Is depression a disease, and how should we treat it?

[bigfootspartan]

Bfs - is that why the pharma companies have announced cures for diabetes, high blood pressure, cancer, ms, Parkinson's, Alzheimer's, HIV, freaking malaria? Anything? No, but they've totally licked that limp dick problem, with another twenty years of monopoly for the exact same chemical with a marginally extended release! Whooo, the system works!

I respect your opinions, you've always kept it relatively real, but I'm afraid you're falling into that white coat bubble.

Those are some pretty good points and I totally see where you're coming from, before I learned about these diseases in depth I had the same opinion. Take diabetes for example, type 1 and two are essentially opposite diseases but we've made pretty big advances in both. Right now there's a lot of research on type 1 diabetes and islet cell transplants as a cure. Problem is islet cell transplants are like any transplants, the body sees them as foreign so you need immunosuppressants to keep the graft alive. You're stuck with choosing between having a "cure" for diabetes but having the side effects of all these immunosuppressants (which can be pretty brutal) or taking the usually well tolerated insulin but still having the complications of diabetes in the future (eye disease, kidney disease, nerve damage 20 years down the road). With type 2 diabetes you're dealing with insulin resistance. There's drugs like metformin which can decrease the insulin resistance, but in the end unless someone changes their lifestyle drugs can only go so far. If there was a "cure" for diabetes you bet the pharma companies would be pushing it, not only would they make a killing but they'd end up hurting their competitors bottom line which would put them in a position to have the next big "cure" before their competitors could come up with anything.

Basically, if you think about it, the body is in equilibrium when we're born. As things start to get out of line we can try our best to fix it, but by trying to fix things we're inevitably going to make other things pop out of equilibrium (side effects). Parkinsons for example - it's a deficiency of dopamine in the substantia nigra of the brainstem (a very specific spot in the brain). The first med for this was simply a dopamine agonist which fixed the symptoms of the parkinsons but caused side effects of too much dopamine in the other parts of the brain. We saw that problem and a brilliant scientist somewhere made a drug that was more focussed on that one area of the brain (I can't remember the different names of these drugs, I'm not much of a neuro guy to be honest). Then some other brilliant person decided that neurosurgery and an implantation of a pulsing electrode in the substantia nigra might work. The pulsing electrode thing almost looks like a cure, when you see someone turn the electrode on and then off (they get a remote control incase they need to turn it off for some reason) it's like night and day, with it on you can't even tell they have parkinsons. Problem is neurosurgery is pretty risky and most people aren't going to be surgical candidates by the time their 60 or 70 when they develop parkinsons.

Another big problem is that people aren't willing to help themselves. We always learn to treat things first through a trial of lifestyle modification. For example high cholesterol and high blood pressure can typically be managed if someone keeps a good diet that's low in salt and exercises 30-60 minutes 4-7 times a day (not always, there's genetic conditions which cause each of these, but in 99% of the cases lifestyle management could work). Everyone agrees in the clinic that they're going to do these things but in the end they don't. I understand why, I certainly don't get that much exercise or eat very well because I just really don't have the time, and I"m also a bit lazy.

I'll also agree that pharma companies do sketchy things. I already outlined the escitalopram and citalopram bit up there, and there was more questionable stuff that made me angry like the whole Colchicine thing in 2009 (worth a read, really made me angry but then again nothing we could really do). I think a bigger problem however is the "free" samples that pharma companies give out. They will only ever give out samples of drugs they still have patent on. The family physician (who means to do well) will typically save the samples for patients who can't afford the drugs themselves. Problem is that if you stabilize a condition on one of those drugs, once you run out of samples you probably won't want to change to a different class of generic drugs because you don't know if they'll work as well or be tolerated by the patient. Therefore, the well meaning family doc ends up putting people who definitely can't afford the expensive medication on the most expensive medication for their disease. This has been a huge problem and in Canada (or at the U of C anyways) the school did a great job of bringing this to students attention so we don't fall into that problem when we're out practicing. We actually had a whole ethics class which taught us how pharma companies try to influence physicians and how to stay relatively bias free from their marketing.

Funny you brought up the Viagra thing. Believe it or not Viagra (and the other ED meds) are actually super useful in other situations too. They cause blood vessels to dilate so we use it as a first line treatment in people with pulmonary hypertension. Made me have a good laugh and then a second take when I did my NICU rotation, half the kids there were on Viagra, and it took me a little bit to figure out why the hell a 28 week preemie would need that

Personally I look at big pharma as a necessary evil. They definitely do sketchy things and they most definitely have some pretty questionable ethics. But if you look at the diabetes thing again, without big pharma we'd only have the original insulin which is short acting. Even with that insulin people with type 1 diabetes had extremely shortened lifespans. With the research behind long acting basal insulin we can mimic the bodies natural insulin patterns so that the complications of diabetes are 20-30 years down the road instead of 5 years down the road.

