Who Died Today?

[speedz99 145]

Let's take gastric bypass surgery as an example.

Someone who gets the gastric bypass surgery has to go through a lifestyle change in order for the procedure to be successful in the long term. A depressed person has to do the same for medication to work in the long term. What's your problem with either of these scenarios? If neither of these "shortcuts" existed, do you think all of those obese and depressed people would be working their situations out in a manner that you find more appropriate? Shit no. Sure, a handful would, but mostly you'd get a lot of heart attacks and suicides that may have been preventable.

[vbnautilus 48]

Someone who gets the gastric bypass surgery has to go through a lifestyle change in order for the procedure to be successful in the long term. A depressed person has to do the same for medication to work in the long term. What's your problem with either of these scenarios? If neither of these "shortcuts" existed, do you think all of those obese and depressed people would be working their situations out in a manner that you find more appropriate? Shit no. Sure, a handful would, but mostly you'd get a lot of heart attacks and suicides that may have been preventable.

I don't have a problem with gastric bypass or with antidepressants. You missed the point of the analogy. What I have a problem with is the conception of depression as caused by a chemical imbalance, which in my analogy equates to the idea that obesity is caused by small stomachs. It's obviously preposterous in the case of obesity, but I think the chemical imbalance idea is making the same logical error. In my view at the heart of this issue is the fact that most people have a misunderstanding about the relationship between the mind and the brain. I think the idea that electrochemical events can cause thoughts is not too hard for most people to get, and that idea has seeped out from neuroscience into the culture, which is why the chemical imbalance story of depression is so successful. But what people seem to have less of a grasp on is that thoughts cause electrochemical events, and this is really why I'm interested in this issue in the first place. The influence is not stronger in one direction than the other, because really there is an identity, an equivalence between thought and electrochemical action in the brain. I think this is one place neuroscience has failed to properly educate the public, and a large reason why stems from the financial interests of pharmaceutical companies, who repeatedly tell people "chemicals cause you think and feel in certain ways".

[speedz99 145]

I don't have a problem with gastric bypass or with antidepressants.

But in the end, that's what we're talking about, right? Who cares how something is classified if it's not about the subsequent treatment. It's a chicken/egg debate, because the treatment is affected by which came first.

The influence is not stronger in one direction than the other.

Then you're fine with the idea that sometimes brain chemistry anomolies predate emotional changes?

[vbnautilus 48]

But in the end, that's what we're talking about, right? Who cares how something is classified if it's not about the subsequent treatment. It's a chicken/egg debate, because the treatment is affected by which came first.

Because that treatment should be a last resort, not a first resort.

Then you're fine with the idea that sometimes brain chemistry anomolies predate emotional changes?

Brain chemistry changes are emotional changes. Sometimes those brain chemistry/emotional changes are largely attributable to genetic or developmental conditions, but I think that is rare among people diagnosed with depression.

[speedz99 145]

Because that treatment should be a last resort, not a first resort.

As for the analogy, you realize that most obese people go through many years of failing at dieting before they try surgery, right? But, as for the original conversation, I'm not sure that's true either. I don't know the exact number, but I believe there are many more practicing clinical psychologists than psychiatrists. And that doesn't even include the professions of people who provide emotional support for depression without prescribing medications, such as social workers, counselors, etc. Every fat person isn't going directly to a surgeon, just as every sad person isn't on meds. So why do you have a problem with it?

Brain chemistry changes are emotional changes.

Sometimes those brain chemistry/emotional changes are largely attributable to genetic or developmental conditions

Before, when I kept saying that it's unfair to blame depression on the depressed (yes, vb, that's what you were doing, even if you didn't mean to) because sometimes it's clearly not totally under the control of the POWER OF POSITIVE THINKING, you kept disagreeing.

[vbnautilus 48]

As for the analogy, you realize that most obese people go through many years of failing at dieting before they try surgery, right?

Yes, that's exactly my point? For obesity the surgery is properly used as a last resort, and we do not generalize from this last resort case to thinking that obesity in general is somehow a stomach size problem.

But, as for the original conversation, I'm not sure that's true either. I don't know the exact number, but I believe there are many more practicing clinical psychologists than psychiatrists. And that doesn't even include the professions of people who provide emotional support for depression without prescribing medications, such as social workers, counselors, etc. Every fat person isn't going directly to a surgeon, just as every sad person isn't on meds. So why do you have a problem with it?

First and foremost I have a problem with the concept that "depression is caused by a chemical imbalance" because it is not true. (There isn't really any such thing as a "chemical imbalance" but ok fine, if that's just a colloquialism for any neurochemical change in the brain. )I think you vastly overestimate the availability of CBT and underestimate the frequency with which people are treated for depression with drugs alone. Antidepressants are the most common medication taken by adults under 45. According to this same report, a "vast majority" of these people say they haven't had contact with a mental health professional for more than a year. Antidepressant usage doubled from 1995 to 2005. We are at the point where use is so widespread that antidepressants are showing up in freshwater fish.I think a lot of this has to do with the misconception I've been describing.

