Depression is...

Great Debates
1

What is depression? Is it simply a chemical imbalance in the brain? An imbalance of neurotransmitters resulting in low mood, sluggish lethargy and general disinterest in life’s activites? An imbalance that can be chemically corrected by medication? Or is it our mental, emotional and psychological reactions and perceptions to events and patterns in our lives that triggers this potentially dangerous unhappiness? Reactions and perceptions that can be “unlearned” and re-taught in a more healthy, realistic manner?

This is the old drugs vs. behavioral therapy debate regarding depression. Advocates of both camps believe it can be treated successfully using only one (their) treatment path. What I have always struggled with is why must it be viewed as an either/or choice? Why not see depression as a hybrid of both schools of thought? It is indeed a chemical imbalance of neurotransmitters BROUGHT ABOUT by events/happenings and/or patterns in one’s life that are perceived to be bad/sad/negative-in-some-way. Now one might immediately argue, “if they weren’t ALREADY depressed, they wouldn’t perceive those events in a negative way to begin with.” So which comes first, the chemical imbalance LEADING to the negative perception of an event, or the negative perception of an event leading to the chemical imbalance?

I know it sounds kind of confusing, so I’ll give an example. Say a man loses his job and falls into a terrible depression. Was this man already suffering from a chemical imbalance of serotonin in his brain that caused him to perceive the loss of his job as a “life-ending”, totallly devastating blow to his life, whereas a proper chemical balance would enable him to interpret this event on a more normal, even keel? OR, was the loss of this man’s job such a devastating blow to this his life that the perception of the experience caused the man’s chemical levels of serotonin (which up to that point had been normal) to become imbalanced, resulting in his depression?

I think both types of depression are out there. Those that suffer a pre-existing chemical imbalance and are prone to perceiving and interpreting the events in their lives’ as excessively negative in some way. And those who go through events or occurences which change a previously “normal” balance of neurotransmitters in the brain. However, if these depressions are never addressed or treated, they ultimately becomes one and the same. Because both types of depression have the bottom line of having an imbalance of chemicals in the brain. And even the person who once had normal levels, after going through whatever they did to make the levels alter, if nothing is done to treat or alleviate this imbalance (this depression) it will remain and they will be prone to perceiving events in their life as excessively negative. Just like the other type.

And you can’t treat the chemical imbalance without treating the person as well. This is where the hybrid aspect comes in. If a pill is just given in order to restore proper neurotransmitter levels, what happens the next time an unexpected tragedy occurs and those levels get unbalanced again? That would happen to the man who became depressed originally as a result of an outside occurrence. This man needs to also have the skills and knowledge to positively and effectively cope and deal with the realities he is facing. He needs medicine AND behavioral/talk therapy. Perhaps medicine-only treatments work for depressed patients who had a pre-existing imbalance, irrespective of any occurrence or event in their lives, but how do you really differentiate those when you get down to it?

2

Oh, shut the fuck up. :frowning:

3

I’ll think you’ll find that whilst your ideas aren’t necessarily that far off the mark, you’re covering territory that is extremely well-trodden by professionals in this area. For example look up chronic vs situational depression.

4

Depression is the result of having one’s bullshit detector calibrated too accurately.

5

Not much debate fodder. I think most of us agree with you. But I can help the conversation.

I will say that you left out another way depression may play out: via a positive feedback loop. You start off with maladaptive brain chemistry, which leds to negative perceptions of reality and self-concept, which then causes negative situations (like losing your job because you’re always in a bad mood), which then makes the depression much worse and longer-lasting until you can’t even remember ever being “normal”. Or it can start off the other way too, with a bad situation. It acts like trauma to your brain, causing screwiness in your brain chemistry, which then causes you to be more depressed, which then causes more bad situations. And so on and so forth. A cascade effect.

I think depression is not a very simple thing at all, and that’s why it is hard to treat chemically (if it were a simple thing, you wouldn’t think there would be so many drugs on the market). I also think there’s being depressed and then having depression, the latter being a clinical condition and the other being not-so-clinical. But at one point should one say, “Hey, I’ve got a problem”? What if you just have poor self-esteem but you’re 100% functional? Is that bad enough to warrant going to a shrink/counselor, or is it something you can fix simply by not focusing so much on yourself? I don’t know.

I wonder which is more frequent: endogenous or situational depression? It seems like life is constantly throwing rotten eggs at us. If a rotten egg to the face is enough to knock people into a depressive state, then it seems we’re really not a tough species, collectively. But I see tough people who have faced tough obstacles their whole lives not succumb to depression. So I’m not thinking situational depression is all that common…and if it is, it resolves itself by-the-by without any external (professional) assistance. And if this is true, then what distinguishes it from just being sad for an extended period of time? If I lost my job and was unemployed for months, and I was sending out resume after resume without hearing a single word, I’d naturally feel pretty down. Probably for all those months that I was unemployed. I’d probably have the symptoms of melancholic depression (listlessness, irritability, social withdrawal, lack of appetite, etc.) That’s what sadness (and grief and heartbreak) do to a person. So should we call this “situational depression” or just sadness? Or we getting to the point of pathologizing everything that’s not happy-happy-joy-joy?

