Lately there's been lots of talk on this topic on other threads so I thought that making this thread would make the forum more organized/clean.

Here's for the people who want to talk about it

Don't know if this is relevant. うつ病治療常識が変わる

Note: it'll be deleted soon.

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Here's a question: is the number of people suffering from depression and then trying to take away their life, significant enough to warrant using suicide as a reason why people should take medicine to treat depression as opposed to doing physical exercise, joining local adcitivites, volunteering and such (preferably with a follow up of course)?

That's what I got from the "phys. exercise" thread.

I'm pretty sure suicides are really small percentage of people treated for depression, because depression has become so rampant in the Western world. It seems that the number one answer is to take medicine that has pretty drastic effects on moods. And then the number one validation for those medicines is "but think of these people who end their life". That does not compute to me.

http://en.wikipedia.org/wiki/Man%27s_Search_for_Meaning

Best book I ever read.

ファブリス Wrote:Here's a question: is the number of people suffering from depression and then trying to take away their life, significant enough to warrant using suicide as a reason why people should take medicine to treat depression as opposed to doing physical exercise, joining local adcitivites, volunteering and such (preferably with a follow up of course)?

I think the question should be "which is the most effective way to treat depression?". Regardless of whether somebody is so depressed as to commit suicide, simply being depressed is a bad place to be. If it turns out that the best way to treat it is exercise &co then we should do that. If medication is the most effective thing we should do that. If the answer is complicated and the best approach varies from patient to patient we should make sure doctors and patients are aware of this and prepared to work through a variety of options to find something that works. But the basic approach (find the most effective thing and do that) shouldn't vary depending on the suicide rate at all. That would be like saying "hospitals will only treat fatal diseases"...

While I'm here I'd just like to say that I appreciated icecream's post in the other thread (although it has gone now).

@Fabrice: even if a person doesn't end up dieing, depression significantly reduces quality of life over months, years, decades, to the point where many depressed people at least consider suicide. Feeling like life is not worth living is probably worse than death itself for those people.

There is no one perfect cure for everyone. Some people with mild depression will benefit from lifestyle changes. Other people with particularly paranoid or other negative thought processes can benefit from CBT. Many others benefit from medication.

What i object to is people spreading the misguided notion that taking medication is somehow weak or false, and that depression is something you must get through on your own. It's EXTREMELY damaging, and can lead to people not even trying to seek treatment when they should do. This tends to be far worse for long term prognosises and causes innumerable trouble and years of suffering, all pointlessly.

Taking medication significantly reduces rates of relapse. And given that a person who experiences 1 major clinical depression is over 50% likely to experience another one at some point, really, that is quite important.

EDIT: thanks pm! i actually copied it to post it again if this thread picked up, but i seem to have lost it... ><

IceCream Wrote:@Fabrice: even if a person doesn't end up dieing, depression significantly reduces quality of life over months, years, decades, to the point where many depressed people at least consider suicide. Feeling like life is not worth living is probably worse than death itself for those people.

There is no one perfect cure for everyone. Some people with mild depression will benefit from lifestyle changes. Other people with particularly paranoid or other negative thought processes can benefit from CBT. Many others benefit from medication.

What i object to is people spreading the misguided notion that taking medication is somehow weak or false, and that depression is something you must get through on your own. It's EXTREMELY damaging, and can lead to people not even trying to seek treatment when they should do. This tends to be far worse for long term prognosises and causes innumerable trouble and years of suffering, all pointlessly.

Taking medication significantly reduces rates of relapse. And given that a person who experiences 1 major clinical depression is over 50% likely to experience another one at some point, really, that is quite important.

EDIT: thanks pm! i actually copied it to post it again if this thread picked up, but i seem to have lost it... ><

Actually anti-depressants are pretty controversial from a scientific point of view. The theories they're based on have no actual evidence going for them and trials have indicated that medication is about as helpful als a placebo, helping only slightly more in cases of severe depression. It's not very wise to mess with brain chemistry we know so little about.

pm215 Wrote:But the basic approach (find the most effective thing and do that) shouldn't vary depending on the suicide rate at all. That would be like saying "hospitals will only treat fatal diseases"...

