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Jonah Lehrer, the editor of Mind Matters, asked Allan Horwitz, professor of sociology at Rutgers University, and Jerome Wakefield, professor of social work at New York University, a few questions about their recent book, The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Illness.
LEHRER: In your book, you take a critical look at major depressive disorder (MDD), a mental illness that will afflict approximately 10 percent of individuals at some point during their life. In recent decades, the number of cases of MDD has sharply increased. Are we currently experiencing an epidemic of depression? Or is this surge due to changes in diagnosis?
HORWITZ AND WAKEFIELD: Our book argues that, despite widespread beliefs to the contrary, the rate of depressive disorders in the population has not undergone a general upsurge. In fact, careful studies that use the same criterion for diagnosis over time reveal no change in the prevalence of depression. What has changed is the growing number of people who seek treatment for this condition, the increase in prescriptions for antidepressant medications, the number of articles about depression in the media and scientific literature, and the growing presence of depression as a phenomenon in popular culture. It is also true that epidemiological studies of the general population appear to reveal immense amounts of untreated depression. All of these changes lead to the perception that the disorder itself has become more common.
In fact, we think what has really changed is that since 1980 psychiatry and the other mental health professions have used a definition of depression that conflates genuine depressive disorder with intense, but normal, states of sadness. Since the third version of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III) was published in 1980 psychiatry has relied primarily on a list of symptoms for its definition of depressive disorder. So someone who has five symptoms out of a list that includes things like depressed mood, loss of interest in usual activities, insomnia, fatigue, lessened appetite, an inability to concentrate and similar symptoms for as brief a period as two weeks is considered to have a depressive disorder.
Yet loss events such as a betrayal by a romantic partner, being passed over for a much-anticipated promotion, failing an important test, having a mortgage foreclosed, or discovering a serious illness in oneself or a loved one could naturally lead the same symptoms to arise and endure for a two-week period. When such criteria are applied to the general population, very large estimates of untreated depressive disorder emerge, because one is capturing intense normal reactions to losses as well as genuine depressive disorder.
Before 1980, for the 2,500 years since the dawn of psychiatric medicine, only symptoms that were “excessive” and inexplicable relative to their provoking context were considered to be signs of a depressive disorder. After 1980 all symptoms, even those that are proportionate to their provoking cause, were defined as disordered. This change means that intense natural reactions to loss events as well as disordered responses have been seen as mental disorders, thus accounting for the apparent increase in depression in recent years.
LEHRER: What has led to these changes in diagnosis?
HORWITZ AND WAKEFIELD: Initially, the changes in the diagnosis of depression resulted from efforts by research scientists, in response to widespread critiques of the unreliability and unscientific nature of psychiatric diagnosis, to make the criteria for depression (and other mental disorders) more easily measurable, precise and reliable so that different mental health professionals would make the same diagnosis when they saw patients with similar symptoms.
Once depression came to be defined by its symptoms, however, the definition of the mental illness took on a life of its own. Mental health advocates, for instance, liked the fact that it produced high estimates of the amount of depressive mental disorder so that it seemed as if depression was a “public health problem” of massive proportions. Clinicians could get reimbursed for conditions that might actually be non-medical problems. Perhaps most important, pharmaceutical companies found that they could portray people who suffered from widespread psychosocial problems in their advertisements while at the same time marketing their products as treatments for depressive mental disorders. And, of course, many individuals find it more acceptable to frame their problems as the result of a mental disorder and to take psychotropic drugs to attempt to relieve their distress than to see their suffering as the result of psychosocial problems. So, although the internal dynamics of the psychiatric profession initially led to the changes in the diagnostic criteria, once the criteria arose they have been perpetuated by a variety of groups that benefit from them.
LEHRER: What are some of the benefits and costs associated with the phenomenon you refer to as the "medicalization of sadness"?
HORWITZ AND WAKEFIELD: We recognize that the symptom-based definition of depression has had some beneficial effects, such as the growing number of people who receive mental health treatment, the decline in the stigma associated with this condition and the flourishing of scientific research about depression. We also think, however, that the medicalization of sadness has a number of costs. One is that calling a condition a “depressive disorder” prejudges the nature of that condition and suggests that medication is the most appropriate response to it. General physicians, as well as psychiatrists, seem almost reflexively to prescribe drugs for many conditions that might actually reflect normal, intense sadness and are likely self-limiting. Another is that defining sadness as depression can tend to close off non-medical interventions including various sorts of social support, psychotherapies, changes in life circumstances or turning the sufferer’s attention to confronting their psychosocial situation—and can undermine resolve to address social problems that make people miserable by reframing that misery as a widespread individual medical disorder.
Some other costs involve the research implications of confusing natural sadness and depressive disorder. Scientists are likely to see these conditions as homogeneous whereas, in fact, they have different etiologies and prognoses. Policy makers, for instance, might be tempted to see high rates of depression as signs that mental health treatment instead of social change is warranted. So, there are many possible costs to the medicalization of sadness because it misleads our thinking in every area, from policy and research to clinical intervention and our own personal understandings.
LEHRER: How can psychiatrists learn to distinguish between "intense sadness," which can often constitute a normal emotional response to loss, and MDD?
Although the distinction between normal intense sadness and depressive disorder is often subtle, there are some differences that can be used to separate these conditions. One is that intense sadness should be sensitive to social context. It not only arises but also persists as a function of a situation of loss. This fact means that if the situation improves—a person who is dumped by a romantic partner finds a new partner or someone who loses a job finds another—the sadness should dissipate. In contrast, depression is relatively impervious to such positive changes. People themselves sometimes can tell the difference—they report that what they are feeling does not feel like being intensely sad when grieving but is qualitatively different in its sense of numbness and immobility. A further difference is that normal sadness is typically of relatively shorter duration, unless the stress is chronic or itself recurs; over time people naturally tend to adjust to situations of loss and there is a spontaneous trajectory of recovery as people reconstruct their lives after the loss. In contrast, depressive disorders are more enduring. Finally, some especially serious symptoms such as hallucinations, delusions and vegetative symptoms in themselves suggest the presence of a disordered condition.
LEHRER: If, as you argue, antidepressants aren't always the answer, then how should people deal with intense sadness?
HORWITZ AND WAKEFIELD: There is no single response that fits all cases of intense sadness, but different people will find various alternatives to be most suitable for their own cases. “Watchful waiting” is often the most desirable alternative to see if the condition improves on its own as the person adjusts to the loss. And there are also many things one can do.
