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

[Sexual_Chocolate]

I think depression is or can be in some ways all of the things you mentioned wub. Depression has many faces and many causes. Sorrow over loss or change is much different than clinical depression. Not in symptom but in the physical response of the body and mind. Therefore any treatment would need to be on a case by case basis. Done by a mental professional who has taken the time to understand the genisis of the patients conciousness. There are many helpful ways to treat and alieviate a persons depression. Drugs, be it prescription of black market are almost never the answer to depression. They can make the symptoms intensified, Leading to further depression and possible suicidal thoughts. The most universally helpful and safe treatments for depression are: keeping a journal of happy or positive thoughts and experiences. Adopting a pet. Creating art or finding a hobby that brings joy. I feel like a lot of people suffer because they cannot understand their own mind. The human mind is a powerful super computer and keeping it running effeciently and properly requires maintenance. All those suffering from depression would do well to look into neuroscience and the workings of the mind. Learning about how wonderful the mind is and how much potential we all have should inspire hope. Focus on the positive and try not to let the negative weigh you down. Think positive and you will feel positive. When you feel positve others pick up on that and they will feel positive. Creating an Exchange of positive thoughts and feelings. Happiness is contagious, unfortunatley the likewise is also true. I cannot overstate the importance of thinking positive and doing positive things that bring joy. Doing so is the best treatment for depression or simply feeling down.
My thoughts and opinions...Take them as you will.

whats depressing is trying to read a massive brick of text with no breaks in it.

[test_recordings]

Actually, if you read the evidence, it's very conflicting. But based on personal experience with psychosis, mania and depression and experiences with relatives and other people who have it, it makes the most sense.

There's even some recent evidence that suggests that schizophrenia and related disorders are one end of a spectrum and autism spectrum type disorders are on the other end of that spectrum. And that allll mental illness falls between each disorders. And that we can get better at predicting both types of disorders even in the womb and possibly cure them.

Cure them in the womb? Are you nuts? What about the stuff that happens outside the womb that can`t be predicted?

You might as well create a horde of zombies, that is essentially what you would be doing.

[bigfootspartan]

1) What is depression? Is it a disease? A mental disorder? Biochemical imbalance? A brain dysfunction? A psychological syndrome? An existential or spiritual crisis?

2) How should be depression be treated and handled, both by the individual and society as a whole?

1) `Depression` is an overarching term for a set of SYMPTOMS that has a multitude of explanations. It appears that the drug companies fudge the reasons behind it to try picture it as a homogeneous, pervasive condition to sell a one-size-fits-all drug to `alleviate symptoms`. In reality it could be any of the reasons mentioned, or even more and then some combinations of them too.

2) Depression should be treated holistically, taking in to consideration a person`s entire life and environment. Society should try to help the individual as much as the individual should help society.

Anyone interested the whole story of how depression became a clinical diagnosis in the last 100 years should check out the statistics for drug trials first, and then the history of the diagnosis to see how it`s been constructed...

Was trying to get to the end before commenting, but just had to pipe up on this because it seems to be quite a common misconception. I'll also say that I'm certainly not an expert in this, I haven't even done my 6 week core rotation in psych, but I have finished a 2 week elective in community psychiatry, so I'll try to give that point of view.

1) Depression most certainly is a diagnosis, although I think the definition is not all encompassing enough yet. Currently the DSM-IV criteria for diagnosing depression can be found here: http://www.ncbi.nlm.nih.gov/books/NBK64063/ . As you can see there have to be 5/9 symptoms for at least a two week stretch. Furthermore it is essentially a diagnosis of exclusion in the sense that you have to exclude any medical causes (like endocrine things). I would say that the more common disorder people have would be "adjustment disorder" which is worth reading about.

