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  1. #1
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    Default Views on the medicalization of depression

    I realize that this is a pretty overdone topic, but I haven't been able to dig up any useful insights elsewhere.

    The "depression is a chemical imbalance in your brain" perspective has never set well with me, because, since everything in our minds occurs on a chemical level, I don't understand why depression is so often discussed in the context of medical pathology.

    Example: Person has a decently healthy self-esteem, a positive outlook on life, and a good support system. He has bounced back from severe depression, for which he's been on a moderate dose of SSRIs for almost a year. He's always felt uneasy about this treatment, but justified it with the idea that his mind was too exhausted to significantly recover by any other means. Person has always had very intense fears about not being himself and has been unnervingly unemotional for as long as he's been on these meds. Feels fine, but numb. At a stable point now, he wants to go off of the medication. His doctor advises against it, saying things like "If it ain't broke, don't fix it" and "I don't think that this would be a good time for you to attempt withdrawal." (It would actually be fine.)

    What do you think that the appropriate step would be in that situation? Would you advise against going off the SSRI?

    (person is the example is obviously me, I just didn't want to write such a succession of first-person statements about the experience. lol. )

    What are your thoughts on medicalization of psychological issues in general?


    edit: I'm not going to go off my medication unless I consult my doctor again and she approves, but for anyone answering the hypothetical "would you advise going off the SSRI?", here are a few details. I was severely depressed and had an anxiety disorder from 2006-mid 2012. I've been well since June and am done with therapy. The only reason I'm still on the meds is because my doctor has a policy of keeping patients on them for at least a year.
    Last edited by decrescendo; 02-06-2013 at 07:03 PM. Reason: clarification

  2. #2
    morose bourgeoisie
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    I have several thoughts about this. PM me if you want to know what they are.

  3. #3
    Senior Member ptgatsby's Avatar
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    Quote Originally Posted by decrescendo View Post
    What do you think that the appropriate step would be in that situation? Would you advise against going off the SSRI?

    (person is the example is obviously me, I just didn't want to write such a succession of first-person statements about the experience. lol. )
    I think it's important to separate the view from your personal circumstances. No matter how much you believe that depression is over-medicated it doesn't follow that you fit into that generalization! Your doctor is essentially the specific measurement you should be using... and he's far more likely to be correct than anyone removed from it (or arguing from the generalized view.) There are also a lot of other issues - withdrawal from SSRIs can be erratic, and re-introducing them is also erratic, especially after withdrawal. Again, a medical professional knowing your specifics will be a much better judge than the generalized view.

  4. #4

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    I'm not qualified to give you medical advice. I wouldnt make a decision on the basis of feedback from a forum of online posters to be frank.

    About the medicalisation, I think that insights as to just how biological (organic), psychological (individual traits) and social (situational stressors) all intersect and opportate in concert has broken down the dichotomy between medical and social or psychological models of diagnosis and treatment, there are amazing findings about stress-resilience models of capacity which assist with treatment plans and I believe are accessed by most or all medical professions called on to make decisions about medication etc. although that's not restricted to things like depression, that goes the same for other illnesses such as diabetes.

    I think all those developments are pretty good, the present levels of evidence based practice I hope will only be improved upon with more information and better systems for tracking it all out.

    The only thing which I think should happen, although to an extent I think this about a lot of different kinds of expertise and not just medicine, is that people should become more informed and it should be effectively, so far as is possible without any ridiculous attempt to subvert the existence of expert opinion altogether, willing to try and assimilate or "socialise" knowledge and evidence based decisions themselves.

  5. #5
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    I think it does follow, because the question bothers me and I'm afraid this unease has led to a self-fulfilling prophecy: if I doubt that I'm truly myself while on the medication, I inevitably feel detached. (Not hugely, but to an uncomfortable degree.) It's just how I am. I do appreciate your advice, though.

    I trust my doctor when it comes to medical reasoning, but this isn't a medical question. And I obviously won't go off of the medication without speaking to my doctor again, because I realize how hazardous SSRI withdrawal can be.

    Anyway, sorry: my main question was how people would respond to this idea
    the "depression is a chemical imbalance in your brain" perspective has never set well with me, because, since everything in our minds occurs on a chemical level, I don't understand why depression is so often discussed in the context of medical pathology.

  6. #6

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    Quote Originally Posted by decrescendo View Post
    I think it does follow, because the question bothers me and I'm afraid this unease has led to a self-fulfilling prophecy: if I doubt that I'm truly myself while on the medication, I inevitably feel detached. (Not hugely, but to an uncomfortable degree.) It's just how I am. I do appreciate your advice, though.

