Although the year is young, it has already brought my first moral dilemma. In early January a friend mentioned that his New Year’s resolution was to beat his chronic depression once and for all. Over the years he had tried a medicine chest’s worth of antidepressants, but none had really helped in any enduring way, and when the side effects became so unpleasant that he stopped taking them, the withdrawal symptoms (cramps, dizziness, headaches) were torture. Did I know of any research that might help him decide whether a new antidepressant his doctor recommended might finally lift his chronic darkness at noon?
The moral dilemma was this: oh, yes, I knew of 20-plus years of research on antidepressants, from the old tricyclics to the newer selective serotonin reuptake inhibitors (SSRIs) that target serotonin (Zoloft, Paxil, and the granddaddy of them all, Prozac, as well as their generic descendants) to even newer ones that also target norepinephrine (Effexor, Wellbutrin). The research had shown that antidepressants help about three quarters of people with depression who take them, a consistent finding that serves as the basis for the oft-repeated mantra “There is no question that the safety and efficacy of antidepressants rest on solid scientific evidence,” as psychiatry professor Richard Friedman of Weill Cornell Medical College recently wrote in The New York Times. But ever since a seminal study in 1998, whose findings were reinforced by landmark research in The Journal of the American Medical Association last month, that evidence has come with a big asterisk. Yes, the drugs are effective, in that they lift depression in most patients. But that benefit is hardly more than what patients get when they, unknowingly and as part of a study, take a dummy pill””a placebo. As more and more scientists who study depression and the drugs that treat it are concluding, that suggests that antidepressants are basically expensive Tic Tacs.
Oh, I’m sorry sir, but you’re wrong.
The most important sentence is near the end ……most of these prescriptions are being written by family practice doctors. Those patients who meet the criteria for a diagnosis of Major Depression are treated ( succesfully) with antidepressents and psychotherapy by a psychiatrist. Those patients who are “unhappy” end up being given prescriptions for antidepressents by their family doctor and may have a significant placebo response. Unfortunately, the stigma surrounding “seeing a psychiatrist” and the cost of medication keeps many people away from receiving the help they need to effectively treat their illness of depression. I hope the readers of this article and the book will be able to distinguish between “unhappy” and the illness of depression which has very clear diagnostic criteria.
The Newsweek article is a classic.
I would advise all people interested in thoughtful analysis — of news of any sort — to carefully read it, and write down their reactions.
Then read the New York Times article referenced in the second paragraph of the Newsweek article and do the same.
This is my first post. My name, student, is an allusion to the justly famous statistician William Sealy Gosset (1876-1937)– originator of the “t” test — who signed and published his articles not under his own name, but as “a student of statistics”. Gosset is commonly referred to by his eponym “Student”; the “t” test — one of the most common and useful of statistics — was commonly known, for many decades, and sometimes still is, as “Student’s t”. I am not famous, nor a statistician.
All men who find themselves suffering from depression would do themselves a big favor by having their hormone levels checked. Low testosterone levels are a definite cause of at least some forms of depression in men. I am on hormone replacement therapy myself and a lot of fellow men have thrown away their anti depressant drugs once they started on hormone replacement.
I agree that there is a world of difference between being “unhappy” and having a real illness of depression (a chemical imbalance or misfire of certain brain functions).
My family has a history of bi-polar mania, ADHD, and clinical depression. After my son was born, I finally admitted I had a problem to my psychologist and he diagnosed me as having bi-polar mania. After much research, I ended up receiving a prescription for a low dose of sertraline (Zoloft) and have been able to regulate my moods without the major highs and lows I had been suffering from. I also don’t have fits of rage like I used to. The medication helps correct the chemical imbalance that caused uncontrollable and drastic mood swings. It also helps a bit with my ADHD. The dose is so low, that I don’t even notice any side-effects, besides the fact that my husband is less frustrated with me now.
Methinks this journalist would be singing a different tune if he were suffering from real depression.
Let me also add that my husband can tell the difference when I forget a pill. Also, I went through years of therapy before I decided to try medication (mainly because women in my family have had bad reactions to anti-depressants).
