Antidepressants

December 16, 2003 6:56 AM

Pills for Problems: The British have taken steps to restrict the use of some antidepressants. Breggin and others have been warning us for some time now about the many problems with medicating behavior. The Big Picture: Aren't "medications" (legal or not) used for behavioral problems just an excuse for us not controlling ourselves?
posted by ewkpates (111 comments total)

First, show me a behavior problem that has no neurochemical corollate whatsoever.

Then show me a biological brain disorder that effects no measurable behavioral change.

Then we'll talk about "excuses" and "controlling ourselves".

The two systems interact. Regardless of which system "started it" (if they can even be considered to be separate at all, which is unlikely), it's generally more effective to treat both biologically (drugs) and behaviorally (therapy) in concert.

[Note: this is in reply to ewkpates' "big picture", not to the articles.]
posted by dmd at 7:20 AM on December 16, 2003

Uhhh, speaking as someone who has OCD, cognitive therapy does work wonders, but it sometimes is not enough. I refused medication for over five years, and instead relied only on therapy. I can tell you firsthand that unfortunately the therapy, while helpful, did not work miracles. It was only after I combined therapy and drugs that I really found true relief, and was able to regain a "normal" (if you can call anything normal) life.

I do think that antidepressants are overprescribed (especially when used in place of/without therapy), but I also think they can be invaluable to those of us who find ourselves fighting conditions like OCD.
posted by greengrl at 7:28 AM on December 16, 2003

I was going to post something, but now I can just say: What dmd said.

With respect to the NY Times article, it's interesting that Prozac is exempted from the restriction. Of the SSRI's, it's my understanding that Prozac has the greatest side-effect profile. I would think that would have been the drug most likely to be restricted.
posted by pardonyou? at 7:28 AM on December 16, 2003

As for the articles:
British: So they deprecate some SSRIs, but not all of them? That seems somewhat suspect to me. I'm going to try not to take out my tin foil hat just yet, but watch and see if a quiet scandal emerges involving Eli Lilly.

Breggin: Yes, sometimes drugs have side effects. Sometimes those side effects aren't things like dry mouth or headache; sometimes they fall within the spectrum of the disease they're supposed to be treating. That's why we have massive controlled tests. That's why we trust the statistical results of large numbers of patient outcomes. If a hundred thousand patients improve their quality of existence, but ten people are pushed into mania and commit suicide, that's a success, not a failure. It's selective reporting - the suicides are far more newsworthy, and very few people create watchdog organizations and protest-websites when things work as intended.

Excuse: Again, one study found something that hundreds of other studies didn't. That makes it less likely to be "correct", not more. People seem to have this weird love-hate relationship with science, where they're more willing to accept data that argues with the prevailing theory than data that supports it. It should be the other way around - the prevailing theory is generally prevailing because it has accumulated a great deal of evidence in its favor. Just because something is new doesn't mean it's correct; rather, something new, to be accepted, needs to work harder to prove its worth.

(Disclaimer: I'm in the same department as DeRubeis.)
posted by dmd at 7:33 AM on December 16, 2003

It's a complex issue and one that isn't easily dissected with a few glib sentences.

The British equivalent of the FDA did the equivalent of a meta-analysis on 11 studies that looked into the effectiveness of these newer antidepressants with children. This would be fine and scientifically meaningful if that analysis was then published in a peer-reviewed journal. The peer review process is designed to ensure studies such as this are balanced and objective and take into account alternative explanations or hypotheses for the results. As the critics pointed out in the article, there are some issues that may not have been adequately addressed by the British researchers.

However, the risk of suicidal ideation (and behavior) with such SSRIs is neither new nor noteworthy. It's been around as long as the SSRIs themselves. Most SSRIs are more energizing than alternative antidepressant medications. And the way they act is often to increase a person's energy level before the actual feelings of depression start lifting. So the depressed person on an SSRI will often still be severely depressed, but have more energy than they may have felt for weeks or months. Unfortunately, that's not always a good thing, because the lack of energy is often what keeps one from acting on suicidal ideation (a symptom of the depression, not the SSRI).

Anyways... I think the Brits jumped the gun on this one, but the feeling that SSRIs are potentially dangerous is one shared by many legitimate professionals within the field. That's why psychotherapy, paired with medications, is usually the best treatment for most people who have depression. Seeing a professional therapist weekly can help ensure that any suicidal ideations are properly addressed.

Of course, the bigger problem is that any GP or family doc is prescribing these SSRIs without any regard for followup with a specialist (psychiatrist) or concurrent psychotherapy.
posted by docjohn at 7:51 AM on December 16, 2003

What greengrl, dmd, and docjohn said. I still find it amazing the ignorance that abounds today regarding mental health issues . From statements like ewkpates "big picture" to physicians that prescribe drugs without regard to therapy just so someone can "feel better". Are antidepressants overprescribed? Definitely, but then again so are most drugs. I don't believe there is anything inherently wrong with drugs used for "behavioral problems" any more than there is for drugs prescribed for "physical problems". The problem is in how they are admisitered.
posted by Eekacat at 7:56 AM on December 16, 2003

The Big Picture: Aren't "medications" (legal or not) used for behavioral problems just an excuse for us not controlling ourselves?

I'd love to hear you say this to someone with a pyschotic disorder. Actually, I'd like to watch.
posted by Hildegarde at 8:04 AM on December 16, 2003

I was on Lexapro for several months this year and just recently decided not to refill my prescription. Not because I finally felt 100% better after months of taking the drug, but because I only felt better after taking the drug. Relying on medication to get me through the day was not how I wanted to live. The side-effects were minor compared to other SSRIs, I was told, but they were extremely frustrating anyway. I'm a firm believer in actually solving problems instead of putting a band-aid on them so they're manageable, so that's why I'm probably going to go back to CBT in 2004 because that was extremely helpful for me the last time I sought it.
posted by emelenjr at 8:05 AM on December 16, 2003

"That's why psychotherapy, paired with medications, is usually the best treatment for most people who have depression. "

I seem to recall having read about many studies that showed that exercise is just as or more effective than ANY drug available at combating depression and has absolutely zero side effects (unless you consider a heightened sex drive a side-effect).

Oh, and don't let me forget meditation.

Of course, I realize not everyone can exercise or meditate, but certainly the vast majority of people on anti-depressant medication have no physical reason they can't exercise. Meditation is a different discipline altogether, but why not look for a wholistic solution to one's problem, rather than medication?
posted by PigAlien at 8:08 AM on December 16, 2003

Without trying to be one of those 'get over it' voices (a sentiment I do not hold), I will say that I believe it is becoming more and more common for people who are experiencing a kind of depression due to normal (and often fixable) situations (i.e. a death in the family, low self-esteem, problems with finances, etc) to be simply provided with a pill to, in essence, make them happy, rather than taking on the harder work of addressing the underlying issues.

For example, a close friend of my mother's was urged by her family physician to start taking Prozac following her husband's death. The MD basically told her (six weeks after the funeral) that it was time for her to stop mourning and get on with her life and that the pill would help her do that.

Certainly in some situations medication is the best bet. But our society has come to associate all "down feelings' with clinical depression, when often those feelings are natural and normal (like mourning) or are caused by underlying situations (like financial problems) that the medication won't help. Medication, however, is the easier route for both doctors (with limited time for each patient) and patients (who may not want to do the hard work that therapy or other programs require).
posted by anastasiav at 8:21 AM on December 16, 2003

Because very often, one of the effects of depression keeps you from being able to start or follow through with an exercise program?

For that matter, isn't a wholistic approach supposed to consider all influences on a problem? How is all medication is bad any more balanced than do nothing but medicate?

It always amazes me when people who've never suffered from a mental illness in their lives try to explain to us that taking medication is a moral failing and we should just "cheer up" and "pull ourselves together". You know, it's also possible to control many kind of diabetes with diet alone (at varying degrees of restruction), but I don't see any lobby groups trying to ban insulin!

That said, consider this article: Glaxo Chief: Our Drugs Do Not Work on Most Patients
posted by Karmakaze at 8:25 AM on December 16, 2003

Great discussion, particulatly dmd's initial comment.

Sometimes such medications make one able to take more proactive steps such as beginning therapy, exercise, meditation, prayer, etc.. In short, if prescribed properly, they are a tool to help you "get over it," "cheer up," and "pull yourself together."
posted by ilsa at 8:49 AM on December 16, 2003

Aren't all medications just an excuse to keep us from controlling ourselves? Those terminal cancer patients should be biting their lips when they experience wrenching pain, instead of running for the morphine. And, for Baal's sake, people with pneumonia should just tough it out instead of being wusses pleading for antibiotics.

And what about this? Doesn't she know it's just a crutch?
posted by Sidhedevil at 8:50 AM on December 16, 2003

This controversy is intriguing to me not just because I take Prozac, but also because it puts the mind/brain problem into stark relief. If you believe that the mind is an emergent property of brain activity, then taking antidepressants has the effect of actually altering who you are, assuming that you equate "who you are" with your mind (which I think many of us do). If you accept, on the other hand, the traditionalist view that the brain is the instrument of the soul, and that mind transcends brain, then antidepressants can be viewed as affecting/correcting the vehicle of mind, without actually altering the mind itself.

Does this mean anything? I don't know; it's a gross oversimplification of a complex matter. But it's fun to think about, anyway.
posted by vraxoin at 8:52 AM on December 16, 2003

I'm not sure of your level of snark, Sidhedevil, but maybe if there were a study showing that cognitive behavior therapy can help mend broken bones or help cancer patients manage their symptoms, that argument would hold more water. I think the point of the discussion is that there's more than one way to manage an illness such as depression and at least one of those methods doesn't involve medication.
posted by emelenjr at 8:58 AM on December 16, 2003

As many of you know I suffer from a type of bipolar disorder that mainly manifests as depression. I take an antidepressant, an anticonvulsant recently approved for this condition-and I exercise like a fiend three to four times a week at a health club (I am talking two or three hours of exercise each visit, not counting showers or breaks.)

All of the above is barely enough to keep my head out of the pit.

I think the decision to use these meds should rest solely on psychiatrists (medical doctors trained in the use of psychotropic medication.) I do not think these drugs should be banned but I also don't think a GP has any business prescribing them either.

And why on earth the British approve Prozac and not the other? It makes no medical sense which leads me to believe that this is mainly a financial decision.

This is an extremely complicated subject and anyone who either advocates only drug treatment or only lifestyle changes and therapy is full of mud.

As far as I and other mental health care consumers are concerned, Breggin's opinions are worth about as much as used toilet paper, and both belong in the same place. A lot of the horror stories he tells most likely are undiagnosed bipolars whose doctors weren't taking that possibility under consideration. That is why GPs have no business prescribing them unless under the direct supervision of a psychiatrist-or better yet prescribed only by a psychiatrist.

And no one should ever stick any kind of pill in their mouth without knowing exactly what it is for, what it does, what the side effects are-in the long run I believe we are responsible for our own health, and need to educate ourselves accordingly.

These pills are very powerful, I have taken some of them before, and they are nothing to play with. But for some of us it is what keeps us alive and what keeps us somewhat normal. If you don't believe me go check the archives for bunnyfire. If I wasn't taking meds, that would be my life, and that would be hell.
posted by konolia at 9:02 AM on December 16, 2003

Konolia - to play devils advocate (because in reality I agree with you w/r/t being highly educated about the drugs we take) ...

"And no one should ever walk into any building without knowing exactly how it was built, what construction materials were used, and its entire inspection history. I believe we are responsible for our own safety, and need to educate ourselves accordingly."

We live in a society where it's expected that we will defer certain aspects of our safety to people who are specifically trained in that aspect. I'm not sure that's a bad thing.
posted by dmd at 9:49 AM on December 16, 2003

well, dmd, I'm not exactly chewing on the drywall of that building ;-)

And if you were buying that building, all that info would be very important to have. Heh.

