From: Linda (joelinda1@home.com)
Date: Fri Aug 18 2000 - 14:14:56 PDT
Eirikur wrote: <<Me, I can get really set back. Too many blows or
setbacks and my physical mind seems to sort of cave in and stop being
able to believe in ANYTHING, or forecast anything except disaster and
pain. And I don't seem to naturally snap out of it. A pill can change
that for me. It's completely astounding.>>
Jeff wrote: <<I'm all for better living through chemistry, but I agree
with cdale that commercial psychomeds are overused, especially the
SSRIs.>>
The way I usually explain it to patients is that we all inherit a
balance of neurotransmitters in the brain which can get out of whack
depending on a number of factors, such as persistent life stressors,
physical illness (chronic pain), coping mechanisms, etc. This
imbalance can result in symptoms of depression/dysthymia and
anxiety disorders. The degree of imbalance and the ability for it to
spontaneously correct is to some degree genetically determined; that
is, some people get clinically depressed over less stress, others never
get depressed despite horrendous life circumstances. That is why a
truly depressed person usually can't just snap out of it. We used
to call this 'endogenous depression', as opposed to 'reactive
depression'. The latter is what many of us may experience with
significant life stress; it's milder in severity, shorter in duration
and does not usually need drug therapy, although some studies have
suggested around a 30% efficacy rate with SSRI's. Perhaps that is
why Jeff was prescribed Zoloft?? With endogenous depressions, the
success rate with SSRI's is closer to 70 or 80%.
That is also why counselling or psychotherapy alone are often not
effective in a truly depressed patient. That neurotransmitter imbalance
needs to be corrected before a patient can benefit from any cognitive
work. All he can see is the dark side of everything. In fact, this is
probably what lead a young female physician/psychotherapist to
jump in front of a subway train with her six month old infant last week
in Toronto. It made headlines here in Canada because she appeared to
have it all: big $750K house with no mortgage, apparently stable
marriage, successful practice full of Bay Street executives, shiny
new Mercedes... So the baby is dead and now she faces murder charges.
Scary stuff. I think those of us who have never suffered a
depression (me included) cannot quite appreciate how it must feel.
The SSRI's are actually not more effective in treating
depression than many of the older antidepressant drugs, but they are
much safer and have less side-effects. What they all do is restore the
neurotransmitter balance so that the patient can think and feel as he
normally would. It restores the mind back to a more normal state of
functioning, much like exogenous insulin might be required to restore
a normal state of glucose metabolism in a diabetic. Since we know
that some patients are prone to recurrent neurotransmitter imbalance
resulting in frequent depressive symptoms (perhaps you, Eirikur), it
makes a lot of sense for these persons to remain on SSRI's
indefinitely.
--Linda
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