Obviously, the best policy is to find what is most effective way to handle depression and take that route, but I think it will be many years (decades?) before there is any strong consensus on that. As you also alluded, the most likely case is that the ideal approach varies from person to person, in which case, pinning down the correct course of action is even harder.

In the absence of that knowledge, I think Mr. Fabrice's point is: is the depression->suicide rate so high that it makes sense to throw dangerous medicines at people at the first sign of depression, in a desperate attempt to stop them from hurting themselves? If the risk of suicide is not as high as people often make it out to be, then that means there is more leeway to try other healthier approaches before resorting to medicine.

IceCream Wrote:What i object to is people spreading the misguided notion that taking medication is somehow weak or false, and that depression is something you must get through on your own.

Do any of the drugs actually treat the cause of the problem? As somebody who's been prescribed medication that did little more than reduce my symptoms while the underlying problem grew critically worse, I've become a bit sceptical about pharmaceuticals, and the willingness of the medical community to dish them out to unwitting patients when they run out of ideas.

I don't think you should have to get through it alone. Communicating your feelings can be an important part of overcoming emotional problems, and others can support you in all sorts of ways, but ultimately the change has to come from within. I guess that's a large part of the problem though. If you're that depressed, you probably don't have the motivation to go about helping yourself head-on. I guess you could make an argument for the drugs if they help you overcome that first hurdle, but going to them as the first and only long-term option seems pretty unwise to me.

Kuma01 Wrote:Actually anti-depressants are pretty controversial from a scientific point of view. The theories they're based on have no actual evidence going for them and trials have indicated that medication is about as helpful als a placebo, helping only slightly more in cases of severe depression. It's not very wise to mess with brain chemistry we know so little about.

That's simply not true. Anti-depressants have been proven more efficient than placebo in many many double blind trials.

We also know plenty about the role of serotonin in the brain, and how it is affected by genes that are involved in putting certain people at risk of depression.

It's true that anti-depressants are not perfect as they are now. One of the reasons for the relatively low efficiency rate of any one drug is that there are multiple types of depression, but the psychological criteria has never been matched properly to any one type of drug.

That's one of the reasons that if you have been prescribed an anti-depressant, and it doesn't have an effect, you should definately definately push to try another one, until you find one with a mechanism that DOES work for you.

Trials indicating the relapse rate after taking anti-depressants compared to placebo are even stronger.

Javizy Wrote:

IceCream Wrote:What i object to is people spreading the misguided notion that taking medication is somehow weak or false, and that depression is something you must get through on your own.

Do any of the drugs actually treat the cause of the problem? As somebody who's been prescribed medication that did little more than reduce my symptoms while the underlying problem grew critically worse, I've become a bit sceptical about pharmaceuticals, and the willingness of the medical community to dish them out to unwitting patients when they run out of ideas.

I don't think you should have to get through it alone. Communicating your feelings can be an important part of overcoming emotional problems, and others can support you in all sorts of ways, but ultimately the change has to come from within. I guess that's a large part of the problem though. If you're that depressed, you probably don't have the motivation to go about helping yourself head-on. I guess you could make an argument for the drugs if they help you overcome that first hurdle, but going to them as the first and only long-term option seems pretty unwise to me.

It depends what the cause of your depression is, of course!

If you feel like there is some underlying problem that you haven't spoken about that is causing your depression, then yes, talk therapy is probably a better option.

Again, i'm not suggesting that anti-depressants are the only option... but that they are one perfectly reasonable way of treating depression, and that help for an enormous amount of people.

hmmm, i guess i should try to rewrite the post i made from memory...

IceCream Wrote:

Kuma01 Wrote:Actually anti-depressants are pretty controversial from a scientific point of view. The theories they're based on have no actual evidence going for them and trials have indicated that medication is about as helpful als a placebo, helping only slightly more in cases of severe depression. It's not very wise to mess with brain chemistry we know so little about.

