Depression - not a chemical imbalance?

[perthblue]

Hey guys,

So this article is doing the rounds and thought I'd see what you all thought

https://qz.com/1162154/30-years-aft...ie-that-chemical-imbalances-cause-depression/

The article is worth a read however here are some interesting points:

One reason the theory of chemical imbalances won’t die is that it fits in with psychiatry’s attempt, over the past half century, to portray depression as a disease of the brain, instead of an illness of the mind. This narrative, which depicts depression as a biological condition that afflicts the material substance of the body, much like cancer, divorces depression from the self. It also casts aside the social factors that contribute to depression, such as isolation, poverty, or tragic events, as secondary concerns. Non-pharmaceutical treatments, such as therapy and exercise, often play second fiddle to drugs.

“Beginning with Freud’s influence, through the first half of the 20th century, the brain almost disappeared from psychiatry,” says Allan Horwitz, a sociology professor at Rutgers University who has written on the social construction of mental disorders. “When it came back, it came back with a vengeance.”

The problem is that, though various people could be classed as suffering from a distinct depressive disorder according to their life events, there aren’t clearly defined treatments for each disorder. Patients from all groups are treated with the same drugs, though they are unlikely to be experiencing the same underlying biological condition, despite sharing some symptoms. Currently, a hugely heterogeneous group of people is prescribed the same antidepressants, adding to the difficulty of figuring out who responds best to which treatment.

Despite the lack of evidence, the theory has saturated society. In their 2007 paper, Lacasse and Leo point to dozens of articles in mainstream publications that refer to chemical imbalances as the unquestioned cause of depression. One New York Times article on Joseph Schildkraut, the psychiatrist who first put forward the theory in 1965, states that his hypothesis “proved to be right.” When Lacasse and Leo asked the reporter for evidence to support this unfounded claim, they did not get a response. A decade on, there are still dozens of articles published every month in which depression is unquestionably described as the result of a chemical imbalance, and many people explain their ownsymptoms by referring to the myth.

Meanwhile, 30 years after Prozac was released, rates of depression are higher than ever.

Now I don't have any personal experience with SSRI's or the like, but I think it is interesting, especially in a world where now we are perhaps overdiagnosing (mostly ourselves) as having depression, and myths such as the chemical imbalance have become a common part of the discussion. Is our misunderstanding of depression and reliance on drugs actually making the problem worse? Or in fact creating a problem where there wasn't one to begin with?

 

[Cmarsh]

The problem with prescribing SSRI's as the only treatment for depression is that it doesn't emphasise the importance of the patient doing behavioural activities in their daily lives that assist greatly in supplementing the medication to treat the depressed person. Very often the depressed person has avoided doing everyday things that promote productivity and wellbeing and get caught in the cycle of unhelpful and inflexible beliefs about the events of their lives and about themselves. Therefore, the cycle of depression continues as a result.

Thankfully, most professional clinicians are aware of this and thus also recommend psychological treatments such as CBT alongside an antidepressant.

On the topic of SSRI effectiveness, the book "The emperors new drugs" does a good job of arguing that meta analysis shows that the drugs do little more than placebo in treating depression. However, it has been shown that antidepressants are generally more effective in more severe cases, especially when the depressed person is unable to participate in psychological or behavioural treatments due to the severity.

 

[GreyCrow]

Its this ''take something'' mentality that is the bigger issue. We go to a mechanic and if we dont hear him clinking and clanking we feel ripped off.

Same as a doctor, if we walk out of the surgery without a script we feel empty or our time was wasted. I am in the CBT camp. Exercise etc. Now I understand the issues surrounding depression and its affect on somebody trying to leave the house but the doctors need to be more insistent

 

[raskolnikov]

I have had major depression twice in my life and they were both triggered by circumstances. Depression can be caused by chemical balance but in a lot of cases it is an excuse.

 

[HairyO]

I have had major depression twice in my life and they were both triggered by circumstances. Depression can be caused by chemical balance but in a lot of cases it is an excuse.

Or if you didnt have a chemical imbalance you would have been better able to deal with your issues.

 

[Run n Spread]

Chemical imbalance is another way of saying your serotonin, dopamine, cortisol etc levels are out of whack. Pretty obvious and also vague at the same time as there is no way to predict an accurate baseline (everyone is different) or measure like you could a blood test. Just like saying someone has cancer has a cellular imbalance.

