well combined with lithium that resets my circadian rhythm on a cellular level. There are studies going on that they might be able to do genetic testing to see if lithium will work for you.
Depression is very real and when docs say you're depressed they are using an umbrella term to cover what is probably a bunch of different disorders they don't understand and can't test for.
Ppen at January 12, 2015 8:37 AM
"Yes, actually, Paxil does work well for most people. For most people it is a cure-all. The drug would not be so prolifically prescribed and successfully taken if it was not"
Are you even going to read the actual studies, and admit, as PPen says, that this is just flat bullshit?
Isab at January 12, 2015 9:41 AM
What, this one, from the NIH? http://www.ncbi.nlm.nih.gov/pubmed/15491239
gooseegg at January 12, 2015 10:06 AM
http://psycnet.apa.org/journals/pre/1/2/2a/
Isab at January 12, 2015 10:25 AM
That's regarding Prozac and it's from 1998.
gooseegg at January 12, 2015 10:31 AM
That's regarding Prozac and it's from 1998.
Posted by: gooseegg at January 12, 2015 10:31 AM
SSRIs are chemically quite similar.
The new ones have been developed primarily for profit. Change one molecule, and get a new patent.
What in your scientific background makes you think the NIH study is a good one and do you know the scientific definition of either *effective* or *the number needed to treat*?
As PPen says, there are a lot of studies out there that show no benefit. Guess why most of those don't get published?
Isab at January 12, 2015 11:00 AM
Because their data points are messed up. There's a bunch of reasons why. Some people are truly helped by antidepressants, some are helped by placebo effect, and some are made worse. But I am alarmed at how you claim they make you suicidal or crazy. How you are always blasting the medical industry - pharmaceuticals and MDs alike. And you go your own way instead of the way of proven hard science - shouting out nonsensical "facts" that I find dangerous because it's just your and your family's experiences. This is from 2012:
http://healthland.time.com/2012/01/18/new-research-on-the-antidepressant-versus-placebo-debate/
gooseegg at January 12, 2015 11:27 AM
http://psychcentral.com/blog/archives/2008/04/30/more-on-infamous-paxil-study-329
Here ya go.
Isab at January 12, 2015 11:57 AM
Offhand, I can't find this, but I remember a 1980s(?) public service message on TV about depression that first showed a male patient lying in a brightly lit operating room, hooked up to this and that, and medical staff saying things like "everything will be OK; we're right here for you." Second scene: The same actor is lying on his bed, in his clothes, in a darkened room at home, looking miserable, while one woman wanders around irritably, telling herself: "He just needs a kick in the pants; there's nothing I can do for him."
There was a narrator, too, but I forget the words.
Can anyone find it?
lenona at January 12, 2015 11:58 AM
I am inherently suspicious of all medical publications until proven otherwise. Man, they don't teach their scientists how to handle statistical or systematic errors. So the fact that two studies disagree?--color me unsurprised.
Now, to be fair, it's very hard to disentangle systematic effects, especially (as gooseegg notes) because the placebo effect is actually quite efficacious. So I don't know why Paxil works well for me while Prozac was meh but I'll keep taking it and encourage those who are depressed to try a variety of treatments in the hopes they find the right solution.
Astra at January 12, 2015 12:06 PM
... I'll keep taking it and encourage those who are depressed to try a variety of treatments in the hopes they find the right solution.
Exactly. I think the original spirit of this post is that some people need medication to manage depression. Of course, that requires finding the *right* medicine, but the need for treatment is legitimate, just as it is for an injury or other illness.
Yet there are a lot of people out there who don't see mental disorders as "real" illnesses and think depression can be managed by taking walks, smelling roses, and sucking it up. Case in point: My hippie-dippy aunt gave my cousin (who suffers from depression) a book about healing spices for Christmas and wrote on the inside cover, "It's up to YOU to determine your own happiness. You have the ability to cast off your demons, if only you'd try."
sofar at January 12, 2015 12:28 PM
"As PPen says, there are a lot of studies out there that show no benefit. Guess why most of those don't get published? "
Are you really going to sit there and claim that the medicine that I take, which I know works and has probably saved my life, doesn't "really" works and therefore it should not be available to me? Fuck you.
Cousin Dave at January 12, 2015 12:29 PM
I take an anti-epileptic for bipolar disorder and trying to find the additional booster to control my moods. The problem for me is that chemically I don't suffer from "regular" depression.
PPen, you might search Emily Deans blogs (personal and Psych Today) for dietary or drug solutions. She's a psychiatrist I find is very evidence-based and innovative in her thinking (and combines evolutionary thinking and dietary science to try to resolve or improve mental health issues).
And studies not being published when they have disappointing (to the drug company) results is called "publication bias," and it's rampant and truly disgusting.
Amy Alkon at January 12, 2015 12:46 PM
Cousin Dave, people are very similar but also varied. Dramamine, which people cheerfully recommend to me for motion sickness, doesn't even begin to cut through the motion sickness I feel. On the other hand, I had Versed when I got an endoscopy and I couldn't access a good deal of my memory for about three weeks. It was terrifying.