That's simply not true. Anti-depressants have been proven more efficient than placebo in many many double blind trials.

We also know plenty about the role of serotonin in the brain, and how it is affected by genes that are involved in putting certain people at risk of depression.

It's true that anti-depressants are not perfect as they are now. One of the reasons for the relatively low efficiency rate of any one drug is that there are multiple types of depression, but the psychological criteria has never been matched properly to any one type of drug.

That's one of the reasons that if you have been prescribed an anti-depressant, and it doesn't have an effect, you should definately definately push to try another one, until you find one with a mechanism that DOES work for you.

Trials indicating the relapse rate after taking anti-depressants compared to placebo are even stronger.

"A meta-analysis by UK, US and Canadian researchers, published in 2008, surveyed all pharmaceutical-company-sponsored drug trials on the six most widely prescribed new-generation antidepressants submitted for approval to the FDA between 1987 and 1999. The results showed, consistent with a prior metaanalysis, that the difference in efficacy between antidepressants and placebo was minimal, but that it increased from virtually no difference at moderate levels of initial depression to a relatively small difference for patients with very severe depression. The difference reached conventional criteria for clinical significance for patients at the upper end of the very severely depressed category, due to a reduction in the efficacy of placebo."

I could link you to the article, but this is the gist of it. Also a meta-study is basically a study of studies, so it incorperates much more data than a single study, and is therefore more accurate.

Yes, i have seen that particular study before. It's something that was picked up on by the mainstream press and vastly overstated.

However, instead of relying on that one study, i really do suggest that you take the time to look up different types of antidepressant for yourself. Some of them are more or less efficient than others.

Also, that meta-analysis also didn't include the significant difference in relapse rates between people given placebos and people given antidepressants. Also, one of the reasons the placebo rate is particularly high in depression to begin with is that for many mild to moderate cases, the percentage of people who go into remission on their own in the time it takes to complete the study is also high. (this doesn't mean that they didn't need antidepressants, if they have recurrant depressive episodes). Also, as i said before, any one medication may not work for one person, but even people that don't respond to 2 or 3 different types of medication can respond to another type.

I'm not saying the antidepressants right now are perfect, they clearly aren't!!! But science is moving forward with new understanding every day... hopefully one day they will be much better targeted with much better efficiency. But even knowing this, it doesn't mean that the drugs available now simply are placebos either...!

EDIT: here is a really good lecture on the state of understanding of depression, the limitations and benefits of current drugs, some of the causes of depression, and where anti-depressant medication might be heading in the future:

also, this is a good overview of some of things about depression:

I always find threads like this very disturbing. There really is no one answer. It has to be on person to person basis, and it depends on what the causes and severity of the depression. If it's another mental disorder, then that disorder should be treated and not depression.

Wikipedia: http://en.wikipedia.org/wiki/Depression_...#Treatment

Quote:What will work to treat a person's depression depends on the cause. This means there are a wide variety of possible solutions, and it can be exceptionally difficult for doctors, psychiatrists and psychologists to know which one is needed. All of this is only harder for non-professionals, and so depressed individuals are advised to talk to professionals.

The best advice for anyone who is depressed is not how to go about treating it, but how to seek professional help. Even then, many people find it very difficult to accept the source or their troubles or talk to people about them, and if someone isn't completely honest with their psychiatrist or psychiatrist, it's difficult for them to assess the actual problem. The end result doesn't always have to end in medication, but if it is what works for that particular individual, then good. It's ultimately up to the person to choose whatever they find works best. But unless you're licensed to do so, you should never advise someone to take any specific medication whether it be anti-depressants or something else. Similarly, you should also not advise someone to not do so, as it is very possible that they may benefit from something like that.

