Depression

Energize · 9 Jun 2014 at 19:27

grumpysculler said:
So depression is not due to low serotonin levels but the first port of call in drugs to fix it is usually SSRIs which increase serotonin levels?

I will quite happily admit to not understanding the biological aspects of depression (although that pic came from a doctor, don't think it was his work) but I am acutely familiar with the emotional and behavioural side of depression.

Anti depressants target various neurotransmitter systems in the brain, including noradrenaline and dopamine. Doctors have the most experience with SSRI's and they are one of the safest so they are prescribed first.

You have to remember that you can treat the symptoms without treating the root cause.

Tefal said:
actually citalopam is being phased out due to heart side effects.

Nice guidelines recommend citalopram or sertraline before any other antidepressant. In no school of thought is venlafaxine an appropriate first line drug given it's toxicity in overdose.

grumpysculler · 10 Jun 2014 at 09:23

Energize said:
Nice guidelines recommend citalopram or sertraline before any other antidepressant. In no school of thought is venlafaxine an appropriate first line drug given it's toxicity in overdose.

Does that advice vary depending on cause?

Everyone I have come across with PND has been prescribed fluoxetine as their first drug. Seems to work well for most, but the case I am most familiar with it did nothing (maybe even made things worse) and she ended up on venlafaxine and mirtazapine.

I hate spelling these things.

Cool Breeze · 10 Jun 2014 at 09:36

nucastle said:
Hold on there cowboy. Ignorance? I'd like to bet you 100 quid that in 100 years time we will look back on our outright barbaric approach to depression, and laugh, or cry at how we tried to 'fix' the problem with pharma.

You'll have to excuse me if I don't have every single fact on the table from the get go, having NOT suffered with serious depression, but I don't think it is in any way ignorant to posit the idea that our current living environment is a large factor in things like this.

Do you think if we all lived on a hot desert island with no tv, internet, marketing etc that we would suffer the SAME rates of depression in the population? Ever wonder why the suicide rate is so high in Iceland? Yes, everyone has their own individual tale to tell, or personal set of circumstances, but it's not IGNORANT to wonder if how we arrange ourselves as a society, and conduct our affairs might be a contributing factor in things. That's called a DISCUSSION, not IGNORANCE.

If the only people commenting here were suffering from actual depression, or had first hand experience of it in friends or family, it would be a very depressing thread indeed. See what I did there?

your views are your views, I don't have to agree with them. What I meant was ignorant as in you haven't suffered from depression so what you say is based on ?. The same way I would be ignorant of sky diving I've never done it so couldn't comment on it.

I actually think this thread has helped a lot of actual suffers as you put it. I can tell you first hand 3rd party observers of depression have no bloody idea about what the sufferer is going through, and thats a fact.

Med's do a lot of good for a lot of people, but I've already said previously they are not a cure they just give your body the tools to recover by making those life style changes and educating yourself to operate again and within your limits. Sure western lifestyles probably have a little to do with it but it's one factor in a pool of thousands as to what can cause the condition. All I can say is it's not that simple!!

Energize · 10 Jun 2014 at 09:44

grumpysculler said:
Does that advice vary depending on cause?

Everyone I have come across with PND has been prescribed fluoxetine as their first drug. Seems to work well for most, but the case I am most familiar with it did nothing (maybe even made things worse) and she ended up on venlafaxine and mirtazapine.

I hate spelling these things.

No, all the antidepressants have the same effectiveness, so guidelines are simply based on side effects and interactions.

Fluoxetine (1987) is older than citalopram (1998) hence many doctors prescribing fluoxetine instead.

Flukester · 10 Jun 2014 at 10:12

As someone who has never been diagnosed with a mental illness I think many forms of it are simply not conditions, just feelings.

When I see someone say 'yeah I suffer with anxiety', well hey ho, we all do. Many of us feel 'down in the dumps', kind of depressed, but to me they are just feelings that need controlling.

