There's Nothing Deep About Depression

[Kire]

There's Nothing Deep About Depression
By PETER D. KRAMER

Published: April 17, 2005

Shortly after the publication of my book ''Listening to Prozac,'' 12 years ago, I became immersed in depression. Not my own. I was contented enough in the slog through midlife. But mood disorder surrounded me, in my contacts with patients and readers. To my mind, my book was never really about depression. Taking the new antidepressants, some of my patients said they found themselves more confident and decisive. I used these claims as a jumping-off point for speculation: what if future medications had the potential to modify personality traits in people who had never experienced mood disorder? If doctors were given access to such drugs, how should they prescribe them? The inquiry moved from medical ethics to social criticism: what does our culture demand of us, in the way of assertiveness?

It was the medications' extra effects -- on personality, not on the symptoms of depression -- that provoked this line of thought. For centuries, doctors have treated depressed patients, using medication and psychological strategies. Those efforts seemed uncontroversial. But authors do not determine the fate of their work. ''Listening to Prozac'' became a ''best-selling book about depression.'' I found myself speaking -- sometimes about ethics, more often about mood disorders -- with many audiences, in bookstores, at gatherings of the mentally ill and their families and at professional meetings. Invariably, as soon as I had finished my remarks, a hand would shoot up. A hearty, jovial man would rise and ask -- always the same question -- ''What if Prozac had been available in van Gogh's time?''

I understood what was intended, a joke about a pill that makes people blandly chipper. The New Yorker had run cartoons along these lines -- Edgar Allan Poe, on Prozac, making nice to a raven. Below the surface humor were issues I had raised in my own writing. Might a widened use of medication deprive us of insight about our condition? But with repetition, the van Gogh question came to sound strange. Facing a man in great pain, headed for self-mutilation and death, who would withhold a potentially helpful treatment?

It may be that my response was grounded less in the intent of the question than in my own experience. For 20 years, I'd spent my afternoons working with psychiatric outpatients in Providence, R.I. As I wrote more, I let my clinical hours dwindle. One result was that more of my time was filled with especially challenging cases, with patients who were not yet better. The popularity of ''Listening to Prozac'' meant that the most insistent new inquiries were from families with depressed members who had done poorly elsewhere. In my life as a doctor, unremitting depression became an intimate. It is poor company. Depression destroys families. It ruins careers. It ages patients prematurely.

More: http://www.nytimes.com/2005/04/17/magazine/17DEPRESSION.html?

[DemExpat]

1. I responded to a posting of this in the Science forum,

so will be lazy here and cut and paste! :-)
Good article for this group. :hi:
DemEx

Good article, thanks for posting.


Although I for one have the view that disagrees with his premise that it is more a disease than existential angst or powerlessness. I experienced my own depression as having been first an attitude of how I stand in life here in the world which then became a physical disorder.

I believe that a spiritual component of depression (chicken or egg, anybody?) is something some people choose to acknowledge and deal with to a good measure of satisfaction.

I also wonder why depression/suicides have not been all but eradicated in the 20 plus years that anti-depressants have been around? And also wonder if medicating a growing number of the population (children included) will not lead to more passivity/less creativity/less impulse to find solutions to growing problems. Perhaps more ambivalence and impotence in the face of growing government and global tendencies away from democracy? (Of course this is a generalization).

From one who has tried the meds with no relief, and has found alleviation in other approaches.


I guess I am of the mind that depression may have many components, and whatever works for you in a satisfactory way is what matters.

No one pill fits all. IMHO.

Thanks for this thoughful article!

DemEx

[hedgehog]

2. DemExPat, you've touched on a source of great confusion

I myself tend to think that there are two issues. Let's bundle one side as attitudes, behavior, outlook, temperament, etc. Let's call the other clinical depression. One is an intellectual or philosophical problem, the other is a medical issue. Can they feed off each other? I think so. Often attitude and habit interferes with medical treatment of clinical depression. People cling to harmful behaviors because they are familiar. The problem comes when people don't recognize that there is such a thing as clinical depression. I don't think you can get better unless you're willing to address your problems and make changes. At the same time, some of us need medical intervention. You can't lift yourself up by your boot straps when the boot straps are frayed.

