counseling and antidepressants

[Rifka]

I just wanted to say that antidepressants DO treat the root cause of depression, if your root cause is chemical imbalance. Otherwise, it just helps regulate the chemicals in your brain and takes the edge off of whatever is going on. Antidepressants just don't cure anything.

Amen! I think too many people see antidepressants as a short-term fix, and the end goal to get off of them. My philosophy is that the utmost goal is to be happy. If it takes medicine to be happy, take it. If it takes counseling to be happy, do it. If it takes both to be happy, do both. If you eventually are able to go off medicine and still be happy, that's great. If not, there's no shame in taking it. It's better to be medicated and be able to live a happy, fulfilling life, even if it means you have to be medicated for the rest of your life, than to spend your life medicine-free and feeling miserable.

Also, don't be afraid to keep trying different medicine if the stuff you're taking doesn't work. I went through 4 or 5 different antidepressants before I found one that works for me. And don't be afraid to switch doctors/psychiatrists if you ever start to feel like he doesn't understand/isn't helping you. The first doctor I went to put me on 2 different antidepressants and then said he didn't have anything more to try me on. Riiiiight. So, I switched and found a great doctor who helped me find medicine that is a better fit for me. My life has been way way better since I did.

[vorpal blade]

I have a few questions, and I really don't wish to offend anyone by asking them. I'm just curious.

It seems to me that depression is more common today than it was fifty years ago. Is this true? If it is true, why is that? Diet? Lifestyle changes? Cultural changes in society? Changes in the weather or degree of atmospheric pollution?

Or is it only a perception that depression is more common because we talk about it more openly today? I know there use to be more of a stigma with depression. Or perhaps people feel more comfortable with treating their depression with medicine and counseling than they used to feel.

Another question is that some people think that in Utah there is more depression than elsewhere. I could see that the gloomy overcast darkness of winter in Salt Lake City can be depressing to some people. I was there last Christmas. Of course, there are those who think that the Mormon emphasis on achieving perfection (their words) leads to depression in Mormons. But how would such thoughts affect brain chemistry? And I can see some people being offended at the suggestion that their depression is merely due to some anxiety or unhealthy thinking or something they can just shake off.

Sorry, I'm really ignorant about this and would like some reliable information. No offense meant.

[bobtheenchantedone]

I think that the commonality is mostly due to it being less stigmatized. Now people feel less like they have to hide it and so don't.

Personally I attribute most of my emotional issues to how I grew up. Not that I had a bad childhood, necessarily, just that the person I was born as did not thrive in the environment I grew up in. That's probably why I responded so much better to therapy than medication - so much of my physical reactions come from habitual thought patterns that, once I learned to recognize and turn them away, didn't affect me as much.

And even if depression is hereditary in a DNA sort of way, I think it's also hereditary in that if a parent's depression isn't taken care of their kids may learn it.

[NerdGirl]

Vorpal, I have a lot of thoughts about your question and possibly some actual research that you might be interested in if I can find the papers. But first I have to go to the grocery store.

[Marduk]

Utah does have a higher rate of prescriptions for anti-depressants, Vorpal. My theory is that it has less to do with increased cases, and more to do with higher incomes and younger ages. Demographically, Utah has a younger populace and a more well-off populace. Both of these groups are more likely to seek mental help than older or poorer people. Hence it yields a higher amount of diagnoses and prescriptions.

[NerdGirl]

Ok, I for real have some interesting stuff about depression epidemiology somewhere, but I am on surgery right now and it is sleeping time because I have to get up way too early.

[vorpal blade]

Utah does have a higher rate of prescriptions for anti-depressants, Vorpal. My theory is that it has less to do with increased cases, and more to do with higher incomes and younger ages. Demographically, Utah has a younger populace and a more well-off populace. Both of these groups are more likely to seek mental help than older or poorer people. Hence it yields a higher amount of diagnoses and prescriptions.

That's an interesting theory, Marduk. I hadn't thought of that before. I guess if someone were highly motivated they could check out other locations with similar demographics.

I'm still not certain the statistic is real. All I've seen is a claim made that a certain brand of anti-depressant was sold at a higher per capita rate in Utah than elsewhere. Apparantly, though, there is more than one brand of anti-depressant. I could see that the statistics could be misleading if this was only true of that particular medication, and other areas had higher usage of other medications for depression. Maybe this brand is just very popular in Utah because a particular group of doctors in Utah really like it. Or maybe antidepressants in general are overprescribed in Utah for some reason. Maybe a doctor or two has stock in the company, perhaps because they really believe in it, and prescribe it much more than they really should. Or maybe other brands have caffeine in them or alcohol and doctors in Utah find patient resistance to using those brands. As I say, I'm just guessing because I know very little about it.

[Rifka]

I've also heard that statistic, but I wonder if it's because Utahns are less-likely to self-medicate with alcohol, drugs, etc. I have no foundation for this theory-- it's just a guess, but it would make sense to me, since such a large percentage of Utah's population are Mormon and therefore abstain from alcohol, drugs, etc. Instead, perhaps we're more likely to actually get medical help, such as antidepressants, for our mental illness.

