Is depression an illness?

[An Infinite Ocean]

Hi all,

Everyone says depression is an illness. Just like heart disease and diabetes. Obviously, with depression there are various symptoms, both mental and physical.

However, what actual evidence is there that it's a fully-fledged illness, rather than simply an unfortunate state of mind that has negative effects upon the body? For instance, I've been severely depressed for many, many months at a time. And yet I wouldn't feel happy saying that I was 'ill'.

Presumably lots of studies must exist somewhere, but I'm not a scientist and I don't understand much in the way of medical jargon - could someone please fill me in?

I hope this is the appropriate category. If not, then... sorry!

[Rolfe]

There are degrees, and perhaps at the milder end the question is rather moot. Look at Winston Churchill's "black dog" - was he ill? He certainly functioned.

But if you'd ever seen my friend Andrew's wife in the throes of post-natal depression so severe I think they called it "puerpural psychosis", you wouldn't need to ask. Sadly, Andrew is now bringing up two little girls alone, after his wife's suicide. At the funeral, the vicar referred to the "illness" which had taken her life.

Rolfe.

[EdipisReks]

depression is often caused by chemical imbalances in the brain. that is by definition an illness. depression drugs operate by attempting to correct these imbalances.

[TruthSeeker]

There is some discussion of depression that might interest you in this thread (http://www.randi.org/vbulletin/showthread.php?s=&threadid=34543)

[epepke]

Originally posted by An Infinite Ocean
Hi all,

Everyone says depression is an illness. Just like heart disease and diabetes. Obviously, with depression there are various symptoms, both mental and physical.

However, what actual evidence is there that it's a fully-fledged illness, rather than simply an unfortunate state of mind that has negative effects upon the body?

At least in the US, depression is carefully called a disorder. Actually, depression itself is a symptom; the disorders are unipolar mood disorder, bipolar mood disorder, and others. But "depression" is often used as shorthand for "chronic unipolar mood disorder." Also, a disorder, like a syndrome, is little more than a collection of symptoms that usually go together.

Whether it's an illness or not, well, "illness" isn't particularly well defined. Mood disorders are like illnesses in that they can debilitate and can be related to other symptoms (severe depression can precipitate schizoaffective features). Most depression does result in some thought disorder; depressed people tend to think poorly of themselves as well as feel poorly.

There's no clear etiology, so it would be a stretch to call it a disease.

Beware of the notion that there are "chemical imbalances." This is purely a folk medicine concept, notwithstanding the fact that many psychiatrists use it.

It is known to be related to the neurotransmitter serotonin in the following way. If one tinkers with serotonin levels, either with MAOIs, which inhibit monoamineoxidase, the enzyme that breaks down serotonin, or SSRI, which selectively reduce the uptake of serotonin, increasing the average time a serotonin receptor has serotonin stuck to it. However, this does not mean that depression is caused by a chemical imbalance, any more than headaches are caused by an aspirin deficiency. There is no known "normal level" for serotonin in the brain and no way of testing for it anyway (except for taking the brain out and putting it in a blender, which is what they do with rats when developing new drugs, and that would make most people really depressed). The closest that one can come is checking for breakdown products in the CS fluid, but that's so indirect as to be pretty useless with respect to an etiology, though it might tell you if a MAOI is doing what it's supposed to be doing.

A few years ago, there was some evidence based on autopsies that chronically depressed people had more serotonin receptors than other people, but that these receptors were considerably smaller. However, the evidence is far from solid, and even if it were, it is not known whether this is a cause of or a result of depression or both, or whether they're both caused by something else, or whatever. It seems more likely that an anatomical property should cause a psychological disorder than the other way around, but that's all it is: something that seems likely. It could easily be that more and smaller serotonin receptors are a developmental adaptation to chronic depression.

[An Infinite Ocean]

Cheers folks. It's this stuff about 'chemical imbalances' that gets to me. I'm curious as to how people know that the chemical changes cause the depression, rather than the depression causing the chemical changes.

I know three people that are very severely depressed (and each is on strong medication). In each of these cases, the depression appears to have situational roots, rather than medical ones.

I just find it quite difficult to see how this depression can be described as an illness per-se. I get quite frustrated when these friends tell me they have an illness, as it seems like an attempt to shift responsibility. Firstly, this makes it 'not their fault' (when I feel that everyone must take a little responsibility for themselves), and secondly it allows them to claim that they can't 'just get better' because 'it's an illness'.

I don't wish to sound ignorant or insensitive, but I think the original question was a valid one. Also, I felt I owed it to my friends to do my research (or get others to do it for me ;) )

Thanks.

[MRC_Hans]

We know that the chemical changes cause the depression, and not vice versa, because when we correct the chemical changes with medication, the depression goes away (more or less).

However, there is a whole scale here; depression is also situation, or trauma induced. I think it is proper to say that it is a disease that is situation induced (there must be a better expression).

You will meet people who have been through literally hell, still come out on the other side without any depression, and others who really ought to be happy, but who stagger from one deep depresion to the next.

Hans

[bug_girl]

well, there seems to be quite a bit of molecular evidence accumulating that depression, or a tendancy for it, is heritable.
one of my favorite journals is molecular psychiatry (http://www.nature.com/mp/) i just scan it because i think it's cool what we learn each day about brains & ourselves.

ultimately, i think it's an illness because it clearly inhibits my student's ability to function. this recent paper (http://www.nimh.nih.gov/events/prgenestress.cfm) in science shows that peple can have a genetic predisposition to depression:
"Among people who suffered multiple stressful life events over 5 years, 43 percent with one version of a gene developed depression, compared to only 17 percent with another version of the gene" (the actual paper is subscription only) this would partly explain why some people can experience trauma, and emerge unscathed.

"illness" is also a legal term, in some ways. and that is a whole other can of worms :)

[TeaBag420]

Depression also occurs as a symptom of a vitamin deficiency called pellagra, which is based on a lack of niacin or poor niacin metabolism. Treatment? Niacin, either as a supplement (pill) or by improving the diet.

To the poster who wrote about measuring the amount of serotonin in the brain, it's not the amount, it's the way it moves around that's important.

[epepke]

Originally posted by TeaBag420
To the poster who wrote about measuring the amount of serotonin in the brain, it's not the amount, it's the way it moves around that's important.

Are you talking about me?

You're probably right, which further shows how the "chemical imbalance" is just a folk concept.

[epepke]

Originally posted by MRC_Hans
We know that the chemical changes cause the depression, and not vice versa, because when we correct the chemical changes with medication, the depression goes away (more or less).

