Posted by CamW on November 10, 2005, at 7:07:21
In reply to Re: Lyrica Update, posted by RobertDavid on November 8, 2005, at 0:51:36
RobertDavid - Treatment-resistant depression really is a pain (pane) where I wouldn't put a window. Unfortunately, we really do not have a good grip on what the cause(s) of depression (& thus, depressive symptoms) really are. It is not due to a lack of serotonin in the brain, nor is it just due to the uncoupling of the body's HPA axis. I strongly believe that reactive depression (ie. depression resulting from the experiencing of a traumatic life experience) is a totally different disorder, with an entirely different set of physiological and genetic mechanisms, than that of most, if not all, cases of treatment-resistant depression.
Even though the overt symptomatology (eg.the lack of energy, the emotional lability and ultimate, physiological expression, etc.) of these (at least) two separate disorders appear identical, their the biochemical causes are probably (more or less) mutually exclusive of one another, in several instances..
Adding serotonin (by treating with SSRIs) over an extended period of time (eg 9 - 12 months) to a reactive depression does seem to "reboot" the body's HPA axis, resulting in the "normalization" of many the brain's other physiological systems. A return to the normalization of functioning to predepression levels is seen in the binding of cortisol to glucocorticoid and mineralocorticoid receptors in the brain.
Also, any abnormal thyroid function usually returns to normal, as do several other hormonally controlled systems (eg. estrogen/testosterone functioning; and cellular surface concentrations of alpha- & beta-adrenoceptors, and other physiological systems that have not been fully recognized as "causing" depression - or at least contributing to the overt symptoms of what we call "depression").
We still do not know the causes of depression, both the reactive form, and the chronic, treatment resistant varieties. I think that it would be a safe bet to hypothesize that the "cause" of most of the treatment-resistant forms of depression is due to some genetic malfunction that has been passed down from one or both parents, &/or from a mutation has arisen spontaneously, in utero, during development.
The pre-, perinatal- and post-natal environments of those who grow-up and experience chronic, treatment-resistant depression later in life, surely also contribute to the extent and severity of the disorder
As with ANY chronic disorder without an effective treatment or cure, the most important thing that one can do (while waiting for science to tease apart the different disorders that we currently call "depression") is to learn to live one's life to the best of their abilities, as is allowed, within the boundaries of the disorder. Just because one has a (currently) untreatable disorder, does not mean the one should give up and let the disorder control them. The afflicted must learn to live their life in such a way as to maximize the quality of that life. An incurable disorder may be a life sentence, but one can, with much hard work, still be able to lead a productive life, and be able to contribute to society.
Just some thoughts I have had since I have come to the realization that I am going to have to live with bouts of depression for the rest of my life. I cannot let the depression control how I live my life. I have a daughter who needs me to teach her the skills that she will need to succeed in this world. Just because my depression sometimes makes me feel like staying in bed, under the covers, for weeks at a time, does not mean that I have to stay in bed. I must force myself to get up, shower, and shave, so that I can be with my daughter and teach her the importance of learning new concepts, so that she too will be better able experience the the sheer ecstacy and pleasure of figuring out how to understand a concept in a much deeper, meaningful way.
Sorry, I know that this is kinda off-topic, but it was something that I just had to put on paper. The Lyrica may not work as well as you wanted it to; but there will be another drug to try, then another, until we have teased apart depression and found an entirely new treatment modality that will work for your particular form of depression.
Just thinking out loud. - Cam
poster:CamW
thread:574925
URL: http://www.dr-bob.org/babble/20051106/msgs/577371.html