"Depression - Pharmaceuticals Required?" - Academic Study - Tilted Forum Project Discussion Community

Jinn · 09-15-2005, 08:47 AM

This thread is devoted to the academic pursuit of depression. Is it a disease which requires pharmaceutical (drug) interaction in order to be fully treated? In maintiaining an academic atmosphere, Tilted Knowledge, I'd like posters to develop a reasoned response supported by with references. Likewise, if you're privy to recent research or documents regarding this topic, feel free to provide a link or bibliographical reference to their existance, as well as your brief summary of the facts. EXPECT your source and the material that it presents to be critiqued for soundness and reliability.[/b] If this topic maintains interest, I'd like to see other "research" oriented topics regarding similiarly controversial topics being created.

That said, my position:

I am not infallible in my personal belief that depression or other "emotional disorders" can be treated without the use of any drugs, but I will require that a poster contribute a reputable source that supports their claim in order to be persuaded. Likewise, I believe anyone participating in this thread should not be convinced by anecdotal evidence towards either side (drugs worked for me, drugs did not work for me). Please keep this discussion as scientific as possible.

(I've copy-pasted the most recent posters in the previous thread for continunity of discussion)

1)

Quote:

Originally Posted by JinnKai

Depression, SAD, OCD, panic attacks, ADD, ADHD.. whatever the flavor of the week is -- it's still something that can be solved by anyone with logical faculties, the desire to change it, and the motivation. The only person who REQUIRES medicine lacks one of the above (usually motivation or logical faculties).

Just because you gave up doesn't mean it wasn't possible to overcome your
paralyzing fears. It certainly would have taken longer and been more difficult, but that does not mean you have a 'chemical imbalance." Chemical imbalance has become a psuedoscience buzzword used to describe ALL of these "emotional disorders" -- and unless your doctor can show you that your serotonin, or dopamine or whatever "chemical" he thinks is causing it is LOWER than an actual average.. its just conjecture and an easy way to 'prove' that you need medicine.

2)

Quote:

Originally Posted by ravenseye

Quote:

Originally Posted by JinnKai

You can't make emphysema go away with the power of your mind. Irrational fears, paranoia, depression, anxiety.. those are pyschological flaws, not physical flaws.

Actually there is much biological research that has shown that all sorts of psychological disorders have organic causes, many of which have a genetic basis. People can learn to live with these disorders just like they can learn to live with emphysema, but the underlying causes are permanent conditions.

3)

Quote:

Originally Posted by JinnKai

Show me a credible (cited, peer reviewed) SCIENTIFIC study that can create a causation (rather than a correlation) between emotional "disorders" and a "chemical imbalance" and I'll believe your statement. Otherwise, its the same psuedoscience nonsense I mentioned above.

4)

Quote:

Originally Posted by Gatorade Frost

Quote:

Originally Posted by The Study

From this data, it is clear that NE
circuits are dysregulated in affective disorders. These
abnormalities likely interfere with concentration, attention,
memory, arousal states, and sleep regulation. The primary dysfunction, if there indeed is one, in depression
is increasingly less likely to be found within the NE
system, per se; however, its dysregulation in the depressed
state apparently contributes to significant symptomatology,
and NE perturbation appears to be critical in treatment
response.

<a href="http://userwww.service.emory.edu/~kressle/papers/ResslerNemeroffNorepinephrineDepress1999BiolPsych.pdf">Role of Norepinephrine in the Pathophysiology and
Treatment of Mood Disorders</a>

5)

Quote:

Originally Posted by raveneye

Think of it this way: behavior is mediated by enzymes, and enzymes can be made nonfunctional by mutation. If the function of a neurotransmitter is knocked out, there is no way that that cannot influence behavior. There are hundreds, probably thousands, of biochemical pathways involved in our behavior, any one of which can be damaged in a multitude of ways.

6)

Quote:

Originally Posted by Suave

Quote:

Originally Posted by raveneye

Think of it this way: behavior is mediated by enzymes, and enzymes can be made nonfunctional by mutation. If the function of a neurotransmitter is knocked out, there is no way that that cannot influence behavior. There are hundreds, probably thousands, of biochemical pathways involved in our behavior, any one of which can be damaged in a multitude of ways.