First, we are very fortunate that there are a variety of psychotherapies that research indicates are as effective as medication in treating depression—perhaps with the exception of the most severe cases. These approaches include, for example: cognitive-behavioral therapy which looks at how an individual’s negative thinking is biasing their interpretation of environmental events and influencing mood; interpersonal therapy, which has the individual work intensively on addressing the most important relationship issues that are a source of depression; and behavioral activation, which has the individual systematically act to change the circumstances that are causing sadness. As you can see, these therapies are based on principles that individuals might apply to themselves even without the help of a therapist, and all involve acting to change one’s relationship to the environmental factors that are causing the distress.
Therapy aside, sadness is a complex emotional/cognitive state that indicates that something has gone wrong with some of the aspects of life the individual most cares about. So one response is to take it seriously and think hard about how one’s life is not going well and what one might do to change it. Seeking social support and altering one’s social and exercise routines can often help. Some might find antidepressants will bring relief for their suffering, even when they don’t have a disorder. This decision, however, should be made under conditions of full knowledge that, despite the intensity of their suffering, it is likely to improve in the future without the aid of a drug.
What we hope people and their physicians don’t do is make the simple assumption that the presence of a particular group of symptoms for a short period of time always indicates the presence of a depressive disorder. Negative emotions such as sadness are a natural part of life and, although there is nothing wrong with wanting to feel better, they should not automatically be treated as signs of a disease.
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25 Comments
Add Commenti am grateful to hear about sadness not always needing the treatment of prescribed drugs. I once was told to ask my family doctor for something to treat bi-polar disorder. Dr. Mull prescribed me one, no questions asked. Our marriage counseler, and a close friend, finally pursuing his masters in psychology, whom i have known for twenty four years, both belive differently. I have done better with the help of counseling or just having someone to mediate and talk to.
Reply | Report Abuse | Link to thisI am so glad that someone is saying that sadness does not equal depression. I am disturbed by the tendency to medicalize all negative feelings when, in fact, these periods of normal sadness can be major learning times. Also, I am wondering whether Mr. Lehrer has heard of the "caveman treatment" for sadness/depression developed by a researcher at Kansas University Medical. It combines excercise, diet, socializing, sunlight and avoidance of brooding on sad thoughts. Sorry I can't be more specific about the identity of the scientist. Thanks for this article and I will be reading Mr. Lehrer's book.
Reply | Report Abuse | Link to thisConfusing sadness and depression actually harms people both ways.
Reply | Report Abuse | Link to thisSomeone suffering from a biochemical imbalance which causes them to respond abnormally may be told by unsympathetic family and friends to pull himself together, as if it that were possible for him. Someone experiencing a perfectly normal negative emotional reaction to a bad situation may label what they experience as being depressed (meaning clinically depressed) and may even fail to try to change the bad situation.
The subtle distinction which needs to be clear is that Clinical Depression is NOT "feeling sad". It is failing to respond normally to a situation which would provoke emotions of a certain kind and at some expected level: failing to feel joy in a pleasant situation, losing one's sense of humor, feeling an excess of sadness or anxiety for no rational reason, responding with more anger than is normal for a situation, etc. One must distinguish situational problems from biochemical problems.
Another problem is that symptoms diagnosed as Clinical Depression may actually be some completely kind of physical problem, such as unrecognized Diabetes, Thyroid problems, sleep deprivation, subtle malnutrition, etc. That is one of the reasons why antidepressants so often do not work for people who try them.
Great article! I worked in psychiatric research for over 10 years and can vouch for the fact that researchers fail to take into account precipitating life events when diagnosing depressive disorders.
Reply | Report Abuse | Link to thisI'm wondering if there is a possibility of a reverse placebo effect. We know that placebos have surprisingly high efficacy rates, so could the reverse be true? Could the medicalization of sadness be causing some bouts of sadness to turn into actual depressive disorders? Once patients hear they have a genetic or biological disorder, could a bout of sadness end up lasting much longer than it otherwise would?
And I might add that the common view of psychiatrists (I've worked with a number of them over the years) is that their patients should be on medications for the rest of their lives.
Yes, I think there is perhaps a possibility of a reverse placebo effect. When I was 16 and in a tough, violent, gang member and drug dealer infested high school, I became profoundly stressed and saddened. On the one hand, I was trying to be a good student in a gifted and talented program, while on the other, I was exposed to hatred, corruption, violence and racism. I hated my school and my fellow students. Rather than listen to my concerns and identify with my unhappiness, adults labeled me as disturbed and sick. I was accused of being lazy, on drugs, a trouble maker, etc. Finally, a psychologist told me I was chronically depressed (dysthymic) and would need meds for the rest of my life and therapy for years. What do you think happened to me? Well, I went on meds and spent years in therapy. I am now in my mid thirties and still single, living at home with my parents, and generally pretty unhappy with my life. This is after years of medication and therapy that were supposed to help me and "fix" my supposedly broken brain.
Reply | Report Abuse | Link to thisIt seems quite possible that people are experiencing more episodes of "sadness" and depression today than in the past, and that there is an explanation beyond overdiagnosis. Numerous studies show that nutrient deficiencies impair brain function and lead to depressive symptoms. As the number of people consuming processed foods that are low in nutrients (most notably long chain essential fatty acids and B vitamins) increases, the number of people with brains predisposed to functioning suboptimally and developing both anxiety and depressive symptoms should be expected to increase.
Reply | Report Abuse | Link to thisDr. Cate Shanahan
www.drcate.com
wasup?
Reply | Report Abuse | Link to thisWow, thats crazy! Thats why, when I had depression, I think that if it weren't for the strength god puts inside us, I wouldn't have been able to get through my depression because those medications they gave worsened my depression, they did not help me one bit.
Reply | Report Abuse | Link to thisI think it is crucial that we learn as a culture to tolerate and work through negative feelings as they are a normal part of life, there are pressures to feel good all the time-- these even occur with children. It is a debilitating belief, and it is important that parents teach their children from an early age to manage getting from point a (a disappointment, or loss), to point b (the recovery or passing of that feeling). I think part of the problem is the ready pathologizing of normal experiences, but I do think that those normal experiences of disappointment can become a pattern of thinking negatively which--if left unchecked-- can become a gateway to depression.
Reply | Report Abuse | Link to thisThis sort of emotional intelligence-- understanding how emotions work and what we can do to help ourselves-- will do much in preventing serious conditions. I write about these ideas in my new book, Freeing Your Child from Negative Thinking: Powerful, Practical Strategies to Build a Lifetime of Resilience, Flexibility and Happiness. If you'd like to check it out, please go to www.freeingyourchild.com
Tamar Chansky
How very refreshing to hear such common sense about sadness and depression. Anything in our remorselessly upbeat "feel good" society that is slightly upsetting or negative tends to get exaggerated into a condition or illness that is treatable only by drugs or therapy, and some people make a lot of money out of this. This approach is particularly harmful towards children, many of whom are talked into so-called conditions by counsellors and other "experts" who bring their mission into schools.
