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Dr. Bob is Robert Hsiung, MD,
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Posted by llrrrpp on August 13, 2006, at 9:01:39
In reply to Re: Is Kramer right?, posted by SLS on August 13, 2006, at 5:54:53
> > > Fortunately, I see that there is going to be a lot of overlap in such research. For instance, parkinsons and alzheimers are two other diseases involving brain cell loss and atrophy.
>
> > I still like to think that the atrophy is due to the disuse of neurons not being called upon because of dysregulation and that any cell loss might be due to reactions secondary to the stresses placed upon the system.
>
> I forgot to say that the reason I like to think of depression this way is that this model renders the atrophy and cell loss as being secondary processes and reversible upon successful treatment. They are not the primary disease process and are not necessary to precipitate the illness. I could be wrong, but this is the way things make sense to me right now.
>Yes, I agree with this. The other thing that is important to consider is that "stress" is a phenomenon that is dramatically influenced by psychology. That is- two people who undergo the same stressful procedure can have dramatically different physiological reactions, depending on how they were primed to interpret this stressful procedure.
I kind of like to think of the hippocampal-pituitary-adrenal axis theory of depression as follows: Some of us interpret our environments differently, and this leads to increased stress, which leads to physiological changes, eventually affecting the structure and responsivity of the stress system, which then leads to responding to stress differently... and so on.
And of course there are many other areas of the brain that become affected by the out of kilter stress-regulation system, like sleeping, appetite, attention and memory... etc. And these malfunctions also affect how resilient we are to stress.
With such a complicated system, it's nearly impossible to nail down cause and effect. It's also possible to create dramatic changes in behavior and functioning by changing only one part of the system, for instance, by blocking the reuptake of serotonin. Also, the way that the individual interprets his or her enviroment, and reacts to it can be dramatically affected by talk therapy, which in turn can create physiological changes in the brain.
In my experience with depression, I was able to pull out of the first bout with exercise, a major cross-country move and starting a new job. The second bout led me to (my current dabblings in psycho-babble), psychotherapy and psychopharm treatments. I think I'm doing much better since I am able to recognize what I'm feeling and perhaps adjust my expectations and reactions to my environment.
I'm glad that Kramer has decided to interpret depression as an illness. Certainly there are behavioral and psychological components too, but this is true for many illnesses- for example colon cancer. Do we blame people and call them weak and freakish for eating a low fiber low nutrient diet and avoiding regular colonoscopy screenings? Not nearly as much as a depressed person is silently blamed for having brought the illness upon herself and having lack of will power to 'snap out of it'
okay, enough of my ranting.
I'm going to clean my place today. That's my goal. one room at a time.
-ll
Posted by laima on August 13, 2006, at 9:26:22
In reply to Re: Is Kramer right? » laima, posted by Dinah on August 13, 2006, at 8:54:45
> Yes, that's him.
>
> I *think* the main point of the book is that our society romanticizes depression and values the symptoms of depression. While it's really a disease that needs to be treated.
>
> Maybe I haven't reached the optimistic part of the book yet.Perhaps he's got some valid points then- and unfortunately, we all know there are lots of people who don't believe depression is a disease, think we should "snap out of it", "adjust our attitude", or something like that. Without having read the book, I might speculate Kramer would overstate his case in an effort to be more convincing? Maybe we aren't the ideal audience for this particular text then, because we already know some of this? We're already convinced! :)
Perhaps the "hopefulness" for us might come indirectly, in that someone is aggressively trying to educate the general public about depression realities(??) Or the book might help someone who is beating themselves up, blaming their mood disorder on a personal character flaw or something like that, realize that it's not so simple-let them be relieved of some guilt or self-blame(??)
Wasn't his last book criticized for allegedly advocating "cosmetic psychopharmacology", "feeling better than well" with prozac, and so on? I haven't ever gotten through that one either, don't know what he actually said, but recall it made a huge media splash, and there was much talk about people who were not even depressed whatsoever demmanding prozac in order to feel "better than well" and to enhance their mental performance. That kind of *frivilousness*, to me, felt as if it degraded the seriousness of clinical depression. As someone who was successfully using prozac for severe depression and considered it profoundly life-saving, I wasn't too happy about all the prozac jokes which were so popular at the time, either. I found them very offensive and hurtful. Perhaps he's trying to "compensate" for that episode? Just speculating.
In any case, my curiousity is now enough that I'm going to try to find a copy to read for myself- especially if I make any more comments!
