as social animals is to become depressed when isolated. This is a perfectly normal response to isolation.
This programming is one of the factors that makes most of us want to have a fair amount of contact with others.
Bears, by contrast, are not “social animals” They do not have a tendency toward depression when isolated from other bears.
Simply put:
It is perfectly possible to feel depressed, for instance, when you see starving people in Africa on the news, but this is not ‘depression’. Depression is a physiological problem, to do with neurotransmitters (ill get to that) and, to a certain extent, hormones. As Miss Pippi said, people suffering from depression do not feel depressed for any particular reason.
Complicated bit:
Depression is treated with drugs because it is just like any other disease. It is not clear what the real causes of it are (there is evidence of genetic causes ie running in families) but it is known that people with depression have low levels of neurotransmitters (mainly norepinephrine, serotonin, and dopamine). Neurotransmitters are chemicals used in the transmission of signals in nerve fibres. Depression is caused by a chemical imbalance in these neurotransmitters. Antidepressants increase the availability of these chemicals to the body, relieving depression, possibly helping the body recover from the imbalance on its own, allowing the slow removal of the drugs. (at least in theory)
I listed the symptoms of both depression and bipolar disorders since they are both affective disorders. Bipolar used to be called manic-depressive disorder. It can be manifested by the manic features described above, but when the mania is over, the person usually has the depressive features. That’s why it’s called “bipolar.” It goes to both extremes.
Hypomania is one of the mood swings of somebody with bipolar, which is not as extreme as mania. It’s “under-mania.”
“Depression is caused by a chemical imbalance in these neurotransmitters”.
Maybe, maybe not. The drugs used for depression act on these neurotransmitters. The fact that lack of serotonin, dopamine, norephinephrine CAUSES depression is not that clear. It’s a useful model. But you might as well say that urinary tract infections are caused by a lack of antibiotics.
“Too many behavioural therapists [don’t prescribe medications]”
I agree. The risk-benefit ratio of the new medications is quite good. But many anti-depressants do have annoying side effects, especially on vision, libido; possibly blood cells or heart rhythm. Sometimes depression is a ratinal response and grief counselling is more appropriate. Personally, I would give most people a trial of medication. But just giving someone some pills is not a panacea either, in most cases. Giving EVERY patient diagnosed as depressed pills is irresponsible, just as not using efficient and well-tolerated medicines can be irresponsible when the benefits outweigh the risks.
Tedster: At any given time, between 2% and 4% of Americans suffer from full blown clinical depression. During the course of a year, 17.5 million Americans suffer from clinical depression. I think you can say depression is “normal.” Not quite as normal as the common cold, but close.
Frinkboy: There are depressed people. And there are manic people. There are some who are both (not at the same time) and they used to be called manic-depressive. A comprehensive list of symptoms is here: http://www.ndmda.org/depover.htm
Everybody: Careful with labels. Their meaning changes rapidly. Even psychiatrists often don’t know what the other one is talking about. Psychiatry is paradigm shift on full auto. Through history, the word “schizophrenia” underwent at least three changes of meaning (and it definitely does not mean split personality). The diagnosis du jour, “bipolar disorder” is often psychiatrist talk for: “I have no idea.” It actually means manic-depressive. But there are lots of people who go from stable periods to depressed poerios and back, and who are labled “bipolar.”
Dr. Paprika:
It’s good that you are bringing up ECT, short for Electroconvulsive Therapy, a.k.a. “Electroshock.” Contrary to popular belief, ECT can be an extremely effective treatment. Due to misuse in the past and other factors, this therapy remains highly controversial. I recommend to keep at least an open mind towards it. To some people, ECT could be the choice between a short and painless (administered under anesthesia) procedure, and a life of drugs and misery.
Atlantic Monthly had an excellent article on the topic http://www.theatlantic.com/issues/2001/02/smith-p1.htm
For both sides of the story, pro and against, go to http://www.ect.org .
Thew trouble of ECT is money. An inordinate amount of money is made with drugs, comparatively little is made with ECT.
I compare depression to diabetes in my mind - diabetes can occur early or late in life, may or may not be affected by the enivironment, may arise through trauma or disease, and can have complications if untreated, including death.
Anyone can spike their blood sugar with the proper type of food, equivalent in this anology to a depressive reaction caused by, say, a death in the family or a loss of employment. But in most folks things normalize in a reasonable amount of time. Trouble is when the blood sugar stays high or the depression never ends. There can be different extremes of these diseases - some diabetes can control their condition with diet and exercise, and some depression can be relieved with a “talking cure” or change of environment. In other cases, the diabetic requires insulin medication and the depressive requires anti-depressives. But giving insulin, no matter how often or in what quantities, is poor diabetes management if you don’t cover dietary modification and monitoring and treament of side effects arising from both insulin and the underlying disease. Likewise, handing out Prozac (or other drug of choice) without dealing with possible environmental triggers or intensifiers of depression and monitoring of conditions is pretty piss-poor mental health practice, however much the drug companies and insurance penny-pinchers would like you to think otherwise.
Sometimes, extraordinary measures are necessary, such as organ transplant for diabetes or ECT for depression. Neither are treatments that should be used lightly, but they can be lifesaving in the right patients when properly used.
And, like diabetes, depression can kill. Even with the best treatment, some people just don’t get better, or having a catastrophic episode.