Student (#3) — if you’re still following this thread, please unpack your comment a little. Alas, the reference to the NYT article is anything but specific, much less with a link, so I could not make a comparison. Alas, again, I am illiterate when it comes to statistics. What is the “t test” — and is your point that it is relevant to how we evaluate the article?
6. “My husband can tell if I forget a pill”.
No kidding. Anything agent that has the slightest side effect will have that effect. Back when it was considered legal and ethical to use placebos we used to have “The big Red Medicine” (slightly nasty but somewhat sweet) for minor problems and the “The Big Black Medicine” with the super nasty (and therefore more effective) taste for major problems. In Sril Lanka depression, conduct disorders etc. are still often treated with the “Big Red Medicine” the “Big Black Medicine” or cod liver oil.
It is surprising how well it works. Especially in children who would qualify as having “ADD” or “Bipolar” in the USA. It seems, if anything to work rather better than standard therapy in America. There is very little ADD or Bipolar in the schools of Sri Lanka. (Just as there was very little pathology in the schools that those of use who attended elementary school before 1970 remember. Class size was 35, and the room was quiet and orderly).
“My family has a history of bi-polar mania, ADHD”
Actually these “diseases” are very poorly validated. Briefly they were “discovered” by hand vote in committee. “Who thinks that ADD is a real disease?” “Who thinks it is normal varient?” “Who thinks it is a developmental phase?” The Aye’s have it. Bipolar illness was “discovered” in a similar fashion, as were most of the “diseases” in the DSM III.
Homosexual attraction was eliminated from the DSM III in the same way. “The Nays have it”.
The democratic process has a lot to recommend itself, however it was never meant to be a substitute for the Scientific Method. As Cardinal Ratzinger (now B16) used to say “Truth is not determined by majority vote”.
And eventually Truth will Out. If folks were not afraid that this would happen, there would be no reason to blackball investigators like Kirsch who asks politically incorrect questions. And blackballing is ubiquitous in the field of psychopharmacology. By contrast , there is very little blackballing of investigators who do research in non-psychiatric illnesses such as hypertension or multiple sclerosis.
#8:
When I say I “forget” a pill, I mean I really, truly, accidentally forget a pill. Meaning I don’t realize that I haven’t taken it. I end up having to count my pills when my husband asks me if I took my medication that morning. That is not exactly a placebo effect.
Please explain what you mean by “validated”?
Depression and ADHD are definitely real diseases in the sense that they are abnormal conditions often caused by a chemical imbalance of norepinephrine, serotonin, and dopamine.
Many diseases are discovered in modern science as means for testing and experimenting are constantly improving. How many diseases in the last forty years or so have been “discovered” due to advances in modern science, and when scientists look back there are usually signs of the disease in history that often were misdiagnosed or shrugged off as eccentricities?
As for the difference between Sri Lanka and the US, I’d make an educated guess that environmental and genetic factors have much to do with the difference between depression statistics in the two countries, not to mention the over-diagnosis that occurs in the US. Just because something is over-diagnosed does not mean it isn’t a real disease.
Also, ADHD manifests itself in different ways in different people. Most girls who are diagnosed correctly do not exhibit the behavioral problems that boys do (I say most because my sister was the exception) or make attempts to hide the difficulties they are having which explains why the majority of diagnosed cases are boys.
Please explain what you mean by “validated�
Proven. Abnormal structures on brain biopsy. Abnormal level of some item on spinal fluid testing. Something real, not just “I think it’s a disease and so does my friend John”.
“Depression and ADHD are definitely real diseases in the sense that they are abnormal conditions often caused by a chemical imbalance of norepinephrine, serotonin, and dopamine.”
That’s the party line. In point of fact your serotonin levels can be markedly influenced by a brisk walk, music, watching stuff that makes you angry etc. Similarly, folks with ADD have (IIRC) reduced dopamine in their frontal lobes and Ritalin improves this. But, so does exercise. So does intensive reading remediation (Fast Forward therapeutic auditory exercises. If you do Pet Scans on somebody who has an active placebo (something they can feel like a nasty taste) you will see chemical changes in the brain. Hopefulness and Cheerfulness in humans are chemically based, because we are not just spirit but matter. That doesn’t make sulleness a disease. We are called to be cheerful (and I fail daily at that one).