Likewise, "we know that chemical changes cause bipolar mood disorder, because when we correct the chemical changes with lithium carbonate, the bipolar mood disorder goes away (more or less)."

Except that this is both wrong and stupid. The normal human body contains essentially no lithium. The lithium ions replace sodium ions which reduces the action potential of some neurons. This is well understood, and it doesn't have jack to do with a "lithium imbalance."

To reiterate:

The fact that aspirin and acetominophen cure headaches does not mean that headaches are causes by an aspirin deficiency.

The fact that aspirin lowers fever says nothing about the source of the fever.

The fact that nitroglycerin is useful for heart disease does not mean that heart disease is caused by not eating enough dynamite.

The fact that digitalis is useful for heart disease does not mean that heart disease is caused by not eating enough foxglove.

And so on, and so forth.

The "chemical imbalance" concept is folk medicine, pure and simple.

People believe in it because there is a stigma attached to mental disorders, and they think that having a scientific-sounding explanation will somehow erase the stigma. But it's bogus.

[Eos of the Eons]

Originally posted by An Infinite Ocean
Cheers folks. It's this stuff about 'chemical imbalances' that gets to me. I'm curious as to how people know that the chemical changes cause the depression, rather than the depression causing the chemical changes.

I know three people that are very severely depressed (and each is on strong medication). In each of these cases, the depression appears to have situational roots, rather than medical ones.

I just find it quite difficult to see how this depression can be described as an illness per-se. I get quite frustrated when these friends tell me they have an illness, as it seems like an attempt to shift responsibility. Firstly, this makes it 'not their fault' (when I feel that everyone must take a little responsibility for themselves), and secondly it allows them to claim that they can't 'just get better' because 'it's an illness'.

I don't wish to sound ignorant or insensitive, but I think the original question was a valid one. Also, I felt I owed it to my friends to do my research (or get others to do it for me ;) )

Thanks.


I've heard it can go both ways. Post partum depression...caused by imbalance?

In my case stress led to the imbalance.

You can get better, if you make it happen. You won't get better sitting around moping about it.

You can't heal a bone properly without getting it set. You won't beat diabetes without insulin.

It's an illness, but not an excuse to stay ill.

[Eos of the Eons]

The "chemical imbalance" concept is folk medicine, pure and simple.

People believe in it because there is a stigma attached to mental disorders, and they think that having a scientific-sounding explanation will somehow erase the stigma. But it's bogus..


Right. Then diabetes is not caused by insulin imbalances. Schizophrenia has nothing to do with dopamine. Lack of iron has no effect on blood cells.

Folk medicine? This isn't woo wooism here. We're talking modern science and medicine, not folk medicine.

How do you explain depression?

[epepke]

Originally posted by Eos of the Eons
Right. Then diabetes is not caused by insulin imbalances. Schizophrenia has nothing to do with dopamine. Lack of iron has no effect on blood cells.

This is dissapointing. I was building up some respect for you. Oh well. At least it's demonstrating something that has bothered me with respect to skeptics for some time, and it inspires me to put together an essay which I'll write later.

Let me try to explain, using simple words. First of all, you will look long and hard before you will find a physician or a medical researcher who will call the cause of diabetes an "insulin imbalance." What you will find is some good research about how the level of insulin in the body relates to the processing of sugar. You will also find some good, simple blood tests for the level of insulin in the blood.

None of these exists with respect to depression. If you doubt me, go to any psychiatrist of your choice on the planet and ask to get a blood test for depression. There is one.

Now, this will require some imagination, and you may try, if you are up to it. It is entirely possible that people with depression respond positively to levels of serotonin that are significantly higher than those of normal people. I am not saying that this is true; we do not know. But if you have some scientific reason that it must necessarily be false, present it.

Folk medicine? This isn't woo wooism here. We're talking modern science and medicine, not folk medicine.

The idea that cream diets were really good for ulcers was also a product of modern science and medicine, and it was wrong. Totally, completely, blatantly wrong. And stupidly, as it's been known for a long time that fats increase stomach acid, and cream has a lot of fats.

[/b]How do you explain depression? [/B]

I don't.

I assert that at the present time there is not enough information to produce an explanation for depression. I support more research. What I do not support is a jumping to conclusions based on a small amount of data.

[Eos of the Eons]

Where in the world do you get your information from? I've built up 5 years of books, therapy, and yes, psychiatrist visits. They ALL talk about brain chemical imbalances.

Please supply your links and reference. I've already provided some links on this forum, and recommended a book by Elaine N. Aron.

[roger]

From Dr. Francis Mark Mondimore's book Bipolar Disorder:
Another broad category of "medical" mood disorders are those related to various hormone imalances.
For decades clinical scientists have searched for a way to test for bipolar disorder...has not yet led to reliable test...we have learned how to look for and measure abnormalities of brain chemistry....A number of studies have shown that persons with bipolar disorder have an increased number of unusual MRI findings called T2 hyperintensities.

The most consistent PET scan finding in bipolar disorder is a decrease in metabolic rate in the frontal lobes for the brain during periods of depression.....

This study found that there were decreased levels of inositol in the frontal lobes of both the bipolar patients and the suicide victims compared with the control subjects.

I quoted very selectively from some long passages. The jist was that while there are not yet reliable diagnostic tests for bipolar, the science is advancing rapidly.

As far as it not being called an illness or disease, I quote from the same book:

In this first part...I present all the possible symptoms of the illness.

In Chapter 4, "The Mood Disease," I show how psychiatrists came to realize that bipolar disorder is indeed a disease....It was only with the discovery of effective pharmaceuticals that psychiatry realized that bipolar disorder is indeed a disease - as real as diabetes or hyperthyrodism."

As for "chemical imbalances", he disparages it as misleading and simplistic:

There is a term...that many nonpsychiatrist use that I dislike .. I suppose somebody had to invent a term for psychiatric illnesses as uopposed to purely psychological conditions, but chemical imbalance implies several things...that are very misleading.

The ...human brain is not simply a ...organ bathed in a soup of "chemicals" that can be adjusted by the addition of medications to achive a "balance".

An Infinite Ocean, this book, available in any good sized bookstore, answers a lot of your questions in great detail (for a layperson such as myself). For example, it discusses how depression can be caused by medical conditions, such as hyperthyroidism or stroke, evidence for genetic components, etc. I believe it is a well respected book, it is published by John Hopkins, and was recommended to my bipolar friend by her psychiatrist. It's certainly more informative than these threads that for some reason quickly become filled with personal invective.

edited to add: of course, this book is talking about bipolar disorder, not unipolar depression, to which you are probably referring. The author states that the biochemistry is probably different. Still, the book is a good introduction to how depressive states can be caused by biochemistry.