As to the causes: Genetic, Circumstance, Environmental, Stress, other health condition, Stress take your pick.

 

[Demosthenes]

There is enough evidence to suggest that some depression can be rectified with SSRIs. Given this, it's reasonable that medical professionals prescribe SSRIs when non-pharmaceutical strategies have failed. Best case, it fixes a chemical imbalance - worst case, you at least get the placebo effect (which is not nothing).

As long as doctors treat SSRIs as a weapon of last resort, I don't see the problem. What's the alternative, leave the patient non-functional?

Honestly, 'throw everything at it and see what sticks' is a more common medical strategy then you think. It's not necessarily a bad one, provided it's done carefully.

 

[Cmarsh]

There is enough evidence to suggest that some depression can be rectified with SSRIs. Given this, it's reasonable that medical professionals prescribe SSRIs when non-pharmaceutical strategies have failed. Best case, it fixes a chemical imbalance - worst case, you at least get the placebo effect (which is not nothing).

As long as doctors treat SSRIs as a weapon of last resort, I don't see the problem. What's the alternative, leave the patient non-functional?

Honestly, 'throw everything at it and see what sticks' is a more common medical strategy then you think. It's not necessarily a bad one, provided it's done carefully.

You forgot about the side effects from antidepressants from your worst case scenarios. This should always be considered when health professionals are consulting with their patients about prescibing decisions.

 

[GreyCrow]

You forgot about the side effects from antidepressants from your worst case scenarios. This should always be considered when health professionals are consulting with their patients about prescibing decisions.

ie the use of alcohol and illicit drugs that can alter the help given

 

[Bunk Moreland]

Always figured it’s a mix - a preexisting chemical issue that is revealed when external circumstances occur.

Medication does help, but it’s not the whole solution.

 

[Scotland]

I sort of figure it's one, none or both. It will always be a grey area because it's not like traditional medicine. Diagnosing/treating depression is more like an episode of House. It could be A because XYZ, and it could be B because XYZ, but it could be C be XY and Z is coincidental. Etc. There's also no one size fits all treatment approach. You can't vaccinate against mental illness, and you can't just cure it with a course of anti-biotics.

Emotions are natural. Feeling sad because something bad happens is just as normal as feeling happy because something good happens. Everyone is different and consequently everyone reacts differently to different events/experiences. But that's only one side of the coin.

 

[Taylor]

Does society really want someone's personality broken down to a balance of brain chemicals? Why are some more resilient than others? Why are some so eager to catastrophise their minor life bump to live as a perpetual victim?

Will we, one day, be genetically testing babies and telling parents that this one will be a pain in the arse, crying drunk, scene maker but that other child will be a battler who keeps their head up through adversity?

 

[kickazz]

I think it is a mistake to try to completely divorce the chemistry of mental illness and the social causes and aspects of it.

No doubt the importance of things like CBT for the long term treatment; and avoidance of excessive stress, loneliness, bullying for prevention.

But I've seen first hand that when things get bad enough, you need to use chemicals to fix up the chemical issues in the brain. Once recovered, then CBT and the like can be effective.

If someone breaks a leg or pulls a hamstring, you don't get them to walk or run it better. You fix it, then do the rehab when ready.

 

[kickazz]

I sort of figure it's one, none or both. It will always be a grey area because it's not like traditional medicine. Diagnosing/treating depression is more like an episode of House. It could be A because XYZ, and it could be B because XYZ, but it could be C be XY and Z is coincidental. Etc. There's also no one size fits all treatment approach. You can't vaccinate against mental illness, and you can't just cure it with a course of anti-biotics.

Emotions are natural. Feeling sad because something bad happens is just as normal as feeling happy because something good happens. Everyone is different and consequently everyone reacts differently to different events/experiences. But that's only one side of the coin.

Emotions are indeed natural and we need to feel them all and respect that.

I was once told that it becomes a problem when our reactions to our emotions become maladaptive, in that it changes our behaviour in ways that do not benefit us.

Sadness and disappointment are necessary so that we can assess and recognise our poor choices. Depressed people however maladapt to these emotions to the point of "learned helplessness" whereby they weigh the negatives too highly. This can for example be caused by societal factors like bullying/abuse, but even when those factors are rectified, the individual's brain pathways have developed in a ****ed up way and can be hard to undo.

 

[GreyCrow]

I think it is a mistake to try to completely divorce the chemistry of mental illness and the social causes and aspects of it.

