Do you consider Depression an Illness?

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

Bottle_of_Smoke

So are you permanently on meds?

I ask because my uncle has the same condition. Are there different levels of manic depression? I was goign out with a girl once who told me she had it but she wasn't taking anything for it.

You mentioned alcohol earlier in the thread, can this be taken with meds like lithium? I mean I'd heard before my uncle couldn't drink due to his meds(long time ago) but he was drinking when I saw him about 6 weeks ago around others(including his wife who I know wouldn't put up with it if he wasn't supposed to be drinking)

I worry about my uncle because I don't think his siblings are the type of people who would understand something like manic depression. My dad will always be there for him, has helped him out big time during manic episodes but I just don't think he knows enough to help him properly, I recently explained to him that manic depression and scizophrenia were in fact, not the same thing.

I wish I knew my uncle better to be honest, I think I understand it more than a lot of people around him + I think he might find it easier to talk to someone outside his immediate family. Unfortunately I don't think he knows I know and its not an easy thing to bring up.

Apologies for hijacking your thread but any info would be appreciated.

Queen-Mise

it is really good to hear you getting on well now snyper. does the winter affect you, does it bring you down at all.

for the past few years the winter has caught me horribly

nesf

Bottle_of_Smoke wrote: »

So are you permanently on meds?

I ask because my uncle has the same condition. Are there different levels of manic depression? I was goign out with a girl once who told me she had it but she wasn't taking anything for it.

You mentioned alcohol earlier in the thread, can this be taken with meds like lithium? I mean I'd heard before my uncle couldn't drink due to his meds(long time ago) but he was drinking when I saw him about 6 weeks ago around others(including his wife who I know wouldn't put up with it if he wasn't supposed to be drinking)

I worry about my uncle because I don't think his siblings are the type of people who would understand something like manic depression. My dad will always be there for him, has helped him out big time during manic episodes but I just don't think he knows enough to help him properly, I recently explained to him that manic depression and scizophrenia were in fact, not the same thing.

I wish I knew my uncle better to be honest, I think I understand it more than a lot of people around him + I think he might find it easier to talk to someone outside his immediate family. Unfortunately I don't think he knows I know and its not an easy thing to bring up.

Apologies for hijacking your thread but any info would be appreciated.

It can be permanent or it can be temporary medication depending on the person and their exact medical condition. The medication may require you to never drink or merely not drink too much too often. It'll be down to his doctor/psychiatrist and they should be telling him whether or not to drink etc. If he is still on drugs it should state on the label giving directions on how to taken them whether he should or should not avoid alcohol.