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

[Samuel_L_Damnson]

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

Imagine a dodgy comedown + actual depression. that would suck.

[bigfootspartan]

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.

From my point of view this is pretty much spot on. The trouble with testing in more "natural" conditions is that:

1) Some populations are exceedingly hard to do randomized controlled trials on (i.e. pregnant women and children) due to ethics.

2) When you initially do a trial it's hard to know whether something is a side effect or not if the population isn't standardized to a point. Also, if you have a very varied population you'd need a larger population in order to ensure the control and the trial group are roughly equal. For example, if you have a trial of a drug that's supposed to reduce heart attacks, if you let in anyone and everyone you wouldn't know if it's better for primary prevention of heart attacks (preventing the first episode) or for preventing secondary events (preventing subsequent heart attacks. Might not seem like an important distinction, but it really changes our management. For example, statins have a Number Needed to Treat of 20 for primary prevention but only 4-5 for secondary prevention.

I guess what I'm trying to say is that focussed trials are great as they allow us to personalize medicine a bit more, but the rather large downside is that we're left extrapolating evidence to populations which may be wildly different from the original trial group. It would be nice to have both types of trials, but this gets expensive really quickly. I really don't know what would be a better option to be honest.

The second bit is also spot on from my point of view. Getting patients to take responsibility of their own health is something that we often try for but haven't achieved yet. Some things we've done are pretty good (i.e. getting asthma patients to do home spirometry actually gives us no useful information, but we still ask patients to do it because it forces them to think about environmental control as well as gives them a baseline marker to try to "improve") but for the most part it's lacking. A family medicine lecture we had presented the evidence I think you're trying to get at, I'll see if I can dig it up. Essentially there's a new model of healthcare trying to start a dialogue between physicians and patients so that the "patient role" no longer exists, instead it's more of a "lets see what areas of your life we can modify to give you the best out of your life."

Then again, that requires patients to be willing to remove themselves from the patient role and into the drivers seat, and from my experience there's only a certain subset of patients who are willing to do this (usually the higher SES patients without too many comorbidities). The patients with 3+ comorbidities usually aren't down for this type of care unfortunately.

[Sonika]

Feel like the ones that are always talking about it might not have it

Interesting view, considering the number of mentions of depression that there are on here from various users.

yeah I'd tend to agree


a friend of mine's dad killed himself suddenly because of a very sudden onset of depression (or at least, seemingly sudden). Real depression definitely has a chemical component as far as I can tell.

But I'd agree with garethom that a lot of people who go around moaning about how they have depression probably just have some things that they're not too happy with in their life at the moment and....dare I say it....are possibly seeking attention maybe just a little bit?

idk, trying to formulate my thoughts on this is pretty tough

[bigfootspartan]

a friend of mine's dad killed himself suddenly because of a very sudden onset of depression (or at least, seemingly sudden). Real depression definitely has a chemical component as far as I can tell.

But I'd agree with garethom that a lot of people who go around moaning about how they have depression probably just have some things that they're not too happy with in their life at the moment and....dare I say it....are possibly seeking attention maybe just a little bit?

idk, trying to formulate my thoughts on this is pretty tough

Yeah adult onset depression can be pretty grim. I saw one fellow who was a very high functioning oil exec (full 6 figure, probably 7 figure salary) with seemingly the perfect life (wife was happy, kids were doing great in college) and he said over a period of one week he began having this full feeling of despair, for no reason at all. Going from fully functioning to functioning at the level of a person on disability in 1 wk stuck out in my mind. Interestingly enough there were no feelings of suicidality, just despair and anhedonia (he barely fit DSM criteria iirc).

For the second bit, look up borderline personality disorder, it essentially describes 97% of these people I'd say. They're also the most frustrating type of patient to deal with and can play the physician like a deck of cards most of the time (myself included)

[butter_man]

Feel like the ones that are always talking about it might not have it

Interesting view, considering the number of mentions of depression that there are on here from various users.

yeah I'd tend to agree
a friend of mine's dad killed himself suddenly because of a very sudden onset of depression (or at least, seemingly sudden). Real depression definitely has a chemical component as far as I can tell.