[epepke]

Originally posted by Eos of the Eons
Where in the world do you get your information from? I've built up 5 years of books, therapy, and yes, psychiatrist visits. They ALL talk about brain chemical imbalances.

That authority is sure great! Eat fecal matter. A billion flies can't be wrong.

Well, let's start with the DSM-IV, shall we? Perhaps you can show me the page and paragraph where it describes this.

[Eos of the Eons]

A good layman's term site

The treatment of depression is the same whether or not it was triggered by stress. If the chemical imbalance is present, it can be treated regardless of the cause. Think of it this way. If someone breaks their leg, they will need a cast. It doesn't matter if it was caused by a fall or a car accident, the treatment of the resulting disability is the same.

When the chemical imbalance is corrected, the person is then better able to deal with their stresses since their thought control has been restored.


http://www.drgrantmullen.com/whtcausdeprn.html

Most of the woo sites claim this is not true. Big surprise there.


More technical here:

The researchers found that individuals who have a particular variation in the serotonin transporter gene were more likely to develop depression after exposure to stress.

http://www.brightsurf.com/news/july_03/EDU_news_071803_c.php

Stress causes chemical changes in the body that, left unchecked, can have negative effects on both mental and physical health.

http://www.stress-and-health.com/


Scientists have now identified approximately 45 different hormones that are associated with behaviour such as sleep, fear, peace, pain, obesity, addiction, hunger, depression and stress. So, there is a lot going on because everything is so inter-connected.

http://www.nlp-romania.ro/en/topics/stress.html


Like it or not, our mental well being is completely connected to physical well being because of the systems our body depends on for feedback.

I'm too tired now to explain much, but I'll try again.

[Eos of the Eons]

Originally posted by epepke


That authority is sure great! Eat fecal matter. A billion flies can't be wrong.

Well, let's start with the DSM-IV, shall we? Perhaps you can show me the page and paragraph where it describes this.

Get a grip dude, it's called anatomy, feedback systems, and the body. Go learn something and come back with some intelligible arguments.

Why do flies love poo? Go learn, it has to do with their anatomy. Why don't we love poo? Gee, I don't know? Maybe because our system isn't geared that way for obvious reasons. What do you think happens in our brain when we smell or tast something?

That's right, chemical messages. Chemicals in the brain. It's not just dry old nerve cells in there.

Your little "you only think that cause someone said so" won't fly here bub. It's called knowledge, not belief. Why do I know? Because not only did I take anatomy, chemistry, etc in college, but I also happen to have a good twenty years of experience with depression and anxiety, and even schizophrenia and tourettes syndrome.

Dopamine, serotonin (sp?), etc. are not figments of our imagination, they are our imagination.

[epepke]

Originally posted by Eos of the Eons


Get a grip dude, it's called anatomy, feedback systems, and the body. Go learn something and come back with some intelligible arguments.

Try and calm yourself for a moment.

You made the assertion that ALL the books in your extensive library talked about "chemical imbalances." I am making the perhaps charitable assumption that any honestly acquired library contains the DSM-IV, which is, after all, the definitive guide for the diagnosis of mental disorders in the United States.

I simply asked you to show me wherein it is written that mental disorders are certainly caused by chemical imbalances.

As far as I can tell, there are three possible answers to this question:

1) A page number and paragraph wherein it is written.

2) An admission that it is not so written.

3) A nolo contendere approach in which you do not admit that it is not so written but neither do you point out where it is so written.

That is all. It is all that I have requested.

However, my interpretation of your reaction is that you have somehow glommed onto me as some sort of enemy. I have experienced this many times before, and while it amuses me, I do not see how it is particularly productive in settling, or even arguing for, any actual issues of fact, or even approximation to reality.

Usually, I ascribe this to some sort of defensive need that overcomes questions of literacy, accuracy, and even open debate. I could always be wrong about this, but I seldom actually am.

[Luke T.]

My personal experience with depression revealed that when doctors start considering what antidepressant to give you, they are totally shooting in the dark. Here, try this one. A couple weeks go by. How do you feel now? Worse? Okay. Try this one. And so on. One of the antidepressants made me so much worse, I had to be hospitalized.

I can understand what epepke is trying to say. It would be like if I had a bad headache and a doctor gave me some ground up tree bark and waited to see if my headache went away. If that didn't work, then he gives me some alum to mix with my Pepsi. And so on.

If ground up tree bark was successful at removing a lot of people's headaches, it would only be natural to try to figure out what the mechanism behind that is. But where it gets tricky is that we might assume the mechanism is related to the cause of the problem.

Put another way, if a door is locked (which is what it feels like when you are trapped in depression), and someone trys to open the door with a screwdriver and that doesn't work, and then they try a crowbar and it works, we can study what that crowbar did to open the door, but we shouldn't assume or conclude that a locked door is caused by a lack of leverage. Just because a crowbar is extremely successful at opening a lot of locked doors doesn't mean a "leverage imbalance" is the key (no pun intended) behind the cause of locked doors.

[Luke T.]

To stretch the analogy really, really far, ( :D ) one could say that chasing after "leverage imbalances" will never reveal the true cause of locked doors being a reaction to thieves and the resultant fear and not having a key to the lock.

Locked doors have a conceptual, spiritual and mechanical explanation. I have the feeling that depression is the same. Sorting out cause and effect can have a sort of snake-swallowing-its-tail feeling to it.

I have edited this post about six times. Apologies to anyone who read it during that process.

[Luke T.]

Originally posted by Eos of the Eons



I've heard it can go both ways. Post partum depression...caused by imbalance?

In my case stress led to the imbalance.

You can get better, if you make it happen. You won't get better sitting around moping about it.

You can't heal a bone properly without getting it set. You won't beat diabetes without insulin.

It's an illness, but not an excuse to stay ill.

I know all about post partum depression. My wife suffered from it, big time, after our twins were born.

And you forgot PMS. :D

Definitely some hormone action involved. (edited to add: ) But I'm not so sure that they are related to serontonin re-uptakes.

[Luke T.]

Originally posted by Eos of the Eons



Right. Then diabetes is not caused by insulin imbalances. Schizophrenia has nothing to do with dopamine. Lack of iron has no effect on blood cells.

Folk medicine? This isn't woo wooism here. We're talking modern science and medicine, not folk medicine.

How do you explain depression?