AS to why there are still depressives and suicides: depression is for many of us a chronic disease. The literature I've seen leans towards this interpretation and indicates a need for life long treatment. The number of suicides indicates that society as a whole still doesn't "get"the seriousness of this disease. We are not talking about a few days with the blues here, but most people don't understand that.

[DemExpat]

3. Further thoughts on your post, hedgehog....

Yes, no one knows for sure, so uncertainty will be an ingredient of all of our stances on this.

Several thoughts of mine: (LONG :evilgrin:)

1) I see all long-term, debilitating depression as more than a case of the blues.

2)For one, I have a great aversion to medicalizing life’s health issues - this began when I was pregnant with my first child and opted to give birth at home with a mid-wife instead of in the hospital. Years of medical treatment of my chronic depression and chronic/acute anxiety/panic disorder did give me insight into the traumas that underlie my mental ill-health, and saved myself several times from suicidal impulses. BUT…there came a point when I felt I was not on the right track for me - and this started out as wanting to be a “real”, undrugged Mom for my children as they were growing up (my Mom retreated into tranquilizers and alcohol from her pain). I also can see why a Mom will CHOOSE medication to be more "herself" for her children in that way! This track also had to do with a growing spiritual awareness of mine that I needed to learn to deal with my trauma and my subsequent whacked out of balance brain, nervous and hormonal system by other means. I felt there were deep lessons within my history and illness that I NEEDED to address without medicating them. This became an aversion to medicalizing my chronic depression and anxiety.
This is purely a personal need, decision, also belief here. I also tend to try to eat foods closer to their naturally grown states, and treat my more physical as well as mental and emotional problems with Complementary medicines and treatments.

3) I myself tend to think that there are two issues. Let's bundle one side as attitudes, behavior, outlook, temperament, etc. Let's call the other clinical depression. One is an intellectual or philosophical problem, the other is a medical issue. Can they feed off each other? I think so.

I agree that there are many aspects of depression - even what you call clinical depression - it DOES become an illness that has factors measurable by science of chemical imbalances and processes that are very hard to turn around, to re-balance to health. But besides the intellectual or philosophical problem, as you call it, and the bundle of behavior, temperament, etc. there is also learned behavior/emotional reactive responses from negative life experiences, especially in baby and childhood, experiencing how parents, for example interacted with each other and the kids, social conditions, cultural attitudes, etc. that have influence in the development of depression IMO…..
It does reach a point when the “medical issues” of imbalances feed off of the learned behaviors/attitudes/thought processes/reactions to stress, etc. and vice versa. I agree here.

And I agree that sometimes medication is necessary and desirable for those who are in crisis or see no other way out.

But for those who need to find another way out, there is the possibility of a way IMO. It might take years, for mostly it is a learning, or unlearning process of dealing with all of these factors noted above (behavior, attitudes, thoughts, reactions, choices we have made, etc.). There is no quick fix here, in my experience.

4) Here we come to your next point:
Often attitude and habit interferes with medical treatment of clinical depression.
Referring to what is stated above; I can, just as you have from the medical point of view, say that…..”often attitude and habit interferes with more “natural” (not medicated) treatments/practices of depression.” This can work in both instances, can it not?

5) I don't think you can get better unless you're willing to address your problems and make changes. At the same time, some of us need medical intervention. You can't lift yourself up by your boot straps when the boot straps are frayed.
I can also say the same in the approach to not medicalize depression - although I agree that medical intervention is sometimes absolutely necessary - “ one cannot get better unless one is willing to address the deep problems and make real changes. One cannot lift oneself up by the boot straps when the boot straps are frayed” (or drugged…..?)