IN point of fact Ritalin makes most people able to concentrate better. So does cocaine. After that you get the rebound, and their is a marked increase in bipolar type symptoms in kids who have been on Ritalin. The shrinks explain it away by saying “Oh they must have had that too”.
There are many things that medication will (for a while and at a cost) improve in folks who are essentially normal. For example it would not be too difficult for me to come up with a check list that would diagnose “Fitness deficiency disorder” (FDD). I could have a nifty list of how many push ups a normal person should be able to do, and how many laps they should be able to run in 15 minutes. I guarantee you that the lower five or even 30% would fail. That is the nature of the bell shaped curve. I could then do a nifty study giving anabolic steroids or placebo to my patients with Fitness Deficiency Disorder, and “prove” that they “get better” with steroids. Getting better with a medication does not make a disease. There is a large range of what is normal, and if it were required that everybody needed to pass 6 weeks of Marine Basic Training in order to attend any college or enter any profession there would be a lot of people who would be claiming their right for an IEP that would include accomodations and steroids because of their “disability”.
The problem lies (mostly) with the schools, and to a lesser extent with the parents and society. That is why when I was in public elementary school in Washington DC back in the 1960s, the classes had 35 kids all of whom sat still and most of whom read pretty well. (the same as Sri Lankan classrooms nowadays – only there are 50 kids in SL classrooms). Now the same Washington DC school has a class size of 24 kids but more than 50% of those chidren purportedly have “special needs”. Go figure.
Since we are material beings, obviously our serotonin levels fluctuate. Duh. They fluctuate a lot in the same person at different times than between ADD and “normal people”.
Thank you Clueless for letting me know that my depression which is part and parcel of my MS is simply non existent. I feel so much better already.
Clueless (an appropriate moniker):
Please do not put words in my mouth. I did not at any point say that Bipolar mania is a disease because medication makes it better. I believe I said in summary that in my case, my bi-polar disorder is a genetic chemical imbalance and is treated by medication.
I may not have the latest medical research at my fingertips, but I do take an interest in my own health. I fought against psychiatrists for years who wanted to just put me on meds because of my mother and grandmother’s history of bad reactions, and I just don’t trust a therapist who doesn’t even try the psychological route first. When I went on a screaming rage in my college cafeteria at my friends who had merely asked “How was your day?”, I still refused to go the medication route (that incident was mostly brought on by stress, but as far as I know, “normal” people don’t tend to go into such a rage as that). It took me until after my pregnancy when my hormones got REALLY out of whack to even consider medication, mainly because I didn’t want to end up hurting my baby and/or scar him for life.
Obviously normal people have fluctuations in the hormone levels in their brains, that’s just the way our bodies work. And yes, when I exercise I feel better (there’s that serotonin thing), so I can experience the normal fluctuations (and I believe I have since starting the medication two years ago). However, I do remember the fits of rage and the bouts of giddiness (for absolutely no reason at all) that I experienced for years. Honestly if I didn’t turn to God during those angry times, I think I may have done things I would have regretted such as seriously injuring someone. I had times when I would consider suicide so strongly that I would begin detailing how I would do it and wonder if I had what I needed (pills, etc.) nearby.
God drew me back from the brink many times (and even blessed me with a wonderful husband who helps balance me out) and for that I am eternally thankful. However, no amount of prayer or faith seemed to help the physical problem that causes these extreme highs and lows. I could not stand to live like that any longer. Now, while I am cautious, I am not afraid that I am going to end up hurting someone, I am able to collect myself and perform a quick self-examination before I end up saying something hurtful when I get upset. Of course I still get upset at things (who doesn’t?) but stressful situations and being upset don’t make me consider doing harm to another person anymore.
So if you want to continue to believe that it’s all in my head (which, technically it is ^_^), go ahead. I am apparently not going to be able to change your mind. In fact I don’t believe any amount of valid (to the rest of us at least) research will change your mind either. So instead I just hope that some day you will get the chance to meet someone who suffers from such a disorder and can show you just how much it affects them and how different they are from people with normal moods.
One more note I would like to add is that not all people who suffer from bi-polar disorder or ADHD need medication for treatment. Often, children exhibiting ADHD symptoms can be treated using psychological methods, homeschooling, tutoring, etc. Sometimes meditation and regular exercise can be enough to alleviate the symptoms of bi-polar disorder. Sometimes it’s not. Like I said before, each person is different.