People with "typical" depression actually are quite similar when you do full interviews. Although there are 9 clinical criteria the one that always sticks out to me is anhedonia (not receiving any pleasure from things that used to be pleasurable). Not every depressed person is suicidal, and not every suicidal person is depressed (I'd actually argue that most suicidal people I have seen actually have "Borderline Personality Disorder" more than depression).

2) Depression is actually treated holistically (I also hate that goddamn word because people throw it around without having a clue what they're talking about). In Canada psychiatrists look at psychiatry in the bio/psycho/social model. This is also demonstrated in the 5 axis model:

Axis 1: Psychiatric diagnosis
Axis 2: Personality disorders
Axis 3: Medical disorders
Axis 4: Social Factors
Axis 5: GAF

The medications that we use covers axis 1. Axis 2 is essentially a permanent disorder, meds can help some people with cluster C traits, but for the most part the only thing that'll help is cognitive behavioural therapy from a psychologist. Axis 4 is looked after more by social workers whom work extremely closely with psychiatrists. Axis 3 is usually the family doctor/specialists role to work on. Axis 5 is essentially your responding variable, you measure it as your patient gets worse or better (this is also the bane of my existence, a 100 point scale/score that I could never get right according to my preceptor).

Overall, it's not uncommon to see people up here with interdisciplinary teams of 3-5 people. People who say psychiatrists treat with a "take this pill and see what happens" attitude have either had terrible physicians or are simply ignorant of the situation. Of course not everyone requires a social worker or psychologist for CBT, but any psychiatrist worth his salts definitely assesses for this even if people don't realize it.

[bigfootspartan]

I think socialisation has a lot to do with it or at least did with hers. A night out with friends would make my ex a different person for the whole week, but the longer she'd go without, the less she'd want to go... her depression had roots in a teenage trauma though; the only way to get over it was counselling - she had to pick through all the issues in her brain like a knotted ball of wool until they unravelled into something she could make sense of. It's a slow process.

BNanni lent me a really good book on mental illness - depression isn't one of the main themes, but it comes up. One of the most eye-opening bits for me was the current generally accepted method of diagnosis. We don't match symptoms to treatments, we match conditions to drugs... you try one drug, it doesn't work, you try a second drug, it doesn't work, you try a third drug, it does work... you have condition three! We're still babies at this area of medicine, it's a little embarrassing.

I agree with the first bit, a big strategy is trying to get people out socializing. That's where medication can really help, especially if someone has an anxiety component to their depression. It's not uncommon for depression to travel in a pack with OCD, panic disorder, social anxiety disorder and generalized anxiety disorder and treating these can help someone get out there.

The second bit I actually completely disagree with. I've never met a single psychiatrist who says "lets try what works and then we know what disorder you have." Sometimes it's hard to tell between depression and bipolar type 2, and sometimes the only way we find out is if someone goes into a manic episode from an anti-depressant. But from the history you should most definitely be able to make the diagnosis (or multiple diagnoses) and have an idea of what medications could be beneficial.

With that said, different medications work better or worse for some people, even if they're within the same class of meds. For example, I met one patient who had tried 3 different SSRIs and an SNRI before he finally settled on the newest SNRI (Symbalta). When I saw him he was doing really good, but he described what his life was like before having meds and after finding the right med.

Things like bipolar and schizophrenia become even more complicated since the meds typically have side effects that are even less tolerable (tardive dyskinesia with the 1st generation anti-psychotics was terrible) but typically by playing with the different meds within the classes it'll work. But I've never ever ever seen anyone get treated with an SSRI, then an anti-psychotic, then a mood stabilizer and finally a benzo and have a psychiatrist say "wow I guess you had anxiety all along." That would just be completely irresponsible medicine.

[Soiree]

As all of you know I suffer from Bi-Polar disorder, I struggle with depression as a result of manic behavior.
I'm sorry for all the insanity in posts past, Bi-Polar isn't to be mixed with too many drugs.
Taking that 2ce before the kode9 show was a big mistake, and really fucked my life up.
Depression is a personality disorder, and should be treated with healthy diet, exercise, and good company.