That's circular logic. Of course if one subscribes to your paradigm they will believe that it is all biologically-based. The point is to get someone to subscribe to it in the first place.

If I were to counter by saying: "Think of it this way: behaviour is a product of the mind, which affects the brain rather than the brain affecting the mind, and therefore when the brain is damaged, it does not necessarily cause any problems." You'd go "okay, so what?"

I don't believe that way exactly, but you see my point? Simply explaining what your belief is will not sway another person. Evidence must be provided, or at least a logical link to something tangible.

..discussion continues.

Jinn · 09-15-2005, 08:53 AM

In http://www.clinical-depression.co.uk...on/causes2.htm, the following passage brings light to an interesting part of this discusison:

Quote:

Depression can not be said to be a disease, because it is not primarily a biological disorder - that is, the root cause of the symptoms are not usually physical. How do we know? Well, here's one way:

People born since 1945 are 10 times more likely to suffer from depression than those born before.

That is an astounding figure, and it cannot be explained away by people going to their doctor more, or depression being diagnosed more easily, as these were taken into account in the study.

I do not know the source of the original study, but it brings a valid point. If depression has increased ten-fold in the last 100 years, does this point to causes OTHER than biology?

Another point of interest is discussed therein:

Quote:

Clinical Depression is often said to be caused by a chemical imbalance in the brain, and this is what most drug treatments are based on. Certainly in many cases, there is a reduction in the amount of certain neurotransmitters found (monoamines such as serotonin and norepinephrine) in depressed people.

However, low serotonin levels are simply another symtom of depression, not a cause. The more negative introspection you carry out, and the fewer pleasure-giving activities you participate in, the lower your serotonin levels become.

Can chemical imbalances be a SYMPTOM of a problem, such as depression, rather than a cause? Is it not likely that a person suffering from depression would have a chemical change that could be modified by drugs? If so, then the pharmaceutical in this role would only be masking the symptoms, rather than dealing with the root cause of the depression, anxiety, or SAD.

Please rebut. I am still reading the study provided above.

Jinn · 09-15-2005, 08:55 AM

Along the thread that "chemical imbalances" are actually a symptom of depression rather than a cause, I found another article by Jake Van Der Borne. He offers no citation or review, but he brings another valid assertion regarding the circular logic:

Quote:

What causes chemical imbalance?
After researching the causes of a chemical imbalance online I came to the conclusion that no one, not even doctors, scientists or clinical researchers, knows what exactly causes a chemical imbalance. In fact, it was virtually impossible to come up with a single source that could provide conclusive evidence.

If you would ask a medical professional the reasons and causes for anxiety or depression, their answer would most likely be “A chemical imbalance…” As a result, the first impulse for most medical professionals and patients alike is to prescribe an SSRI, MAOI or similar “chemical balancer” to treat the condition.

But in the majority of cases, the most important question has not yet been addressed:

What’s causing the chemical imbalance?

Over the years, researchers have noted a handful of possible underlying reasons for a chemical imbalance, from genetic factors to irregular brain development.

The most promising (and comforting might I add) is the theory that chemical imbalance actually stems from our own thoughts and actions.

\

Article: http://www.anxiety-and-depression-so...limbalance.htm

Jinn · 09-15-2005, 08:58 AM

To clarify the discussion, included is an excerpt from a wikipedia article (http://en.wikipedia.org/wiki/Clinica...ion#Medication) defining the "pharmaceuticals" being discussed:

Quote:

Medication which relieves the symptoms of depression has been available for several decades.

Tricyclic antidepressants are the oldest, and include such medications as amitriptyline and desipramine. They are used less commonly now, due to side-effects which may include increased heart rate, drowsiness, dry mouth, and memory impairment. Most importantly, they have a high potential to be lethal in moderate overdose. The reason why tricyclic antidepressants are still used is their high potency, especially in severe cases of clinical depression.