Reply | Report Abuse | Link to thisI DO have a Clinical Depressive Disorder. Sadness was never a part of it. And there are an amazing number of people who think that I should be able to just "snap out of it". That the right amount of psychotherapy should fix me right up. But I am the one stuck in this malfunctioning body. Life without medication is a horror - of being trapped. The different sections of my brain stop communicating properly because of a chemical imbalance. As the imbalance gets worse, my cognitive functions begin to shut down in order to preserve the chemicals needed to run basic functions. I experience loss of time. Body temperature is not properly balanced; and you experience hot and cold flashes. All kinds of physical symptoms related to faulty brain functioning. After a week solid of out-of-body experiences, and everyone telling you there is nothing wrong... You begin to feel suicidal - because you want the problem to stop. And nothing helps. Alcohol, drugs, tea, vitamins. I ate liver and onions and spinach quite a bit for a couple months. It was not until I called the local University Hospital Psych ward, that a nurse there laughed and told me exactly what my problem was, and exactly who I needed to see to get medications to make me better. And even after that, it took six months of experimentation to discover the medication that would make me better. I do treasure my sanity. I take my meds religiously. And I can't help but pity those people who are insane - when meds would fix them right up. And a lot of those people are among the homeless/jobless. I am among the few that established a job/career before Clinical Depression came along. I can afford my doctor and my meds. So many needy people cannot afford help.
Reply | Report Abuse | Link to thisIn my time, we called sadness due to an external event , "reactive depression"as opposed to "Endogenous depression". We did not use drugs to treat the former.
Reply | Report Abuse | Link to thisVarious conditions such as "personality disorders" suffer depression.
To just treat the depression with drugs is to miss the underlying disorder.
R Skinner M.B. B.S.
Anyone not depressed right now is out of touch with reality. The world is going down the crapper politically and environmentally, our future national leaders, A.K.A. the up and coming "generation Y'ers" are for the most part vapid self- centered fools, and let's not even discuss the economy. My question to anybody who is feeling cheerful at the moment: what's wrong with you?!
Reply | Report Abuse | Link to thisAnyone not depressed right now is out of touch with reality. The world is going down the crapper politically and environmentally, our future national leaders, A.K.A. the up and coming "generation Y'ers" are for the most part vapid self- centered fools, and let's not even discuss the economy. My question to anybody who is feeling cheerful at the moment: what's wrong with you?!
Reply | Report Abuse | Link to thisA lot of things may cause depression, and there is a wide range of degrees on it. Every person has his own depression's feature, and there is no way to
Reply | Report Abuse | Link to thisconsider it as an unique form. So, the best thing to do is to develop one's self-analysis to discover the source of depression. Taking medicines not always leads to solution. One of the best medicine ever discovered is
called phenylethylamine and it is free. In other words, all you need is love.
As the author of a recent editorial on the Horwitz-Wakefield book, I would encourage readers of this exchange to take a look at my comments at the following website:
Reply | Report Abuse | Link to thishttp://www.psychiatrictimes.com/display/article/10168/1357799
Sincerely, Ronald Pies MD
I hope that readers of this exchange will take a close look at my editorial on the Horwitz-Wakefield thesis, in the December issue of Psychiatric Times. The article may be seen at the address below. --Sincerely, Ronald Pies MD
Reply | Report Abuse | Link to thishttp://www.psychiatrictimes.com/display/article/10168/1357799
Serotonin Enhancing Psychotropic Pharmaceuticals
Reply | Report Abuse | Link to thisIn the 1930s, physicians approached the mental illness of depression a bit differently that we do today. While acknowledging a likely cause of depression in one of their patients is often due to some great misfortune, they seemed to focus on what is called a complex. A complex is disturbances of ideas and impulses that are the cause of consistent habitual patterns of thought, feelings, and behavior. An example of this state of mind of one who is depressed is one who experiences an exaggerated or obsessive concern or fear. And the etiology for this mental disorder was often undefined. People react differently to life stressors in their life, so depression cannot be empirically determined.
In the 1930s, psychotherapy such as cognitive therapy was recommended for treating the depressed patient, and not pharmacological therapy. Also considered for the depressed patient was positive lifestyle changes that would lessen the pain that the depression was causing them. Try and be grateful, they would tell their patient, as well as thankful and appreciative for whatever good may be in their life, and normally the depressed patient would eventually recover
Times have changed since then.
Presently, serotonin-enhancing drugs are the therapeutic regimens for those who are suspect of having a depressed state, or perhaps the patient simply asks for these types of drugs due to their perception that they are depressed. Furthermore, and remarkably, various other mood disorders one may have can be treated with these drugs, typically called SSRIs. What is remarkable is that the mood disorders which will be discussed later are subject to debate and have also been brought to the attention to so many others through disease awareness campaigns by the makers of these SSRI drugs. So mental flaws claimed to be relieved by SSRI drugs may not be the case at all.
With depression, the most severe cognitive and behavioral malfunctions are expressed in what is called a major depressive disorder, which is also called clinical depression or major depression. Symptoms of this type of depression, which is the most concerning to health care providers in particular due to its severity, include decreased or flat affect, decreased interest in activities once enjoyable, self perceptions of worthiness, guilt, regret, helplessness, and hopeless by the sufferer, to name a few of the diagnostic features that may be present with one who has such a major depressive disorder. The disease has a vexing insistence on staying with the victim for a lengthy period of time- often continuing to progress symptomatically in severity and discomfort. This disease is very disabling, and cannot be lifted by one’s will, so all health care professionals likely agree that depression is a potentially serious condition with their patients. Suicidal ideation and attempts are associated with major depression.
These SSRI drugs mentioned earlier are known by some health care providers as third generation anti-depressants. Such drugs, drugs that affect the mind, are called psychotropic medications. SSRIs also include a few drugs in this class that include the addition of a norepinephrine uptake inhibitor added to the SSRI in one capsule, and these drugs are referred to as SNRI medications. The combination of two different drugs has made them the top class of prescriptions for psychological misalignment.
