Antidepressants: What's the idea?

Mark, as far as malfunctioning -- couldn't your question apply to another disease that affects the body? Why do humans get cancer or parkinson's disease as well as clinical depression? I think the question of depression is a little tricker since we still know so little about the human mind and how it works.

There are also lots of arguments implied here about what is "normal" behavior and functioning for people, how these perceptions have changed throughout history and are affected by culture. I'm sure someone else will address them though.

As far as my own experience, I've taken paxil, wellbutrin and zoloft. I'm still prescribed the latter two - 300mg and 200mg daily, respectively - but take them spottily. Mental illness runs in my family on both sides with close relatives suffering from bipolar manic depression, schizophrenia and alcoholism. Even with all this and my own diagnosis of severe depression I've had trouble with the idea of taking medicine (hence my spottiness). But I can't deny their effectiveness. They aren't the entire answer but they can be a very important part of the answer.

You can function effectively in society or you can allow your moods to play unencumbered but it is increasingly unfeasible to do both.

Samantha -- I see what you mean about other diseases, but here is a quote from NIMH: "In any given 1-year period, 9.5 percent of the population, or about 18.8 million American adults, suffer from a depressive illness." Depression just seems too common for a disease model that includes cancer & Parkinson's. One could think of it like influenza, which probably has similar numbers, but that comes from a virus. Maybe we don't know enough about the mind, but I'm curious what the psychiatric community thinks about the roots of depression, if anyone knows.

I don't know Mark. Personally I'd like to see depression figures for under-developed countries. Although I doubt they're available due to the fact that they are underdeveloped.

I suspect there are less incidents of clinical depression in societies where there isn't a lot of free time. I'm not sure if I'm negating the assertion that depression is disease here but i can't imagine much depression happening when your day is consumed with trying to fulfill basic needs.

This was mentioned in the other depression thread but I do think activity, usefulness, routine are key to managing the condition. Afgahni women are reportedly experiencing high levels of depression. They are a developing nation and no doubt are consumed with trying to fulfill basic life needs but I think the actions of the Taliban -- forcing educated women who once held professional careers to remain indoors behind blackened windows -- is directly contributing to this.

mild depression is normal but sometimes depression is truly life debilitating and may be caused by many different factors, in addition to chemical imbalances in the brain that inhibit the normal "happy mood" function of a healthy brain. But medication alone i rarely enough, extensive therapy and changes in personality must occur.

Too much information leads to confusion, maybe. (I know it does with me.) As Samantha said, if we were in an underdeveloped country, we wouldn't have time to think about getting depressed, in a developed country our brain is structured for free thought and free thoughts can sometimes be too much for us to cope with.

This pops in the anorexia discussion as well. To think that it only occurs in developed countries. I assure you it happens in every society. Secondly I think to say that depression only occurs when you have time, isn't going to help the person at all. He is suffering and therefore should be helped. This week a guy I know killed himself. It pains me so much. I hope I turn for help before I see death as the only solution to my problems. I wish he had as well.

helen, don't misinterpret what I said. Having a lot of personal experience I know how devasting depression can be and that it is not due to any fault or shortcoming of the sufferer. however, activity and routine are key to management of long-term clinical depression. My comments about underdeveloped nations were speaking more I think to Mark's wondering about the recognition of depression and it's turning into such a common condition. I do think the luxury of the industrialized world has led to the recognition and clinicinazation of chronic depression.

Oh oops, sorry. I shouldn't read faster than I can process information.
I actually wonder how much the mind really plays a role in most disorder. Maybe the cause is mainly chemically. Just look at anorexia: only recently has research shown that a large portion is cause by an element in the skin (too much causes binges, too little causes the person to abstain from eating). Maybe in a couple of decades clinical psychology will be pushed to the margins?

That's really fascination about the skin/anorexia connection. I'll probably have more to say about depression later. must work now.

I think it would be a mistake to discount the role of the mind in disorders, even w/ seemingly physical things like cancer. If for no other reason than the brain produces chemicals the body needs constantly, & output is affected by emotion.

But I do wonder if depression is more common in the industrialized world, or if it just able to be measured. Maybe there is no way of knowing at the moment.

From what I've read of eating disorders, the vast number of cases come from a certain socioeconomic background. Does new research suggest otherwise?

But really what I'm getting at is that it seems like brains do not work correctly in managing mood in many, many people. And I'm wondering if the brain is "designed" poorly (not adapted to modern life) or if we're using it wrong. Does that make sense?