I am not deferring my safety to anyone. Reason being is that professionals of any ilk are human-but they don't have to live with their mistakes. I do. Do I consult professionals? Of course. My doc is fantastic and brilliant and I trust him. I still try to know as much about meds as he does.
Do I use pharmacists? Yeah-but I check the bottle to make sure what I got was exactly what was prescribed.

Mechanics? Yeah, I don't know squat about cars-but I sure as heck find someone that does to help me guard against being ripped off because of my ignorance.

Lawyers? Don't need one but if I did you bet your sweet bippy I would be reading up on things right behind him or her.

Back to our building example: if I were trying to determine if that building were safe enough to ride out a hurricane in it, I better have some info on it to make an informed decision instead of a half-***ed guess.

You know, trust but verify.
posted by konolia at 10:07 AM on December 16, 2003

Right, sure, the under-18 thing in the first article is completely valid. There's plenty to back that up, including the fact that clinical trials are done on people over the age of 18, and don't consider the biological changes in a growing child.

That said, however, making blanket statements about psychiatric medications doesn't do anyone any good. I take Zoloft and I'm not currently in therapy, but I have an anxiety disorder with agoraphobia, and I have to work through going to the supermarket before I can go to a therapist. (It doesn't help that my brief experience with therapy consisted of a very unprofessional person telling me that because I am a white, middle-class female from the suburbs, I'm not allowed to have problems and could I kindly stop wasting their time.)

But basically, what ilsa said.
posted by Ruki at 10:07 AM on December 16, 2003

emelnjr, my "level of snark" comes from the fact that I take medication to keep my neurochemistry from telling my brain to try to kill me. And I go to therapy to work through my problems. And I don't confuse the two.

People without neurochemical imbalances don't understand what it feels like to have your brain try to kill you anymore than I, as a non-diabetic, don't know what it feels like to go into a diabetic coma.

In my own experience, the death chemicals have nothing to do with my thoughts, spirituality, attitudes, or ability to handle my actual life problems. I do pretty well with all of those, despite a difficult childhood by financially comfortable Western standards (mother died when I was a child, father 'checked out' emotionally instead of dealing with grief, mother's family blamed father for mother's death and focused a lot of hostility on me because I was father's favorite child, etc.)

But I remember experiencing neurochemical depression as early as three years old. I would tell my parents that I was having a "gray day", which began with a hollow feeling in the middle of my chest and generally ended with my banging my head against a wall until I was tired enough to go to sleep.

If someone can explain to me how I can "tough that out", I'd be delighted--you'd save me money and wear and tear on my liver.
posted by Sidhedevil at 10:15 AM on December 16, 2003

Here's the all time whopper of a medical dilemma.

apotemnophilia: the desire to be an amputee

Amputation Fixation. What do you do when neither therapy nor drugs help?
posted by kablam at 10:43 AM on December 16, 2003

PigAlien:

Of course, I realize not everyone can exercise or meditate, but certainly the vast majority of people on anti-depressant medication have no physical reason they can't exercise. Meditation is a different discipline altogether, but why not look for a wholistic solution to one's problem, rather than medication?

there is no reason not to consider wholistic options when it comes to one's mental health. i would say that there is no small number of therapists who would tell their patients to try meditation and exercise. the severity of the disorder is a factor that should not be overlooked, as it may well preclude the ability to choose between wholistic and medicative options.
posted by moz at 10:44 AM on December 16, 2003

One of the reasons that prozac was not taken off the list of allowable drugs to be prescribed could be that Eli Lilly's patent on Prozac is expiring. Thus, Prozac is likely to be the only new generic anti-depressant available to the NHS and prescribing it will be less of a financial burden on the British health system compared to other, newer name-brand anti-depressants.
posted by deanc at 10:46 AM on December 16, 2003

deanc, I would place money on your explanation.

Another reason why socialized medicine scares me. (Yes, I know the present system stinks, too. )
posted by konolia at 10:57 AM on December 16, 2003

'Neurochemical imbalance' is a theory, it's not a fact. Sometimes people don't realize that, but a simple search of the literature shows this to be true. So what the drug companies have are only theories as to why their antidepressant drugs work (yet they often portray these theories as facts in marketing literature and to most laypeople, to the point where people talk about the theories as though they were simpel truths).

For balance sake, there's also a great deal of theory for the explanation of feelings and behaviors that doesn't involve neurochemistry.
posted by docjohn at 10:58 AM on December 16, 2003

I think one problem here is people who truly do require medications or who benefit tremendously from them, such as sidhedevil and konolia, somehow think this is their fight. I'm sorry, but its not your fight. This discussion is not about people who NEED drugs. This discussion is about the abuse and over-prescription of drugs and the use of drugs on a population (youth) for which they have not been tested. Sorry, guys, but don't take it personally. Keep taking your drugs, we're glad they help you.
posted by PigAlien at 11:03 AM on December 16, 2003

Why do people look down on drugs as a solution? Is it because they are perceived as "easy" and thus don't make the sufferer work hard enough for relief? I'm really curious as to where this attitude stems from, and what it's based on.
posted by beth at 11:06 AM on December 16, 2003

When the data suggests that people can regain mental control with cognitive therapy alone, one of two things is true: 1) People don't need drugs to regain mental control; or 2) the same problem (depression) can be caused by different things.

I have yet to see evidence that behavioral disorders are caused by more than one thing.

If an alcoholic tells us that he/she needs alcohol to feel better, we say, no you are an addict, learn to deal with your problem. But if big drug companies market fancy chemicals that do strange things to us, then hey, that's TREATMENT.

If you can write a comment and post it to Metafilter, then you can stop yourself from eating, control your fear enough to go outside, and pretty much do anything anyone else can do. And you may need the help of friends, family, support groups, religious leaders, and COMPETENT therapists, but you don't need drugs, alcohol, or "medication".

Now, if you can't use a computer and you think that the USSR is invading the US through your uterus, then hey, maybe a pill is a good idea. (Man who mistook his wife for a hat)

There's more than two options, it isn't just "get tough" or "get medicated". It may be that significant changes in values, environment, behavior patterns and life experience are in order. But drugs just make you feel better. They don't help you be a better person or learn to control impulses or teach you how to use a computer (or control yourself).

And another thing- Physical problems and mental problems are NOT NOT NOT analogous. A broken arm and a broken heart cannot be equated.
posted by ewkpates at 11:09 AM on December 16, 2003

docjohn: there's also a great deal of theory for the explanation of feelings and behaviors that doesn't involve neurochemistry

yeah, I suppose you could say that is true--theories involving the four humors, and excess black bile, and misaligned chakras, and unresolved birth trauma, and possession by demons.

Oh, wait, none of those can really be measured or studied scientifically, now can they. So how is neurochemical imbalance just the same?
posted by mooncrow at 11:15 AM on December 16, 2003

It's not a question of "behavioral disorders"--there are actual physiological symptoms, unrelated to behavior, of clinical depression.

I think it's true that there are probably people taking medication for situational depression that would be better resolved through therapy.

But I can't talk or feel the neuropathy, sleep disturbances, weird hollow feelings, or serotonin spikes away. If ewkpates or docjohn choose to believe that I (and the Robert Wood Johnson Medical Center) imagine this stuff, I can't do anything about it.

But I wonder why they feel the need to disparage medications that work for many people. Doctors used to think that ulcers were caused by stress, and that the best way to treat them was to calm down and drink milk, and if your ulcer didn't go away that was because you weren't trying hard enough. Now doctors know that most ulcers are caused by bacteria, and the best way to treat them is with antibiotics.
posted by Sidhedevil at 11:16 AM on December 16, 2003

ewkpates, have you ever been diagnosed with a behavioural disorder? Is your steadfast opinion based on personal experience? If it is, please share how you overcame it. If not, why are you so adamant about something you have never personally felt? What experience do you have that you feel justified in telling others how to solve their problems?

No snark here, just geniunely curious.
posted by Ruki at 11:26 AM on December 16, 2003

Those people who have never suffered serious clinical depression just cannot understand how utterly paralyzing it is. It can be an enormous effort just to get out of bed in the mornings. You have no energy and cannot make yourself care about virtually anything.

"If you can write a comment and post it to Metafilter, then you can stop yourself from eating, control your fear enough to go outside, and pretty much do anything anyone else can do."

Ewkpates, unless you've been there yourself and experienced the blackness that many people suffer from, your contention is both ignorant and offensive.
posted by John Smallberries at 11:42 AM on December 16, 2003

The whole problem in the UK as far as I can see is that people with mild depression and other moderate disorders have had Prozac etc., thrown at them. I know of people who this has happened to who have been so surprised by the prescription it has shaken them from their negative schemas and without a tablet taken helped them to get better.

It is becoming less true, in my experience, that doctors are looking at medication as the be-all-and-end-all; hey - it'd be great if you could get gym memberships on the NHS, I'm sure it'd be hella cost effective - but you have to draw a big line and make sure people who need medication get it; sometimes you need a spell on meds to be able to have the willpower to get yourself out of a hole.

"If you can write a comment and post it to Metafilter, then you can stop yourself from eating, control your fear enough to go outside,.."

Ever had a week where you could face a living breathing soul and took refuge in the degree of separation afforded by t'internet?
posted by boneybaloney at 11:42 AM on December 16, 2003

Why do people look down on drugs as a solution? Is it because they are perceived as "easy" and thus don't make the sufferer work hard enough for relief? I'm really curious as to where this attitude stems from, and what it's based on.

I, personally, absolutely do not look down on drugs as one possible solution, and they are very suitable for many people with a range of psychological issues.

What I do strongly believe, however, is that we've become a society far too fixated on "feeling happy". Some sad, mad, or bad feelings are, in fact, a normal part of being human (see, for instance, the 'death of my spouse of 20+ years' example I cited above). I know far to many people who are in bad relationships, or who are depressed about their weight and/or personal appearance, or who have mountains of debt who turn to drugs to help them actually avoid the feelings they are having about these situations rather than trying to actually address the underlying problems in their life.

I strongly agree with what PigAlien said above -- we're not talking about people with serious clinical depression or other like disorders here. What I think we're talking about is the increasing tendency to hand every sad or upset person a pill and say "here, take this, you'll feel better" rather than helping the person actually change the things in their life which are causing the situational distress.

I think, in part, this is because this is an 'easy' solution for both the patient and the doctor. But is it better for a person with a fixable life-issue to be dependent on medication for years (or even decades) or for them to, with help, do the work necessary to improve their life and not need the medication in order to function on a daily basis?
posted by anastasiav at 11:44 AM on December 16, 2003

Um, what exactly is wrong with controlling yourself?
posted by delmoi at 11:56 AM on December 16, 2003

If you can write a comment and post it to Metafilter, then you can stop yourself from eating, control your fear enough to go outside, and pretty much do anything anyone else can do. And you may need the help of friends, family, support groups, religious leaders, and COMPETENT therapists, but you don't need drugs, alcohol, or "medication".

Sorry, I call horse manure on this one.

Bunnyfire sure as heck could make a post, and even tho she had all of the above as a support, it took the proper medication to take care of it.

Now lest someone misunderstand, let me make it plain that I don't believe everyone needs meds to fix their lives.

But when you have tried therapy, support of friends, suppportive family and clergy and anything and everything including even unorthodox remedies, and none of it works,

GET A PRESCRIPTION.

As for the question of the under-18 crowd, you should have seen the crap they had me on in high school. If I had had these meds around then (they didn't even exist at that time) I could have enjoyed or at least tolerated high school instead of it being a living hell. With some kids, there is nothing left to do but take the risk with meds in order for them to have any kind of life.

And let me also reiterate that drugs are not the whole answer. They don't fix everything. Therapy/support groups/patient friends/whatever is still needed. You still need to learn how to cope with life. The drugs simply make it possible to work on whatever needs to be worked on. Many counselors prefer their clients to be medicated and somewhat stable in order to be able to do the therapeutic work necessary.
posted by konolia at 11:56 AM on December 16, 2003

Okay, so how would you propose to discern which people are depressed because they have a shitty life, and which people have a shitty life because they're depressed?