    I trust my doctor when it comes to medical reasoning, but this isn't a medical question. And I obviously won't go off of the medication without speaking to my doctor again, because I realize how hazardous SSRI withdrawal can be.

    Anyway, sorry: my main question was how people would respond to this idea
    Depression IS a chemical imbalance in the brain.

    It can be situational and correspond to trauma or life events, such as a bereavement (just to state the obvious and cliched example for instance) or loss (losing a job or house), which its just possible with situational change the depression will lift and the individual will return to their preset level of happiness (or "ordinary misery").

    Everyone has that more or less preset and sustained across the life course level of happiness and its a consequence of physiology, biology and patterning of the brain, that's been proven, its been evidenced by people who've had windfalls and great success or fortune, such as lottery winners, as much as by those experiencing the opposite lows.

    The other variety of depression, so far as I know, is endogenous, not exogenous or situational, that is an individual whose biology and physiology means they will experience depressive lows all the time without any sort of corrective medical intervention.

    To be honest the idea that you could quit depressive meds, if you're experiencing that sort of depression with ongoing imbalance in brain chemistry, because you have particular feelings about them, particularly ones with dependency factors like I think is implied in your posts (I'm sorry I dont know anything about them) is a little worrying, it'd be like a diabetic deciding they just dont want to use insuline anymore, its a need and its there, its not going away.

    Diabetes is an ongoing imbalance or potential imbalance in body chemistry, ie abscence or resistance to insulin, but what you going to do? Without the medical intervention life is going to be a lot worse.

    There's a host of other examples, like deciding you dont like glasses to correct sight problems. At least this is how I see the question in a general rather than specific sense, like I say I dont feel qualified to speak about your unique situation.

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    Retired Nicki's Avatar
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    I really enjoy this thread.

  8. #8
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    Quote Originally Posted by Lark View Post
    Depression IS a chemical imbalance in the brain.

    It can be situational and correspond to trauma or life events, such as a bereavement (just to state the obvious and cliched example for instance) or loss (losing a job or house), which its just possible with situational change the depression will lift and the individual will return to their preset level of happiness (or "ordinary misery").

    Everyone has that more or less preset and sustained across the life course level of happiness and its a consequence of physiology, biology and patterning of the brain, that's been proven, its been evidenced by people who've had windfalls and great success or fortune, such as lottery winners, as much as by those experiencing the opposite lows.

    The other variety of depression, so far as I know, is endogenous, not exogenous or situational, that is an individual whose biology and physiology means they will experience depressive lows all the time without any sort of corrective medical intervention.

    To be honest the idea that you could quit depressive meds, if you're experiencing that sort of depression with ongoing imbalance in brain chemistry, because you have particular feelings about them, particularly ones with dependency factors like I think is implied in your posts (I'm sorry I dont know anything about them) is a little worrying, it'd be like a diabetic deciding they just dont want to use insuline anymore, its a need and its there, its not going away.

    Diabetes is an ongoing imbalance or potential imbalance in body chemistry, ie abscence or resistance to insulin, but what you going to do? Without the medical intervention life is going to be a lot worse.

    There's a host of other examples, like deciding you dont like glasses to correct sight problems. At least this is how I see the question in a general rather than specific sense, like I say I dont feel qualified to speak about your unique situation.
    I completely understand that depression is a consequence of physiology/biology on one level. I'm just questioning whether it should always be approached that way, rather than on another (equally valid) level.

    I might be missing the point entirely. I don't know.

  9. #9
    Senior Member ptgatsby's Avatar
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    Quote Originally Posted by decrescendo View Post
    I might be missing the point entirely. I don't know.
    I would ask; why is that 'chemical reaction' different than other examples? A cut on your finger, diabetes, cancer, and so forth? I ask to understand your view on what makes it different, even from a philosophical ("it changes who I am, for I am what I think") point of view.

  10. #10
    Senior Member Viridian's Avatar
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    Well, I'm not a professional or anything, but I've thought quite a bit about this specific subject...

    There are depressive states, and there's clinical depression. There're factors both within and outside your locus of control when it comes to both, which is why a shrink worth their salt will treat it from both ends (restoring the serotonin balance and fostering examination of self-destructive thought patterns and their origins).

    Have you expressed those doubts to your therapist? It could help. If you feel you're being gaslighted by them, though, that sounds like a bit of a red flag to me...

    Also, this here could be useful:

    http://www.helpfordepression.com/sli...ths-depression

    Take care.
    Tentative typing: ISFJ 6w5 or 9w1 (Sp/S[?]).

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