Amy Alkon at January 12, 2015 12:48 PM
I'd like to add to the discussion on anti-depressants. I know that it's not widely known outside of the medical community yet, but one of the medical research labs in Toronto is developing a blood test to determine which anti-depressant will work best with your body chemistry. It's supposed to be something like 70-80 percent effective. The major barrier to its wide spread use is the long wait time for results (1.5-2 months).
Nicky at January 12, 2015 1:26 PM
When I was in my 20s, I was experiencing what appeared to be mental illness. I started having these irrational thoughts I knew were completely crazy, but I couldn't keep them from entering my mind. I knew something was wrong. I refused to let these thoughts take control. I was able to overcome them without the aid of drugs, therapy or counseling. (I had no choice at the time. I was unemployed and had no insurance.) I used to be very unsympathetic to anyone complaining of depression and other mental issues because I felt like they were just being weak-minded and chose to let the mental illness take over. But I don't feel that way anymore.
Fayd at January 12, 2015 1:34 PM
Amy Alkon
http://www.advicegoddess.com/archives/2015/01/12/we_need_to_chan.html#comment-5764521">comment from FaydWow, Fayd -- very sorry you went through this, and appreciate your more sympathetic take in the wake of this.
Amy Alkon
at January 12, 2015 3:15 PM
The problem looks to me to be the whole diagnosed with depression thing as it really looks to be symptom, maybe even a symptom of symptom. It is like diagnosing some one with a "running nose" instead of being infected with the cold virus or hayfever. Once further knowledge is gained it will be better.
The two who I have known close enough to know about their specific treatment both went through lots of ---oh, that didn't work, lets try this...
The Former Banker at January 12, 2015 7:45 PM
TFB's comment is a good one. I was having some depressive symptoms and also having some trouble with bleeding gums. At my regular physical, they added a vitamin D to the blood panel (not because of those two things, but because it was the new standard of care), and it turned out I was SEVERELY low in vitamin D (almost below detection levels). Ack? Massive supplementation later, my blood D levels were better, the depressive symptoms were much improved and my dental checkup went like:
Doc: Great home care! What'd you change?
Me: Nothing
Doc: Nothing? But this is so different from before.
Me: Well, my doctors gave me like 2 years worth of vitamin D...
(my dentist now recommends all his patients with persistent bleeding gums get tested for vitamin D).
So, I was probably both harboring some infection AND had a vitamin deficiency. What was a cause and what was a symptom, I dunno for sure, but I can tell you it was probably all related somehow!
Shannon at January 12, 2015 8:35 PM
I agree with A Former Banker. Depression is just a symptom.
I have had chronic mild depression for about half of my life. I first remember feeling depressed at about 8 years old. I've just fought it my entire life.
I suspect that there is a link with the immune system, but what came first, the chicken or the egg? That year I was diagnosed with ulcers, shingles, chronic tonsillitis, and chronic bronchitis.
I tried antidepressants once. They were so bizarre. I didn't feel depressed per se. I could not give a damn though. I slept 20 hours a day, showered, exercised, ate, and went right back to sleep. I went off of them when I needed to go back to work. It was a "lost summer."
Jen at January 12, 2015 8:50 PM
This is a slippery slope, and there are a couple of things to remember...
One is not entitled to medication.
Many kinds of "depression" are not fixable.
Some diagnoses of "depression" are incorrect as to cause and magnitude.
Radwaste at January 13, 2015 5:09 AM
"Are you really going to sit there and claim that the medicine that I take, which I know works and has probably saved my life, doesn't "really" works and therefore it should not be available to me? Fuck you.
Posted by: Cousin Dave at January 12, 2015 12:29 PM"
Absolutely not. I am all in favor of people being able to take a wide variety of medications that may or may not actually do anything for them, or have serious side effects. Freedom is a great thing.
But right now, the hoops that you have to jump through to sell a drug in the US means that a lot of benign and helpful stuff is totally unavailable, and a lot of dangerous and ineffective stuff is widely prescribed.
I just recognize that the games played by big Pharma with the FDA yields drug studies that are less legitimate than the data backing the global warming scam.
And the long term side effects of the medications are largely unknown. The studies aren't long enough or large enough to find out.
You might find that your indoor lifestyle and your diet are the cause of most of your health problems. I did.
http://www.webmd.com/depression/news/20120627/vitamin-d-deficiency-linked-to-depression
Isab at January 13, 2015 6:34 AM
"You might find that your indoor lifestyle and your diet are the cause of most of your health problems. I did. "
Been through all that crap. Didn't make a bit of difference.
Cousin Dave at January 13, 2015 11:31 AM
"You might find that your indoor lifestyle and your diet are the cause of most of your health problems. I did. "
Been through all that crap. Didn't make a bit of difference.
Posted by: Cousin Dave at January 13, 2015 11:31 AM
Really. What did you try?
And I hope if you have an indoor job you are still taking the vitamin D, and having your levels checked regularly.
I had to totally stop drinking coffee and black tea, stopped eating or drinking dairy before I really started feeling well.
I got tired of taking one pill after another, when the purpose of the second pill was to take care of the side effects from the first medication.....
Finally went to a Spots Medicine MD, and he did the tests, put me on the supplements that I needed for my autoimmune disease.
I feel better now than I did 20 years ago.
Isab at January 13, 2015 12:37 PM
Leave a comment