Life Circumstance Or Chemical Imbalance?

[Anarchy]

@LifeCutShort
That is a very profound insight and question.

Bessel van der Kolk, one of my personal heroes in researching trauma, describes the automatic recourse to drugs as "a post alcoholic culture" - the idea that you have to stick something in your mouth to change your view of the world.

He contrasts that with yoga, mindfulness, tai chi etc and of course with psychotherapy, which achieve the same and better results in the short term, and far better results in the long term, by teaching us actual coping skills, and helping us get to the point where we can change our circumstances.

One thing which came up in a big post here a few days back, was a woman saying that she had self medicated with alcohol and illegal drugs, but was now "clean"

a drug is a drug, regardless of what some poxy little politician or bureautwat writes on a piece of paper. van der Kolk points out that alcoholics and addicts are self medicating, and that alcohol works pretty well, until it doesn't! To my way of thinking, the woman was never "unclean".

I've seen friends suffer all of the symptoms described by William Burroughs, for coming off morphine, when they've tried to come off SSRIs too fast, but SSRI's are not supposed to be addictive or to give cold turkey - they're given other newspeak names instead.

The drugs (of any sort) do not teach coping skills and do not change our life circumstances.

 

[darrenS]

i always find the chemical imbalance theory interesting, its been a theory for decades now , but not once has anyone been able to identify the so called chemicals an how they are imbalanced. Its similar to the disease theory of addiction

 

[shimmerz]

I have tried anti-depressants and am still taking them but they do nothing to rectify the reality,

No, of course they don't. Pills don't change reality, people do. ;-)

 

[KwanYingirl]

@LifeCutShort you say the trauma remains. Are you still being traumatized? I think if not, that you try to remember that it is not happening now. Now you are safe. Now you can learn to overcome the effects of remembering it. Now you are safe.

 

[Lucycat]

I was distressed but the doctor interpreted that as depressed and 'insisted' I needed anti-depressants. I agreed to take them so that I could get discharged, but knew they would not help. I did continue them for about 8 weeks, I think, and then I stopped. When I later saw my own doctor she expressed surprise that I had even taken them that long.

The impression I got was that the prescribing doctor was afraid of being accused of medical negligence for failing to treat my supposed depression if I then went on to commit suicide. I was there following an overdose after all. He was simply covering his own back and protecting his professional career, by treating me the way he thought best ( regardless of my thoughts or opinions as at that time I was not entitled to think!)

I do think anti-depressants are helpful to some people. However I don't think for one minute they treat PTSD although as others have said if they enable therapy to happen then why not? But only take them if they work for you.

 

[sun seeker]

Because it's what they are taught. Because pharmaceutical companies are part of a multi-billion-dollar industry. Because the drugs do help some people even when their life situations haven't changed, by giving them enough energy to do something more direct about those situations. In my opinion they are way, way over-prescribed and the dangers hugely downplayed, though. They certainly never did anything for me.

@LifeCutShort, on a different topic, I'm noticing you don't use the quote function in your posts and I wonder if you aren't aware of it? It makes conversations much easier so when you want to respond to a particular part of a post, you don't have to copy it and put it in quotation marks. It also makes the quote stand out more clearly so someone reading the post can immediately tell what is the new post and what is being quoted. To do that, use your mouse to select the section you want to quote, then let go of the mouse button. Below the selection you should see a little black box that says "Quote" on the right. Click on that (not the quote with a plus sign on the left) and the selection will appear as a quote in a separate box in your new post. It might make it easier for you.

 

[Anarchy]

In my opinion they are way, way over-prescribed and the dangers hugely downplayed, though. They certainly never did anything for me.

That's the impression that I get.

I know this is a single person's experience and can't be extrapolated to everyone:

a former gf was prescribed them. they did nothing for her low moods and suicidal ideation, she became actively suicidal every time she tried to get off them, and they severely and permenantly damaged her sexual function, those effects (impaired orgasm, bye bye to multiple ones, couldn't lubricate, and she was producing breast milk) stayed with her when she eventually did manage to get off the drug.

The few people who I have heard sharing experiences suggest that the sexual side effects are much more widespread than popular perception suggests.

 

[Mit]

I took anti depressants for nearly four years, and diazepam, and sleeping tablets. They kept me going through the darkest period of my life, just. My doctor at the time was primarily concerned with enabling me to function, and keeping me safe. After four years I didn't think they were helping much, I felt disconnected, they were affecting my memory and I worried I might be addicted. My doctor and I agreed a very slow reduction, and after six months I stopped all medication, and I've been clear for 18 months.

From the outset my doctor explained to me medication wasn't a solution, it wouldn't change whatever it was that distressing me. It bought me time, to think, and try to get some help with sorting out the real issues. And I was wrong about them not helping me, a year after I stopped medication I started getting crushing anxiety attacks, and deeply depressive moods. I still get these now. I am strongly tempted to go back on to medication, but so far I have resisted. If you were to ask my partner I think she say life was easier for her and my kids when I was on medication - but she supports me either way.

I started therapy a while ago, and it really disturbs and upsets me sometimes, often in fact. Medication would help smooth out the peaks and troughs whilst I work through my issues, it might even make the therapy more effective - who knows. But I'm determined to get through this without medication if I can.

Medication has it's place (in my opinion) but only as one part of a holistic approach to treatment. And knowing when to get off....that's pretty important too.

 

[Deleted member 1860]

@sun seeker,

Many of us don't use quotes because they are a PITA on a tablet or smartphone. I tend not to use them myself for the most part. Many sites these days are not tablet or smartphone friendly, which is surprising given that a high percentage of people only use one of the two.

