There was an article on the BBC News website a couple of weeks ago outlining a potential new treatment for the severely depressed. The treatment is nasally-administered ketamine which, according to a study published in the American Journal of Psychiatry, led to significant improvements in the symptoms of heavily depressed and suicidal patients.
The effects were short-lived, levelling out after 25 days, but were considered to be significant enough that the team behind the trial are now entering phase three trials (the last phase of clinical trials in which the drug is tested for efficacy and safety on a large group of patients) with the intention of bringing a new product to market.
Whether this treatment turns out to be genuinely useful remains to be seen, but the article prompted me to read a bunch of other things about the use of chemicals in treating depression. It also made me wonder whether consuming chemicals is really a good idea for the majority of those suffering from depression. I certainly considered medication and it was suggested to me; ultimately I decided against and am very glad that I did because, as a consequence, I learned to manage my emotion.
It turns out that, contrary to my assumption, depression is not thought to be caused by chemical imbalance in the brain. That theory turns out to be mostly the creation of pharmaceutical companies looking to make a buck or two million.
It is certainly the case that there are chemicals in our brains that regulate our emotions. Some of those, serotonin, for example, are part of an extremely old system and perform functions that have been central to our social development over millions of years. Our position in any given dominance hierarchy, for example, is measured by our serotonin levels – the more valued we perceive ourselves to be, the more serotonin is produced and the more satisfied we feel.
But it turns out that depression isn’t simply the product of abnormally low levels of serotonin or other biogenic amines. More recent research, such as that presented by Thomas Insel in 2011, suggests that there is a more complex relationship between biological and psychosocial factors. (Moran, M.: ‘Brain, Gene Discoveries Drive New Concept of Mental Illness’, Psychiatric News. June 17, 2011.)
Insel suggests two things. The first is that severe depressive conditions such as schizophrenia or bipolar disorder are caused by genetic dysfunction. The second is that the way in which the genetic dysfunction manifests itself is dependent on a person’s experiences and environment. This means that a genetic predisposition to depression may by more likely to develop if the subject is exposed to, for example, childhood trauma.
What this means is that depression should not be viewed as a temporary imbalance that can be adjusted but rather an ongoing, integral part of our brain’s function. In terms of treatment, this implies a more holistic approach considering both medication and psychotherapy as complementary rather than discrete approaches.
My instinct about the treatment of my own depression has always been that chemical interference is potentially dangerous. That instinct is mostly rooted in the sense that if my psychiatric chemical make-up is already wonky, then putting more chemicals in there is unlikely to add clarity.
Experience has shown me that increased understanding of my condition and the development of techniques for managing it have given the most potent results in my day-to-day life. I have never been clinically diagnosed but I’m fairly sure that I have a mild bipolar disorder – I experience both extreme highs and extreme lows. In the highs I am extremely energetic, productive, focused, and positive. I can also be self-aggrandizing, over confident, and impatient. In the lows I am lethargic, self-critical, negative, quick to anger and to blame others.
Since I started to practice mindfulness, got fit again, and reclaimed some control over my decision making, however, I have found that my mood is much more level, or at least, I have more control over the extent to which I vacillate in either direction. I am also aware of being about to shift gears, so to speak, either up or down which has enabled me to help myself deal with my emotions and communicate much better about them.
None of this is to say that there is no value in treating depression chemically. I am a single example and my experiences are merely anecdotal. I have experienced significant periods of intense depression and, at my worst, been almost unable to function but I am quite certain that there are others whose experience is considerably more debilitating on an every-day level. It would also be enormously patronising to suggest that the simple exercise of will and discipline is the salve to all mental health issues.
Nevertheless, I am persuaded from my own reading and conversations with many others who have depression and connected mental health issues that lifestyle and socialisation in many cases form a large part of the problem.
My suspicion is that the number of people with true difficulties is a small fraction of those in total who consider themselves to be depressed or in some similar way unwell. We are sold, not only in the media but also in the way we tend to be socialised, a paradigm in which everyone conforms to a norm. If you don’t conform to that, then something is wrong. Clearly, this is enormously beneficial to pharmaceutical companies in particular who are very happy to offer treatments with limited or no side effects and whose true effectiveness is easily clouded by a myriad of other potential symptoms.
You don’t have to look far to see products that apparently make you more attractive or improve your state of mind but which are essentially useless. Mouthwash, endless cough and cold remedies, Viagra, mood enhancers, vitamin supplements… We are constantly told that this or that could be better: ‘Have you been feeling low? Well, why not try PepMeUp, the new magic pill that will transform your every moment!’
The reality is that we all exist on a continuum in a plethora of characteristics. Height, build, colour, attractiveness, IQ… We understand some of these quite well, others – especially those connected to brain function – we understand very little. Our uniquely developmental psychology tends to focus on what we don’t know and look for solutions to it; a characteristic exploited mercilessly by all forms of advertising.
We all change mood dependent on a huge variety of factors. For some of us, the mood swing can be dramatic and feel uncontrollable. For a very few of us, something different is going on and the wiring is literally different. For the vast majority, however, I believe that the greatest benefit can be found from focusing on your health, both physical and mental, and taking the time to understand how you work.
I allowed other peoples’ opinions and decisions to control my own and that – coupled with a tendency for extreme moods – was the beginning of a slippery slope that nearly cost me my life. I would not wish that experience on anyone and what I take from it is that we should all be more aware of our own influence over our health.
We are much better off learning how to eat well, exercise effectively, understand our brain function and how to communicate with family and friends than being drawn to the idea that there is something wrong with us that needs fixing externally.
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One thought on “Chemicals and depression”
Thymia. We’re all on a spectrum*. Those highs and lows you’re describing are the phenomenon of cyclothymia. The exaggeration of which approximates to bipolar disorder. Euthymia, in contrast, is having a single mood which doesn’t change much, and when it’s a straight line – that’s the real problem. The explosion of anti-depressant prescriptions in the 90s, following the ‘tranquillisers’ of the 80s, has been difficult to reverse. Many prescriptions are for the lows we all go through, rather than the debilitating, horror that is major depression. That’s not to belittle the effects that minor depression has on people, it’s a problem I wouldn’t wish on anyone, but there’s no doubt depression is over diagnosed in the community: certainly antidepressants are over prescribed. Many people who feel low need psychological support, advice on mindfulness, exercise programs, dietary input, holistic care, friends, family, support, a blog to write…. But it’s easier to write a prescription for citalopram.
What was I on about? Yes. Thymia, spectrums. Recognition that it’s OK to feel good, and OK to feel low, for no particular reason is very important, under-recognised, and under-appreciated by many.
A bit of cyclothymia between friends? You can come to tea any time.
*Not the ZX81, that’s a different kind of spectrum.