May you have a pleasant evening and may the peace of the Lord be with you.
As a matter of fact I suffer from depression myself. So do a number of family members, including one who was hospitalized for it. During winter I often do put myself on antidepressants for the placebo effect if nothing else, and I have a buddy to force me to exercise (bought a dog for the purpose). And I keep in mind that despair is a mortal sin. I usually feel better after adoration, etc.
My child would easily have qualified for ADD (and Bipolar). Everybody urged us to put her on meds. But guess what. A large number of teenagers would meet the check lists. But Ritalin has significant side effects, (including incrasing the risk of Bipolar illness. I have seen a number of kids who had frank hallucinations on it, with the shrinks urging their parents that they were really schizophrenic and needed antipsychotics added to the drug cocktail. The hallucinations improved with LESS medication, not more). Contrary to public belief, there are no “long term studies” of safety and efficacy in most psych. meds. The longest safety and efficacy “long term study” for Ritalin was 18 months. A year and a half is a blink in time for a child
So we did it the hard way. We spent hours tutoring. We remediated the processing disorders (spent thousands of dollars and thousands of hours of time). We put locks on every door and window, called the police and had the boyfriends arrested. Toured the jail. Wept, counselled, disciplined etc.
Her IQ went from 68 to 110 over 5 years with remediation of processing difficulties. Her ADD improved with a tonsilectomy (big tonsils and sleep apnea cause 30% of what gets misdiagnosed ADD), her mood swings improved with counselling, exercise, discipline and most of all TIME. Because a large number of teenagers would qualify as Bipolar based on “checklists”. They do get better if you can only keep them away from drugs, porn and bad influences. Mine did.
Nobody is stopping you from taking antidepressants if it “makes you happy”. In India, psych meds are reserved for periods of less than 3 months during acute flares (for both schizoprenia, depression etc.). In between people work on increasing their coping skills.
I want my kids to have good coping skills. My daughters skills are now quite excellent. She is now 19 and a sophamore in college (in terms of both time spent and credit hours, on target to graduate in 4 years). Hopefully she will continue to do well. God knows that she improves my prayer life. However, we have not had a meltdown or screaming fit for over two years. Growing up and learning to take responsibility for yourself has that effect on you.
I agree that there is no proof of *causality* of our chemical fluctuations.
It’s often a case of “which came first, the chicken or the egg.”
My own opinion, based only on correlative research — not causal, because again, as Clueless said, we can’t put our brains into a controlled, one variable laboratory setting — is that early childhood influences probably permanently *set* the seretonin/hormonal/other chemical ranges with only fluctuations thereafter.
Doesn’t mean that progress can’t be made after, for instance, an abusive childhood. As Clueless says — and he or she is right — any *action* affects brain chemistry — a smile, a frown, getting up and cleaning out the refrigerator. Of course, the problem is that when the brain chemistry is at the lower range for that person, it’s awfully hard to get up and clean out the refrigerator. But boy do small accomplishments affect one’s mood — and thus one’s energy to pursue more accomplishments. Success breeds success. It’s shocking how affected by yesterday’s minor successful meeting, for instance, my energy and action and ability to complete odious tasks was later on in the day. ; > )
So my suspicion is that people who have actions *done to them* as powerless children have very long-lasting and ill effects on their brain chemistry. But adults have, for good or ill, the ability to take actions themselves.
I have watched all of this battled in two different ways. One person, suffering under serious clinical depression [including fixated suicidal tendencies] refused drugs and embarked on severe actions: a rigorous exercise program [agonizing to accomplish because of the horrendous emotions — plenty of runs done while sobbing], spends a lot of time in the sun, can’t let sleep hygiene slip, years of therapy that helped her learn to improve coping skills that she simply didn’t gain in childhood, lots of other disciplines that she can’t let slip.
Others have gone the drug route.
The former improved immensely — but it was a long, winding, agonizing, fearful task. Others on the drug route have improved, some haven’t.
