Views on the medicalization of depression

[mintleaf]

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.

 

[Stanton Moore]

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

 

[ptgatsby]

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.

 

[Lark]

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.

 

[mintleaf]

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.

 

[Lark]

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.

 

[Nicki]

I really enjoy this thread.

 

[mintleaf]

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.

 

[ptgatsby]

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.

 

[Viridian]

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/slideshow/drugs-and-medications/9-myths-depression

Take care.

 

[Randomnity]

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.

Because everything in our minds occurs on a chemical level, it makes perfect sense to discuss it in the context of medical pathology. That doesn't imply that pills are the solution 100% of the time, but they should always be an option to consider.

It's like if you have high blood pressure - you'd talk to your doctor and he might give you pills, but would also suggest lifestyle changes that could help. For some people, those lifestyle changes can be helpful enough that you don't need medication. For others, the medication is necessary for life. Your doctor is the best person to figure out which group you fall into - going off necessary medications can have severe consequences, and unnecessary medications are also stressful for the body - your doctor will do his/her best to figure out what option is best for you.

Also many SSRIs can have a really, really nasty withdrawal with symptoms that may require medical attention, so if you're planning to stop you really need to talk your doctor about it first - they can help manage your meds so the withdrawal isn't as bad.

edit: Also consider that it's extremely likely that a large part of why you feel good now is a direct result of the meds, not a sign that they're unnecessary. This is particularly true if your depression was kinda "out of nowhere" as opposed to a reaction to a really bad situation which is now over.

 

[mintleaf]

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.

Because I want my mind to heal itself. What goes on chemically in my brain = what goes on in my mind*. My mind is my territory, so I do see pharmacological interference as artificial, though not in the same way as an artificial limb. My limbs are unessential appendages of my essential self, whereas my brain is my self. Or something along those lines.

I truly was unsure when I created this thread - I didn't just start it for the purpose of sharing my own view - but now I've reached a tentative conclusion. StantonMoore articulated it well here:

Depression and anxiety are natural states, and while uncomfortable, not without purpose, that being that they signal that something is wrong in one’s life and/or relationships and must be addressed on that level. It may be true that depression is a chemical imbalance, but that is very different than saying that depression is caused by that imbalance. Drugs seek to cover symptoms, but not to address underlying causes. ... I have had some very low moments, but I have also evolved in ways that would not have been possible on meds. Depression is a process that you can go through to your betterment, but only if you feel and experience what it’s trying to tell you.

*with the exception of issues like Lyme disease, brain damage, etc. The distinction is that depression usually arises as a result of the mind itself, not as a result of purely physical/biological factors. I realize this logic isn't airtight, so feel free to dispute it if you want.

 

[garbage]

Medication is worth it to some, but not to others.

It's easier if you eschew the whole "identity" thing. "Being myself" is a foreign concept to me, since I've been under so many altered states, but the lack of an actual identity crisis is worth it. The truth is that I am all of those states, and there's no point in pinpointing exactly who I am.

 

[Tiltyred]

Stay on your meds for at least a year, like your doctor said. When the year is over, see how you feel then.

What's the rush?

 

[ptgatsby]

I appreciate where you are coming from. To preface my comments, I'm not trying to convince you to (not) do, only to challenge the rationalisation for it.

Because I want my mind to heal itself.

There are two arguments against this;

1) The assumption of a norm, or the existance of a 'correct state'. This is no "state" in which we are normal. We are not closed systems - trauma from outside affects us through our senses, high calorie food re-write our reward centers, forget emotional highs from love/whatever. Nor is there a notable existance - memories are re-fabricated at every recall. The "us" we think of is only a concept, a fabricated projection of self.

2) Not everything can be healed. Diabetics are so for life, blood pressure and heart issues, etc. This could be compared to someone's blood pressure being reduced by medication and arguing that they should go off of it.

What goes on chemically in my brain = what goes on in my mind*. My mind is my territory,

You are not just your brain. I really mean this - the mind is not physiologically separated from the body. Your body's reactions feed the mind. Being breathing shallow and rapidly and your mind will follow through with physiological arousal - stress, anxiety, etc. It works in reverse too (hence progressive muscle relaxation and deep breathing exercise). To give a more common example - asking someone on a date in a 'danger' location is more successful because the mind is reacting to a physiological arousal that originates from our senses more than our mind. Nor is there any measurement of "what is". Information you bring on is emotionally tagged first; the depressive state is different than the emotional state than the restful state. Meaning, everything you process is "uniquely" tagged on your state of mind at that moment. Sure, medication will affect that... so will standing on a bridge, running a mile or being blindfolded.

