What Causes Depression?

Seems to me like there are far too many professionals hanging on to the old 'disease' model of looking at depression, how about looking at it from a psychological perspective ie. mental distress and how professionals can use the psychological approach in helping people.

I thought we had gone beyond the old psychiatric approach of bunging people on meds for years on end and saying tough luck that's your lot!

It is actually well known in psychiatric circles that AD's, SSRIs in particular are not that effective. This was to be expected as the serotonin system in the CNS is like a dimmer switch and exhibits minimal control over overall brain functioning; it is also a very small set of neurons compared to many other systems.
It is drug companies that try to make SSRIs seem so effective. I would like to add that even though SSRIs over all are not so hot, they help alot of people. I have seen lives changed by these meds.

I think depression has a multitude of "causes" and still isn't very well understood yet. It's not the day-to-day, specific, momentary sadnesses/changes in mood we feel. I believe the problem with treating depression is that there are so many causes and we don't know how to figure out specific/idiopathic causes so are pretending they don't exist and confusing heck out of the situation.

Depression can be "caused" by bad diet or heart problems; they're not the same. The last instance cited about depression following heart attacks is a heart-related depression, not something any of us (unless we have heart problems) have to worry about. Depression can be primary or secondary, uni or bipolar, episodic or chronic, etc. Anti-depressants aren't for everyone or for every depression.

My mother died of a brain tumor in 1954. They finally operated in 1952 to find out what was going on and closed her back up as there was nothing, at that time, that they could do. She had been having grand mal seizures since 1948 and at that time, they decided it was all in her head. . . and sent her to a psychiatrist for treatment. I can't tell you how many years I "wondered" why my father didn't "like" psychiatrists until I learned that little fact :-)

I don't think we're a whole lot past that situation yet. We send people with life problems to psychiatrists who decide they're depressed and they get meds that don't do anything or have horrific side effects (possibilities unknown until an individual gets them and it further negatively affects their life, sometimes permanently).

I had a job with a boss who wouldn't change and my therapist said I could either quit/change jobs or get depressed. Life problems are like that but meds aren't going to change the situation if I refuse to quit/change jobs and get depressed. And, once I get depressed, there is a good chance that I'll "stay" depressed/get even further depressed until I change any life problem, make it "right" for myself in some way. Meds can't help that any more than self-medication/street drugs/alcohol can. If I'm lacking B vitamins, am a strict and somewhat clueless vegetarian and get depressed, meds aren't going to help that either! I just wish doctors and pharmaceutical companies were a bit more honest, that the doctors truly worked to make sure the pharmaceutical companies didn't get out of control like they are. The pharmaceuticals can only get prescribed by the doctors, they can't prescribe themselves and I think the doctors are shooting themselves in the foot prescribing harmful stuff that probably won't work to keep a "public"/patient who can get seriously ill from taking wrong meds and cause them a real problem! I "laugh" at the public service ads about how antibiotics don't help a cold; what part of that did doctors not understand all along and what's with "giving in" to the patient because they "demand" certain meds they've seen on TV? The whole advertising of meds on TV, any meds, pisses me off. And I blame the doctors (not the Feds) for "allowing" it to get to this, for not "protecting" me from the money grubbers at any cost. "First, do no harm" shouldn't be such a novel concept.

, Perna

> It is actually well known in psychiatric circles that AD's, SSRIs in particular are not that effective.

then why does the APA make the reccomendation that it does regarding people staying on them?

> It is drug companies that try to make SSRIs seem so effective. I would like to add that even though SSRIs over all are not so hot, they help alot of people. I have seen lives changed by these meds.

yes. but i guess the issue is whether the SSRI caused the change or whether the active ingredient simply coincided with whatever else was responsible for the causal change (e.g., life circumstances altered, the doctor believed the med would help, the patient believed the med would help, the brain 'righted itself' etc).

then weigh in the harmful side effects of medictions...

help more than harm? hard to say...

i think it is appalling that GIVEN THAT it is common knowledge that SSRI's aren't all that effective the APA makes the reccomendation that it does.