I came to these conclusions some time after the death of my sister. She had clinical depression for 17 years. Although in many ways a highly functional person who sought treatment more often than not, in the end her mental illness killed her. When I considered how awful I felt for the few months just after her death, and realized that she had spent much of 17 years in a similar state, or perhaps worse state, I became less puzzled by her suicide than by why she survived so long.
ECT is very inaccurately displayed in the movies. Small electrical shocks are often given to cardiac patients with abnormal rhythms; ECT is a very small electrical shock given to the brain to induce a short seizure. Like most modern minor operations, the most dangerous part of it is the anesthesia and not the actual shock.
Does it work? It seems to be very useful in catatonic states and suicidal depression. It was applied to many other populations in the past and does not help most other conditions, except people wth mania who fail other mood stabilizers. It seems to be very helpful in people with parkinson’s disease. Unfortunately, it is underutilized due to its reputation and legal concerns. I don’t know how the finances work in the States, but I suspect it is also unprofitable.
Having nothing to gain from giving my opinion of ECT, I would be hesitant to use it on anyone who didn’t have a very clear indication for it. Use it on a patient who recieves little benefit, and I’d wager everything else that goes wrong becomes related to the shock.
As for suicide, this is no small concern. Up to 35% of manics and 20% of major depressives do kill themselves eventually.
I have often heard references to chemical changes in the brain. How is this verified? Is it verified with each individual or do they make this judgement based upon behaviour?
This PET scan shows changes in brain metabolism (probably glucose) brought about by treatment for depression.
Diagnosis is usually based on behavior.
Some of the posts said that you don’t use anti-psychotic medication for depression. However, depression can reach psychotic proportions, in which case Haldol or other anti-psychotic medication is used. In most cases, depression does not become a psychosis, but witness this lady with post-partum depression who killed her children.
Diagnosis has to be based on behaviour. Measuring blood and urine chemicals doesn’t seem to be that helpful, yet. The drug actions are known through lab experiments. However, the relationship between the biochemistry and clinical picture is complex. It is simplistic to say “Prozac raises level of brain serotonin. Prozac helps depression in some people.” then conclude “Depression has to be caused by low serotonin”. It need not be. We don’t know.
Paprika:
Roger that, based on information received from longterm expert.
Question: “Can’t neurotransmitter imbalance be measured?”
Answer: “It can, to a degree, it is complicated, unreliable and not worth the effort. Currently, the best measuring device is the patient.”
Barbi:
It was me who recommended extreme caution with anti-psychotic medication. It’s a heavy weapon.
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Haldol, Thorazine, even the newer ones such as Zyprexa are termed dopamine blockers, and blocked dopamine is exactly what many depressive patients don’t need. In these cases, condition may worsen. According to http://www.mentalhealth.com/drug/p30-c01.html , “the exact mechanism of dopaminergic interference responsible for the drugs antipsychotic activity has not been determined.”
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We talked about side effects such as dry mouth etc. If you worry about these, then you should be highly alarmed about the serious side effects anti-psychotic drugs can have. With certain patients, anti-psychotic drugs can cause serious and irreversible psychological and physical damage including death. This is well documented, but tends to be played down. http://www.idiom.com/~drjohn/biblio.html and http://www.ninds.nih.gov/health_and_medical/disorders/tardive_doc.htm .
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While depression can indeed reach psychotic proportions, in many patients the psychotic symptoms can and will clear rapidly if the depression itself is properly treated.
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There are people who equate anti-psychotic drugs with a “chemical lobotomy.” http://www.sntp.net/drugs/thorazine.htm
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Catch22 with the above: You don’t know whether you are amongst the group that shows these serious side effects. Only treatment will tell. If the doctor doesn’t watch for the side effects and immediately stops the drug, then you are in serious trouble. If, OTOH, psychosis is diagnosed and the doctor does not treat you with anti-psychotic drugs, then the doctor can be in serious trouble. Add to that a patient who is completely out of it, but who is supposed to give an informed consent to treatment that can kill or damage, and you have the ingredients of a serious mess.
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It is important that your history is known to any doctor treating. If you are delivered to the ER with full blown psychosis, they have no history, and they will focus on the psychosis. If you suffer from depression, you run a higher risk of psychosis. A patient who is in treatment for depression should carry a card which says so, which notes the drugs the patient is on, and which gives consent to the exchange of patient information between your doctor and emergency personnel. It may sound crazy, but in many states a practitioner treating you is prohibited from exchanging patient information withb your doctor. They need your consent. But they don’t have to ask you for it. Even if a family member or friend alerts your doctor, and he contacts the place that has you, they can simply refuse to talk to him.
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Note the qualifiers such as “some,” “many,” “can,” “may” etc.
http://www.sciam.com/1998/0698issue/0698nemeroff.html
An article explaining depression and bipolar disorder and the chemistry involved.
Many theorize that depression is an addaptive mechanism which has become increasingly maladaptive in modern life. As an analogy consider how maladaptive the fight or flight reaction can be when driving a car.
In a primative society depression could simply be a mechanism for lower status members to avoid conflict through supression of desires while not overly interfering with the day to day necessities of life. In a hunter gatherer lifestyle depression could provide contentment rather than misery. In modern life depression creates far more difficulties dealing with day to day demands creating more stress, feelings of hopelessness and deeper depression.