What Causes Depression?

DSF You said "Someone who manages to go to work every day is not depression by DSM criteria, because there is supposed to be proper impairment in functioning."

I don't know where you found that, but it isn't in my books.

Are you arguing over whether you are depressed or not? (Not necessarily with others, but with yourself?)

You also said "So ... I work. I am not as sick as someone who doesn't work."
This isn't rational. You are making conclusions that just aren't there, imo.

(((hugs)))

Here Em, maybe this will help?
http://pn.psychiatryonline.org/cgi/c...ull/36/22/17-a

DSF, why this? </font><blockquote><div id="quote"><font class="small">Quote:</font>
So Sky, you are saying people do not have real depression on here?

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The very obvious observation that you are misconstruing what others are telling you, imo, shows me you could be quite depressed. (There are other factors of life that give ppl this attitude also. )

Why would you even begin to think that I would so much as hint that members here don't have depression???? Of course there are millions of ppl who are depressed, and thousands right here as members I bet! I have depression, for one.

DSF, I hope you feel better soon, and are able to cogently communicate with so many of us that are truly trying to help you.

Let me tell ya... a person can be having a major depression and still work. Part of that has to do with fortitude and what work you do among other things. I have cried much of the last few weeks...at work... with my door closed. But I have been productive. Not optimal but functional..... for the most part.

Three sessions for a call of needing meds for life is one more than what my pdoc told me after number two... I have been off meds for a couple months and have restarted... Circumstances and inclinations. Suckaroonie but reality.

Also.... the ability to work can indeed deteriorate... particularly for higher functioning needs but the depressive level starts somewhere and if not kept in check can go to major beyond the ability to work.

My pdoc has given me that dx sporatically and I still work... Paying my mortgage and my second mortgage is a motivator.

It causes being not functioning.

If you go to work, it's still functioning.

Tell me where in the DSM that is not a criteria?

So SecretGarden, you are like me. According to this defn we are to do with something like PMS (read psisci's first article).

And we still function, despite how I interpret the DSM.

I don't know. I am being argumentative, or to couch it, 'devil's advocate'.

Is your argument with the DSM? .. I have not read the links...

Okay.... perhaps I will tackle looking at the links.

Believe me I have just (after more than a decade) just gotten my pdoc to agree that I have PMS issues. And I may get medicated for that after I get this other lovely stuff under control. This is way more than just PMS.

Well the first article that's linked is to do with PMS, PMDD, postnatal, and menopause.

It says 80% is linked to female probs, in a nutshell.

I now argue that you and I just have the 'blues' because as ppl here have said the DSM has minor and moderate and severe.

The fact we go to work and do well financially etc means we fall into minor.

Just IMO ... do contradict.

I work my *** off, but I fit other depression criteria. But according to what emily etc say, i only have minor depression.

It's cool, I just want clarification and discussion ...

i have major depression and i work. and i work hard, have to be on my game at all times. or maybe "even cowgirls get the blues"..........

According to DSM-IV, the diagnostic manual from American Psychiatric Association, criteria used by mental health professionals, you have Major Depressive Disorder if:

You have had an episode of depression lasting at least two weeks with at least five of the following symptoms:
(1) You are depressed, sad, blue, tearful.
(2) You have lost interest or pleasure in things you previously liked to do.
(3) Your appetite is much less or much greater than usual and you have lost or gained weight.
(4) You have a lot of trouble sleeping or sleep too much.
(5) You are so agitated, restless, or slowed down that others have begun to notice.
(6) You are tired and have no energy.
(7) You feel worthless or excessively guilty about things you have done or not done.
(8) You have trouble concentrating, thinking clearly, or making decisions.
(9) You feel you would be better off dead or have thoughts about killing yourself.

These symptoms are severe enough to upset your daily routine, or to seriously impair your work, or to interfere with your relationships.

The depression does not have a specific cause like alcohol, drugs, medication side effect, or physical illness.

Your depression is not just a normal reaction to the death of a loved one.

Out of the links Dr Wylie gave us, yes, ONE of them says this:</font><blockquote><div id="quote"><font class="small">Quote:</font>
Unfortunately, high-quality, empirical data on depressive disorders specific to women are limited and there are no comprehensive, evidence-based practice guidelines on the best approaches for treating depression in women. The Expert Consensus Guidelines™ for the Treatment of Depression in Women aim to fill that gap by drawing on findings in the available research literature as well as the results of a survey of 36 experts in the field of women's mental health. The guidelines cover four main areas: premenstrual dysphoric disorder, depression that occurs while trying to conceive or during pregnancy, postpartum depression, and depression related to menopause

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The gap is this information that includes those aspects of women's lives, not applicable to children and men. It does not replace nor counter the standard information we know about major depressive disorder. That's my POV.

