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Tilting at Windmills

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March 23, 2006
By: Kevin Drum

DEPRESSED ABOUT ANTIDEPRESSANTS?....For some reason, I was fascinated by the different leads written today about the government's recent antidepressant study. Here's how the three biggest dailies reported it, starting with the most pessimistic and working upward:

  • Washington Post: "Antidepressants fail to cure the symptoms of major depression in half of all patients with the disease even if they receive the best possible care, according to a definitive government study released yesterday."

  • New York Times: "Some people with depression who do not recover with an initial course of antidepressant therapy can increase their chances of finding relief by trying other drug treatments, researchers are reporting today."

  • Los Angeles Times: "In the long and frustrating battle against depression, persistence does pay."

To Shankar Vedantam of the Washington Post, a 50% success rate is a gloomy result (though he admits that this is "a result that quickly lent itself to interpretations that the glass was either half empty or half full.") To Thomas H. Maugh II of the LA Times, it's apparently cause for hope.

But 50% doesn't sound too bad to me. If these results hold up, and fiddling around with various antidepressants really has strong positive results in half or more of the patients, that's pretty good news, isn't it? I'm a little surprised that the news reports have been so ambivalent.

Kevin Drum 12:29 PM Permalink | Trackbacks | Comments (68)

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Case in point: me. I didn't have any sucess on escitalopram, but fluoxetine has worked wonders for me. It makes a significant and noticeable difference in my mood and thought process. That's not a commercial for fluoxetine--if there's one thing talking to other people on antidepressants has proven to me, it's that different drugs work for different people.

But it is a mark for persistence--just because SSRI A doesn't work doesn't mean SSRI B won't, and if neither work, a different class of antidepressant might work.

All I know is that 50% is a darn sight better than 0%, especially when you're part of the 50%. Hopefully this provides data that helps bring that number up.

Posted by: Jeff Fecke on March 23, 2006 at 12:33 PM | PERMALINK

They're not ambivalent --- they are just depressed about the results.

Posted by: kathyp on March 23, 2006 at 12:35 PM | PERMALINK

Cue the Scientologists to parade this as yet more definitive proof that pyschiatry/psychology/psychopharmacology doesn't work--that true happiness comes from having one's engram's cleared.

Posted by: Derelict on March 23, 2006 at 12:36 PM | PERMALINK

Everyone should just deal with every disease God gives them! And bear any child, rather than let RU-486 rip a child from his mother!

Posted by: Freedom Phukher on March 23, 2006 at 12:37 PM | PERMALINK

A 50% cure rate is pretty good for something as complex as depression. You'd be pretty disappointed with a 50% cure rate on bacterial infections, but pretty happy with a 50% cure rate for some types of cancer. Depression is more similar to the latter in terms of difficulty in understanding the mechanism.

Posted by: SP on March 23, 2006 at 12:37 PM | PERMALINK

I think it's important to remember that anti-depressants were never supposed to be "happy" drugs, but to treat specific chemical imbalances. Until scientists can test to determine if a specific chemical imbalance is the, or a major, cause of a specific patient's depression, there's no reason to believe that SSRI's or any other class of anti-depressants will work for all people who exhibit symptoms of depression. Given the inability to pinpoint diagnosis for such a diffuse condition, I think that 50% is a positive number.

Posted by: Barbara on March 23, 2006 at 12:42 PM | PERMALINK

I bet if Bush could get back to 50%, he wouldn't think that was depressing.

Posted by: craigie on March 23, 2006 at 12:42 PM | PERMALINK

actually, contrary to SP's assertion, we understand the mechanism a lot better than you'd think. Unfortunately, the serotonin system has been the pharmacological target for the last 30+ years, when the best evidence available says we should have been looking at cortisol. there have been some cortisol-blockers that have made it to clinical trials, but the glut of available SSRIs doesnt really give me much hope that theyll either be approved or that theyll find much use with modern american psychiatry. those dorks give ssri's away like candy.

Incidentally, one side effect of RU-486, which blocks cortisol, in pregnant women with a history of bipolar disorder is that, in a large number of cases, the depression totally clears up for a few days after taking it.

Posted by: random neuro-guy on March 23, 2006 at 12:46 PM | PERMALINK

As one drug company executive mentioned, (cut and paste,please):
http://news.bbc.co.uk/2/hi/health/3299945.stm
most drugs do not work for most people. Anti-depressants are no exception. Psychiatrists spend a large amount of time trying drug after drug on their patients, until one "clicks"...and of course, the side effects on the poor patients explain the name patient, since these are frequently distressing.

Nonetheless, that some people are helped is good. But you start wondering about the value of all these new drugs when you get bombarded by TV ads asking you to ask your doctor. There must be a large placebo effect.

