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Dr. Bob is Robert Hsiung, MD,
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Posted by Dinah on August 12, 2006, at 20:36:40
In reply to Re: Is Kramer right? » notfred, posted by laima on August 12, 2006, at 19:26:51
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. That's simplifying it a lot. He refers to it as the "failed resilience model of depression".
"Depression is characterized by frank abnormalities in the nervous system, such as the changes observed by Rajkowska and Sheline. These defects arise from failures in protection and repair of cells in critical brain regions." is one excerpt.
He's clearly familiar with neuroplasticity and the growth of new cells.
On the other hand, I think the one thing we know is that they don't know much yet. I've been listening to "A Short History of Nearly Everything" which is basically a story of science changing its mind an awful lot.
Yes, his point is that depression is a disease, with physical symptoms like other diseases.
I just wonder if he's overemphasizing it.
On the other hand, I don't have the brain I used to. :(
Posted by Dinah on August 12, 2006, at 20:39:19
In reply to Re: Is Kramer right?, posted by SLS on August 12, 2006, at 13:56:43
I'm actually on a very low dose for migraines. I wouldn't mind increasing it, as I haven't felt any ill effects. If I get up my nerve enough, maybe I'll mention it to my pdoc. (I'm more than a bit scared of my new psychiatrist, but there isn't a lot of choice out there.)
It doesn't make you stupid does it? I've lost enough IQ points as it is.
Posted by Phillipa on August 12, 2006, at 21:22:59
In reply to Re: Is Kramer right? » SLS, posted by Dinah on August 12, 2006, at 20:39:19
Dinah maybe now isn't the right time to read this book? Maybe a romance or mystery instead? I know all about the stress thing it's become my life and I don't like it one bit. I won't watch scarey movies either. Love Phillipa
Posted by SLS on August 12, 2006, at 21:46:43
In reply to Re: Is Kramer right?, posted by Dinah on August 12, 2006, at 20:36:40
> 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.
- Scott
Posted by SLS on August 12, 2006, at 22:27:29
In reply to Re: Is Kramer right? » SLS, posted by Dinah on August 12, 2006, at 20:39:19
> I'm actually on a very low dose for migraines. I wouldn't mind increasing it, as I haven't felt any ill effects. If I get up my nerve enough, maybe I'll mention it to my pdoc. (I'm more than a bit scared of my new psychiatrist, but there isn't a lot of choice out there.)
>
> It doesn't make you stupid does it? I've lost enough IQ points as it is.It can, but it is infrequent. However, when it does happen, it usually doesn't appear until one reaches dosages of 300mg and higher. 200mg seems to be the average effective dosage for bipolar disorder. No guarantees. You have to try it and see. Lamictal became popular, in part, because it was considered to be relatively free of cognitive side effects compared to the other anticonvulsants. I found that it produced some memory problems early in treatment that dissipated with continued use. I began to experience cognitive side effects at 300mg. At 150mg, I suffer no memory or cognitive impairments at all.
If you have the bad luck to be in the minority, and you find yourself getting really stupid, all you have to do is reduce the dosage. Nobody is going to hold a gun to your head. After being at 300mg for months, my head cleared within 48 hours after reducing the dosage to 200mg. Very few people on Psycho-Babble complain of cognitive side effects with Lamictal.
- Scott
Posted by linkadge on August 12, 2006, at 22:36:51
In reply to Re: Is Kramer right? » Dinah, posted by SLS on August 12, 2006, at 22:27:29
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.
Emerging drugs with neuroprotective and/or neurotrophic potential, may find their way into the armorarium of doctors for depressed patients.
Linkadge
Posted by laima on August 12, 2006, at 23:08:21
In reply to Re: Is Kramer right?, posted by Dinah on August 12, 2006, at 20:36:40
Now I understand better- makes sense, what he says. And I'm with you, I've been rather dismayed to not quite have the same brain as I did when I was much younger, too. Now I've got some memory of reading an interview with Kramer- he seemed to be arguing against people who romanticized or somehow belittled depression and other mental illness? Is that right? If that is the case, no wonder he would be heavy with his points. Maybe I'll go look for a copy of this book at the library after all.> 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. That's simplifying it a lot. He refers to it as the "failed resilience model of depression".
>
> "Depression is characterized by frank abnormalities in the nervous system, such as the changes observed by Rajkowska and Sheline. These defects arise from failures in protection and repair of cells in critical brain regions." is one excerpt.
>
> He's clearly familiar with neuroplasticity and the growth of new cells.
>
> On the other hand, I think the one thing we know is that they don't know much yet. I've been listening to "A Short History of Nearly Everything" which is basically a story of science changing its mind an awful lot.
>
> Yes, his point is that depression is a disease, with physical symptoms like other diseases.
>
> I just wonder if he's overemphasizing it.
>
> On the other hand, I don't have the brain I used to. :(
Posted by laima on August 12, 2006, at 23:09:29
In reply to Re: Is Kramer right? » Dinah, posted by Phillipa on August 12, 2006, at 21:22:59
> Dinah maybe now isn't the right time to read this book? Maybe a romance or mystery instead? I know all about the stress thing it's become my life and I don't like it one bit. I won't watch scarey movies either. Love Phillipa
Phillipa, you may have a good point here.
Posted by SLS on August 13, 2006, at 5:33:45
In reply to Re: Is Kramer right?, posted by linkadge on August 12, 2006, at 22:36:51
> 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.
> Emerging drugs with neuroprotective and/or neurotrophic potential, may find their way into the armorarium of doctors for depressed patients.
I really don't know what role such specialized drugs will play. They might occupy more of a supportive and maintenance role to drugs that produce more direct changes in neurotransmission. Both types of drugs should act synergistically to produce a more robust healing effect. That's what I would imagine, anyway.
- Scott
Posted by SLS on August 13, 2006, at 5:54:53
In reply to Re: Is Kramer right?, posted by SLS on August 13, 2006, at 5:33:45
> > 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.
- Scott
Posted by llrrrpp on August 13, 2006, at 8:41:24
In reply to Re: Is Kramer right?, posted by laima on August 12, 2006, at 17:01:42
> Just wanted to add, didn't they just recently discover that adults do indeed grow new brain cells? They used to think that a person had only so many brain cells, and that was it.
yep, recently it has been discovered that adults add new brain cells to the hippocampus, an area of the brain involved in memory processes, learning spatial directions and regulating long term stress. There are many theories of depression that cite the possible role of the hippocampus in the symptoms and perhaps the cause of depression. People under chronic stress often have a somewhat atrophied hippocampus. Also, it's thought that the SSRI's may induce a change in neural plasticity within the hippocampus (possibly even by adding new neurons to the hippocampus), which might explain why they take weeks to kick in.
-ll
Posted by Dinah on August 13, 2006, at 8:54:45
In reply to Re: Is Kramer right? » Dinah, posted by laima on August 12, 2006, at 23:08:21
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.
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
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