Do you consider Depression an Illness?

AckwelFoley

If you do, then id like to Introduce myself

I inherited this condition from my fathers side of the family, and at 30, ive been diadnosed with it for 7 years now.

I take 120mgs of cymbalta daily and i am finishing up on almost 10 weeks off work due to a really poor state. It started getting bad 6 months ago but came to a point when i cried uncontrollably in the toilet in work every hour or so..

One friday i had enough and decided enough was enough, took my rifle with me and went down to a lake near me..

Only for my sister kept ringing me and crying on the phone i wouldnt be here now. I spent a short stay in the "hospital" went abroad to some close family friends in The US for a few weeks, continued my course of increased meds and seen a psyc in John of Gods.

Next step is back to work, meet a behavioural cognative therapist once a week and give myself some positive goals.

The break up of a long term relationship and some other contributing personal factors didnt help me, along with the change of medication away from ciprimal.

Im in good shape now and very positive. Im blessed by having great family and friends and yes, talking about it online has helped me too.

Yes, i do consider it an illness, you cant cure it, just control it.

AckwelFoley

oh god. i thought i was in better shape

Im just after having a real bad setback

Filan

There is so many different forms of depression and everyone's depression experience is different. I don't believe that generalising is truthful. It depends on one's definition of an illness. I personaly believe that depression is huegly over diagnosed... Life can be hard...life can be a hard place for people to be happy in...some naturaly cope better with challenges than others.... many so called depression sufferers are simply experiencing the natural lows that life sometimes brings.... yet if they present to a G.P or a Psychiatrist they will be prescribed tablets...tablets which are expected to solve their life's challenges??. Such a policy is creating a nation of addicts when in many cases such medication was not necessary originaly. It's an insane practice....but it's cheaper and less time consuming....less of a strain than a comprehensive Counselling service. Symptoms are treated and not causes.

That dosen't mean that there isn't a chemical imbalance or inherited element in depression....but I feel that it is hugely overstated.

I personaly view depression as an undeniably negative feeling...a symptom of distress. But does it really matter whether that qualifies it as an illness?. What matters is you and how it impacts on you...not whether it is technicaly an illness. The medical profession will say it is....but just because they believe this does not necessarily make it correct.

AckwelFoley

One of the major reasons for the failures to identify and treat the illness is a result of the 'stigma' associated with the term 'depression'.

Anyone who thinks depression is all in one's head has never been depressed - or never realized it. Depression affects more than the mind - it has significant physical symptoms as well.

Depression is probably the most common psychological disorder and the one that receives the most attention.

Depression makes a person feel sad, hopeless, worthless, pessimistic and guilty. Often the sufferer has difficulty concentrating and making decisions, has a loss of appetite and weight or a weight gain, has difficulty sleeping, has a lack of energy and sometimes physical symptoms such as slow movement and speech. Depression must be taken seriously because of the high rate of suicide associated with it.

Many people are not aware of the many types of depression besides what is termed unipolar depression where the sufferer feels melancholic and never feels any highs. A brief description of manic depression (bipolar disorder), major depression, atypical depression, psychotic depression and dysthymia

Major Depression: Major depression is probably one of the most common forms of depression. You probably know a handful of people who suffer from it. The sufferer seems to walk around with the weight of the world on his or her shoulders. He or she seems disinterested in becoming involved in regular activities and seems convinced that he or she will always be in this hopeless state. There is a lack of interest in sexual activity and in appetite and a weight loss.

Atypical Depression: Atypical depression is a variation of depression that is slightly different from major depression. The sufferer is sometimes able to experience happiness and moments of elation. Symptoms of atypical depression include fatigue, oversleeping, overeating and weight gain. People who suffer from atypical depression believe that outside events control their mood (i.e. success, attention and praise). Episodes of atypical depression can last for months or a sufferer may live with it forever.

Psychotic Depression: Sufferers of psychotic depression begin to hear and see imaginary things - - sounds, voices and visuals that do not exist. These are referred to as hallucinations, which are generally more common with someone suffering from schizophrenia. The hallucinations are not "positive" like they are with a manic depressive. The sufferer of psychotic depression imagines frightening and negative sounds and images.

Dysthymia: Many people just walk around seeming depressed - - simply sad, blue or melancholic. They have been this way all of their lives. This is dysthymia - - a condition that people are not even aware of but just live with daily. They go through life feeling unimportant, dissatisfied, frightened and simply don't enjoy their lives. Medication is beneficial for this type of depression.

Manic Depression:(Better known as bi polar) Manic depression can be defined as an emotional disorder characterized by changing mood shifts from depression to mania which can sometimes be quite rapid. People who suffer from manic depression have an extremely high rate of suicide.

Many depressed people never get help, because they don't know that their physical symptoms might be caused by depression. A lot of doctors miss the symptoms, too.

These physical symptoms aren't "all in your head." Depression can cause real changes in your body. For instance, it can slow down your digestion, which can result in stomach problems.

Depression seems to be related to an imbalance of certain chemicals in your brain. Some of these same chemicals play an important role in how you feel pain. So many experts think that depression can make you feel pain differently than other people.

For many sufferers, depression brings on feelings of guilt and shame and because of these feelings, they will not seek help. But are these feelings valid? Lack of understanding ? both in sufferers and non-sufferers ? clouds the issue. So here's how to end the stigma associated with depression, stress, and anxiety.