Before, when I kept saying that it's unfair to blame depression on the depressed (yes, vb, that's what you were doing, even if you didn't mean to) because sometimes it's clearly not totally under the control of the POWER OF POSITIVE THINKING, you kept disagreeing.

Yeah I guess people just have very little idea of what really happens in CBT. It's not Tony Robbins positive thinking bullcrap*, it has to do with completely restructuring your through process, how you interpret and respond to events in your life and sensations in your body.Doesn't the success rate of CBT empirically refute this claim? It does in fact work most of the time, and more of the time than drugs alone do. *not that TR doesn't have anything valuable to say

[speedz99 145]

Yes, that's exactly my point? For obesity the surgery is properly used as a last resort, and we do not generalize from this last resort case to thinking that obesity in general is somehow a stomach size problem.

So you think that prescription medication should also be a "last resort" for depression. And you think that professional psychologists and psychiatrists are allowing people to lean on meds too quickly, as well as failing to educate the public on the fact that depression should be treated behaviorally first and foremost. Yah?

First and foremost I have a problem with the concept that "depression is caused by a chemical imbalance" because it is not true. (There isn't really any such thing as a "chemical imbalance" but ok fine, if that's just a colloquialism for any neurochemical change in the brain. )

Of course it is, as I'm not sure how else to characterize it. Really, functionally speaking, especially to a layperson like myself, what's the difference between "chemical imbalance" and "neurochemical changes in the brain that bring about negative consequences"?

I think you vastly overestimate the availability of CBT and underestimate the frequency with which people are treated for depression with drugs alone. Antidepressants are the most common medication taken by adults under 45. According to this same report, a vast majority of these people say they haven't had contact with a mental health professional for more than a year. Antidepressant usage doubled from 1995 to 2005. We are at the point where use is so widespread that antidepressants are showing up in freshwater fish.I think a lot of this has to do with the misconception I've been describing.

Ok, I agree that's pretty ridiculous. But remember, within those crazy stats there ARE lots of people who really do need those medications and really do work hard with therapists as well.

Yeah I guess people just have very little idea of what really happens in CBT. It's not Tony Robbins positive thinking bullcrap, it has to do with completely restructuring your through process, how you interpret and respond to events in your life and sensations in your body.

I think you drastically overestimate your fellow humans if you think that's going to happen with the majority of people without any chemical assistance. Like it or not, drugs often have to play some part, and it would be unfortunate to characterize the whole situation based on the people who abuse that system.

[vbnautilus 48]

So you think that prescription medication should also be a "last resort" for depression. And you think that professional psychologists and psychiatrists are allowing people to lean on meds too quickly, as well as failing to educate the public on the fact that depression should be treated behaviorally first and foremost. Yah?

Yeah, that's pretty close. This is where most people get their view of depression from: http://www.youtube.com/watch?v=6vfSFXKlnO0notice that they were legally required to say "although the cause of depression is unknown..." before they go on to explain to you how it is caused by a chemical imbalance. with pictures!

I think you drastically overestimate your fellow humans if you think that's going to happen with the majority of people without any chemical assistance. Like it or not, drugs often have to play some part, and it would be unfortunate to characterize the whole situation based on the people who abuse that system.

That's just not what the data show. Drugs do not have to play a part in most people's recovery. (we haven't even dealt with the potential dangers. antidepressants increase the rate of suicide in teenagers. the brain downregulates the number of receptors in response to the drugs. it might be more correct to say that the cause a chemical imbalance than that they solve one). But after thinking about this some more, the real issue is more general than just depression. The main thing that bothers me is the mistaken idea that because a mental event has some chemical change associated with it, that this means we are not responsible for it. People think that if they find a brain change associated with something, this always means that psychological/behavioral thing was caused by the brain change. It's an idea that is affecting our justice system. Lawyers are using brain imaging data to show: hey, this guy has decreased activity in his frontal lobe, there's something wrong with his brain, it's not his fault that he killed three people (this is not rare nowadays, I know someone who repeatedly provides this testimony). The fact is that absolutely everything we do is associated with a functional change in the brain. If you start acting like a douchebag, this will be associated with measurable changes in your brain function. If I find increased dopamine levels in brain region X of douchebags, this has nothing to do with what causes it. You're still a douchebag because of the choices you made. This is all coming out of the same basic misunderstanding about the relationship between brain and mind. (and before anyone says that I am making an analogy between depressed people and criminals, come on. I guess i have to include a positive example to counteract this? Finding high levels of opiates in the brains of extremely happy people does not mean their happiness was caused by a pre-existing level of opioids. )

[brvheart 1,752]

I know that everyone already knows this, but I am fully in VB's camp on this issue. After I finish my counseling masters someone (JJJ) remind me to come back in here and update my thoughts.