Also, contrary to popular belief, pharma can't "bribe" physicians with holidays or cruises (at least in Canada). The most the Canadian government lets them do is give us free lunch while they give us free samples and brochures about whatever new drugs there are. I'd also say that the majority of family physicians I've worked with do work on preventative healthcare (in fact, the family medicine program is being sold to us as being "specialists" in preventative care). Problem is that preventative care can only get so far and it requires co-operation on both ends. Sure over prescribing and over diagnosing occurs and I wish it didn't. I'll probably over prescribe some things at some point in my career too, but I think it's important to remember that most physicians really do just want to help in whatever way we can, no one goes into medicine thinking "I'm going to go out there and prescribe the shit out of all the meds I can so that the whole population is medicated for things they don't need."

[test_recordings]

While they can`t bribe you in Canada, they can definitely so it in the UK and the USA. I actually found it very hard to get a non-pharmaceutical-based treatment for ANYTHING in the UK so I had to go research what the process was myself and tell the doctor to do it

Research outlining how the mechanism of antidepressants is not understood: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3368202/

Just because humans know how to make something happen doesn`t mean we know how it`s done.

[nowaysj]

@Bfs: True, true, agree w/ parts, but also have issues with some of that ^ reasoning. But the bottom line remains, the most profitable industry in the US is producing little substantial innovation, AND those profits are solely derived from granted monopolies.

[Mason]

Pharma in us is the most profitable industry, and they can't solve any of these riddles? Sorry, not buying. I appreciate the complexity, but the will is not there. We, as a people, bestow a monopoly on these companies, and are not receiving a collective return.

While i understand what your saying, you can't just throw money at something like cancer and expect to find a cure, nor can you will it to go away. That's like whoever you work for paying you three times as much and then complaining that your not producing work three times as good. Also at the end of the day what people seem to forget is that these companies are companies and so there incentive is to make money, however immoral you may see that as, if it wasn't for their large profits no drugs would be researched and nothing would be cured. If a company did find a cure for cancer and then gave it away for free or cheaply, as i'm sure people would say is the right thing to do, the companies would lose billions and probably thousands of people would be unemployed.

[kay]

There is of course also a big crisis going on in big pharma at the moment. Bringing in too many bean counters at the board level has pretty much harpooned most of their r&d capabilities. There are actually going to be relatively few classes of completely new medication lines coming out in the next decade.

And I think there is also the growing consensus that we still simply do not know enough about how everything interacts in humans well enough to deal with side effects or hidden symptoms that don't become apparent until the primary effect goes away. There has been an increasing momentum building up towards personalised medication tailored towards specific individuals. But it's still very early days for that.

[herbs]

1) All of the above.
2) Self medicate with MDMA.

[travis_baker]

this thread should be called- is depression a disease, and should i wear it?

[nowaysj]

That's like whoever you work for paying you three times as much and then complaining that your not producing work three times as good.

As a lover of hyperbole, I applaud you!

I think it is more like your boss coming to you and saying I pay you three times what I pay other employees and you produce one third the value, why should I not fire you?

Also at the end of the day what people seem to forget is that these companies are companies and so there incentive is to make money, however immoral you may see that as, if it wasn't for their large profits no drugs would be researched and nothing would be cured.

Am going to reiterate for like the tenth time, it is not the fact that these companies are making a profit, it is that this is the most profitable industry, and those profits are solely based upon a gifted monopoly, and while that monopoly is producing a minor amount of innovation, it is no where near enough to justify that level of profit.

Solutions to this are end pretextual patent extensions, forcing these companies to reinvest their (unparallelled) profits in R&D (as the system was initially designed), and develop a tiered duration patent system with the longest patents bestowed for the most socially useful drugs, incentivizing the industry to actually work towards cures to diseases that plague us, instead of just boner pills. And finally, the federal government should be allowed to enter the marketplace. Without the need to pay 20% in dividends to shareholders annually, I'm sure the gov could innovate beyond the "free market" we have today, producing greater social benefit, at much lower cost.

[hugh]

I was feelin depressed as shit today, I hate my fucking job

[Sexual_Chocolate]

1) All of the above.
2) Self medicate with MDMA.

if only it was that easy

[kay]

That's like whoever you work for paying you three times as much and then complaining that your not producing work three times as good.

As a lover of hyperbole, I applaud you!

I think it is more like your boss coming to you and saying I pay you three times what I pay other employees and you produce one third the value, why should I not fire you?

Also at the end of the day what people seem to forget is that these companies are companies and so there incentive is to make money, however immoral you may see that as, if it wasn't for their large profits no drugs would be researched and nothing would be cured.

Am going to reiterate for like the tenth time, it is not the fact that these companies are making a profit, it is that this is the most profitable industry, and those profits are solely based upon a gifted monopoly, and while that monopoly is producing a minor amount of innovation, it is no where near enough to justify that level of profit.

Solutions to this are end pretextual patent extensions, forcing these companies to reinvest their (unparallelled) profits in R&D (as the system was initially designed), and develop a tiered duration patent system with the longest patents bestowed for the most socially useful drugs, incentivizing the industry to actually work towards cures to diseases that plague us, instead of just boner pills. And finally, the federal government should be allowed to enter the marketplace. Without the need to pay 20% in dividends to shareholders annually, I'm sure the gov could innovate beyond the "free market" we have today, producing greater social benefit, at much lower cost.