1. The majority of people in our society experience psychological problems during their lives: Problems from childhood with parents and siblings; stress at work; marital breakdown; losing loved ones and of course, making mistakes. Very few people go through life without experiencing mental trauma of some description. So there's nothing odd or unique happening here, indeed, depressive illnesses are as common as colds. These are real illnesses. There's no stigma associated with diabetes, asthma, or allergies for example, so why should there be with these? Just like the above illnesses, depression, anxiety and stress have specific causes that can be addressed. You wouldn't think an asthma sufferer could just "snap out of it", yet many people say this to depression and anxiety sufferers. Lack of understanding again causes such a reaction and it is the reaction that is wrong, not the sufferer.

Suffering a depressive episode is not your fault so why feel guilty? You didn't wake up one morning and think "right, I know, I'll become anxious from now on". It doesn't happen like that. No one CHOOSES depression, it can happen to people just like many illnesses do. And like other illnesses, depression can be treated very effectively. But not one sufferer is to blame. You wouldn't blame someone who hadn't been taught to read or write, you wouldn't blame someone who suffered from hay fever so why blame yourself and feel guilty because you're suffering a stressful illness?

LegacyUser

Filan wrote: »

I personaly view depression as an undeniably negative feeling...a symptom of distress.

I think you're misunderstanding the term 'depression'. Depression in psychiatric/psychological terms refers to a disorder with a number of different symptoms and can be of varying levels of severity. However the word is commonly used as a term for an emotion or negative feeling. That's two very different meanings. Having a depressive illness is not just feeling down/miserable/unhappy.

Basically the medical/psychological/counselling professions should probably think of another name for it. Maybe in the DSM-V...

LegacyUser

Also (and maybe medical people here can correct me if I'm wrong) I think the medical term depression refers not only to depressed mood but also to a depression of various physiological functions.

Sorry if I'm being a pedant

AckwelFoley

DGH wrote: »

I think you're misunderstanding the term 'depression'. Depression in psychiatric/psychological terms refers to a disorder with a number of different symptoms and can be of varying levels of severity. However the word is commonly used as a term for an emotion or negative feeling. That's two very different meanings. Having a depressive illness is not just feeling down/miserable/unhappy.

Basically the medical/psychological/counselling professions should probably think of another name for it. Maybe in the DSM-V...

Very well explained.

witnessmenow

Hi Snyper,

sorry to hear your not doing to well lately. I would certainly call depression a illness. anything that you have no control over that makes you require medical help is an illnes in my mind

Good luck snyper

jtsuited

it's absolutely undeniably an illness. and a physical one at that. it's unfortunate that the term 'depression' is used. many people think that it just means feeling depressed and sad etc.
however in reality it's a serious (sometimes life threatening) illness that disrupts your sleeping, eating, thinking, feeling, sex drive, and many other things.
Feeling sad is just one of the MANY symptoms. And the antidepressant medication has a huge success rate.
Anyone who feels that clinical depression is not an illness and people need to snap out of it are dangerously ignorant.

Having suffered from serious clinical depression for the past few years, I can tell you that it's a horror you wouldn't inflict on your worst enemy. And many people simply cannot endure it (hence suicide).

I do agree that it's over diagnosed. However I think that this is done simply because the SSRI's have such a beneficial effect on a wide range of problems (everything from depression/anxiety to ptsd to anorexia/bulimia). I think that doctors prescribe these medications with the knowledge that they will fix most physiological/psychosomatic problems and just put them under the banner of depression.

The anti-psychiatry movement in the U.S (scientology, tom cruise etc.) worries me greatly, and I think that a lot of people will not get the help they need because of the silliness the movement puts forward.

It's also important to realise that we are only now finding out about the biochemical basis of our brains, and so debate is commonplace about such matters. The study of the brain in western medical science is still in it's relative infancy.
It was only really after Hoffman discovered LSD that western medicine began probing the physical organic basis of mental illness in the 1930's. Lithium carbonate only started being used as a mood stabiliser in the 1950's. And prozac and the rest of the SSRI's have only been around since the late 80's/early 90's.

hope you are doing well.
And yes DGH the diagnosis of depression is normally more based on your physiological functions than your state of mind (even by a psychiatrist).

old boy

hi snyper, best of luck, i suffer from the black as i call it, jeeze its not easy, if you have family or friends that understand you are not 2 bad, i had peeps around me saying get the fcuk up theres nothing wrong with you, an all thet ****e, only for the day hospital i was in deep ****e, i find a few at the weekend helps, altho some medics says no.

AckwelFoley

Yea, i understand what you say about having a few at the weekend, but as booze is a depressant, its important not to "overdo it"

I attended my first group meeting with "Aware" and i must say it was excellent to talk to ppl with the same condition in confidence.

M.T. Cranium

Snyper, I may be fairly similar to you from what I've just read. Although I live in Canada my last name is O'Donnell and my mother was Irish. Not that it matters, anyone can be depressed.

As you seem to be saying, depression is a very complex business. There is bound to be a trigger for it in one's personal life. You wouldn't be depressed after winning the lottery or rafting down the Grand Canyon. You might be after the love of your life indicates you are not much more than a nuisance in their estimation.

