6 ms·

When you use words like "bi-polar and depression" it gives the sense that this is a medical disease. And while speaking strictly, it is indeed a medical disease

When you use words like "bi-polar and depression" it gives the sense that this is a medical disease. And while speaking strictly, it is indeed a medical disease -- I want people to see the raw human factor in this. Depression, for example, in my experience, and from what I've seen -- often has a cause; a rational, explainable cause (that the sufferer often isn't aware of). When you treat someone's depression as a "medical disease" like the cold or the flu, you are completely ignoring the human factor. Many cases of depression can actually be solved without drugs -- by addressing the problem at the root of it. "Feeling Good: The New Mood Therapy" by David D. Burns, goes into this. (http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/0380810336 http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/03808...) I don't know why people ignore the real human factor when it comes to depression. Instead they resort to a bunch of drugs that do not address the root (psychological) cause of the depression, but rather just give some temporary fleeting relief.

tjtrapp 13y ago
Pills are easy... Aside from a 30 minute visit to the doc. Addressing the root cause typically requires working with others over a period of time... and that work is oftentimes what people with depression want to avoid.
- thoughtcriminal 13y ago
  No. That's a lie. I'm bipolar and have spells of depression that feel like doom. I've been dealing with it as long as I can remember. It can get really bad. Working out helps (if I have the strength to move), medication helps, but nothing and I mean NOTHING can make it go away until it has run its course.
marquis 13y ago
The many many people in our lives suffering from a chemical/medical issue can not solve their problems with therapy alone. Depression is multi-factored and definitely partly chemical - maybe for some it's solved by spending more time in the sun but for many of our friends it is a serious clinical issue not to be mistaken as having a purely talk-it-out solution. Stephen is an excellent example here: he has the sheer intellect and forwardness of self-examination to know it can't be beat without looking at all factors and wouldn't presume to say that it's solved with drugs, or therapy, alone.
- ghswa 13y ago
  And in these cases the situation can be exasperated by well meaning friends, relatives and practitioners searching for a root cause that, if addressed, will make it all go away.
  - daeken 13y ago
    Jesus christ, yes. This is why many people suffering from mental illness don't talk about their problems: they end up feeling worse because their friends either try to "fix" them, or they end up comforting the friend, or both. It's always with the best of intentions, but I recently had an experience where I truly understood how terminal cancer patients feel; a friend wanted so badly to help, and kept feeling worse and worse about what was going on with me, and I just tried my best to comfort them at my own expense. When the only reason you haven't killed yourself is that you don't have the strength to do so, the last thing you want to do is have the people you love going down with you. (Note, before people get worried: I'm on the way up again now, and getting the help I need to ensure I don't get bad again.)
    - m-ramige 13y ago
      I always cringe when I hear or read a non-depressed person's advice to a depressed person. It often involves getting more exercise and going out in the sun. Getting more exercise and sunlight might help this person, but it probably won't be enough. The person will probably need cognitive-behavioral therapy and maybe even medication. Even then, a depression-free life is not guaranteed. Mental illness is complicated.
    - meric 13y ago
      If I was one of your friends, would you have liked me to have just treated you as I normally do? If I had someone close who was dying, when I'm seeing them I think I'd just interact with them as I normally do (though accepting and recognising they are, in fact, dying), and not let the fact that they were dying to get in the way of our relationship. I rationalize this by thinking people don't want to feel being pitied upon. They want to feel important; and seeing them just because I want to see them would help in that regard. Am I doing the right thing?
thisone 13y ago
mental illness is an illness where something has gone wrong with the body in the same way that cancer is an illness where something has gone wrong with the body. Stigmatizing it in any way is not useful. Telling people to "just be happy!" isn't useful.
anigbrowl 13y ago
Temporary relief may be what is needed under many circumstances. I'm personally quite clear on the roots of my depression, but that doesn't make it easier to cope with. For some people it's a mystery or problem that once solved, ceases to be debilitating. For others it's an endocrine problem, best treated with drugs. For yet others, it is best treated with cognitive exercise. Each case is different and dismissing a whole class of clinical strategies is no better than treating those strategies as a panacea.