Posted by Aphrodite on August 13, 2006, at 14:20:56
In reply to Re: Is Kramer right? » laima, posted by Dinah on August 13, 2006, at 8:54:45
>
> Maybe I haven't reached the optimistic part of the book yet.Hi Dinah, Remember me? I used to be on the Psych board but only lurk here now on the meds part. (I've mostly given up on therapy and am into seeking biological/alternative treatments.)
Anyway, I never post but just had to when I saw your comments. I just finished the book. Put it down. There is no optimistic part;) I read it to the end for that very reason -- looking for hope. My dismay came not so much from the brain comments (y'know, when he says he looks at depressed patients and sees their brains as abnormal like a cardiologist sees clogged arteries in a heart attack patient) but also from his dismissal of people who try to find meaning in their suffering. He means well and is making a much needed point, but all the coping skills I have involve thinking of my depression in terms of redemptive suffering. He pretty much blows that out of the water.
Still, the studies that show SSRI's grow new brain cells are hopeful: http://newsvote.bbc.co.uk/mpapps/pagetools/print/news.bbc.co.uk/2/hi/health/3136613.stm
Take care.
Posted by Dinah on August 13, 2006, at 14:25:44
In reply to Re: Optimistic part, posted by Aphrodite on August 13, 2006, at 14:20:56
Great to see you! I think of you often.
It's good to know about the book. I think I won't bother reading it to the end then, since I've already gotten the points he's trying to make.
Posted by linkadge on August 13, 2006, at 15:41:00
In reply to Re: Optimistic part » Aphrodite, posted by Dinah on August 13, 2006, at 14:25:44
Its difficult to say that SSRI's are targeting the exact form of neurotrophic deficit seen in depression.
Dr. Manjii, a cellular biologist, who has done a lot of research into mood disorder underpinnins and mood stabilizer action says that the brain abnormalities in depression go beyond atrophy to the hippocampus.
He explains it as mood disorders suffering from neuronal resilliancy deficits. He thinks that those with mood disorders have an imborn disoposition for weak neuronal survival mechanisms.
He is also the one who noticed that while a family history of bipolar or unipolar often correlates with atrophy to the frontal cortex, antidepressants do not treat that atropy. Most anticonvulsant mood stabilisers to not as well. The reason he puts lithium and depakote above other moood stabilizers is in their ability to activate growth factors and neuronal resiliance in many brain regions.Even in his experiements with subtheraputic doses of lithium, he found that there were dramatic increases in BCL-2, and agent that protects brain cells from hypoxia, excess glutamate, free radicals etc. Lithium also increases total grey matter volume and increases stem cell proliferation.
The reason I say that drugs for alzheimers or parkinsons might be usefull for depression is the notion that neurotrophic agents of many different forms are able to reduce depression in animal models. Ampakins, for instance, are agents capable of boosting cognition, learning, and neruogenesis, and are being tested for alzheimers, but show significant overlap with depression.
>forgot to say that the reason I like to think >of depression this way is that this model >renders the atrophy and cell loss as >beingsecondary processes and reversible upon >successful treatment.
Perhaps. It could be too that a regional dysregulation of neuronal survivial mechanisms is the core issue. When a stressfull life event comes around, this deficit imediately translates to a high disposition to depression.
>They are not the primary disease process and >are not necessary to precipitate the illness. I >could be wrong, but this is the way things make >sense to me right now.
I don't know if we know yet how the dysregulation initially occurs. When an antidepressant works, its easy to assume that one is suffering from an antidepressant deficiancy, but it could be from something like a growth factor deficiancy. Research into the association between mood disorders and genes encoding for BDNF production, for instance, are somewhat promising.
As some of the research is showing that a lot of depressed people are developing parkinsons, and a lot of parkinsons patients are developing depression.
Linkadge
Posted by laima on August 13, 2006, at 16:13:13
In reply to Re: Optimistic part, posted by linkadge on August 13, 2006, at 15:41:00
The Parkinson's connection is scary. How do you know so many things, anyway?
> Its difficult to say that SSRI's are targeting the exact form of neurotrophic deficit seen in depression.
>
> Dr. Manjii, a cellular biologist, who has done a lot of research into mood disorder underpinnins and mood stabilizer action says that the brain abnormalities in depression go beyond atrophy to the hippocampus.
>
> He explains it as mood disorders suffering from neuronal resilliancy deficits. He thinks that those with mood disorders have an imborn disoposition for weak neuronal survival mechanisms.