Posted by: Carol on March 23, 2006 at 12:48 PM | PERMALINK

Really, it's pretty obvious that 50% can be regarded as bad only based on some gaming of the expectations. This is especially so since, as I recollect in my initial reading of the article, mere IMPROVEMENTS in level of depression didn't count, but only cures.

Posted by: frankly0 on March 23, 2006 at 12:48 PM | PERMALINK

Kevin Drum >"...I'm a little surprised that the news reports have been so ambivalent."

That`s because BigPharma is depressed that they haven`t figured out (yet) a way to make even more money off the research results

"Self-mastery is the key to the portals of the universe" - Joseph W. Kittinger

Posted by: daCascadian on March 23, 2006 at 12:59 PM | PERMALINK

Shrinks know very little of the various causes of depression. It really should be treated as a symptom.

Posted by: Matt on March 23, 2006 at 1:06 PM | PERMALINK

NPR last night went with almost exactly the same lede as the LATimes this morning: Persistence pays.

The study is pretty good news, especially since the more we know about depression, the more we realize how damaging ("lesioning") it is to the brain. The more depression a person experiences, the more he or she is likely to experience, and the less it is likely to be tied to an external cause. Researchers today are more likely to compare depression to a chronic condition like diabetes than to unhappiness, and to urge the vulnerable to stay on their medication, rather than to try and go it alone. It's dangerous, bodily, mentally, and psychically.

Without getting into a huge amount of detail, I think the news reports are trying to be encouraging without claiming that the battle is won, which to me sounds more or less on target. The public is way way behind the curve on this, largely because many Americans find sadness frightening, I think, and fear contagion.

Posted by: Kit Stolz on March 23, 2006 at 1:13 PM | PERMALINK

The paradox, of course, is that if drugs were able to cure depression, that would be depressing news. Fortunately, drugs can't cure depression, but hopefully the drugs can buy the person some time to come to grips with the reasons behind their depression.

There's no "cure" for depression that doesn't involve the individual taking responsibility for their lives.

Posted by: Jeffrey Davis on March 23, 2006 at 1:16 PM | PERMALINK

You have to compare to the number of people who will get better with no treatment (or with a placebo). If that is close to 50% then 50% doesn't look so good.

Posted by: James B. Shearer on March 23, 2006 at 1:16 PM | PERMALINK

This seems to be a terrific illustration, if we needed yet another one, why charges of "MSM bias and corruption" are foolish. Even relatively straightforward information, like this story, is complex enough that different interpretations are inevitable.

Posted by: Michael on March 23, 2006 at 1:16 PM | PERMALINK

The reporters who wrote the "half-empty" stories, or their editors who rewrote the leads, are the just the ones who don't know much of anything about major depression. Fifty percent is a lot higher "cure" rate than I would have guessed. People with major depression can spend years and years trying different drugs, which is depressing even if you aren't depressed. The hard data that it's worth it to keep trying is a major boost.

Posted by: gyrfalcon on March 23, 2006 at 1:19 PM | PERMALINK

The 50% success rate would be great if anti-depressants did nothing to people for whom they were ineffective in treating depression.

Its less good given that that is not the case, but still not bad.

I suspect the cautionary tone is most proper given the context of the rosy image sold by pharmaceutical advertisement, and the resulting high expectations lots of people have.

Posted by: cmdicely on March 23, 2006 at 1:20 PM | PERMALINK

Sounds like good news to me. When I took physiological psych way too many years ago to count, the best drugs of the day (tricyclics) were helping about one-third of the cases of depression. And that was a big improvement over all the other approaches of the day then.

Posted by: thebears on March 23, 2006 at 1:23 PM | PERMALINK

Is 90%-100% realistic for one or even for all meds combined?

Posted by: ET on March 23, 2006 at 1:32 PM | PERMALINK

The first thing I thought when I saw the headline this morning was "Hey, the glass is half full!" I guess I'm not depressed.

Posted by: Roger on March 23, 2006 at 1:34 PM | PERMALINK

There's no "cure" for depression that doesn't involve the individual taking responsibility for their lives.

Complete and utter nonsense. One might as well write "there's no 'cure' for cancer that doesn't involve the individual taking responsibility for their lives."

It's a disease, and a particularly insidious and frightening one because it attacks the invidual at the core of his being. It's not possible to cheer yourself up or talk your way out of a depression.

Posted by: Stefan on March 23, 2006 at 1:40 PM | PERMALINK

I wish depression were about taking responsibility for my life. I have no trouble taking responsibility for my life, but without anti-depressants, that life sucks. Plain and simple. I can do all the things I'm supposed to do to take care of myself, and I still feel hopeless. I'm fortunate to be part of that 50% for whom the drugs are working, but it was a long haul getting here, and I tried more than one drug before I got here.