adrianbye 13y ago
what is ignored (thanks to psychiatry being left wing, and trying to mitigate the downside rather than build on the upside) is that bipolar brings a lot of BENEFITS. when bipolar people are very hyper, they can achieve great things. thats the reason why people with bipolar usually don't want to be medicated - the highs bring genius.. the problem are the lows which follow it. average people don't make the big breakthroughs. http://en.wikipedia.org/wiki/List_of_people_with_bipolar_disorder http://en.wikipedia.org/wiki/List_of_people_with_bipolar_dis...
- solomatov 13y ago
  In bipolar disorder, depressive episodes are much more common than manic episodes. They get high , but they suffer much more than they gain from their illness and AFAIK, bipolar depression is much worse than usual unipolar depression and much much worse than depression caused by life events.
  - ghswa 13y ago
    I'm not aware of any conclusive research showing that depression is more common than mania although people are more likely to seek treatment when depressed than when they're manic. I also struggle to believe that there is any evidence to support your claim that depression as experienced by somebody who is bipolar is worse than somebody who is unipolar which is again worse than depression caused by life events.
- ghswa 13y ago
  This doesn't sound like you're talking from personal experience. Saying that the highs bring genius is a gross simplification. Yes, manic episodes can provide productivity boosts and huge amounts of energy but it doesn't have to go much further before it becomes impossible to complete a thought let alone a sentence, where you cannot sit still, where your judgement is severely impaired or you're suffering psychoses. None of these symptoms (and there are many more) are particularly conducive to productive work, let alone breakthroughs.
  - 13y ago
gregorymichael 13y ago
Are anti-depressants over prescribed? Sure. Are there cases where the root cause of depression is biochemical? Yes. I've been on meds for bipolar for five years, and I see a therapist every week. The meds get me stable - like healing a broken broken leg - and the therapy is my personal trainer building me up to run the marathon. Neither would be as effective without the other, but in my case, if I could only have one, it'd be the meds.
solomatov 13y ago
There are cases of depression, so called endogenous depression, which can't be cured in any other way than with medication.
DanBC 13y ago
Fry has Bipolar Disorder, diagnosed in England. This is a very different illness to depression. And depression has different forms. Yes, talking therapies are powerful. But you seem to be making the mistake that a talking therapy isn't affecting brain chemistry, or that drugs are inherently bad. Comments like yours are very frustrating. Do you talk about people ignoring the real human factor when we put a broken bone in a cast?
- gruseom 13y ago
  But the biological theory of mental illnesses is very far from established. We have no reliable way of identifying them and no understanding of their mechanism. Existing studies of the medications we use to treat them have been subjected to pretty devastating critique; e.g. the most comprehensive review of the SSRI studies (by Irving Kirsch et. al.) found no clinical significance beyond placebo for the vast majority of patients. The belief that mental illness is biological ("chemical imbalance in the brain" and so on) is very widespread and very emphatic. But the gap between that and what we actually know is drastic. What explains that gap? Most likely, it's that (a) people very much want to believe it, and (b) the belief has been heavily marketed.
  - scott_s 13y ago
    Steven Novella addresses the biological theory of mental illness quite well in this 10 minute segment from the podcast The Skeptics Guide to the Universe: http://www.youtube.com/watch?v=-MLdvKzLl6k http://www.youtube.com/watch?v=-MLdvKzLl6k
  - logjam 13y ago
    > the most comprehensive review of the SSRI studies (by Irving Kirsch et. al.) found no clinical significance beyond placebo for the vast majority of patients. No. Biological theories of mental health and mental illness are very much established. And yours is a complete mischaracterization of the work of Kirsch et al. Their meta-analysis found that in ALL cases of depression, there is statistically significant improvement in quantitative measures of depression treated with SSRI. In moderate to severe cases of depression, the improvement was clinically significant (ie a clinician and patient clearly note the improvement). The meta-analysis done on clinical trials were overwhelmingly trials of 6 weeks of SSRI or less. Suicidal patients are almost all excluded from such trials. Treatment groups were treated with SSRIs via research protocols, and not usual clinical practice: there were no attempts made to match patients to an SSRI that would be most likely to help, to wait on