Posted by SLS on May 10, 2002, at 7:54:53
In reply to Looking good, Scott » SLS, posted by lizzyg on May 9, 2002, at 11:40:41
Hi Lizzy.
The "depressive pressure" conceptualization is my own, and should not be construed as fact. However, it has helped me to explain depressive disorders to people.> From what I (and various psychiatrists and psychotherapists) can tell, my depressive episodes are endogenous. You said:
> > "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."
> But my own experience has been the exact opposite to your final two sentences - each successive episode has been easier to manage, and the time lapse between episodes has increased.
It's nice to be wrong sometimes. :-)
(only sometimes)
> The first time I experienced depression and anxiety I couldn't function at all
Depression comes in many flavors (none of them being a gustatory delight). Not only does depression manifest differently between individuals, but it can also vary its expression within any one individual over time. During the first 3-5 years of my depression, the most prominent features were depressed mood and paralyzing social anxiety, rumination, and occasional suicidal ideation. Although my memory and concentration were moderately impaired, I was able to read, learn, and remember enough to do well during my first two years at college. However, as the years passed, both depressed mood and anxiety diminished while anergia and cognitive impairment worsened. Now, I can't read more than two complete sentences consecutively. I've had to rely upon skimming, targeting key words to focus upon.
I think this scenario represents the majority. As one ages, depression drifts away from depressed mood and towards cognitive impairement. In the elderly, depression is often misdiagnosed as dementia. In fact, the term "pseudodementia" is used to describe this.
Regarding the reduction of my experience of depressed mood and anxiety, I can't exclude the contribution of the psychological improvements that I have worked (and continue to work) toward. One issue that I have resolved significantly is perfectionism. One of my former doctors told me that even if I were to respond well to a particular treatment, continued chronic obsessive perfectionism might lead to medication break-through and relapse. His words have stayed with me. I have thus broadened the scope of "depressive pressures" to remove or mitigate so as to include just about anything that produces psychosocial stress.
> During successive attacks, I've experienced more treatments options, have learnt that the episodes are self-limiting, and have discovered lifestyle changes that act as prophylactics to a certain extent (for me, exercise is the best form of therapy; in fact, indolence seems to be a trigger factor for depression). I was lucky to have had well over six years between my last depression and the most recent earlier this year.
By far, the single most significant reduction of psychosocial stress (depressive pressure) for me has been the understanding that my depressive thinking and vegetative state was being caused by a self-perpetuating abnormal brain function that was beyond my cognitive control. Perhaps you have experienced something similar with what you have learned and now understand about the nature of your illness. I guess a didactic argument can be made that the reduction in the frequency and severity of your depressive episodes is due to a reduction of depressive pressure facilitated the changes you have made in your lifestyle and your psychological relationship with the depression once it is triggered.
> To your knowledge, is my pattern unusual, or are there any studies with similar findings? Historically, I've always dropped the ADs after four or five months, and been subsequently symptom free for anything from a year to six years. At the moment, I'm just using SAM-e and fish oils, so I guess it wouldn't be a great hardship to keep this going for longer... Any views?
If I were you, I would not consider Scott's views to be reliable. :-)
Don't fix it if it ain't broke? I guess you are doing the right thing for yourself. As you describe your life-chart, it seems that the trend has been toward reduced frequency and severity, and increased treatability. The key for you seems to be prophylaxis.
- Scott
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Major depression:"Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Later episodes of illness typically are precipitated by only mild stresses, or none at all."
http://www.nimh.nih.gov/publicat/depression.cfm#ptdep4
"Untreated depression often has an accelerating course, in which episodes become more frequent and severe over time. Researchers are now considering whether early intervention with medications and maintenance treatment during well periods will prevent recurrence of episodes. To date, there is no evidence of any adverse effects of long-term antidepressant use."http://www.nimh.nih.gov/publicat/depresfact.cfm
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Bipolar disorder:"Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared."
http://www.nimh.nih.gov/publicat/bipolar.cfm#bp3
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poster:SLS
thread:105245
URL: http://www.dr-bob.org/babble/20020510/msgs/105857.html