is depression caused by mental imbalance?

victory2

http://www.dbsalliance.org/info/depression.html

Depression is a treatable illness involving an imbalance of brain chemicals called neurotransmitters. It is not a character flaw or a sign of personal weakness. You can’t make yourself well by trying to "snap out of it." Although it can run in families, you can’t catch it from someone else. The direct causes of the illness are unclear, however it is known that body chemistry can bring on a depressive disorder, due to experiencing a traumatic event, hormonal changes, altered health habits, the presence of another illness or substance abuse.

do other members agree or disagree that depression is caused by mental imbalance?

bounty_hunter

Of course it is. This isn't really a debatable issue, it's just science.

Matthewthebig

since when be this personal issues?

Zillah

Matthewthebig wrote:

since when be this personal issues?

Presumably its in reference to the fact that people often come here asking for help about depression.


To the OP: Yes, its science. But don't confuse clinical depression with someone in grief or simply feeling sad or lazy or apathetic.

Gordon

Moved from PI.

bounty_hunter

Zillah wrote:

To the OP: Yes, its science. But don't confuse clinical depression with someone in grief or simply feeling sad or lazy or apathetic.

Exactly what I might have said if I had been bothered

Clinical depression is one thing, just feeling like ****e is another.

DrIndy

bounty_hunter wrote:

Exactly what I might have said if I had been bothered

Clinical depression is one thing, just feeling like ****e is another.

And then there is the huge grey area in between and the clinical dilemma of is treatment appropriate and if so which kind. Psychiatry is one of the least well defined areas of medicine - and two equally qualified psychiatrists can have two quite different approaches which result in the same end result.

Also every persons response to depression is different, some people can take all that life throws at them and shrug it off, whereas someone else is psychologically hammered by what others would percieve as a slight.

In treating depression - you can attempt to correct the imbalance of mood and mood chemicals with counselling or medication - both achieve this, one artificially. Most people respond best to a combination - but each individual needs it tailored.

Captain Trips

DrIndy wrote:

In treating depression - you can attempt to correct the imbalance of mood and mood chemicals with counselling or medication - both achieve this, one artificially. Most people respond best to a combination - but each individual needs it tailored.

While mild depression can be treated successfully by psychotherapy, this is less so for moderate and severe types. There are specific criteria to define exactly what constitutes these categories. Unfortunately, the word depression is inaccurate and broad meaning.

ICD-10 and DSM-IV will show you what the criteria are for a depressive episode.

Prior Of Taize

if it isnt a question and its definitely a mental imbalance then perhaps asking why the person is unbalanced will get you more information...nature or nurture causes a person to be the way they are?...

DrIndy

True - but genetics are also increasingly being recognised as a cause. Research with Ashkenazi jews in america showed strong family history and potential explanations.

Also depression is related to social function and the "premorbid personality" which is the personality before the episode. If they have a strong personality and good social network, they can cope much better - whereas someone who is vulnerable will be much more affected.

ICD-10 and DSM-IV talk of adjustment disorder and other variants of depressive illness which are not classic depression. However those criteria are a guide to classification and not a guide to treatment as it is much more important in psychiatry than in any other branch of medicine to tailor treatment to the person with their agreement to ensure success.

victory2

ICD-10 and DSM-IV

1) excuse my ignorance--what is the meaning of these acronyms?
2) can someone quote sources to prove that some sort of physical chemical mental imbalance causes depression? thanks

nesf

DrIndy wrote:

ICD-10 and DSM-IV talk of adjustment disorder and other variants of depressive illness which are not classic depression. However those criteria are a guide to classification and not a guide to treatment as it is much more important in psychiatry than in any other branch of medicine to tailor treatment to the person with their agreement to ensure success.

Exactly.

The DSM and ICD only provide general outlines that "most" people will fall into. Mental illnesses are very hard to "pin down". They are not like physical illnesses which tend to be more distinct from one another.

They are not in themselves actual illnesses per sae, it's more that they are handy labels for clinical use and communication between professionals. Also treatments can be tailored for specific diagnoses.

But, believe me, it's not as a simple as "having a single cause in every depressive" that only needs a specific form of treatment.

Anyone who tells you otherwise really does not know what they are talking about. And yes, I've known medical professionals to think and say the above.

nesf

victory2 wrote:

1) excuse my ignorance--what is the meaning of these acronyms?
2) can someone quote sources to prove that some sort of physical chemical mental imbalance causes depression? thanks

Do your own googling. It's more rewarding that way.