a response, to use SSRIs that were helpful based on a family history; dose adjustments were typically prescribed by study protocol and not by patient response, patients were not switched to another SSRI when there was no response or if intolerable side effects developed, often no attempt to treat side effects with other agents were done, etc. In other words, none of the things any physician routinely does to optimize treatment were done in those trials, and yet there were STILL improvements in measures of depression across the board. No reputable psychiatrist or physician will fail to recommend an SSRI in cases of moderate to severe depression. Therapy can also be helpful, but the evidence is overwhelming that SSRIs help in clinically significant ways in moderate to severe depression. There is no credible doubt about it. Despite your assertions about what "people very much want to believe" - in my experience, people very much want to believe that the brain is somehow different - that something beyond biology is at work. Believing that somehow depressed or otherwise mentally ill people can just "snap out of it" or "pull themselves up by their bootstraps" is erroneous, unhelpful, but fits nicely into really completely shitty and cruel narratives about human beings. But please. Perhaps you'd like to advance a theory on how an organ like the brain differs from every other organ and does its work in ways not explainable by biology, chemistry, physics, etc.
hvs 13y ago
Bipolar disorder cannot be solved with therapy. Additionally, clinical depression is different from situational depression. Yes, you are right, that many people would benefit from therapy in addition to drugs, but bipolar disorder, especially, is not a disease that responds to it. It is a chemical/biological disorder and needs to be treated as such.
edwkar 13y ago
I roughly agree with your sentiment, but your last sentence is IMO a bit too rough with the "resort to a bunch of drugs" part. Any psychiatrist worth his salt, will primarly prescribe drugs as a means to help people cope, while working on the actual underlying causes. Indeed, in many cases, using drugs in the treatment may be the only option to make the patient's day-to-day life bearable. Drugs may also be essential for allowing the treatment team to examine, possibly very problematic, underlying issues. Also, a SSRI, for instance, can of course not "treat" someone of a clinical depression; you will virtually always need professional cause-oriented therapy to get better. Most patients know this, or will realize it as they experience how their meds work. Finally, there are some mental disorders, and many individual cases, that require constant medication, despite of the quality of the other treatment given. For example, full-fleged bi-polar disorder, where a manic or a depressive episode may have very severe consequences.
rhizome 13y ago
As a counterpoint, I offer Robert Sapolsky, who most emphatically calls depression a disease: http://www.youtube.com/watch?v=NOAgplgTxfc http://www.youtube.com/watch?v=NOAgplgTxfc
- scott_s 13y ago
  I've watched 11 minutes of it, and I plan to watch the rest. Fascinating lecture.
  - stevenrace 13y ago
    This lecture is part of Dr. Sapolsky's Stanford class on 'Behavioral Biology', which in itself is captivating.
deleted 13y ago
[deleted]
vacri 13y ago
Please stop spreading misinformation. There are many kinds of depression, and there are two significant camps - little-d depression, which is depressed mood from negative life events (missing the bus up to funerals) and big-d Depression, which has biological elements and is what people mean by 'clinical depression'.
joshhart 13y ago
I have read that book and it is indeed very good because it gives the reader tools to succeed and the clinical research proving that what we think and the way we think greatly influences our mood. Dr. Burns stated that the methods often work best when used in conjunction with medication. Some people may be so far down the rabbit hole that medication is necessary to restore improper brain chemistry.
baby 13y ago
Are people really not aware nowadays that Depression is used wildly and can be a real neuro-disease? Did you know they can surgically put a pacemaker in your brain to "treat" you? I thought it was common knowledge.
baby 13y ago
Are people really not aware nowadays that Depression is used wildly and can be a real neuro-disease? Did you know they can surgically put a pacemaker in your brain to "treat" you? I thought it was common knowledge.
andrewfelix 13y ago
"Depression, for example, in my experience, and from what I've seen..." Your anecdotal observations shouldn't drive your understanding. Go read up on it. Suffering from mental illness myself I find your post quite offensive.
PeterisP 13y ago
Even in cases that can/should be solved by addressing a root problem, often you still want to apply drugs so that the patient doesn't, for example, kill himself in a down period between his/her second and third psychotherapy session.
stef25 13y ago
It IS a disease in the sense that it's an abnormal reaction to something.