I don't see how diabetes being caused by insulin imbalances is proof that depression is caused by a "chemical imbalance."

I used that kind of argument in my satirical Case for Blue Fairies (http://www.skepticreport.com/funnies/bluefairies.htm) on Claus' web site.

All they can do is attack me with personal slanders because their holy Science is unable to deal with reality. They once said the Earth was flat, and they were wrong. Now they say there are no Blue Fairies. Wrong again!

[Eos of the Eons]

Originally posted by Luke T.


I don't see how diabetes being caused by insulin imbalances is proof that depression is caused by a "chemical imbalance."

I used that kind of argument in my satirical Case for Blue Fairies (http://www.skepticreport.com/funnies/bluefairies.htm) on Claus' web site.



Yes, anecdotes are not proof. It's just an example to help give a clear picture.

I can't put everything my and my son's psychiatrists said here because it's not down on paper, and will be rejected.

My son's psychiatrist was great with anecdotes because he deals with parents every day that need to understand what is going on in their child's brain.

The reasons people have to find drugs that work for them? Everyone is different when it comes to our brains. You can't gear one drug to everyone's imbalance because not every imbalance is the same.

You also then have to work with dosage. This is where balance is worked out over time.

That is why some people will reject the whole process. They feel it is hit and miss instead of zeroing in. That's fair enough.



I simply asked you to show me wherein it is written that mental disorders are certainly caused by chemical imbalances.

As far as I can tell, there are three possible answers to this question:

1) A page number and paragraph wherein it is written.

2) An admission that it is not so written.

3) A nolo contendere approach in which you do not admit that it is not so written but neither do you point out where it is so written.


It is written, and I already showed where. Apparently you missed my post, so here it is again:


A good layman's term site



quote:
--------------------------------------------------------------------------------
The treatment of depression is the same whether or not it was triggered by stress. If the chemical imbalance is present, it can be treated regardless of the cause. Think of it this way. If someone breaks their leg, they will need a cast. It doesn't matter if it was caused by a fall or a car accident, the treatment of the resulting disability is the same.

When the chemical imbalance is corrected, the person is then better able to deal with their stresses since their thought control has been restored.

--------------------------------------------------------------------------------



http://www.drgrantmullen.com/whtcausdeprn.html

Most of the woo sites claim this is not true. Big surprise there.


More technical here:


quote:
--------------------------------------------------------------------------------
The researchers found that individuals who have a particular variation in the serotonin transporter gene were more likely to develop depression after exposure to stress.
--------------------------------------------------------------------------------



http://www.brightsurf.com/news/july...ws_071803_c.php


quote:
--------------------------------------------------------------------------------
Stress causes chemical changes in the body that, left unchecked, can have negative effects on both mental and physical health.
--------------------------------------------------------------------------------



http://www.stress-and-health.com/



quote:
--------------------------------------------------------------------------------
Scientists have now identified approximately 45 different hormones that are associated with behaviour such as sleep, fear, peace, pain, obesity, addiction, hunger, depression and stress. So, there is a lot going on because everything is so inter-connected.
--------------------------------------------------------------------------------



http://www.nlp-romania.ro/en/topics/stress.html



So, now your turn epeke, show us a credible source that "it is written" chemicals have nothing to do with depression or other mental illnesses.

Include examples for

a) schizophrenia
b) Bi-polar
c) depression
d) tourettes syndrome
c) parkinson's disease
etc etc etc.

I will be waiting patiently, don't worry.

I'm also curious. Are you into scientology/dianetics?

[roger]

May I humbly suggest that people read my post above? I feel like I'm invisible here! :) It contains quotes from a very well respected psychiatrist on exactly this issue. Sorry, Eos, but he does discourage the use of "chemical imbalance", not because chemicals don't play a role, not even because a lack of a chemical can cause depression, but because it is far too simplistic and misleading. It's not a matter of too little of chemical A, so we dose with A and patient gets better.

It _really_ is an excellent book, if you want a view into the current thinking about the biochemical basic of depression in general, and bipolar disorder in detail.

[bug_girl]

Originally posted by roger
May I humbly suggest that people read my post above? I feel like I'm invisible here! :)


welcome to my world, roger :)

[roger]

Did somebody say something???

[El Greco]

Originally posted by roger
It contains quotes from a very well respected psychiatrist on exactly this issue. Sorry, Eos, but he does discourage the use of "chemical imbalance", not because chemicals don't play a role, not even because a lack of a chemical can cause depression, but because it is far too simplistic and misleading.

I would guess that he just doesn't like the terminology "chemical imbalance", because it implies that we can somehow fix this imbalance by adding something or subtracting something else, without taking into account unmodifiable gene expression.

But this doesn't change anything for us, does it ? I mean, depression is still something that has a molecular / cellular basis.

[roger]

Originally posted by El Greco
I would guess that he just doesn't like the terminology "chemical imbalance", because it implies that we can somehow fix this imbalance by adding something or subtracting something else, without taking into account unmodifiable gene expression.Well, partially. Also part of the problem is that chemical and psychological causes overlap.

But this doesn't change anything for us, does it ? I mean, depression is still something that has a molecular / cellular basis. Perhaps to us layman (I hesitate to include you in that category, as if i rmember correctly you are trained in pharmacology) nothing is changed, but doctors are not trying to just adjust chemical levels. They need to look into medical causes - vitamin deficiancy, hormones whacked out, etc., provide psychological counseling (either to help treat the disorder, or at least teach coping skills), etc. Calling it a "chemical imbalance", while correctly identifing the problem as biochemically based, both ignores the complexity of the situation and fails to identify many of the other factors which may be involved.

With that said, I think everyone in this thread pretty much agrees with that, but are just expressing it differently. I could be wrong.

[El Greco]

Originally posted by roger
Well, partially. Also part of the problem is that chemical and psychological causes overlap.

I would argue here that "psychological causes" are also "chemical" in their basis. What else could they be ?

And of course it is much more complicated than a "chemical imbalance", but it is also amazing that we have managed with simple molecules to reverse such a complicated disease.

[Eos of the Eons]

Originally posted by roger
Well, partially. Also part of the problem is that chemical and psychological causes overlap.

Perhaps to us layman (I hesitate to include you in that category, as if i rmember correctly you are trained in pharmacology) nothing is changed, but doctors are not trying to just adjust chemical levels. They need to look into medical causes - vitamin deficiancy, hormones whacked out, etc., provide psychological counseling (either to help treat the disorder, or at least teach coping skills), etc. Calling it a "chemical imbalance", while correctly identifing the problem as biochemically based, both ignores the complexity of the situation and fails to identify many of the other factors which may be involved.