Before the current crisis, I had been doing a lot of independent reading about the relationship between exercise and depression. I read that in their daily routine the Cro-Magnon performed the equivalent of walking ten miles a day with a forty-pound backpack on your back. I'm sure my figures are off, but it was some surprising amount of work. I've seen how exercise helps with my own depression (I don't have it anymore), and I suspect that sedentary lifestyles have quite a bit to do with it.

I think there is a flaw in the argument about people working to much to think and get depressed. A lot of people get depressed and attribute the trigger to working too hard much, not taking time to relax and unwind. Too much stress. So that's why I'd argue that depression affects all humans equally, just some people are never identified.

People have been clinically depressed for centuries. I think that the only change has been that more people are seeking and receiving psychosomatic treatment for it. I'm not saying that it's a bad thing either, I think that it's a quality of life issue. If taking anti-depressants improves your quality of life, then go for it.

I also think that taking medicine is easier for some people than changing their lifestyle, exercising more, counseling etc. People and doctor's want an easy solution, which isn't to say that it's the best or ideal solution.

I would like to hear about people's experiences coming off anti-depressents.

So basically you just want us to solve the nature vs. nurture debate in one thread, eh? Seriously, one thing I would add, that from what I know, it's anti-depressants going hand in hand with therapy that is the most effective deterrent against depression. I say this only because psychiatrists have been handing out SSRI's to our generation at an alarming rate considering the facts that a) they have no clue how or why they really work and b) the potential for long term harmful effects.

There's also the argument that throughout history (and in less- developed nations today), mild or non-deblitating mental disorders were most likely explained as personality issues. E.g., "melacholia," or just plain "that guy's a little weird." This is the weird thing with emotional disorders -- so long as they don't obviously affect your ability to function in the world, there's no good "objective" way to figure out if they're really there or not. So half of the problem is that one needs to be familiar with the very idea of "depression" to even start thinking "Maybe there's something wrong with me" -- and the other half is that only when life is really safe and codified and regimented and normative does it become possible to isolate these sorts of things.

There's a lot of interesting research concerning mental illness and its relation to culture, the most fascinating having to do with culture-specific disorders. There's also a lot of research supporting the contention that poverty is a direct route to clinical depression, only we don't notice because we assume its symptoms to be the cause rather than the effect of poverty.

Yeah, solving the nature/nurture debate would probably do it. Have at it...

Part of what I'm getting at (Do I know what I'm getting at? Not really. Just trying to leverage the intellectual capital of ILE to explore a subject I find interesting) is that the trend in medication suggests that we're getting closer to calling depression a strictly medical problem. If we're really going to say that 10% of the world's population has always had depression, than I wonder why such a debilitating illness would be so common.

I don't think that most depression is debilitating. Most people have a depressive episode, but it isn't aways that severe.

Dammit, where did my answer go?

Marianna, there is a difference between depressed feelings that everyone has at one time or another and clinical, chronic depression. The former is a natural part of life and the latter is debilitating, life-threatening and not attritubatable to the normal ups and downs of life.

There was a thread from back in ILE's nascence (all of 4 months ago?) that tackled this topic. I think it was the Dr. Phil / Oprah bugaboo. I'd go dig it up, but I'm feeling lazy. There were some good points made about medicating and such in that thread, though.

I, too, was once under medication (Zoloft). It didn't work for me, though, because while I had been diagnosed with clinical depression (back in high school), the situation that led to Zoloft was caused by something emotional, not a chemical deficiency. And weening myself off the drug (when I realized this) was hellish. Now, I'm OK (1 year and counting) - prone to some depressive episodes now and then, but nothing a video game or a few friends or a nice friendly chat can't cure, thankfully.

Has there been any research done on what effect the environment (notably pollution) has had on the body? I doubt that all those carcinogens and chemicals put into the atmosphere and ourselves haven't affected human development in some fashion. Perhaps (sort of springboarding from Mark's idea) our brains HAVE evolved into this state where, due to exposure to harmful chemicals, other chemicals are needed to right the balance...?

I don't know if the effectiveness of medical treatment for "depression" is proof that the sources of the depression are purely biochemical. They're simply drugs, albeit non-intoxicating ones. Naturally, I hold the liberal view on drugs, so I don't judge others for taking them. However, I am skeptical of many of the claims made about depression and treatment. I only say this as someone who went through all the psychiatric bullshit and whose doctor was little more than a pusher. I quit taking the stuff because they seemed less effective after about a year and the shit was expensive anyway, even after insurance. I haven't needed it, though, since I made some changes in my life and became more active and involved in my community.