However, I believe there are other factors at play. One is environmental. It is easier to get depressed in cloudy, low-light weather. February and March can be very depressing months in parts of Canada, not where I live now so much, the winter never seems to end and you start getting stir-crazy. When higher pressure is overhead and the ionization factor is positive in the air, you can develop these negative thoughts faster and keep them going longer. When the air is light, from the ocean and negatively charged, you often feel better. This is perhaps why you went towards water with the rifle, you were looking for the change to better that the ocean represents. You were not really committed to the ending of your life, thank God for that.

Diet is another issue. It may sound trite, but too much sugar can set up metabolic cycles that send you down and into depression. I'm not talking about diabetes here, have you thought about cutting sugar out of your diet, processed food in general? I don't mean go for rabbit food and granola every meal, but try this if you haven't, your moods may stabilize. Sugar does our bodies almost no good.

If the news of the day depresses you, think of what you are interested in otherwise, and focus on that instead. Of course the world is a sh*t hole in general terms, why would it not be, human beings are in charge of it. But there are so many good people out there. Have you ever worked with mentally handicapped people? It can be a way to overcome depression, if you don't get into it too deeply right away, seeing how they cope with what you know would depress you, will uplift you. See if there is a community called L'Arche anywhere in your part of the world, and visit. Tell the staff you are just looking for a deeper meaning in life and suffering, and ask them if you can visit and just be there with them.

Travel is of course a good thing too, it excites and stimulates. That's why so many people come to Ireland, oddly enough, in a nation of people with plenty of issues, there are thousands of visitors lured by the promise of meeting the friendliest people on earth. And they do, too. So there's something to be said for it.

Final thought, try to read less of my stuff. You might find that depressing as hell.

Agonist

I suffer from depression/bipolar too. It started in childhood and I've been hospitalised several times and on medication for most of my life. I've had a rough time of it but I've had a few good spells where I've made progress. Mostly, life's a struggle with very little point to it.

Firstly,

M.T. Cranium wrote: »

As you seem to be saying, depression is a very complex business. There is bound to be a trigger for it in one's personal life. You wouldn't be depressed after winning the lottery or rafting down the Grand Canyon. You might be after the love of your life indicates you are not much more than a nuisance in their estimation.

This is wrong. A good indicator of serious depression is failure to be perked up by good news. With milder depression it's possible for the depression to lift for a while when good things happen.

Snyper, I hope you are feeling a bit better now. You mentioned you're going to Aware. I've been going there for the last few weeks and I've found it a source of good, competent advice and support. I'm also pleased to find myself feeling more comfortable sitting with a group of people already.

I went to Grow meetings for a couple of years and it helped me a lot at a very tough time. It's, as someone else on boards said, an acquired taste, but interestingly there's research to show that its methods work. That's one of the reasons it receives state funding, although this was cut this year.

I'm also on the waiting list for cognitive behavioural therapy. It's been a year now and there's no sign of an appointment coming my way. Good old HSE.
I started CBT with a GP who has had no training in psychotherapy, just his MD and an interest in mental health. It was a disaster. He invalidated me with everything he said - Me: This is what happened... Him: No, you interpreted it wrong. Me: So this is how I felt. Him: Ah, that was the wrong way to feel. Gah.

I'd love to hear anything people have to say about self-help groups or different forms of psychotherapy. It's so hard to get any services in Ireland apart from medication and inpatient.

eth0_

Agonist wrote: »

I started CBT with a GP who has had no training in psychotherapy, just his MD and an interest in mental health. It was a disaster. He invalidated me with everything he said - Me: This is what happened... Him: No, you interpreted it wrong. Me: So this is how I felt. Him: Ah, that was the wrong way to feel. Gah.

I hope you get an appointment with a proper CBT therapist soon. That GP sounds like an idiot, you should report him to the HSE, i'm sure there are rules about GP's practicing in areas they have no qualifications in.

Yes CBT is about re-training your thought processes but it's not as simple as just saying 'You're thinking about this the wrong way, think of it this way'.

Could you go private if the HSE can't get you an appointment any time soon?

nesf

Agonist wrote: »

It's so hard to get any services in Ireland apart from medication and inpatient.

What services could be reasonably provided? Beyond Aware/Samaritans services with emergency numbers/self help groups, what options are there that are feasible?

angeldelight

Just as an aside to the person who stated depression was over-diagnosed and leads to a large number of addicts.... the SSRIs and Tricyclics aren't addictive. Many people believe that anti-depressants are addictive but it is a myth - the confusion is due to the addictive properties of some other agents used for other mental health conditions e.g. benzodiazepines for anxiety

nesf

angeldelight wrote: »

Just as an aside to the person who stated depression was over-diagnosed and leads to a large number of addicts.... the SSRIs and Tricyclics aren't addictive. Many people believe that anti-depressants are addictive but it is a myth - the confusion is due to the addictive properties of some other agents used for other mental health conditions e.g. benzodiazepines for anxiety

Addiction isn't limited to things that are physically addictive though. That depression is over-diagnosed is pretty much a given in certain countries.

eth0_

What is the definition of addictive? Some anti depressant/anti anxiety drugs such as Effexor have horrendous side effects whether you stop suddenly or are weaned off them.