Maybe there are some with some chemical imbalance that causes feelings to get out of control... but for most sufferers I would stake my life on the fact they just need to chin up and get on with life.

I'm sorry if the above sounds harsh, but it's just my view and it's no worse than anyone elses.

I do feel sorry for those whose chemistry means they cannot cope, but I suspect most people actually could cope if they stopped focusing on themselves and looked at the bigger picture.

I'm not concerned about offending anyone here, as if anyone has a true medical condition an internet forum is not the place to be talking about it in the first place.

krooton · 10 Jun 2014 at 10:16

I've had some close friends really struggle with depression, even had to save one from a suicide attempt. I'm really thankful that I haven't suffered from anything like that myself, must be so horrible

krooton · 10 Jun 2014 at 10:17

Flukester said:
I do feel sorry for those whose chemistry means they cannot cope, but I suspect most people actually could cope if they stopped focusing on themselves and looked at the bigger picture.

When the chemical imbalance prevents you from chinning up or looking at the bigger picture, there isn't a whole lot of other choice in how to deal with it.

Flukester · 10 Jun 2014 at 10:21

krooton, I think most depression is just a set of circumstances that makes them feel out of control and in a spiral downwards. It doesn't mean for sure it's a medical condition though.

I've known a few who have decided to end their life (either with success or not), and in all cases afaik it was down to the blows life was dealing them and ability to cope.

If I lost my job, family, health... maybe all at once I could imagine feeling very low indeed.

Flukester · 10 Jun 2014 at 10:22

krooton said:
When the chemical imbalance prevents you from chinning up or looking at the bigger picture, there isn't a whole lot of other choice in how to deal with it.

yeah I can see that, that's when they do indeed need help

TheMeekon · 10 Jun 2014 at 10:25

Flukester said:
krooton, I think most depression is just a set of circumstances that makes them feel out of control and in a spiral downwards. It doesn't mean for sure it's a medical condition though.

I've known a few who have decided to end their life (either with success or not), and in all cases afaik it was down to the blows life was dealing them and ability to cope.

If I lost my job, family, health... maybe all at once I could imagine feeling very low indeed.

This is big misunderstanding of mental illness. Its not based on circumstances, it is totally irrational, that's the killer. It swallows you up regardless of you having a perfect life or not.

Seeing the bigger picture as you put does not help because you can't see it! It's hard to describe it until you truly feel it.

Cool Breeze · 10 Jun 2014 at 10:25

Flukester said:
As someone who has never been diagnosed with a mental illness I think many forms of it are simply not conditions, just feelings.

When I see someone say 'yeah I suffer with anxiety', well hey ho, we all do. Many of us feel 'down in the dumps', kind of depressed, but to me they are just feelings that need controlling.

Maybe there are some with some chemical imbalance that causes feelings to get out of control... but for most sufferers I would stake my life on the fact they just need to chin up and get on with life.

I'm sorry if the above sounds harsh, but it's just my view and it's no worse than anyone elses.

I do feel sorry for those whose chemistry means they cannot cope, but I suspect most people actually could cope if they stopped focusing on themselves and looked at the bigger picture.

I'm not concerned about offending anyone here, as if anyone has a true medical condition an internet forum is not the place to be talking about it in the first place.

Well on that basis maybe we should close the thread and just stop discussing a valid and serious condition on a public forum? I mean this is just a place for the elite and those alpha males that are fully in control of their destiny and feelings right ?

This people is true ignorance in it's purest form Flukester I salute you, just maybe if you have nothing to contribute you should refrain and post in the more elite subjects where your ego would be better suited.

BTW not offended this after all is a discussion forum!

TheMeekon · 10 Jun 2014 at 10:27

But you are right saying that there is a large percentage of people that do not help themselves, they almost seem to revel in the fact they are ill and refuse to make changes to get their lives back. I've seen them at help groups and other forums.