>
>
>
>
> He is also the one who noticed that while a family history of bipolar or unipolar often correlates with atrophy to the frontal cortex, antidepressants do not treat that atropy. Most anticonvulsant mood stabilisers to not as well. The reason he puts lithium and depakote above other moood stabilizers is in their ability to activate growth factors and neuronal resiliance in many brain regions.
>
> Even in his experiements with subtheraputic doses of lithium, he found that there were dramatic increases in BCL-2, and agent that protects brain cells from hypoxia, excess glutamate, free radicals etc. Lithium also increases total grey matter volume and increases stem cell proliferation.
>
> The reason I say that drugs for alzheimers or parkinsons might be usefull for depression is the notion that neurotrophic agents of many different forms are able to reduce depression in animal models. Ampakins, for instance, are agents capable of boosting cognition, learning, and neruogenesis, and are being tested for alzheimers, but show significant overlap with depression.
>
> >forgot to say that the reason I like to think >of depression this way is that this model >renders the atrophy and cell loss as >beingsecondary processes and reversible upon >successful treatment.
>
> Perhaps. It could be too that a regional dysregulation of neuronal survivial mechanisms is the core issue. When a stressfull life event comes around, this deficit imediately translates to a high disposition to depression.
>
> >They are not the primary disease process and >are not necessary to precipitate the illness. I >could be wrong, but this is the way things make >sense to me right now.
>
> I don't know if we know yet how the dysregulation initially occurs. When an antidepressant works, its easy to assume that one is suffering from an antidepressant deficiancy, but it could be from something like a growth factor deficiancy. Research into the association between mood disorders and genes encoding for BDNF production, for instance, are somewhat promising.
>
> As some of the research is showing that a lot of depressed people are developing parkinsons, and a lot of parkinsons patients are developing depression.
>
> Linkadge
>
Posted by mike lynch on August 13, 2006, at 16:47:33
In reply to Is Kramer right?, posted by Dinah on August 12, 2006, at 11:57:21
I wonder if they're the same as mine.
Posted by willyee on August 13, 2006, at 16:51:56
In reply to Re: Optimistic part » linkadge, posted by laima on August 13, 2006, at 16:13:13
Im trying my hardest to follow this thread as it has me concerned,however in all honesty and i guess im just not quick on the draw im quite lost,can anyone put any of this into a lamons term at all,i know linkadge and scott alone can have a conversation that would loose me in a milisecond,i suppose i should just get the book eh,lol in all seriousness im left only with the conlusion that im screwed trying to make anything from this thread,is that pretty much correct?
Posted by Aphrodite on August 13, 2006, at 17:24:32
In reply to Re: Optimistic part, posted by linkadge on August 13, 2006, at 15:41:00
Is lithium commonly prescribed for the subject Kramer speaks of, which is major depressive disorder? It was my understanding that it was used for bipolar disorder.
On the other hand, I've also read that lithium is given to the seriously suicidal, so that would indicate efficacy in that particular symptom of severe depression.
Interesting information -- thanks!
Posted by laima on August 13, 2006, at 19:25:04
In reply to Re: Optimistic part, posted by willyee on August 13, 2006, at 16:51:56
> Im trying my hardest to follow this thread as it has me concerned,however in all honesty and i guess im just not quick on the draw im quite lost,can anyone put any of this into a lamons term at all,i know linkadge and scott alone can have a conversation that would loose me in a milisecond,i suppose i should just get the book eh,lol in all seriousness im left only with the conlusion that im screwed trying to make anything from this thread,is that pretty much correct?
Very, very loosely, and hopefully someone can jump in, correct, and fill in for me, Dinah has been reading Kramer's book which sounds as if it is saying something about how depressed brains are not the same as "normal" brains. That that depressed brains are "atrophied", or somehow shrunken or damaged. Maybe even that a depressed brain can never be like a "normal" brain. The thought of this is obviously rather depressing in itself, so Linkadage and the rest jumped in to offer evidence that a depressed brain CAN change, CAN get better. "Neurogenesis" is something like "growing new brain cells", or getting better. One of the the major theories of depression these days is that depressed brains have "atrophied", or somehow shrunken. The agreement of the thread is that a depressed brain can in fact grow new cells and get much better. So why would Kramer write this sort of stuff? Possibly because some people don't believe depression is a real, actual condition- that it is merely an "attitude problem" or something like that- and he's trying to convince them that it is much more serious and "real" than that. It is a genuine medical condition. The good news for depressed people here is that hopefully others will learn more about what we go really through. Dinah let us know that she understands Kramer believes that a brain can get better, too. But nevertheless, it sounds like a depressing book. However, probably nothing we should worry about, we are probably not even the audience he intended it for. We already know what it is like to be depressed, after all.