I'd call that having an addiction.

nesf

eth0_ wrote: »

What is the definition of addictive? Some anti depressant/anti anxiety drugs such as Effexor have horrendous side effects whether you stop suddenly or are weaned off them.

I'd call that having an addiction.

I'd differ on that. Coming off Effexor can be rough but you won't feel any urge to take them again afterwards. Just because something has side effects when you stop it doesn't necessarily make it addictive. There has to be some compulsion or need to take it for this to be the case. Cigarettes have nasty withdrawal effects but the real killer is the ever present urge to have a smoke that comes back every so often.

Agonist

nesf wrote: »

What services could be reasonably provided? Beyond Aware/Samaritans services with emergency numbers/self help groups, what options are there that are feasible?

I'm thinking of services that are supposed to be available now, but that have waiting lists of years or in some cases the post is not filled. A few examples - psychotherapy, inc. CBT; day hospitals/drop in centres; a community psychiatric nurse to visit to make sure home life is ok; psychiatric social workers for practical help with day to day life; group therapy sessions. I'd like to see stuff like music therapy, guided relaxation and meditation. Mindfulness is looking like an effective treatment for stress and some kinds of depression.

I heard on the news that St. Patrick's Hospital are starting up a 3 million euro outpatients' program including online interaction with a psychiatrist and mood monitoring by text message. If this helps to keep people well/alive, then it should be offered by the HSE too.
http://www.rte.ie/news/2008/0219/1news.html

Agonist

eth0_ wrote: »

I hope you get an appointment with a proper CBT therapist soon. That GP sounds like an idiot, you should report him to the HSE, i'm sure there are rules about GP's practicing in areas they have no qualifications in.

Yes CBT is about re-training your thought processes but it's not as simple as just saying 'You're thinking about this the wrong way, think of it this way'.

Could you go private if the HSE can't get you an appointment any time soon?

Thanks for your response. I just spent ages researching this and it seems that there are no restrictions on the use of terms like 'counsellor' and 'psychologist'. Anyway, you can get a counselling certificate after a 10 week distance learning course. It seems to be up to the individual to check their therapist's training and qualifications. Good websites to check are:
http://www.psychotherapy-ireland.com/
http://www.psihq.ie/
I think what the GP is doing is wrong and dangerous but I don't think he's doing anything against any regulations.

As for seeing a therapist privately - it's expensive but I might have to seriously consider it. I'm in the VHI and I just had a look at their benefits. They cover absolutely no mental health outpatient appointments bar psychiatrists and yet they do cover acupuncture, osteopathy and chiropractic. That's just silly, imo.

nesf

Agonist wrote: »

As for seeing a therapist privately - it's expensive but I might have to seriously consider it. I'm in the VHI and I just had a look at their benefits. They cover absolutely no mental health outpatient appointments bar psychiatrists and yet they do cover acupuncture, osteopathy and chiropractic. That's just silly, imo.

I'm in a similar position, on VHI and getting private treatment. It's very annoying that the VHI don't cover treatment, similar to how it's very annoying that I don't qualify for free medication similar to other people with long term illnesses. Part of the reason, and it touches upon the services question above, is the potential over subscription of these services. There is a large subset of people suffering from "depression" that are just going through normal lows rather than an actual depressive episode. There's a good article in the latest Scientific American Mind about it. Though it was more focussed on the American situation (which is far worse than ours, pharmaceutical companies being able to advertise to the general public is a really bad thing).

This isn't a simple, easy to diagnose (or more importantly, easy to rule out) set of conditions where the VHI or the State can ascertain whose treatment should be covered and whose shouldn't.

eth0_

St Pat's is awesome, it's a pity that is a rare occurance in Irish mental hospitals.

jtsuited

ok just to clear something up about the 'addictive' nature of SSRI's.

I checked this out with a psychiatrist before and it's pretty interesting. SSRI's are not addictive in the context of medical science. For something to be addictive, the addict must show increased tolerance to the substance and hence take more.

Like if you start taking benzodiazepenes regularly you develop a tolerance to certain levels. this leads to a harmful dependence as you need more and more all the time.
Whereas with SSRI's, while there is discontinuation syndrome, they can't be classed as addictive as you don't develop a tolerance to them.
You do however develop some sort of tolerance to the initial side effects.

tallaght01

Agonist....1 year waitinf for CBT?? That's pretty shocking. I had no idea that was the case in Ireland.

As for the GP providing CBT. It would be pretty unlikely that he/she isn't from a psych background. Sure, anyone can offer it, but it would be frowned on by there psychiatry colleagues. He could be an ex-psych. Lots of specialists go into GP-land. Lots of my paediatrics colleagues have gone off to become GPs and offer minor specialist services in that area.

Is there evidence to show depression is over diagnosed on this side of the pond?

Agree with the above re: SRRIs and addiction. The psyciatrists claim they're not addictive. I think it's probably true, and as angeldelight says, the confusion is down to the previous benzodiazepine generation getting addicted regularly.

I've only just seen this thread a while back. Just wanted to say well done to snyper for starting it. It's not easy to admit the things you admitted. It's all small steps in the road to de-sigmatising this illness. So, thanks for contributing.

jtsuited

tallaght01 wrote: »

Agonist....1 year waitinf for CBT?? That's pretty shocking. I had no idea that was the case in Ireland.