Personally, I have ADHD and OCPD. Originally, I was diagnosed ADHD when I was a kid. I stopped taking medication for it shortly afterward not thinking much of it. It wasn't until I was in college and took a Psychology course that I came to realize the possibility that I might need to get help for it. It was a problem that I ignored for almost a decade, because I was young and listened to what other people said and was told that "ADHD was a fake diagnosis for laziness." When I did go back to see a psychologist almost a decade after I had stopped taking any medication, I was also diagnosed with OCD and was put on a trial period of anti-depressants alongside Adderall (what I took as a kid for ADHD). The trial period for the anti-depressants came several months after a trial period of being back on Adderall. I found that the anti-depressants didn't help me, so I stopped taking them and searched for alternative solutions. I kept taking the ADHD medication, and I found that alone to be more than enough. It took well over two years from the time I was told I had OCD to find out it was actually OCPD. Finding that out explained why Adderall was enough, since my happiness stems from productivity (working out, studying Japanese, etc.). Anti-depressants made me feel really good, but in a carefree way. It took away worry, but it also took away meaning from the work I very much enjoyed doing. Though they didn't work for me, there are plenty of people that can and do benefit from them.

It's a very long process of trial and error. Medication may not work for you or the people you know, but that doesn't mean it doesn't work for everyone. Being honest with yourself and accepting your faults is probably the most difficult aspect for anyone to overcome, as it is very difficult for someone to examine their actions without bias. It's much easier to ignore the source of a serious illness and attribute it to something that is much easier to cope with. The best help you can give is to be supportive of them seeking professional help. Anyone who tries to give another advice in handling depression should really take a step back and try to understand the complexity of mental disorders, since the wrong advice can be very dangerous for the person receiving it. Wikipedia, as always, is a good starting point. http://en.wikipedia.org/wiki/Psychological_disorder

I believe the point is that there are cases of depression which depend on imbalances in brain chemistry rather than external circumstances. This is where you have absolutely no reason to feel down about anything, yet suddenly, it hits you like a truck.

In that case, you can't really blame anybody. And if you still can make do without meds, then that's awesome. It's probably better not to muck with that kind of stuff if you can avoid it. But for severe cases, it may be the only way to recuperate.

Now, I mostly came here to chime in with pm215. Appreciated your post in the other thread, Ice. I have had the occasional bipolar-ish attack, but it's usually not so bad that I can't pull myself up. I don't like taking meds of any kind and refuse to do so if I can reasonably avoid it, but I'll definitely keep your story in mind for the future.

And to follow up what I said, being supportive can be taken as an attack of them if you're too abrupt even if you're only intention is to help them. Unless they seem like they might hurt someone or themselves, there are much less invasive ways to be supportive. If someone shows signs of depression, it's better to say something like "Oh, I have a friend that is like that." Explain the problem you see the person having as though you're explaining your friend's problem and then follow up with something like "He has some form of depression though, so I'm not sure what the actual problem is. I think he sees a psychiatrist for it." That example might be a little vague, but what you say all depends on what you THINK might be the problem. I say think, because there is no real way that you can know what the problem really is. The idea is to get them thinking about seeking help without being judgmental. It might even be worth talking to a counselor of some sort about your friend and ask their opinion. If the problem persists for a long period of time after this approach and depending on your relation to the person, it might be appropriate to suggest they see a psychiatrist. However, you should take the utmost care in doing so. You should acknowledge to them that you don't know how to help and express your overall concern for their well-being.

astendra Wrote:I believe the point is that there are cases of depression which depend on imbalances in brain chemistry rather than external circumstances. This is where you have absolutely no reason to feel down about anything, yet suddenly, it hits you like a truck.

Exactly. It's no different than treating asthma with an inhaler or diabetes with insulin.

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Icecream Wrote:What i object to is people spreading the misguided notion that taking medication is somehow weak or false, and that depression is something you must get through on your own.

It's not what I'm thinking. Only that medicines should not be sold as the final answer to depression. It does not cure unless the person wants to heal. That's the key.