Confession time! As some of you know, I suffered from Obsessive Compulsive Disorder (I now define my current situation as 'irritated by') quite badly until the end of last year, which is really why I don't have a job, don't have to sign on, never finished my A- levels, and why I'm such a fat bastard. I struggled on with it until the end of 1999 when I was overcome and essentially crippled by it for most of last year, which is when the doctors started to suggest pills, which before I had stubbornly refused to dabble in (I have a nasty feeling the whole 2000 episode was brought on by my experiments with E). I started with Prozac, which was rubbish (except for one totally brilliant day), and proceeded to munch my way through many drugs, most of which I've now forgotten the names of but can find out should anyone be interested. Sadly, they did little but produce horrible side effects, ranging from nausea through to incontinence. But eventually I got better, and here I am now. I take one Seroxat a day, which is a little blue pill that doesn't seem to do much but make it difficult to get pissed, which means I have to drink more and spend more money, chiz chiz. In short: don't get OCD kids, it's rubbish and not even fashionable.

Mark, I think the original assertion you made SSRIs and related drugs have proven the most effective treatment for depression. Treating depression using a medical model and drug therapy implies that depression arises because the brain is not functioning properly... is only true to the same extent that Paracetamol and Asprin have proven the most effective treatment for headaches. Treating headaches using a medical model and drug therapy implies that depression arises because the brain is not functioning properly....

Just as a headache might be caused by stress, dehydration, lack of sleep, bright lights, poor posture, a hard knock, etc. then so to might depression be caused by some sort of physical, emotional or environmental stimulus.

The fact that some sort of chemical imbalance may exist in the brain at the time of the depression should not be taken to imply that the depression was caused by a chemical imbalance.

Damn, in that purple stuff I meant: Treating headaches using a medical model and drug therapy implies that headaches arise because the brain is not functioning properly

From what I've read of eating disorders, the vast number of cases come from a certain socioeconomic background. Does new research suggest otherwise?
Yes, it has. It shows that it does not so much have to do with the place where one lives. This leads me to think that maybe the cause might be a chemical one. Hence me not being surprised reading in the papers that research has shown that an element in the skin leads to either abstaining from food or binges. I looked it up on the web but couldn't find any info on it.

Has nobody thought of the placebo effect inherent in SSRIs? The thought that they 'must' be working (added to the confidence boost brought on by 'doing something about the problem', i.e. getting off your ass to go out and get a prescription instead of lying in bed) MUST have an effect on some people. (Especially the reinforcement from others who support your efforts at self-rehabilitation)

have had eating disorder, anxiety disorder, full breakdown (or as clinic likes to call them, a serious episode) and various addictions - ssri's helped me recover from them, though I still have chronic depression which I have learnt to manage, most of the time - it stops me from studying/wroking fulltime, but does give me a "unique" outlook onl ife which I've found helpful,r ather than debilitating, in my attempts at "normalising" my life. as far as specific atnidepressants go, zoloft turned my bowels into linda blair - 6 crpas in first two hours of waking, ervy day for 3 months; aropax fucked me over; efexor have been the most helpful, especially XR - delayed release. My Pa has been on prozac, efexor, aropax, the round red ones - prothiadine etc, he's on a new one, can't remember which - most have failed to work, though prozac made him scarily aggro, as opposed to drunken but manageable aggro when he was alcho.; mum is a strange case - rohypnol acted like spped in her system, so she's now on a multi-cocatil including largactil, which seems to manage things ok....my borther, on the other hand,, refuses all medication and is a fundie chritian - you can make yr own judgements there. But at least we're not like our great uncle who took a gun to hismelf on his son's brithday, or the rgeat grandad who kcike d out my grandma at gunpoint...

Geoff, are you sure we aren't related? Our families sound remarkably similiar. .

Luckily I've never had bad side effects with any meds other than some sexual dulling. Ginko Biloba seems to help here. I'm thinking of switching myself to StJohn's Wort since I don't seem to need my full on does of prescribed meds at the moment. The depression monster seems to be beaten down for the time being.

Torenko, I agree with what your saying. I heard a discussion along these lines once on the radio. To paraphrase: current medical treatments focus on regulating the seronitn in the brain (or something along those lines) which helps the symptoms but with lots of unwanted side effects and it takes awhile to kick. This is b/c we don't yet know what causes the serontin to be imbalance so we really aren't treating the cause of the problem, just tinkering with the effects to get a more pleasurable mix.

The main objection I see to SSRIs is "They don't make you better, they just make you feel like you are." Isn't that good enough though? No solution = no problem!