As for the GP providing CBT. It would be pretty unlikely that he/she isn't from a psych background. Sure, anyone can offer it, but it would be frowned on by there psychiatry colleagues. He could be an ex-psych. Lots of specialists go into GP-land. Lots of my paediatrics colleagues have gone off to become GPs and offer minor specialist services in that area.

Is there evidence to show depression is over diagnosed on this side of the pond?

Agree with the above re: SRRIs and addiction. The psyciatrists claim they're not addictive. I think it's probably true, and as angeldelight says, the confusion is down to the previous benzodiazepine generation getting addicted regularly.

I've only just seen this thread a while back. Just wanted to say well done to snyper for starting it. It's not easy to admit the things you admitted. It's all small steps in the road to de-sigmatising this illness. So, thanks for contributing.

well said.
as to is there any evidence to the over-diagnosis - there's a lot of evidence that it is underdiagnosed eg. the high suicide rate in this part of the world.

i think that's evidence enough.

nesf

jtsuited wrote: »

as to is there any evidence to the over-diagnosis - there's a lot of evidence that it is underdiagnosed eg. the high suicide rate in this part of the world.

i think that's evidence enough.

I disagree. If someone is severely depressed then they'll have a lot of difficulty getting help or diagnosed, through a combination of stigma and the illness itself. The disease/condition could be heavily over-diagnoses but it wouldn't mean that these people would be getting help any faster. That, and suicide doesn't mean the person was depressed or mentally ill necessarily.

My point was more about the over-medication of people with "mild depression" rather than saying that they're not missing any cases or that there's people not getting help that they need. A person whose marriage just broke up mightn't need to be given Prozac but they might be given it as a soft option by some GPs. There's an important difference between someone showing depressive symptoms when there is a reason for them being there and someone who shows them when there is no rational reason for them being this way.

jtsuited

nesf wrote: »

I disagree. If someone is severely depressed then they'll have a lot of difficulty getting help or diagnosed, through a combination of stigma and the illness itself. The disease/condition could be heavily over-diagnoses but it wouldn't mean that these people would be getting help any faster. That, and suicide doesn't mean the person was depressed or mentally ill necessarily.

My point was more about the over-medication of people with "mild depression" rather than saying that they're not missing any cases or that there's people not getting help that they need. A person whose marriage just broke up mightn't need to be given Prozac but they might be given it as a soft option by some GPs. There's an important difference between someone showing depressive symptoms when there is a reason for them being there and someone who shows them when there is no rational reason for them being this way.

yeah i see your point. i don't know the exact statistics here but i think they did a study of suicides and found that near 80% were showing clear symptoms of a depressive episode.

To be honest, after a few years of looking into this, I feel that GPs over-prescription of ssri's is not necessarily a bad thing. while there are side-effects and horror stories, for the vast majority of people who are prescribed them they work quite effectively.

I may differ from some people in that I don't believe in any sort of noble suffering. If you are depressed, and there's something that makes you not feel so bad that has comparatively few downsides, I don't see any reason not to take it. In so many cases, it literally is a lifesaver.

I have seen and experienced first hand the absolute horror of depressive episodes and would honestly not wish it upon my worst enemy. If someone doesn't have to go through it because of unsympathetic gp's handing out prozac like they're sweets, then so be it.

i find the whole therapy/counselling route, while being beneficial to people experiencing mild depression (maybe caused by all manner of cognitive distortions) is a very time consuming and expensive area. And also one riddled with bull****. having read much of Aaron Beck's work (CBT creator), I have found there is a very naive conception of clinical depression in this world.

I'm not ridiculing these approaches for everyone (i'm sure it's worked for many people), but realistically (and statistically) your best chance of surviving serious depression is a good psychiatrist and whatever cocktail of drugs he may feel is right to end your suffering.
I spent much of my adult life enduring agonising depression and looking for answers and solutions everywhere - workaholism, alcoholism, obsessive perfectionism, recreational drugs, tai chi, yoga, fitness, self-help books, light therapy, CBT, psychotherapy, hypnotherapy, counselling, etc, etc,

But to be honest, none of those did a fraction of what psychiatric drugs did to improve my life. While the drugs may take a long time to work properly, it's only in hindsight you realise how much of a difference they make.

tallaght01

The high suicide rate doesn't neccesariy correate with either A) a high depression rate (ie, you don't get X number of suicides per Y number of depressions in a popuation) or a high rate of misdiagnoses. I woud imagine the type of peope who are depressed enough to kill themseves are not the ones that typically get missed.

I would agree that antidepressants are possibly overdiagnosed in mild depression, where they aren't though to be very useful as first line treatment.

I don't know about the study you're taking about with the 80% figure quaoted. But A) you don't say how many of these people were being treated already when they commited suicide, It's gotta be hard to get reliable evidence of "clear symptoms" of depression after someone is dead. And C) You don't say how many of these had been to a doctor and not been given any treatment.

tallaght01

jtsuited wrote: »

yeah i see your point. i don't know the exact statistics here but i think they did a study of suicides and found that near 80% were showing clear symptoms of a depressive episode.

To be honest, after a few years of looking into this, I feel that GPs over-prescription of ssri's is not necessarily a bad thing. while there are side-effects and horror stories, for the vast majority of people who are prescribed them they work quite effectively.