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_Sky said:
According to DSM-IV, the diagnostic manual from American Psychiatric Association, criteria used by mental health professionals, you have Major Depressive Disorder if:

You have had an episode of depression lasting at least two weeks with at least five of the following symptoms:
(1) You are depressed, sad, blue, tearful.
(2) You have lost interest or pleasure in things you previously liked to do.
(3) Your appetite is much less or much greater than usual and you have lost or gained weight.
(4) You have a lot of trouble sleeping or sleep too much.
(5) You are so agitated, restless, or slowed down that others have begun to notice.
(6) You are tired and have no energy.
(7) You feel worthless or excessively guilty about things you have done or not done.
(8) You have trouble concentrating, thinking clearly, or making decisions.
(9) You feel you would be better off dead or have thoughts about killing yourself.

These symptoms are severe enough to upset your daily routine, or to seriously impair your work, or to interfere with your relationships.

The depression does not have a specific cause like alcohol, drugs, medication side effect, or physical illness.

Your depression is not just a normal reaction to the death of a loved one.

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Yes, that means you have depression aka 296.xx. And, as you know of course, they need to decide whether it is recurrent, and how severe it is.....

Specifiers associated with the mood disorders are listed below:

Mild: A few symptoms, if any, are present beyond what is needed to make a diagnosis, and a person can function normally although with extra effort.

Moderate: The severity of symptoms is between mild and severe. For a manic episode, a person's activity is increased or judgment is impaired.

Severe Without Psychotic Features: Most symptoms are present and a person clearly has little or no ability to function. For a manic or mixed episode, a person needs to be supervised to protect him/her from harm to self or others.

Severe With Psychotic Features: A person experiences hallucinations or delusions. Psychoses may develop in about 15% of those with major depressive disorder. The presence of delusions and hallucinations often interfere with a person's ability to make sound judgments about consequences of their actions and this may put them at risk for harming themselves. Psychotic symptoms are serious and a person in this condition needs immediate medical attention and possibly hospitalization. (from http://www.allaboutdepression.com/dia_01.html)

Severe depressive disorder is dibilitating. It's causes major impairment.

Someone mentioned fortitude....this dx has more to do with serotonin then fortitude...imo.

em

Yes, so the end conclusion is that someone who's very depressed cannot get out of bed.

Someone who is mildly depressed goes to work.

Not so! I suspect it is your depression that is keeping you from understanding (((Dsf))) feel better soon hon.

Tis, according to em's definition.

It's not my definition...wish I was smart enough to write like that. It's basically from the DSM.

And really, the DSM is just a book for docs and insurance companies to use. Don't let the codes and definitions make you think that your depression isn't significant or important or difficult to endure. All depression sucks big time.

Hugs, em

I suspect that there is some interrelation between serotonin and fortitude and knowledge of self.... and tenacity. Sometimes the depression wins....but with skills, etc... that can assist. JMO

Of course I have been burned before.... but I like to believe I can work to fight the bastards of depression. Giving in often will just facilitate it. I know this... for myself. I might not win but often I do.

Emily,

I am sorry. It does appear that you are depressed.

I think that sometimes as we read things we have to let go of some of it as it is not an one size fits all kind of thing.

I think you are having alot of people here agreeing with YOU in terms of your personal experience.

Time to let go of this ...you can do it..... and work on nourishing yourself to get out of this place you are in. (I am currently doing this too.) Focus on things that you know will get you out and then we can come back to this.... and it may look differently.

Peace within....

I have no clue whacha talking about. I posted nothing personal - just what anyone could Google.

em - who is not feeling depressed

Ultimately, if you are really depressed you won't be able to get out of bed.

That is what the DSM appears to say.

I have several drivers that MAKE me go to work. So I guess I just make sure I do. Most of the time.

shrug i dunno, it does seem that people believe 'true' depression is where you can't get out of bed.

I am trying a new technique that I haven't before.

It is called 'throwing oneself into whatever is available to do to distract oneself from the reality of feeling like cat vomit'.

I have got myself super involved with scoping out our MidWinter Ball at work, I have made plans for 3 nights this week with friends (after tonight - I must do laundry) and I am damn well going to FORCE myself to go and not pike and go to bed as soon as I can legitimately do so.

I have set myself deadlines for the project I am currently working on that I WILL meet by Friday.

This is not going to ruin and control my life anymore.

I swear it is not a way to live ...

> Kirsch concludes from his research that much of the apparent therapeutic benefit of antidepressants may derive from amplification of placebo responding by convincing patients that they are receiving a potent drug. Placebos are found to be approximately 75% as effective as antidepressant medications across all outcome studies in which it is possible to measure pre-post effect sizes. Analysis of the New Drug Application (NDA) data sets sent to the FDA by the manufacturers of the six most widely prescribed antidepressants has shown that although the response to antidepressants was substantial, the response to inert placebo was almost as great. More than half of the clinical trials sponsored by the pharmaceutical companies failed to find significant drug/placebo difference, and there were no advantages for higher doses of antidepressants. These data reinforce the argument that the small size of the average drug/placebo difference is an artifact associated with the breaking of the blind in clinical trials and of questionable clinical significance. The small magnitude of the so-called antidepressant effect in clinical trials should be more widely known. Kirsch proposes the development of nondeceptive methods of eliciting the placebo effect in treatment of depression. Psychotherapies may accomplish their effects by changing expectations, but unlike placebos, they do so without deception.14 The point is that the effectiveness of antidepressants has not been demonstrated empirically.