Given how little we really understand about the mechanisms in the brain that cause depression, and the idiosyncratic way different drugs work on different people, 50% is an amazing rate. But if I were in that other 50%, I probably wouldn't find it so amazing.

Posted by: WritingMom on March 23, 2006 at 1:56 PM | PERMALINK

First, I agree with Stefan--happy talk and wishful thinking can't snap you out of major depression.
Also, it sounds like the study looked only at treating patients with a single antidepressant drug at a time. More and more research at the Nat. Inst. for Mental Health is looking at combination therapies, where antidepressants are combined with mood stabilizers, dopamine agonists, or atypical antipsychotics (and, of course, psychotherapy).

Posted by: Justin on March 23, 2006 at 1:57 PM | PERMALINK

James B Sherer at about 1:16 PM made the only rational observation in this entire thread so far. "You have to compare to the number of people who will get better with no treatment (or with a placebo). If that is close to 50% then 50% doesn't look so good."

Posted by: Ron Byers on March 23, 2006 at 2:16 PM | PERMALINK

A 50% cure rate is pretty good for something as complex as depression

Read the article carefully. The study doesn't cite a 50 percent cure rate. It cites a 50 percent remission rate, a very different kettle of fish.

Depression is a cyclical condition. Most successfully "treated" for depression will go into "remission" at some point, but they remain very likely to "relapse". So much so that the hot topic in psychparmachology is the "prophylactic" use of anti-depressives where patients take the drugs, even without symptoms, and for very long periods.

Also, we don't know the exact conditions of the study. How much additional support, other than the medication, was made available, is not clear. It wouldn't be ethical for the researchers not to offer counselling as well as the drugs, for example, and the effects of the medication cannot easily be teased out or even conceptually distinguished from the effects of treatment as a whole. Indeed, the very nature of the study itself is another confound: participating in a "special depression study" is just the kind of meaning-laden activity that tends to cheer depressed people up and give them a sense of purpose.

The 50 percent rate has actually been floating around for a while; it's been proposed as a rule of thumb that half of all depressed patients receive no benefit from drug treatment. Since drug treatment is all that most psychiatrists ever try, it suggests that the well known complaint of patients about psychiatrists is that all they do is prescribe one useless medication after another is well grounded.

Posted by: Jason Stokes on March 23, 2006 at 2:18 PM | PERMALINK

participating in a "special depression study" is just the kind of meaning-laden activity that tends to cheer depressed people up and give them a sense of purpose.

WTF? Making depressed people "feel special" is all that it takes to cheer them up?

Do you know *anything* about depression?

Posted by: Tripp on March 23, 2006 at 2:27 PM | PERMALINK

50% is a pretty bad effectiveness rate if 50% respond equally well to placebo or no treatment. Check out this article about 47 studies which showed no significant benefit from drug treatment vs. placebo.

USAToday

Posted by: Sabin on March 23, 2006 at 2:31 PM | PERMALINK

Do you know *anything* about depression?

I know a little, and enough not to make dogmatic assertions about what does and doesn't work. But I'm afraid I mis-edited/wrote. I should have said it may be that participating in a "special depression study" is just the kind of meaning-laden activity that tends to cheer depressed people up and give them a sense of purpose.

And I didn't say "make depressed people feel special." What I said was, "participating in meaning laden activity" might cheer people up. There's some evidence for this, and I don't think this has been looked at enough in the literature to exclude it as a possible confound.

And I notice the study included no control, making baseline expectations hard to measure.

Posted by: Jason Stokes on March 23, 2006 at 2:37 PM | PERMALINK

Two stiff drinks work every time!

Posted by: Hedley Lamarr on March 23, 2006 at 2:49 PM | PERMALINK

Jason,

Huh?

Where did you say "participating in meaning laden activity" might cheer people up."

Maybe that is what you meant to say, but what you actually said was (there is a) kind of meaning-laden activity that tends to cheer depressed people up.

Depression is not about a lack of cheer. Depressed people don't need to "cheer up."

I think you have some incorrect ideas about depression, just like the guy above who thinks all that depressed people need to do is take responsibility for their actions.


Posted by: Tripp on March 23, 2006 at 2:50 PM | PERMALINK

30% respond to a placebo. That means that the drugs only work 20% of the time. Are the side effects worth it?

Posted by: cheflovesbeer on March 23, 2006 at 3:01 PM | PERMALINK


*sigh* I'm clearly speaking casually. I'm not a psychologist; I don't feel the need to adopt ponderous medspeak to sound "scientific". I have, in fact, suffered (formal diagnosis and everything) from depression for 15 years.

If you don't think depression is a chronic lack of cheer, what do you think it is? A metaphysical condition? I didn't say "depressed people need to cheer up", which I agree is a cheap stereotype, and probably what's led you astray.

Maybe that is what you meant to say, but what you actually said was (there is a) kind of meaning-laden activity that tends to cheer depressed people up.