I may differ from some people in that I don't believe in any sort of noble suffering. If you are depressed, and there's something that makes you not feel so bad that has comparatively few downsides, I don't see any reason not to take it. In so many cases, it literally is a lifesaver.

I have seen and experienced first hand the absolute horror of depressive episodes and would honestly not wish it upon my worst enemy. If someone doesn't have to go through it because of unsympathetic gp's handing out prozac like they're sweets, then so be it.

i find the whole therapy/counselling route, while being beneficial to people experiencing mild depression (maybe caused by all manner of cognitive distortions) is a very time consuming and expensive area. And also one riddled with bull****. having read much of Aaron Beck's work (CBT creator), I have found there is a very naive conception of clinical depression in this world.

I'm not ridiculing these approaches for everyone (i'm sure it's worked for many people), but realistically (and statistically) your best chance of surviving serious depression is a good psychiatrist and whatever cocktail of drugs he may feel is right to end your suffering.
I spent much of my adult life enduring agonising depression and looking for answers and solutions everywhere - workaholism, alcoholism, obsessive perfectionism, recreational drugs, tai chi, yoga, fitness, self-help books, light therapy, CBT, psychotherapy, hypnotherapy, counselling, etc, etc,

But to be honest, none of those did a fraction of what psychiatric drugs did to improve my life. While the drugs may take a long time to work properly, it's only in hindsight you realise how much of a difference they make.

Definitely agree with some of this.

CBT etc does work well for alot of patients.

But anti-depressants get a bad name, when we've all seen the dramatic effect they can have on a person's illness. They can be a godsend for a lot of patients. Shame how many peope keep getting told by friends and family that they're highy addictive,

nesf

tallaght01 wrote: »

But anti-depressants get a bad name, when we've all seen the dramatic effect they can have on a person's illness. They can be a godsend for a lot of patients. Shame how many peope keep getting told by friends and family that they're highly addictive,

a) Misinformation, b) General stigma and c) they're effectiveness is "questioned" by their over prescription in cases where they'll most likely have little benefit for the individual. So the person gets to go through some unpleasant side effects for several weeks for no benefit. Paracetamol only working with really bad pain not your average headache would be a tidy analogy imho.

I've also a sneaking suspicion that for some people medication is bad because it's artificial. Working along the same lines as artificial colours are bad etc. Now, I only wish the sedative side of my drugs would actually kick in at some point.

nesf

jtsuited wrote: »

To be honest, after a few years of looking into this, I feel that GPs over-prescription of ssri's is not necessarily a bad thing. while there are side-effects and horror stories, for the vast majority of people who are prescribed them they work quite effectively.

I pretty much agree with you about the effectiveness of medication in general and how it deserves more credit than it gets. However, I disagree with you here. If you look at the recent research over and over again SSRIs are being shown to be relatively ineffective for mild depression yet they are the front line treatment handed out by many GPs in many countries. Some studies have Prozac and the like no more effective than placebos in some cases. These aren't the wonder drugs that have little to no side effects and fantastic effectiveness that they were once thought to be. The prescription of medication where it is unnecessary is something that we should avoid, generally speaking.

jtsuited

nesf wrote: »

I pretty much agree with you about the effectiveness of medication in general and how it deserves more credit than it gets. However, I disagree with you here. If you look at the recent research over and over again SSRIs are being shown to be relatively ineffective for mild depression yet they are the front line treatment handed out by many GPs in many countries. Some studies have Prozac and the like no more effective than placebos in some cases. These aren't the wonder drugs that have little to no side effects and fantastic effectiveness that they were once thought to be. The prescription of medication where it is unnecessary is something that we should avoid, generally speaking.

I have read many of the studies you are referring to here, and to be honest I have not been convinced by them. The prozac versus placebo studies were carried out on mild to moderate cases iirc.

Yes prozac etc. will have little effect on mild depression. probably because this 'mild' depression is an entirely different entity than real clinical depression and in these cases a change of diet, fitness regime, and talking to someone will fix their problem to a certain extent.

my point was that I feel GP's overprescribe as a safety measure more than anything else.

It's quite clear that serious depression is rampant in this part of the world. I know you disagree with my admittedly vague statements about most suicides being caused by severe depression (i'll try find the statistic later), but suicide is not an act carried out by someone who is mentally balanced and not enduring extreme psychological suffering (well most of the time anyway). Maybe it's a debate for a different day (or thread).

Because of this huge health risk (again I know you don't necessarily agree with me on the suicide-depression thing. i'm just explaining my reasoning behind my opinion), i think it's fairly acceptable to overprescribe even if it causes some people unpleasant side effects etc.
It's a risk that can be rationally taken in order to prevent more serious events (suicide) taking place.

To be honest, there is a fairly easy way of working this out mathematically. Not being a GP, I don't have the figures necessary to do such a calculation, but it would basically be:

the harm of prescribing ssri's to people who don't need them and of those people being harmed by said prescription

versus

the serious cases which may not be easily and quickly diagnosed and in which cases the prescription acts as a lifesaver to the sufferer.