DrIndy

victory2 wrote:

1) excuse my ignorance--what is the meaning of these acronyms?
2) can someone quote sources to prove that some sort of physical chemical mental imbalance causes depression? thanks

ICD-10 stands for International Classification of Disease, 10th edition
DSM-IV - stands for Diagnostic and Statistical Manual for Mental Disease, 4th edition

DSM-IV is American, ICD-10 is international and tends to be used in Europe. Both classifications are used in Ireland as many psychiatrists here are american trained.

Here is a link on depression from the National Institute of Health in the USA:

http://www.nlm.nih.gov/medlineplus/depression.html

There is some information on the biological basis for mental disorders. The original papers are very old and cannot be referenced directly online unfortunately. However, remember than depression is not ONLY a biological disease.

On an aside, the first ever antidepressant was discovered by accident. Researchers were trying out new TB drugs to treat it when it was otherwise untreatable. They noted that although one drug they were using was useless in fighting TB, the patients were happy and didn't mind it so much anymore!

This became the first class of antidepressants, the MAO inhibitors (monoamine oxidase inhibitors) which had serious side effects including the cheese effect where intake of tyramine (an amino acid) caused serious/lethal high blood pressure. Innovative research done in Trinity College Dublin then discovered that there were in fact two MAO's - MAO A and MAO B and it was possible to create a drug which only targetted the brain and not the body!

These now have been supplanted by new drugs such as the tricyclic antidepressants and even new drugs such as the SSRI's (Selective Serotonin Reuptake Inhibitors) which in general are very well tolerated.

nesf

Some newer drugs like (and the good doctor can correct me here) SNRIs are used when first line drugs such as SSRI's are uneffective or where stronger drugs are needed.

SNRIs effect seratonin and non-adrenaline at most dosage levels. Some at higher levels also effect dopamine.

They are more complex than more standard anti-depressants and tend to carry more serious side-effects although this is mostly due to their newness.


Treatment of depression is not limited to anti-depressants though. Atypical and typical mood stabilisers and anti-psychotics may prove benificial in some cases. Generally speaking it will a psychiatrist (and probably a specialist in whatever) that will prescribing mixes of the above.

Fortunately, most people respond well to their first course of their first anti-depressant. The unlucky few can spend years before benifits can be achieved.

DrIndy

Of note as well - ECT or electroconvulsive therapy was discovered as a means of treatment by accident and careful observation.

Doctors noted that depressed patients with epilepsy had an improved mood for some time after they had a seizure. There have been many reason postulated for this, from increasing blood flow to altering neurotransmitter release and the true mechanism is still subject to debate (I actually quoted one of those reasons to one of my examiners - he said "Rubbish! You shouldn't make stuff up!" and the other examiner looked quizically at him and then winked at me as he had lectured us on the other cause! nevertheless, I got the grade after all from that exam). But this is the basis for its use nowadays. People are sedated and anesthetised and a short burst of electrical energy triggers a seizure. They are anaesthetised to prevent muscle tearing which would otherwise be a side effect.

Gone are the barbaric days of liberal treatment without anaesthetic, however ECT WORKS very well for people with severe/life threatening depression where they are actively suicidal, stop eating/drinking etc..... and allows the time needed to allow antidepressants to work which take some weeks to fully have an effect.

DrIndy

nesf wrote:

Some newer drugs like (and the good doctor can correct me here) SNRIs are used when first line drugs such as SSRI's are uneffective or where stronger drugs are needed.

SNRIs effect seratonin and non-adrenaline at most dosage levels. Some at higher levels also effect dopamine.

They are more complex than more standard anti-depressants and tend to carry more serious side-effects although this is mostly due to their newness.


Treatment of depression is not limited to anti-depressants though. Atypical and typical mood stabilisers and anti-psychotics may prove benificial in some cases. Generally speaking it will a psychiatrist (and probably a specialist in whatever) that will prescribing mixes of the above.

Fortunately, most people respond well to their first course of their first anti-depressant. The unlucky few can spend years before benifits can be achieved.

SNRI's are excellent for treating people who have depression with anxiety. They also respond to SSRI's, but supremely more effectively to SNRI's.

In more complex cases, people can be treated with multiple drugs and tend to be treated for symptoms such as psychotic features would have an anti-psychotic included. This is very much reserved for psychiatrists and they undertake this with trepidation as you increase the potential side effect profile.

Also of note is that antidepressant drugs alter the neurotransmitter profile of the whole brain at the same time, rather than just the site that causes depression. It is very much cracking a nut with a sledgehammer - it WORKS, but not tidily. This is the reason for the side effects although the newer medications are much better than the old (SSRI's are like using a small hammer in contrast, but ideally drugs should be like a laser guided tool). Thus ideally, antidepressants should only be used a low dose and other interventions such as psychotherapy instituted if possible as part of the problem is coping with depression, not depression on its own.

nesf

Good article on ECT here, courtesy of Wikipedia.

