Depression

[Julia]

herzy, thank you for your comments and your own experience which seems like a pretty objective personal insight.

This may be of interest - but it's very far from being hard science. http://www.iol.co.za/lifestyle/blood-test-may-help-diagnose-depression-1.1754474#.VCZPt51--70

This, inter alia, says

scientists from North Western University in Chicago say they have identified nine chemicals in the blood which are raised during depression.

They have devised a blood test which measures three of these chemicals to diagnose depression.

The researchers measured chemical levels in the blood of 32 patients with severe depression and compared them to 32 non-depressed individuals.

As you say, it's not any sort of hard science. 32 patients are not statistically significant and neither do we know anything about the methodology. Further they say they have 'identified nine chemicals in the blood which are raised during depression' but do not list these chemicals. Then they claim to have devised a blood test which measures just three of these nine chemicals.
All very vague and I'd be very surprised if it were to be peer reviewed or printed in any substantial journal.
I might, of course, be completely wrong.

I have a family history of depression and come from a fairly neglected childhood.

Which is possibly going to predispose you to think about inheriting the genetic disposition toward depression?

When I was 17 I got glandular fever, which knocked me out (left me depressed, demotivated and exhausted) for about 6 months.

Very common, and used to be called 'post viral syndrome' often subsequently interchanged with 'chronic fatigue syndrome' for no particularly good reason that I've ever seen documented.

(I also had glandular fever at age 16, with the resulting post-viral symptoms you describe, off school for more than a year and intermittent recurrences of the acute phase for more than two years afterwards. Since then any significant viral infection will result in the same syndrome, biologically demonstrated by significantly elevated liver enzymes which lead to the conclusion that it is in fact a biological disorder, rather than one which is purely psychological.)
Of course, psychological repercussions would seem to be a pretty normal response to months of feeling sick, loss of appetite, fevers and chills, and minimal energy.

I found it impossible to get out of this negative sphere, and was quite depressed (but able to recognise that it was - hopefully - a temporary state, and was therefore not suicidal).

Good for you. A long time ago before many of the current terms were adopted, there used to be in the literature a clear differentiation between 'reactive depression' and 'endogenous depression'. ie perfectly rational to feel depressed when unwell and not seeing a resolution to that, and a sense of misery for no discernible reason.

I started seeing a psychologist but found that entirely useless.

Some are a waste of time and money. Others are thoughtful and very helpful.
One I consulted about the repetitive nightmares emanating from PTSD had the profound suggestion "just think happy thoughts when you turn out the light!"
Right. Could have got that from "New Idea" or the "Women's Weekly" for a couple of dollars.

I started antidepressants (and went on exchange) and stopped taking them a few months later. I thought they were great, and have a personal theory that post-glandular I had a chemical imbalance / consistently lowered serotonin (this can also happen during traumatic events) which became the new 'baseline'/normal level. As such, the SSRIs were great for re-establishing a 'normal' level, and cognitive behavioural therapy relatively useless.

Glad to know it worked for you.

I do think my case is rarer though, and psychologists are generally a MUCH better solution than SSRIs. I still feel like my default state is 'unhappy', and that it actively takes effort for me to be neutral or happy (although I am most of the time). I wouldn't classify myself as depressed any more (by any means) but rather as having a tendency towards depression.

Sounds like a very thoughtful conclusion and not too dissimilar to my earlier expressed notion of minimal expectations of "happiness".

I think things like social support, being outside as much as possible (and as physically active as possible) are essential. These things have consistently been proven to be immensely good for health.

+1, yes very much so.

I do also feel like more intelligent people tend to 'think' more about the world, and that given how many bad things there are in this world (climate change, humanitarian crises, etc - pick your poison), it's impossible not to take this to heart to some extent. That said, that might just be because of my depressive prism - I'm not sure.

Again, a thoughtful and realistic comment. I think you're right. If we are involved in pubs, pokies and partying we will perhaps be less disposed to be concerned about global and national worries.
I like the AA philosophy of worrying about only the things about which you can effect a change, but it's easier said than done.

Thanks again for such an interesting post, herzy.