Yes, and I apologise for not hedging that. But in fact I believe that; I think there's good evidence for it. Unemployment and retirement are two big risk factors for depression, for example.

I think you have some incorrect ideas about depression, just like the guy above who thinks all that depressed people need to do is take responsibility for their actions

Who are you to say what's "incorrect"? Are you claiming to be the expert, now?

Posted by: Jason Stokes on March 23, 2006 at 3:05 PM | PERMALINK

Snarky depressionists

How interesting...

"The future will be a struggle between huge competing systems of psychopathology." - J. G. Ballard

Posted by: daCascadian on March 23, 2006 at 3:18 PM | PERMALINK

Jason is largely correct. While it is impossible to "cheer yourself up" out of a depression, there is evidence that participating in some form of activity, of whatever type -- work, exercise, etc. -- will tend, to some degree, to ameliorate the symptoms if not the cause of the disease. Depression is a turning inward, and any activity that turns the psyche outward, back into the world, may, if not a complete cure, be at least partly helpful.

That is why, as he notes, people who are isolated, whether through old age, imprisonment, retirement, job loss, social ostracism, etc. are more vulnerable to depression than the general population.

Posted by: Stefan on March 23, 2006 at 3:45 PM | PERMALINK

Jason,

What is the meaning-laden activity that would help women suffering from post-partum depression?

How about depression brought on by alcohol use? What meaning-laden activity will help that depression?

Posted by: Tripp on March 23, 2006 at 3:47 PM | PERMALINK

Tripp, there's no "meaning-laden activity" that will, by itself, cure that depression. But there may be activities -- for example, getting some exercise, doing volunteer work, art therapy, helping others, feeling needed, even getting out of bed to take a ten minute walk every day, etc. -- that will help those sufferers ameliorate their symtoms and will help them focus on some activity outside of their own psyches. And of course you'd have to combine this with medication and therapy.

The cruel truth, though, is that the people suffering most from depression are the least likely to be able to make themselves be able to do any of these activities.

Posted by: Stefan on March 23, 2006 at 3:53 PM | PERMALINK

Stefan,

My point was that global statements about depression are difficult to make and usually incorrect in certain cases. Certain activities may help to some extent in some cases of depression, sometimes, but making simple statements like depressed people will be helped by turning them outwards suggests that depression is caused by something simple and would be easy to fix.

Posted by: Tripp on March 23, 2006 at 4:00 PM | PERMALINK

But I don't think that Jason, who is himself a sufferer, was making a global statement -- as he says, "I'm merely speaking casually." Just sprinkle a lot of "mays", "mights" and "maybes" around what he wrote.

Posted by: Stefan on March 23, 2006 at 4:04 PM | PERMALINK

Stefan,

My wife suffered fairly extreme post-partum depression.

Telling her she needed to get some exercise, do volunteer work, art therapy, help others, or feel more needed would be insulting.

I doubt there is any human that feels more 'needed' than a nursing mother feeding a newborn every couple hours.

Posted by: Tripp on March 23, 2006 at 4:06 PM | PERMALINK

Jason,

If you don't think depression is a chronic lack of cheer, what do you think it is?

I think it is a chemical imbalance in the brain that changes the way the brain operates. Chronic lack of cheer may be a symptom of depression, but it is not the depression itself.

When I had a pinched nerve in my neck I had excrutiang pain. You could say that I suffered from excrutiating pain and therefore painkillers would cure me but the best they could do was alleviate some symptoms.

I agree that, to a small extent, behavior can lead to changes in brain chemistry for some people at some times, but I've heard too many people tell my wife "cheer up" because they thought that was all it would take so I guess I'm sensitive on the topic.

Posted by: Tripp on March 23, 2006 at 4:16 PM | PERMALINK

Telling her she needed to get some exercise, do volunteer work, art therapy, help others, or feel more needed would be insulting.

Again, I think you're misinterpreting. Those were only suggestions, possible examples, and not commands. It's not that she needed to do these, it's that doing any of those things might possibly provide her or any sufferer some moments of respite from the storm in their brain -- or they might not. And none of those things are any sort of substitute for a rigorous program of medication and therapy -- they're merely a potentially helpful supplement.

Believe me, I am sadly more than familiar with severe depression and the havoc it can wreak, and how devastating and intractable it can seem when someone is in its grip. It's a disease, and you throw anything at it that will work.

Posted by: Stefan on March 23, 2006 at 4:21 PM | PERMALINK

Trust me, depression is a terrible disease that kills people. A little art therapy or exercise is NOT going to help anyone with severe depression. I am a mental health professional who has spent the last 20 years helping people in the community who are suicidal as well as teaching students how to spot and help people who might be suicidal. I have treated the survivors of suicide.

