Daniel Rushton

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Is depression merely a keyword for a much larger field?

I can't help but feeling that depression is referred to in generic terms. I suffer from depression too, but almost nothing that was said in this video, (which was honest and beautiful,) would be a true statement about myself.
Is it possible that we have taken the humour we would use on say Freud's mother and apply it in a physiological sense too... only to invest the effort to look at the individuals for a 'happy pill' that seems to have at least some positive effects of the symptoms regardless of the underlying cause of why we had them in the first place.
To use the broken arm analogy; do we treat a sprain, a fracture, and a break with the same treatment? Or more horrifically still could we justify taking the psychological approach and tell the guy with the bone sticking out of his arm to come back next week, as fifty minutes just isn't enough?
Does the proverbial morphine just stop the patient complaining?

Closing Statement from Daniel Rushton

From the responses in this conversation, I would say that the general consensus I that yes - depression is a keyword for a much larger field. Though I would probably change one thing if I were to start this conversation again, (and replace keyword for place-holder.) There is clearly not enough known to be able to define all these problems explicitly - and a place-holder is better than nothing at all.

That being said, I think it is also clear from the broad spectrum within a small number of comments, that just how unmeasured in aperture this word is a place-holder for. The word itself almost seems to be addressed ad-hoc as a genetic condition, a physical disorder, a perceptional state of the world, a life-long ailment, and even in a spiritual sense. For those reasons it would be inappropriate to cite a specific comment or participant as it would merely be suggesting that depression should mean exactly what I have.

From a more personal place I think that when people know exactly what your 'issue' is, they tend - unsurprisingly - to be warm hearted an eager to help. As unrealistic as the prospect my sound, I think the medical world could help itself greatly if it were able to name individually as many of the conditions of 'depression' as possible. On a selfish day the place-holder can almost be a trigger itself. I sometimes want to be able to get out a book and say, "Here - that is what I have!... And no, it isn't the same as when your pet hamster died."

*Apologies to anyone who has recently lost a hamster.

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    Oct 10 2013: Because depression is not fully understood even by medical practitioners and practitioners of psychology, it is one of those 'open to interpretation' dilemmas as to what might be the best treatment for it. I think you are right - depression is merely a keyword for a much larger field.

    The severity of depression in some people means that the first-line treatment is the magic bullet of antidepressant medication, to try and make the depression 'safe' and less likely to be life-threatening. However, the medicalised state of 'being safe' is often left alone for too long - even becoming a life-sentence for some. This is contrary to the medication's original purpose as first-line treatment, and happens because the medical condition, for various reasons, never goes further than the patient's General Practitioner.

    What should happen, in my opinion, is that the medicalised route should have its place in moderate to severe depression, but it is absolutely essential that it should also be meshed in with counselling and psychotherapy, so that the very root of why depression has become a problem can be understood and come to terms with. Once that has been achieved, then the medication can be tailed off, as it has served its correct purpose.

    There are caveats to this, in that a psychotherapist treating a medicalised patient would not necessarily be treating the 'raw condition' of depression. He/she would be treating a condition altered by changes in neurochemicals, making it difficult to get at depression's roots. Then the patient discovers that if he is offered counselling, it is only six 50 minute sessions of CBT - and then that's it - even if the root has not yet been found.

    CBT has many limitations, because it is a standardised route to address all severities of mental health conditions (which of course, it can't). I'm an advocate of the Rogerian person-centred approach to counselling, which is open-ended and entirely cognizant of signs of recovery in the patient.
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      Oct 10 2013: I think you also bring up another element to this issue which is often forgot almost in its entirety. When we apply a medication for a symptom - even as a crutch - we are literally altering the brain chemistry of the individual. Are we then even dealing with the same condition?
      Would I be too far out of line to suggest that we have a preference to treat ourselves, and the empathetical discomfort we feel by making a sufferer leave the room with a smile on their face; regardless of the torture in their minds.
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        Oct 10 2013: Daniel, yes the altered brain chemistry can make psychotherapy tricky, because the smile sometimes does belie the torture inside. Having said that, it is important to realise that antidepressants do have a crucial role to play in patients whose pain seems to them to be unbearable.