I should probably also qualify my comments with the effects of having worked for many years in the multinational pharmaceutical industry, including very short stays with two major companies because of ethical differences. There are absolutely companies which have sound ethical frameworks, but rather more which will manipulate data and interpret results to their own ends.

One of the very real problems (unless it has very recently been established) is that there is no such thing as a central register of drug trials. No requirement for any researcher to - when engaging on any sort of study - register details of that study so that it can later be followed up in terms of results.

As a consequence, drug companies can and do simply junk trials that do not elicit the results they seek.
They might do ten trials which all show unacceptable side effects of their potential new drug, just obliterate them as though they had never happened, and then widely publicise any trial which shows their product in a favourable light.

A simple register of all trials with full results of each one would give a much more clear and authentic framework for the prescribing community.

 

[wayneL]

Do you really think there is still stigma attached to depression?

I think there is, less so than before, but still there. Moreso, there is a lack of understanding of clinical depression.

This is why, having decided upon the necessity to do so, I blabbed here. My personal contacts are intertwined with my professional contacts and would have most certainly had ramifications on my business.

...the unnecessary and boring compulsion of so many to describe their every mood change and treatment thereof to the world at large.

And Julia, I do apologize for my boring revelation. As it happens, it was most helpful for me to a/ address the issue as detailed earlier and b/ have some useful private discussions with others who have been very helpful with advice on what to do next. Already I think I am benefiting from the exercise; so for me at least, not unnecessary at all.

I sure you are aware of the most effective way to mitigate the tedium however.

 

[Julia]

And Julia, I do apologize for my boring revelation.

It's an open forum. We are both equally entitled to express a view, surely?
No need for either you or I to apologise. I don't think your sarcasm is really necessary.

As it happens, it was most helpful for me to a/ address the issue as detailed earlier and b/ have some useful private discussions with others who have been very helpful with advice on what to do next. Already I think I am benefiting from the exercise; so for me at least, not unnecessary at all.

That's good to hear.

I sure you are aware of the most effective way to mitigate the tedium however.

I have no idea what you mean. Perhaps you could clarify?
I'd ask via PM but, following your last go at me in public, when I asked for the reason via PM in order to avoid a public spat, there was no response.

I made it clear that my remarks were not addressed to anyone in particular, just my own observations from personal experience and objective observations from many qualified people over a long period of time. Such remarks included my own experience of a suicidal level of depression over more than two years.

Surely a forum is a place where various views can be expressed without the obligation for everyone to fall into line and agree with a particular sentiment?

 

[SirRumpole]

One I consulted about the repetitive nightmares emanating from PTSD had the profound suggestion "just think happy thoughts when you turn out the light!"
Right. Could have got that from "New Idea" or the "Women's Weekly" for a couple of dollars.

Did that idea work ?

I'm not passing judgements on the competence of your consultant, but it would seem a good idea to try some simple things first, (esp not prescribing drugs) and if they don't work then move on to something more intensive.

 

[wayneL]

Thanks Julia, you have confirmed my reticence to go anywhere near the "professional" psychology communitym

 

[herzy]

Thanks again for such an interesting post, herzy.

And thank you for your response.

One of the very real problems (unless it has very recently been established) is that there is no such thing as a central register of drug trials. No requirement for any researcher to - when engaging on any sort of study - register details of that study so that it can later be followed up in terms of results.

As a consequence, drug companies can and do simply junk trials that do not elicit the results they seek.
They might do ten trials which all show unacceptable side effects of their potential new drug, just obliterate them as though they had never happened, and then widely publicise any trial which shows their product in a favourable light.

A simple register of all trials with full results of each one would give a much more clear and authentic framework for the prescribing community.

Interesting (and problematic) - kinda undermines the idea of statistical validity, empiricism etc.

 

[burglar]

Did that idea work ?

I'm not passing judgements on the competence of your consultant, but it would seem a good idea to try some simple things first, (esp not prescribing drugs) and if they don't work then move on to something more intensive.

I find that idea works for me, how about you?

Another simple idea that works for me is:
"Take joy in the little things ... "

Ohh! And take a walk on the beach!

 

[Julia]

Did that idea work ?