I also discovered rather late in my life that I come from from a family where all of its members were either drunks or depressed. Nice genes, huh? Both maladies may be on the same or similar genes. It is 100% going back 3 generations. Good thing my kids are adopted! My Mother is 90 and she is STILL depressed!

Major depression is not something you can just "get over". As a matter of fact, studies have shown that those people who can get their depression into remission when it first hits stand a better chance of it not coming back over and over again. Of course, it is only in the past several decades that we have had medications that actually could get people into remission and only lately that we began to realize that sometimes it took several medications together to do this, if only in 50% of the population as the most recent study showed.

Using the data from the same study, they noticed that the children whose Mothers were treated did much better that the children whose Mothers who were NOT treated. That just shows how very important it is for parents to take care of themselves and be treated for mental health issues immediately, if only for their children's sakes. As the child of a life long depressed Mother who had no treatment when I was growing up, I can vouch for that!

Posted by: rain39 on March 23, 2006 at 4:39 PM | PERMALINK

Trust me, depression is a terrible disease that kills people. A little art therapy or exercise is NOT going to help anyone with severe depression.

Oh, for God's sake. For the last time -- I'm not saying that it will CURE depression, or that it will necessarily even help very much -- but it may, and helping the depressed person to engage in something, anything, is at least better than laying in bed all day. Depression isolates, and the more depressed the more isolated you become, in a vicious self-reinforcing cycle. Anything to break that isolation MAY be helpful, and it usually can't hurt.

And again, it's not a cure. The cure is medication and intensive therapy, coninually adjusting the dosage and type of medication until you hit on the one that will work.

Posted by: Stefan on March 23, 2006 at 4:47 PM | PERMALINK

I agree that, to a small extent, behavior can lead to changes in brain chemistry for some people at some times, but I've heard too many people tell my wife "cheer up" because they thought that was all it would take so I guess I'm sensitive on the topic.

I agree -- it's infuriating. If you could cheer up you wouldn't be depressed in the first place. It's like telling someone in a wheelchair "you should really try walking, you'd get around so much better!"

Posted by: Stefan on March 23, 2006 at 4:53 PM | PERMALINK

I have a couple of friends who have been struggling with severe, treatment-resistent depression for years. It's not just a matter of feeling down -- it's being unable to get up, wash your hair, leave the house, do anything, make yourself eat... it affects memory, energy, and lots of other things.

To get such an illness, and then have it turn out that it's quite possible that you'll never feel better again -- well, no wonder those articles were "ambivalent."

I hope treatment rates improve...

Posted by: webmacher on March 23, 2006 at 5:16 PM | PERMALINK

It's not just a matter of feeling down -- it's being unable to get up, wash your hair, leave the house, do anything, make yourself eat... it affects memory, energy, and lots of other things.

What people who've never experienced depression or had a loved one who succumbed to it understand is that it's not just a severe form of sadness, it's an annihilation of the self. It attacks the very root of one's personality, one's ability to think and feel. It's as if someone had taken an eraser and scrubbed out all the parts of oneself that made one feel unique and whole, so that nothing was left but a numb, formless entity.

Posted by: Stefan on March 23, 2006 at 5:47 PM | PERMALINK

We were just given a 20 to 30 % chance of success with a new drug for my Dad. We'll gladly take it over the alternative.

Posted by: ranaaurora on March 23, 2006 at 8:47 PM | PERMALINK

I presume the patients think the glass is half-empty.

Gee, the Scientologists are half right.

Posted by: McA on March 23, 2006 at 9:02 PM | PERMALINK

No one seems to take into account the side-effects that introduce new problems and stress into the already fragile lives of depressed individuals, I think. Nor the fact that a willingness to use drug therapy to cure a condition that comes to exist as a warning about the conditions that cause depression (personal problems, traumatic painful events in life, cultural breakdowns) involves a level of dishonesty at the outset that itself becomes a predicate for further depression-causing stress and disillusionment. Humans have always suffered deep sadness. Some are better equipped to cope with it and eventually recover. Some sink lower each time their depression is triggered. Anti-depression drugs, in my single experience with them, had an interesting uplifting effect; but I don't think they're more effective than drinking enough water, getting enough rest, and physical exercise were. Making simple healthy choices is certainly a lot less expensive than taking drugs and saving the money (and avoiding the side-effects) is a lot more uplifting than anti-depressant drugs. Like so many of the drugs big pharmaceutical companies have produced in the past thrity years or so, I think most anti-depressant medications are there more to boost drug company profits than to actually provide relief or a cure.

Posted by: NealB on March 23, 2006 at 9:18 PM | PERMALINK

NealB, Stefan, and others...

You appear to be defining depression as an existential pain-- that depression is a warning about negative life events, and that depression can be cured or helped by better eating, living, coping, or exercise skills.