[bigfootspartan]

In my opinion, it is a profiteering product of pharmaceutical companies. The drug based medical world is desperate to A) give a definite name to a group of symptoms, and B) create a drug tailored to that name.

Medicine - Oh shit, the fire alarms going off! Quick, spray the extinguisher at the fire alarm...

Sorry for the triple post, I'm pretty late on this train and pretty shitty at quoting lots of different people within a single post.

A) Of course, that's essentially a requirement in medicine. Take pre-eclampsia for example. For someone to have pre-eclampsia they have to have proteinuria, hypertension and be pregnant. There's a constellation of symptoms. But we have given this a name because it gets tiring to say "they symptom a and b and c and d so we're going to utilize the treatment pathway for symptom a and b and c and d".

B) Isn't that the whole point of medicine? Young people always bash medicine because they're essentially pretty healthy but until they've seen how much it can help they typically bash medicine because it's the cool thing to do. I agree to a point that pharmaceutical companies focus on profit, but then again they're a company that's the whole point. There's definitely stories about some pharmaceutical companies that make me cringe, but for the most part they play a critical role in society.

That last bit is ridiculous. Why do you think we treat hypertension or dyslipidemia? It's not because we like to see low numbers, it's so we can prevent stroke, vascular disease, erectile dysfunction etc.

Not to get in a pissing contest, but I remember you're a chiropractor, and this is a common thing I hear from them. I'm not sure if chiropractor school teaches you guys to bash physicians and medicine in general but I'm just curious why this seems to be such a pervasive attitude chiropractors have?

[Mason]

The reason pharmaceutical companys focus on making money is because it costs them so much to develop drugs. It will cost them about $7,500,000 to get a drug to clinical human trials and if that drug then has undesirable side effects in even 10% of patients, it will be scraped and that $7,500,000 will have been completely wasted. This is why some of these companys are now having to shut down or even focus on other things, especially in the U.K. To be honest i would rather the companies trying to make drugs to better our lives are making money than Apple or some other bullshit company.

[Terpit]

I think depression is or can be in some ways all of the things you mentioned wub. Depression has many faces and many causes. Sorrow over loss or change is much different than clinical depression. Not in symptom but in the physical response of the body and mind. Therefore any treatment would need to be on a case by case basis. Done by a mental professional who has taken the time to understand the genisis of the patients conciousness. There are many helpful ways to treat and alieviate a persons depression. Drugs, be it prescription of black market are almost never the answer to depression. They can make the symptoms intensified, Leading to further depression and possible suicidal thoughts. The most universally helpful and safe treatments for depression are: keeping a journal of happy or positive thoughts and experiences. Adopting a pet. Creating art or finding a hobby that brings joy. I feel like a lot of people suffer because they cannot understand their own mind. The human mind is a powerful super computer and keeping it running effeciently and properly requires maintenance. All those suffering from depression would do well to look into neuroscience and the workings of the mind. Learning about how wonderful the mind is and how much potential we all have should inspire hope. Focus on the positive and try not to let the negative weigh you down. Think positive and you will feel positive. When you feel positve others pick up on that and they will feel positive. Creating an Exchange of positive thoughts and feelings. Happiness is contagious, unfortunatley the likewise is also true. I cannot overstate the importance of thinking positive and doing positive things that bring joy. Doing so is the best treatment for depression or simply feeling down.
My thoughts and opinions...Take them as you will.

What if you're so depressed you believe you deserve it and don't want help?

Well I am no mental health professional and shouldnt give anyone advice. However its all a scale if you feel like your going to hurt yourself, please seek help. Suicide doesn't just effect the person who commits it, same with self harm. Feeling like you deserve depression is tough and I can say that no one deserves to feel down all the time. Every one deserves some joy. Forgive yourself for whatever you think makes you deserve it, make peace with yourself. There is so much joy out there, maybe you just need to change your perspective to see it.
Think positive = feel positive! ...that's corny as hell...but I believe it to be true.