I'm guessing you'd withhold the antidepressants from the former group, and give them to the latter?

Teasing out cause and effect isn't nearly as straightforward as it seems.
posted by beth at 12:04 PM on December 16, 2003

Mr. Smallberries, if that's your real name, and the rest of those who confuse science with experience: Don't.

You don't need to break your arm to know how to set someone else's. First person experience is not a criteria of the natural sciences.
posted by ewkpates at 12:23 PM on December 16, 2003

ewkpates has the kind of ignorant attitude that I was talking about in my earlier post. Clinical depression is NOT a broken heart, and to compare it as such is completely moronic. It is also moronic to prescribe antidepressants for someone who has a broken heart, and not actual clinical depression. It is just as moronic to prescribe antibiotics to someone who has a virus, but doctors still do it. Does that mean viral diseases don't exist? Clinical depression isn't about being sad because you didn't get what you wanted for christmas or your girlfriend dumped you, it is an actual disease just like cancer or whatever else you can think of. There are studies showing brain scans of people with clinical depression that show lower brain activity, and like with cancer or other diseases there has also been shown to be a genetic component in some cases. Clinical depression can be mind-numbingly paralyzing. Sure, exercise helps, but you have to go and do it. CBT helps too, but again it requires a lot of work. Antidepressants can take away the symptoms so that you can do things like exercise and CBT and whatever else, and hopefully get off the medications.
posted by Eekacat at 12:37 PM on December 16, 2003

ewkpates, maybe you should try some of your science and go do some research before you make an ass of yourself.
posted by Eekacat at 12:40 PM on December 16, 2003

Beth, I guess trying nondrug options first might be the best unless there was a risk the person would harm him/herself or someone else. I agree it's hard to know for certain sometimes.

On the other hand, I do have a friend who was widowed after 20 years of marriage. She did temporarily go on an antidepressant which allowed her to take care of some practical things and also to help her children adjust. It did not interfere with the grieving process from what I observed. And again I stress it was temporary.

So it isn't that I would automatically say a person whose problems came from outside shouldn't have a little chemical help. And I also don't think that someone with a mild chemical depression can't perhaps find ways to cope without drugs. In some cases I understand exercise really is a viable antidepressant, for example.

But I think you agree with me that no one needs to suffer just because it's "character building." After all, for some people depression is a death sentence.
posted by konolia at 12:45 PM on December 16, 2003

ewkpates, in order to set a broken arm, I believe it is necessary to believe that such a thing as a broken arm exists, and that it should be treated differently than a sprain.
posted by konolia at 12:47 PM on December 16, 2003

ewkpates: You talk about science, after your post contains a classic false dilemma fallacy like this?

When the data suggests that people can regain mental control with cognitive therapy alone, one of two things is true: 1) People don't need drugs to regain mental control; or 2) the same problem (depression) can be caused by different things.

These are not the only two conclusions one could make from these facts. At the very least, there is a third possibility: 3) Not every case of depression is equal in severity or symptoms. That is, some people may be helped with therapy alone; others may not be stable enough to get much benefit from therapy. The second group would benefit from a drug regimen that helps to stabilize them enough for therapy to work for them.
posted by vorfeed at 12:53 PM on December 16, 2003

ewkpates:If you can write a comment and post it to Metafilter, then you can stop yourself from eating, control your fear enough to go outside, and pretty much do anything anyone else can do. And you may need the help of friends, family, support groups, religious leaders, and COMPETENT therapists, but you don't need drugs, alcohol, or "medication".

Bullshit

Tell that to my uncle who comitted suicide before any of these drugs were available. Or my other uncle who wasn't on any medication but was so depressed that all he could do was sit in a chair in a corner and chainsmoke all day. Or my father who had a breakdown so severe that he stopped eating and couldn't get out of bed. Or the countless other cousins on that side of the family who had debilitating symptoms of severe depression or bipolar disorder.

I'd love it if you could live inside my unmedicated mind for a month. You'd start tasks but couldn't complete them because of the murky whirlpool of constantly shifting thoughts. You'd have a relentless barrage of thoughts that tell you that you are a waste of flesh and blood and that you should kill yourself and spare everyone another 35 years of shame and disappointment. You can't eat without wanting to vomit, your stomach is so violently cramping and contracting. Your dreams are filled with images of things like mutilated corpses or leeches and ticks covering your body. People tell you to cheer up, be grateful for what you have, look at others who have bigger problems than you (which makes you feel more worthless and makes you want to kill yourself even more), try taking vitamins, try exercise, try Jesus, blah,blah,blah - all of which makes you feel even more isolated and ashamed.

Then try taking an appropriate medication. Slowly but surely, as the weeks pass, you'd feel the murk clear and the thoughts slow. You could start and complete tasks. The relentless self-hatred would become quieter, less obvious. You'd realize that no one is ashamed of you, that all any of your friends and family want is for you to not suffer like you have been. You're not necessarily happy - medication doesn't do that no matter what people think - but you see that it is possible to be happy if you make the right changes in your life. In short, you are now capable of doing the things necessarily to make your life better because you can think clearly.

Are these drugs overprescribed? Yes and no. Yes because these drugs are being over-prescribed by GPs who don't have any real knowlege of what the drugs are supposed to do and who needs them. No, because many of the people who really, really need them don't have access to qualified doctors who can accurately diagnose their condition or they don't have the financial means to afford them.
posted by echolalia67 at 1:04 PM on December 16, 2003

necessary, not necessarily
posted by echolalia67 at 1:06 PM on December 16, 2003

ewkpates, your posting tone and comments in this thread seemed unusually shrill and contentious to me, so I went back and checked out your posting history. In doing so, I found this gem of a past post:

Why Do Gays Smoke So Much? Yet another escape from the cruel shackles of responsibility. Why do Gays smoke? 1. They have no children. 2. Social Opprobrium. 3. People are mean. This isn't journalism. It's crap. High risk behaviors tend to promote other high risk behaviors, like the tattoos-sex-cigaretts connection. It could be something even more sinister, like the values of particular subcultures. How can we get people to take more responsibility for self destructive behavior? Cigarettes, fat, alcohol, unsafe sex... if we are ever forced into National Health Care, there will be no reason to deny ourselves anything. Have another cigarette on me. (bold & italics for emphasis)

You also posted about race and gender, stating that "the US has no race problem," and "Race and gender are just more games for people who need hobbies." Another quote from you in that thread: "When you allow people who do bad things to define the reasons for their badness, you perpetuate a lie." (bold original)

You seem to have a track record of wanting to deny those in disadvantaged social situations (ill or socially oppressed) the power to define their experience of those situations. Am I wrong in thinking that your world consists in part of depressed people who just need to get a damn grip, gay people who just need to stop pursuing their risky lifestyle, and uppity minorities and women who should get over their misconception that racism and sexism are real and serious social issues? If I'm right, sheesh, and fooey on you. If I'm wrong, well, please do tell me so.

...And last but not least, I'd appreciate it if you'd avoid such inflammatory and blatantly agenda-laden FPPs.
posted by clever sheep at 1:50 PM on December 16, 2003

echolalia67: I'm proud of your courage. Thanks for posting. I have posted about this subject before, so I'm being a little cautious here. Thanks to all the revealing peeps on here.
posted by dash_slot- at 1:58 PM on December 16, 2003

I've seen these kinds of medications do wonders for friends of mine, particularly those who needed to overcome serious OCD.

However, there's definitely a movement toward making consumers think medication should be used to solve everything. The Zoloft commercial, with the animated bubble person, describes feelings that every "normal" person seems to have now and then.

If the pharmaceutical companies weren't pushing an agenda, you wouldn't see ads for Zoloft, Paxil, etc., in magazines like Time and People. Those companies want people to head to the doctor, screeching, "I'm depressed and I need Paxil."
posted by shmeggy at 2:08 PM on December 16, 2003

If you reject anti-depressant medication on the grounds that we don't fully understand how they work, you should reject therapy even more thoroughly on the same grounds.
posted by kindall at 2:17 PM on December 16, 2003

echolalia67, I second dash_slot's post. Thanks for putting it all into words.

It is a special pain to be trying to cope as hard as you can-even making a superhuman effort-and have those around you treat you like you just need to "straighten up and fly right." They truly have no idea just how cruel they are being.

In my case, altho my diagnosis was a shock, it was also a relief. There was finally a reason things were so incredibly hard.
posted by konolia at 2:35 PM on December 16, 2003

Following up on shmeggy's comment, and to clarify my own, I believe that there are people in the US currently receiving medications for conditions that could potentially be addressed via changes in lifestyle (such as mild cases of high blood pressure). And still more people are just plain receiving medication when they shouldn't (antibiotics for viral infections being a prime example).

That said, I see no need to demonize the entire class of people taking medications as simply lacking the will power to control their conditions on their own, or with therapy, or with exercise, or with prayer, or any other restrictive regime. The person with the condition(s) will ultimately determine what works for them; it's a necessarily individual process.
posted by clever sheep at 2:51 PM on December 16, 2003

*hands ewkpates some Viagra*

Here. Go make yourself useful.
posted by Hildegarde at 3:21 PM on December 16, 2003

Dear gods, Hildegarde, NO! Do you really want more of him?
posted by dmd at 5:11 PM on December 16, 2003

[Thanks dmd for his initial comment. That was wonderfully concise and restrained.]

I'm normally not nearly so concise and restrained when it comes to upbraiding little shits like ewkpates, who makes his statements from a sucking black hole of ignorance.

I've come to realize there are a lot of judgemental people out there who have absolutely no ability to conceive how terrible depression is, incorrectly figure it's kind of like their own experiences of "being blue," and draw erroneous conclusions about those of us who require medication.

So in this case I shall bite my tongue. It's not worth wasting time on the arrogant little turd.

Thanks to everyone who has shared their experiences. Keep on it!
posted by five fresh fish at 5:47 PM on December 16, 2003

Thanks to echolalia67 (and others in the past, like dash-slot), who have bravely and openly been willing to share some of their personal journeys in these matters. Keep up the good fight. I admire you.

ewkpates, you're simply wrong. Hundreds (if not thousands) of studies have shown the efficaciousness of medication for just the kind of behaviors you allude to. In most studies, they are much more effective than therapy alone, and infinitely more effective than trying to tough it out on your own. I recommend a review of the literature to you.

Of course, the bigger problem is that any GP or family doc is prescribing these SSRIs without any regard for followup with a specialist (psychiatrist) or concurrent psychotherapy.

I agree that followup is always important, and therapy usually so. But I'm much more interested in generalists becoming more comfortable prescribing some of these medications, given that upwards of 40% of visits to a family doc on any given day have a behavioral medicine component. These medications work (the cure rate via medication for some of these behavioral medicine conditions is far greater than medical cures of other non-psychiatric maladies), with the usual caveats pointed out so well above about side effects, followup, etc...

For balance sake, there's also a great deal of theory for the explanation of feelings and behaviors that doesn't involve neurochemistry.

Really? Which supratentorial processes don't involve neurochemistry?
posted by fold_and_mutilate at 11:42 PM on December 16, 2003

...And still more people are just plain receiving medication when they shouldn't (antibiotics for viral infections being a prime example).

That said, I see no need to demonize the entire class of people taking medications as simply lacking the will power to control their conditions on their own, or with therapy, or with exercise, or with prayer, or any other restrictive regime. The person with the condition(s) will ultimately determine what works for them; it's a necessarily individual process.

Right. And one has to also take into consideration that patients are often trusting their doctors, and taking the meds because their doctor thinks it's a good idea, even when the patient sometimes isn't so sure.

Sure, some patients go in demanding meds but in my experience, doctors just as often seem to suggest these meds when the patient wouldn't have even thought of them.

But I'm much more interested in generalists becoming more comfortable prescribing some of these medications, given that upwards of 40% of visits to a family doc on any given day have a behavioral medicine component.

I worry about this somewhat.