PS... i was actually rather surprised to hear you conceed that it is commonly acknowledged that they aren't all that effective. i have found some stuff but i really am having trouble finding reputable studies / sources / critiques of studies to that effect. if you have any references or acknowledgent of that then i'd really be very grateful.

it appears that a post of mine concerning elderly people having depression has disappeared. i work with geratric patients and caregivers. these are people who are trying to keep the patient at home, be it husband or wife. their mental health needs are great. it's a hard job. they are depressed and a lot of it comes from their age.

they don't believe in meds because when they grew up, you didn't talk about being "depressed" or "blue". it was "all in your head". the reason they deal with me as well as they do is probably because i am 63 and have the experience that they believe in.

i work four days a week and am on call every other weekend. i'd say that i know that elderly people get depressed.......age-related. they can't do what they used to be able to accomplish, they are lonely and they are scared. pat

So what happened to your post? Elderly people are the #1 population to get depressed, and that Dx has a high correlation to morbidity. I do the nursing home rounds with the residents I teach, and the shock on these young doctor's faces is something I will never forget. I have nothing but respect for those who have the courage to work with the elderly.

DISCLAIMER: This is just an anecdote - not supposed to detract from the thread - just interested

Pat, so what you are saying is, it's to do with loss of ability to participate in activities they have loved during their lifetime? E.g. physical capabilities to do so, people to do these things with, etc?

Anecdotally, I have just been doing some research with people who have a huge passion with the marine environment. I won't go into details but while these thoughts are not really relevant to the project per se, some of the older men in the sample talked a lot about the day that they will not be able to go boating and yachting etc.

They are getting there now ... and the language that came out was all around depression ... loss of passion and lust and love for life ... because they have lost something that has been such a huge part of their lives for so long. It is as if long as they are able to sail ... or even just keep their vessel, even if they're not actively using it ... they are still active and ALIVE.

Once they lose it, it's symbolic of the beginning of the end of their lifetime. Breaking their connection with their passion is like breaking their connection with the living world because it is so painful to lose. The words they used to describe it just evoked a depressed mindset - it was sad to watch ...

I know there are many things around health, etc, that also plunge older people in depression (losing friends, partners, health issues) but I suppose I just found this aspect interesting - the symbolism of a loved activity being curtailed pretty much meaning 'this is the end of my life'.

Just off topic ramblings - sorry.

And btw, the reason for me probing around this sort of thing in a research capacity even though I'm doing something on Biosecurity is that to develop successful communications strategies you need to understand the relationship between the target demographic and their environment, in this case it's marine ... one technique is to explore the proposition of loss. I just found your post interesting cos of that, pat

It's not all fluffy wuffy steez

DSF, the wife of one of my patients cried for days after they sold her car.....she could in no form or fashion drive......but it was "her link" to the good days.........

there was a huge snake eating the bird eggs, around the farmhouse, and i caught it and took it away. she cried over that "because i used to be able to take care of things".......yes, it is a cessation of the ordinary, the expected, the usual and the valuable events in their lives that hurt so very much.

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fayerody said:
DSF, the wife of one of my patients cried for days after they sold her car.....she could in no form or fashion drive......but it was "her link" to the good days.........

there was a huge snake eating the bird eggs, around the farmhouse, and i caught it and took it away. she cried over that "because i used to be able to take care of things".......yes, it is a cessation of the ordinary, the expected, the usual and the valuable events in their lives that hurt so very much.

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pride and independence au :/

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emily4040 said:
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

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I realise you didn't write it.

psicsi,

good to see this post. i was just reading recently about a study involving SSRI's and placebos and the symptomatic relief was nearly the same for each. interesting.

now a question. anxiety and depression are more and more being defined as biological, but is that always the cause? and if not, what is the explanation if it is non-biological causes?

I think it is perception, making therapy the best answer, but am curious as to what you know and think.

It seems to me that depression and anxiety are more often secondary symptoms, caused by perception issues that affect all aspects of our lives. That brings to mind personality disorders and makes them seem much more prevalent, whether mild or severe, acute or chronic. I wonder if that will be the new target area of treatment.

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ECHOES said:
psicsi,

good to see this post. i was just reading recently about a study involving SSRI's and placebos and the symptomatic relief was nearly the same for each. interesting.

now a question. anxiety and depression are more and more being defined as biological, but is that always the cause? and if not, what is the explanation if it is non-biological causes?

I think it is perception, making therapy the best answer, but am curious as to what you know and think.

It seems to me that depression and anxiety are more often secondary symptoms, caused by perception issues that affect all aspects of our lives. That brings to mind personality disorders and makes them seem much more prevalent, whether mild or severe, acute or chronic. I wonder if that will be the new target area of treatment.