There are several available SSRIs presently, yet it is believed that only two SNRIs are available, which are Cymbalta and Effexor. Some consider these classes of meds, the serotonin enhancers in these medications, have been considered the next generation mood enhancers- after the benzodiazepine hype decades ago, which was followed by what were called trycyclic drugs for depression for some time. Furthermore, regarding SNRIs, adding the additional agent of norepinepherine is presumed to increase the effectiveness of SSRIs by some, yet not everyone claims relief from these types of drugs.
Some Definitions:
Serotonin is a neurotransmitter thought to be associated with mood. The hypothesis was first suggested in the mid 1960s that this neurotransmitter may play a role in moods and emotions in humans. Yet to this day, the serotonin correlation with such behavioral and mental conditions is only theoretical. In fact, the psychiatrist’s bible, which is known as the DSM, states that the definite etiology of depression remains a mystery and remains unknown with complete certainty. So a chemical imbalance in the brain is not proven to be the cause of mood disorders, it is only suspected as a result of limited scientific evidence. In fact, diagnosing mental diseases such as depression is based on subjective assessment only, as interpreted by the prescriber, so one could question the accuracy of such diagnoses.
Norepinepherine is a stress hormone, which many believe help those who have such mood disorders as depression. Basically, with the theory that by adding this hormone, the SSRI will be more efficacious for a patient prescribed such a med, as suggested earlier.
And the depressive state of a patient certainly can be aggravated by another mood disorder at the same time with some patients. Anxiety usually exists with one who has a major depressive disorder. An objective diagnosis of such a mental condition is rather impossible to assess objectively. Therefore any diagnosis made for a mental abnormality lacks complete accuracy and assurance. Such illnesses can only be assessed conceptually, so the diagnosis or impression concluded by the patient’s health care provider is dependent on subjective criteria expressed by the suspected patient that is not mentally sound. At times, there have been screening programs that have been used for identifying depressed patients have proven to be largely ineffective. A social patient history is uncertain and tricky as well, some have said, yet is obtained often from such patients. There is no objective diagnostic testing for any mental malfunction to validate as to whether or not such a disease is present. A health care provider has to assess as to whether certain non-verbal or vocalized features are present with a patient in order to conclude confidently that one may have in fact some degree or level of depression. To assess a suspected depressed patient is further complicated by the fact that the exact cause of major depression is unknown. Research says that there is a strong genetic component to this illness.
The diagnosis of depression as well as mood disorders that may exist within patients has increased quite a bit over the past few decades. Some have asked themselves, as well as others- actually how many people are really and actually depressed? What is believed is that if one determined to be cognitively impaired from a mental paradigm, then this may be in fact major depression. If this mental disorder is determined by a health care provider, it is possible that pharmacological therapy may be considered reasonable and necessary, as well as psychotherapy either suggested to be performed with or in place of medicinal therapy. Studies show that both therapies working together may be of most benefit for the depressive patient, yet it is not a guaranteed protocol for treatment in this way.
It has been reported that around 10 percent of the U.S. population will at some point be affected by an episode of what may be a major depressive disorder. This is much greater in number than just a few decades ago. Perhaps media sources are to blame, by suggesting to their viewers that they may in fact be depressed. So the diagnosis and medicinal treatment have remarkably increased in a relatively short period of time in the United States. Of course, the expansion of those claimed and determined to be depressed does not sadden the makers of these drugs used to treat this mental disorder one bit, I’m sure.
Some have said that so many more people seek treatment now for what they believe is a major depressive disorder they are experiencing, when in fact it may be possibly intense sadness, perhaps, due to a loss of some sort in their lives. There is a difference, and health care providers should have the appropriate tools and knowledge to discriminate between the two states of mental conditions. Sadness is not a medical problem. Symptoms associated with an unfavorable mental state need to be excessive and chronic to be considered to have in fact the medical problem of a major depressive disorder, as stated by others.
In Time magazine’s June 16th 2008 cover story, it was reported that the military personnel in the Iraq war are pounding down SSRIs often. Every time there is a new war, there is a new drug, it seems. Yet the story may illustrate the frequent usage of these types of medications in a variety of different areas for different reasons. Some reasons may be valid and appropriate, yet others perhaps may not be reasonable for such medicinal therapy. However, as illustrated in this situation, they appear to be accepted as a treatment option without reservation.
In regards to those pharmaceutical companies who make and market such psychotropic drugs in the manner that their manufacturers do is largely unknown to others, such as with screenings performed essentially by front groups, and so forth. However, what is known is that the psychiatry specialty, as they often treats and manages depressed patients, is the one specialty that receives the most monetary funding that is paid to them by these certain pharmaceutical companies for ultimately what they hope will be continued and additional support of the psychotropic meds that they currently promote to these doctors. Needless to say, the desire and the aspect of the pharmaceutical industry clearly is primarily concerned with encouraging as much use out of their products as possible- with both doctors and patients being the route of that increased use they desperately hope will occur.
Regardless, SSRIs and SRNIs are the preferred treatment methods if depression or other mood disorders that are suspected and determined by the health care providers who treat such patients. Yet these drugs discussed clearly are not the only treatments, medicinally or otherwise, for depression and other related and suspected mental disease states, moods, or disorders. Patients should be aware of this fact as well as caregivers. And they may not be aware of the options available to them.
For example, tens of millions of prescriptions are written by health care providers for these types of medications for their patients. These drugs are not inexpensive, either, as it is not unusual for a patient to pay greater than one hundred dollars to have their prescription filled for only a month’s worth of these particular drugs.
Presently, there are about ten different SSRI/SRNI meds available, many of which are now generic, yet essentially, they appear to be similar in regards to their efficacy and adverse events. The newest one, a SNRI called Pristiq, was approved in 2008, and is believed to be launched as a treatment for menopause.
The first one of these SSRI meds was Prozac, which was available in 1988, and the drug was greatly praised for its ability to transform the lives of those who consumed this medication in the years that followed. Some termed Prozac, ‘the happy pill’. In addition, as the years went by and more drugs in this class became available, Prozac was the one of preference for many doctors for children. A favorable book was published specifically regarding this medication soon after it became so popular with others.
Furthermore, these meds have received upon request of their makers to the FDA to have additional indications besides depression for these types of drugs they produce and market, and the indications they have received are for some really questionable conditions , such as social phobia and premenstrual syndrome. Also included with indications that now exist with these types of medications are the quite devastating conditions of what may be mild anxiety and shyness, yet the makers of these drugs consider such patients as having chronic anxiety with severe anxiety disorder, which others have said is rather obsurd. And it gets worse with the indications received for these types of drugs, which now include Obsessive-Compulsive Disorder, Panic Disorder, Agoraphobia, Post Traumatic Stress Disorder, Bulimia, and any form of stress disorders in general. I understand they are seeking indications for pain management as well with these SSRI or SRNI pharmaceuticals. Likely, they will get the indication for their drugs to treat such creative cognitive states apparently others have in great numbers.