Certainly I can't say the mind isn't that important... but would you consider yourself not-you if you had a concussion? Resulting in minor memory loss? Total memory loss? Are you less you when you don't sleep (similar chemical issue as depression) and are anxious and irrtable? What about just stress? The you you are is the you at any given point, because the you that exists is the only one that is (this is back to the "correct state" issue). To believe otherwise is to rely on the projection of "self". One interesting point to bring up here is that cognitive behavioral therapy changes your thought patterns: are you less you when you reroute around negative feedback loops?

What about the concept that there is no "you" driving you, and that the inner dialogue you have is actually just a rationalisation mechanism for subconscious actions? Are you less of you because you have shifted your reactions deep down and in reality are completely unaware of why you act in a particular way? The voice being a narrative, a recorder of what you did, not the driver. Keep in mind that these things change dramatically. I can given two topical examples - if you were to write down a list of things you find attractive, then find someone attractive that did not have those things, the next list you wrote would include the things you now find attractive. Or, picking your favorite picture out of a line up changes you to like that picture more, even if you don't remember picking it. Both of these fundamentally change "who you are" at an extremely core level.

In all cases, medication would change "who" you are. To say it is artificial and/or external is an appeal to nature, which is to say that it is wrong because of it's inherent nature, not because of what it does to you.

I truly was unsure when I created this thread - I didn't just start it for the purpose of sharing my own view - but now I've reached a tentative conclusion. StantonMoore articulated it well here:

Here, I'll comment personally. StantonMoore is both correct and incorrect. With a high level of confidence, depression is caused by 'that' chemical imbalance. However, it is difficult to correct that imbalance because of the number of interactions and specific causes. The degree of depression, or what gets called depression, is an important factor in what we describe. To argue one way or the other requires specifics, but for any moderate+, chronic, or debilitating case, I would consider it incorrect.

Short run events caused by events can be "gotten over" (assuming no pattern forms, no susceptibility and no trauma) by most people. These are abnormal conditions and it's rare treatment is given here unless it is severe (impact wise) enough. Depression is only a natural state in chronic depressives. They are the ones that need medication the most. For most of us, depression is mostly just feeling down. This is not clinical depression. It may or may not be best to medicate it. It's easy to underestimate the impact depression has. Depression is a trap. It spirals. Those with clinical depression rarely, if ever, have it solved (IIRC, 80%+ over even moderate run periods). Those that reach very strong lows also have it recur at very high rates, notably because they are prone to the mood swings. This going untreated destroy lives... and it goes untreated a significant amount of the time because depressives do not seek help.

It is possible to quantify the damage it does; even if some are "better off" being depressed rather than treating it, the vast majority are not... and this is especially true when considering that most that are better off recovering on their own are likely to have low susceptibility in the first place.

 

[Stanton Moore]

I appreciate where you are coming from. To preface my comments, I'm not trying to convince you to (not) do, only to challenge the rationalisation for it.



There are two arguments against this;

1) The assumption of a norm, or the existance of a 'correct state'. This is no "state" in which we are normal. We are not closed systems - trauma from outside affects us through our senses, high calorie food re-write our reward centers, forget emotional highs from love/whatever. Nor is there a notable existance - memories are re-fabricated at every recall. The "us" we think of is only a concept, a fabricated projection of self.

2) Not everything can be healed. Diabetics are so for life, blood pressure and heart issues, etc. This could be compared to someone's blood pressure being reduced by medication and arguing that they should go off of it.



You are not just your brain. I really mean this - the mind is not physiologically separated from the body. Your body's reactions feed the mind. Being breathing shallow and rapidly and your mind will follow through with physiological arousal - stress, anxiety, etc. It works in reverse too (hence progressive muscle relaxation and deep breathing exercise). To give a more common example - asking someone on a date in a 'danger' location is more successful because the mind is reacting to a physiological arousal that originates from our senses more than our mind. Nor is there any measurement of "what is". Information you bring on is emotionally tagged first; the depressive state is different than the emotional state than the restful state. Meaning, everything you process is "uniquely" tagged on your state of mind at that moment. Sure, medication will affect that... so will standing on a bridge, running a mile or being blindfolded.

Certainly I can't say the mind isn't that important... but would you consider yourself not-you if you had a concussion? Resulting in minor memory loss? Total memory loss? Are you less you when you don't sleep (similar chemical issue as depression) and are anxious and irrtable? What about just stress? The you you are is the you at any given point, because the you that exists is the only one that is (this is back to the "correct state" issue). To believe otherwise is to rely on the projection of "self". One interesting point to bring up here is that cognitive behavioral therapy changes your thought patterns: are you less you when you reroute around negative feedback loops?