Anyone an actuary?
I can make a reasonable guess that while it may come across as being unsympathetic the line taken by many GPs is the one that works out better in a pragmatic sense.

jtsuited

nesf wrote: »

I've also a sneaking suspicion that for some people medication is bad because it's artificial. Working along the same lines as artificial colours are bad etc. Now, I only wish the sedative side of my drugs would actually kick in at some point.

yes, I think this is a huge problem. If we weren't surrounded by 'artificial' light, 'artificial' noise, and an environment highly conducive to massive stress levels the argument would hold some sort of validity. however, we'd also have to start living in the sticks, hunting our own food, not using fire (an 'artificial' method of cooking food) and a load of other things.

The 'artificial is bad' argument really gets my goat as it has absolutely no substance whatsoever and seems like a hangover from the 'new-age/organic/etc' boom.

nesf

jtsuited wrote: »

I have read many of the studies you are referring to here, and to be honest I have not been convinced by them. The prozac versus placebo studies were carried out on mild to moderate cases iirc.

Yes prozac etc. will have little effect on mild depression. probably because this 'mild' depression is an entirely different entity than real clinical depression and in these cases a change of diet, fitness regime, and talking to someone will fix their problem to a certain extent.

my point was that I feel GP's overprescribe as a safety measure more than anything else.

Your post talked about the vast majority of people prescribed with these drugs not cases of real clinical depression not people with "real clinical depression". I sincerely doubt that the vast majority of prescriptions of SSRIs are for "real clinical depression" considering how easily these prescriptions are handed out. I'm not trying to attack you here or anything, I'm just not quite sure what you're trying to say. Do you mean that GPs are accurately prescribing these drugs on average or do you mean that it's worth mistakenly prescribing these drugs to get it right occasionally (the shotgun approach). The latter questions whether GPs are the correct first line in the treatment of mental illness (imho).

jtsuited

i'm firmly of the opinion that they're using the shotgun approach. sorry for not being clear. it's late and i'm also waiting for a sedative to kick in !!

tbh i don't think it questions whether GPs are the correct first line. Ideally it should be a situation where someone sees a GP, is referred to a psychiatrist and then it goes from there.
the reality of the situation is that in many cases (enough in my opinion to justify the shotgun approach) there will be an interval where the patient will be at risk of committing suicide without some sort of serious intervention.

i understand you're not having a go. I think our disagreement is more about whether the risk justifies the practice of overprescribing ssri's. You feel (and quite understandably at that) that the wreckless overprescription of these drugs does more harm than good. I feel that because of the small percentage of cases where it does good justifies this practice.
It's a fairly minor disagreement in my opinion and you've made a lot of very valid points in your posts.
Admittedly, this is more of a suspicion/hunch of mine and a relatively vague opinion on the matter than anything I can really prove conclusively.

jtsuited

also from what i've read, the shotgun approach is used quite widely in modern medicine, particularly in psychiatry where we are only beginning to even see the tip of the iceberg of understanding the human brain/mind.

Agonist

tallaght01 wrote: »

Agonist....1 year waitinf for CBT?? That's pretty shocking. I had no idea that was the case in Ireland.

As for the GP providing CBT. It would be pretty unlikely that he/she isn't from a psych background. Sure, anyone can offer it, but it would be frowned on by there psychiatry colleagues. He could be an ex-psych. Lots of specialists go into GP-land. Lots of my paediatrics colleagues have gone off to become GPs and offer minor specialist services in that area.

He's definitely 'just' a GP. I've been a patient of his since he first opened his pratice as a young doctor. He may be doing a training course in CBT now but either way he's playing with fire, using people with mental illness to experiment on. I'll be mentioning it to my psychiatrist when I see him.

AckwelFoley

My problem with GP's is exactly that.. they are simply general Practictioners. They dont really know detailed information about any one topic. They do a good job, but you wouldnt go to one to get a lump taken off your breast or conduct heart surgery..

Yet i find many ppl deal only with them and are prescribed the meds.

This is not enough for serious suffers like myself and it took me a long time to find this out.

AckwelFoley

i came to the conclusion this weekend that i feel that ive become resigned to the fact that some day i will die other than a natural cause. Im feeling great now, and rather positive, but if i ever get into the same situation i was in over the last 2 months of 07 i think i wouldnt be strong enough to deal with it.

I fear that some life crisis, such as the loss of a parent or close relative will put me in a situation where i will just give up. What scare sme the most about this, if im resigned to this fact when im in great form / mood like now.. what happens when i get into a severe depressive situation like 2007? Im freaking out a little about it to be honest and it worrys me. Ive always been able to deal with my depressive moods until the ast one, but its had such an effect on me its like a serious wound im trying to keep safe, and protect it from agrivating it... My medication does help to stabilise my depression, but seems ineffective in preventing a serious depressive state

Im really worried about my longterm future.. Ironically i get depressed thinking about it *sigh*

nesf

The thing is, with depressions, you do come up out of them eventually (as long as you're being a good boy and seeing your therapists/taking your meds). Don't worry about 07, you might never go as low again and talk to your psychiatrist about your fears. He/She will be able to give you some prognosis about relapse and the signs to watch for (i.e. when you see them, talk to a professional about them before it becomes a full blown mania or depression).