> The motion is seconded by Joanna Moncrieff, Senior Lecturer in Social and Community Psychiatry at University College London... She discusses "The Antidepressant Debate" in an editorial in the British Journal of Psychiatry. In particular, she highlights the methodological problems of antidepressant trials, including the evidence for the amplification of the placebo effect from studies comparing antidepressants with active placebos. The antidepressant effect does not seem to be specific to identified antidepressants as other drugs not classed as antidepressants have been shown to have positive effects in depression in controlled clinical trials. Moncrieff suggests that the interests of the pharmaceutical industry and the psychiatric profession have helped to establish the notion of the efficacy and specificity of antidepressant drugs.

http://www.critpsynet.freeuk.com/Conferencedebate.htm

What I'm trying to do here is to go some way towards undermining the necessity of medication for recovery.

> (1) Bias in clinical trials

> Randomised controlled trials have replaced uncontrolled studies and become accepted as the scientific "gold-standard". However, randomised controlled trials are too often assumed to produce unbiased evidence (Chalmers, 1998). The most methodically rigorous trials are associated with less treatment benefit than poor quality trials (Moher, et al, 1998). Even the best quality trials may still not completely eliminate bias because of difficulties is sustaining the two key elements of the method: that the trial is conducted "double-blind", which means that neither subjects nor experimenters are aware of their group allocation so that their expectancies do not bias outcome; and that any inherent differences between groups are equalised by randomisation. Randomisation can be confounded because of drop-outs from the trial, leading to bias because of exclusions after randomisation.

> One history of medicine is of doctors prescribing medication which is subsequently regarded as useless and often dangerous (Shapiro and Shapiro, 1997). The question is how much this situation continues into the present. Two examples will be considered (i) the efficacy of antidepressants, including the problem of antidepressant discontinuation and (ii) the efficacy of lithium

> (i) The efficacy of antidepressants

> Reviewing the research on antidepressant trials is a massive task. The first attempts to systematise the data such as Morris and Beck (1974) looked at those trials published between 1958 and 1972 and found that tricyclic antidepressants were significantly more effective than placebo in 61 out of 93 group comparisons. Rogers and Clay (1975) concluded that the evidence for imipramine, the original antidepressant, was so strong that further trials of this drug were not justified in endogenous depression in non-institutionalised patients. Since these two reviews, many new antidepressants have been introduced, particularly the class of SSRIs (serotonin specific reuptake inhibitors).

> However, New Scientist could still report in 1998 that the benefits of antidepressant medication could be "mostly in the mind" (Day, 1998). At least one third of the published clinical trials of approved antidepressants are negative for efficacy (Thase, 1999). The US Agency for Health Care Policy and Research (1999) produced a conservative lower limit to treatment efficacy for newer antidepressants using an intention to treat analysis of response rates of 50% for antidepressants and 32% for placebo in major depression. Antidepressants are not always effective and there is a considerable placebo response.

> The double-blind methodology is inadequate in many antidepressant trials (Even, et al, 2000). Patients and doctors may be cued in to whether patients are taking active or placebo medication by a variety of means. In fact if treatment is clearly superior to placebo, this should be obvious to raters in the trial making it not technically blind. Patients in clinical trials are naturally curious to ascertain whether they are in the active or placebo group, and may for example notice that placebo tablets they have been taking taste differently from medication to which they have previously become accustomed. Active medication may produce side effects which distinguishes it from inert medication. The difference between drug and placebo effect may be a true pharmacological effect, but the possibility that it is an enhanced placebo effect cannot be excluded (Kirsch and Sapirstein, 1998).

> Using active drugs without apparent specific treatment effects as controls generally reduces the effect size of antidepressant treatment, maybe because bias is less likely to be introduced because of the detection of active effects in the control drug (Thomson, 1982). However, the adequacy of these active placebo trials can be questioned (Quitkin, et al, 2000).

> The importance of the placebo response is relevant to problems in discontinuing medication. People may form attachments to their medications more because of what they mean to them than what they do. Psychiatric patients often stay on medications, maybe several at once, even though their actual benefit is questionable. Any change threatens an equilibrium related to a complex set of meanings that their medications have acquired. These issues of dependence should not be minimised, yet commonly treatment is reinforced by emphasising that antidepressants are not addictive. For example, the Defeat Depression Campaign of the Royal College of Psychiatrists criticised the general public for generally taking this view (Priest, et al, 1996). The general public might reasonably expect psychiatrists specialising in disorders of the mind to recognise psychological dependence, base their advice on clinical experience, and use their common sense (Double, 1997).

> A sceptical view about the value of antidepressant medication is commonly rejected because it is regarded as undermining people's faith in their treatment. The issue is really about the scientific validity of claims for the efficacy of antidepressants. There is more uncertainty about this issue that many seem prepared to accept.

http://www.critpsynet.freeuk.com/incorporate.htm

Wooooo
Too much information for me. My brain just doesn't digest things like it use too. When there is too much information I just can not process it.

> When there is too much information I just can not process it.

thats when it can help to break it down into parts.

just read one paragraph at a time.

its not going anywhere. you can always come back to it later...

or... other people might benefit from it even if you do not.