I wasn't talking about me

[Genevieve]

Actually, if you read the evidence, it's very conflicting. But based on personal experience with psychosis, mania and depression and experiences with relatives and other people who have it, it makes the most sense.

There's even some recent evidence that suggests that schizophrenia and related disorders are one end of a spectrum and autism spectrum type disorders are on the other end of that spectrum. And that allll mental illness falls between each disorders. And that we can get better at predicting both types of disorders even in the womb and possibly cure them.

Cure them in the womb? Are you nuts? What about the stuff that happens outside the womb that can`t be predicted?

You might as well create a horde of zombies, that is essentially what you would be doing.

Schizophrenia and autism HAPPEN, they're not brought on by something. You don't just get autistic later on in life, autistic people are born with a different nervous system (either more or less sensitive than most people's). Schizophrenia too, is an abnormality of the brain. In fact, schizophrenics have trouble with tracking moving objects with their eyes, this even before the first symptoms pop up. Also hinting at a difference in brain structure.

[Samuel_L_Damnson]

its probably drugs.

[SCope13]

Really good discussion going there for a while...I was learning a few things.

Def gonna check out that book you posted Magma, sounds really interesting.

Also, I agree EF is a giant fucking tnuc, but I don't think he should be banned just because he's a tnuc. Idk, maybe I'm wrong here.

[esfandyar]

so many feels.

[test_recordings]

Actually, if you read the evidence, it's very conflicting. But based on personal experience with psychosis, mania and depression and experiences with relatives and other people who have it, it makes the most sense.

There's even some recent evidence that suggests that schizophrenia and related disorders are one end of a spectrum and autism spectrum type disorders are on the other end of that spectrum. And that allll mental illness falls between each disorders. And that we can get better at predicting both types of disorders even in the womb and possibly cure them.

Cure them in the womb? Are you nuts? What about the stuff that happens outside the womb that can`t be predicted?

You might as well create a horde of zombies, that is essentially what you would be doing.

Schizophrenia and autism HAPPEN, they're not brought on by something. You don't just get autistic later on in life, autistic people are born with a different nervous system (either more or less sensitive than most people's). Schizophrenia too, is an abnormality of the brain. In fact, schizophrenics have trouble with tracking moving objects with their eyes, this even before the first symptoms pop up. Also hinting at a difference in brain structure.

How do you learn this stuff? Do you do comprehensive reviews on all the available evidence or just read internet news and article abstracts? I`d love to see where you get what you`re reading so I can check it out but everything about schizophrenia and autism resulting from different physiology has fallen pretty flat in the past few decades, multiple times at that. Whatever you`re basing that judgement on will be pulled to pieces quietly in 5-10 years.

The DIAGNOSES happen and every case isn`t necessarily identical, the categories are over-inclusive and don`t take in to consideration contributing factors. Take schizophrenia, you can have 15 different individuals with different symptom combinations but the same diagnostic label. It`s useless for establishing individual needs to actually get people back on the right track!

The reason pharmaceutical companys focus on making money is because it costs them so much to develop drugs. It will cost them about $7,500,000 to get a drug to clinical human trials and if that drug then has undesirable side effects in even 10% of patients, it will be scraped and that $7,500,000 will have been completely wasted. This is why some of these companys are now having to shut down or even focus on other things, especially in the U.K. To be honest i would rather the companies trying to make drugs to better our lives are making money than Apple or some other bullshit company.

Actually, companies spend very, very little on making anything new or novel. The marketing budget for drug companies is several times larger than their R&D expenditure and often they just slightly modify existing drugs just as the patent is about to run out so they can market it as `new and impoved` to maintain sales for little extra cost. Also, drug companies just copy each other to make use of the current marketing trend which is why there are only about 3 main types of anti-depressants in existance. You will also find that a lot of medication`s mechanism of action (i.e. how it works) is unknown and will state so on the information supplied with the drugs.