(And this definition does suggest that the person with depression is partially at fault, in that they aren't doing everything possible to optimize their health and coping skills vs. people who never get depressed. Would you say the same thing to narcoleptics, that perhaps they just need to sleep more...?)

Well, physical pain itself is a warning about bad physical conditions (heat, cold, broken tissues), but we don't ask people to simply try to heal the conditions. That not everyone needs a strong painkiller when they've broken a bone doesn't mean it isn't painful. We also know a pain signal can hit people without any real triggering mechanism. Too much pain can make the body even more sensitive to pain signals, creating a nasty feedback loop. Depression can have a similar result.

But what about depression in people who already have optimized their health and life circumstances? People who are already resilient? Its not uncommon.

And especially, what about depression caused simply by a medication?

For example, my aunt is as resilient a person as I know: relaxed, calm, happy with life, able to cope with anything (and she's gone through a lot). She was plunged into a deep and horrifying depression- guilt, fear, self-loathing - simply because she took a beta-blocker medication. As soon as she stopped the meds, this strong depression went away.

If an instant depression can be caused by mere biochemistry (and beta blockers aren't the only medication with this side effect), doesn't this suggest that depression can be merely a biochemical illness?

Posted by: Helen of Troy on March 23, 2006 at 10:12 PM | PERMALINK

No one seems to take into account the side-effects that introduce new problems and stress into the already fragile lives of depressed individuals, I think. Nor the fact that a willingness to use drug therapy to cure a condition that comes to exist as a warning about the conditions that cause depression (personal problems, traumatic painful events in life, cultural breakdowns) involves a level of dishonesty at the outset that itself becomes a predicate for further depression-causing stress and disillusionment. Humans have always suffered deep sadness. Some are better equipped to cope with it and eventually recover. Some sink lower each time their depression is triggered. Anti-depression drugs, in my single experience with them, had an interesting uplifting effect; but I don't think they're more effective than drinking enough water, getting enough rest, and physical exercise were. Making simple healthy choices is certainly a lot less expensive than taking drugs and saving the money (and avoiding the side-effects) is a lot more uplifting than anti-depressant drugs. Like so many of the drugs big pharmaceutical companies have produced in the past thrity years or so, I think most anti-depressant medications are there more to boost drug company profits than to actually provide relief or a cure.

It's obvious you don't know the first thing about major depression. I have suffered from this disease for 30 years and everyone I know would tell you that I do more for other people than anyone they know. Depression is not about self-pity or any of the other things you mention. If there was any way to get out of it anyone who has it would be glad to try anything. The only way I can describe it is to say it's like being in a deep black hole with your brain going around on a merry-go-round at a million miles an hour. You can't stop it. You don't even know what you are thinking. Your brain won't stop going around long enough to even let you sort out your thoughts. That's why so many depressed people commit suicide.

Posted by: JT on March 24, 2006 at 12:35 AM | PERMALINK

NealB, Stefan, and others...You appear to be defining depression as an existential pain-- that depression is a warning about negative life events, and that depression can be cured or helped by better eating, living, coping, or exercise skills. If an instant depression can be caused by mere biochemistry (and beta blockers aren't the only medication with this side effect), doesn't this suggest that depression can be merely a biochemical illness?

Oh, for fuck's sake! Haven't I said over and over again on this thread that depression is a biochemical disease, an illness, and that the best way to treat it is via medication, coupled with therapy? Where on earth is anyone getting this idea that I regard it as "a warning about negative life events"?

To the sufferer, yes, it can feel like existential pain, it can feel like the annihilation of the self, but it is quite clearly brought on by some major biochemical events (which can be triggered by many things, such as a negative life event, genetic heritage, a suddden illness, an adverse reaction to medication, job loss, death of a loved one, "mere" biochemistry, anything at all, really).

But believe me, I would never and have never suggested that "the person with depression is partially at fault" -- I don't know how you can possibly read what I wrote and come to that conclusion. The person who is struck by depression is as little as fault as the person struck by a lightning bolt from the sky.

And finally, for the last time, I have never said that depression can be "cured....by better eating, living, coping, or exercise skills," though yes, those things can slightly ameliorate the symptoms of depression, just as they can for any other chronic disease such as cancer, diabetes, etc.. If you have cancer, for example, eating well and exercising won't help cure the cancer, but they may make you slightly more resistant or resilient -- the same applies for depression. But you cannot exercise or will yourself out of depression, or cheer yourself up out of it, just as you cannot exercise or will yourself out of cancer.

But once again, and I cannot make this any clearer, depression is a quite serious illness, potentially fatal, with a strong possibility of relapse, that can only be cured (and often not cured, but merely brought into remission) through combined medication and therapy. It can hit almost anyone, at any time in their lives, and can often come on quite suddenly.