The majority of the newest advances in medication are all coming through from universities and research institutions at the moment though, not big pharma. Unfortunately, they have a habit of spinning them out into start-ups, which inevitably get bought up by big pharma 3-5 years later.

[nowaysj]

Exactly!

[kay]

The problem really is that small companies can rarely get the capital/finances together to pay for the horrendous amount of (flawed) drug trials. It's a real barrier to new entrants to the drug supply market, whether research institutions, charities, governments or otherwise.

[travis_baker]

1) All of the above.
2) Self medicate with MDMA.

if only it was that easy

man good food is so important

[Jizz]

especially in the developed world i think technologys also partly to blame, with all this advancement it creates a seriously competitive environment, encourages people to be even more individual and each-to-their-own than ever before... People who are genetically of a less happy disposition nowadays feel more alone and alien than previous generations; back in the day anyone who says depression is a disease would be seen as crazy, today we have enough depressed people to actually have discussions about it lol

Romance barely exists today, when you can just tweet ur new gal wenever u miss her xxx, let the world know that you're not alone... People are just a lot more prone to get depressed cos there just isnt as much to look forward to in life today. Depression is alive and well, feeding off these loveless people along with some 9-5 victims and people who realize how pointless their existence is if you look at the bigger picture


I'm quite happy with my life though, no clue where all this negativitys coming from lool

[Electric_Head]

It seems loads of depressions stems from being alone or am I reading into it too much?
Some of you need to find peace within yourself, you'll start enjoying time alone.

[test_recordings]

It seems loads of depressions stems from being alone or am I reading into it too much?
Some of you need to find peace within yourself, you'll start enjoying time alone.

It`s also not letting go of negativity, and not necessarily chasing positives at that.

I also have the best idea for killing big pharma scams: independent testing. I`m not against them turning a profit as long as it`s worth it for everyone involved, not only the recipient but also the people they know and others paying for their treatment. Most profit of big pharma companies is through marketing of substandard treatments for an otherwise unjustifiable cost, indepedent testing would kill this off because then doctors would be able to make an effective CLINICAL judgement (or just having the options narrowed to whatever`s useful).

A lot of testing is currently carried out in very unnatural conditions with carefully selected participants that uncommonly have certain specific disease characteristics unrepresentative of most patients (who will most likely have co-morbid diseases in an uncontrolled environment). Independent testing in more natural conditions would give a more accurate assessment of a treatment`s effectiveness.

Also, non-pharmacological treatment is probably going to be more effective in the long run in giving them the tools they need to manage their problems themselves. It has been well documented since the start of `standardised` diagnoses and pills for everything that they can delay recovery as they encourage people to adopt a passive, patient-as-receiver role and so do not try to make themselves better. I will try dig the research out but I have seen it myself with my friends and some are being held down with unnecessary diagnoses or the treatment of such.

[butter_man]

It seems loads of depressions stems from being alone or am I reading into it too much?
Some of you need to find peace within yourself, you'll start enjoying time alone.

All the lonely people and that, the friends of mine who are depressed are part of a large circle of people and have a fair bit going for them. On the surface they seem great but look a little deeper and...

Also, i read earlier that a psychiatric unit is the benchmark that all sadness should be checked against. I think alot of people suffer quietly and only open up round people with similar problems or friends with same thing. Alot of people might not understand and give them one of the many wishy washy self help philosophies or try and psyxho analyse and fix the problem when, even though they mean well, is annoying and patronising as fuck.
if theres an answer out there to fix it im sure they are looking for it, its not something you bring out the bag to trump people in woe stories. Its with you everyday from the second you wake up till you pass out. Somedays are easier than others, somedays u forget slightly, u might even be convinced its gone for good sometimes but no..

[butter_man]

It seems loads of depressions stems from being alone or am I reading into it too much?
Some of you need to find peace within yourself, you'll start enjoying time alone.

It`s also not letting go of negativity, and not necessarily chasing positives at that.

from my limited experience, choice doesnt seem to be an option. You cant escape ur head like u cant escape this world. You can read techniques, philosophy, excercise, eat healthy, work hard, try and get as much out of your day as you can and its still with you. People with depression arent stupid or lazy (in some cases, maybe but not as a rule) theres a barrier in between them and a normal life, one where you dont have to struggle to do things that comes naturally to others. To think that people would consciously hold on to that barrier, and for what? Top trumps in the woe stories again, pretty weak, or sympathy from family, friends and sympathetic listener, fuck that! Noone likes a mope. Im not saying that some people dont do this just seems an insult to people who suffer in what seem unnecesarrily.

[butter_man]

Last point, for today at least.


The medication ive come into with worked sumwhat. Dips into depression and anxiety where rare and a healthy routine could be maintained for as long as the tablets were taken. After a while though you notice its like looking through a lens. It looks like the world appears to be everything it was but its different, it doesnt feel the same and whats worse is you dont feel as if you experiencing first hand. Thats a scarey thought, ur changing into someone who doesnt feel like you. How long can you go on until u dont recognise u or who wud need to recognise as ur not u who needs to be recognised. Do u travel down that path into the darkness and leave who u know behind. Or stop taking them and grit ur teeth.