6

Well… it’s actually quite amusing in some sense, but my ex (who I keep in touch with) went off of her antidepressants after our break up. She didn’t need them any more… and she is happier now (we both are- sometimes love ain’t enough when you have conflicting goals / plans).

So the antidepressants helped her when she was in a bad situation, in other words the antidepressants compensated for the influence of the environment upon her mental state.

Of course a 2 pronged approach may be necessary in some cases.

Some of the time depression comes about because of the situation one is in- one has certain goals that are perceived as unattainable in the current situation. The constant lack of satisfaction of a major drive can lead to depression.

Sometimes it is due to an inherent “physical” condition, which is more easily addressed with a physical remedy.

Of course, it’s always possible that there is both a physical and environmental issue. Sometimes environmental issues can be worked around with therapy- people can be taught to let go of certain goals, or at least put off dwelling upon them until a time in which they can be accomplished.

anyways.//

7

But what is the chemical difference between endogenous and situational depression? Isn’t the end result the same? Isn’t it a disruption and imbalance of neurotransmitters, regardless of what causes said imbalance?

8

[moderator warning]
This comment is highly inappropriate for the GD forum. Do not do this again.
[/moderator warning]

9

I was just thinking about this the other day after seeing post a comment on Facebook similar to, “yeah, I choose to exercise and snap myself out of it when I’m depressed. I don’t take the easy way with medication” You get the gist, it’s the attitude that people who need meds are lazy, or that it’s some kind of moral failing.

Sure, lifestyle changes very well do help people “cheer up,” but it certainly isn’t that simple for people who have chronic, debilitating depression. A lot of people seem to think if it’s not something they can understand or relate to that it couldn’t possibly be a real issue for anyone else either.

10

I think there is a difference. But take my “thought” with a grain of salt, as I’m not a professional.

Endogenous depression often has a different set of symptoms than situational (or existential) depression. The binge-eating, sleeping-a-lot, crying-a-lot, no-energy-having depressive often is experiencing the latter. The no-eating, insomnia-suffering, blunt-affected, physically-agitated depressive is often experiencing the former.

In other words, the situational depressive is more readily identified as depressed because they are indeed sad all the time, which is what we tend to think of as being “depressed”. The person who’s depressed for no “good” reason can go hidden for years until they are driven to get help because of something else. Like a referral from a GP to a shrink because of physical complaints that don’t make sense. A situational depressive will almost always know when they are depressed. Someone who has only a chemical imbalance will often not know, and will often be in denial when someone tells them that they have a problem.

Endogenous depression will generally not resolve with changes in environment. You can not cheer someone up who is depressed in this way. Not even a winning lottery ticket will jolt them out of it, if they are in too deep. But someone who is depressed because of a situation can be cheered up. They tend to respond favorably to talk therapy, for instance.

While I agree with you that environmental trauma can trigger altered brain chemistry, I don’t know if I agree with you that it’s “just like” endogenous depression in its manifestion. That would be like me saying that breaking my leg, rendering it useless, is just like having it rendered useless by severing a tendon or a nerve. The only thing that makes them similar is that crutches will be needed to get around. But the underlying issues and the treatment will be different.

11

First of all, I think the symptoms you’ve used to describe and discern between the two types of depression are very subjective and interchangeable. A “situationally depressed” person could just as easily exhibit sypmtoms of insomnia and flat affect and others that you have categorized as being sympomatic of “endogenous depression” and vice versa. The bottom line in both cases, regardless of whether or not the depression came about situationally or endogenously, is that the brain has an imbalance of neurotransmitters. Now, if left untreated, or treated unsuccessfully, what makes one form any different than another? Is unsuccessfully treated “situational” depression actually misdiagnosed “endogenous” depression?

12

As I said…

Someone who is depressed because of circumstances can be cheered up. It usually resolves on its own, in due time. A spurned lover may be situationally depressed for awhile, but will bounce back when her girlfriends hook her up with the “perfect” guy. Someone who is depressed because they have been unemployed for a while will bounce back when they get a new job that elevates their self-esteem. Someone who is situationally depressed because they are grieving over a loved one will eventually, in due time, get to the point where they are functional and NOT depressed. This doesn’t happen always, of course. There are some people who fall into grief and never quite climb out of it. But since everyone eventually experiences the loss of a loved one but do not stay depressed for years because of it, I’d say that this is the minority.

A person who is suffering from clinical depression for no “good” reason is not like this at all. They may hook up with the “perfect” guy or a girl, and still be a miserable human being. Or they may get a new job, move halfway across the country, be surrounded by natural beauty and splendor, get a substantial pay raise, and still find life to be joyless and dull. They won’t even recognized that their state of mind is abnormal.

I don’t know the ins and outs of the brain chemistry behind sadness, trauma, and endogenous depression. I DO feel uncomfortable calling them all same thing, though, as well as pathologizing “sadness”. It would be normal to feel extended periods of sadness to many traumatic events, and by calling it “depression”, you are saying that that response is NOT normal, that the normal response would be something else. If my house burns down and I lose my job and I am disowned by my family all on the same week, what would be the normal response? Happiness? How long is the “normal” length of time for someone to be sad in this situation? A few days? A few weeks? Just how “sad” can I get away with being without being labeled as “depressed”? If I cry everyday for a half an hour, is that bad? Am I depressed just because I don’t want to hang out with the fellas while dealing with all of this?