In my observations I’ve seen one thing that’s cause for concern with the drug route. The people on them — and boy do I have a lot of friends on SSRIs! — don’t do the other things that they need to be doing in order to permanently improve. That’s my main cause of concern. So I watch them move from drug to drug. One will help for six months, then it will stop helping. They’ll move on to the next one. In the meantime, they’ve never dealt with numerous blows inflicted on them in life — they never learned how to do that for some reason — they have nasty jobs and haven’t found new ones, they’re out of shape and have physical problems associated with that, crazy-making dysfunctional friends, etc, etc, etc.
I also think there are societal influences in the US that affect brain chemistry. Our sedentary indoor lifestyle. Our poor eating and sleep habits. Our loss of meaning and community. And our complete pulverization of stable healthy families with functional, leaders and shepherds for parents. Hah — we have families that are predominantly made up of just the opposite and we now have two generations of products from those families who were thrust into the unforgiving world with precious few resources — the spiritual and psychological resources that parents are supposed to give their children as a legacy.
And then, the sense of purposelessness and loss of community that so many experience as well. Frankly, when you’re out on the frontier trying desperately to harvest the crops before the first rain sets in because if you succeed you eat that winter, there’s little time to wonder if your life has meaning. You already *have* purpose, and it’s a purpose that also involves community — your family and your neighbors. These days our work is essentially cut off from a sense of purpose — it’s disconnected from “real life” — and there’s precious little community unless you have a great boss who’s worked hard to create that.
I’m fortunate enough to have very stimulating and interesting work. But I think, in observing others, that the vast majority of Americans find very little of interest or meaning in their work. It doesn’t generally fit their skills and gifts and “uniqueness.” It’s cut off from a sense of service or mission. In the old days, you “found your way.” If you could do something — weld metal or fix wheels or survey property or cool masses of food or scout the land for Indians — you offered it up and people paid you for it. Now, in the industrial “system” in which we live, most people are stamping widgets indoors — or at least . . . *feel* as if they are stamping widgets.
Just some random thoughts. I know that Clueless is a physician and sees alot of craziness. There are often times that I look at people’s lives and think “yep — there’s a reason why you’re depressed — you’d be crazy if you *weren’t* depressed.” So, though I wouldn’t quite put it like Clueless has, I do acknowledge that we simply don’t know why our brain chemistry fluctuates so dramatically — it’s a mystery. And it’s definitely true that we live in a “diagnosis happy” world — *everything* is a cause for a diagnosis. And yes, I’m pretty certain that the whole ADHD/ritalin monster that has been unleashed is largely a sham with symptoms caused by CRAZY FAMILIES.
On the other hand, I’ve seen dramatic improvement with drugs in the lives of some people. When you’ve got someone who’s basically catatonic, and drugs get them up and moving again to at least attempt to straighten themselves out, that’s miraculous and a gift from God. I’ve seen it effect loved ones of mine and I’m just grateful for the research and the gift.
My Dad — also a physician — says that people with mental illness [yep, that’s what I’m going to call it] don’t have “the slack” that others have. It’s a bit like people with diabetes who need insulin. Many diabetics can, with careful discipline and rigorous quotas of exercise, weight control, sleep hygiene, and food regulation, eliminate their insulin meds. But let’s face it, the “average” person who is not diabetic doesn’t have to go through all that pain and discipline. They can eat like pigs and wallow around on the couch and toddle off to work and they don’t have diabetes.
In the same way are people who struggle with their minds. They don’t have “the slack in the system.” Yet they often treat themselves as if they do. Heck if their friends stay up late and party, why can’t they?
At any rate, just some rambling thoughts on this subject offered up for the jeers and boos and cheers. ; > )
Clueless, I tend to agree that children and teens are medicated too often without warrant. But you also address the use of medications for depression and such by adults. And to that I must respond.
I currently am not on any anti depressents. Not because I don’t believe they don’t work but because the effects (in long term usage) they had on me outweighed any benefits I saw. However at no time did I take the pills in order to just “feel happy.” One pill I took was both for my depression and for pain. Unfortunately though it did slightly help the depression my pain continued so it ended up not being an option after all. It also helps greatly that I know “this too will pass.” and that the depression is a little bonus of my MS. I always cope better knowing than not knowing.