Posted by: Stefan on March 24, 2006 at 12:40 AM | PERMALINK

Anti-depression drugs, in my single experience with them, had an interesting uplifting effect; but I don't think they're more effective than drinking enough water, getting enough rest, and physical exercise were.

If rest and exercise did as much for you as anti-depressants, then you may have been "depressed" in the everyday common English usage of the term but you weren't suffering from clinical depression.

Making simple healthy choices is certainly a lot less expensive than taking drugs and saving the money (and avoiding the side-effects) is a lot more uplifting than anti-depressant drugs.

You can't make "simple healthy choices" when you're depressed -- if you were you wouldn't, ipso facto, be depressed. Depression attacks the mind's ability to think and reason, to care for itself. A depressive cannot "uplift" himself out of the disease any more than a schizophrenic can.

Posted by: Stefan on March 24, 2006 at 12:45 AM | PERMALINK

Stefan- sorry, I was combining responses, and I should not have put your name there. I agree, like any other type of illness, keeping up one's health in every other possible area will increase the chances of recovery. As you said, its the same with cancer, or diabetes.

The core of my response is directed to people who seem to think depression is something like a smoke alarm to let people know something is wrong. I provided evidence that depression can result strictly as a biochemical event- no bad circumstances needed.

But why think of depression as a natural response to bad events at all? Grief, stress, loss, pain- those are what all people can feel in response to bad events. Depression, in comparison, seems as useful as schizophrenia. It's no more a warning sign than cancer or diebetes: its simply a dreadful illness.

Posted by: Helen of Troy on March 24, 2006 at 2:13 AM | PERMALINK

You know Stefan you are way off base when you said--- just kidding, I think you explained yourself clearly (and sensibly) in your first post.

There are degrees of depression, and just as first degree burns and third degree burns are treated in different way-- for the milder cases of depression, what you said about exercise and outside activites make a lot of sense. As for the matter of "cheering oneself up" Isn't the whole idea of cognitive therapy that is is possible for some (and I stress the word SOME) people to talk themselves out of their depression by gradually changing the internal dialogue from negative thoughts to more positive ones?

And there is that Duke study (which I remember linking to in a thread here last year) that showed that exercise three times a week had similiar results as a Zoloft prescription. http://www.psychologytoday.com/articles/pto-2914.html

There are different causes of depression (be it genetics, grief or a traumatic event) and I'm not discounting the folks who've written about their own or their loved ones severe depression. I do wonder if a certain percentage of depression and anxiety cases are a result (or perhaps, exacebated) by the lack of physical exertion in our daily lives, a luxury our ancestors did not have.

Again, I'm not discounting those who suffer from severe depression, but most SSRI scripts (more than 60% from the stats I've seen) are written by internists or FPs. Presumably, these patients aren't suffering from major depression (if they are, one hopes they'd be referred out to a psychiatrist).

Posted by: beowulf on March 24, 2006 at 4:01 AM | PERMALINK

Insurance companies seem to be afraid to say no to all kinds of psycho-active, mood altering drugs that may be prescribed for everything from clinical depression to diabetic chronic grouchiness.

In many insteances, the thought behind the therapy seems to be about on the level of the campaigns behind Viagra and Cialis. The consumer thinks, "Well, it is low cost to me and it might help...."

The provider thinks, "Gee, if the patient asks for it, and we refuse, some jury might hold us responsible for the mother who drowns the kiddies in the tub or the pathetic middle-aged accountant whose wife leaves him because it's been a dozen years since he performed his husbandly duties."

Boy children tend to be stuffed full of ADD medications because they are boys in a school system mainly staffed and run by females in a style where girls learn far better than boys do.
Being a former school counselor, I could go into that in far more detail and get a long angrier, but I think I'll just go take a couple pills and lie down. . .

Posted by: Michael L. Cook on March 24, 2006 at 10:05 AM | PERMALINK

What does any of that have to do with depression, Cook? Depression is, if anything, under-treated in our society. Half of those with serious depression don't even seek treatment, and of those that do a large proportion are given inadequate amounts of either medication and/or therapy.

Posted by: Stefan on March 24, 2006 at 10:46 AM | PERMALINK

One of the problems in talking about depression is the word itself. Unfortunately we use the same word to connote both the common, everyday sense of feeling slightly down ("How you doin?", "Eh, I'm kinda depressed") and the far more serious clinical disease itself. A main reason that people with depression do not often receive the treatment they need is that the seriousness of the disease is discounted by others who've never experienced it -- they think "hey, I've been depressed and I got over it" when what they really mean is that they've been a bit down, or in a bad mood.

Depression is nothing like that. Imagine how you would feel, for example, if you heard that your parents had died, how grief-stricken and hopeless and shattered. Now imagine that instead of that lifting, that that was how you felt all day long, every day, for years and years, with no sense that you would ever feel any better. That's clinical depression.

