Depression is far more complex than patients were led to believe
Gregory K. Fritz: Depression is far more complex than patients were led to believe
Published: January 09, 2015 01:00 AM
Some years ago, a resident I was supervising told me how hed described to the parents of a depressed 12-year-old that low levels of the neurotransmitter serotonin were the cause of their childs depression and that antidepressants worked to cure this chemical imbalance and reduce depressive symptoms.
When I chided him that his description of depression was at best a significant oversimplification, he argued that hed used it with this unsophisticated family to get informed consent for a needed treatment. Suffice it to say, an animated supervisory session ensued that dealt with patronizing physician attitudes, the influence of the pharmaceutical industry on medical practice, and the limits of our knowledge about the etiology of depression.
Remarkably, I still hear the idea of a chemical imbalance discussed in relation to depression, though fortunately not among psychiatrists. Given that there is no empirical evidence for this explanation of the cause or treatment of depression, why is it so tenaciously a part of the lay understanding of the disorder?
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I believe that the enduring appeal of the chemical imbalance explanation of depression stems from humans desire for meaning and our distaste for ambiguity. The complex truth about depression that many genetic, environmental, biological, social, physiological, and psychological factors interact with development and other, still unknown factors in complicated ways to produce depression, and that were not really sure how antidepressants work is not very satisfying to parents of a suicidal adolescent faced with treatment decisions.
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The problem with the chemical imbalance explanation, in addition to the primary fact that its an untrue oversimplification, is that it undermines the professional/patient relationship. Psychiatrists and other mental health professionals have an obligation to stay abreast of developments in the field and to accurately translate this knowledge to our patients and their families to the best of our ability. Anything less than this is a violation of their trust.
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Trillo
(9,154 posts)bemildred
(90,061 posts)I mean it would be cool if it were true, but it doesn't coincide at all with observation. Getting drunk will make you feel better, for a short while, but you haven't fixed anything. And the same can be said of any drug maintenance regimen, you are not fixing anything that way, just making it more tolerable.
adirondacker
(2,921 posts)Although I'm well aware of genetic dispositions for mental illness, I often wonder what percentages of those suffering from depression is caused by environmental/financial.
I know for myself, I am quite content (mind-wise, not with the world) when I have a stable income. When the rug gets pulled out, my mood shifts dramatically with the stress.
bemildred
(90,061 posts)I'm more about doing what I want to and less about accumulating as much stuff as possible to impress somebody else.
I tend to moody anyway and I have learned to be very careful about what situations I let myself stay in. I hate dealing with all the retail marketing crap, for example, whats your phone #, what's you zip code, will you take a short survey about how we're doing, etc. etc. etc. Soon they will have us liking and unliking everything we see at the market. And it's really none of their fucking business, but it's just a waste of time to complain, they don't actually give a crap what you think, they want to know how to use it to manipulate your purchases, and all you do is get the clerk in trouble for not "handling" you.
So I avoid it as much as possible and then I go around and do it all at once and I lie a lot about such things which are none of their business. Sometimes you can pick up on who is selling your info to whom that way.
midnight
(26,624 posts)depression, why is it so tenaciously a part of the lay understanding of the disorder?" It sells pills.
I had a family member who would know what doc was on staff depending on diagnosis.
Canoe52
(2,948 posts)Came about in the 1980's. A new generation of antidepressives had come along that were really working, but the medical profession was at a loss to explain why they worked. A theory at the time was that the amount of seratonin crossing the synapses, was increased (or decreased depending on the theory) by the antidepressant.
Also at the same time those of us active in support groups were fighting stigma against depression, and talk shows were going gaga over these "new fangeled" drugs. They would have some fundy on saying how you shouldn't need drugs to "make you feel good" you should depend on God. Up to then depression was considered a moral failing and a personal weakness. The easiest explanation that got through to most people at the time was that depression had, or could have an organic basis, and that was by putting it in terms of a chemical imbalance in the brain.