With some of these indications for these classes of drugs, I question as to whether or not they are actual and treatable disease states or medical problems. Yet with additional indications for particular drugs in these classes of medications, one can be assured that the market for these drugs will continue to grow- as more are prescribed to those patients who are progressively asking for them specifically for relief they anticipate they will receive from taking these drugs. What such patients are not aware of is that studies have shown that this class of medications is only effective in roughly half of those who take them. And some of the indications granted to drugs in these classes of medications may be considered disease mongering tacitly performed by the makers and marketers of these drugs to again grow the market share for particular drugs of this type. This is combined with drug companies who make these types of meds either forming or creating front groups in order to have more diagnosed with various medical problems that may not exist so their medication can be utilized more. And as mentioned earlier, such pharmaceutical companies have been known to either create or support front groups to ultimately encourage who may be normal people to get evaluated for the diseases indicated with these medications. Of course, such tactics implemented by such pharmaceutical companies are deceptive, inappropriate, unreasonable, unnecessary, and potentially if not actually dangerous to others.
Perhaps of greater concern and danger with these particular psychotropic medications involve the adverse effects associated with these types of drugs, which include suicidal thoughts and actions, violence- including acts of homicide, and aggression- and this is only to name a few. Such events are devastating and have been demonstrated by those who have or are taking these types of drugs. It has been reported that the makers of such drugs are suspected to have known about these toxic and dangerous effects of their drugs and did not share them with the public in a timely and critical manner until forced to do so. While most SSRIs and SNRIs are approved for use in adults only, prescribing these meds to children and adolescents has drawn the most attention and debate with others for understandable reasons, which have included those in the medical profession as well as citizen watchdog groups. The reasons for this attention are due to the potential off-label use of these meds in this population of children, yet what may be most shocking is the fact that some of the makers of these meds did not release clinical study information about the risks of suicide as well as the other adverse events related to such populations, combined with the true decreased efficacy of SSRIs in general, which is believed to be only less than 10 percent more effective than a placebo. Paxil caught the attention of the government regarding this issue of data suppression some time ago, this hiding of such important information- Elliot Spitzer specifically was the catalyst for this awareness, as I recall. Furthermore, that drug is in the spotlight once again years later. Some believe the drug maker knew about possible risk to the youth as early as 1991. Yet did not disclose such danger associated with their drug to the public or the FDA, and this was done with intent.
And there are very serious questions about the use of SSRIs in children and adolescents regarding the possible damaging effects of these meds on them as they get older- these children and teenagers who are prescribed these drugs. Others are asking if this is really necessary- and are these drugs doing more harm than good for their children.
For example, do the SSRIs correct or create brain states considered not within normal limits, which in effect would possibly cause harm rather than benefit a patient on such a drug? Are adolescents really depressed, or just experiencing what was once considered normal teenage angst? Do SSRIs have an effect on the brain development and their self identity of such young people? Do adolescents in particular become dangerous or bizarre due to SSRIs interfering with the myelination occurring within their still developing brains? No one seems to know the correct answer to such questions, yet the danger associated with the use of SSRIs does in fact exist, as demonstrated by others. It is observed in some who take such drugs, but not all who take these drugs. Yet health care providers possibly should be much more aware of these possibilities, possibly, along with the black box warning now on SSRI prescribing information for the youth that has existed since 1994. There are other medications health care providers could prescribe for such patients that have no less benefit for them then the serotonin drugs discussed.
Finally, if SSRIs or SNRIs are discontinued by a patient rapidly, abruptly, and without medical supervision, withdrawals experienced by many of these patients are believed to be quite brutal that follow soon after this drug is not taken anymore by a former patient. This in itself may be a catalyst for one to consider or attempt suicide, others have suggested. Many are aware and understand that discontinuing these SSRIs and SSNIs leaves the brain in a state of neurochemical instability for some great length of time as the neurons need to recalibrate after existing in a brain over-saturated with serotonin and neuron alteration. This occurs to some degree with any psychotropic medication, yet the withdrawals can reach a state of danger for the victim in some classes of meds such as SSRIs and SNRIs, it is believed. And this seems to concern many, yet does not inhibit health care providers for continuing to select such therapy with these drugs for their patients.
SSRIs and SRNIs have been claimed by doctors as well as patients to be extremely beneficial for the patient’s well -being regarding their apparent mental issues that resolve in time. Yet overall, the factors associated with this class of medications may outweigh any perceived benefit for the patient taking such a drug that can harm themselves and others.
Before these medications mentioned were developed, doctors praised trycyclics, another class of anti-depressants mentioned earlier, in a similar manner some time ago. Considering the lack of efficacy that has been demonstrated objectively with these new serotonin specific psychotropics, along with the deadly adverse events with these SSRI and SSNI meds only recently brought to the attention of others, other pharmacological and non- pharmacological treatment options should probably be considered, but that is up to the discretion of the prescriber. And the perception of the benefits derived by these types of drugs may be flawed, as there has been no decrease in incidences of suicide or remission of depression since these drugs have been available, many have concluded. Furthermore, recent studies have suggested that the supplement, St. John’s Wart, has shown to be as effective as medicine for major depression. Deficiencies in vitamins B12 and Folate have been suggested as a cause for depression as well. One study showed that a small jog performed by a depressed patient offered similar if not greater relief than a SSRI drug.
It is my hope that such a prescriber rules out possible other etiologies for their patients’ mental conditions before they conclude that such a patient is suffering from true mental illness requiring the medications mentioned earlier, such as asking their patients about life stressors and other medications these patients have taken or are presently taking. Because at times, a doctor can in fact do harm without intent.
“I use to care, but now I take a pill for that.” --- Author unknown*
Dan Abshear
*Addendum to this article based on the following link recently discovered:
http://www.medicalnewstoday.com/articles/132005.php
There are greater than 60 symptoms associated with one who is or may be depressed, and there are different degrees of depression. The number of symptoms expressed by one who suffers from depression determines the severity of their depression.
The characteristics associated with depression are affective, cognitive, and somatic.
For example, affective symptoms are the core symptoms of a depressed mood, and the term that one has a flat affect is an indication that one may be suffering from depression. These symptoms may include sadness, dissatisfaction, crying episodes, irritability, as well as social withdrawal. It should be noted that many events could cause the expression of such symptoms besides depression in itself.
Cognitive symptoms associated with depression may include pessimism, a sense of failure as well as guilt, suicidal ideation, and dislike of self.
