Tag Archives: depression

Why Psychiatric Medication is Confusing

“Hey Doc, why are you using me as a guinea pig? I am not taking these meds!”

Anybody who has been around people who need psychotropic medications (drugs for mental illness) has heard this complaint. Psychiatrists can never be sure if the prescription they write will do the “magic” that is sought. It is normal practice for a physician to give a trail of one medicine for a few weeks (or months) and if it is not working, try something very different. Or even begin a “cocktail” of medicines that might just do the trick.

It seems unusually cruel that people who have issues trusting people are given medicine that is so unreliable.  In American culture physicians are the most trusted of people. But when some of us feel so bad that we can’t even think straight, and we can’t trust anybody, we often go to a doctor who will write something on that special pad that might help, but might even harm! Why is the system so cruel?

To understand this, we need to understand a little bit about psychiatric diagnosis, and then a little bit about the medicines themselves.

Psychiatric diagnoses or the types and categories of mental illness is defined in a book called DSM (Diagnostic and Statistical Manual) published by the American Psychiatric Association (APA). This book is periodically updated and is currently in the fourth edition. The APA is an association for physicians who specialize in psychiatry. So they are interested in having their particular specialty be as similar to other medical specialties as possible. But there is a major, essential difference. Mental illness is not like most other medical illnesses. Most illnesses are defined by what causes them. Mental illness is defined by symptoms.

In most fields of medicine a disease is defined by the pathogen (the “bug”- virus, bacteria, etc.) that causes it. You have a sore throat so you go to the doctor to find out what you have. She takes a culture and tells you that you have strep throat. And she writes out a prescription for a medicine that will kill the strep.

The sore throat is a symptom. Before you went to the doctor you knew you had a sore throat. You did not know if it was strep throat or post nasal drip. Any symptom can have multiple or various causes. It is the doctor’s job to figure out the cause in order to prescribe a cure. Otherwise, you could just go and but some Cepacol.

But the DSM does not define mental illness according to cause. That because we generally do not have much of a clue about the causes of mental illness. (Except for one case, I will mention later.) So all of the categories in the DSM are defined by symptoms. A person has bipolar disorder because he or she acts like a person with bipolar disorder. A person is labeled schizophrenic because he or she has two or more of one set of symptoms and a certain amount of other symptoms. But nowhere is there a diagnostic test that is similar to a blood test, MRI, or throat culture. (This is also why people with major mental disorders usually have multiple diagnoses or the diagnoses change over time.)

All of the symptoms are behavioral. That means, we can look at the way a person is acting and apply the label that fits best. Of a seven year old has six or more features of inattention for at least six months, then he has ADHD. But do we know (or care) if it is caused by a malfunction of the brain or because the home is so unorganized that the kid rarely gets enough sleep? (Try staying focused on 4 hours a night of sleep.) Or some other reason?

Since psychiatric illness is defined by symptoms and not causes, the medicines are also given to address the symptoms and not the causes. That can be very good. If you need to control the symptom of hallucinations, it is fine to give anything that will work. If you need some immediate relief for your sore throat there is nothing wrong with a Cepacol. But it might not work, if the cause remains and can overpower the symptom. So if it doesn’t work, we can’t be sure why not. So the next best thing is to try the next best thing. Try a different medicine that might attack the symptom a bit more efficiently.

There is one category of psychiatric illness where we do know the cause. That is Post Traumatic Stress Disorder, and the related diagnoses. We know that there is a clear environmental cause. But that just makes the problem of prescribing medication even more complex. You cannot prescribe a retroactive anti-trauma medicine. (It would be wonderful, wouldn’t it?) Which is why there is no medical intervention for ex-abused people or people who have survived trauma. And when medicine is helpful, it is very difficult to apply that helpful experience from one person to another.

So if symptom relief is the best we can get, go for it. It can be much better than being with the symptoms. Without a cure, I’ll go get a Cepacol.


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Depression and Anxiety vs. Sorrow and Fear What is means to us.

In a recent discussion with Dr. Steven Brownlow (http://sgbrownlow.com) we discussed the difference between depression vs. sorrow and anxiety vs. fear. The thoughts were important and worthwhile sharing. The distinctions are not really clear to many folk, and can be really important when dealing with these emotions either in yourself or in loved ones.
The distinction can be especially important when you seek to set emotional goals for yourself. The type of work you need to do and what you can expect to achieve can be significantly different depending on what type of emotion you are actually experiencing.