With that said, I think everyone in this thread pretty much agrees with that, but are just expressing it differently. I could be wrong.

Sorry Roger, yeah arguing semantics is missing the point, and you make some really good ones.

I don't know if I used "chemical imbalance", but I did mean that the stress over a prolonged period of time, or hormonal changes during pregnancy, birth, etc, do cause the brain chemicals to be upset (serotonin too low too long affects the receptors, etc...I posted a genetic component as well). If caught soon enough, a person shouldn't even need medication. Some stress management would be in order, and even some therapy. That way the brain gets the break it needs in order to get back to 'normal' for that person.


I didn't try meds until I was at my wit's end (took years for me to try it).


Looking into medical causes first (pregnancy, poor diet, lack of exercise) is definitely the only way to start out. I tried making sure all these things in order to make sure I wasn't lacking in the wellness area physically.

Stress management as well. And yes, coping skills.

Meds are usually a last resort, and are not a quick fix, but a way of managing the illness until a person can get better. It's rare for people to take them longer than 2-6 months.

Then you get folks like me, and that's a little more extreme.
Others with post traumatic stress are also a bit more of a challenge.

Everyone has different levels of stress tolerance. It would be nice if we all had high levels of tolerance, but that is not the case. The saying "what doesn't kill you only makes you stronger" is not always the case. It can cause irreversible damage. Giving yourself a break is not selfish, and can save your sanity.

Roger, Do you mean psychological as in the way a person thinks. That is another area to address with depression. Negative thinking doesn't do a body any good.

It's all complex and everyone is different. There are many ways to help a person who is depressed, it's not like schizophrenia.

Thank you Roger.

[roger]

Originally posted by El Greco
I would argue here that "psychological causes" are also "chemical" in their basis. What else could they be ? Process, for one. Structural, for another. I'll expand on that in a minute.

But first, let me say I am all for reductionism, but for useful reductionism. One can say, truly, that the computer programs I write all come down to quantum mechanics. But what a completely useless way to try to understand or debug a program.

Likewise, behavior patterns, thinking patterns, etc, while implemented on a substrate of biology and chemicals, are best understood as processes and structure, not as chemical.

A concrete example: say I have sleep aphia (however you spell it) caused by enlarged structures in my throat. I barely get any sleep over a long period of time, and this exacerbates, or even causes a depression. At some point, somewhere, sure, there is biochemistry involved that translates that lack of sleep into a depressive episode, but it may be quite normal biochemistry. Nothing is out of 'balance', and nothing has to be treated at the chemical level. I just need throat surgery.

Similarly, somebody may have low self esteem that stems from a difficult childhood. This leads to negative thinking, which perpetuates and worsens an existing depression. Dealing with these underlying issues, plus education (teach the person that negative thoughts fuel depression, teach them strategies to recognize when it happens and how to change the thinking) will do wonders to fix the depression. Again, is there biochemistry in there? Absolutely. Is the issue poorly adjusted neurotransmitters? Probably not. The therapy in this case may be sufficient to fix the problem.

You may reasonable counter the "probably not" by pointing out that the existing depression was probably caused my neurotransmitters. Well, the jury is out on that one is my understanding, and there are many other factors which can cause depression. For example, genetic factors can cause your brain to be "wired" badly (yes, wild hand waving is going on now :)). I'd much rather call that a structural problem rather than chemicals, even though of course chemicals are involved.

So anyway, that's the problem with "chemical imbalance". Yes, drugs are getting much more successful at treating these diseases. But that doesn't mean that is the only treatment modality (which I don't think you were saying anyway), and thus, saying it all comes down to chemistry is, IMO, misleading in it's implications.

Eos, I hope this suffices as an answer to your question to me.

Finally, I wrote the above with more authority than I can claim. I am a layperson, explaining my understanding of what I have read
and also what I have been told in therapy.

[epepke]

Originally posted by Luke T.
My personal experience with depression revealed that when doctors start considering what antidepressant to give you, they are totally shooting in the dark. Here, try this one. A couple weeks go by. How do you feel now? Worse? Okay. Try this one. And so on. One of the antidepressants made me so much worse, I had to be hospitalized.

I can understand what epepke is trying to say. It would be like if I had a bad headache and a doctor gave me some ground up tree bark and waited to see if my headache went away. If that didn't work, then he gives me some alum to mix with my Pepsi. And so on.

Unfortunately, this due to the state of the art. The fact that pychs basically have to shoot in the dark to treat depression just shows that we're that much further from having an etiology.

Nobody knows what causes depression. A corrolary of that is that, certainly, nobody knows that there is a single cause for depression. There could be hundreds of diseases, all of which cause depression.

Not too long ago, I had a really bad cold, which still lingers. I find myself sleeping a lot. When I get up, I cannot marshall the mental clarity required to do programming fo my contract jobs. Whether this is due to the effects of the anti-symptom preparations or due to having a head full of snot is a bit of a toss-up. I got depressed. So what's the cause of this one?

Put another way, if a door is locked (which is what it feels like when you are trapped in depression), and someone trys to open the door with a screwdriver and that doesn't work, and then they try a crowbar and it works, we can study what that crowbar did to open the door, but we shouldn't assume or conclude that a locked door is caused by a lack of leverage.

That's a good analogy, but a better one would be the assertion that the door lockage is caused by a crowbar imbalance.

[epepke]

Originally posted by roger
May I humbly suggest that people read my post above? I feel like I'm invisible here! :)

Nah, I heard you, and you make eminent sense, but me-tooism is fairly rare, and as for Eos, I can't even get her to read what I wrote without going off on a something-or-other.

[tamiO]

Originally posted by roger

A concrete example: say I have sleep aphia (however you spell it) caused by enlarged structures in my throat. I barely get any sleep over a long period of time, and this exacerbates, or even causes a depression. At some point, somewhere, sure, there is biochemistry involved that translates that lack of sleep into a depressive episode, but it may be quite normal biochemistry. Nothing is out of 'balance', and nothing has to be treated at the chemical level. I just need throat surgery.

I agree that depression brought on by chronic illness and stress can be treated successfully without drugs, but I think a combination of SSRIs and therapy is the best approach. It puts you in a better frame of mind to heal from surgery and/or make attitude/behavioural changes.

[epepke]

Originally posted by tamiO


I agree that depression brought on by chronic illness and stress can be treated successfully without drugs, but I think a combination of SSRIs and therapy is the best approach. It puts you in a better frame of mind to heal from surgery and/or make attitude/behavioural changes.