Somatic symptoms may include insomnia, fatigue, weight change, and loss of interests, such as sex or other activities engaged in historically with a depressed patient. It should be noted that stress can cause such symptoms as well, in my opinion.
Recommended sites:
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020392
http://www.nimh.nih.gov/health/trials/practical/stard/index.shtml
Dan Abshear
Serotonin Enhancing Psychotropic Pharmaceuticals
Reply | Report Abuse | Link to thisIn the 1930s, physicians approached the mental illness of depression a bit differently that we do today. While acknowledging a likely cause of depression in one of their patients is often due to some great misfortune, they seemed to focus on what is called a complex. A complex is disturbances of ideas and impulses that are the cause of consistent habitual patterns of thought, feelings, and behavior. An example of this state of mind of one who is depressed is one who experiences an exaggerated or obsessive concern or fear. And the etiology for this mental disorder was often undefined. People react differently to life stressors in their life, so depression cannot be empirically determined.
In the 1930s, psychotherapy such as cognitive therapy was recommended for treating the depressed patient, and not pharmacological therapy. Also considered for the depressed patient was positive lifestyle changes that would lessen the pain that the depression was causing them. Try and be grateful, they would tell their patient, as well as thankful and appreciative for whatever good may be in their life, and normally the depressed patient would eventually recover
Times have changed since then.
Presently, serotonin-enhancing drugs are the therapeutic regimens for those who are suspect of having a depressed state, or perhaps the patient simply asks for these types of drugs due to their perception that they are depressed. Furthermore, and remarkably, various other mood disorders one may have can be treated with these drugs, typically called SSRIs. What is remarkable is that the mood disorders which will be discussed later are subject to debate and have also been brought to the attention to so many others through disease awareness campaigns by the makers of these SSRI drugs. So mental flaws claimed to be relieved by SSRI drugs may not be the case at all.
With depression, the most severe cognitive and behavioral malfunctions are expressed in what is called a major depressive disorder, which is also called clinical depression or major depression. Symptoms of this type of depression, which is the most concerning to health care providers in particular due to its severity, include decreased or flat affect, decreased interest in activities once enjoyable, self perceptions of worthiness, guilt, regret, helplessness, and hopeless by the sufferer, to name a few of the diagnostic features that may be present with one who has such a major depressive disorder. The disease has a vexing insistence on staying with the victim for a lengthy period of time- often continuing to progress symptomatically in severity and discomfort. This disease is very disabling, and cannot be lifted by one’s will, so all health care professionals likely agree that depression is a potentially serious condition with their patients. Suicidal ideation and attempts are associated with major depression.
These SSRI drugs mentioned earlier are known by some health care providers as third generation anti-depressants. Such drugs, drugs that affect the mind, are called psychotropic medications. SSRIs also include a few drugs in this class that include the addition of a norepinephrine uptake inhibitor added to the SSRI in one capsule, and these drugs are referred to as SNRI medications. The combination of two different drugs has made them the top class of prescriptions for psychological misalignment.
There are several available SSRIs presently, yet it is believed that only two SNRIs are available, which are Cymbalta and Effexor. Some consider these classes of meds, the serotonin enhancers in these medications, have been considered the next generation mood enhancers- after the benzodiazepine hype decades ago, which was followed by what were called trycyclic drugs for depression for some time. Furthermore, regarding SNRIs, adding the additional agent of norepinepherine is presumed to increase the effectiveness of SSRIs by some, yet not everyone claims relief from these types of drugs.
Some Definitions:
Serotonin is a neurotransmitter thought to be associated with mood. The hypothesis was first suggested in the mid 1960s that this neurotransmitter may play a role in moods and emotions in humans. Yet to this day, the serotonin correlation with such behavioral and mental conditions is only theoretical. In fact, the psychiatrist’s bible, which is known as the DSM, states that the definite etiology of depression remains a mystery and remains unknown with complete certainty. So a chemical imbalance in the brain is not proven to be the cause of mood disorders, it is only suspected as a result of limited scientific evidence. In fact, diagnosing mental diseases such as depression is based on subjective assessment only, as interpreted by the prescriber, so one could question the accuracy of such diagnoses.
Norepinepherine is a stress hormone, which many believe help those who have such mood disorders as depression. Basically, with the theory that by adding this hormone, the SSRI will be more efficacious for a patient prescribed such a med, as suggested earlier.
And the depressive state of a patient certainly can be aggravated by another mood disorder at the same time with some patients. Anxiety usually exists with one who has a major depressive disorder. An objective diagnosis of such a mental condition is rather impossible to assess objectively. Therefore any diagnosis made for a mental abnormality lacks complete accuracy and assurance. Such illnesses can only be assessed conceptually, so the diagnosis or impression concluded by the patient’s health care provider is dependent on subjective criteria expressed by the suspected patient that is not mentally sound. At times, there have been screening programs that have been used for identifying depressed patients have proven to be largely ineffective. A social patient history is uncertain and tricky as well, some have said, yet is obtained often from such patients. There is no objective diagnostic testing for any mental malfunction to validate as to whether or not such a disease is present. A health care provider has to assess as to whether certain non-verbal or vocalized features are present with a patient in order to conclude confidently that one may have in fact some degree or level of depression. To assess a suspected depressed patient is further complicated by the fact that the exact cause of major depression is unknown. Research says that there is a strong genetic component to this illness.
The diagnosis of depression as well as mood disorders that may exist within patients has increased quite a bit over the past few decades. Some have asked themselves, as well as others- actually how many people are really and actually depressed? What is believed is that if one determined to be cognitively impaired from a mental paradigm, then this may be in fact major depression. If this mental disorder is determined by a health care provider, it is possible that pharmacological therapy may be considered reasonable and necessary, as well as psychotherapy either suggested to be performed with or in place of medicinal therapy. Studies show that both therapies working together may be of most benefit for the depressive patient, yet it is not a guaranteed protocol for treatment in this way.
It has been reported that around 10 percent of the U.S. population will at some point be affected by an episode of what may be a major depressive disorder. This is much greater in number than just a few decades ago. Perhaps media sources are to blame, by suggesting to their viewers that they may in fact be depressed. So the diagnosis and medicinal treatment have remarkably increased in a relatively short period of time in the United States. Of course, the expansion of those claimed and determined to be depressed does not sadden the makers of these drugs used to treat this mental disorder one bit, I’m sure.