 

[joeylittle]

If you go to a psychiatrist and complain you are lonely, it doesn't matter if you actually are alone or isolated (in which case feeling lonely would be normal) or if your loneliness stems from a chemical imbalance, the prescription is always the same.

But you are leaving out the possibility that the isolation behavior is a result of an organic imbalance. If you are alone and isolated, but it makes you desperately unhappy, then a 'healthy' (I use that word very lightly) individual would make a choice to change the isolation and alone-ness.

So the real question you are asking is, what is the cause of the isolation?

It might be situational - anything from a recent death of a loved one to incarceration - in which case, it can (theoretically) be addressed cognitively without medical intervention.

But it might be organic/situational - and those two examples given above could also be influenced by organics - in which case, medication would help, but cognitive work is necessary.

I don't think doctors are totally ignorant to the concept of situational (environmental) vs. organic depression. I do think they make an evaluation based on how the individual reports their story, what their own bias is, and their prediction of how likely the individual will either seek cognitive help or be capable of applying cognitive help in their current state. So yes, bias matters.

The two most important questions (in my opinion) to ask a psychiatrist before anything happens are, "what do you believe medication is meant to do?" and "when would you choose to not prescribe?" You'll learn almost everything about their bias from those two questions. And if you don't like the answer, move on - or if you can't move on, be frank with them about your thoughts.

I say all this as a person with organic and situational depression; I'm very aware of each, and how one influences the other, and how I can handle one without meds, but the other absolutely needs the chemical assistance. I've only become aware of them through engaging in treatment of both, and really trying hard to sort it out. Plus questioning my doctors, and switching if they didn't make sense to me. It's a ton of work, but it does pay off when you find someone you can trust.

 

[Friday]

Have you asked these health professionals this same question?

No, I think it would be a waste of time to ask.

LMAO... As a matter of fact, yes. Not only is it an ongoing and evolving conversation between myself and my own doctors, but it's been a regular conversation in both of my schools, as well as the family dinner table. Which is only relevant as my grandfather was not only a doctor and several of my extended family in medicine & research...but that they also helped set curriculum at a few different medschools in the country.

While I can personally attest to hundreds of conversations over the years of them being frustrated with patients who
- Don't want to educate themselves, even to understand the very basics of their own issues or the medications they take...
- Just want a magic wand to make them better
- Won't listen that meds are a stopgap and partial treatment, not a solution
- Even then won't talk about their side effects they're dealing with so that the right med can be found... When there are hundreds of medications out there, and they don't have to be suffering with these side effects.
- Consistently refuse referrals to specialists, no matter how many times they're recommended, nor how strongly.
- Refuse to follow simple instruction
- Not only refuse to be an active participant in their own treatment, but worse than not talking... Lie. Constantly. Recklessly jeopardizing their own health


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Also that the core curriculum on psychiatric meds from Undergrad Psych classes on up to Graduate Health Sciences programs are (to oversimplify for brevity)

1) Three Main Classes :
- Permanent Necessary (such as a schizoaffecfive disorder where a person is an ongoing danger to themselves or others, and will never be able to function or live a functional life without medication)
- Permanent Optional (such as ADHD or Structural Depressive disorders, -or PTSD- where the underlying neurological condition is permanent, but while meds may be beneficial, the disorder or condition can be managed without medication, and it really is up to the patient if they choose to which tools work best in their own lives)
- Temporary Optional (ranging from short term situational issues -grief following death of a child- for example... To long term issues which have acute spikes in symptoms -like acute onset of anxiety or suicidal impulse for people with MDD, GAD, PTSD, etc.)

2) That meds are never, in any of the 3 above categories, a complete treatment. That they need to be combined with therapy in all cases, and in most cases are nothing more than a stop gap measure... To get a person able to conduct therapy in the first place. To assist them over the hump and in the most difficult part of the learning curve or in acute and overwhelming symptoms.

3) To insist as much as possible, that medication management be overseen by a psychiatrist, prescribing psychiatric nurse, or neurologist / aka specialist who can keep up to date on all the particulars of their field & work in conjunction with the psychologist/MSW/person conducting the therapeutical aspect of treatment.

 

[anthony]

Life circumstances or chemical imbalance? The first is closer to the truth, the latter is proven beyond a doubt as no such thing. Neuronal synapse firing is not a chemical balance as pharmaceutical companies claimed for near 40 years.

Life circumstances affect your perception of the world and others. This creates what we simply call "mood." Mood is cognitive and behavioural. So then... to answer:

why do health professionals prescribe anti-depressants?

Two primary reasons, being:

1. Duty of care to try and give a patient some attempt at righting the issue via the easiest method physicians know, and
2. Because pharmaceutical companies have so much power in medicine, they attempt to transfer that to mental health as though cognition is medical, and they give kickbacks to prescribing physicians.

Pharmaceuticals is hit and miss, and there are more studies annually coming out that show anti-depressants are not the solution, there is no serotonin correction needed, and in fact a recent study of significant validity demonstrated a strong belief that serotonin levels increased in many with depression, not decreased. Though as serotonin cannot be directly measured, they measured an alternative way in which was validated as scientifically accurate to date.

Mounting evidence is against pharmaceutical companies hypothesis for the past 40 years in which they claimed drugs are the solution... with absolute zero scientific evidence to support their hypothethis. People just jumped onboard with all the money being handed around, and the fact that they work for some, not for others.