Posted by SLS on April 22, 2002, at 14:09:48
In reply to Re: Need help to refute the anti-biological camp » judy1, posted by Chris A on April 18, 2002, at 20:25:41
I don't know if this helps, but this is how I currently approach things. I like the word "spectrum".
1. "Clinical depression" is a diagnosis of an observable syndrome. It is not an assignment of cause or etiology.2. The etiologies of what is characterized as "depression" are numerous. For example, the word "depression" is used to describe a symptom of hypothyroidism. In this case, depression can disappear immediately upon the ingestion of pills containing T3 or T4 hormone. Is not the cause of this depression completely biological?
2. The word "depression" is used by people to describe quite a variety of subjective experiences. Any two people whom describe themselves as being depressed might be experiencing completely different things. In such a case, person #1 might have a tendency to deem their depression as being equivalent to that of person #2. It makes sense to person #1 that person #2 came to be depressed in the same way, and that the same treatment will prove successful.
3. There is a spectrum of varying ratios of nature versus nurture as contributions to the evolution of depression in the individual. At one end, there is a depression that is completely psychological, and at the other a depression that is completely biological. (I think it is worth repeating that the one word "depression" might be describing two completely different experiential phenomena). In between lies a dynamic interaction between biological vulnerability and psychosocial stress.
I like to use the term "depressive pressure" to describe the psychological experiences that act to stress the biological system. Sometimes these are acute events like the death of a spouse or child. Sometimes they are chronic patterns of depressive thought-styles. For those individuals whom possess a biological vulnerability, there is a threshold of depressive pressure beyond which causes the biological system to collapse beneath this pressure and function abnormally.
1. Some people experience depression, even though no collapse of the biological system has occurred. Psychotherapy alone can be sufficient.
2. Some people who have experienced a collapse of the biological system can recover, as the system will repair itself once the depressive pressure is removed. Psychotherapy alone can be sufficient. However, the continued depressed mood produced by the alterations in biology can hinder one's ability to respond to psychotherapy, as it is more difficult to process through thought the psychological issues producing the depressive pressure. This can end up being a self-reinforcing loop that perpetuates the dynamics causing the depression. Additional treatment with antidepressants might alter the system in such a way as to produce a more functional milieu within which psychotherapy can work.
3. For some people, the biological collapse can produce long-lasting deformities in supportive structures, leaving these people more vulnerable to depression with each successive collapse. Removal of the majority of depressive pressure through psychotherapy might not be sufficient to prevent periodic collapses, especially when the system is challenged by subsequent psychosocial stresses. Longer-term antidepressant therapy might be indicated. Perhaps this extended use of antidepressants creates a temporary structure to support the weight of the depressive pressure while the system rebuilds itself. However, managing psychosocial depressive pressure with continuing psychotherapy can be important or necessary. Of course, sometimes the system cannot rebuild itself sufficiently to remain standing when the scaffolding created by antidepressants are removed. Indefinite treatment with antidepressants might be necessary.
4. For some people, the biological system can begin to function abnormally in the absence of concurrent depressive pressure. A variety of genetic and environmental factors can play a role in the evolution of system dysfunction. Bipolar depression is probably a good example of this, although I think many cases of unipolar are just as biological. Studies of heritability probably demonstrate this for both, and the genes responsible eventually will be identified. Treatment with antidepressants alone are necessary and often sufficient. However, psychotherapy might be helpful to manage the perturbations in psychosocial function produced within the milieu of the biologically altered state of affect and cognition. Indefinite treatment with antidepressants is often necessary, especially if recurrent episodes have occurred. Each successive collapse of the system produces an increasing deformity of the structure of the biological system, such that it becomes less amenable to repair and treatment-resistant.
- Scott
poster:SLS
thread:103336
URL: http://www.dr-bob.org/babble/20020416/msgs/103824.html