The costs of depression on a variety of levels are huge: Marriages and families splinter, individuals suffer, societies suffer the consequences of the often destructive behaviors of people coping badly or not at all with their depression, businesses suffer the negative effects of employees too disabled to function properly, the economic costs of greater health care expenses are greater for depressed patients, and there is the tragedy of suicide -- lives lost to despair and apathy. Depression is a terribly disabling disorder, and despite significant advances in treatment, the problem continues to grow.
Depression is a multi-dimensional disorder. It has biological components based in genetics, neurochemistry and physical health, it has psychological components that involve many individual factors such as cognitive style, coping style, and qualities of personal behavior. And, it has social components, factors that are mediated by the quality of one's relationships, including such variables as the family and the culture one is socialized into, and one's range of social skills. The best, most accurate answer to the basic question, "What causes depression?" is, "Many things."
Currently, however, the medical model of depression receives the greatest attention for a variety of reasons. The pharmaceutical industry in particular has invested literally tens of billions of dollars in advertising to the public as well as investing directly in individual physicians, encouraging us all to define depression as a disease caused by a neurochemical imbalance that requires medication to manage. The lion's share of research money goes to drug research, further elevating drugs to the status of being the source of hope for everyone who suffers depression. As a result, antidepressants are the most widely prescribed medication in the U.S., and are considered a first-line treatment approach, de-emphasizing the value of psychotherapy despite its success not only in treatment, but in the area of prevention.
This is a tragic misconception that is actually making the problem worse. It may sound extreme to some, but I stand by this statement: Depression is more a social problem than a medical one, and no purely biological cure will be found for it any more than biology alone will cure other social ills such as poverty or child abuse. This is not to say that antidepressant medications shouldn't be a part of treatment, especially in those specific instances where there are clear benefits medication can provide over psychotherapy. Rather, medications should be used more carefully and with an associated recommendation for a well-considered skill-building psychotherapy. No amount of medication can address the psychological and social dimensions of depression, assuring that people will be treated only one-dimensionally. Under-treating depresion is a reliable pathway to it increasing in prevalence, just as it is doing.
The social side of depression is especially important, yet is terribly under-considered in most people's consideration. We know, for example, that depression runs in families: The child of a depressed parent is anywhere from three to six times more likely to become depressed than the child of a non-depressed parent. The genetics research makes it quite clear that it isn't entirely -- or even mostly -- faulty genes responsible, especially since there is no "depression gene." It has more to do with the patterns of thinking, coping, behaving, and relating that parents (and other significant role models in our society) model day in and day out than it does one's genetic makeup. When you have the largest demographic group of depression sufferers now raising children, it should surprise no one that their children are the fastest growing group of depression sufferers. After all, parents can't teach their children what they don't know.
Furthermore, the more distressed one's marriage or primary relationship, the more likely one is to either already be or to become depressed. The quality of one's deepest relationship is a very large risk factor, yet many people never consider how powerful a good relationship can be in helping insulate its members against depression. Shining the spotlight on this very issue is why I wrote my most recent book, Depression is Contagious. (A lively interview on the subject).
These points provide excellent reasons to want to strengthen parents and marriages, something no antidepressant medication alone can accomplish. To think of depression as only an individual's biochemical disorder, as if he or she isn't a product of powerful social forces that operate in families, organizations, and cultures, or to reduce it even further to a purely biochemical phenomenon, is so terribly reductionistic as to disempower the very people who need help changing their lives, not just their brain chemistry. It's true: You are more than your biochemistry.
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Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women: a double-blind, placebo-controlled, randomized clinical trial.
Psychological distress (PD) and depressive symptoms are commonly observed during menopausal transition. Studies suggest that omega-3 (n-3) fatty acids may help alleviate depression. OBJECTIVE: The objective was to compare enriched ethyl-eicosapentaenoic acid (E-EPA) supplementation with placebo for the treatment of PD and depressive symptoms in middle-aged women. DESIGN: Women with moderate-to-severe PD (n = 120) were randomly assigned to receive 1.05 g E-EPA/d plus 0.15 g ethyl-docosahexaenoic acid/d (n = 59) or placebo (n = 61) for 8 wk. The main outcomes were 8-wk changes in PD scores [Psychological General Well-Being Schedule (PGWB)] and depressive scales [20-item Hopkins Symptom Checklist Depression Scale (HSCL-D-20) and the 21-item Hamilton Depression Rating Scale (HAM-D-21)].