[bigfootspartan]

The reason pharmaceutical companys focus on making money is because it costs them so much to develop drugs. It will cost them about $7,500,000 to get a drug to clinical human trials and if that drug then has undesirable side effects in even 10% of patients, it will be scraped and that $7,500,000 will have been completely wasted. This is why some of these companys are now having to shut down or even focus on other things, especially in the U.K. To be honest i would rather the companies trying to make drugs to better our lives are making money than Apple or some other bullshit company.

Actually, companies spend very, very little on making anything new or novel. The marketing budget for drug companies is several times larger than their R&D expenditure and often they just slightly modify existing drugs just as the patent is about to run out so they can market it as `new and impoved` to maintain sales for little extra cost. Also, drug companies just copy each other to make use of the current marketing trend which is why there are only about 3 main types of anti-depressants in existance. You will also find that a lot of medication`s mechanism of action (i.e. how it works) is unknown and will state so on the information supplied with the drugs.

Haven't seen their budgets, so can't comment completely on it although I know Phase 3 trials are ridiculously expensive (I remember hearing a general rule of thumb is that each new drug on the market takes approx $500 million to run through Phase 1-3 as well as R&D, don't have a reference since it was just in a lecture). In some cases you're correct, for example citalopram's patent was running out so the pharmaceutical company (not sure which one) released escitalopram which is a purified version with only the medicinally active enantiomer in it. There was a big stink because physicians started prescribing it a ton more (mostly due to free samples) even though the generic citalopram was cheaper.

However, I wouldn't say that having variety within a class of drugs is a bad thing. For example, I've seen people have significant differences in their symptoms between different SSRIs or even the three different SNRIs on the market. Since the chemical structures are different the theory is that they inhibit uptake of serotonin in different areas of the brain (and for example, this is why it's different than MDMA, MDMA is non selective and globally releases serotonin, which is why you get euphoria for a period of time rather than the subtle mood stabilizing effects of SSRIs).

I'd say we actually have a shitload of information about how most drugs work. I'd love to see some examples of where we don't know the mechanism of action if you could provide any, I'm sure there's a few but I'm not really aware of any.

One interesting one is SSRIs for example. Initially it was thought that they worked by increasing the amount of serotonin in some synapses. However, it was found that SSRIs take approx 6 weeks to reach their full effectiveness, even though the serotonin levels should be maximized within around a week. The current theory is that the overstimulation of certain synapses causes a decreased sensitivity in those receptors (which has been demonstrated to take approximately 6 weeks) and for some reason the decreased sensitivity of those receptors seems to be what helps.

But most other medicines we know the mechanism of action. Furthermore we also know how drugs are metabolized and cleared (although this is more in the realm of the pharmacist to be honest). I don't know where these rumours come from, but I'd argue there's not much substance to them...

[Phigure]

highly recommend a book called our daily meds. goes in depth on that sort of thing ^

[SCope13]

highly recommend a book called our daily meds. goes in depth on that sort of thing ^

Sounds interesting, I'll give it a check.

[bigfootspartan]

highly recommend a book called our daily meds. goes in depth on that sort of thing ^

Hmm I'll try giving it a read over the holidays, always like learning new stuff!

[nowaysj]

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.

[Phigure]

bigfootspatan is right about pretty much all of what he said though. cancer, alzheimers, parkinson's, etc are so much more complicated to fully understand and then develop a cure for than something relatively simple like erectile dysfunction.

it's not like universities aren't trying to find cures for those things... they havent because it's fucking difficult, but they are making progress on many of the diseases you mentioned

[nowaysj]

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. Side note: a tiered duration of monopoly based on social utility, makes much more sense than disincentivizing new valuable research by doling out renewed monopolies for the same shit based upon pretextual variations. IMO.