But I'd agree with garethom that a lot of people who go around moaning about how they have depression probably just have some things that they're not too happy with in their life at the moment and....dare I say it....are possibly seeking attention maybe just a little bit?

idk, trying to formulate my thoughts on this is pretty tough

Your still in school. I doubt you know many, if any people with depression.

[garethom]

What makes you say that?

[butter_man]

Fuck knows. Just a hunch. What i should of said was (to the pair of you as your both of the same opinion) that if 97% of the people surrounding you who claim depression are attention seeking then that doesnt say much for ur assosciates. Unless ur in school (like sonika is) where exagerating ur pain is accepted almost expected of you to theatricise (word?) ur troubles.

[Sonika]

fair, but as I said, a good friend of mine's dad killed himself. suddenly. with no warning. there was a history of depression in his family. I'd say that was depression

[butter_man]

My point was that amongst ur peer group, of people may say there depressed when not, making ur understanding of 97% bullshitting true. But within a larger scope (life outside of school, and depending on ur socail circle) u'd realise that that figure is bullshit.

[nowaysj]

I don't know about that one. I recall almost everyone in my high school class as being fairly fucked up. Kids that got into drugs too early (looking away from Sonika), jocks that had fucked up fathers and all kinds of really profound issues with self worth and their (repressed) sexual relationships, loners who just couldn't find a way to relate to other people, I'm leaving a lot out, but... shit was a wasteland. A lot of those people were really really unhappy a lot of the time, and some did not make it through.

[butter_man]

I don't know about that one. I recall almost everyone in my high school class as being fairly fucked up. Kids that got into drugs too early (looking away from Sonika), jocks that had fucked up fathers and all kinds of really profound issues with self worth and their (repressed) sexual relationships, loners who just couldn't find a way to relate to other people, I'm leaving a lot out, but... shit was a wasteland. A lot of those people were really really unhappy a lot of the time, and some did not make it through.

So you disagree with the 97% bullshitting then.

[nowaysj]

Nah, I'm just sayin. Highschool is like the penultimate cauldron in the forge of character, some people get burned.

[butter_man]

Well put.

[wub]

a friend of mine's dad killed himself suddenly because of a very sudden onset of depression (or at least, seemingly sudden). Real depression definitely has a chemical component as far as I can tell.

Could've just as easily been guilt as sudden onset depression - got caught masturbating in a porn theater whilst stroking the spine of a fat young boy, that sort of thing.

But I'd agree with garethom that a lot of people who go around moaning about how they have depression probably just have some things that they're not too happy with in their life at the moment and....dare I say it....are possibly seeking attention maybe just a little bit?

Are there any people in particular on DSF that you would accuse of attention seeking with regards to their claims of depression?

[nowaysj]

got caught masturbating in a porn theater whilst stroking the spine of a fat young boy

Oddly specific...

[Electric_Head]

He only speaks from experience.

[Figment]

Feel like the ones that are always talking about it might not have it

Interesting view, considering the number of mentions of depression that there are on here from various users.

yeah I'd tend to agree


a friend of mine's dad killed himself suddenly because of a very sudden onset of depression (or at least, seemingly sudden). Real depression definitely has a chemical component as far as I can tell.

But I'd agree with garethom that a lot of people who go around moaning about how they have depression probably just have some things that they're not too happy with in their life at the moment and....dare I say it....are possibly seeking attention maybe just a little bit?

idk, trying to formulate my thoughts on this is pretty tough

2 much stand against war for u m8.

if you have the ability to know, you can know people who have depression.

here is one though.. can someone be depressed, but not suffer from depression? or be diagnosed/have depression? (most likely those attention seekers, but i think there is discussion)

[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.

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.

Choice is an option, even if it`s not available to everyone. What I was pointing out is that this option`s never given to many people and any such notion is automatically withheld. It would be nice, and clinically useful, for them to exercise such choice.

[Sonika]

Are there any people in particular on DSF that you would accuse of attention seeking with regards to their claims of depression?

now why would I call out someone like that? I don't want to start any arguments

2 much stand against war for u m8.

touché!

[Terpit]

More cats = less depression