I've been on antidepressants twice; neither time was I depressed. I saw the doctor for other issues completely, and I walked out with antidepressants. When I questioned this, I was told "Don't worry, they will help. Just take them." The first time I was concerned with a fatigue issue. The second time it was pain from a car accident injury. I can only guess that the doctors in this case thought the problem was in my head.

Both times the meds did nothing but make me feel groggy and slow. Since the first time I was having fatigue problems, this was not helpful. Both times I ended up throwing away the meds after taking them for a couple of months.

Eventually both problems were solved, by different doctors, no thanks to the ones who were so quick to assume I was depressed and to disregard my statements that I was not.

I want people who need these medications to be easily able to get them. They really do save lives. But I also fear that many doctors use them as a crutch when they can't immediately diagnose a problem, especially when the patient is female.

Just because someone is tired or feeling pain does not mean that person has clinical depression, and in my experience a lot of GPs don't want to take the time to find the difference. They really should refer such patients to specialists to verify their diagnoses, at least.
posted by litlnemo at 1:11 AM on December 17, 2003

(You know, five fresh fish, I was more than ready to cut you some slack, even after you drove UncleFes away from the fold, but calling someone an 'upbraiding little shit' and an 'arrogant little turd' doesn't exactly indicate that you've learned much from that episode. Still, I suppose the same could be said of me.)

Anyway, on topic. Drugs are good, mmkay, but I remain convinced that drugs of this type (and other au courant chemicals like Ritalin and Adderal) are wildly overprescribed, and as such, are eating away at the core of our cultures.

I'd much rather have cocaine or heroin do that.

There are those who require medication, and they dive into each and every one of these threads to tell us how the drugs have changed their lives, and that's all to the good, I reckon, and more power to 'em. But I do think it's a concern that there are so many medicated people, adults and children both, out there. (I sometimes wonder if I think like this because I was so terrified of a nuclear-war-created fall of civilization when I was a teen, and swore to myself that I would never become dependant on things manufactured and purchased to the point I couldn't function without them. But that's another story.)
posted by stavrosthewonderchicken at 1:50 AM on December 17, 2003

Ritalin and Adderall are extremely hard to get. In many states, they ask for your Social Security number each time you pick up your prescription (which must be written each time.) I've read a number of alarmist stories in the "raves are killing your kids" vein about how they sometimes go for $10-$20 a pill on the college black market - if legitimate prescriptions were easy to get, no one would be paying that. (As someone who's on Adderall with a prescription, I'm pretty sure that a lot of the amazing effects described by students in these articles are almost all placebo effect, but that's another story.)

I have had Prozac offered to me for conditions I'm sure do not approach the clinical depression described here, and I've always turned it down.
posted by transona5 at 2:02 AM on December 17, 2003

What's wrong with inflammatory posts? If you aren't passionate about your posts don't bother posting.

Hats off to Clever Sheep. Do sheep wear hats? PEOPLE DON'T GET TO DEFINE THEIR OWN CONDITIONS. That goes for minorities, majorities, people with a skin condition, people with "clinical depression", people having a bad day, people that nobody likes (ewkpates?). Objective data gets to define conditions.

And while I'm at it, let's all stop pretending that psychology and definitions like "clinical depression" are hard science. That's simply ridiculous. Freud anyone? Psychology is mostly classification at this point.

Clinical Depression, less brain activity or not, is NOT NOT NOT a disease, if disease is a failure of the immune system, or involves viruses or bacteria, or can be transmitted by blood, urine, or any other goodies.

Name calling doesn't make anyone feel better, you know. It also doesn't prove anything. Neither does anyone saying anyone else is ignorant.

I would like to understand the argument for behavioral disorders requiring medication, but I CAN'T FIND IT, NOT EVEN ON THIS POST. Is alcoholism a "disease"? Is a "disease" anything anyone who doesn't feel good says it is? Do you get to take medication if you feel bad? How about if you feel really bad? How about if you feel so bad that you can't get out of bed and want to shoot yourself? Is this just a slippery slope? Does anyone who isn't on the slope at the same place that you are get to tell you its time to stop taking pills or start taking them?

There has to be a difference between alcoholism and depression if we want to call depression a disease. What are the differences? Both have behavioral systems. Both have a neurochemistry component. Both involve people making poor choices.

But that's a far cry from cancer.

What psychology needs is more science, and less painkillers. No one claimed that painkillers don't work. They do. But they don't help you learn to tolerate and manage pain. They don't help you grieve or move on. As far as I can tell, antidepressants are just fancy painkillers.
posted by ewkpates at 5:02 AM on December 17, 2003

But I do think it's a concern that there are so many medicated people, adults and children both, out there.

Why? I see that as a reflection of a world full of misery.

swore to myself that I would never become dependant on things manufactured and purchased to the point I couldn't function without them

Better hope you're never diabetic then.
posted by ROU_Xenophobe at 5:16 AM on December 17, 2003

Name calling doesn't make anyone feel better, you know. It also doesn't prove anything. Neither does anyone saying anyone else is ignorant.

I don't think people were calling you ignorant to prove a point. I think it's just an observation based on empirical data.
posted by Karmakaze at 6:48 AM on December 17, 2003

What in the world do you mean, "clinical depression isn't science?" That's a clear-cut untruth.

It's like this: If seratonin isn't abundantly enough available in your brain it will effect your brain's ability to function normally. Period. No amount of pulling yourself up by the boot-straps will improve the situation.

Neurotransmitters, and how they shape emotions and behavior, are accepted scientific fact. The American Medical Association accepts this. Are you a more august authority than the American Medical Association?

All issues of whether or not anti-depressants are over-prescribed aside, if you are trying to base your argument on the premise that there is no such thing as clinical depression, you have no reason to expect rational people to engage in dialog with you. I'm not trying to be harsh, I simply can't understand why you're arguing from such an absurd position. There are valid points to be made about the ways in which antidepressants are used, but whether or not imbalances in neurochemistry can cause debilitating conditions that cannot be "wished away" is not open for argument.
posted by Fenriss at 7:55 AM on December 17, 2003

Ewkpates, Webster's English Dictionary defines disease as an impairment of the normal state of the living animal or plant body that affects the performance of the vital functions. You claim to want more science, i.e., facts, but you are not well-informed.

The AMA and the APA both recognize depression as a disease. I don't have time to research every other major medical association. As noted above, there are certainly physicians who over-prescribe anti-depressant mediation, just as they over-prescribe antibiotics. I blame advertising.

The causes of depression and other illnesses of the mind and brain are not well-understood at all. I hope my child will have far better options. SSRTs are far better than the tricyclic anti-depressants that used to be the only thing available.

A lot of us who take anti-depressants are defensive about it, but I think it's irresponsible and cruel to withhold medication from a person who is suffering from serious depression. The idea that a depressed person can will himself to feel better is not accurate, just as a person can't will herself not to have measles. I've seen some wrecked lives due to mental illness. Prolonging that suffering is just plain wrong.
posted by theora55 at 7:58 AM on December 17, 2003

If seratonin isn't abundantly (sic) enough available in your brain it will effect your brain's ability to function normally. Period. No amount of pulling yourself up by the boot-straps will improve the situation... Neurotransmitters, and how they shape emotions and behavior, are accepted scientific fact. The American Medical Association accepts this.

How often do physicians order a spinal tap or an imipramine platelet test or a fenfluramine test to try to determine a serotonin level?

They don't.

There are two types of people who take antidepressants: those who are truly clinically depressed, and those who are not.

The problem, IMO, is that too many physicians are pushers, and not practitioners of science, and that too many people who aren't truly clinically depressed are looking for a free lunch.

The idea that a depressed person can will himself to feel better is not accurate, just as a person can't will herself not to have measles.

Is it impossible for a depressed person to realize that diet and exercise have a substantial chance to help him escape his predicament? Perhaps he realizes it, but he won't get off his ass anyway? If that's the case, shouldn't we stop calling it "depression", and start calling it insanity?

Do you have less sympathy for a lung cancer victim who continues to smoke than you have for one who stops (or never started)? What about the obese guy with the super-sized double-quarter pounder meal? The AMA recognizes obesity as a disease! Should we just give him some drugs? Maybe he's addicted to food. Is addiction a disease? Does he deserve the same compassion as a breast-cancer sufferer?

I'm no busybody. But if I, who eats right, exercises, goes to bed at a decent hour, and generally takes good care of myself, will be forced to pay higher taxes and insurance premiums so the couchridden can get their meds, I'd like the establishment to be damn sure that the depressed people are truly depressed, and that they're not just junkies, or chronically lazy.
posted by trharlan at 8:43 AM on December 17, 2003

"(I sometimes wonder if I think like this because I was so terrified of a nuclear-war-created fall of civilization when I was a teen, and swore to myself that I would never become dependant on things manufactured and purchased to the point I couldn't function without them. But that's another story.)"

OH MY GOD! I thought I was the only one! I was going to say something along those lines, but then thought people would think I'm crazy! Thanks so much, Stavros!
posted by PigAlien at 9:04 AM on December 17, 2003

Do you have less sympathy for a lung cancer victim who continues to smoke than you have for one who stops (or never started)?

Nope. I have the same compassion for all cancer victims.

But if I, who eats right, exercises, goes to bed at a decent hour, and generally takes good care of myself, will be forced to pay higher taxes and insurance premiums so the couchridden can get their meds, I'd like the establishment to be damn sure that the depressed people are truly depressed, and that they're not just junkies, or chronically lazy.

Well. In the unlikely event that anyone ever cares to know the difference between you and me, there it is. No more to say on that subject.
posted by Fenriss at 9:08 AM on December 17, 2003

PS, trharlan, thank you for being the first to mention diet. I meant to mention it earlier along with exercise and forgot.

I really don't know about the hard science, but I do know there are those who believe that what we eat does have an affect on our brain chemistry. Some people are supposedly allergic to some foods and this can cause mental problems.

In fact, my first partner claimed to have a food allergy to wheat. He never ate anything with wheat. When we first started dating, I asked him why, and he told me that it made him feel suicidal. I thought he was probably being dramatic, but I have to say that occasionally he would eat certain foods at restaurants and go into a very lethargic state and complain that he couldn't think clearly. Then we would ask about the ingredients and there you go -- they had wheat (where you might not expect it)!

I have heard anecdotal reports that some people with severe OCD or depression have changed their diet and gotten rid of the problem. Unfortunately, I don't have the hard science to make a case, but it may be available with a google search (maybe I'll do that...)
posted by PigAlien at 9:16 AM on December 17, 2003

trharlan:

The problem, IMO, is that too many physicians are pushers, and not practitioners of science, and that too many people who aren't truly clinically depressed are looking for a free lunch.

i won't dispute that some who seek the use of antidepressants are not clinically depressed, but how can you call pills a "free lunch"? the consequent side effects of the medications, in tandem with the small if not negligible positive effects the pills may have for those not truly suffering from clinical depression, make the use of the stuff more ignorance than a free lunch.

Is it impossible for a depressed person to realize that diet and exercise have a substantial chance to help him escape his predicament? Perhaps he realizes it, but he won't get off his ass anyway? If that's the case, shouldn't we stop calling it "depression", and start calling it insanity? ... Do you have less sympathy for a lung cancer victim who continues to smoke than you have for one who stops (or never started)?

i think the connection between lung cancer and smoking is much stronger than the tenuous one between exercise and mental health established by some in this thread. according to the American Cancer Society, smoking causes 80% of lung carcinoma. can you demonstrate that the relationship between mental health and exercise or diet is as strong?
posted by moz at 9:43 AM on December 17, 2003

[alcoholism]...want to call depression a disease. What are the differences? Both have behavioral systems. Both have a neurochemistry component. Both involve people making poor choices.

Pray tell, how does one who is serotonin-deficient make choices? When depression is so crippling that the most you can do is curl up in a dark closet and think about how to best kill yourself without hurting those who know you, one is hardly capable of making "good" choices.

I wish there were a depressant drug, so that you could be introduced to the reality of depression. Until you've been there, you really have no understanding of it.