        In touching and recognising the source of the internal torture during psychotherapy, sometimes the condition can momentarily worsen before it gets better. On balance then, it is better to treat someone who has been medicalised out of an initially dangerous condition, rather than one who isn't, and who runs the risk of going home after therapy with an even more unbearable burden.

        I can't stress enough the importance of the dual approach to treating depression. Using your example of the person with the broken arm - The Accident and Emergency Department at the hospital should be the equivalent of antidepressant treatment, and the following physiotherapy at the hospital equivalent to psychotherapy. Each treatment has its correct place, at the right time.

        It's also important to emphasise that it is the person being treated - not just the condition.
        • Oct 10 2013: Hello Allan,

          I agree with the importance of the dual approach to treating depression (and anxiety, which is my main problem.)

          Some of us literally end up in the Accident and Emergency Department because of the severity of the level of depression and/or anxiety that we're experiencing and in my case I was then admitted to a Psychiatric Hospital. I would say most if not all people in my situation would be.

          This is where medication is important, as you have pointed out, as the person is "in crises", as we refer to it, here. I was already seeing a Psychiatrist and on medication, but this was increased when I was admitted to hospital.

          While in hospital, we were expected (and rightly so) to attend Group Therapy sessions. This is another area where medication becomes important. In order to gain anything from any kind of therapy (we also had individual therapy in hospital), one has to be able to concentrate on what is being taught and discussed, something that a person in crises mode would find extremely difficult. Medication served to decrease our depression/anxiety to a level where we were able to concentrate and thus was seen as a way to help us to gain as much benefit as we could from the therapy that was offered.

          I was discharged after several months and my medications have changed over time, depending on my symptoms. Overall, my medications have decreased and my therapy continues. I hope to be medication free one day.
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    Oct 10 2013: I agree that, yes, medication can be considered a crutch, but it can also be considered a tool that the user can manipulate to achieve a desired outcome. It is like using a screwdriver, but when the screw is loose, you use your hand to either tighten it, or loosen it, but when that action becomes difficult, you need a tool that can make the job possible. I myself suffer from depression, and I believe that even though I don't like taking medication, I need it, and it has made a significant difference in the way i feel and think, and my ability to function in a near normal way. And in reference to Yoka's comment on not being born with depression, I believe that while that is true, genetics can play a large role in the fact that you can be more vulnerable to having depression. It is a combination of both nature and nurture, which together cause many mental-related issues.
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    Oct 10 2013: Daniel hello, thank you for starting this conversation.

    Depression is very complex. The more I read about it, the more I learn.
    From what little I read, I have learned that not all individuals suffer in the same way.

    I think the more we talk about the issue, the more we'll learn, the more hope for the sufferers.
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    Oct 10 2013: depression it can be caused when the life is in insecurity or when we imagining ourselves in insecurity ,it can be the real meaning of depression ,the first is real but the second is caused by hallicination ,the first is in need to save him or her from an exterior danger ,the second is in need to protect him or her from an interior danger (itself) ;the first it depends the destiny ,the second it depends the free will ;the first anyone have power can change it but the second is in need to makes him or her seeing with eyes of the truth to itself ( learn his conscious about his unconscious) ,the society ( learn his logic the ethics ) ,for he or she can have the consience become itself in their future.
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      Oct 10 2013: And can either be solved in fifty minutes of talk time, and a bottle of the same pills do they same for the next guy?

      I think it like a Chinese remedy shop - as good a meaning as they might have had when it all started out, they all seem to be paying for the same bag of brews.

      Prozac could be the greatest thing for Elizabeth Wurtzel, but I don't see the possibility for the next fifty people in line unless they have the exact same problem.

      Excuse the abruptness of the following comment as it isn't directed but merely to illustrate point. Heroin will make as all feel happy all the time if someone is silly enough to prescribe it.

      If I have issues that stem from a lifetime, then it could take a lifetime to sort it out. Fifty minutes on the couch without or without a prescription tells me someone thinks they can deal with my issues in fifty minutes, or worst still shut me up for a week until I can afford to see them again.

      I guess what I would like to see is an understanding - you deal with those people over there first, and then we will see about getting you some more. Its time to go back to the science or counting the misses as well as the hits.