What about the concept that there is no "you" driving you, and that the inner dialogue you have is actually just a rationalisation mechanism for subconscious actions? Are you less of you because you have shifted your reactions deep down and in reality are completely unaware of why you act in a particular way? The voice being a narrative, a recorder of what you did, not the driver. Keep in mind that these things change dramatically. I can given two topical examples - if you were to write down a list of things you find attractive, then find someone attractive that did not have those things, the next list you wrote would include the things you now find attractive. Or, picking your favorite picture out of a line up changes you to like that picture more, even if you don't remember picking it. Both of these fundamentally change "who you are" at an extremely core level.

In all cases, medication would change "who" you are. To say it is artificial and/or external is an appeal to nature, which is to say that it is wrong because of it's inherent nature, not because of what it does to you.



Here, I'll comment personally. StantonMoore is both correct and incorrect. With a high level of confidence, depression is caused by 'that' chemical imbalance. However, it is difficult to correct that imbalance because of the number of interactions and specific causes. The degree of depression, or what gets called depression, is an important factor in what we describe. To argue one way or the other requires specifics, but for any moderate+, chronic, or debilitating case, I would consider it incorrect.

Short run events caused by events can be "gotten over" (assuming no pattern forms, no susceptibility and no trauma) by most people. These are abnormal conditions and it's rare treatment is given here unless it is severe (impact wise) enough. Depression is only a natural state in chronic depressives. They are the ones that need medication the most. For most of us, depression is mostly just feeling down. This is not clinical depression. It may or may not be best to medicate it. It's easy to underestimate the impact depression has. Depression is a trap. It spirals. Those with clinical depression rarely, if ever, have it solved (IIRC, 80%+ over even moderate run periods). Those that reach very strong lows also have it recur at very high rates, notably because they are prone to the mood swings. This going untreated destroy lives... and it goes untreated a significant amount of the time because depressives do not seek help.

It is possible to quantify the damage it does; even if some are "better off" being depressed rather than treating it, the vast majority are not... and this is especially true when considering that most that are better off recovering on their own are likely to have low susceptibility in the first place.

Are you a doctor or a clinical professional?

 

[ptgatsby]

Are you a doctor or a clinical professional?

Nope!

 

[Stanton Moore]

Nope!

I'm glad that has been publically stated. Hopefully others will be able to exclude the factually inaccurate info from the accurate in that post.

 

[ptgatsby]

I'm glad that has been publically stated. Hopefully others will be able to exclude the factually inaccurate info from the accurate in that post.

Enumeration would help others more, since you were able to do it already.

 

[mintleaf]

Certainly I can't say the mind isn't that important... but would you consider yourself not-you if you had a concussion? Resulting in minor memory loss? Total memory loss? Are you less you when you don't sleep (similar chemical issue as depression) and are anxious and irrtable? What about just stress? The you you are is the you at any given point, because the you that exists is the only one that is (this is back to the "correct state" issue). To believe otherwise is to rely on the projection of "self". One interesting point to bring up here is that cognitive behavioral therapy changes your thought patterns: are you less you when you reroute around negative feedback loops?

I'm not sure whether I've brought this up, but while I'm generally doing well, I feel numb a lot of the time. So, even if I'm no less "myself" while on the medication than I am when sleep-deprived, I still don't feel quite like myself. It may just be that I need to switch medications, exercise more or change some other factor(s).

hm. The thing is, in CBT, you're actively engaging in addressing your depression on a cognitive level. Very different than just letting antidepressants run their course. (Obviously, the peace of mind brought about by successful medication helps to facilitate such reflective behavior, but still. Doesn't seem like a solid analogy.)

Short run events caused by events can be "gotten over" (assuming no pattern forms, no susceptibility and no trauma) by most people. These are abnormal conditions and it's rare treatment is given here unless it is severe (impact wise) enough. Depression is only a natural state in chronic depressives. They are the ones that need medication the most. For most of us, depression is mostly just feeling down. This is not clinical depression. It may or may not be best to medicate it. It's easy to underestimate the impact depression has. Depression is a trap. It spirals. Those with clinical depression rarely, if ever, have it solved (IIRC, 80%+ over even moderate run periods). Those that reach very strong lows also have it recur at very high rates, notably because they are prone to the mood swings. This going untreated destroy lives... and it goes untreated a significant amount of the time because depressives do not seek help.

What you wrote here does seem true for me, now that I look back. I consider myself an extremely resilient and optimistic person not prone to self-destruction, and this was especially true during the worst phase of my depression...yet no amount of positive thinking or healthy choices made a dent in what I felt. And it was not just dysthymia, it was totally unhinging and hellish and agonizing. I'm not considering that it was a purely biological depression, since I'm able to identify what set the initial depression in motion. But it's plausible that that first phase took such a toll on my mind that it was too exhausted to recover, even when my perspective had.

I'm sorry for implying that medication was to be avoided in all cases. I know that there are those who literally couldn't survive without it, and that black-and-white arguments like that can discourage people from seeking help.