Some have said that so many more people seek treatment now for what they believe is a major depressive disorder they are experiencing, when in fact it may be possibly intense sadness, perhaps, due to a loss of some sort in their lives. There is a difference, and health care providers should have the appropriate tools and knowledge to discriminate between the two states of mental conditions. Sadness is not a medical problem. Symptoms associated with an unfavorable mental state need to be excessive and chronic to be considered to have in fact the medical problem of a major depressive disorder, as stated by others.
In Time magazine’s June 16th 2008 cover story, it was reported that the military personnel in the Iraq war are pounding down SSRIs often. Every time there is a new war, there is a new drug, it seems. Yet the story may illustrate the frequent usage of these types of medications in a variety of different areas for different reasons. Some reasons may be valid and appropriate, yet others perhaps may not be reasonable for such medicinal therapy. However, as illustrated in this situation, they appear to be accepted as a treatment option without reservation.
In regards to those pharmaceutical companies who make and market such psychotropic drugs in the manner that their manufacturers do is largely unknown to others, such as with screenings performed essentially by front groups, and so forth. However, what is known is that the psychiatry specialty, as they often treats and manages depressed patients, is the one specialty that receives the most monetary funding that is paid to them by these certain pharmaceutical companies for ultimately what they hope will be continued and additional support of the psychotropic meds that they currently promote to these doctors. Needless to say, the desire and the aspect of the pharmaceutical industry clearly is primarily concerned with encouraging as much use out of their products as possible- with both doctors and patients being the route of that increased use they desperately hope will occur.
Regardless, SSRIs and SRNIs are the preferred treatment methods if depression or other mood disorders that are suspected and determined by the health care providers who treat such patients. Yet these drugs discussed clearly are not the only treatments, medicinally or otherwise, for depression and other related and suspected mental disease states, moods, or disorders. Patients should be aware of this fact as well as caregivers. And they may not be aware of the options available to them.
For example, tens of millions of prescriptions are written by health care providers for these types of medications for their patients. These drugs are not inexpensive, either, as it is not unusual for a patient to pay greater than one hundred dollars to have their prescription filled for only a month’s worth of these particular drugs.
Presently, there are about ten different SSRI/SRNI meds available, many of which are now generic, yet essentially, they appear to be similar in regards to their efficacy and adverse events. The newest one, a SNRI called Pristiq, was approved in 2008, and is believed to be launched as a treatment for menopause.
The first one of these SSRI meds was Prozac, which was available in 1988, and the drug was greatly praised for its ability to transform the lives of those who consumed this medication in the years that followed. Some termed Prozac, ‘the happy pill’. In addition, as the years went by and more drugs in this class became available, Prozac was the one of preference for many doctors for children. A favorable book was published specifically regarding this medication soon after it became so popular with others.
Furthermore, these meds have received upon request of their makers to the FDA to have additional indications besides depression for these types of drugs they produce and market, and the indications they have received are for some really questionable conditions , such as social phobia and premenstrual syndrome. Also included with indications that now exist with these types of medications are the quite devastating conditions of what may be mild anxiety and shyness, yet the makers of these drugs consider such patients as having chronic anxiety with severe anxiety disorder, which others have said is rather obsurd. And it gets worse with the indications received for these types of drugs, which now include Obsessive-Compulsive Disorder, Panic Disorder, Agoraphobia, Post Traumatic Stress Disorder, Bulimia, and any form of stress disorders in general. I understand they are seeking indications for pain management as well with these SSRI or SRNI pharmaceuticals. Likely, they will get the indication for their drugs to treat such creative cognitive states apparently others have in great numbers.
With some of these indications for these classes of drugs, I question as to whether or not they are actual and treatable disease states or medical problems. Yet with additional indications for particular drugs in these classes of medications, one can be assured that the market for these drugs will continue to grow- as more are prescribed to those patients who are progressively asking for them specifically for relief they anticipate they will receive from taking these drugs. What such patients are not aware of is that studies have shown that this class of medications is only effective in roughly half of those who take them. And some of the indications granted to drugs in these classes of medications may be considered disease mongering tacitly performed by the makers and marketers of these drugs to again grow the market share for particular drugs of this type. This is combined with drug companies who make these types of meds either forming or creating front groups in order to have more diagnosed with various medical problems that may not exist so their medication can be utilized more. And as mentioned earlier, such pharmaceutical companies have been known to either create or support front groups to ultimately encourage who may be normal people to get evaluated for the diseases indicated with these medications. Of course, such tactics implemented by such pharmaceutical companies are deceptive, inappropriate, unreasonable, unnecessary, and potentially if not actually dangerous to others.
Perhaps of greater concern and danger with these particular psychotropic medications involve the adverse effects associated with these types of drugs, which include suicidal thoughts and actions, violence- including acts of homicide, and aggression- and this is only to name a few. Such events are devastating and have been demonstrated by those who have or are taking these types of drugs. It has been reported that the makers of such drugs are suspected to have known about these toxic and dangerous effects of their drugs and did not share them with the public in a timely and critical manner until forced to do so. While most SSRIs and SNRIs are approved for use in adults only, prescribing these meds to children and adolescents has drawn the most attention and debate with others for understandable reasons, which have included those in the medical profession as well as citizen watchdog groups. The reasons for this attention are due to the potential off-label use of these meds in this population of children, yet what may be most shocking is the fact that some of the makers of these meds did not release clinical study information about the risks of suicide as well as the other adverse events related to such populations, combined with the true decreased efficacy of SSRIs in general, which is believed to be only less than 10 percent more effective than a placebo. Paxil caught the attention of the government regarding this issue of data suppression some time ago, this hiding of such important information- Elliot Spitzer specifically was the catalyst for this awareness, as I recall. Furthermore, that drug is in the spotlight once again years later. Some believe the drug maker knew about possible risk to the youth as early as 1991. Yet did not disclose such danger associated with their drug to the public or the FDA, and this was done with intent.
And there are very serious questions about the use of SSRIs in children and adolescents regarding the possible damaging effects of these meds on them as they get older- these children and teenagers who are prescribed these drugs. Others are asking if this is really necessary- and are these drugs doing more harm than good for their children.
For example, do the SSRIs correct or create brain states considered not within normal limits, which in effect would possibly cause harm rather than benefit a patient on such a drug? Are adolescents really depressed, or just experiencing what was once considered normal teenage angst? Do SSRIs have an effect on the brain development and their self identity of such young people? Do adolescents in particular become dangerous or bizarre due to SSRIs interfering with the myelination occurring within their still developing brains? No one seems to know the correct answer to such questions, yet the danger associated with the use of SSRIs does in fact exist, as demonstrated by others. It is observed in some who take such drugs, but not all who take these drugs. Yet health care providers possibly should be much more aware of these possibilities, possibly, along with the black box warning now on SSRI prescribing information for the youth that has existed since 1994. There are other medications health care providers could prescribe for such patients that have no less benefit for them then the serotonin drugs discussed.