I'm not passing judgements on the competence of your consultant, but it would seem a good idea to try some simple things first, (esp not prescribing drugs) and if they don't work then move on to something more intensive.

Rumpole, I don't need to pay $160 or more per hour for something so utterly obvious that a total dope would try that first. Trauma that is deeply embedded into the subconscious and relived when the conscious mind is not in control is not so easily dealt with. I don't want to discuss my personal situation any more than that.

Thanks Julia, you have confirmed my reticence to go anywhere near the "professional" psychology communitym

Wayne, if I've created that impression, it was unintentional. The psychological profession, along with the medical profession, just in my own experience at least, contains very good and very poor individuals along with every standard in between.
Someone suggested recently in a discussion about this that the scheme which ran for some years whereby people could get ten sessions with a psychologist, completely free of charge via Medicare has brought forth so much business for psychologists that they had become complacent and lazy. I don't think that scheme is now available and the closest to it does offer Medicare subsidy but this is by no means the entire cost and varies from practitioner to practitioner.

A psychiatrist, being medically trained, might be better, but perhaps more focused on the use of drugs, though I have no good reason for that thought.

Interesting (and problematic) - kinda undermines the idea of statistical validity, empiricism etc.

Indeed. And it would seem such a simple idea to set up. Vested interests no doubt prevail.

One of the reasons I'm so cautious about drugs, especially those where no clear mechanism of action has been demonstrated, is the sheer huge value of the industry. I don't think it's any coincidence that there is such widespread discussion about depression, apparently innocently placed articles in magazines/newspapers/the web, 'experts' being interviewed at the same time as more and more manufacturers of antidepressants are reaping the benefits.

I've organised such publicity myself in the past and been highly paid for good placements. Also for such as arranging 'educational seminars' where one has managed to persuade an opinion maker (senior specialist eg) to talk on a general educational topic but of course with appropriate mentions throughout of the sponsor's fine product, such meeting attracting GPs, registrars et al who ask their questions and receive all the necessary reassurances about side effects, benefits v risks etc.

I'd be very surprised if such practices do not still exist and then some. It's a multi billion dollar industry, very much for profit, as distinct from any altruistic notion of improving the lives of patients. We have previously on this forum had detailed the utterly miserable results of the daughter of one of our members being prescribed a potent anti-psychotic drug, largely (as I recall) to help her sleep. The repercussions have been dreadful and long lasting. Some of these drugs are genuine lifesavers for people with psychosis but it's hard to see that they are the first choice for just sedation considering their side effect profile.
I am, perhaps, particularly cynical and quite possibly unfair.

All last week I couldn't turn on ABC Radio without being bombarded with something called "Mental As Week". I took from this incessant urging that listeners were encouraged to approach people with a question along the lines of "how's your mental health"? Well, good luck with that. Probably get a smack in the face if you just up and said that to someone.

Then it doesn't seem possible to stand in a supermarket queue, idly observing the magazines, without noticing how many have headers like "XYZ admits to long standing battle with depression": "Your solution to the blues", etc etc.

To those of us who are trying to focus on what's good about lives rather than the tough bits, it just seems all pervasive and possibly counter-productive.

As always, I'm speaking from a purely personal perspective and not directing any remarks at or about anyone, just a wide and general observation.

herzy, I've been thinking about your comment that you believe you are perhaps somewhat disposed toward unhappiness. So interesting. Do you think it's a genetic thing, not so different from the colour of your eyes etc? Brings up once again the old nature/nurture argument.
I do not mean to ask anything intrusive, but I'd be keen to hear more of your thoughts on this if you're so inclined.

 

[SirRumpole]

Rumpole, I don't need to pay $160 or more per hour for something so utterly obvious that a total dope would try that first.

Fair enough, but sometimes when people aren't thinking straight, the obvious doesn't occur to them.

 

[Julia]

Yesterday's RN program "The World Today" included an interview with Professor Anthony Jorm, from Melbourne University's School of Population and Global Health, who has just published a paper in the ANZ Journal of Psychiatry.

Inter alia, he says

I think what's happened is that historically, we had mental health services for people who really had the more severe mental illnesses like schizophrenia and then what we tend to do is we try and increase the ambit of mental health services so they cover more and more people with milder problems, and I think treatments tend to work best for people with the more severe problems.