I would guess that someone who says they are situationally depressed but reports never feeling sadness is not suffering SOLELY from the effects of a situation, but that the situation combined with pre-existing brain chemistry are interacting with each other to produce a person who has a maladaptive response to emotional stress. This is probably much more common than falling into major depression JUST because of a situation.

That is not to say that endogenous depression does not have a “sadness” component. But often times, a person who has been identified as being depressed for this reason will not know why they are sad. They may report having low self-esteem, but cannot really articulate why they feel this way.

But as I said earlier, I am not a professional, and my only experience with depression has been my own and the knowledge I have cobbled together from reading about it and asking questions from my therapist.

13

So let me ask you again, a little more clearly; a person experiencing depression that is brought about by some tragic life event and showing all the symptoms you’ve described that are the criteria for situational depression that has failed to “snap out of it” or respond to attempts to be “cheered up”, what type of depression does this person suffer from?

14

If you can be “cheered up,” or make yourself “snap out of it,” it’s not clinical depression. It may be very deep sadness. But sadness is not an illness. And depression is not a matter of attitude. When you are just sad, you may “feel” depressed – even very depressed, but you don’t “have” depression.

Different people can have the same illness and react with different symptoms. And the same person can have different symptoms at different times during her or his life. Weight gain and weight loss are both signs of depression. So is a change in sleeping patterns.

You cannot will yourself out of depression or out of the state of confusion that you may find yourself in. There were times when I would cry when I had depression and break out in a cold sweat and couldn’t stop shaking. There were other times in my life when I had depression that was so bad that I was numb and could not cry. I felt empty and removed from any emotion. It was the most debilitating illness I have ever had. In my case it never completely goes away, but medication makes a big difference. I also had the world’s best therapist.

I am not a professional either. But I have had experience with my own depression since my late teens. That’s about fifty years. I agree with the OP in general. Once brain chemistry gets involved, I think that medication is worth a try. It doesn’t always work. At any rate, the right therapist can be very helpful. Sometimes it takes a while to find the one who is just right.

15

I’d say the cause is secondary if they are meeting all the criteria for clinical depression.

But I think that’s key.

Meeting the criteria for clinical depression.

Simply being sad for an extended period of time does not mean “clinical depression.” It may be depression, but not in a clinical sense. One has to meet certain cognitive, physical, and emotional criteria to get this label. Most reactive depressive episodes are, IMHO, just extended forms of sadness. But not clinical depression. If my heart were broken for a long time, I would think it would be unwise to take medication for it, even if–at least on the surface–I looked like a depressed person. Taking medication in such common situations will not help me cope with future emotional donkey-punches. It will just speed up a recovery that is inevitable.

The cause is important when treatment is being considered. If someone is showing signs of clinical depression but they know it can be traced to a traumatic event, then talk therapy may be the right treatment of course before going with drugs. However, if someone has a long history of dysthymia that then descends into a major depression, and talking doesn’t seem to be effective, then I would think drugs may be called for ASAP.

Reaching for medicine FIRST regardless of the cause is a mistake. To make sure that an individual is really experiencing a chemical imbalance, it might be wise to let them go awhile without medication and try to work out their distorted cognition/emotional problems first. The failure of improvement, and even the worsening of the conditioning, may be all that it takes for the person to “get” that they really have a problem and that it is indeed a chemical one. That was how I was able to distinguish my personality from my depression. I went almost a year without drugs while doing the therapy thing until my symptoms got so bad that I could no longer be in denial about it. My therapist observed the decline and was there to talk me through it, but silently waited for me to say, “Hey, I think I need to go to the doctor now. I’m ready.” I had tried drugs previous to that but because I didn’t believe I had serious problems, I was not diligent about taking them (I was the in-denial depressive…the one who had to be constantly lectured to about how abnormal I was behaving and thinking). Also, the side-effects were so awful that I thought it just wasn’t worth it. I could tough it out on my own, right? For me, it was almost like I had to hit rock bottom before I could really get it.

I do not think people who are reacting to recent, non-repressed psychological trauma go through this struggle to such a degree. Their pain is much more on the surface and in their face, so many do not don’t go through a “I’m not depressed, dammit!” phase. Which means their cognition probably does not become as distorted as someone who has endogenous depression. I don’t know if this is a by-product of underlying brain chemistry differences or duration spent in the condition or what. And as Zoe said, everyone’s depression is different, and it manifests itself differently even in the same person. I have (was) diagnosed with atypical for form of depression (the melancholic kind characterized by agitation, lack of appetite, and emotional deadness), so that’s where my experience lies. I have never experienced anything remotely close to classical depression (crying all the time, never getting out of bed, eating a lot, etc). Those symptoms are so disparate that it suggests to me that there is not the same underlying brain chemistry going on with them. And why should there be? You can have a respiratory problems from a variety of causes, so why wouldn’t depression be just as complicated?