A fucked-up brain that doesn't do the right biological thing with serotonin is every bit as dysfunctional as a fucked-up pancreas that doesn't do the right biological things with insulin. You don't properly treat either condition throught the power of positive thought.

Are antidepressants overprescribed? Hell, yes, I'm sure there are doctors who hand them out like candy, just like some doctors are stupid about antibiotics.

But the fact remains: a good many of us live or die by the use of antidepressants.

I haven't had obsessive thoughts about killing myself since taking up Celexa, and the only way I'll come off that drug is over my dead body.
posted by five fresh fish at 10:08 AM on December 17, 2003

I have, at times over the last few years, lurked on and participated in newsgroups and forums for shyness and social phobia. I have also attended a support group in Toronto for social phobia. Many of the people in these groups also label themselves depressed. I'm resistant to the concept of social phobia, because I question the drive to frame personality characteristics as disease. I know I'm quiet and withdrawn, and I know that my life has been constricted to a degree that I've achieved little, and I understand there is a relationship, but that doesn't make something a disease. I don't feel a label will make my life better, it can't excuse my failures; I don't see Paxil, Zoloft, Effexor or any of the other pills that are being pimped as solutions to dubious medical conditions as a solution.

I've never taken any of these drugs. I'd like to attempt cognitive therapy, but I think most professionals want to couple it with drug treatment and I don't want that. One of the facilitators at the support group said, "so, you're white-knuckling it then." But I don't see myself white-knuckling anything; I'm just living with the person I am.

My completely unscientific observations of the people who are taking these drugs is that most are on a cycle of hope and withdrawal. Most people have a laundry list of brands they've attempted, upping dosages until they determine they're not getting the results they were promised, or that the side-effects are too difficult to live with. So, desperate to feel different, they move on to the next one - hey, how about the one with the cute little bubble/rock cartoon thingie I see on TV, I'll try that. Then, I've heard, withdrawal can be difficult, despite the claims of the manufacturers that their products are not habit forming.

It seems to me that there are many good reasons to be sceptical of the new push to cure everyone's unhappiness. We live in a time that promises so much but elevates so few, and when we find ourselves unfullfilled, not living the life of our teenage dreams, we're told we must have a problem with the chemistry in our brains, it's not our fault, we have a disease. Here, take a pill - you'll feel better in the morning.
posted by TimTypeZed at 10:16 AM on December 17, 2003

"i think the connection between lung cancer and smoking is much stronger than the tenuous one between exercise and mental health established by some in this thread."

Every single study I have ever seen on the issue has shown that exercise has a stronger effect than anti-depressants on depression. I can't speak for OCD or other behavioural disorders, but certainly when it comes to depression there appears to be no BETTER treatment than exercise.

Exercise may not be a complete miracle cure, but it is documented to be more effective than any drug ever compared to it in head-on tests. I challenge you to present an unbiased scientific study that shows there exists an anti-depressant medication that is more effective than exercise. The challenge has been laid before you!

And no, I have not really read every single study and can't be bothered to post any because they're too numerous and too easy to find by googling...
posted by PigAlien at 10:37 AM on December 17, 2003

[alcoholism]...want to call depression a disease. What are the differences? Both have behavioral systems. Both have a neurochemistry component. Both involve people making poor choices.

Pray tell, how does one who is serotonin-deficient make choices? When depression is so crippling that the most you can do is curl up in a dark closet and think about how to best kill yourself without hurting those who know you, one is hardly capable of making "good" choices.

Pray tell, how does an alcoholic make choices? When alcoholism is so crippling that the most you can do is curl up in a dark closet and think about how to get another drink while keeping your job and your driver's license, one is hardly capable of making "good" choices.
posted by trharlan at 10:43 AM on December 17, 2003

I'm no busybody. But if I, who eats right, exercises, goes to bed at a decent hour, and generally takes good care of myself, will be forced to pay higher taxes and insurance premiums so the couchridden can get their meds, I'd like the establishment to be damn sure that the depressed people are truly depressed, and that they're not just junkies, or chronically lazy.

Well, no, that does in fact make you a busybody.
A busybody arguing against his own welfare for the sake of being a busybody, even.

Even at a crass economic level, antidepressants are cheap compared to the benefits they bring. Imagine how many people are more productive on their meds than off, even if the drugs are only reducing their vile immoral chronic junkie laziness. Imagine how many people can become more long-term-employable (and taxpaying) on meds. Imagine how many fewer "sick" days get taken when people feel better on their meds.
posted by ROU_Xenophobe at 10:57 AM on December 17, 2003

I fail to follow you, trharlan. I haven't the foggiest idea where you're going with that.

Replace "alcoholic" with "diabetic" in your message, and get back to me.
posted by five fresh fish at 11:28 AM on December 17, 2003

Apples and oranges, apples and oranges. Yes, there are a lot of people who are on medication that really shouldn't be; yes, the drug companies use some nefarious marketing to make people believe that a little pill will make all their little problems go away- but that's a reflection on our society, and while I don't believe it's right, it's not the fault of those of us who legitimately need medication to function. We're really not eschewing personal responsibility, as previously mentioned by others, we're actually becoming productive members of society.

Being shy doesn't need medication, not being able to leave the house probably does. Feeling down in the dumps doesn't need medication, a chronic, paralyzing depression that is seriously affecting your quality of life probably does. Apples and oranges.

Depression can be caused by a variety of biological reasons. In addition to the serotonin deficiency, there is also the sudden drop of estrogen in post-partum women, a malfunctioning thyroid gland, an overactive HPA axis... (And there's also the ongoing genetic studies.) Really, how is a mental illness any different from any other disease that alters brain chemistry? Do you go up to Alzheimer's patients and tell them to buck up and try harder? I would hope not.

The field of medicine is constantly evolving. We've come a long way from the days of leeching, and we've still got further to go. Just because there is not, today, a definitive cause to satisfy MeFi's armchair doctors does not mean that it's "all in our heads."
posted by Ruki at 11:30 AM on December 17, 2003

How do doctors determine the serotonin levels of the people they are prescribing meds to? It seems that they talk to the patient for a few moments and then just toss pills in there and wait to see what happens. If the patient is cured, then the diagnosis is deemed correct, which is dubious 'science' at best. This, as a methodology, is testing without use of a control. There are studies about serotonin and populations, but we are talking about individual treatment (and even those flaunted studies are more statistical than scientific.) Perhaps if there was an empirical way to determine who needed these treatments (because many do) and who does not, the ideas behind these treatments would be more accepted. As it stands, there is good science around serotonin, but bad practices in the use of drugs.

As an aside, it bothers me that some assume that we have no control of ourselves, that we are somehow only reacting to neurochemistry events. Under that view, all activities, thoughts and feelings can be medicated into whatever is thought of as a normal baseline. This view of the human mind is teetering on a slippery slope. The human mind is still barely understood and there are many forces at work that create our moods. exercise, diet, our interactions with other people and environmental factors all impact our mental well being. To hold serotonin up as the sole agent of the human mind is to ignore the possibilities that exist and could also be worked with.
posted by elwoodwiles at 11:40 AM on December 17, 2003

It's like this: If seratonin isn't abundantly enough available in your brain it will effect your brain's ability to function normally.

It's actually like this: Seratonin levels are affected by many things, including attitude, exercise, light exposure, and on and on. Some people have lower levels than others, and some with lower levels feel bad. That's science. Give them drugs! - that's Big Medicine.

Ewkpates, Webster's English Dictionary defines disease as an impairment...

Good question, thanks. Disease is a tricky word. Websters is a pretty poor source, but let's work with it. Is alcoholism a disease? With this definition, it might be. Heck, chronic staying up too late might qualify with good old Webster.

So let's just say we don't know if behavioral disorders are diseases. Let's say we know that therapies that change and refine coping mechanisms are successful.

My suggestion? Glad you asked. We have clinics, like for alcoholics, where you go to get help with behavioral disorders. No drugs, but also, no free time to lie in bed. People treat you nicely, therapists work with you, etc.

No nasty uncertain chemicals, no mucking about with brain chemistry. Is this going to happen? Not until we stop popping pills, that's for sure. Its all about money in exchange for a temporary solution, which you have to keep paying for.

I'm not saying its as simple as drugs are bad or behavioral disorders aren't a problem. I'm saying that we aren't being honest about the solutions. Most of what we've seen in this post just underscores that...
posted by ewkpates at 11:52 AM on December 17, 2003

Both involve people making poor choices.

Would you care to enlighten us what the poor choices were that put so many of us in the pit of hell called depression?

Well, go ahead in that smug little world of yours while people jump off bridges, blow their own brains out, take massive overdoses of drugs, hang themselves, slit their wrists-want me to keep going?

Yes, for some exercise and diet and other lifestyle changes can help. Just like with some diabetics and some with high blood pressure. For others, the pit is too deep to get out of without medication. I suppose you would rather them die.

My own doctor told me that my kind of depression was indeed like high blood pressure-it can be handled drugfree for awhile, perhaps, but as a person gets older the ability to cope lessens quite a bit. I was drugfree for years, hanging on by my fingernails-and one day I lost my grip and went freefall.

I think the decision about drugs should be left to doctors and patients. I agree that advertising the med du jour is a bad idea. I agree that diet and exercise is a good thing.But while you argue that depression is a character flaw and that all you have to do is pull yourself up by your own bootstraps, there are people dying-leaving devastation and pain behind them for their loved ones...these deaths are so unnecessary-and the misunderstandings and platitudes and scorn of those who don't understand bear some of the responsibility.

When you feel like sh*t and you feel worthless, and someone comes along and tells you to snap out of it, you feel even worse because you have already tried and failed. After awhile you no longer feel deserving of the space you take up and the air that you breathe. You are told that you have no reason to be depressed and then judged when you cannot function to the level people think you should. And over and over and over no one will take your word for it when you tell them how you feel.

No wonder people suicide. And for failed suicides, they are judged for that-told how selfish they are, etc. A hint: we already know that, we already are ashamed, we just want the pain to stop...and then we are told even more strongly just what an evil piece of crap we really are.

And all this hell is so unnecessary.
posted by konolia at 11:54 AM on December 17, 2003

Oh, and ps: A lot of the ssri antidepressants have a side effect of sexual problems-severe ones in some cases. Many people who are on these drugs are happy to trade their sex lives for feeling better the rest of the time. That should tell you something.
posted by konolia at 12:02 PM on December 17, 2003

Ugh...again with this discussion. Others have done a good job, but I'll just point out one thing: there is no "free lunch" when you get antidepressants when you may not need them - they are not uppers, they don't make you happy, and they are not even 'mood elevators' in the sense most people use the term, all they do is get depressed people to a point where they can start working on ways to combat their depression. I just loathe this kind of ignorant thinking, that depression is just another word for a lack of moral fibre, that antidepressants are "happy pills" that help you avoid dealing with your troubles. Yes, they are likely overprescribed, you know what the main fallout of this is? People buying and taking drugs that will have little or no effect on them bar side effects. That's it. Antidepressants do not facilitate avoiding your problems, they don't make you happy, they don't do any of the things ewkpates et al seem to think they do. If a few people who don't have clinical depression take Prozac or whichever drug the doctor prescribes, so what? The ease with which people who have never suffered from a mental illness more disabling than ignorance toss out things which basically amount to "pull yourself together" is just unbelievable. Why not worry about something that actually affects you? Or, if you can't do that, why not do some actual research?
posted by biscotti at 12:09 PM on December 17, 2003

I don't doubt that connections have been made between biological indicators and feelings of depression. But can feelings of depression not also be traced to the normal realities of people's lives: not having a respectable, fulfilling or enriching occupation; not being attractive or popular to others; not being successful at pursuits that are important to you; not having supportive relationships; poor housing; economic difficulties; aging; losing dreams; personal failures; medical setbacks? Can medicine make the bad feelings that stem from actual disappointment go away, or is it only effective for the people who clearly have everything but still feel empty?