But it was one of my first symptoms and prediagnosis it was quite frankly scary as hell to find myself contrary to all my strongly held beliefs, contrary to the many wonderful good things in my life, contrary to the support and love from family and friends seriously viewing suicide as not just a viable option but my only option. Yes even knowing that there was a real risk of damnation I still at times ached for it.
And you know what, I was fortunate to finally get diagnosed and as part of treatment see a Neuropsychiatrist and a Psychiatrist. The latter prescribed anti-depressants. And they worked well enough in the short term to keep me alive. Not happy, but sane and functioning and able to see joy. Joy in myself, others and most importantly God.
So when you dismiss medication as just some kind of crutch of the weak minded I find it terribly insulting, cruel and ignorant. And it saddens me to know you believe as you do.
[blockquote]My Dad—also a physician—says that people with mental illness [yep, that’s what I’m going to call it] don’t have “the slack†that others have. It’s a bit like people with diabetes who need insulin. [b]Many diabetics can, with careful discipline and rigorous quotas of exercise, weight control, sleep hygiene, and food regulation, eliminate their insulin meds.[/b] But let’s face it, the “average†person who is not diabetic doesn’t have to go through all that pain and discipline. They can eat like pigs and wallow around on the couch and toddle off to work and they don’t have diabetes.[/blockquote]
This was kind of the point I was trying to make, a very good analogy! The key here is many. Like people with certain mental illnesses, probably most of the ones diagnosed can be treated effectively without medication. But there are always the ones who absolutely cannot control their diabetes without insulin. I’m going to tell another story 🙂 My mother is diabetic (type 2) and disabled as well. She is unable to walk due to knee degeneration and the stroke she had two years ago, and so is unable to exercise effectively (she also lives in a rural area and does not have access to regular PT). However, she controls her diet like crazy. She is super careful about what she eats and tries to move as much as her body will allow, but her blood sugar ranges from 150-300 even though she does take insulin. Without the insulin it goes even higher. So she just happens to be one of those people who can’t control their diabetes without insulin.
Going off subject a bit, since I brought it up, if you have time please say a prayer for my mom. She is 57, and in addition to the diabetes and disability her potassium levels are spiking up (an indication of kidney failure). I keep trying to get her and my grandmother (70 and taking care of my mother) to sell their house and move down to my city into an assisted living center but so far they are resisting. As is they are a 2 hour drive away and I don’t get to see them as often as I’d like.
Clueless and Sarah are correct in their perspective. Modern society creates as well as improves many problems in life. It’s nice that most of us don’t worry about starving to death or dying young of a dread disease. On the other hand, for instance, our marriages tend to end more frequently by divorce than those in the past because women don’t die in childbirth as often after only a few years of marriage, so us men don’t get to enjoy serial monogamy in a Biblically sound way like our forebears did. Hence, the 50% divorce rate.
I realize this perspective sounds cruel and heartless, but there is alot of truth in it. It just shows that the human problems of sin don’t go away because of science and technology–they just get shifted somewhere else. And hey, I like living in modern society with heat and plenty of food and delayed arthritis due to not having to do manual labor all day.
Oh, clueless is correct about the exercise issue too. The studies show that exercise is as effective as medication for ADD, depression, etc. In my medical practice, 90% of what I see is lifestyle caused illness, or at least illness made much worse by lifestyle. The number one issue in my opinion is weight, and that is caused by lack of exercise and overeating. It really is that simple.
But simple does not mean that resolving it is easy. Look around the world and in your family and you will see very simple and straightforward things that seem to not get solved. The gospel tells us why we can’t seem to get beyond our sin natures.
Yes, I prescribe antidepressants and lipitor. But do they solve the underlying problems? No, they just give people a little more “slack” as Sarah says. Unfortunately many people just use up that slack with more bad behavior, just as they max out their credit cards when their old debts are cancelled.
Paula, I didn’t see that Clueless dismissed “medication as just some kind of crutch of the weak minded.”
I think Clueless was making other points. I think you are being too hard on Clueless.
After all, Clueless admitted that he or she takes medication for depression in the winter. And he/she acknowledges that he/she does not know why it works, except that it does appear to. Clueless has, like a good doctor should, a natural suspicion of medication and a knowledge of the many people who flow through his or her office every day who have far far deeper problems that won’t be fixed by medication at all and so the prescription of medication is but a “compromise.”