In any case, this is what I understand about the thread- but I might be wrong, because I haven't read the book.
Posted by Phillipa on August 13, 2006, at 19:41:12
In reply to Re: Optimistic part » willyee, posted by laima on August 13, 2006, at 19:25:04
Excellent summary. Thanks it definitely helped me too. It must be like listening to prozac that book scared me. Love Phillipa
Posted by linkadge on August 13, 2006, at 19:55:37
In reply to Re: Optimistic part » linkadge, posted by laima on August 13, 2006, at 16:13:13
>How do you know so many things, anyway?
Perhaps some of my attemtps to grow new brain cells have been sucessfull :)
Probably more that the topic interests me.
Linkadge
Posted by linkadge on August 13, 2006, at 20:04:09
In reply to Re: Optimistic part » linkadge, posted by Aphrodite on August 13, 2006, at 17:24:32
Lithium is generally not a first line treatment for depression, at least here in America. I understand that things are slightly different in Europe, where the drug is used for depression more often.
Kramer was a doctor not a medical researcher, so I wouldn't say that he was on the forefront of this type of thing.
I think he was really just attemtping to reduce some of the stimga about the disease.
Nobody would dare to blame something like cancer on a "personaltiy flaw" or weakenss. Yet depression is still seen as such by many people.
Ie. I don't know if Kramer was aware of Lithium's capabilities.
If Manjii's work is right, there is reason to believe that either lithium or valproate (even if only used in small doses), may have more ability to reduce the progression of the disease, than antidepressants do.
See:http://www.mcmanweb.com/article-191.htm
Linkadge
Posted by cecilia on August 13, 2006, at 20:51:30
In reply to Re: Optimistic part » Aphrodite, posted by linkadge on August 13, 2006, at 20:04:09
Actually, people dare to blame people with cancer for their personal flaws or weakness all the time. They are blamed for their "cancer prone personalities" and their bad health habits. I read an article by a woman with lung cancer who was one of the 15% of women with lung cancer who had never smoked, even so, she said, she was treated like dirt, like it must be her fault. (And even if someone does smoke, the blame should go to the tobacco companies who try so hard to get teenagers hooked on tobacco when they are young and think they're immortal. Has anyone noticed those "antismoking" commercials sponsored by the tobacco companies. They make me furious!!!!!! They tell parents to "talk to your kids about not smoking". Those companies aren't dumb, just extremely evil, they know the best way to get kids smoking is to have parents telling them not to. Cecilia
Posted by cecilia on August 13, 2006, at 21:18:53
In reply to Is Kramer right?, posted by Dinah on August 12, 2006, at 11:57:21
I haven't read Kramer's latest book, but I skimmed through it at the bookstore and it looked like it was taking hundreds of pages to say "depression is bad". Like, does anyone really think it's good? Who wouldn't want it eliminated? Unfortunately, not everyone responds to Prozac or any other med the way the patients in his 1st book so miraculously did. Cecilia
Posted by Phillipa on August 13, 2006, at 21:24:08
In reply to Re: Is Kramer right?, posted by cecilia on August 13, 2006, at 21:18:53
Cecelia thanks. I haven't read the book. So his patients miraculously respond to meds? That would be depressing in itself to read. It would mean that I have a fatal flaw, what's wrong with me everyone else is fine what about me? Is this what it's about? Love Phillipa
Posted by willyee on August 13, 2006, at 22:40:42
In reply to Re: Optimistic part » willyee, posted by laima on August 13, 2006, at 19:25:04
Thanks a million,much clearer now!!!!!!!!!
Posted by willyee on August 13, 2006, at 22:42:43
In reply to Re: Optimistic part, posted by willyee on August 13, 2006, at 16:51:56
Oh just FYI,just in case,that was sincere not sarcasim,it does make more sense to me now,ty.
Posted by laima on August 13, 2006, at 23:54:12
In reply to Re: Optimistic part » willyee, posted by willyee on August 13, 2006, at 22:42:43
> Oh just FYI,just in case,that was sincere not sarcasim,it does make more sense to me now,ty.