Xordium · 10 Jun 2014 at 10:30

Energize said:
No, all the antidepressants have the same effectiveness, so guidelines are simply based on side effects and interactions.

Err, are you seriously saying all antidepressants have the same effectiveness? Really? So if we give 1 million people with depression antidepressant A another million antidepressant B, etc the removal of symptoms will be equal across all groups (even if the side-effect frequency and severity will vary). Because that is how that reads and that is just wrong.

Energize · 10 Jun 2014 at 10:36

Xordium said:
Err, are you seriously saying all antidepressants have the same effectiveness? Really? So if we give 1 million people with depression antidepressant A another million antidepressant B, etc the removal of symptoms will be equal across all groups (even if the side-effect frequency and severity will vary). Because that is how that reads and that is just wrong.

That's what the systematic reviews show.

All the SSRI's, tricyclics and MAOI's have broadly the same efficacy.

Xordium · 10 Jun 2014 at 10:42

Energize said:
the SSRI's, tricyclics and MAOI's have broadly the same efficacy.

Okay ... if you think so.

krooton · 10 Jun 2014 at 10:43

TheMeekon said:
But you are right saying that there is a large percentage of people that do not help themselves, they almost seem to revel in the fact they are ill and refuse to make changes to get their lives back. I've seen them at help groups and other forums.

Vocal minority rather than large percentage, many, many people suffer from depression without making it known to those around them.

Flukester · 10 Jun 2014 at 10:44

Cool Breeze said:
Well on that basis maybe we should close the thread and just stop discussing a valid and serious condition on a public forum? I mean this is just a place for the elite and those alpha males that are fully in control of their destiny and feelings right ?

This people is true ignorance in it's purest form Flukester I salute you, just maybe if you have nothing to contribute you should refrain and post in the more elite subjects where your ego would be better suited.

BTW not offended this after all is a discussion forum!

Just because I have different views from you doesn't mean i'm ignorant. I just posted something I feel quite strongly about.

Ego has no place on a forum either... if you think someone has a ego purely on the fact that they have different views to you, then maybe the ego problem lies within yourself :-)

Cool Breeze · 10 Jun 2014 at 10:48

TheMeekon said:
But you are right saying that there is a large percentage of people that do not help themselves, they almost seem to revel in the fact they are ill and refuse to make changes to get their lives back. I've seen them at help groups and other forums.

True enough you have to want to help youself, it's difficult though recognising you have any sort of issue. And people who revel in being depressed I'm not so sure because if they use it as an excuse for anything then they are smarter than they let on and are not truelly suffering. IMO

Energize · 10 Jun 2014 at 10:49

Xordium said:
Okay ... if you think so.

It's more what NICE, the NIMH and CDC thinks based on the meta-analyses and systematic reviews.

http://publications.nice.org.uk/fir...alised-anxiety-disorder-ktt8/evidence-context

The full guideline on depression in adults concluded that antidepressants have largely equal efficacy and that choice should mainly depend on side-effect profile, people's preference and previous experience of treatments, propensity to cause discontinuation symptoms, safety in overdose, interactions and cost.

Cool Breeze · 10 Jun 2014 at 10:53

Flukester said:
Just because I have different views from you doesn't mean i'm ignorant. I just posted something I feel quite strongly about.

Ego has no place on a forum either... if you think someone has a ego purely on the fact that they have different views to you, then maybe the ego problem lies within yourself

Not at all Flukester, lets just agree to disagree. But I can whole heartedly tell you that feelings or having a blue day are the least worry of any depression sufferer.

So I hope that has enlightened you some what into what depression is not.

May be not ignorant as i'll informed I don't know.

But for reference.

ig·no·rant [ig-ner-uhnt] Show IPA
adjective
1.
lacking in knowledge or training; unlearned: an ignorant man.
2.
lacking knowledge or information as to a particular subject or fact: i.e ignorant of quantum physics.
3.
uninformed; unaware.
4.
due to or showing lack of knowledge or training: an ignorant statement.