Depression:


The most important thing anyone reading this needs to know is that everyone with depression will get better. The sooner you treat it the quicker and better the results.


LIfe time prevalence 4%, in fact in the USA up to 10% struggle with depression.

280 million people world-wide suffer from depression.


20% risk of suicide in untreated depression.


Used to be the 5th commonest cause of illness and death, now it is the commonest.

It is not because we have all become genetically susceptible to clinical depression, rather we have become more and more unhappy and stressed with modern life. What has risen is social media with the pressure to be perfect compare and online bullying and economic uncertainty as well as recent lockdown and health hysteria and vaccine mandates and most recently Ukraine War and spiralling energy prices. Mental health referrals are at all time highs.

Neuroscience New and Research July 2022 Ruairi J Mackenzie: Serotonin theory has been seen for years as an oversimplification. SSRI medications do often work in depression but depression is multifactorial and likely more than one illness.  The Biopsychosocial model of depression is preferred.

Even Epicurus 2,500 years ago and before him Buddha both said that seeking of pleasure would cause unhappiness as pleasure is transient and leads to more seeking of it hence is not only meaningless but destructive. Yet as a society that is exactly what we have become: cyclical reflex dopamine seekers especially with social media.

Furthermore the teaching of socialisation has been reversed with smart phone hunched pleasure seekers. We are all becoming depressed children with no effective parental supervision apart from the social media CEOs temping us ever further down the rabbit hole of instant gratification..

One of the definitions of the most dysfunctional members of our society namely personality disorders is self obsession as this is not tribe compatible yet the rest of us are rapidly heading that way pulling apart the integrity of our society and even civilisation itself if it continues. Close on the heals of self obsession is loss of boundaries and rules aka political correctness which is a Marxist view of demanding the same outcome for everyone despite the fact that everyone is different.

Without boundaries we are lost  because we have evolved to function in tribes with structure hierarchy and leadership. Now we are led by self serving politicians who will say anything that gets them elected which is what they think the voters want but voters are influenced by mass and social media. Add into that that 98% of what we do and think is emotional and not logical which means that currently we are being led by media driven hysteria which the politicians respond to. Even more dangerous is that media controls the masses on a global scale now almost instantly.

Diagnosis of clinical depression:

Diagnostic and Statistical Manual 5th Edition Americal Psychiatric Association  and International Classification of Diseases 11th Edition 296. And F32 codes respectively:

Require are certain number of symptoms for a certain period of time typically 5 symptoms for at least 2 weeks although this can be altered according to severity.

Symptoms making up depression include:

Low mood typically worse in the morning improving as the day goes on (diurnal mood variation)-  said to be due to raised levels of cortisol in depression with the coritsol peak being in the morning and lowest in the middle of the night-  I have seen severely depressed people walking around the ward at 2am feeling fine. This is one the reasons metyrapone is used with is a cortisol synthesis inhibitor in a resistant depressionL Ted Dinan et al.

Disturbed sleep typically waking early in the morning unable to get back to sleep

Reduced appetite and weight loss (although people can comfort eat) reduced energy concentration enjoyment motivation confidence libido and suicidal thoughts.


Treatment of depression:

Firstly there needs to be a risk assessment of suicide . in 2005 1.5% of all deaths were suicide and the commonst cause was depression and it is going up.

Investigation:

Biological:

Thyroid , metabolic, autoimmune, dietary, epileptic , raised indices of inflammation. Females my have hormonal issues including sensitivity to progesterone in oral contraceptives.

Psychological:

Aristotle argued that virtue is functioning according to you values and beliefs . A blunt knife is not a vrituous knife as knives are designed to cut. A virtuous human being is a human able to function according to their values and beliefs which is socialisation and reproduction. However in todays goal oriented society the pressure is one of endless goal seeking and perfectionism. That alone severely raises stress and cortisol levels but also makes you more unhappy as you not functioning according to your values and beliefs. It also means that if you achieve something at the cost of your values and beliefs you value it less in any case. Hence it is impossible to ever be happy with he result that more and more of us are depressed.

Note that chronic sleep deprivation causes clinical depression.


Treatment of depression:

Classically it is a combination of medication and psychological treatment eg cognitive behaviour therapy.

However one third of patients have raised indices of inflammation and those are likely to be resistant to antidepressants and can respond to aspirin.

Furthermore for moderate depression regular exercise is as effective as antidepressant.

Antidepressants: Currently they all work on a combination of serotonin noradrenaline and dopamine and a couple work additionally on melatonin receptors. None are better than the other although the newer ones have less side effects.

The new generation coming through are going to be based on psychedelics and glutamate receptor antagonists . In fact the latter has a drug licensed in the UK for 3rd line treatment of depression s ketamine nasal spray.


Treatment resistant depression:

Requires a review of diagnosis and physical investigations then switching to a different antidepressant and raising the dose according to plasma levels , combining antidepressants and adding in thyroid hormone, lithium or antipsychotic such as risperidone.

-Electro Convulsive Therapy

-rTMS daily for 4 weeks.


-Neurofeedback can be an alternative to antidepressants.

Sleep Deprivation and Depression: National Library of Medicine Jan 2021


Why is ECT becoming a preferred treatment for depression March 2022 Maclean Hospital Harvard Medical School Affiliate


Using neurofeedback as a means of reducing self blame in depression: Dr Zahn  Kings College News Centre  Sept 2021


Review of social participation interventions for those with mental health problems Social Psychiatry Psychiatric Epidemiology March 2017 Martin Webber


Exercise is an all natural treatment to fight depression: Harvard Health Publishing Dr Miller February 2021


The relationship between excessive internet use and Depression:

Morrison Gore Psychopathology 2010 43: 121-126


Treatment Resistant Depression: Web Med:  Dr Bruce  May 2022


Esketamine For Treatment Resistant Depression: BMJ Sept 2019 Jauhar


An evidence based approach for augmentation and combination strategies for treatment resistant depression Psychiatry July 2006 Barowski


Key differences between Venlafaxine XR and Desvenlafaxine: An analysis of pharmacokinetic and clinical data 

Michelle D. Colvard, PharmD

Mental Health Clinician (2014) 4 (1): 35–39.




 




A Popular Theory About Depression Wasn’t "Debunked" by a New Review

Published: July 22, 2022

 

| 

Ruairi J Mackenzie

A Popular Theory About Depression Wasn’t "Debunked" by a New Review

Published: July 22, 2022

 

| 

Ruairi J Mackenzie

A Popular Theory About Depression Wasn’t "Debunked" by a New Review

Published: July 22, 2022

 

| 

Ruairi J Mackenzie