Please do not think that I am arguing with you here on whether one road is better than the other…..I absolutely see this issue as one of personal choice - and that is also a vital reason to me why I do not wish to see a medicalizing of mental health problems - this in a very real way takes away choice to work through problems in other ways if other options are not offered/condoned in society. (this is where I have real fears of mandatory mental health testing of children - certainly this, in the light of the huge increase of medications for children as well as adults now, will lead to more medicating. Medicating some (or many)children might become mandatory for school attendence for those unruly, restless and disturbed children to keep it all manageable. (Which I can appreciate from a teacher's p.o.v.!) This really is a Brave New World scenario for me, and one that some ruling elites might love to encourage - but that is another aspect of this discussion imo….:-)

And 6) I consider chronic depression, anxiety, suicidal impulses to be very serious, and an issue with so many components (personal, spiritual, societal and cultural, even political) that I touched on above that medicating it in all people is a dangerous and undesirable road to go down IMO.

I only partake in these discussions because the subject matters greatly to me, as it does to all of us here, and fascinates me too! And, as you noted, it is a topic of relative confusion for many people involved.
That is why talking about this stuff here is clarifying for us as we express our thoughts and experiences to each other!

DemEx

[hedgehog]

4. I would tend to agree with much of what you say with one

clarification. For example, many people sabotage their recovery regardless of whether it is based in medicine or behavior change or some combination of both. For them, being ill is a way of life they are not willing to give up. I think we agree there.

The one clarification I would make is that for some of us, treating depression without medication is like treating a heart attack with a pep talk. Depression in my family can be traced back several generations and across cousins in the 2nd and 3rd generation. I wouldn't say I've experienced any traumas, but I can look back now and realize I had depressive episodes when I was in 2nd grade.I spent years working around my illness until it got bad enough that I finally recognized that what I was going through was something different from the way other people experience life. I work hard every day to recognize and handle depressive triggers, I take Omega-3 and B vitamins because they're supposed to help, I get enough sleep, exercise and even use a lamp every morning. I also take my medications faithfully. As someone who has a life-long chronic disease, I won't risk not treating it. My understanding of current science is that untreated depression eventually destroys the brain's ability to respond to seretonin. In other words, bouncing on and off SSRIs may eventually make them ineffective. You can see why I won't take that risk.

For now, language is our only access to the brain, and it is possible that different people use the same words to describe subtly different conditions. As brain imaging improves, we may yet discover that what we lump as depression is actually brain disease in some cases, "soul-sickness" in others and a combination in yet other cases. Please be careful not to put some of us down because we need our medicine. I agree with you that not everyone needs medication, but for some of us it is as essential as insulin to a diabetic.

[DemExpat]

5. We can agree on this, hedgehog, that depression is devastating

and needs earnest attention for finding avenues for relief.

I thought I was careful in my post to make sure that I in no way belittle or put down those who need and find relief through meds! :-(
I tried many, and they did not provide me with what I needed.

The crux of my position is that there are many factors of depression and other mental health problems that, when addressed, might resolve any imbalances or heal disease in many people. For me it comes down to keeping options open - not rushing down the road to medicalize it all in everybody who is diagnosed because this often gives quicker results to some - but to leave it to each to find the best path to either heal or manage the life condition. Not to culturally become expected that those with depression/anxiety take meds......

I just have deep reservations about what I see as a rush to put a growing number of people with depression and anxiety on medication, and from my experience and that of others I know, this is not necessarily true:
My understanding of current science is that untreated depression eventually destroys the brain's ability to respond to seretonin.

Since I am now generally free from depression, I take it that my brain has restored its ability to respond to serotonin?

These drugs are a godsend for some people, I just don't believe that they are the answer for everybody, that is all.

:hi:

DemEx

edit: your regimen looks similar to mine with the B vitamins, I take fish oil, sleep, avoiding old triggers, etc.....and I am happy for you that with your meds you have a balance that helps you survive and feel human! :hug:

[hedgehog]

6. There is one school of thought that speculates that depressive

illnesses can be differentiated based upon which medications they respond to. I agree with you that not everyone needs to be medicated, but consider the possibility that we are talking about two different conditions that can't readily be differentiated today. Medical imaging is very close to being able to "see" the depressed brain. Until then, all of us are dependent upon language and observation to determine what is going on. It may be that soul sickness and brain sickness can't be readily distinguished, especially since they so often intertwine. The first would probably made worse by medication while the second probably requires medical treatment.