Sure! No problem, I'm so happy I could be of any help.
Posted by laima on August 13, 2006, at 23:57:24
In reply to Re: Optimistic part » laima, posted by Phillipa on August 13, 2006, at 19:41:12
> Excellent summary. Thanks it definitely helped me too. It must be like listening to prozac that book scared me. Love Phillipa
Oh yes- that's the other book I was referring to in earlier posts- I never read it- I picked it up a few times, but somehow just couldn't get into it. I have no idea if I was being fair or not, but in my mind I always blamed Kramer for the prozac rucous of that era...Do you remember that stuff and all those jokes???
Posted by laima on August 13, 2006, at 23:58:54
In reply to Re: Optimistic part, posted by linkadge on August 13, 2006, at 19:55:37
> >How do you know so many things, anyway?
>
> Perhaps some of my attemtps to grow new brain cells have been sucessfull :)
>
> Probably more that the topic interests me.
>
> Linkadge
It interests me too- it's so key for a lot of us!
Thanks again for sharing that long list.
Posted by laima on August 14, 2006, at 0:01:51
In reply to Re: Optimistic part » Aphrodite, posted by linkadge on August 13, 2006, at 20:04:09
>Nobody would dare to blame something like cancer on a "personaltiy flaw" or weakenss
You'd be surprised- it's happened to a friend of mine who is battleing brain tumours. It's happened to her a lot- people directly and indirectly accusing her of unhealthy living and such.
Posted by laima on August 14, 2006, at 0:04:15
In reply to Re: Optimistic part » linkadge, posted by cecilia on August 13, 2006, at 20:51:30
> Has anyone noticed those "antismoking" commercials sponsored by the tobacco companies. They make me furious!!!!!! They tell parents to "talk to your kids about not smoking". Those companies aren't dumb, just extremely evil, they know the best way to get kids smoking is to have parents telling them not to. Cecilia
That's so sinister!!! I never understood before why they did that!
Posted by laima on August 14, 2006, at 0:27:09
In reply to Re: Is Kramer right?, posted by cecilia on August 13, 2006, at 21:18:53
> Unfortunately, not everyone responds to Prozac or any other med the way the patients in his 1st book so miraculously did. Cecilia
When prozac came out it REALLY was a miraculous breakthrough:
Easy to use, "activating", supposedly very safe, relatively free of the side effects that plagued the tricyclics and maois. And that of course was well before anyone knew about the "poop out" and before anyone spoke of sexual side effects or emotional blunting. Right before its introduction, I tried just about every single available tricyclic, one after another, but they all made me lethargic, slug-like, and gain weight. (No one dared give me, sneaky teenager, any maoi, or even mentioned the possibility.) Then came prozac- brand new- and it truely seemed miraculous. I had never even heard of it when I got my first prescription. It was the start of an entirely new class of drugs. It was supposed to revolutionize psychiatry by being safe, effective, and super-easy to prescribe. True- did not likely work for everyone-but in the begining when it worked, it REALLY worked! It worked great for me-I had dropped out of college and felt like a doomed loser, but went right back and did very well there within a couple weeks. Prozac made quite a media splash, too: on the cover of Time Magazine and everything. I get the impression Kramer was swept up in all of the excitement when he wrote that prozac book. I venture to speculate that we are all a bit wiser and more sophisticated nowadays. It's still great for some people-no doubt-but it's not a magic cure for everyone, and does come with the possibility for some hefty side effects after all.
Posted by SLS on August 14, 2006, at 8:00:50
In reply to Re: Is Kramer right?, posted by SLS on August 12, 2006, at 21:46:43
> > What he's actually saying, to paraphrase as best as I can understand, is that people prone to multiple bouts of depression are people who have a defect in brain repair.
>
> As opposed to a defect in brain regulation?
>
> I think the latter is closer to the truth.
Depression appears to be a complicated illness with a multiplicity of factors contributing to its induction and persistence. Right now, I still don't think that it is a defect in brain repair that is responsible for its induction. I believe this to be more a product of dysregulation in neurotransmission and circuitry. However, I can see how such a defect could contribute to its persistence. I guess the illness might progress as a self-reenforcing process, with the inability of the brain to recover from stress-induced cell loss hindering the reestablishment of healthy interactions between entire circuits. Still, this is probably a matter of a diminished rate of repair rather than its complete absence as has been demonstrated by the recovery of brain tissue seen with lithium and antidepressant use.
- Scott
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