I've also seen people wanting to establish dichotomies between regular people who feel a little sad and people who suffer depression, regular people who get a little nervous and people who suffer panic attacks, regular people who feel a little shy and people who suffer agoraphobia. They seek a line between us and them, the sufferers and the normies, as if there must be a clear distinction. But all behaviour must fall on a continuum, where does the line fall between those who require medication and those who would be getting a quick and unsuccessful fix for their minor problems?

Another unscientific observation from my socialphobia support-group mates: Many, having found a label that explains their behaviour to them, having adopted a drug regiment, have tapped into the system further, and been placed on long term disability, despite any clear sign (to me, anyway) that they couldn't function in employment. So I don't necessarily see these treatments reestablishing their patients as meaningful contributors to society.
posted by TimTypeZed at 12:47 PM on December 17, 2003

>swore to myself that I would never become dependant on things manufactured and purchased to the point I couldn't function without them

>>Better hope you're never diabetic then.

Funny you should say that, although I know you're just snarking me because you're still miffed about my comments in the last thread on this topic. Fair enough.

I actually do have a number of chronic and painful medical conditions that I do not medicate (but do occasionally visit chinese-medicine practitioners for herbal and acupuncture treatments) for this very reason. Diabetes would be terrible, and yes, I would certainly choose medication over death if I were to develop it, but it's not as if you're pulling the scales from my eyes, there ROU_Xeno..
posted by stavrosthewonderchicken at 1:13 PM on December 17, 2003

Well, there's other reasons too. I'm not a complete loon. (joking, joking)
posted by stavrosthewonderchicken at 1:20 PM on December 17, 2003

TimTypeZed, as Biscotti said, these are not "happy pills."

Can medicine make the bad feelings that stem from actual disappointment go away, or is it only effective for the people who clearly have everything but still feel empty?

The line is not that clearcut. We all have disappointments, etc. These sorts of things CAN trigger an actual clinical depression.

When we talk about a clinical depression there are two types. One is unipolar depression, which manifests itself in loss of weight, early awakening without being able to go back to sleep, lack of interest in things that usually bring enjoyment, etc. There are physical signs that a good shrink can pick up just by looking at the person.

Another type is known as atypical depression. These are characterized with weight gain, hypersommnia, etc. (this type is many times typical of a bipolar depression.) Bipolar itself can be triggered by stressful events-triggered into mania as well as triggered into depression.

If someone has a disappointment or a bad day these are generally self limited conditions. Clinical depression can go on for months and years. In my case I have in the past gone over a YEAR without a single positive emotion-I went from numb to hell and back again.

I have also had the experience of going thru painful outside events while medicated. The meds did not keep me from feeling the sad emotions but they did enable me to cope with them appropriately.

I used to be the type of person who thought medication was for weak people. But God has a sense of humor.
posted by konolia at 1:43 PM on December 17, 2003

Pray tell, how does an alcoholic make choices? When alcoholism is so crippling that the most you can do is curl up in a dark closet and think about how to get another drink while keeping your job and your driver's license, one is hardly capable of making "good" choices.

So, if there were a pill that successfully treated alcoholism, you'd be against alcoholics taking it? This seems unnecessarily cruel. The fact that alcoholics have to address their problems using willpower, 12-step programs, and therapy because there is no other option doesn't necessarily mean that treatment of all problems must be limited in the same way.

While there's currently no pill for alcoholism, there is a drug -- ibogaine -- which is anecdotally reported to have good results in curing heroin addiction. Unfortunately, ibogaine is a powerful hallucinogen, and those who have taken it say that the drug's psychedelic properties were part and parcel of their cure, so it'll probably be a while before our drug-phobic culture comes around to researching the potential of ibogaine seriously. Still, who knows what other addictions it might cure? If someone was an addict, would it be wrong to give them their lives back, even if it was in the form of an ibogaine tablet?
posted by kindall at 2:48 PM on December 17, 2003

My last words in this thread:

I used to want to kill myself, hated myself for not being able to get my shit together enough to actually do the deed, and only got out of my house and to work through the greatest amount of effort.

I know what efforts I made to "just snap out of it," including exercise, sunlight, forced socialization, LGAT positive-thought programming, and talk therapy, and I know how badly they failed.

In the end the only thing that brought me back to life was medication. Meds might not work for everyone, but they saved my life. There are side effects and things are not all a rosy bloom, but it's a damn sight better than suicide.

So the only thing I can possibly say to every person out there who has read these tales of depressed life and the joy of finding a solution, yet who still thinks it's just a matter of "getting happy" is that you have no goddamn idea what you're talking about, and your opinion is not the least relevant.

Which is why this is likely my last contribution to this thread: those who know, know; those who wish to know, now know; and those who still don't know will never know, and it's a waste of time trying to politely clue them in.
posted by five fresh fish at 2:58 PM on December 17, 2003

Pretty much like fff said.

If anyone out there would like info on online support groups or stuff, my email is in my profile.
posted by konolia at 3:09 PM on December 17, 2003

those who know, know; those who wish to know, now know; and those who still don't know will never know, and it's a waste of time trying to politely clue them in.

Well put.
posted by dash_slot- at 4:33 PM on December 17, 2003

Of the many points of controversy surrounding this issue, dash_slot and others have boiled it down to this:

"Unless you've experienced what I've experienced, you have no role in analyzing the problem."

Well, sorry, but that's just crazy.

Alcoholics suffer as much as anyone. And pills for alcoholics? That's the whole point: It's not the brain chemicals of alcoholics that are the problem, if it were, a pill would be fine. Alcoholics have a MASSIVE self control problem, and no pill is going to teach you the 12 steps. And ditto for all the other behavioral disorders.
posted by ewkpates at 5:17 AM on December 18, 2003

ewkpates, how long have you been a Scientologist?

I don't know what it's like to lose a child. I don't know what it's like to be shot at in war. I don't know what it's like to be President. I don't know what it's like to be African American.

How dare I assume I know how any of that feels.

Alcoholism most likely has many causes, and all would need to be addressed. But for the ones who are self-medicating, the 12 steps won't do a d*mn bit of good until their underlying disease is taken care of.

Why don't you leave the analysis of these things to the professionals and the sufferers? If you are neither, you may have a right to an opinion but no right to assume you actually know what you are talking about.

I wish you could be one of us for just one day. But you won the lottery in the seratonin sweepstakes so naturally you think we should all be as you are.

Yes, I am angry. That does not happen much around here. I would take this to email except you have none listed. I suggest Hotmail.
posted by konolia at 8:39 AM on December 18, 2003

Here are a few factoids about mental illness, for those who refuse to believe that there is a biological factor to it.

A Finnish study found that that there was a 13% incidence of schizophrenia amongst individuals who were concieved and gestated during a influenza epidemic. The normal incidence is 2%.

Individuals who exhibited symptoms of schizophrenia after smoking marijuana for the first time were found to have twice as many cannabinoid receptors as non-schizophrenic individuals.

Leisons to the frontal lobe, caused by epilepsy or head trauma, can cause behavioral changes that are indistinguishable from the symptoms of bipolar disorder. The majority of drugs used to treat bipolar disorder were originally used to treat epilepsy.

Brain scans of individuals diagnosed with clinical depression but are untreated show area of abnormally low brain activity. In one study individuals were given brain scans and then sorted into 4 groups, no treatment, medication only, therapy only, and treatment and medication. Afterwards, all were given brain scans again. The medication & therapy group's scans looked like normal, healthy brains. The medication only and therapy only groups showed some improvement. The no treatment group showed very little change.
posted by echolalia67 at 11:10 AM on December 18, 2003

Why don't you leave the analysis of these things to the professionals and the sufferers?

Sufferers, professionals (not by any means a homogeneous group in terms of competence) and everyone else - all are equally well qualified to ANALYZE THE DATA. Analysis is what matters, not whether or not you have a piece of paper or a problem. Studies matter, how you feel doesn't. That's what science is all about. Data. Not feelings. Even if you feel bad, its still about the data.

echolalia67 - you're in some big trouble kid. Schizophrenia is not a behavioral disorder. Again, brain activity ISN'T CAUSAL in clinical depression. It's a symptom. I would agree that some, ONLY A FEW, treatment plans for clinical depression MIGHT need to start with a SHORT term medication cycle combined with treatment to get the patient into treatment. But how many clinically depressed people are seeing a therapist four or five times a week? Or at all?

Come on already. Brain lesions? That's really grasping at straws. What are you after? Permission for people to take pills rather than make categorical life changes? Permission to cede responsibility to a "chemical imbalance" rather than do to kind of hard work that alcoholics have to do?
posted by ewkpates at 11:50 AM on December 18, 2003

ewkpates, so you are saying is that schizophrenics don't have a behavioral disorder. Well, what about bipolar type I individuals who have concurrent psychotic periods occasionally either while manic or depressed? What about Bipolar type Is who do NOT have psychotic episodes? What about bipolar type II-differentiated by hypomania rather than mania but still suffering from the depressive part of the cycle? (some doctors think it is just as if not more debilitating than type I). What about clinical unipolar depression that comes, stays for months and perhaps years then disappears as mysteriously as it comes-with absolutely no concurrence with life events?

What if any of these people drink because they are undiagnosed and suffering?

One of the things that is drummed into me and every other bipolar is STAY ON YOUR MEDS. One of our common characteristics is thinking we can go medless, then crashing-in some cases ruining lives, relationships, credit ratings and Lord knows what else. At the very least, making it harder to achieve medical stability the next time, as some of these meds do not work as well the second or third time around. And most of us wind up having to switch meds occasionally no matter what.

A lot of bipolars are in therapy, using various techniques-Including cbt-my online support group even posts about various therapy styles, etc. Very informative. But not enough.

And occasionally one of our members checks out permanently-or they have unmedicated friends who do the same.

All I know is I did therapy and it only helped to a point. It helped me to act in socially acceptable ways but never took the pain and despair out of my heart.

If you have an issue with alcoholics, post about that but leave the mental and depressive disorders out of it. You obviously don't know that bipolar disorder is a hereditary condition. You obviously don't know about the neuropsychological exams that some of us undergo.

And finally, why the heck is it that people can have heart disorders, kidney disorders, blood disorders, liver disorders-but when someone has a brain disorder, people like you just don't get it?

Finally, I don't need your permission to take my medication, and neither do people with unipolar depression. But somebody might actually read what you wrote and out of misplaced guilt, not get the proper treatment.

Why don't you do some CURRENT research and get educated?

Of course, if you are a Scientologist, you will keep on spouting the same opinions, in which case be intellectually honest enough to admit that is what you are. I know-and so do a lot of us online-how Scientologists get on online forums and spout anti-med diatribes, many times in a deceptive manner. On my support group we have experienced that a few times. They are fairly easy to smoke out by now, as we know the drill.
posted by konolia at 12:41 PM on December 18, 2003

ewkpates, for someone who appears nigh fanatical about insisting on scientific evidence, your posts are remarkably free of same. Can you provide data to support your contention that "brain activity isn't causal in clinical depression, it's a symptom"? Until such time, I'm sure you'll understand why it will carry no weight whatsoever with me.

In addition, your insistence on "data, not feelings" overlooks a very elementary connection between the two. Put simply: what do you think many studies re: drug impact on mental health and behavior MEASURE?

There are multiple ways to measure the impact of drugs on mental health. One involves administering a drug and observing physical/chemical changes in the brain, and I assume can be performed with a minimum of the first-person subjectivity that you seem so hell-bent to denounce. But this data is, simply put, not as immediately useful as the second way of measuring drug impact on mental health--which relies on administering a drug and tracking subsequent feelings and behavior changes.

I make this offhand value judgment on the greater immediate usefulness of the later because the entire point of changing said brain chemistry is to produce changes, hopefully improvements, in mental states and behavior.

In other words: feelings ARE data. Useful data. Valuable data. And many researchers, presumably several orders of magnitude better grounded in survey procedures and statistics than you or me, have spent decades working out methods to procure, sift, weigh, and act on this data.