tjtrapp 13y ago

Pills are easy... Aside from a 30 minute visit to the doc. Addressing the root cause typically requires working with others over a period of time... and that work is oftentimes what people with depression want to avoid.

thoughtcriminal 13y ago
No. That's a lie. I'm bipolar and have spells of depression that feel like doom. I've been dealing with it as long as I can remember. It can get really bad. Working out helps (if I have the strength to move), medication helps, but nothing and I mean NOTHING can make it go away until it has run its course.

marquis 13y ago

The many many people in our lives suffering from a chemical/medical issue can not solve their problems with therapy alone. Depression is multi-factored and definitely partly chemical - maybe for some it's solved by spending more time in the sun but for many of our friends it is a serious clinical issue not to be mistaken as having a purely talk-it-out solution. Stephen is an excellent example here: he has the sheer intellect and forwardness of self-examination to know it can't be beat without looking at all factors and wouldn't presume to say that it's solved with drugs, or therapy, alone.

ghswa 13y ago
And in these cases the situation can be exasperated by well meaning friends, relatives and practitioners searching for a root cause that, if addressed, will make it all go away.
- daeken 13y ago
  Jesus christ, yes. This is why many people suffering from mental illness don't talk about their problems: they end up feeling worse because their friends either try to "fix" them, or they end up comforting the friend, or both. It's always with the best of intentions, but I recently had an experience where I truly understood how terminal cancer patients feel; a friend wanted so badly to help, and kept feeling worse and worse about what was going on with me, and I just tried my best to comfort them at my own expense. When the only reason you haven't killed yourself is that you don't have the strength to do so, the last thing you want to do is have the people you love going down with you. (Note, before people get worried: I'm on the way up again now, and getting the help I need to ensure I don't get bad again.)
  - m-ramige 13y ago
    I always cringe when I hear or read a non-depressed person's advice to a depressed person. It often involves getting more exercise and going out in the sun. Getting more exercise and sunlight might help this person, but it probably won't be enough. The person will probably need cognitive-behavioral therapy and maybe even medication. Even then, a depression-free life is not guaranteed. Mental illness is complicated.
  - meric 13y ago
    If I was one of your friends, would you have liked me to have just treated you as I normally do? If I had someone close who was dying, when I'm seeing them I think I'd just interact with them as I normally do (though accepting and recognising they are, in fact, dying), and not let the fact that they were dying to get in the way of our relationship. I rationalize this by thinking people don't want to feel being pitied upon. They want to feel important; and seeing them just because I want to see them would help in that regard. Am I doing the right thing?

thisone 13y ago

mental illness is an illness where something has gone wrong with the body in the same way that cancer is an illness where something has gone wrong with the body. Stigmatizing it in any way is not useful. Telling people to "just be happy!" isn't useful.

anigbrowl 13y ago

Temporary relief may be what is needed under many circumstances. I'm personally quite clear on the roots of my depression, but that doesn't make it easier to cope with. For some people it's a mystery or problem that once solved, ceases to be debilitating. For others it's an endocrine problem, best treated with drugs. For yet others, it is best treated with cognitive exercise. Each case is different and dismissing a whole class of clinical strategies is no better than treating those strategies as a panacea.