I've known people that have recieved the treatment. It is effective for some who have treatment resistant conditions. It is also, these days, safe and causes less distress than "more accepted" chemical treatments.

The development of a magnetic alternative looks promising.

nesf

DrIndy wrote:

In more complex cases, people can be treated with multiple drugs and tend to be treated for symptoms such as psychotic features would have an anti-psychotic included. This is very much reserved for psychiatrists and they undertake this with trepidation as you increase the potential side effect profile.

Yes. Any GP who'd presume to attempt it deserves to lose his licence imho.

DrIndy wrote:

Also of note is that antidepressant drugs alter the neurotransmitter profile of the whole brain at the same time, rather than just the site that causes depression. It is very much cracking a nut with a sledgehammer - it WORKS, but not tidily. This is the reason for the side effects although the newer medications are much better than the old (SSRI's are like using a small hammer in contrast, but ideally drugs should be like a laser guided tool). Thus ideally, antidepressants should only be used a low dose and other interventions such as psychotherapy instituted if possible as part of the problem is coping with depression, not depression on its own.

Agreed on both points.

The refinement of drugs and treatments is however part and parcel of medicine in general and not just restricted to mental health issues. Sometimes I think people are too quick to critisise medical professionals on this matter when the doctor in question is literally doing all he can. Although to be fair, anything more serious than a mild depression should be reffered onto a psychiatrist.


The psychological issues that come with depression are sometimes more troublesome than the condition itself. Unfortunately the only person that can truly alieviate them is the patient themselves. A therapist (psycho-therapist or whatever) can only help the patient do this and cannot do it for them.

As the old adage goes:

"The art of medicine consists in amusing the patient while nature cures the disease."
Voltaire (1694 - 1778)

victory2

thanks for all your insightful comments
still, no one has mentioned solid proof that chemical imbalance actually causes depression, as opposed to being a symptom of it--which was my original question, and I'm still waiting ...

Stark

It is quite common for people to suffer winter time depression, as lack of sunlight/changing sleep rhythms causes a hormonal shift in the brain. That could be used as one form of proof that a chemical imbalance causes depression.

Another form of proof could be the effects on people who have followed the strict Atkins diet for too long. In the initial 2 weeks of Atkins diet, dieters eat no carbohydrates other than the ones in vegetables. Carbohydrates are needed in order to stimulate the body to make insulin which allows the movement of L-tryptophan past the brain blood barrier. L-tryptophan is the amino acid the brain needs to make serotonin, a key neurotransmitter when it comes to depression. It has been observed that people who follow this induction phase for more than a few weeks end up suffering from depression.

Of course, there is a two-way relationship between mind and physiology so that's why counselling can be helpful in treating depression even if it was a physiological complaint that initially caused it. Similarly alternative medicines such as acupuncture could be helpful in treating depression.

Years ago, doctors were allowed treat depression by prescribing patients L-tryptophan directly, which was quite an effective method of treatment. However a factory once produced a bad batch of it which killed a few people, so since then the FDA has banned its use. That forced the development of SSRIs (Serotonin Reuptake inhibitors) to "hack" the brain and force it to retain what serotonin supplies it has.

nesf

victory2 wrote:

thanks for all your insightful comments
still, no one has mentioned solid proof that chemical imbalance actually causes depression, as opposed to being a symptom of it--which was my original question, and I'm still waiting ...

Ah but you see.

"Causes" are very very vague things in psychology. It's impossible (atm) to actually see what's happening inside someone's mind accurately. So the best that can be done is "guesswork".

Take it this way, if your serotonin levels drop then there is a very high chance of you developing depression. This has been demonstrated in animals, and indirectly in humans.

It has been well established that there is not one single cause to depression. But then, it's also been established that "depression" isn't a very quantifiable disease/illness. There are many flavours and varieties of it. There is a "typical" version, but that at best is a loose grouping of symptoms that generally respond to the same treatment approaches.

It's a very complex question. To take a look for a cause you first need to know what you're looking for a cause of. And that's even more difficult with psychiatric illnesses where most "symptoms" cannot be directly observed but only reported. And as such will always be distorted to an extent by the patient.


Take it this way. A chemical imbalance is a factor in most depressions. Depleted serotonin levels (amoung others) can result in a person developing depression. They are also found in patients with depression.

So if chemical imbalances are not a "cause" in themselves they are definitely an important contributing factor and a directly treatable aspect of the illness.