[Tactical Bear 3]

Whatever, Tom Cruise

[vbnautilus 48]

Whatever, Tom Cruise

This may be like the one thing they got right. (not counting Battlefield Earth)

[Tactical Bear 3]

This may be like the one thing they got right. (not counting Battlefield Earth)

Are you sue you don't mean "we?"

[The_Grim_Reaper 0]

Somebody famous needs to die to get this thread back on track!

Any requests?

[GeneralGeeWhiz 0]

im officially dead on the inside, does that count?

[rsmbox 1]

Have you tried cognitive behavioral therapy?

I think you missed the part where I said my life is pretty damn awesome, giving me no "cognitive behavioral" reason to be depressed...ever. Yet without medication, my general state of mind can and quite often does lean towards an unfounded state of "I should just kill myself" hopelessness. All the "happy thoughts" in the world cannot "cure" what you seem to perceive as me just having a case of the Mondays. Of course I think that without truly suffering from crippling bouts with depression it is impossible to understand the disease/disorder/illness/whatever you want to refer to it as. Until you go to bed one night feeling pretty great about your life, seeing the world in bright shades of illuminated optimism only to wake up thinking you would be better off putting a bullet in your brain because there is nothing in life worth living for, you can never really understand how depression is more than just "sad thoughts."

[SuitedAces21 2,722]

I think you missed the part where I said my life is pretty damn awesome, giving me no "cognitive behavioral" reason to be depressed...ever.

my understanding is that CBT doesnt address the outside influences on your life, it addresses the way you react to them. beck's cognitive triad (really the only thing i learned in college) is about negative self-reinforcing thoughts. specifically dealing with feelings of helplessness about the self, about current experiences resulting in failure, and a hopeless future.

[digitalmonkey 929]

Somebody famous needs to die to get this thread back on track!

I'm working on it.Oh! You said famous. Nevermind.Carry on.

[digitalmonkey 929]

Here's my analogy:Depression is a fat man standing on a line. One side of the line signifies the neurochemical cause of depression. The other side signifies the behavioural cause of depression. The psychiatrists (and others who profit from pushing pills) are trying to push the fat man completely over the line into the neurochemical side, while the psychologists (and others who profit from pushing CBT) are trying to push the fat man completely over the line into the behavioural side.My view is that neither side is completely correct and that depression is a combination of both. Sometimes the fat man is more on one side then the other. It may be next to impossible to determine the exact neurochemical/behavioural division so perhaps we should always start by treating BOTH. VB, isn't it possible that the concept of attractors that you brought up may also have contributions from both chemical and behavioural factors?When I hear someone say that depression is not a disease, I hear them discrediting the chemical side of the issue altogether. Yes, chemicals affect thoughts, and thoughts affect chemistry, but claiming that depression is not a disease is like saying that the only problem is that thoughts are affecting your brain chemistry AND this is not true in the majority of diagnoses of depression. In circumstantial of situational depression I do believe that the majority of cause is due to thoughts affecting chemistry, but then there is the question of whether someone's pre-existing brain chemistry makes them more susceptible to "depressive thoughts."Behavioural modification such as eating well, not smoking, exercising, using sunblock, etc, has most likely resulted in many people not getting cancer (does ANYONE other than brvheart disagree with this?) but some people who modify there behaviour as such still get cancer. Some people smoke all their lives and never get cancer. Would it make sense to claim that someone smokes two packs a day and gets diagnosed with cancer does NOT have a disease? I believe cancer and depression are similar in this regard. I believe they both have chemical and behavioural factors that contribute to their presentation.Notes:- apologies to Americans for my spelling of behaviour/behavioural- great discussion- 99.44% of stats are made up to support the cause of those presenting the stats- I'm hungry- great job Speedz!

[vbnautilus 48]

I think you missed the part where I said my life is pretty damn awesome, giving me no "cognitive behavioral" reason to be depressed...ever. Yet without medication, my general state of mind can and quite often does lean towards an unfounded state of "I should just kill myself" hopelessness. All the "happy thoughts" in the world cannot "cure" what you seem to perceive as me just having a case of the Mondays. Of course I think that without truly suffering from crippling bouts with depression it is impossible to understand the disease/disorder/illness/whatever you want to refer to it as. Until you go to bed one night feeling pretty great about your life, seeing the world in bright shades of illuminated optimism only to wake up thinking you would be better off putting a bullet in your brain because there is nothing in life worth living for, you can never really understand how depression is more than just "sad thoughts."

