The Case Against Depression
The title is stolen from an article by Dr. Donald Nathanson. That article is linked at the bottom, and I would strongly suggest it, especially to professionals. The video by Dr. Cambell is excellent. It is excellent, but I hope to do him one better.. If you have time please compare and contrast.
First, I am going to speak about the video and then briefly summarize Dr. Nathanson‘s article.
The overall idea of the video by Dr. John Campbell, RN, Ph.D., who I have introduced before, is that depression, as with many diseases, needs to be treated holistically.
He has a guest who is a knowledgable general practitioner, and anyone would be lucky to have him as their doc.
The video states that 14% of people in the UK have been on an antidepressant.
It goes on to speak about all the other avenues that can be pursued, and need to be pursued when one has depression or is treating someone with depression
As I’ve said these messages are not meant to attack medicine but to explain why we do the things we do and that means why we do things we do not only individually but in systems and organizations such as organized medicine.
Knowledge accumulates and it takes time to be put into practice, to be organized in a way that we know will help someone. By the time we implement what was discovered twenty years ago, and implement it today, obviously, we are twenty years behind.
It is said that doctors take a year to change a medication that they were convinced was better when they were introduced to it a year ago. We are all playing catch-up all the time.
Next, there is no magical way to put more time into the day. The rise of technology, including pharmacology, has been a huge boon but it has also made us lazy. We reach for a prescription pad 90% of the time or some kind of procedure to fix the problem. As I’ve noted we are not much into prevention. We are into fixing it now after the damage has been done.
I want to warn you that at the end I am going to speak a bit about a ringer, and that is that we don’t want to use the word depression. I use it at all because that is the world we live in, and whether you watch the video or not, that is the word they use in the video.
Some general facts about medication for depression.
Before the advent of Prozac, and later its sister drugs, the classes of SSRIs (serotonin reuptake inhibitor‘s) and SNRI’S, we didn’t have a lot of options, at least good options, most of the drugs had severe or at least bothersome effects.
Most new drugs are safer with fewer side effects, but they are not without problems. The main ones are decreasing sexual desire and weight gain. And importantly, they do not work any better than the old drugs in terms of lifting spirits.
And as we’ve gone long, 20 years is not that long, we have realized that they don’t work all that well in many people. There’s no magic formula to tell you what drug to give someone. I suppose there are psychiatrists out there that have seen hundreds of patients and have a handle on it. But another fact I always emphasize is that at least 80% of the psychiatric drugs are given by primary care doctors, other than psychiatrists, and thus they aren’t going to have a huge amount of experience.
The recommendation is if you give a drug for a month or two months and you don’t see improvement you switch the drug and then you switch it again. You hope by the second or third one you will see improvement, but there’s no guarantee.
In the spirit of transparency, I have treated relatively few patients with antidepressants. In those I did treat, I was struck by the fact that many of them did not seem to improve much.
Once you think about it the video brings home an obvious point and that is we have tunnel vision focused on medication.
Disclaimer: none of this is to suggest anyone go off their medication. Medication can be lifesaving. And none of this is medical advice.
Once you start thinking about what else you can do to treat you become open to new possibilities. Many things I have spoken about and will probably repeat many times in the future. The reason is that I am trying to get myself and others to think expansively about their health and incorporate things we have known for years but avoid doing. Why we don’t do these things can lead to a discussion that involves social, political, economic, and time restraints. Being swept up as an individual in society trying to navigate technical medical matters when we have our own lives to live. We have to trust the system.
The system can go in the wrong direction and stay there.
To get to the point, there are many things we can do. I’ve said before it’s called lifestyle changes. At this point in history, it seems like we are nailing down what works for us in terms of diet, activity, light exposure, socialization, and sleep. If everyone would at least work on these issues we would be much better off even if it’s only a 10% improvement in our health and life.
Right now we have to generally look outside the medical system to get help in these areas as the medical system is driven by economic forces no matter how useful it is and can be in its own right.
if you watch the video you will see at the end the general practitioner gets into and has a little bit of a hard time articulating the difference between mind and body. What he ends up saying is what I’ve said previously and that is there isn’t mind and body there’s just mind-body. The mind is part of the body. The mind is embodied. The distinction of mind is becoming less and less useful. If so, if our psychology is determined by our genetics, epigenetics, diet, and our community then it’s determined by our body, our physical body which includes the mind. How the integral body interfaces with the external world is the interface that is important.
It becomes clear why I have to try various antidepressants to get results. Maybe it’s because there are so many other factors that can be tweaked and worked on besides giving a pill.
I repeat another favorite phrase of mine which is that when you take Prozac the pill doesn’t go in your brain open up and spit out a psychiatric fortune cookie-type guide telling you how to live your life. Taking Prozac is not going to help you necessarily get more and better sleep, get more sunlight, or have a better diet of fruits and vegetables every day. It may help you do those things but you also have to have the information of how to do them and the environment to do them. It’s simply not going to do that.
Now I promised you that there’s a ringer here and that is to move away from using the word depression altogether.
What I am proposing is going to be, if it ever takes place, difficult and radical because it means to essentially overthrow the existing paradigm and nomenclature of much of psychiatry.
What Nathanson does is recognize the interface between our psychology and our physical body which takes place within our nervous system. And that is a system of nerves that are dedicated to telling us to process information through what we call emotion.
Although it’s going to be difficult there is much research solidifying the idea that we have a set of emotions that are well-delineated.
The list I work with is:
interest
joy
surprise
anger
fear
distress
disgust
contempt
and shame
For this discussion note that we are bottom-heavy with unpleasant feelings. Six of the nine feelings are meant to get our attention about something going wrong. They are not meant to be done away with but meant to be information that we can act on.
If you would rate yourself on a scale of 0 to 10 about how you feel right now with each of these feelings you might understand better why you feel really good or really bad.
One thing to note if you do this you will see that it’s hard not to be feeling a bit bad. And you don’t want to feel too good.
If your interest and or joy are at “10”. you might worry about being manic.
Surprise is good or bad depending on the situation and you can’t control it.
After that, we are left with six others. Note that if interest and joy add up to 20 in order for the six unpleasant feelings to be less than 20, they have to be, on average, below 3.5 or so.
And as noted we do not want to be walking around with the maximum intensity of interest and joy unless we just had a baby or win the lottery. I think we are lucky to have interest around 7 and joy of 6 and if so it is now even harder to be on the positive side.
Obviously, this is a short introduction that many of you are familiar with. What the system does is put a lot of power into your hands. We think we know what depression is but it’s a learned word that has no particular basis in our bodies. It’s a description.
If you identify anger in yourself or fear I think you know what that is much better than you know what depression is.
We see depression as lumping together in a garbage basket all the bad feelings, a way to tie up unpleasant feelings in one package. What this does is helps us avoid dealing with these individual feelings.
What do you think?
This is not to say that this is the end all be all to treating many conditions that we identify in psychiatry. That said you can do the same thing for anxiety. Rate yourself on the same scale for anxiety as for depression. You should start to see that you get much more information using the system. That said, also I have to say that teaching this has been difficult because people will continue to use the word depression for years after they have learned in the system. I have to say that I use it because it is shorthand for “I’m feeling bad”. But I then try and do an inventory of the six feelings.
Depression is often a proxy for covering up feelings of chronic shame.
A Review of the Serotonin Theory of Depression