DrIndy

victory2 wrote:

thanks for all your insightful comments
still, no one has mentioned solid proof that chemical imbalance actually causes depression, as opposed to being a symptom of it--which was my original question, and I'm still waiting ...

You cannot look at things in medicine as black or white, especially psychiatry.

Yes a chemical imbalance CAN cause depression. People with genetic predisposition such as in families of ashkenazi jews where almost every member of the family suffer severe depression, a gene has been isolated which causes a low serotonin level to exist in the brain and they become depressed.

This is black and white - for the vast majority however, it is more complex. This is good, because those with full genetic predisposition tend unfortunately to be treatment resistant.

nesf

I should just leave you to reply...

Your posts are always so much clearer and to the point on this topic!!

victory2

thanks, guys

if I remember feeling depression throughout childhood, does that mean it's genetic?
are there any telltale indicators that it's genetic?

aldous_huxley

Years ago, doctors were allowed treat depression by prescribing patients L-tryptophan directly, which was quite an effective method of treatment. However a factory once produced a bad batch of it which killed a few people, so since then the FDA has banned its use. That forced the development of SSRIs (Serotonin Reuptake inhibitors) to "hack" the brain and force it to retain what serotonin supplies it has.

L-tryptophan -> 5,htp -> serotonin

5,htp was recently withdrawn in ireland - but is available stateside(=online) - and as shown above, is a pre-cursor to serotonin.

"The fact that the FDA ban of L-Tryptophan and the Newsweek Prozac cover story occurred within four days of each other went unnoticed by both the media and the public."...taken from this.

DrIndy

victory2 wrote:

thanks, guys

if I remember feeling depression throughout childhood, does that mean it's genetic?
are there any telltale indicators that it's genetic?

Not by any means at all. It is extremely unlikely you can fall into the full genetic depression bracket unless many members of your immediate family have this tendency.

Even then, there can be an upbringing or psyche predisposition to being depressed - which is not genetic, merely familial if you follow me.

Yes though neurotransmitter imbalances = depression, but the cause is in part predisposition, be it background or genes and the other part is the person. Treating depression involves correcting the imbalance with drugs if needed and then treating the predisposition with psychotherapy (if appropriate) to try to prevent the triggers reoccuring that caused the initial depressive episode.

Things are NOT black and white in psychiatry and people can help themselves to correct their own neurotransmitter imbalances - just they need guidance.

Its good to talk and it is especially good to talk about psychiatric illnesses. I would recommend a chat with your GP, you may well be surprised how much this may help.

leddpipe

Depression is like an irresistible sneeze, you have no control over it!
It’s so unwanted, obviously, but there’s **** all you can do!
It makes you question things; it makes you look at things differently! It comes out of nowhere and saturates every waking thought!
But while it doesn’t, it’s fine, at least from my experience!
Most of your time can be spent enjoying life, and then……………….
And it’s cyclic, which is where its real power is!
Before, I could handle it generally, but when it repeats itself, constantly, and for no good reason, literally, out of nowhere, that’s where it gets you!
It’s that constant erosive effect, when it bites at you, intermittently, but significantly, that’s what makes you wonder why??
Why bother?

SLUSK

nesf wrote: »

Good article on ECT here, courtesy of Wikipedia.

I've known people that have recieved the treatment. It is effective for some who have treatment resistant conditions. It is also, these days, safe and causes less distress than "more accepted" chemical treatments.

The development of a magnetic alternative looks promising.

Saying that ECT is safe is just plain wrong. There are people who lost years of their memories permanently. I saw that in a Swedish documentary on public television.
http://www.thelocal.se/23336/20091118/

locum-motion

Sorry folks, I'm going to lock this.

Leddpipe: You dragged up a 4 1/2 year old thread to add your thoughts about depression, which weren't strictly revelant to the debate and even if they were, the debate ended 4 1/2 years ago. If you want to discuss the subject, please start a new thread. Aslo, because you posted on an old thread, it was bumped back to the front page which I reckon is the only reason why SLUSK even read it.

SLUSK: Nobody in this thread said "ECT is safe". One poster spoke about it being an option in serious cases where patients are suicidal which are therefore cases where the benefit outweighs the risk. He didn't say there's no risk. The other poster merely pointed out an article that he said was good. Bearing in mind that the article is on Wikipedia, the article Nesf looked at in June 05 is almost certainly not the same article that the link points to in December 09, so following the link now has no relevance to the point made by Nesf in 2005.
If you wish to debate the risk:benefit ratio of ECT, please start a new thread.

Thanks.