The interesting thing about this thread is the original "Listening to Prozac" spurred the same misunderstanding if I understand the author's comments. I was bothered by the book because he seemed to say that my use of medication was a needless crutch. In the article that started this thread, he seems to be saying that medications are vital for some, but a distraction for others who should be developing other skills to improve their lives.

[DemExpat]

7. There might well come a time soon that they can diagnose

or "see" the depressed brain as having this and that deviation from the normal brain, but this does not to me prove that depression is inherently and in all cases a physical disease. The abnormal brain in depressed people may be the result of mental/emotional suffering, social stress, or a spiritual crisis for those who believe in spirit, perhaps drugs/alcohol,..... not the cause, as it were....it goes back once again to the chicken or egg question, in my view.

Fascinating subject, though, one that I don't think will be answered definitively any time soon. One study will come out and say this about it, and another will say something else. And people's living personal experience of depression might say something else as well.

But whatever gets us through is a positive outcome - whatever the treatment! And with depression I am certain that nothing that helps is a needless crutch.

DemEx

[Kashka-Kat]

8. Not either-or

Hi all ( & Dem-ex, a lot of your exp/ awarenesses mirror my own-- I think we may have talked before about primal therapy & I too have come to some profound realizations about how my body/soul shut down at birth in response to a brutal (albeit ordinary) welcome into the world... taken away from mother and met with indifference, coldness and extreme physical pain... This is the American way of birthing children and very well could account for the high depression rates here...) Depression is not really, in my experience, a feeling of sadness, but whole body & soul shutdown... what's helped me is to take the lid off enough to release life force energy and to be able to feel the underlying immense pain, grief, fear, rage, etc. Which then allows feelings of joy and love to surface as well....

I was depressed most of my life ... as long as I can remember... I remember in grade school looking around at other children and having the awareness that "they don't feel what I feel, they don't drag around this same heavy sadness like I do..." Then in last 5 yrs. went thru pretty profound life crisis == my motto was change or die-- having huge emotional upheavals, flashbacks, etc. Going through this does seem to have changed me.

The thing is though, I think that there are times in one's life where this can happen-- when the support is there, when one's stamina is up to facing it, when one has reached point of being so thoroughly fed up with ones own life that "change or die" is the only way out of it...

... and then there are times in life when it just isn't possible, when all one can do is go into survival mode and try to hold it together enough to get thru the day...

I would say even if the drugs are a crutch then there are times in life when one needs a crutch! Like if you have a broken leg or something! Or the psychological equivalent. Or if your born without the freakin leg then you do need some kind of artificial prosthesis!

I certainly made use of the drugs, and have no regrets-- I was able to keep a job and get myself out of homelessness and get myself in a stronger position for being able to go thru the upheaval in my life 20 yrs. later...

And yes I do think some people may be simply born w/ impaired neurology and/or biochemistry... instead of it being damaged by trauma, like mine was. (Actually I don't think mine will ever be really "normal", but its certainly better than it was.)

That said I do think the psych establishment pushes drugs at expense of other therapies and is pretty LACKING in resources for people who ARE at the point in their lives when they might need or want to do this kind of deep inner work. I've had to pretty much pay for alternative therapists out of my own pocket... after trying about 5 or so HMO therapists who were not very good at all... some were more afraid of my pain and erupting fear/rage/grief than I was! (And one who kept rolling her eyes---kinda rude...) the therapist I ended up with was SO accepting and I think that alone was therapeutic-- instead of labeling "mental illness" it was "life crisis", my occasional hallucinations were "visuals," that acceptance helped me to accept myself and allow the process to unfold...

[DemExpat]

9. Hi, Kashka-Kat....

Thanks for your experiences and thoughts on this.

I do believe that the birthing methods and separation of infants from their Moms is a huge contributing factor to growing mental illnesses today. :-(

And the power of labelling is demonstrated in your experience as well.

:hi:

DemEx