Life Circumstance Or Chemical Imbalance?

[SeaQuel]

@anthony Are you referring to serotonin levels in depression or in PTSD or in both? Can you provide a link to some of the new studies that demonstrate there is no serotonin correction needed? I'm very interested in this subject, as it's the primary reason I'm giving drugs a shot.

 

[Chava]

Are you in therapy? Meds don't "cure" PTSD as well as therapy does. Good therapy also helps feel hopeful and like you aren't powerless. For me it's stuff of nervous system regulation...not being too hyped up or too far down and immobilized. Lately I'm more depressed. It does connect with feeling hopeless, too and sometimes those thoughts that things will never change. If you find a good therapist and work you can do something and slowly slowly heal stuff. Even if not immediately helpful, this helps me not feel like I am forever trapped. Meds help manage symptoms. They don't work for me so I'm not on any aside from some pain medication (tried every major SSRI, SNRI, NNRI). I'm sure benzos would but my doctor won't prescribe them because I'd be taking them in overdoses all day.

I had a therapist who pushed meds (wanted me to get Prozac or anything from doc) and it was like a roadblock in my case because those had not worked and I felt like the therapist didn't feel like she had any helpful tools...like I just needed to be medicated to feel better. Current therapist never talks about meds. We work directly with trauma, regulation stuff, feelings. She seems more equipped to offer something more than meds. If you don't have a trauma therapist is that something you can consider?

 

[anthony]

Are you referring to serotonin levels in depression

The study was depression... though depression is comorbid PTSD in the majority of sufferers. Serotonin, period, cannot be directly measured, and synapses are not serotonin.

I don't remember which study it was, as I'm reading way too many in the past months writing newsletter pieces. You will find them in scholar or pubmed.

 

[anthony]

Here was the linked story to the study: https://www.myptsd.com/threads/sero...le-in-depression-new-evidence-suggests.47158/

There's another study in the vault... and article there, which demonstrated the tainting of results in SSRI and such depression medication studies. When court ordered to do so, companies and academic institutions had to release all the failed studies that didn't demonstrate effective treatment (especially as many were paid by pharmaceutical companies and buried). When combined into a huge meta-analysis, it was very clear that serotonin based medication had a very low success rate versus the perceived high success rate.

It didn't do the pharmaceutical industry much good, that one.

 

[joeylittle]

This article is a nice read, from 2009: http://www.health.harvard.edu/mind-and-mood/what-causes-depression

Taken from: http://www.scientificamerican.com/article/is-depression-just-bad-chemistry/

...depression cannot be boiled down to an excess or deficit of any particular chemical or even a suite of chemicals. “Chemical imbalance is sort of last-century thinking. It's much more complicated than that,” neuroscientist Joseph Coyle of Harvard Medical School was quoted as saying in a blog by National Public Radio's Alix Spiegel. Indeed, it is very likely that depression stems from influences other than neurotransmitter abnormalities. Among the problems correlated with the disease are irregularities in brain structure and function, disturbances in neural circuitry, and various psychological contributions, such as life stressors.

This article does a good job at connecting these points more aggressively: http://bigthink.com/devil-in-the-data/the-chemical-imbalance-myth

The “Chemical Imbalance” Explanation for Depression: Origins, Lay Endorsement, and Clinical Implications is a paper published in 2007 - which is awhile ago, but it's not like there has been a quantum leap in the information since then.

So, the idea that you have one chemical out of whack with the other is just an early, early hypothesis gone viral. But this doesn't mean that there are not potentially organic causes. What's funny (not) about the seratonin thing is just how well it stuck. There are studies disproving the seratonin hypothesis.

I hate to make the age-old comparison to Cancer (people living with Cancer, forgive me) - but the best way to understand cancer is that it is a disease with different causes, it takes different forms, and it is treated in different ways depending on the cause and form and what is known or not known about them.

Depression has different causes, takes different forms, and is treated in different ways depending on the cause and form and what is known or not known.

The profound difference between these two is that cancer is recognized as a terminal illness, and depression clearly is not - philosophical debates notwithstanding - depression does not at all meet the medical criterion for "terminal". And so, depression sufferers actually can have the time to try different ways to treat their illness, including ways that don't involve medicine at all.

Sorry for the soapbox - it's just a complex issue.

 

[SeaQuel]

Ok, mind is blown. In a good way. And that was just after reading one of those articles (I will go back and read the others). I guess when I was doing my own research into SSRIs I must have found all of the "viral" supporting studies and not the newer and more comprehensive data. Why is that medical professionals (therapists and psychiatrists) haven't caught up to the science? How does this fit into the freeze flight fight cycle? Or does it?