SSRIs are pretty cool. I think they work best when combined with Buspar or in the combinations that have a Buspar-like end, such as Serzone or Wellbutrin, because you get the anxiolytic effect as well, or combined with a more traditional anxiolytic such as Ativan.

I've seen little evidence that they work so hot over the long term. Still, they can be effective, if even by giving a patient a short-term referent for what it's like not to be depressed.

[El Greco]

Originally posted by roger
Similarly, somebody may have low self esteem that stems from a difficult childhood. This leads to negative thinking, which perpetuates and worsens an existing depression. Dealing with these underlying issues, plus education (teach the person that negative thoughts fuel depression, teach them strategies to recognize when it happens and how to change the thinking) will do wonders to fix the depression. Again, is there biochemistry in there? Absolutely. Is the issue poorly adjusted neurotransmitters? Probably not. The therapy in this case may be sufficient to fix the problem.

When major depression diagnosis is (properly) made, considerations like the ones you mention are thoroughly evaluated. From this page (http://www.allaboutdepression.com/dia_03.html#1), two diagnostic criteria for major depression:

4. The person's symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder.

5. The person's symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down (psychomotor retardation).

My point is that psychiatrists know how to make a differential diagnosis and exclude other medical conditions or socioeconimic problems from the picture. When someone is diagnosed with major depression, we are talking about a serious medical condition that can be aggravated but cannot be caused (as far as we know) by misfortunes in one's life.

Check the site I linked for other types of mood disorders that may be more like what you have in mind.

[roger]

Originally posted by El Greco
My point is that psychiatrists know how to make a differential diagnosis and exclude other medical conditions or socioeconimic problems from the picture. When someone is diagnosed with major depression, we are talking about a serious medical condition that can be aggravated but cannot be caused (as far as we know) by misfortunes in one's life.I think we agree, and are just talking past each other a bit.

[Eos of the Eons]

My point is that psychiatrists know how to make a differential diagnosis and exclude other medical conditions or socioeconimic problems from the picture. When someone is diagnosed with major depression, we are talking about a serious medical condition that can be aggravated but cannot be caused (as far as we know) by misfortunes in one's life.

I'm glad to see someone knows what they are talking about :p

***pokes epeke with a stick***

[Dancing David]

Originally posted by epepke


Are you talking about me?

You're probably right, which further shows how the "chemical imbalance" is just a folk concept.

It is a matter of scale, if you say to someone "hey your depression is caused by a lack of an adequate post sysnaptic receptors/post synatptic response leading to overactivity in the serotonin and dopaminic system which in turn creates the symptoms of depression", they are just as likely to say 'why didn't you just say chemical imbalance?"

It probably be more acurate to say "you have a stress related disorder that manifests itself as depression".

On the whole depression is an illness issue:

There are people who use anything as an excuse. the point to labeling mental illness as mental 'illness' is to get away from the moral judgements that people get into; like; 'they are just lazy','they just don't try hard enough','they just need to get over it'.

When I am depressed it seems to have two effects, one an overwheliming sense of being flooded by sensations and obsessive/compulsive thoughts and behaviors OR feeling like I need to sleep or cry all the time, it is like 'walking under water', everything requires alot of effort in motivation. Fortunately Zoloft does away with most of it.

Wether depression is situational/exogenous or biological/endogenous is not material, if someone is still grieving the loss of a loved one and can't function, they can't function. If someone is jusy totaly lacking in the will to face the day and they can't function, they can't function. The question that leads people to treatment is two fold, are you functioning, what areas would you like to function in?

Mental illness sounds better to me than the one NAMI is proposing 'brain disorder'. I would rather be a patient than a 'mental health consumer'.

Some people can get thier lives back on track with just some cognitive restructuring, some need medication. The biggest problem for most people with depression is giving up thier unhealty coping skills. Like alcohol or avoidant behaviors.

[Dancing David]

Originally posted by epepke


That authority is sure great! Eat fecal matter. A billion flies can't be wrong.

Well, let's start with the DSM-IV, shall we? Perhaps you can show me the page and paragraph where it describes this.


And what are you some religous kook, did you read a book by Thomas Sasz and just lap it up? There is plenty of research into the biological basis of mental illness.

You must be suffering from some grand delusional scheme to take the DSM as some sort of proof of anything, it is a manual for the description of disorders that psychiatrist and psychologists treat.

What is the matter Epekeke , you want to just stigmatize people because it makes you feel good, you obviously have some critiacl thinking skills, use them! Where did EoE say any of the crap you acuse her of, I suppose you think we should burn witches too?

The problem most likely is that you just want to feel superior to people who live with mental illness, thanks a lot shmuck. Do us all a favor and shut up!

[Dancing David]

Originally posted by epepke


Unfortunately, this due to the state of the art. The fact that pychs basically have to shoot in the dark to treat depression just shows that we're that much further from having an etiology.

Nobody knows what causes depression. A corrolary of that is that, certainly, nobody knows that there is a single cause for depression. There could be hundreds of diseases, all of which cause depression.



And this is news to who, some ignoramus who just started to spout off in some forum and demostrates the lack of thier knowledge. This is a well known fact in the mental health community, something you could have even read on this board!

Duh, dude! What other pearls of wisdom do you have to offer, anything from this century, there is a sound basis for knowing the roots of a lot of depression.

Which is why a statement like "Nobody knows what causes depression" just shows a contradiction in your thinking. Duh, again. If you already knew that there are multiple neuro transmitters and they they may all be part of depression, then you would already know that. Gee that was common knowledge in 1982!

It just happens that depression manifests in just a few choice systems in the brain, for about 80% of depression, it manifests in the serotonin and the dopamine/acetyl choline system. So those people will respond well to treatment with SSRI or TCA. Recently estrogen therapy is very effective for treating some women.

You are just amazing, there has been research into the causes of depression for over 25 years, good solid nuero-biology and you just missed it all.

A chemical imabalance is as good as most people want to hear.

[Dancing David]

Originally posted by El Greco


When major depression diagnosis is (properly) made, considerations like the ones you mention are thoroughly evaluated. From this page (http://www.allaboutdepression.com/dia_03.html#1), two diagnostic criteria for major depression:



My point is that psychiatrists know how to make a differential diagnosis and exclude other medical conditions or socioeconimic problems from the picture. When someone is diagnosed with major depression, we are talking about a serious medical condition that can be aggravated but cannot be caused (as far as we know) by misfortunes in one's life.