I know some doctors who refuse to prescribe ritalin and thus refuse to see ADHD patients. They know that Ritalin could alleviate the symptoms — at least for a while — but they’ve seen how desperately the family needs healing and how the child would blossom if only it could happen. It goes against their conscience to prescribe ritalin — like prescribing “another credit card” to a person already in debt. So they have decided to no longer see ADHD patients.
Medicine is full of compromises and checks-in-conscience. If a child were being physically abused and you had reported the case to child services, would you prescribe prozac for the child’s obvious seretonin deficiencies?
Maybe so.
But I have a sympathy for physicians and what they see every day and the decisions they must make about what they see.
Courageous Grace I’m so sorry about your mother. What a mess.
Is there any chance she could get a knee replacement?
Sarah, I don’t want to say Clueless had no valid points. I agree in large part with what was written. But what set me off was the remark about taking anti depressants if “it makes you happy.” I thought that remark did show insensitivity and a tone of dismissal. I could be mistaken and not taking it as intended.
And I certainly believe medication should be used in combination with other approaches and never as a first resort unless things have reached a crisis. I also believe that sometimes we should act as everything is how we wish it could be and by doing so we somehow start to reshape our reality. I think this is called “fake it till you make it.” The other factor I believe plays a very important part in depression is how well our bodies are absorbing and processing sunlight. Not sure if that makes sense and if it was mentioned above I missed it.
I sometimes wonder too that if the loss of a day clearly divided into hours for activity and hours for sleep might play a role in the rise of depression. At one time we did not have ready access to diversions that allowed us to be awake at all wee hours of the night. You couldn’t sleep you stayed up and read a book or some similar activity. Which in itself I think relaxes and retools our brains. And I believe this process is an important aspect of mental health. I could be totally off base on this and have no medical stats to quote.
I apologize to Clueless for regardless of his intention my response was harsh and grating and I should have tempered it with a lot more charity.
“On the other hand, I’ve seen dramatic improvement with drugs in the lives of some people. When you’ve got someone who’s basically catatonic, and drugs get them up and moving again to at least attempt to straighten themselves out, that’s miraculous and a gift from God. ”
Yup. Seen it too. And I think that anything one does to get the person up and moving is fair game. However after that one needs to engage in the difficult work of being a human being who lives in a crazy society. And being a human being is extremely difficult work, and I do not doubt that it is harder for some than for others. I agree that the set points of some people, whether because of childhood influences or genetics or some other environmental insult makes such work far harder for some than for others.
I personally find it a serious strain to be cheerful and sociable. I would far rather do pushups for 5 minutes than to speak socially to a complete stranger for 5 minutes outside of work. Other folks have other challenges – justice, temperance, prudence, etc. My set point is higher for those tasks and I find those virtues easier to wear habitually, than I find guarding myself from the sin of despair.
However it does not matter that I am rotten at the virtues of cheerfulness and patience (very likely due to abnormal set points or genetic/environmental influences or whatever). God knows that I am broken. I am called to increase in all virtues, not just the ones I happen to be already good at. Thus, for my Lenten penance, I plan to speak for at least 5 minutes to a stranger-neighbor-associate every day. Frankly I think I would prefer to engage in self-flagellation (though I have never tried that, and don’t plan to). I am naturally painfully shy, I loathe small talk and am bad at it, so this will be quite a difficult task for me. However, I hope to increase my Fortitude by doing so, and if it makes me a nicer person bearing a few more fruits of the Holy Spirit such as Joy etc. well that will be good too. However, it may be an extremely long Lent, and I am already looking forward to Easter where I can go back to being dour, sullen and irritable. Or not, as the case may be.
Peace.
Clueless, your Lenten discipline reminds me of the Lent where I tried to learn to be an optimist. It was an extremely debilitating experience, and sent me into some despair post Lent, as I radically failed in the attempt.
Heh.
One of the best populist books I’ve read on the subject of optimism [and its related characteristics of cheer and joy] was the one called Learned Optimism. It really is quite a good analysis of the trait of optimism.
What I found the most shocking and frightening was its work on correlating the optimism scores of childhood with the onset of depression two or three years later and the accompaniment of long-term adult depression.