And yes, your genetic makeup may predispose you to mood disorders, psychological issues. At the same time it's already been proven that a simple twenty minutes of meditation a day for a month shows noticeable changes in plasticity of the brain (nestOr posted such research papers a while ago).

astendra Wrote:I believe the point is that there are cases of depression which depend on imbalances in brain chemistry rather than external circumstances. This is where you have absolutely no reason to feel down about anything, yet suddenly, it hits you like a truck.

Yes but it's more complicated than that, as I suggested above with the brain plasticity research. I don't believe one moment that things happen without a reason. It's well known we have an "unconscious" part and some traumatic issues can stay buried for your entire life if never addressed. And by "traumatic" it can be anything really, suffering is relative. That emotional pain starts in the womb may be subject to debate, but that it starts in the first year of life is definitely not.

Actually if there are sudden mood changes, it is pretty much a dead giveaway that there is more than meets the eye.

ファブリス Wrote:It's not what I'm thinking. Only that medicines should not be sold as the final answer to depression. It does not cure unless the person wants to heal. That's the key.

I wouldn't say that. I lived with depression for years, exercising and not, with and without CBT, and antidepressants have changed my life. I don't think my "wanting" them to work had any relevance, not any more than "wanting" antibiotics to work helps them. A positive attitude is useful, yes, but there's a lot more to it than that. In any case, drugs were a successful treatment for me.

Quote:Actually if there are sudden mood changes, it is pretty much a dead giveaway that there is more than meets the eye.

Why?

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Received this email:

someone Wrote:I want to delete my account because I find your opinions on depression and antidepressants so objectionable that I want nothing more to do with this site.

Says the person who posted just once in eighteen months of membership. Guess we won't miss your opinions on here. Goodbye.

For the record I also think gay people are O.K. Feminists are annoying. Peak oil and global warming is a myth. UFOs do exist. Crop circles are cool. And so are Leprechauns. Sue me.

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Javizy Wrote:I don't think my "wanting" them to work had any relevance, not any more than "wanting" antibiotics to work helps them. A positive attitude is useful, yes, but there's a lot more to it than that. In any case, drugs were a successful treatment for me.

That's not what I said. I wasn't talking about positive thinking. I never suggested here that drugs don't work either.

I'm surprised really that there seems to be so much resistance to the simple idea that there is more to depression than what physical symptoms can be seen and treated.

Anyway that's it for me.

ファブリス Wrote:For the record I also think gay people are O.K. Feminists are annoying. Peak oil and global warming is a myth. UFOs do exist. Crop circles are cool. And so are Leprechauns. Sue me.

lol that made me smile.

ファブリス Wrote:I'm surprised really that there seems to be so much resistance to the simple idea that there is more to depression than what physical symptoms can be seen and treated.

Shrug. I don't think there's anything more to the world than physical stuff in the end, so obviously I don't think there's anything different here. It's a situation we don't like, so pick the best option we can think of for changing the universe (including ourselves) into some configuration we like better.

ファブリス Wrote:That's not what I said.

To go meta for a bit here... I think this is one of those areas of debate where there are a couple of preexisting strongly defined poles of argument (in this case we could caricature them as "drugs always work" vs "everybody should just get a grip"). So if you want to express some point of view that's a bit more nuanced, it requires a greater spelling out of detail and where you differ from the preexisting 'camps' if you want to avoid the danger that some of your readers will read you as supporting whichever pole you're nearest to.

ファブリス Wrote:

Icecream Wrote:What i object to is people spreading the misguided notion that taking medication is somehow weak or false, and that depression is something you must get through on your own.

It's not what I'm thinking. Only that medicines should not be sold as the final answer to depression. It does not cure unless the person wants to heal. That's the key.

It really really does depend on what kind of depression you're experiencing, and what the causes of it are.

I'm going to try to write similar things to what i wrote in the other post then lost from clipboard...

1stly, about medication alone not helping depression. With medication, a significant proportion of people are going to go into complete remission. (another significant proportion will have to try another therapy or type of medication, and another will only respond partially to any one medication). However, yes, even those people whose depression remits fully will likely have to make other changes to their lives as well. That's because someone who has been depressed for any significant length of time is likely to have stopped many activities they once enjoyed, and developed some bad thinking habits. So these people will have to make a conscious effort to get out of the rut and change things in order to live fully again. That doesn't mean that the medication alone is ineffective, or doing those things in the first place would necessarily have the same effect.