Sure, some studies that focus on assessing feelings and behavior changes are crap. But some percentage of any aggregate group of studies will be fatally flawed--every field has its incompetents. The existence of poorly executed examples does not disprove the value of the category, so please don't waste any time digging up and knocking down straw men.

I repeat, in case you missed it: feelings ARE data. Repeat as necessary until the overhead light comes on, and please moderate your tone toward those people in this thread whose experiences (and highly literate description of same) are of the sort that are regularly sought out and valued by the scientific community.

What are you after? Permission for people to take pills rather than make categorical life changes? Permission to cede responsibility to a "chemical imbalance" rather than do to kind of hard work that alcoholics have to do?

ewkpates, what are YOU after? Permission to blame those with mental health challenges for not simply squaring their shoulders and looking on the sunny side of life? Well, you won't get that from me, any more than I'll accept your invitation to slam women and black people for their temerity to complain about sexism and racism, or gay people for their "risky lifestyle choices."

I have no idea why you are so driven to rhetorically kick in the face the disadvantaged of our society. Maybe it provides you a feeling of superiority, as you've managed to deal with your own issues without complaint or chemical aid, and it bucks you up to look down on those who haven't accomplished the same. Am I wrong? If so, feel free to explain your remarkably one-track posting history in more satisfactory fashion.

echolalia67 - you're in some big trouble kid

This thread has demonstrated that echolalia thinks much more clearly than you do. So, who's in trouble here?

p.s. On preview: Konolia, we'll never see eye-to-eye on religion, but you've won serious respect from me over the course of this discussion. Glad to share community with ya.
posted by clever sheep at 1:17 PM on December 18, 2003

ewkpates: some enrichment reading for you, all to be had simply by five minutes of Googling. Please feel free to surprise me by learning something.

An example of scientific assessment of surveying methods for depression study design.

A research review across studies that concludes that the presence of diabetes doubles the odds of comorbid depression.

An overview of a Journal of the American Medical Association (JAMA) study on the comparative impact of SSRI vs. tricyclics for treatment of depression. Please note, ewkpates, that "The primary outcomes of this study were resolution of depression and the effect of therapy on quality of life scores." In other words, the data consisted of asking the study participants how they felt and whether their behaviors changed.

*ahem* Feelings ARE data, and surveys frequently are designed around this very simple fact.
posted by clever sheep at 1:52 PM on December 18, 2003

Clever sheep, thank you for the kind words-and thank you for your post to eukpates-including the links. It may not benefit him, but for others reading this thread it is valuable education. In general the public is woefully uninformed on the topic of mental health and its causes-even tho I considered myself well read on many topics I myself was clueless till my diagnosis. Hopefully this will change, sooner rather than later.
posted by konolia at 2:10 PM on December 18, 2003

Other than a few folk who remain ignorant and prejudiced, I've found MetaFilter to be open and supportive. It's been great to hear of other's experiences and successes. Thanks to all you depressed people who've been brave enough to talk about it!
posted by five fresh fish at 4:43 PM on December 18, 2003

The inconsistencies are endless.

I. I'm not proposing to introduce science to this dialogue by presenting it. I'm point out that there are inconsistencies and a lack of science in the dialogue.

There were also discrepancies in quantifying 'severity' of life event stress, with patients and their corroborative witnesses rating such events as more severe than either the interviewing psychiatrist or psychiatrists involved in consensus rating sessions.

What does this mean? Why would you link to it to refute me? In context, this pretty much says patients can't accurately/objectively rate stress. Sounds like a skills problem.

Recent meta-analyses link depression in diabetes with hyperglycemia [1] and with an increased risk for complications of the metabolic disorder [2].

This is really exciting. Metabolic disorder is brand new, and very interesting from several angles, one of which is it points to conditions that are result of a combination of other conditions. Given that depression is affected by behavioral conditioning/dietary/exercise changes in some, I am excited about the possibilities of understanding behavioral disorders in the context of "multiple system failures" i.e. diet, stress tolerance, exercise. That these three could be corrupted to produce a chemical imbalance in the brain resulting in depression or any behavioral disorder is really exciting. My fantasy camp for anorexics involving immersion in a restructured environment may not be such a crazy thought after all.

II. I'm not arguing, that is I UNDERSTAND THE TRUTH OF, the following:

1. Behavioral disorders cause suffering.
2. Drugs mitigate the suffering of behavioral disorders.
3. There are no non-drug high percentage cures for behavioral disorders. (or drug cures).
4. Patient reports of internal experience are data.

III. I am arguing, that is I have seen no evidence to disprove, the following:
1. "Drugs make me feel better" does not establish whether drugs are an acceptable or optimal treatment or cure.
2. Subjective experience of an illness or condition is not necessarily helpful/a prerequisite for understanding successful treatment methodologies.
3. Behavioral disorders are not caused by biochemical or genetic disorders that can only be treated by chemical intervention.
4. Behavioral disorders are caused by at minimum, a variety of stressors, to include: genetic predisposition, failure of coping mechanisms, diet and exercise problems, failure of socialization skills, significant life trauma, reoccurring life trauma, lack of physical and emotional safety, congnative impairment (i.e. feeling bad is what I'm use to) and more to be identified as research permits.

And, since you must all love me to expect so much of me, NO, I'm not a Scientologist, I think that the whole aliens thing is a fantasy.

BUT: As A.E. VanVogt, he wrote about a guy with two brains. This guy's most powerful skill was called a "cortical thamic pause". By doing this, he arrested the activities of glands and brain in order to halt the fear/anxiety/panic cycle.

Interestingly enough, serious meditation, biofeedback, systematic desensitization and other things can provide a doorway to the same skill.

Generally I found that it pays to look carefully: There is some truth in many things, only a fool does not study carefully even his enemy. (And by enemy, here, I refer to people who depart from reason, specifically those who advocate interactions with aliens have taken place without providing grounds. Anything not Real is the enemy. But be careful what you say Real is.)
posted by ewkpates at 4:40 AM on December 19, 2003

I. I'm not proposing to introduce science to this dialogue by presenting it. I'm point out that there are inconsistencies and a lack of science in the dialogue.

Nonsense. Throughout this thread you have dismissed--often rudely--the value of other community members' first-person experiences, while insisting on the citation of data and studies. At the same time, you have utterly failed to introduce any such data to support your own assertions. This is a particularly egregious offense considering that the argumentative burden of proof is on YOU.

II. I'm not arguing, that is I UNDERSTAND THE TRUTH OF, the following:
1. Behavioral disorders cause suffering.
2. Drugs mitigate the suffering of behavioral disorders.
3. There are no non-drug high percentage cures for behavioral disorders. (or drug cures).
4. Patient reports of internal experience are data.

I'm pleasantly surprised to note that you are conceding 1, 2, and 4, after so much contention. However, 3 is a fresh assertion on your part, and requires evidence if you want the audience to give it any weight. What support can you provide that "drug cures provide no high percentage cures for behavioral disorders"? And what definition do you propose for "high percentage"?

III. I am arguing, that is I have seen no evidence to disprove, the following: [long list follows]

Nope. You're not arguing. You're asserting. And as I said before, the burden of proof is on YOU. It is not the responsibility of your audience to bring up evidence to prove or disprove unsupported statements from you.

1. "Drugs make me feel better" does not establish whether drugs are an acceptable or optimal treatment or cure.

The impact of drugs on a patient's feelings and behaviors most certainly is a common and accepted measure of whether that drug is considered efficacious in treating mental health problems. Whether it is "acceptable" is a social variable with a much more expansive context. Whether it is "optimal" implies the drug treatment's placement amidst a range of options. You've got a lot of evidence to research and present before you're ready to argue any of this.

3. Behavioral disorders are not caused by biochemical or genetic disorders that can only be treated by chemical intervention.

You've shifted ground on your assertions here. In the above thread, you've taken the position that disorders are not caused by biochemistry or genetics, PERIOD, with no conditions about whether chemistry is the only treatment. And once again, you've utterly failed to provide evidence for your statements. I challenged you once already to back this up: "brain activity ISN'T CAUSAL in clinical depression. It's a symptom." Forgive me for the crudeness of my construction here, but put up or shut up.

4. Behavioral disorders are caused by at minimum, a variety of stressors [list follows]

This statement disingenuously ignores much of what has passed above in the thread: specifically, that many posters have tried to inform you that drug treatments are often what allows a depressed individual to deal with their immediate sympoms to a sufficient extent that they can institute lifestyle changes. Many posters here have stated that they engage in therapy and exercise.

To sum up: I don't mean to sound completely harsh here; I appreciate the mitigation of your tone. But you still fail to understand the most basic elements of argumentation, and you have completely failed to meet the burden of proof. Couple these failures with your rude and inflammatory statements above, and your overall ethos is toast. You've got a lot of damage control and homework to do before any arguments from you can be taken seriously.
posted by clever sheep at 6:58 AM on December 19, 2003

Mr. Sheep: You utterly fail to apply logic to this process, and it dooms your ability to understand both this issue, and the broader picture of argument as a whole.

1. The argumentative burden of proof is on YOU.

Ah, no it isn't. I'm saying, again, that I'm pointing out that there are inconsistencies and a lack of science in the dialogue. I only have to prove there are inconsistencies and that the science is not conclusive, which we can argue that I haven't done successfully. Otherwise, YOU have to prove that the causes are chemical or that drugs are a acceptable or optimal treatment. I'm just saying IT HASN'T BEEN SHOWN. I don't have to prove the negative. The people who claim the positive have to prove it.

2. Acceptable - I mean that the benefits outweigh the costs, Optimal - I mean that the benefit/cost ratio is the best possible. Drugs have not been established by any research as either acceptable or optimal. Do they produce an effect that some people prefer? undoubtedly.

3. I'm inflammatory, fine. But rude is a stretch. I haven't called anyone ignorant, although in your case I'm willing to make an exception because of your fascination with having me prove the negative. Many people expressing a dislike for what you have to say, your person, and your beliefs, rather than carefully analyzing the principles, generally points to a rude and poorly educated group of people, but not a rude speaker. I am well aware that I'm inflammatory. If we aren't inflammatory, then we are, pardon me, sheep.

I REALLY REALLY want to reach some kind of consensus on this issue because its so important to me, but it isn't easy.

We don't know if drugs are a good idea. Drugs don't cure the problem, they only mitigate it while patients take them. Drugs may cause lasting harm, and they may reduce the brain's ability to chemically regulate.

We have other somewhat successful ways to treat.

Do we have to way these against risk to the patient? Yes. But the MUST BE WEIGHED.

Finally, subjective or first person experience is useful as data, but it is does not mitigate harm to patients or prove efficacy or serve as a prerequisite for understanding successful treatment methodologies.

When people take cocaine, they feel good. But that doesn't mean good things are happening to them. Subjective data JUST establish perceived impact, it doesn't establish objective good necessarily.
posted by ewkpates at 7:21 AM on December 19, 2003

Excuse me, that's either Ms. or Mrs. Sheep. I suppose that your failure to check my profile might be seen as remaining true to form, in neglecting to do even the most basic of homework.

You utterly fail to apply logic to this process, and it dooms your ability to understand both this issue, and the broader picture of argument as a whole.

The irony is priceless. Post after post from you, containing one groundless assertion after another, and you claim that I have failed to apply necessary logic? And therefore my ability to understand is doomed?

I can't help it, even though it's rank ad hominem. I must ask: how long have you been off your medication?

[1. The argumentative burden of proof is on YOU.]
Ah, no it isn't. I'm saying, again, that I'm pointing out that there are inconsistencies and a lack of science in the dialogue. I only have to prove there are inconsistencies and that the science is not conclusive, which we can argue that I haven't done successfully.

I repeat: the burden of proof is on YOU. You began the discussion, therefore providing the original grounds for argument. You did it very poorly, true, but it was your role; and in raising the issue, and establishing your position, it is incumbent upon YOU to provide substance to support and defend it. Which you have not done.