I'm used to some of my cycles at this stage and I get through the depressions simply by clutching to the thought that things will pick up after Easter.

kelle

After my second child was born, I suffered postnatal depression which lasted for several weeks. It was the worst feeling ever and I wouldn't wish it on anybody.
What astounded me was the attitude of the medical profession to my illness. When I told the midwives one night I was feeling so bad I wanted to throw myself out of a window I was told the doctors were too busy and to return to my room, my feelings were normal. I discharged myself from hospital even though I was only 3 days post Caesarean Section.
At home, I was very tearful, I couldn't eat. My poor mother and husband did their best to try and make things as good as they could for me, but I knew they were both worried sick. I went to my GP about it, but he kept emphasising to me that my feelings were perfectly normal! The thing is, they did NOT feel normal to me. He wouldn't prescribe me any medication. (Same GP failed to diagnose my friend's baby's meningitis, and it's a miracle this child is still alive! - Thank God he no longer practices in my town)
I'll never know how I got through it. I'm still angry at the way I was treated, as my children who were both under 2 at the time could have been left without a mother.
I was better prepared when I was going into hospital to have no.3 - I made sure to have a supply of Xanax in my handbag (handy when you work in a hospital and you can get doctor friends to write prescriptions). As it happens, I got no PND!

Snyper, I'm sorry to read about your depression and I wish you all the best.

nesf

kelle wrote: »

I was better prepared when I was going into hospital to have no.3 - I made sure to have a supply of Xanax in my handbag (handy when you work in a hospital and you can get doctor friends to write prescriptions). As it happens, I got no PND!

Your friend prescribed you Xanax when there was nothing wrong with you?


You also do realise that your GP might have been right and that you might have not needed medication, don't you?

AckwelFoley

nesf wrote: »

The thing is, with depressions, you do come up out of them eventually (as long as you're being a good boy and seeing your therapists/taking your meds). Don't worry about 07, you might never go as low again and talk to your psychiatrist about your fears. He/She will be able to give you some prognosis about relapse and the signs to watch for (i.e. when you see them, talk to a professional about them before it becomes a full blown mania or depression).

I'm used to some of my cycles at this stage and I get through the depressions simply by clutching to the thought that things will pick up after Easter.

Thanks for the advice Nesf.

Do you ever just get tired of it tho? Burnt out?

tbh

couple of typos there synper that made it a bit ambiguous as to what you were saying. I changed "tough" to "tho", hope that's ok

nesf

snyper wrote: »

Do you ever just get tired of it tho? Burnt out?

Yes, constantly. It's a marathon not a sprint though, when I'm depressed or in a dysphoric mania I just try to get to the end of the week, I try not to think too much about the bigger picture because through the lens of depression even the most positive things can seem negative. It's a hard habit to get into but focussing more on getting through today rather than focussing on how you'll ever survive another two or three months possibly of it make's things easier to handle.

The best advice I can give you is that when you're not cycling and neither depressed nor elated is to just ****ing enjoy it while it lasts and try not to think too hard about possible future episodes. Enjoy today while you're capable of enjoying things rather than worrying about some indeterminate day next year when you mightn't be able to even enjoy playing with your kid or similar.

kelle

nesf wrote: »

Your friend prescribed you Xanax when there was nothing wrong with you?

A very understanding one, who knew what PND was like. If I'd got it again I wasn't going to risk being ignored my nursing and medical staff as I had before!

nesf wrote: »

You also do realise that your GP might have been right and that you might have not needed medication, don't you?

My ex-GP! I definitely don't think he was right, I think he was neglectful. I've got a different GP now, and he is very understanding about depression.

nesf

kelle wrote: »

A very understanding one, who knew what PND was like. If I'd got it again I wasn't going to risk being ignored my nursing and medical staff as I had before!

Yeah but benzos aren't exactly something they should hand out easily. They're really not something you "want to get used to".

kelle wrote: »

My ex-GP! I definitely don't think he was right, I think he was neglectful. I've got a different GP now, and he is very understanding about depression.

Fair enough, some of them are clueless about psychiatry from my experience but meds aren't necessarily the answer for everyone and it's sometimes better to try the psychological approaches first (less side effects for one thing).

kelle

nesf wrote: »

Yeah but benzos aren't exactly something they should hand out easily. They're really not something you "want to get used to".



Fair enough, some of them are clueless about psychiatry from my experience but meds aren't necessarily the answer for everyone and it's sometimes better to try the psychological approaches first (less side effects for one thing).

True. You sound like my mother:D. Only for her I would never have got through my PND. Sadly she has since died. That was the main reason I wanted medication should it happen again, as I knew I wouldn't have her there to help me. But she must have been looking after me....

nesf

kelle wrote: »

True. You sound like my mother:D. Only for her I would never have got through my PND. Sadly she has since died. That was the main reason I wanted medication should it happen again, as I knew I wouldn't have her there to help me. But she must have been looking after me....

My advice, don't get too used to renewing the prescription for them. I've seen people who don't need them start to need them if you get what I mean.

AckwelFoley

Its been a year since i had my serious breakdown that left me out of work for 2 months and got me hooked on boards

Since January my life has changed very much. Its been a battle and very difficult, I started a new relationship with a woman in June, she was told pretty early on in the relationship about my Manic depression. I have to say i have gone well over 6 months now without feeling any serious periods of depression. If i can get through the winter into the spring on the same note i will be a happy camper