adrianbye 13y ago

what is ignored (thanks to psychiatry being left wing, and trying to mitigate the downside rather than build on the upside) is that bipolar brings a lot of BENEFITS. when bipolar people are very hyper, they can achieve great things. thats the reason why people with bipolar usually don't want to be medicated - the highs bring genius.. the problem are the lows which follow it. average people don't make the big breakthroughs. http://en.wikipedia.org/wiki/List_of_people_with_bipolar_disorder http://en.wikipedia.org/wiki/List_of_people_with_bipolar_dis...

solomatov 13y ago
In bipolar disorder, depressive episodes are much more common than manic episodes. They get high , but they suffer much more than they gain from their illness and AFAIK, bipolar depression is much worse than usual unipolar depression and much much worse than depression caused by life events.
- ghswa 13y ago
  I'm not aware of any conclusive research showing that depression is more common than mania although people are more likely to seek treatment when depressed than when they're manic. I also struggle to believe that there is any evidence to support your claim that depression as experienced by somebody who is bipolar is worse than somebody who is unipolar which is again worse than depression caused by life events.
ghswa 13y ago
This doesn't sound like you're talking from personal experience. Saying that the highs bring genius is a gross simplification. Yes, manic episodes can provide productivity boosts and huge amounts of energy but it doesn't have to go much further before it becomes impossible to complete a thought let alone a sentence, where you cannot sit still, where your judgement is severely impaired or you're suffering psychoses. None of these symptoms (and there are many more) are particularly conducive to productive work, let alone breakthroughs.
- 13y ago

gregorymichael 13y ago

Are anti-depressants over prescribed? Sure. Are there cases where the root cause of depression is biochemical? Yes. I've been on meds for bipolar for five years, and I see a therapist every week. The meds get me stable - like healing a broken broken leg - and the therapy is my personal trainer building me up to run the marathon. Neither would be as effective without the other, but in my case, if I could only have one, it'd be the meds.

solomatov 13y ago

There are cases of depression, so called endogenous depression, which can't be cured in any other way than with medication.

DanBC 13y ago

Fry has Bipolar Disorder, diagnosed in England. This is a very different illness to depression. And depression has different forms. Yes, talking therapies are powerful. But you seem to be making the mistake that a talking therapy isn't affecting brain chemistry, or that drugs are inherently bad. Comments like yours are very frustrating. Do you talk about people ignoring the real human factor when we put a broken bone in a cast?

gruseom 13y ago
But the biological theory of mental illnesses is very far from established. We have no reliable way of identifying them and no understanding of their mechanism. Existing studies of the medications we use to treat them have been subjected to pretty devastating critique; e.g. the most comprehensive review of the SSRI studies (by Irving Kirsch et. al.) found no clinical significance beyond placebo for the vast majority of patients. The belief that mental illness is biological ("chemical imbalance in the brain" and so on) is very widespread and very emphatic. But the gap between that and what we actually know is drastic. What explains that gap? Most likely, it's that (a) people very much want to believe it, and (b) the belief has been heavily marketed.
- scott_s 13y ago
  Steven Novella addresses the biological theory of mental illness quite well in this 10 minute segment from the podcast The Skeptics Guide to the Universe: http://www.youtube.com/watch?v=-MLdvKzLl6k http://www.youtube.com/watch?v=-MLdvKzLl6k
- logjam 13y ago
  > the most comprehensive review of the SSRI studies (by Irving Kirsch et. al.) found no clinical significance beyond placebo for the vast majority of patients. No. Biological theories of mental health and mental illness are very much established. And yours is a complete mischaracterization of the work of Kirsch et al. Their meta-analysis found that in ALL cases of depression, there is statistically significant improvement in quantitative measures of depression treated with SSRI. In moderate to severe cases of depression, the improvement was clinically significant (ie a clinician and patient clearly note the improvement). The meta-analysis done on clinical trials were overwhelmingly trials of 6 weeks of SSRI or less. Suicidal patients are almost all excluded from such trials. Treatment groups were treated with SSRIs via research protocols, and not usual clinical practice: there were no attempts made to match patients to an SSRI that would be most likely to help, to wait on a response, to use SSRIs that were helpful based on a family history; dose adjustments were typically prescribed by study protocol and not by patient response, patients were not switched to another SSRI when there was no response or if intolerable side effects developed, often no attempt to treat side effects with other agents were done, etc. In other words, none of the things any physician routinely does to optimize treatment were done in those trials, and yet there were STILL improvements in measures of depression across the board. No reputable psychiatrist or physician will fail to recommend an SSRI in cases of moderate to severe depression. Therapy can also be helpful, but the evidence is overwhelming that SSRIs help in clinically significant ways in moderate to severe depression. There is no credible doubt about it. Despite your assertions about what "people very much want to believe" - in my experience, people very much want to believe that the brain is somehow different - that something beyond biology is at work. Believing that somehow depressed or otherwise mentally ill people can just "snap out of it" or "pull themselves up by their bootstraps" is erroneous, unhelpful, but fits nicely into really completely shitty and cruel narratives about human beings. But please. Perhaps you'd like to advance a theory on how an organ like the brain differs from every other organ and does its work in ways not explainable by biology, chemistry, physics, etc.