Briefly, the optimism scores of “normal” children exceeded the optimism scores of the average successful adult life insurance salesman, which in his tests had ranked the highest on adult optimism scores. Heh. The author postulated that this was so because children are naturally endowed with levels of optimism approaching the level of insanity in order to meet the challenges of constant childhood “failures.” ; > )
And when those levels were greatly off from that natural baseline in a child, the correlations with Great Anguish later on in life were extremely high.
His work on vocation and optimism — and helping organizations, particularly the military, make some sort of accurate predictions as to success rates — was most interesting.
All in all, a very challenging and somewhat demoralizing book. I have long been envious of people with banks of optimism at their beck and call. I can say that having been a business partner with a hopeless optimist, it is quite a gift from God to have it, allowing him to recover from losses and defeat about 10 to 20 times faster than I do, and allowing him to bounce back into work amazingly quickly. It’s as if he had a reset button.
My envy of optimism was only increased after reading the book. It was really impressive analysis and work.
Good luck with your Lenten effort.
One thing that helps me — “as if by magic” — is to pray specifically for the strangers that I meet. Perhaps you can try to pray for the person you are going to meet and have to engage in conversation for a full five minutes. You never know, Clueless, just who God has in mind for you to connect with that day or why — I have no doubt that He will guide you to the one who needs some faint expression of interest from a stranger or acquaintance. You *really* never know.
Recently, after having had a horrible day full of defeats and miseries, I dragged my body off to a quiet restaurant — late too, having missed meals that day — and sat there brooding. The owner of the restaurant came up and chatted a bit, took my order, went on his way. At the end of my meal, a strange waiter came up to me and said “the meal’s on the house — the owner said so, and you’ve been a great customer for years.” This in a recession when restaurants everywhere — including this one — are really struggling.
He’ll never know what that meant to me — the shock and gratification of the simple attentiveness of another essentially stranger — though I tried to express it in a thank-you note later on.
Clueless, I beg you do not find me to forward if I say I will be praying that your Lenten penance is filled with Grace enabling you to perform it with both cheerful face and heart.
PS: I should add that I in no way exhibited the fact that I had been dragged backwards through the mud by my hair that day. I don’t have a problem engaging with strangers and we had a good little exchange about a business startup he was working on. So the gift made it even better for me — he had no way of knowing what a horrible day and week it had been.
“Clueless, I beg you do not find me to forward if I say I will be praying that your Lenten penance is filled with Grace enabling you to perform it with both cheerful face and heart”
Thank you. I will need all the prayers I can get. (A Courageous Grace, I will be praying for your mother).
“Perhaps you can try to pray for the person you are going to meet and have to engage in conversation for a full five minutes. You never know, Clueless, just who God has in mind for you to connect with that day or why—I have no doubt that He will guide you to the one who needs some faint expression of interest from a stranger or acquaintance. You *really* never know.”
A very good idea. I shall do it that way. Thanks
Sarah, thank you for your prayers. No, she does not do well with surgeries. Like me, she does not heal as fast as most people (we have the strangest health problems in my family!), and has ended up with serious complications after nearly every surgery she had. One time one of her intestines ruptured after a hernia surgery and she almost died. So she is very wary of surgery.
She has had multiple arthroscopic surgeries to remove the bonespurs that kept popping up but within a couple of month after each one she ended up in more pain and less mobility than she had before the surgeries. Her doctors have recommended against knee replacement. Something else is since her stroke her memory has become more faulty to a point that is starting to worry me. No one should have to go through what she has been dealing with these last few years. I have a strong suspicion that she’s not going to live to see her grandson (he is 2 now) graduate from high school, which breaks my heart.
If I could nominate the greatest medical breakthrough in the last decade, it would be the new understanding of Vitamine D. We now know that the best level is above 35 and probably 70. It treats muscle weakness, bone and joint problems, dementia prevention, depression, MS, recurrence of cancer. Still, many doctors don’t know of the latest findings. If you can’t get a blood level, then take between 2000-5000 units of D3 found on the shelves of your drugstore without a perscription and later get a level. I’ve seen some need 30,000 units three times a week, but that is rare. Amazing.