Clinical Depression

[BVESBC]

This was to far off track for the last thread about antidepressants and their use by providers.

The following was posted by VirginaNPP

Clinical Depression is hereditary ( think like a physical illness) and truly a chemical imbalance (I hate that phrase its so over used). It will not really respond to these lifestyle changes. I know I did psychotherapy for years with some of these patients, so frustrating for me and them.

Another comment, when someone is truly having a major clinical depression they literally cannot do these things, they cannot force them selves to make changes or "pull themselves up by their bootstraps". It is not a matter of weakness of character or lack of trying. It is a DISEASE with a biochemical cause (may be worsened by many factors) But there are true brain changes in persons with depression.

Major depression can and does result in psychosis (really !!!) and suicide. It is a horrible disease, worse then many physical illnesses.

Again the real problem is misdiagnoses and overuse of SSRIs. They do not work with sadness, personality disorder (another whole story) anger, and lots of other things they are prescribed for.

One of the reasons I think it is difficult for so many to accepting clinical depression as a disease is that we all like to believe we can use our mind to control our mood, other wise we feel out of control ! Oh Well, sorry but this can be true.

Ok enough already, hope I have convinced some.

Virginia

Virginia Duffy PhD Psychiatric NP

BVESBC,

What can causes the chemical imbalance? Are the chemical imbalances the same for different kinds of depression? (Situational, Anaclitic, Postpartum, Manic Depressive Psychosis) Are there any obvious heriditary marker's other than the obvious PMH of family members? Can the body compensate for the imbalances, similar to a heart rate increasing to compensate for loss of volume untill they crash? From the responses, I can conclude that orthomolecular treatments are the general consensus here.

[AnthonyM83]

I'll admit I didn't read the previous thread at all, but if the issue is whether someone with depression should just be able to tough it out and change their lifestyle and thinking to move on, then I'll say that's not being inclusive of all types of depression.

Most current theories in psychology seem to be adopting the biopsychosocial model, in which biological chemicals, ones own psychology and mind, and one's environment all play varying roles in mental disorders.

If you're depressed because of poor coping skills, internalizing and globalizing negative events, and don't have a social support network then you could end up very depressed when something traumatic happens....but you might be able to pull out if you learn how to better cope and deal with those traumatic stresses and changing how you look at the world.

But if biology is a strong enough factor, you're going to get pulled in deep to the point where you can't even help yourself. It would be unreasonable to expect someone to pull out of it without professional assistance and probably drugs (to get you through while you retrain your brain with things like cognitive therapy...which will physically change your brain back).

[Virginia NPP]

BVESBC,

What can causes the chemical imbalance? Are the chemical imbalances the same for different kinds of depression? (Situational, Anaclitic, Postpartum, Manic Depressive Psychosis) Are there any obvious heriditary marker's other than the obvious PMH of family members? Can the body compensate for the imbalances, similar to a heart rate increasing to compensate for loss of volume untill they crash? From the responses, I can conclude that orthomolecular treatments are the general consensus here.

Wow lots of big words here (I had to look up anaclitic had not heard it in years For others not in the know it refers to emotional dependence) and Orthomolecular (Ortho Molecular Science, which prevents and treats disease by optimizing the body's natural substances)!

Any way as you very well know we don't have the answers to many questions about depression. Actually the latest theory (and much of medicine is theory, not just psych) is that clinical depression is a combination of chemical imbalance ( most often caused by genetics, heredity) and a stressor which sets it off somehow.

I never quite get why some people need to protest so hard about a physical basis for depression, do you think is something to do with a need to feel in control issue??

Virginia

[BVESBC]

I'm not sure if it could be a need to feel in control, I see that a lot of depression Pt's report feeling that they can't control their life / events. I think that everyone wants to feel like they are in control of their body and mind. Theory, that is why we practice medicine and the same reason they call fishing, fishing not catching. I am still learning about this and there is a ton of research material available. Thanks for the posts!

[Superfly]

MAO inhibitors and SSRI's have been common place in treating clinical depression, however, for most the root of the problem is not physiological but psychological. The problem is people are being dx'ed by their family docs, and should really be seeing the psychiatrist...

[emt322632]

Superfly,

I don't know that MAOIs are very common in treating your "run of the mill" depression". More often than not tricyclics or SSRIs are prescribed.

MAOIs are often reserved for those with severe depression, for which previous SSRI, Tricyclic, and psychiatric therapy have failed.

The reason they are reserved is due to the severe hypertensive crises than can occur if too much tyramine is ingested. These drugs are only for people who want something to change in their lives, and who are willing and able to follow the strict diet that comes with the medication.

[Virginia NPP]

Superfly is correct MAOIs are RARELY used today. Tricyclic antidepressants are not used often either (lots of side effects and VERY lethal in overdose.

I think we are again mixing up Clinical Depression (most often genetic, "chemical imbalance") with "run of the mill depression" which is really mood changes due to circumstances, grief, sadness loss, anger (other things) and is mainly psychologically/ emotionally based. This type of "depression" usually responds to time and counselling. (Now personality disorder is another entire subject that often is misdiagnosed as depression, especially by non-psych professionals)

Virginia NPP