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So are you suggesting that 'depression' is not caused by the lack of certain brain chemicals that use of antidepressants corrects?

I am confused as to what you mean in terms of personality disorders.

Causes of anxiety and depression? There is not a one-size fits all.

My view is that it can be due to trauma experienced during childhood. So many adults with mental health problems have been abused as children. It is during childhood that the emotions are forming, behaviours are being learn't and learning how to manage feelings. Or having not learnt as a child how to manage stress.

The fact is that one in four will have a mental health problem at some point in our lives. And for each person the causes and reasons will be different as will the treatment.

Thankfully the psychological approach ie. talking therapy seems to be the way forward. Psychology is taking over from psychiatry. Talking treatments work because with mental health we are talking about feelings and behaviours and the knowledge gained in being able to cope with that.

When my stepmother got senile we had to take away her car, "importing" my brother from Hawaii (to Maryland) to do it as it was my stepsister and myself and my mother would "listen" better to a "man". Anyway, after the week or two after my brother went home, my stepmother would call my stepsister and myself and would alternately revile us/call us names and "plead" to be allowed to have her car/drive, using arguments like, "my friends still drive and they're older than I am!" :-) Losing the familiar is very hard, I'm already worrying about that for myself now that I'm retired.

It's extremely odd getting interested in something on TV and then realizing it has to do with careers/jobs/working and I'm not "part of" that anymore. So, what am I part of? Too, as I get older I notice that I've "tried" most of my interests, skills, etc. and "been there, done that" and there's less "new" to pull me forward. I worry that my world will get smaller and smaller and smaller, etc. through no fault or ability to "correct" on my own, that's just how it will be. I can see how moving out of one's house into an assisted living or nursing home would really devastate one. Sometimes I try to imagine what I'll "do" when I can't drive (especially in the evenings), my eyes and ears are pretty much gone (won't be able to read/study or do much on the computer? or listen to the TV, which like music evolution will be about subjects I won't be tuned into/interested in anymore), and what have you. I can seriously see how many elderly get depressed!

the terminology runs a little different in psychiatry / psychology than it does in philosophy...

but in psychiatry / psychology it is quite common to see people railing against 'dualism' (where 'dualism means something quite different from what it means in current philosophy of mind). it basically seems to mean 'cartesian dualism' which hasn't been popular since... the 1800's but i guess we will have to forgive the scientists with outdated philosophy as we will have to forgive the philosophers with outdated facts ;-)

it is worth distinguishing between two different (though surely related) senses of 'biological'.

1) genetic
2) neurophysiological

a disorder can be 'biological' in the sense that is is determined by genes (which is just to say that vary the environment fairly much as you will given the genetics certain people just will develop huntingtons if there genes are such that...). a disorder can be 'biological' in the sense that it is determined by neurophysiology - where only an old fashioned dualist (of which there are no theorists left) would maintain that neurophysiology doesn't cause behaviour. the crucial issue here is... what causes the neurophysiology to be the way it is? is it genetic (in the sense of given the genetics the neurophysiology will be fairly similar no matter how you vary the environments) or is it environmental (in the sense of whatever the genetics certain environments will produce neurophysiology such that...)

?

even if we grant that depression is some disorder of the brain (which we will surely grant unless we are good old fashioned 19th century cartesian dualists) it doesn't follow that medication is the most effective way of treating it.

psychotherapy causes neurophysiological changes (and really unless you were an 19th centuary cartesian dualist how did you expect it to lead to behavioural change?)

social intervention causes neurophysiological changes (ditto)

as does psychosurgery and medication.

which is the most effective is an empirical matter.

despite what the drug companies would have us believe...
despite what the APA would have us believe (given the funding source for their conferences and lunches and stationary)

medication simply isn't that effective. future medications may well be... but then the best way to teach someone to cook is likely to be to SHOW THEM HOW for many years to come. why is it that we expect depression (or psychosis for that matter) to be any different???

i'm not sure...

oh yeah... the notion that if it isn't biological (in the sense of being treatable by medication) then it is all your fault. that doesn't follow... but push it enough and consumers will buy in... dammit.

Well put, and I agree. The nature/nurture argument presents a false dualism, when in fact it is always both, and both have direct effects on the other. Behavior can cause neurophysiological changes, that can then change gene expression, that has been shown to actually change genes (mainly by methylation of nucleic acids) that can then get passed on to offspring.