No doubt the importance of things like CBT for the long term treatment; and avoidance of excessive stress, loneliness, bullying for prevention.

But I've seen first hand that when things get bad enough, you need to use chemicals to fix up the chemical issues in the brain. Once recovered, then CBT and the like can be effective.

If someone breaks a leg or pulls a hamstring, you don't get them to walk or run it better. You fix it, then do the rehab when ready.

I accept the premise that you treat the problem then look to resolve it. My concern is with those GPs whose first and only recourse is to a medicated approach.

Emotions are indeed natural and we need to feel them all and respect that.

I was once told that it becomes a problem when our reactions to our emotions become maladaptive, in that it changes our behaviour in ways that do not benefit us.

Sadness and disappointment are necessary so that we can assess and recognise our poor choices. Depressed people however maladapt to these emotions to the point of "learned helplessness" whereby they weigh the negatives too highly. This can for example be caused by societal factors like bullying/abuse, but even when those factors are rectified, the individual's brain pathways have developed in a ****** up way and can be hard to undo.

Agreed. We are our own worst enemies when it comes to choosing the right strategies.

 

[Taylor]

What evolutionary purpose would depression have?

 

[GreyCrow]

What evolutionary purpose would depression have?

Its an interesting question. Some have argued that sleep is a poor evolutionary defence as well. And depression and sleep are linked

I think this is where most of the discussion about its medical diagnosis falls. It seems to be a modern malady or at least more reported in the last 100 years.

 

[kickazz]

Its an interesting question. Some have argued that sleep is a poor evolutionary defence as well. And depression and sleep are linked

I think this is where most of the discussion about its medical diagnosis falls. It seems to be a modern malady or at least more reported in the last 100 years.

Sleep has a purpose though, it engages the parasympathetic nervous system, enabling better digestion, healing and regeneration. I've heard people say it's the ideal natural state, we only need to be awake to avoid predators, to find food and reproduce.

 

[Proud SJW]

What evolutionary purpose would depression have?

It doesn't.
Many moons ago, a lot of people would have simply done themselves in, now they don't (so much). Many people who have it still survive, depending upon the degree.

Not every aspect of humanity is beneficial, evolution is concerned more with survival traits, not useless ones.
Basically, it doesn't matter what happens to you after you spit out a kid or two. You've done your job.
So while it obviously isn't beneficial, it isn't detrimental either. Depressed people still have sex.

 

[John Who]

Here's my take on depression, and hopefully it gives you guys an idea of what it is:
Depression is the state your mind is in, and it gives off signs in the body/cognitive functions that it "wants a break".
Depression is either from external causes (circumstances causality) or internal causes (chronic illnesses, chemical imbalances in the brain, illict drug use etc). Often, depression is caused by both internal and external factors, as one often affects the other.

 

[Run n Spread]

What evolutionary purpose would depression have?

None. What evolutionary purpose would cancer have?

 

[Taylor]

None. What evolutionary purpose would cancer have?

Outside of cervical cancer, can you catch cancer from the outcome of social situations?

We are highly social, community (herd) animals so anything that is part of how or why we interact should be looked at.

 

[Run n Spread]

Outside of cervical cancer, can you catch cancer from the outcome of social situations?

We are highly social, community (herd) animals so anything that is part of how or why we interact should be looked at.

True just like we avoid smoking, working with asbestos.

My point was not all things have an evolutionary advantage. Depression, illness etc.

 

[John Who]

What evolutionary purpose would depression have?

Not sure what you're trying to ask, but it serves the body a purpose by enforcing you to rest up, and not do much else. It also allows others to leave you alone or give you more empathy (unless the person is a narcissist). Without "clinical depression", then you're just a "happy person feeling stressed".

 

[Taylor]

Not sure what you're trying to ask, but it serves the body a purpose by enforcing you to rest up, and not do much else. It also allows others to leave you alone or give you more empathy (unless the person is a narcissist). Without "clinical depression", then you're just a "happy person feeling stressed".

I'm wondering if there is a link to that brain process, such as it being a runaway version of peer pressure trying to keep the group moving together (like how yawning is a socially sympathetic action) and those who aren't in the same path as the rest of their peers feel bad and are motivated by that feeling to get in line. The world is so big now and there are so many paths to take that not taking a path is seen as independent, right at the time teenagers are trying to find their own identity.

Perhaps clinical depression is the runaway chemical process of that.