Finally, if SSRIs or SNRIs are discontinued by a patient rapidly, abruptly, and without medical supervision, withdrawals experienced by many of these patients are believed to be quite brutal that follow soon after this drug is not taken anymore by a former patient. This in itself may be a catalyst for one to consider or attempt suicide, others have suggested. Many are aware and understand that discontinuing these SSRIs and SSNIs leaves the brain in a state of neurochemical instability for some great length of time as the neurons need to recalibrate after existing in a brain over-saturated with serotonin and neuron alteration. This occurs to some degree with any psychotropic medication, yet the withdrawals can reach a state of danger for the victim in some classes of meds such as SSRIs and SNRIs, it is believed. And this seems to concern many, yet does not inhibit health care providers for continuing to select such therapy with these drugs for their patients.
SSRIs and SRNIs have been claimed by doctors as well as patients to be extremely beneficial for the patient’s well -being regarding their apparent mental issues that resolve in time. Yet overall, the factors associated with this class of medications may outweigh any perceived benefit for the patient taking such a drug that can harm themselves and others.
Before these medications mentioned were developed, doctors praised trycyclics, another class of anti-depressants mentioned earlier, in a similar manner some time ago. Considering the lack of efficacy that has been demonstrated objectively with these new serotonin specific psychotropics, along with the deadly adverse events with these SSRI and SSNI meds only recently brought to the attention of others, other pharmacological and non- pharmacological treatment options should probably be considered, but that is up to the discretion of the prescriber. And the perception of the benefits derived by these types of drugs may be flawed, as there has been no decrease in incidences of suicide or remission of depression since these drugs have been available, many have concluded. Furthermore, recent studies have suggested that the supplement, St. John’s Wart, has shown to be as effective as medicine for major depression. Deficiencies in vitamins B12 and Folate have been suggested as a cause for depression as well. One study showed that a small jog performed by a depressed patient offered similar if not greater relief than a SSRI drug.
It is my hope that such a prescriber rules out possible other etiologies for their patients’ mental conditions before they conclude that such a patient is suffering from true mental illness requiring the medications mentioned earlier, such as asking their patients about life stressors and other medications these patients have taken or are presently taking. Because at times, a doctor can in fact do harm without intent.
“I use to care, but now I take a pill for that.” --- Author unknown*
Dan Abshear
*Addendum to this article based on the following link recently discovered:
http://www.medicalnewstoday.com/articles/132005.php
There are greater than 60 symptoms associated with one who is or may be depressed, and there are different degrees of depression. The number of symptoms expressed by one who suffers from depression determines the severity of their depression.
The characteristics associated with depression are affective, cognitive, and somatic.
For example, affective symptoms are the core symptoms of a depressed mood, and the term that one has a flat affect is an indication that one may be suffering from depression. These symptoms may include sadness, dissatisfaction, crying episodes, irritability, as well as social withdrawal. It should be noted that many events could cause the expression of such symptoms besides depression in itself.
Cognitive symptoms associated with depression may include pessimism, a sense of failure as well as guilt, suicidal ideation, and dislike of self.
Somatic symptoms may include insomnia, fatigue, weight change, and loss of interests, such as sex or other activities engaged in historically with a depressed patient. It should be noted that stress can cause such symptoms as well, in my opinion.
Recommended sites:
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020392
http://www.nimh.nih.gov/health/trials/practical/stard/index.shtml
Dan Abshear
For a different perspective on the issue of antidepressants--and in particular, for a more nuanced view of the putative risks associated with these agents--please see my essay, "Devil of Angel?" at:
Reply | Report Abuse | Link to thishttp://psychcentral.com/blog/archives/2008/03/02/devil-or-angel-the-role-of-psychotropics-put-in-perspective?pp=2
Ronald Pies MD
Yes our circumstance could be depressing but when you have faith and put your trust in God, you have love, hope and joy. Although you still feel sad here and there, you cannot help saying this happily and gratefully: "this is the day the Lord has made. Let us rejoice and be glad on it."
Reply | Report Abuse | Link to thisPeople who aren't depressed have a tendency to belittle depression in others, since they have no idea what it feels like. Sadness is NOT the same as clinical depression.
Reply | Report Abuse | Link to thisAgree! The article is great as it breaks the paradigm that has been risen up about treating "bad feelings" or "negative feelings" like sadness, or deep sadness, as if people were not able to deal with the complexity of their emotions, and feeling blue or down was terrible. Consumism and the media continuously send messages of buying this or that, for having the feeling of "completeness", to be joyful all the time which would be great, but is not possible in real life.
Reply | Report Abuse | Link to thisI think depression in the form of melancholy, is something truly difficult to treat, as it has no specific cause. When it has an specific cause, such as the physical or emotional loss of a loved one, then, the suffering and pain is localized and some counseling or actions could be useful to deal with such intense pain.
I think it would be great beginning to introduce psychoanalysis in this kind of articles, even the magazine is "scientifically oriented", they are talking about what happens inside the human mind, emotions, thoughts and feeling, which are not 100% measurable, human being are greatly structured in subjectivity, in language.
It's time to incorporate different visions, more open, more human, without fear of not being scientific in off...Psychoanalysis in its different orientations have great things in these kind of issues and could be really interesting to read whatever they have to say.
Here is an angle on the cause of the depression epidemic that probably very few people here will have even considered: it may be caused by an infectious virus.
Reply | Report Abuse | Link to thisI myself caught a virus (that also spread around my social connections), and without any doubt, precipitated mental state change in many of those who caught it. Increased susceptibly to stress often occurred in most of the infectees; fatigue, lethargy and depression was also common, as were increased memory problems.
For those interested in this, see here:
http://chronicsorethroat.wordpress.com/
http://chronicsorethroat.wordpress.com/site-map/viruses-in-perspective/
I suspect that this virus I caught is a new (or a new strain) of enterovirus. Enteroviruses are very hard to detect once they have formed a long term infection in the host.
I would recommend that everyone with depression test to see if their depression is caused by chronic brain inflammation.
Reply | Report Abuse | Link to thisTo test this, you can simply try out the anti-inflammatory treatments detailed here:
http://chronicsorethroat.wordpress.com/site-map/chronic-fatigue-syndrome-research-chronic-fatigue-syndrome/
For more information on the link between brain inflammation and depression, see Dr GIna Nick's body of work here: http://sicksyndrome.com/index.php