I take it the answer to my question was "No."I encourage you to look into it before you dismiss it. Empirical research shows a very high success rate for CBT compared with drugs. Again, this has nothing to do with "happy thoughts" or avoiding "reasons to be depressed". In fact if one has good reasons to be depressed you will often not qualify for a clinical diagnosis because of that. I think you simply don't understand what is involved in CBT, because your response is aimed at something entirely different. The techniques have been refined through decades of research on what works and what doesn't. I'm not unfamiliar with depression.

[vbnautilus 48]

Here's my analogy:Depression is a fat man standing on a line. One side of the line signifies the neurochemical cause of depression. The other side signifies the behavioural cause of depression. The psychiatrists (and others who profit from pushing pills) are trying to push the fat man completely over the line into the neurochemical side, while the psychologists (and others who profit from pushing CBT) are trying to push the fat man completely over the line into the behavioural side.My view is that neither side is completely correct and that depression is a combination of both. Sometimes the fat man is more on one side then the other. It may be next to impossible to determine the exact neurochemical/behavioural division so perhaps we should always start by treating BOTH. VB, isn't it possible that the concept of attractors that you brought up may also have contributions from both chemical and behavioural factors?

Yes, in a sense. But my underlying point is that there's no such thing as either a chemical or mental factor. Both are both. Mental events are chemical events and chemical events are mental events.

When I hear someone say that depression is not a disease, I hear them discrediting the chemical side of the issue altogether. Yes, chemicals affect thoughts, and thoughts affect chemistry, but claiming that depression is not a disease is like saying that the only problem is that thoughts are affecting your brain chemistry AND this is not true in the majority of diagnoses of depression.

That's a testable hypothesis that is not supported by the evidence.

In circumstantial of situational depression I do believe that the majority of cause is due to thoughts affecting chemistry, but then there is the question of whether someone's pre-existing brain chemistry makes them more susceptible to "depressive thoughts."

I think this is a reasonable way of looking at it.

Behavioural modification such as eating well, not smoking, exercising, using sunblock, etc, has most likely resulted in many people not getting cancer (does ANYONE other than brvheart disagree with this?) but some people who modify there behaviour as such still get cancer. Some people smoke all their lives and never get cancer. Would it make sense to claim that someone smokes two packs a day and gets diagnosed with cancer does NOT have a disease? I believe cancer and depression are similar in this regard. I believe they both have chemical and behavioural factors that contribute to their presentation.

Cancer is different. Although your behavior can affect your likelihood of getting it (as with any disease), once you have it it has a life of its own and you can not become cancer-free by changing your thought patterns.

[SAM_Hard8 50]

I was suffering from serious depression, then my wife left me.I'm much better now, thanks.

[qyayqi 11]

i'm not a fan of how much the chemical solutions are being defended. all the commercials about depression are NOT there to help the viewer. they are there to sell the viewer drugs.divergently, while the backlash against drugs in our food supply has come along nicely ('organic' farming), it needs to keep up momentum against the burgeoning counterforce of the drug companies & their moolah that want more drugs used-- and therefore more control ceded to their companies.fight the drugs.<lighting cig to calm down>....sonofa--

[speedz99 145]

i'm not a fan of how much the chemical solutions are being defended. all the commercials about depression are NOT there to help the viewer. they are there to sell the viewer drugs.

They're there to help the viewer via selling them the drug, and I don't think anyone is confused about that relationship in advertising. It's not like they're using subliminal messaging.

divergently, while the backlash against drugs in our food supply has come along nicely ('organic' farming), it needs to keep up momentum against the burgeoning counterforce of the drug companies & their moolah that want more drugs used-- and therefore more control ceded to their companies.

I'd like to chime in here and say that "organic" meats are almost exclusively complete bullshit. If you want to get something nature-friendly, get "cage free" or "free range". Trust me when I say that you want drugs used in your meat and milk-producers, and the FDA is pretty stringent about making sure there aren't dangerous residues in either when you ingest them. Watch the episode of "Bullshit" about the whole organic thing in general.

[Dread Aidan 8]

If you want to get something nature-friendly, get "cage free" or "free range".

The term "free range" is absolutely unregulated for eggs, beef or any food except live poultry. It’s a marketing claim with no standard definition and no government agency enforcing it......even though the U.S. Department of Agriculture regulates "free range" poultry, its rules differ from that mental image of birds fluttering across a field and pecking at the ground. As Eco-labels put it: "The government only requires that outdoor access be made available for 'an undetermined period each day.' That means that the door to the coop or stall could be opened for five minutes a day and if the animal(s) did not see the open door or chose not to leave--even everyday--it could still qualify as ‘free range.'" The USDA considers five minutes of daily open-air access adequate for use of the "free range" label.link

[qyayqi 11]

nicely co-opted definition by the producers. and... you trust the usda with your food? and the fda with your drugs?