Check the site I linked for other types of mood disorders that may be more like what you have in mind.

The other issue is that it can very hard to get an accurate history when a decompensated person presents for the first time, depression and schizophrenia look amazing alike when the person is full blown and florid. Are they psychotic or do they have obsessive compulsive disorder? Are they really psychotic or are they way manic? Are they really bipolar or just high on cocaine? What possibility is there that they have suffered organic braib damage of some sort?

Great post!

[Dancing David]

If you do a google search on neuro-biology/neuro transmitter/depression you get over 9,700 hits and there is only one woo woo enough to use the phrase holisitic on the first two pages.

Following are four links out of the first two pages, Folk medicine indeed, folk doctors only wish!

Abnormal signaling, over secretion.
http://www.neurotransmitter.net/crf.html

Neurotransmitters activate secondary message
http://www.psychiatrist.com/pcc/brainstorm/br6010.htm

Neurobiology of depression
http://www.sci.sdsu.edu/classes/psychology/psy760/handouts/depression.htm

Stress and depression
http://cpn.umc.edu/NSSP/presenations/PrestSMcDaniel.pdf

[hammegk]

You mean it isn't possession by demon(s)? :(

HUH? Oh, OK.


Nevermind! :p

[epepke]

Originally posted by Dancing David
It is a matter of scale, if you say to someone "hey your depression is caused by a lack of an adequate post sysnaptic receptors/post synatptic response leading to overactivity in the serotonin and dopaminic system which in turn creates the symptoms of depression", they are just as likely to say 'why didn't you just say chemical imbalance?"

Well, this is not known. That's what it means to say that the cause of depression is not known.

It probably be more acurate to say "you have a stress related disorder that manifests itself as depression".

Or, rather more honestly, "you have something that manifests itself as depression, and although we don't know what causes it, tinkering with serotonin sometimes helps."

Depression isn't necessarily stress-related. It may be, but at the crude and imperfect level of psychiatric medicine, those generally tend to get labeled as situational depressions.

There are people who use anything as an excuse. the point to labeling mental illness as mental 'illness' is to get away from the moral judgements that people get into; like; 'they are just lazy','they just don't try hard enough','they just need to get over it'.

That's a very good point. There do exist what for want of a better word one might call "moral models" of depression. Of course, one of the symptoms of depression is feeling bad about one's character, and it seems fairly clear that depression can amplify these messages.

Without pointing fingers, I think that some people have glommed onto the "chemical imbalance" concept as the only possible alternative to a moral judgement and stick to it for that reason. And so, when the "chemical imbalance" concept is questioned, they consider it an attempt to take away what they consider to be their only bulwark against a moral judgement.

Yet this is a kind of a mythological battle here, and while I do consider mythology to have some value, I would hope that the researchers who are looking for the ultimate causes work in terms of something better and more accurate and precise than mythology.

When I am depressed it seems to have two effects, one an overwheliming sense of being flooded by sensations and obsessive/compulsive thoughts and behaviors OR feeling like I need to sleep or cry all the time, it is like 'walking under water', everything requires alot of effort in motivation. Fortunately Zoloft does away with most of it.

Fairly classical descriptions of depression. For me, Zoloft just gave me anorgasmia, which didn't exactly cheer me up.

Wether depression is situational/exogenous or biological/endogenous is not material, if someone is still grieving the loss of a loved one and can't function, they can't function. If someone is jusy totaly lacking in the will to face the day and they can't function, they can't function. The question that leads people to treatment is two fold, are you functioning, what areas would you like to function in?

That seems to me an eminently healthy attitude. But I have to reiterate that what I am saying doesn't really impinge on the idea of whether it's exogenous or endogenous. Of course, this too is all going to have to be worked out. But simply saying that the notion of a chemical imbalance is folk medicine does not mean that there is not an endogenous condition. It really doesn't enter into the picture at all.

It also doesn't say anything about the value of medication. As I think I posted before, NSAIDs such as aspirin can be used to treat headaches. I'm simply pointing out that there is no evidence that headaches are caused by an "NSAID imbalanace."

Mental illness sounds better to me than the one NAMI is proposing 'brain disorder'. I would rather be a patient than a 'mental health consumer'.

I've often found that I have a problem with the tendency to call mental health patients "clients," but this is still an observation based on mythology. Whether one is called a patient or a client or a consumer says little or nothing about underlying causes.

[epepke]

Originally posted by Dancing David
And this is news to who, some ignoramus who just started to spout off in some forum and demostrates the lack of thier knowledge. This is a well known fact in the mental health community, something you could have even read on this board!

Duh, dude! What other pearls of wisdom do you have to offer, anything from this century, there is a sound basis for knowing the roots of a lot of depression.

I'm honestly unsure of what exactly you're excited about.

I made what seemed to me a fairly obvious observation, that nobody knows what causes depression, and that the "chemical imbalance" was a folk medicine concept and inadequate to describe an actual etiology. I fully expected the matter to die out there.

However, Eos of the Eon's went and got all huffy about it. So, given that challenge, I felt that I had to respond and reiterate that the cause is not known, because she, at least, as a participant in this thread, has demonstrated hostility toward the idea.

Now you are getting all huffy because, what, it isn't New™ or Exciting Enough™ for you?

Just what the hell is wrong with you?

It just happens that depression manifests in just a few choice systems in the brain, for about 80% of depression, it manifests in the serotonin and the dopamine/acetyl choline system. So those people will respond well to treatment with SSRI or TCA. Recently estrogen therapy is very effective for treating some women.

You are just amazing, there has been research into the causes of depression for over 25 years, good solid nuero-biology and you just missed it all.

And, how, exactly, does that contradict anything that I have said here?

[epepke]

Originally posted by Dancing David
And what are you some religous kook, did you read a book by Thomas Sasz and just lap it up? There is plenty of research into the biological basis of mental illness.

You must be suffering from some grand delusional scheme to take the DSM as some sort of proof of anything, it is a manual for the description of disorders that psychiatrist and psychologists treat.

What is the matter Epekeke , you want to just stigmatize people because it makes you feel good, you obviously have some critiacl thinking skills, use them! Where did EoE say any of the crap you acuse her of, I suppose you think we should burn witches too?

Man, this is so over the top that I can only hope that it's a satire. It reads like a satire.

[epepke]

Originally posted by Eos of the Eons


I'm glad to see someone knows what they are talking about :p

***pokes epeke with a stick***

Have you learned how to read yet?

[Dancing David]

Originally posted by epepke


Man, this is so over the top that I can only hope that it's a satire. It reads like a satire.