 

[anthony]

a) they're just busy with their jobs and believe all the rubbish thrown their way,
b) they're ignorant and don't care,
c) they're getting kickbacks from prescribing pharmaceuticals, so there's no way they're going to stop it.

 

[joeylittle]

d) if the drug works....(a bit like 'if the shoe fits')

I'm not defending over-prescribing or irresponsible medicine - but there are a good handful of drugs that reliably relieve certain symptom-sets in a certain percentage of the population. What I think is annoying is that they don't bother to explain that the action of the drug or why it is effective isn't fully understood.

My first drug was Cymbalta - the (bad) psychiatrist was clearly pushing what the drug reps wanted him to push. It was new-ish then, and insanely expensive (which I didn't know at first, because he got me started on samples. Watch out for samples). But what also turned out to be true was that it helped me for a decent chunk of time. Now, I'm talking about severe MDD, not depression associated with PTSD - so it's all relative.

Being a doctor is a job, like any other job. There are people who are good at it and people who suck at it, and people who are basically OK at it. And people who are great at it. You'd think it'd be a little more of a level playing field, but really, I think the most unifying test doctors go through is when they are residents. SO, if you have endurance and can survive crazy hours, you can be a doctor. Doesn't guarantee intelligence.

Upshot: always do your own research to the best of your ability.

 

[Friday]

e) It takes about 10-20 years for anything new to bottom-up through medicine to become standard practice or common knowledge.

_________

Meaning "new" protocol, methods, etc. are jumped on by medschools. Whether it's empiracle evidence proving XYZ ,or a surgery technique, or method, etc... as shaaaazam! Wow. This has just become absolutely required knowledge! And it starts being taught.

- It takes about 10 years for those students to pass through school, residency, interning.
- It takes about 10 more years for those students to be in positions of authority to be able to implement those "new" (now 20 years old) protocols, methods, techniques, study findings, etc. Either opening their own practice, or to rise high enough up the ladder to have a say in hospital policy.

There's the 10 year possibility, as doctors attend conferences several times a year, and read monthly journals, and weekly announcements, and daily recalls. So some really promising things can make it out the gate fairly quickly, of DocA has attended a conference on XYZ, and has some residents who got to use XYZ in school, and there's a meeting of the minds, the stars align & hospital admin agrees to pay for it, and it gets implemented as a trial. But it still takes about 10 more years before XYZ is known and offered just about everywhere.

The only time anything ever comes top-down in medicine (exp people come across XYZ, and then institute it field wide as they have the clout to be able to do so)... Is once in a blue moon (think cure for cancer discovered "big"), except in times of war. MRIs, laparoscopic surgery, literally 1000s of innovations in medicine -each year- all have to bubble up through the 10-20 year bottom-up. A relatively minor thing like 1 drug not being as effective as previously thought? Will be a looooong ass time before that's general knowledge outside of pharmacy & psychiatric specialties.

 

[Digz]

This is an interesting thread. I have had many types of drugs thrown at me over the years (or at least, that's what it feels like!) I'm currently taking a relatively small dose of Effexor - 75mg. I experience many side effects from the drugs, but at this dose I don't have a problem. My bad periods are less frequent than they once were, but I can guarantee when I do go through one there will be some professional who suggests strongly that I change my medication or up the dose. Nowadays I just tell them a flat out, 'no'. All it does, I say, it screw me up more. I'm not only unbalanced from the PTSD, flashback and anxiety - I become unbalanced due to changing medications.
People ask me, does my medication help. And honestly, I don't know. My therapy has definitely helped, but since I've been more stable, I have never been not on the medication. I know, however, if I forget to take it I got into withdrawals very quickly - and that is something I cannot handle, even though I'm more stable than I used to be. So, where does that leave me? Stuck on the medication forever? I don't know.

 

[anthony]

I felt like a zombie on it... I was volatile during withdrawals... I feel normal without it, able to know what is going on and then work at an issue head on as it arises, as I can feel what my mind and body are doing at all times.

 

[Anarchy]

There is an argument to be made for depression being a stress response. The stress hormones, cortisol in particular, run wild in depression.

The argument for seretonin deficeincy being the cause of depression, fails on its own terms. Seretonin levels increase within hours of taking the first pill, yet it is usually six weeks or so before there is any improvement in the symptoms of the depression.