Monoamine oxidase inhibitors (MAOIs) may be used if other antidepressant medications are ineffective. Because there are undesirable interactions between this class of medication and certain foods and drugs, it is important that the user be aware of which ones to avoid. A new MAOI has recently been introduced. Moclobemide (Manerix), known as a reversible inhibitor of monoamine oxidase A (RIMA), follows a very specific chemical pathway and does not require a special diet.

Selective serotonin reuptake inhibitors (SSRIs) comprise the current standard family of antidepressants. It is thought that one cause of depression is that an inadequate amount of serotonin, a chemical which the brain uses to transmit signals between nerve cells, is produced. These drugs work by preventing the reabsorption of serotonin by the nerve cell, thus maintaining the levels the brain needs to function effectively. This family of drugs includes fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). These antidepressants typically have fewer adverse side effects than the tricyclics or the MAOIs, though such effects as drowsiness, dry mouth, and decreased ability to function sexually may occur.

Selective norepinephrine reuptake inhibitors (NARIs) such as reboxetine (Edronax) act via noradrenaline. SNRIs are thought to have a positive effect on concentration and motivation in particular.

Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor) and duloxetine (Cymbalta) are a newer form of anti-depressant which work both on noradrenaline and on serotonin. They typically have similar side-effects to the SSRIs although there may be a withdrawal syndrome on discontinuation which may require a tapering of the dose.

S-adenosyl methionine (SAM-e) is a derivative of the amino acid methionine that is found throughout the human body, where it acts as a methyl donor and participates in other biochemical reactions. It is available as a prescription antidepressant in Europe, and an over-the-counter dietary supplement in the United States. Clinical trials have shown SAM-e to be as effective as standard antidepressant medication, with many fewer side effects.[4],[5] Its mode of action is unknown.

Omega-3 fatty acids (found naturally in oily fish, flax seeds, hemp seeds, walnuts, canola oil etc.) have also been found to be effective while used as a dietary supplement.

Some antidepressants have been found to work more effectively in some patients when used in combination with another drug. Such "augmentor" drugs include tryptophan (Tryptan) and buspirone (Buspar).

Tranquillizers and sedatives, typically the benzodiazepines, may be prescribed to ease anxiety and promote sleep. Because of their high potential for addiction, these medications are intended only for short-term or occasional use. Medications are often employed not for their primary function, but to exploit what are normally side effects. Quetiapine fumarate (Seroquel) is designed primarily to treat schizophrenia and bipolar disorder, but a frequently-reported side-effect is somnolence. Hence, this non-addictive drug can be used in place of an addictive anti-anxiety agent such as clonazepam (Klonopin, Rivotril).

Antipsychotics such as risperidone (Risperdal) and olanzapine (Zyprexa) are prescribed as mood stabilizers and are also effective in treating anxiety. Antipsychotics (typical or atypical) may be also prescribed in an attempt to augment an antidepressant, to make antidepressant blood concentration higher, or to relieve psychotic or paranoid symptoms often accompanying clinical depression. However, they may have serious side effects, particularly at high doses, which may include blurred vision, muscle spasms, restlessness, tardive dyskinesia, and weight gain.

Lithium remains the standard treatment for bipolar disorder, but may also be effective for people with depression, particularly in preventing relapse. Lithium's potential side effects include thirst, tremors, light-headedness, and nausea or diarrhea. Some of the anticonvulsants such as carbamazepine (Tegretol), sodium valproate (Epilim), and lamotrigine (Lamictal) are also used as mood stabilisers, particularly in bipolar disorder.

Failure to take medication, or failure to take it as prescribed, is one of the major causes of relapse. Should one feel a change or discontinuation of medication is necessary, it is critical that this be done in consultation with a doctor.

raveneye · 09-15-2005, 09:18 AM

Quote:

This thread is devoted to the academic pursuit of depression. Is it a disease which requires pharmaceutical (drug) interaction in order to be fully treated?

No, drugs aren't required to treat any disorder, regardless of whether the disorder causes psychological problems or not. But that doesn't mean they can't be very effective and useful. It's up to the individual, in consultation with his/her doctor, to decide.