While I have already blogged about the different types of depression and how one might deal with a non-clinical depression in a positive manner, in this blog I will use the term in a technical manner and not as the popular term. That will help us to see some characteristics of the clinical state that is not in the popular usage of the word “Depression.”

Depression and anxiety are the subjects of psychotherapy. One way of defining psychotherapy is that the therapist attempts to have the client’s subjective view of reality coincide with the objective view. When a person is clinically depressed (for purposes of this blog at least) one can say that the person feels sad, lacks motivation, etc., and attributes those feelings to circumstances that are not based in reality. He or she sees the world as a hostile or grim place and feels hopeless and helpless as a result.

Clinical anxiety has a similar dynamic. A person feels anxious because of a subjective perception that does not reflect the objective reality. One is afraid of spiders even though the spiders one sees are not dangerous. A person can suffer from overwhelming anxiety due to a trauma that happened in the past, even though it cannot happen in present circumstance. Such is the dynamic in PTSD, for example. A soldier will play out his or her anxiety at home far from the battlefield. And the anxiety might pervade his or her whole world-view. Now, you will argue that there is a real fear here and the behavior is caused by a real fear. That is true. But the fear is fueled and constructed from an anxiety that is based in an unrealistic, subjective perception and not objective reality.

Sorrow and fear might feel bad but they are positive emotions. Just like pain is not something we like, but without pain we would be in much greater trouble. We would not know when there is some damage to our bodies if we did not feel pain.

Sorrow is the real emotional pain that results from loss. Not a threatened loss. Real loss. Loss of anything can cause sorrow, and that is a natural and positive emotion. It tells us that we need to reevaluate our relationship with the object of the loss and refine our perspective. It could be the loss of a loved one, loss of a job, or loss of an ability. We still need to go on living and learn how to live without that thing we lost. This is the realm of coaching. It is not a pathology. It is not illness. It is a healthy process that we sometimes need help in order to redefine ourselves and set new goals for new levels of fulfillment, accomplishment and flourishing.

Fear, when it is based in reality, is also positive. It tells us that we need to prepare ourselves for possible impending danger. We need to muster up our innate strengths, set strategies and use our skills to deal with whatever it is that poses a threat. It is obviously very important, although it should not overpower the rest of our abilities. In our society we are not to be afraid, but it makes more sense to embrace the fear and the power it gives us to find extra strength to initiative to meet the oncoming challenge. Positive psychology coaching can give us the tools to meet such challenges by focusing on global strengths or higher values, or inner commitment. These are the tools that every healthy person who finds the power to meet scary situations uses, but many of us are not able to consistently muster up these potentials.

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Not Common Cold Depression

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Like all psychiatric diagnoses, depression is defined by its symptoms. Other illnesses are usually defined by the cause. A sore throat is a symptom while strep throat is a disease. Once we realize that depression is a symptom we notice that it is a symptom of numerous conditions.

Depression can be a symptom of thyroid disfunction. We know of SAD which is caused by lack of sunlight. There is post-partum depression. Also, since depressive symptoms are more common in women of childbearing years there seems to be something in thay population that preciptates those symptoms. The same is true for men with sexual dysfuntions.

In all of the above mentioned groups most people never have serious problems. They are resilient. The big question is how to increase resilence. Most psychologist can tell you how to combat depressive thoughts when they invade your mind but only recently have researchers and clinicians focused on prevention of depressive habits.

There are a number of useful habits. One well known exercise (mentioned by Martin Seligman in his new book, “Flourish”) is to write down your daily accomplishments. This type of journal has been shown to produce results in as little as four days. I have seen it work with true skeptics. It works because it forces us to think about what we have done well. And although many of us have been taught that complimenting ourselves is immodest and prideful, we all feel good with a job well done.

The resulting good feelings produce endorphins in the brain which ward off depressive symptoms. It allows you to rejuvenate your immune system and reduce actual stress. And it is more efficient than pleasuable distractions like watching a movie or having a good meal (which is also beneficial.)

This works for most people when they are overwhelmed but it is debatable that they are depressed. People who have too much stress. When responsibilies compete for your attention and you feel that if you do not give your all then things will fall apart.

Try it. You’ll like it.

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