Posted by: Stefan on March 24, 2006 at 11:00 AM | PERMALINK

Stefan-

i'd like to say i think you did a great job trying to explain depression and how some daily activities can help alleviate the symptoms. if people don't want to read what you've actually written, it's on them.

~~~~
i'll add this, i'm also a mental health professional who's been treating people in crisis and people with chronic mental illnesses for 10 yrs. i've also suffered with depression (on and off) since i was 12. i often encourage clients to find activities that they enjoy and do them even when they think they won'y enjoy them, as an addition to meds and therapy. it goes along with encouraging clients to build and maintain a social support system and both are as essential to recovery as the meds and therapy. the clients i've seen who've done the best are the ones who've tried all four things, and kept trying even when at first it didn't seem to be making any difference.

so to say that doing acitivties and being engaged in life won't help depression because depression is a disease is wrong. it'd be like telling a person with heart disease the same thing.

Posted by: e1 on March 24, 2006 at 11:30 AM | PERMALINK

stefan, sorry everyone's ganging up you. they're totally misreading what you've written. "why do non-depressives hate stefan?"

Posted by: EM on March 24, 2006 at 11:49 AM | PERMALINK

nealb,
for years i heard the mantra that excercise cures depression. despite the fact that my grandfather was one of the discoverers of serotonin, my whole family has believed that you can excercise your way out of depression. and all of them still suffer from mild depression. so for years i tried and tried to do it their way. i lived a very healthy lifestyle in terms of diet and excercise. but i still landed in the hospital for suicidal ideations. it took medication to get me out of it. i was on it for three years, and i've been off for about three years. but i always have to monitor my moods and look for warning signs of it coming back. i do think changing my internal dialogue can help me avoid going back into a severe depression, and behavior modifications can be helpful. but i also know positive thinking is not a full-proof plan, and i'm perfectly willing to go back on the medications if i have to. sometimes biology just can't be overcome.

Posted by: EM on March 24, 2006 at 11:51 AM | PERMALINK

Studies show that cognitive therapy does as well as drugs in dealing with depression.

Posted by: vorkosigan1 on March 24, 2006 at 2:34 PM | PERMALINK

studies also show that the most effective treatment is a combination of therapy and meds.

Posted by: e1 on March 24, 2006 at 2:52 PM | PERMALINK

#1) Most neuroses dissipate within three years of onset, so it seems worth asking whether it is the drugs that are effective or if given due time the condition will subside on its own.

#2) I don't however buy the notion that these drugs (SSRIs and the other new antidepressants) are causing anyone to kill themselves. It is more likely that are not effective enough to prevent people from harming themselves. But the one way they may actually worsen depression and even potentially psychopathic tendencies is by interfering with the sleep cycle. Many depressed people are already sleep-deprived, and that sleep deprivation can worsen the condition.

#3) Don't believe the hype about talk therapy either. With the exception of cognitive behavioral therapy (which shows very limited effectiveness) virtually every brand of talk therapy shows statistically insignificant results. You can get the same results having good relations with friends or other significant others. Buyer beware.

Posted by: The Blue Nomad on March 24, 2006 at 8:06 PM | PERMALINK

Assorted comments:

Blue Nomad: I don't however buy the notion that these drugs (SSRIs and the other new antidepressants) are causing anyone to kill themselves.

Me: I have heard of some cases in teenagers, actually, where there seems to be some sort of connection; although, granted, it must be very difficult to sort out what the drug is responsible for and what the disorder itself is responsible for. I guess I would just reserve judgment on this one. (I'm definitely with you on talk therapy, though.)

re exercising: I've been told (by my doctor) that fairly strenuous exercise can help with anxiety disorders. But OTOH I know that with anxiety, you may have pretty wretched downs, but you also have ups, which (IIRC) you don't with depression; so maybe what works to sort of activate positive feelings in my OCD self wouldn't work on someone who was depressed, and just didn't have any positive feelings *left.*

As to the ambivalent reaction of the newspapers, I really think it can be attributed to the hype around the drugs. I'm fairly skeptical of the drugs, but even I had the impression the success rate was a lot higher than half.

Shoshana

Posted by: Shoshana on March 25, 2006 at 2:02 AM | PERMALINK

As one who has major depression and has also studied it at University - for what it is worth, I believe that depression is or is not developed during the first few months of life when the brain is still connecting neurons. If a baby is nurtured by its own caregiver (not a child care centre staffmember) during these months then depression is unlikely. If a baby is abused or does not achieve good attachment skills during these months then depression later in life is highly likely. There is no cure, only relief which can be attained with drugs (when you find the right one) plus very good doctor/counsellor/friend i.e any person who one can talk to in confidence, and who has very positive regard for the person with depression.

Posted by: pastro on March 26, 2006 at 9:16 PM | PERMALINK




 

 

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