We review three studies of omega-3 fatty acids in the treatment of depression that were carried out by our research group at the Beer Sheva Mental Health Center. The first study examined eicosapentaenoic acid (EPA) versus placebo as an adjunct to antidepressant treatment in 20 unipolar patients with recurrent major depression. The second study used omega-3 fatty acids in childhood major depression; 28 children aged 6-12 were randomized to omega-3 fatty acids or placebo as pharmacologic monotherapy. The third study was an open-label add-on trial of EPA in bipolar depression. Twelve bipolar outpatients with depressive symptoms were treated with 1.5-2.0 g/day of EPA for up to 6 months. In the adult unipolar depression study, highly significant benefits were found by week 3 of EPA treatment compared with placebo. In the child study, an analysis of variance (ANOVA) showed highly significant effects of omega-3 on each of the three rating scales. In the bipolar depression study, 8 of the 10 patients who completed at least 1 month of follow-up achieved a 50% or greater reduction in Hamilton depression (Ham-D) scores within 1 month. No significant side effects were reported in any of the studies. Omega-3 fatty acids were shown to be more effective than placebo for depression in both adults and children in small controlled studies and in an open study of bipolar depression.
Is there a risk to taking omega 3s? No. The "side effects" are all beneficial, such a lower risk of heart disease and diabetes.
Big trials of natural medicines are almost never performed, because 1) there is not enough financial incentive for supplement companies to do them, since the materials are not patentable. 2) drug companies wont do the studies, and actually hope they dont get done at all, since the natural treatment would compete with their patented drugs and 3) the government doesnt spend enough money on this stuff to fund big studies on natural medicine. The government and FDA are more interested in helping the drug companies maintain their dominance of the medicine market.
Consequently natural medicine is chronically and severely underfunded, though it is effective, safe and the most logical way to treat diseases. And the medical establishment, which is dependent on drug industry support, perpetually criticizes the approach as "unproven", despite many (smaller) studies showing the opposite.
The result is that many millions of people wind up taking toxic and dangerous SSRIs for depression, when fish oil, minerals and vitamins would be a more effective and safer treatment.
And dont forget that drug companies regularly lie and fraudulently manipulate data in their clinical trials.
Omega-3 fatty acids in depression: a review of three studies.
Ben Gurion University of the Negev, Beer Sheva, Israel.
We review three studies of omega-3 fatty acids in the treatment of depression that were carried out by our research group at the Beer Sheva Mental Health Center.
http://www.amazon.com/Omega-3-Connection-Groundbreaking-Antidepression-Program/dp/0684871394/ref=sr_1_1?ie=UTF8&s=books&qid=1257560662&sr=8-1
Depression IS biochemical, even if depressed people are "stuck" in depressing situations. However, the biochemical problem is not the one big pharma wants you to think it is. It is not a deficiency of medication. It is a deficiency of essential nutrients that is causing the problem.
The following nutrient deficiencies will cause depression (though the cause is different for different people):
omega 3 fatty acids (15 grams fish oil or 3-4 grams EPA+DHA is required). Many who try omega 3 fail to take enough, or consume excessive omega-6 or hydrogenated oil, which reduces the effectiveness.
vitamin D
vitamin K2
methylfolate
B12
lecithin
B6 (pyridoxal 5 phosphate) (the most common vitamin deficiency)
iodine
selenium
chromium
magnesium (80%+ of americans are magnesium deficient)
SAM-e/trimethylglycine and other methyl donors
carnitine
saturated fats (especially short chain sat fats found in butter and coconut oil)
And others...But these nutrients must be taken in the right forms, and in sufficient dosages.
So, this article is not as informed and broad as it seems. It is silent about the most effective and logical depression treatments. Many people who try nutritional treatments do not do it properly: they take inadequate dosages and persist in consuming antinutrients (e.g., hydrogenated oil, food colorants, sugars).
Neurotoxins/exitotoxins also contribute to many disorders, including depression. Additives to our food and drink such as MSG and Aspartame are two examples of neurotoxins, and they're in just about everything prepared, processed (and in the case of Aspartame, diet) that you eat.
These foods need to be eliminated as much as possible to get your nervous system (and other systems) back on track. These toxic additives also may be the culprit in anxiety, insomnia, headaches/migraines and much worse.