2ndly, about the causes of depression. There is no single cause of depression, and different people's depression is triggered by different things. For example, taking too many drugs like E or coke significantly increases your risk of experiencing major depression. (as a side point... to any of you who have never experienced depression, but have experienced a really bad come down at any time, that's pretty much how a depressed person feels in day to day life). Other people have recurrent depression that appears to come on for no apparent reason at all. In these cases, it probably isn't that there's some underlying "reason" for your depression that you have to look for. All you need is for your brain to work properly again.

Other people may have genes that predispose them to depression if combined with traumatic events. Still others may experience one clear emotional trigger. Even for those people whose depression is clearly triggered by an emotional event, it's not because they are particularly weak people, just that for whatever reason, that person's brain wasn't able to recover properly. In these cases, perhaps some kind of talk therapy is useful. But still, these people need their brain to work properly too.

3rdly, there are good reasons doctors prescribe medication. One of these is it's effectiveness in preventing relapse as opposed to placebo. Another is that being depressed for significant lengths of time damages your brain pretty much irreversibly. One of these is shrinkage of the hippocampus. You can find more information about that in the videos above. Anyway, taking antidepressents protects against this damage.

4thly, about dependancy on medication... antidepressants are not habit forming drugs!

Excersise and meditation are also good for depression in a certain percentage of people too, that is well proven. But there's absolutely no reason why more than one strategy can't be used. In fact, combining strategies tends to raise their efficiency overall, and so is probably the best option!

As for my own story, i wasted over half my life beleiving the common conception of depression... that depression is a personal weakness, that you have to fight and overcome it on your own, that medication would just be something that conceals the symptoms and is therefore sort of fake. I've had depressive episodes since i was young, that got worse and worse as it recurred.

in just the last episode, i tried the following things to get through it on my own: walking 1.5-2 hours a day and 5,6,7 hours at weekends, eating healthily, getting a job to make sure i had to do something every day, getting a weekend job tutoring a girl who had fallen behind in school due to illness - so i could feel like i was helping someone, moving away to a sunny country, travelling, forcing myself to go out every time i was invited somewhere, making new friends, relaxing with old friends, taking up new hobbies, making myself see new things, go sightseeing and stuff, and cognitive behavioural therapy.

Many of those things were helpful in the very short term... i felt better when i was doing them (barring CBT and the full time job). But overall, no matter what i did, my condition got worse.

My best friend finally told me that i had to try antidepressants, and that my preconceptions were wrong... depression is just an illness that can be treated with medication like any other. I'm so grateful to him for that!!!

The first 2 medications i tried had little to no effect, and by the time i was on the 3rd, i had entirely given up hope. I expected it wouldn't really change anything. But... it did!!! Living for me now is like living in a totally different world than the one i was living in before. I can't tell you how different things are for me now!!!

I've been on antidepressants for 2 years now, and i will continue for however long the doctor tells me to. I don't feel numb at all, though i think i did to start with. It was a long time before it had any effect, and even longer before i felt really better. It's a slow process. But now, it really annoys me to see people write the same myths that i wasted so many years believing. If i had just gone to the doctor and asked for help years before, i wouldn't have had to go through the absolute hell i did, and waste so many years of my life.

So please, everyone, think before you write!!! Don't tell people they shouldn't be taking medication the doctor has prescribed them. Don't discourage them from seeking help, or make them feel like they are weak. If you can overcome your depression with other methods, that's great, it really is!!! But if someone else can't, that doesn't mean they are weak, or haven't tried hard enough. It probably means that there's something different going on in their brain to yours. The popular conceptions of depression are really quite harmful to many people who actually experience it. It's not weakness, or selfishness, just an illness, and you don't have to waste years of your life fighting it by yourself.