Since your original post, you have attempted to recast your position in less inflammatory and more specific terms. That's fine, even admirable; but the original burden is not lifted from you.

Where is your evidence that there is a lack of science "in the dialogue" (which dialogue???). What examples of inconsistencies have you presented for discussion? In other words, where is your case?

YOU have to prove that the causes are chemical or that drugs are a acceptable or optimal treatment. I'm just saying IT HASN'T BEEN SHOWN. I don't have to prove the negative. The people who claim the positive have to prove it.

Wrong. There is no burden on your argumentative opponents to attempt to prove the opposite of your assertions, or to attempt to argue an unrelated third position defined by you (e.g., that drugs as treatment are either acceptable or optimal).

Our responsibility extends only to the critical assessment of your evidence--which so far, is nonexistent--and, based on that assessment, to accept or reject your argument.

What is the basis for your extremely odd concept of argumentation? I'd like to see a few citations to support your understanding of how arguments should be conducted. My own concept comes from my experience teaching argumentation, logic, and rhetorical theory at university for a few years. (Psst: that's an "argument from authority.")

2. Acceptable - I mean that the benefits outweigh the costs, Optimal - I mean that the benefit/cost ratio is the best possible.

Again, you fail to define your terms, and shirk your argumentative obligations. What benefits, and what costs? Individual? Societal? Quantifiable? Subjective? You do not offer a framework within which benefits and costs should be considered and a conclusion could be reached. I mean, really, do you intend to do any homework AT ALL that would make it possible to have a discussion? Or are you just trying to save face?

Drugs have not been established by any research as either acceptable or optimal.

You do not escape the argumentative burden of proof by stating your hypothesis as a negative. This statement could and should be supported by providing a review of existing research using a defined cost/benefit framework (which you fail to establish above). But once again, you simply wish to make assertions, not to engage in argument. Bad form, bad ethos.

your fascination with having me prove the negative.

I followed your link, and was amused to see that you presumably wished me to note the section about "Appeal to Ignorance (Proving a Negative): an argument that asserts a claim is true because no one can prove it is wrong"--which shifts the burden of proof to the audience or opponent.

Ingenious, but you've misunderstood the concept. My stating that you have utterly failed to establish a basic argumentative case does not involve me in fallacy. "You haven't proven X" is clearly distinct from, "I believe X and you can't prove otherwise."

I have made very few claims other than that your assertions are groundless and that your ethos is sunk. And that's taken remarkably little work on my part, as you've been so kind as to consistently, if unintentionally, support my case.

If we aren't inflammatory, then we are, pardon me, sheep.

Nope. Inflammatory rhetoric is not equivalent to, nor necessary for, spirited advocacy of an argumentative position.

I REALLY REALLY want to reach some kind of consensus on this issue because its so important to me, but it isn't easy.

Well, since you REALLY REALLY want consensus, then you should REALLY REALLY do the homework necessary to support a genuine argument. That requires YOU to bring evidence to the table, and your utter failure to do so up to this point makes your statement of motivation appear highly questionable.

We don't know if drugs are a good idea. Drugs don't cure the problem, they only mitigate it while patients take them. Drugs may cause lasting harm, and they may reduce the brain's ability to chemically regulate. We have other somewhat successful ways to treat.

Oh, goody. More unsupported assertions. Please, please, please: pick ONE. Narrow it. Define it. Research it. THEN post it, with appropriate links to supporting evidence that you wish to submit to critical examination. Otherwise you're wasting your time and those of your readers, and damaging your credibility.

Finally, subjective or first person experience is useful as data, but it is does not mitigate harm to patients or prove efficacy or serve as a prerequisite for understanding successful treatment methodologies.

Do you read your own sentences? Why on earth would first person experience ever be thought to "mitigate harm to patients"?

And I thought that we already established that said subjective data is routinely used to assess drug efficacy in people experiencing mental health problems. Unlike you, I provided citations from credible sources about methodology for assessing chemical treatment; scroll up for the links, and read them this time.

When people take cocaine, they feel good. But that doesn't mean good things are happening to them. Subjective data JUST establish perceived impact, it doesn't establish objective good necessarily.

False analogy. You cannot expect me to accept a simplistic comparison of recreational drug use with experimentally tested, prescribed, and controlled medication designed to address physical and mental health problems.

Also, did you pay any attention whatsoever to the previous posts in this thread in which members of this community pointed out the significant side effects attendant on taking common psychosomatic medications? These drugs can cause a host of seriously unpleasant physical reactions and take away your sex drive to boot. And yet many, many people adhere to a regimen of these drugs regardless, because they save lives, or make life possible. That is as close as you will get to an "objective good" (what do you mean by that?) in this situation.

You're out of your argumentative depth here, ewkpates. Your positions on this topic are formed and maintained in ignorance. You either are incapable of doing or uninclined to do what it takes to build a credible argument. And yes, I'm prepared to refute post after post from you designed to fraudulently convince readers otherwise.
posted by clever sheep at 9:03 AM on December 19, 2003

As an addendum, ewkpates, may I suggest that your next FPP consist of a solidly constructed argumentative case for this particular ungrounded assertion?

brain activity ISN'T CAUSAL in clinical depression. It's a symptom

Evidence? ...Bueller? ...Bueller?
posted by clever sheep at 9:06 AM on December 19, 2003

On later reflection, ewkpates, I hope you can find it in yourself to believe me when I say that I would enjoy a structured argument with you. I think you have some points of value to make; I simply want them properly made.

...Besides, anybody who tells SpaceCadet that his arguments on feminism show that he's been "smoking some serious crackfish" is somebody I owe a beer.
posted by clever sheep at 9:41 AM on December 19, 2003

I'm not concerned with who you are, so I didn't look you up. I will now because it will help me make more ad hominem attacks.

I'm concerned with what you say. Also, I only drink root beer, and only when it's on tap.

Who posts what - doesn't change the context, which is truth (research) and validity.

So, with all due respect, let's begin again.

I say:

1. Drugs may harm patients.
2. Drugs may mitigate symptoms.
3. Symptoms recur when drug treatments stops (drugs don't cure).
4. Some patients are cured by cog/beh treatment.

Therefore, drugs are not in the best interest of patients unless it can be proved that cog/beh therapy is unable to cure some patients due to a physical condition.

If you genuinely need to see evidence of 1-4, fine.

In order to assert that drugs are a good option, you still have to prove it.

I don't have to prove anything just because I posted something. This is a comment forum. Isn't it? The burden of proof is on those WHO ADVOCATE DRUG TREATMENT.

I advocate exercise, cog/beh therapy, and radical life changes. Studies show these cure sometimes.

Put your sylogism where your keyboard is.
posted by ewkpates at 12:08 PM on December 19, 2003

ewkpates, I see I underestimated your appetite for appearing foolish in public. Back for more, are you? And go ahead, look up my post history, throw out a few ad hominems if it tickles you to do so; I've seen the folderol you try to pass off as serious discourse, and vitriol looks to be about all that's left for you. And anyway, it'll roll off my back like water off wool.

So, to quote you, with all due respect, let's begin again, but I'll keep it relatively short, for reasons which I'll specify in a moment.

You list four statements, all of which beg for some--ANY--specific parameters (e.g., what drugs? what harm? what percentage of the time?). Further, these generalities are by no means established as inherently true (e.g., drugs don't cure--what, never? under no conditions?). In other words, these are invalid argumentative premises.

From this rickety structure, you leap to a wholly unwarranted and specious conclusion.

And when you're done with that, you once again deny your burden of proof, and fallaciously seek to assign it to your audience.

You then make laughable reference to syllogisms. Yes, laughable. Do you know what they are? And aren't? Clearly not.

And to wrap it all up, you still haven't provided evidence. Not a lick; not a shred; not a citation. Not for your current dreck or for any that preceded it--even when explicitly challenged to do so.

This makes a conclusion possible--you're a classic crank, as defined by Slithy_Tove in this current MeTa thread:
A crank, on the other hand [as compared to trolls], may start arguments, but that's not his intent. A crank is a someone completely, obsessively, insanely committed to some idea. He can't stop thinking about it, talking about it, defending it if anyone challenges it. He is irrationally committed to the validity of his idée fixe. No facts to the contrary will change his mind. It is impossible to talk to him about it except to agree with him. A crank has been described as "someone who can't change his mind and won't change the subject."

That's the shoe, and it looks mighty nice on your foot. You refuse to argue, and yet you refuse to shut up. Well, enjoy talking to yourself. Because with the credibility hara-kiri you've committed in this thread, it will be a marvel if anyone ever wastes their time responding to you in the future.

And I'm done wasting my time on you now. Have a good time shrieking into the void, sunshine.
posted by clever sheep at 2:23 PM on December 19, 2003

ewkpates, so do you consider bipolar disorder a behavioral disorder? Think carefully before you answer.
posted by konolia at 3:31 PM on December 19, 2003

Best.Fisking.Ever!
posted by dash_slot- at 6:26 PM on December 19, 2003

Konolia: If the universe is more or less behavioral disorders and cognitive disorders, then yes, I think bipolar is a behavioral disorder.
posted by ewkpates at 7:53 AM on December 22, 2003

First, where did you get the idea that the universe is divided into behavioral and cognitive disorders?

Now you're sounding like a Christian Scientist. According to your statement the flu would be treatable by talk therapy.

Meanwhile, not even discussing the research on genetic and hereditary causes, I can tell you that as a sufferer there is no way this could be solely treated nonmedically.

I have rapid cycling. That means that in the course of weeks or days my moods can swing immediately from pole to pole. My most recent bout with that was-two days feeling well, two days feeling hypomanic and two days of depression. I charted this for awhile just to make sure-outside events had no effect whatsoever. I called my doctor and he recommended an increase in my mood stabilizer-voila, problem solved, and I have enjoyed weeks of stability. I have had times when I was suicidal at breakfast, fine at lunch, and suicidal at dinner.

It would be nice if I could go without meds. In fact I face that very thing when my insurance runs out the end of March. It is ironic and cruel that when I finally have things balanced out well, I will have to go back to the reality of horrible emotional pain combined with bouts of hyper stupidity. I will be exercising and taking my fish oil, and receiving support from friends, having access to my counselor (yes, I use one) but I know it won't be enough.

My therapist has advised me many times that I have to live with some symptoms-for example I was going thru a bout of crying hysterically every time I read or saw news about someone dying or suffering-I wanted him to help me but he told me to accept it, that was the way I was at that time. The only thing I could do was take the meds, which helped somewhat when tweaked just right.

There is also a seasonal aspect to this-a lot of us are more depressed in fall, more manic in spring (due to sunlight or lack of it.)

None of us bipolars really like taking meds-most if not all of us try to do without, then get into trouble. That too is part of the cycle.

Well, ewkpates, you believe what you want. Thank God you or a loved one is not afflicted with this- and if someone is, then for pity's sake, keep your mouth shut. We face enough cruelty in this world as it is.

It is very easy to tell you have an agenda, btw.
posted by konolia at 9:13 AM on December 22, 2003

Wow. It really doesn't look like we are qualified to discuss this after all.

Here's a link I was sent the other day. ADHD is probably a behavioral disorder too, although the diagnosis may not be refined enough yet.
posted by ewkpates at 11:03 AM on December 22, 2003

I don't think much of Ritalin myself.

They have just come out with a non-stimulating add drug called Strattera, which has also been shown to help with some bipolar depressions. I was on it briefly myself, and experienced no side effects.It's a selective Norepinephrine reuptake inhibitor ( SNRI rather than SSRI drug (which affects serotonin.)

I think in many cases kids are being drugged for no reason, but there are some cases that I think really do need meds. Also there is some speculation that there may be some kind of relationship between bipolar and add (I don't think it works the other way though.)

I never said, (nor will I) that these drugs aren't powerful and not to be played with. But some of us have to risk it, and for us the benefits outweigh the risks. That's life.
posted by konolia at 12:28 PM on December 22, 2003