[Violet]

Ok, I for real have some interesting stuff about depression epidemiology somewhere, but I am on surgery right now and it is sleeping time because I have to get up way too early.

Whenever you have time, I'd be interested in this.

[NerdGirl]

Ok, so I don't know where I put all these articles that I looked up earlier in the year (basically, while we were doing our psychiatry block in school I became interested in depression prevalence and looked up some stuff on pubmed). But if I wait until I actually have time to find them, I'll never get around to posting anything. If anyone really wants actual literature, though, I recommend doing a search for depression prevalence on pubmed. There are a lot of papers and I don't have time to dig through them again and find what I found, but it's a good place to search if you're interested (and do it on campus if you're a student somewhere if you can so you can get full text). From what I remember, though, the prevalence of major depression is basically the same in high, middle, and low income countries. And the idea that depression prevalence has actually increased in recent years is controversial. There's not a lot of good data to go back very far (like hundreds of years) and compare prevalences, but there are studies that have found that over the past few decades the actual prevalence has not increased. We just hear about it more because it's more ok to talk about it now.

And because I know people here are probably particularly interested in the claim the Utah has really high rates of depression compared with the rest of the US, I did a little searching just now to see what I could find. I found this report from the Utah department of health that shows that depression rates in Utah are comparable with the national average. http://health.utah.gov/opha/publication ... on/CMD.pdf I've only skimmed it, but it looks like an interesting read.

And just some comments about depression in general. In psychiatry (and really in all of medicine), people use a biopsychosocial approach to mental illness (and physical illness). If you break up that word, you will see that there are three main types of factors that contribute to mental health problems - biological factors, psychological factors, and social factors. Some mental illnesses like schizophrenia are very biological. Depression tends to have a lot of contributors from all three areas. So when make claims that Utah has really high rates of depression and it's obviously because of the social factors involved in being in the LDS church and pressure to be perfect, that really shows a lack of understanding that there are biological factors (like imbalances of various neurotransmitters in the brain) and psychological factors that contribute as well. Pressure to be perfect and lack of social support can certainly make depression worse and can be a barrier to treatment. But even if we fixed all of the unsupportive social environments in the world, some people will still have depression because they will still have an imbalance of neurotransmitters in their brains.

And when I say that the biopsychosocial approach applies to physical illness as well, I don't mean people get diabetes, for example, because they have psychological issues or an unsupportive social environment. What I mean is that those factors affect how people cope with illness and what resources they have to deal with their medical problems. Two people with the exact same physical disease state may have very different levels of functioning because of those factors. It's an interesting concept, and the wikipedia article on it is actually pretty good: http://en.wikipedia.org/wiki/Biopsychosocial_model

Something else people here may find interesting if they haven't encountered it before are the social determinants of health (http://en.wikipedia.org/wiki/Social_det ... _of_health) although that's getting a bit further from the main topic here.

If I come across anything else interesting I'll post it.

[Vorpal]

I studied the first link and didn't understand how they arrived at the numbers. Who was surveyed, and how?

But the link provides some interesting correlations. Now, I know that correlation is not the same as causation, but the correlation suggests that active members of the LDS church are less likely to be suffering from major depression. Among the significant factors associated with major depression are:
Smoking
Binge drinking
Less physical activity
Not eating fruits and vegetable

It is curious that men, blacks, and Pacific Islanders in Utah are significantly less like to have major depression. Also married persons were less likely to be depressed. I can see how being unemployed could make you depressed, and also how being depressed could make you less likely to keep a job. The less education you have the more likely you are to be depressed. There is also a correlation between depression and other health problems. Very interesting.

It would be interesting to see if those in this forum are more likely to have experienced depression than the general public.

[yayfulness]

I just thought I'd give you all an update. My antidepressant (fluoxetine, for anyone who's curious) started helping me about a month after I started taking it. It's been nearly two months now, and my depression certainly isn't gone, but antidepressants have done more than any other person or thing I have encountered in the past year to reduce the severity and frequency of my episodes and help me turn depression into something I can deal with. I know it's not a cure and it's not right for everyone, but I can't say enough good things about my own experience with antidepressants.

Thanks again for all of your support. I'm in a much, much better place now than I was when I first started this thread.

[Portia]

I just thought I'd give you all an update. My antidepressant (fluoxetine, for anyone who's curious) started helping me about a month after I started taking it. It's been nearly two months now, and my depression certainly isn't gone, but antidepressants have done more than any other person or thing I have encountered in the past year to reduce the severity and frequency of my episodes and help me turn depression into something I can deal with. I know it's not a cure and it's not right for everyone, but I can't say enough good things about my own experience with antidepressants.

Thanks again for all of your support. I'm in a much, much better place now than I was when I first started this thread.

Glad to hear it. Have you avoided any negative side-effects?

[yayfulness]

I've been having more headaches than usual for the past week or two, but I have no idea whether that's related in any way. Other than that, nothing at all that I know of.

[bobtheenchantedone]

Good to hear it's working for you!

[NerdGirl]