hvs 13y ago

Bipolar disorder cannot be solved with therapy. Additionally, clinical depression is different from situational depression. Yes, you are right, that many people would benefit from therapy in addition to drugs, but bipolar disorder, especially, is not a disease that responds to it. It is a chemical/biological disorder and needs to be treated as such.

edwkar 13y ago

I roughly agree with your sentiment, but your last sentence is IMO a bit too rough with the "resort to a bunch of drugs" part. Any psychiatrist worth his salt, will primarly prescribe drugs as a means to help people cope, while working on the actual underlying causes. Indeed, in many cases, using drugs in the treatment may be the only option to make the patient's day-to-day life bearable. Drugs may also be essential for allowing the treatment team to examine, possibly very problematic, underlying issues. Also, a SSRI, for instance, can of course not "treat" someone of a clinical depression; you will virtually always need professional cause-oriented therapy to get better. Most patients know this, or will realize it as they experience how their meds work. Finally, there are some mental disorders, and many individual cases, that require constant medication, despite of the quality of the other treatment given. For example, full-fleged bi-polar disorder, where a manic or a depressive episode may have very severe consequences.

rhizome 13y ago

As a counterpoint, I offer Robert Sapolsky, who most emphatically calls depression a disease: http://www.youtube.com/watch?v=NOAgplgTxfc http://www.youtube.com/watch?v=NOAgplgTxfc

scott_s 13y ago
I've watched 11 minutes of it, and I plan to watch the rest. Fascinating lecture.
- stevenrace 13y ago
  This lecture is part of Dr. Sapolsky's Stanford class on 'Behavioral Biology', which in itself is captivating.

deleted 13y ago

[deleted]

vacri 13y ago

Please stop spreading misinformation. There are many kinds of depression, and there are two significant camps - little-d depression, which is depressed mood from negative life events (missing the bus up to funerals) and big-d Depression, which has biological elements and is what people mean by 'clinical depression'.

joshhart 13y ago

I have read that book and it is indeed very good because it gives the reader tools to succeed and the clinical research proving that what we think and the way we think greatly influences our mood. Dr. Burns stated that the methods often work best when used in conjunction with medication. Some people may be so far down the rabbit hole that medication is necessary to restore improper brain chemistry.

baby 13y ago

Are people really not aware nowadays that Depression is used wildly and can be a real neuro-disease? Did you know they can surgically put a pacemaker in your brain to "treat" you? I thought it was common knowledge.

baby 13y ago

andrewfelix 13y ago

"Depression, for example, in my experience, and from what I've seen..." Your anecdotal observations shouldn't drive your understanding. Go read up on it. Suffering from mental illness myself I find your post quite offensive.

PeterisP 13y ago

Even in cases that can/should be solved by addressing a root problem, often you still want to apply drugs so that the patient doesn't, for example, kill himself in a down period between his/her second and third psychotherapy session.

stef25 13y ago

It IS a disease in the sense that it's an abnormal reaction to something.