Neurotoxins = brain cell damage
http://www.nccn.net/~wwithin/aspartame.htm
Also, the tartrazine food colorants (e.g. yellow #6) are quite toxic and antagonize vitamin B6 activity. They increase the bodies need for B6. B6 is the most common vitamin deficiency. most people dont get even the minimal RDA. And some people actually consumre more yellow #6 than vitamin B6!
No wonder people are so damn sick all the time.
The FDA is hopelessly corrupt and interested only in protecting the food/drug industries. They dont give a damn about public health. They dragged their feet for 30 years over the mercury fillings outrage. And now that food colorants have been proven to cause psychological problems in childen, they are silent and havent done anything about it.
Someone with depression should take ALL the nutrients in the list above. Then, they might suddenly be motivated to change their situation and patterned behavior.
its biochemical, I tell you.
Did you take extra nutrients? change your diet?
Depression is a symptom of nutrient and vitamin deficiencies. It is correctable by taking the proper nutritional supplements and improving the diet.
I also think family relationships can greatly help or hurt treatment of the patient. It's very difficult to live with a person who is mentally ill and have to work harder to hold a family together. And that is probably where counseling can be most effective.
So, I've got a fairly complex personal and intellectual engagement with depression.
My problem with this piece (in addition to its being a book plug) is that in my experience, people DON'T tend to rush for the magic pill. Most people I know (myself included) have a strong innate resistance to taking this kind of medication for lots of reasons.
For me, 30 years of depression lifted when, finally, nervously, I tried Wellbutrin.
I don't believe that this is the solution for all people, but I read the comments here about how fixing depression is about fixing your life and it makes me sick to my stomach-- this is precisely what keeps many people from help, because they feel like somehow they're weak, or they've screw.ed up, or they're too incapable of coping and it's their fault.
Or the comment from one poster "human beings don't require pharmaceutical interference to live a happy life" -- this is EXACTLY what people fighting depression fight against. Yes, when it's a biological issue with low seratonin levels, pharmaceutical "interference" is exactly what people need.
We are still so far from mental illness being seen as something other than a character failing it's downright irresponsible to suggest otherwise.
I had a similar experience where I suffered for years and resisted medication because I thought using it made me "weak", etc. When I finally tried it, it made a huge difference in my life. It brought my symptoms to a more manageable level where I could actually benefit from therapy and make significant changes in my life. However, I still have to deal with comments from friends and family along the lines of "you don't really NEED that stuff" or "you're going to have to learn to cope someday".
The APA is highly funded by Big Pharma.
Good reads:
"Toxic Psychiatry" by Peter R. Breggin, MD
"Confessions of an RX Drug Pusher" by Gwen Olsen
"Prozac Backlash" by Joseph Glenmullen, MD
It turned out that I was misdiagnosed (or just under-diagnosed) with depression. I started seeing a psychiatrist after several years of unsuccessful treatment for depression, and she told me that the reason the meds didn't work is because I'm not depressed, I have a type 2 bipolar disorder.
I started going to therapy and taking a mood stabilizer instead of an antidepressant, and WOW, what a difference!
By downplaying the seriousness of depression, I think that we create a culture where people are ashamed to go to specialists and seek proper diagnoses. We just want to take a pill and go away. But how many antidepressants out there are prescribed by general practitioners who never do a proper DSM evaluation of the patient?
People will never get well without getting a proper diagnosis before starting a treatment.
The differential diagnosis for depression is far too subtle to pick up on a regular office visit. If your GP prescribes an antidepressant, mood stabilizer, or any other psychopharmacologic treatment, run for zee hills!
I got rushed through to a psychiatrist after being screened by a social worker (which I have never felt comfortable with) because I was due to be married and it was clear I needed medical intervention because talking was not helping. When my psychiatrist retired and I was shuffled through 3 doctors in as many months, I decided to see my internist for maintenance medication and she is quite comfortable in providing that for me.
And Chandelier--I know what you mean. It took almost 2 years of regular visits & med checks before my psychiatrist felt comfortable diagnosing me with Type 2 bipolar rather than major depression. I have not made the move to a mood stabilizer yet & the majority of my disease seems to be rooted in the depression. But I'm sure it will come soon enough and dread having to find another psychiatrist.
This was in parallel with the initial story about persons with depression getting meds and not enough psychological support