The Profession of Understanding Depression Has Undergone a Major Upheaval

4791043670_f2b094609b_zI have experienced depression for over 60 years as best as I can understand it. I always felt that more activity could make me feel better. So I became an overachiever. I had no concept of less being more. I thought more was more. So I became my own whirling dervish. Round and round I went. Then I found alcohol at the age of 18 in my freshman year of college. What a wonderful release. It removed my need to whirl and whirl. It worked for awhile. And then I started making choices that weren’t in my best interest. I was fortunate to have been raised in a home controlled by alcohol. You know what happens because of alcohol because you see it every time someone drinks too much. It is the same pattern over and over. So I knew I had to quit drinking. And I did quit—in 1976.

But the depression didn’t go away. I struggled along until my 10th year of sobriety when I had clinical depression for two years. I’ve written about that elsewhere here on my blogs. I write about this today to begin sharing all the information I’ve been learning about depression over the last 2 years. I’m not going to do it chronologically but rather repost what I’ve learned from sources I trust.

1.  From  Deepak Chopra, M.D., FACP, Murali Doraiswamy, MD, Professor of Psychiatry, Duke University Medical Center, Durham, North Carolina and Rudolph E. Tanzi, Ph.D., Joseph P. and Rose F. Kennedy Professor of Neurology at Harvard University, and Director of the Genetics and Aging Research Unit at Massachusetts General Hospital (MGH):

The magazine ScienceNews begins a recent article on depression with a blanket judgment: “A massive effort to uncover genes involved in depression has largely failed.” A general reader would probably not feel the shock waves that spread from this assessment. Gene research is always going up and down. That doesn’t change the public’s general sense that depression is being handled pretty well. Billion-dollar antidepressants continue to flourish. Somewhere in the future, better ones will improve the situation even more.

Informed opinion on the subject is very different, however, because the model for depression that has been accepted for decades counts it as a brain disorder, and brain disorders are rooted in genetics. The failure to find the genes involved in depression strongly suggest – as more than one prominent researcher now concedes – that the genes of depressed people are not damaged or distorted compared with the genes of people who aren’t depressed. Alternatively, it may just be very difficult to find genes for a condition that is so pervasive in society today regardless of genetic composition. What follows is another false assumption. The most popular antidepressants supposedly worked by repairing chemical imbalances in the synapses – the gaps between two nerve endings – where the culprit seemed to be an imbalance of serotonin. But serotonin is directly regulated by genes, and some key research indicates that drugs aimed at fixing the serotonin problem either don’t work that way or that there wasn’t a serotonin problem in the first place.

The ScienceNews report doesn’t leave much wiggle room for a laissez-faire attitude on this point: “By combing through the DNA of 34,549 volunteers, an international team of 86 scientists hoped to uncover genetic influences that affect a person’s vulnerability to depression. But the analysis turned up nothing.” Nothing doesn’t mean something.

If the chain of explanation running from genes to the synapses and finally to the pharmaceutical lab is broken, a host of doubts arises. Is depression a brain disease in the first place, or is it, as psychiatry assumed before the arrival of modern drug treatment, a disorder of the mind? The latest theories haven’t gone back to square one. What we know isn’t black and white. There are many variables in depression, which leads to some fairly good conclusions:

• There are many kinds of depression.

• Each depressed person displays their own mixture of causes and symptoms.
• The mental component in depression includes upbringing, learned behavior, core beliefs, and judgment about the self.

2.  From Beyond Meds:  “A doctor who talks sense about the all too frequent use of coercion in medicine”:

There is pressure on doctors to ‘follow the evidence’ even though the evidence may be deeply flawed and biased due to considerable conflicts of interest. Another concern is the fact that doctors are remunerated for doing certain things, which can make it difficult for them to take a truly objective stance of some of what they do.

Patients who dissent and question or refuse treatment are openly scolded. There are many potential examples of this, but mammography and treatment with statins readily spring to mind.

The end result is that patients can end up being exposed to interventions for which there is little indication or evidence of benefit. Worse still, they can feel pushed or cajoled into things that they feel are not right for them…

<snip>

…Particularly in the information age, individuals have much more access to medical information than they used to have. While doctors can be dismissive of ‘Dr Google’ I, for one, am not. The fact is patients often have more time and more motivation to research their health issues and arrive at plausible diagnoses. Whatever insecurities we doctors have about the fact that the patient may have made the right diagnosis (and not us) need to put to one side, I think.

In my experiences, patients are not infallible, but rarely do their ideas have no merit. Usually, they are highly useful. My personal view is that patients should be listened to when they offer their views on the cause of their symptoms. And even if they don’t, my experience tells me that perhaps the most useful questions a doctor can a patient is: “What do you think is going on?” (continue reading here)

3.  From Storied Mind:  “Choices in Healing”:

When you seek out help to deal with depression, you have a lot of choices about what to do, but you might not realize it. If you head to a primary care physician or health clinic, you’ll most likely get a prescription for an antidepressant. Medication may give you exactly the relief you need, but many people do not respond to antidepressants.

In that case, you have to start looking for more effective methods, but information about the great variety of therapies can be hard to get. Finding something that works is usually a trial-and-error process that can take a long time, even years.

Storied Mind has a lot that may be helpful to you in this search. The core posts listed here explore the early phases of finding the right treatment: learning as much as you can about your specific symptoms; dealing with doubts that can block your commitment to getting well; and ideas about how to get started. The posts listed in the sections on Psychiatric Medical Treatment, Psychotherapy and Self-Help describe many specific forms of therapy from the perspective of someone trying to get well.

Photo credit.

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