      If Freud's intention was to turn misery into common unhappiness; I think our statistical world has in the intervening time had the indecency to overlap the bell curves and pretend that the mission had been accomplished.

      Maybe we should start paying these mind doctors by tips alone, and see how much they will then make.

      I probably over written that a little - my apologies.
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        Oct 10 2013: you can always delete some from your writing if that will makes you feel more better and i was not talking about freud here and be careful the catch of attention it can be the cause of the depression and they give placebo for it....wish you peace with yourself and more luck.
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    Oct 10 2013: i thank you for your participation , i hope you believe that you can find in the river what dosen't exist in the ocean and you believe in changing yourself first for we can maybe help you ,what's mean the best cure is the hardest enemy ourselves ,wish you the very best.
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    Oct 10 2013: Yes, and the much larger field that depression is a keyword for is "the search for a sense of meaning and purpose in life".
    This I would suggest is a matter of consciousness, rather than chemistry-biology. The former would advocate "talk-therapies" as primary, but with short-terms pills for the chemistry-biology aspect in severe cases.
    As for the cause with respect to nature/nurture, I agree with Tim Chapman, it's both, and begins with a certain pre-disposition with which one is born - if recognised early, it can be 'nurtured out of you'. If not, it will get amplified the older you get.
  • Oct 10 2013: Like so many things about humans, i think of depression as multi-dimensional. You have degree, type, individual factors, cause, society, environment, to name just of the dimensions needed to consider.

    We are just starting to learn about the chemistry of the brain.

    The question is do we fix the symptom which depression in some cases can be considered or fix the root cause. The human body is a wonderful thing and it can fix itself with help - do we do it this way or make chemical changes using external forces?

    I think there are many questions which should be asked to create a treatment for each individual.
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    Oct 10 2013: I've learned some people used traveling to cure their autism and depression successfully. :)
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    Oct 10 2013: I'm sorry to hear that. I think no one was born to be depressive. So if you can't be happy in your current living status by all means, I'd like to advise you to change your living environment. Maybe you can try to travel around the world to focus yourself on new experience and people or you can come to China. I think you'll have no living pressure in China and people here can influence you in getting a happy feeling.
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    Oct 10 2013: Is it your experience as someone who suffers from depression that medical practitioners who treat depression suggest the same course of treatment regardless of cause?

    The Mayo Clinic website is down right now, but I thought I had read there that depression is addressed with a variety of talk-based treatments, self-care regimen, medications, and sometimes adjustment in unrelated medications a person is taking that have depression as a side effect. I thought that the course of treatment is determined on a case by case basis.

    Is that not your experience or understanding?
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      Oct 10 2013: I know sufferers of depression.....some were under medication for a short while, and the depression went away. Others went to psychologists, and after a few sessions, the depression went away. Still others have been under a psychiatrist's treatment plan (medication) for years.....

      I would like to know why some individuals go to a psychologist, and why others go to a psychiatrist.
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        Oct 10 2013: Here is what I found that may address your question: http://depression.about.com/cs/psychotherapy/f/psychologist.htm

        Essentially, in most places a psychologist, as he is not a medical doctor, cannot prescribe medications or certain sorts of medical treatments.
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          Oct 10 2013: That helps a lot thanks.

          What I also have always wondered about, is, how do the individual sufferers choose where to go?
          Do you think perhaps they start with one, and end up getting referred to another?
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        Oct 10 2013: My guess is that the primary care physician would effectively do triage and direct a person to the most promising place to start.
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      Oct 10 2013: I wouldn't go quite so far as to say that everyone with depression is treated in the same way, but there seems to be a lack of differential diagnosis involved.
      If I had to explain it in different terms, I often see it like a menu where all the dishes and their flavours are written down for all to see. The waiters are convinced they are working in the finest restaurant. No-one is questioning what the chef does. The chef doesn't seem to be taking special orders. And the wine list is either white or red - depending on which item the waiter made you point to on the menu.
      And as a side note - I have known many other people with depression in their lives. A pregnant woman for example who had suffered all her life. The post-partum depression in any other woman would have been treated as a thing in and of itself. In her case, it was just treated like a bad episode of her generic condition.