All good satire contains an element of the truth. And yes when i find myself getting prosaic, I tend to lampoon myself.

Whats your excuse?

[Dancing David]

Originally posted by epepke


I'm honestly unsure of what exactly you're excited about.

I made what seemed to me a fairly obvious observation, that nobody knows what causes depression, and that the "chemical imbalance" was a folk medicine concept and inadequate to describe an actual etiology. I fully expected the matter to die out there.

Yeah well, it is a useful term for those in society who use the medical system but don't want to understand what a post synaptic response is.
Your still foolish for dictating what is basicaly a biochemical imbalance and not being a chemical imbalance. But then I suppose you never had to talk to someone who never went to high school about why thier family member should take medicine to reduce thier psychosis. I am sure that telling them "the eitiology of mental illness is not clearly understood but we highly recomend that your family member take this medicine because it seems to provide some relief from the symptoms, although we don't know if the effect is pallative or restorative" would get a resounding, yes I understood that.


However, Eos of the Eon's went and got all huffy about it. So, given that challenge, I felt that I had to respond and reiterate that the cause is not known, because she, at least, as a participant in this thread, has demonstrated hostility toward the idea.

Now you are getting all huffy because, what, it isn't New™ or Exciting Enough™ for you?


No, because you just demonstrated a complete and total lack of any knowledge about the traetment of mental health in the USA, if you did have any knowledge then you would not state these facts as though they weren't already known in the mental health community.
The issue is that there is one percent of the population that lives with schizophrenia and similar numbers for people who have severe depression and bipolar disorder. If they are helped to get relieve from thier sysmptoms by the phrase 'chemical imbalance', then fine.

You see when you say the phrase you have to hold your hands out and make this balancing motion. When you talk about someone getting 'sick', ie thier symptoms getting worse, then you move your hands out of balance and then you talk about the role of medication and bring your hands back to the same level.

The importance of the phrase is in the hand gestures! ;)

The other point being that it is very hard to get family memebers to stop plying thier menatly ill family members with alocohol and street drugs, unless you brandish the phrase 'chemical imbalance'.


Just what the hell is wrong with you?

I don't know, you seem to be the one with the problem!
Have you vere worked in menatl health, do you even have an idea of what you are talking about. I mean really, there are people who take insulin for thier 'sugar' as well.You aren't one of those people trying to turn every one into 'prosumers' are you?



And, how, exactly, does that contradict anything that I have said here?
You act as though these things are not aleady well know, which they are.
The myth of mental illness causes many people to suffer when they could be helped.
The point is that you need to educate yourself about the current level of treatment in the USA. It is a fine philosophical point you have made, but believe me when you talk to the average person recieving mental health services about 'post synaptic response' and how 'depression is caused by overactivity of a brain area', and 'schizophrenia is caused by a lack of activity in a brain area' they will just look at you and say
"Why didn't you tell me I have a chemical imbalance!"

[Dancing David]

Originally posted by hammegk
You mean it isn't possession by demon(s)? :(

HUH? Oh, OK.


Nevermind! :p

Could be, thats why I have a priests bless my medicine!

[Eos of the Eons]

Originally posted by epepke


Have you learned how to read yet?

I think Dancing David pointed out who can't/won't read.

I asked you for one simple thing, back up for your opinion that chemical balances don't cause depression.

You have yet to do that, but slander you do instead.

Just goes to show who doesn't have a clue what he is talking about.

Thank you for the good posts Dancing David, with some great technical information. :)

[Dancing David]

Originally posted by epepke


Well, this is not known. That's what it means to say that the cause of depression is not known.

Must they wait for the cause to be understood to get help?
The treatment of cholesterol in the uS in much more expensive and likely to be a total waste of money. But I don't read you calling that folk medicine.



Or, rather more honestly, "you have something that manifests itself as depression, and although we don't know what causes it, tinkering with serotonin sometimes helps."

You left out dopamine and GABA.


Depression isn't necessarily stress-related. It may be, but at the crude and imperfect level of psychiatric medicine, those generally tend to get labeled as situational depressions.

i beg to differ, most mental illness have a stress related component, if you look at the course of a person in recovery with mental illness, their progess almost always requires they learn to keep thier stress levels under control.

That's a very good point. There do exist what for want of a better word one might call "moral models" of depression. Of course, one of the symptoms of depression is feeling bad about one's character, and it seems fairly clear that depression can amplify these messages.

Without pointing fingers, I think that some people have glommed onto the "chemical imbalance" concept as the only possible alternative to a moral judgement and stick to it for that reason. And so, when the "chemical imbalance" concept is questioned, they consider it an attempt to take away what they consider to be their only bulwark against a moral judgement.

And getting people to give up thier less than healthy behaviors is very difficult, especialy the self medication and avoidant behaviors.
But if someone's lack of progress is stressing you , the best you can do for them is take a vacation.
When you have schizophrenia or depression it is important that people try to not moral trump you.

Yet this is a kind of a mythological battle here, and while I do consider mythology to have some value, I would hope that the researchers who are looking for the ultimate causes work in terms of something better and more accurate and precise than mythology.

The Atkins diet would be a better example, or the get more exercise and you will feel better myth.

Fairly classical descriptions of depression. For me, Zoloft just gave me anorgasmia, which didn't exactly cheer me up.

I will agree that the treatment of depression is totaly hit or miss, even though they could measure the level of serotonin and dopamine byproducts in the urine.
I thought I had bipolar disorder and OCD, the doctor chose to treat me for derpression, And I am very lucky I responded in two days.

Worst side effect ever(except for TD and EPS): is the 'retrograde ejaculation'.

That seems to me an eminently healthy attitude. But I have to reiterate that what I am saying doesn't really impinge on the idea of whether it's exogenous or endogenous. Of course, this too is all going to have to be worked out. But simply saying that the notion of a chemical imbalance is folk medicine does not mean that there is not an endogenous condition. It really doesn't enter into the picture at all.

It also doesn't say anything about the value of medication. As I think I posted before, NSAIDs such as aspirin can be used to treat headaches. I'm simply pointing out that there is no evidence that headaches are caused by an "NSAID imbalanace."

I've often found that I have a problem with the tendency to call mental health patients "clients," but this is still an observation based on mythology. Whether one is called a patient or a client or a consumer says little or nothing about underlying causes.

It is not mythology, if you are a professional providing a service you call the recipients 'clients', and in the 1990s there was this whole movement by people with too much time on thier hands to be called 'consumers'.

Clients recieve services from mental health professionals, i always called mine by thier names.