ELEANOR HALL: And Professor Jorm, I'm intrigued in your paper that Australia has the second-highest use of antidepressants in the OECD after Iceland. Does that seem curious to you?

ANTHONY JORM: No, it doesn't surprise me at all.

We've had a massive increase in antidepressant use, and we are very high in international stakes, and one might expect that that might improve the mental health of the population, and apparently it hasn't.

Full transcript here:http://www.abc.net.au/worldtoday/content/2014/s4101044.htm
The whole interview is well worth reading or listening to.

That depression might be increased in the cold and extended hours of darkness of Iceland seems less surprising than that a not much better stat applies in this place of sunshine and warmth for much of the year.

 

[Knobby22]

Yesterday's RN program "The World Today" included an interview with Professor Anthony Jorm, from Melbourne University's School of Population and Global Health, who has just published a paper in the ANZ Journal of Psychiatry.

Inter alia, he says




Full transcript here:http://www.abc.net.au/worldtoday/content/2014/s4101044.htm
The whole interview is well worth reading or listening to.

That depression might be increased in the cold and extended hours of darkness of Iceland seems less surprising than that a not much better stat applies in this place of sunshine and warmth for much of the year.

Iceland would be depressing during winter.
Maybe there is something lacking in the Australian philosophy of life. Maybe we are too lucky.

I've just come back from Victorian Cuboree and though I was exhausted it was refreshing and helps the soul and I now have more great experiences with people that give a damn. Maybe the new car is not the way to happiness.
https://www.facebook.com/scoutsvictoria

 

[wayneL]

My black dog died.... may he RIP.

Still have bad days, but doesn't everyone?

I feel I'm past depression in the clinical sense.

IOW - I'm back.

 

[trainspotter]

My black dog died.... may he RIP.

Still have bad days, but doesn't everyone?

I feel I'm past depression in the clinical sense.

IOW - I'm back.

Hey wayneL ... my black dog is dead and buried in my back yard. I still go and visit the grave site every now and then to remind myself what it was like when he was around. Good to see you back on deck my friend.

 

[wayneL]

Thanks man.

Great to feel normal eh?

 

[Joe Blow]

My black dog died.... may he RIP.

Still have bad days, but doesn't everyone?

I feel I'm past depression in the clinical sense.

IOW - I'm back.

Wayne, that's great news! Good to have you back on board. You've been missed.

 

[dutchie]

My black dog died.... may he RIP.

Still have bad days, but doesn't everyone?

I feel I'm past depression in the clinical sense.

IOW - I'm back.

Good on you Wayne, glad to see your back.

Now here's ten option questions you could answer....

Just kidding!

I am in awe of blokes who can face and beat their demons and air them publicly to help other people!

 

[sails]

My black dog died.... may he RIP.

Still have bad days, but doesn't everyone?

I feel I'm past depression in the clinical sense.

IOW - I'm back.

Wonderful news and good to see you back

 

[johenmo]

A psychiatrist, being medically trained, might be better, but perhaps more focused on the use of drugs, though I have no good reason for that thought.

A member of my family has problems and after seeing Drs, Psychs and counsellors went to a new GP because the latest meds weren't helping much. GP said it's psychiatrist time. Psychiatrist in first visit said I think I know what your problem is, let me think about it. Visit 2 - got a diagnosis (which fit perfectly), different meds to suit & a big improvement to life. I think it helped the ability to cope when a divorce happened some time later. So from our experience, there was a benefit and shoudl be considered (forget the stigma).

I have always considered there to be a chemical/genetic reason for some people (vs the reactive). This is a long-term harder to treat/help situation. It's good to read of people who have managed to climb (at least part of the way) out of the pit.

And good to hear Wayne is in a better place.
!

 

[Logique]

Hey wayneL ... my black dog is dead and buried in my back yard. I still go and visit the grave site every now and then to remind myself what it was like when he was around. Good to see you back on deck my friend...

I second that.

Bravo to you both WayneL and Traino.

 

[Tink]

Great to hear, Wayne, and welcome back

I saw someone mentioned a 'like' button in another thread, I still think it's a good idea in this forum.