Posted by ksvt on July 14, 2000, at 21:24:24
In reply to Re: Stress, Depression role of ADs, posted by SLS on July 12, 2000, at 21:12:00
> Hi dj.
>
> I would like to offer a few points of contention.
>
> > > "Citing evidence that stress reduces >neurogenesis (the production of new nerve cells)
>
> > Which again shows the need to deal with the underlying source of the stress and not just the symptoms of...
>
> What is the underlying source of the stress that produces these symptoms? What are symptoms? Is depression a symptom or an illness? Is depressed mood an illness or a symptom?
>
> > As they clearly pointed out in today's very balanced discussion of ADs and their effectiveness, once you cut through the statistical smoke and mirrors they only have about a 40% effectiveness rating and deal with symptoms not causes.
>
> What are the causes?
>
> Depression is but one word used to describe more than one human condition. Certainly, for people suffering a depressive episode of bipolar disorder, depression (the word used to label a phenomenological phase of this illness) is the cause of their depressive symptoms. In this case, the depressed state reflects the autonomous depressive neuronal activity that is independent of exogenous and psychogenic influence. The best demonstration of the autonomous nature of bipolar depression (and mania) is represented by individuals for whom their conscious state changes abruptly and dramatically (mania -> depression -> mania -> depression...) every 24 hours without fail. This presentation is known as ultra rapid-cyclicity. Another example of the autonomous nature of some depressive phenomena is the regularly periodic and episodic mood lability that occurs in many women that begins a few days prior menses.
>
> What percentage of the cases that are diagnosed as major depression are sustained by autonomous biological abnormalities, regardless of induction, that are not acutely responsive to psychotherapies and behavioral changes? I don't know. My guess is the majority. What percentage of these biologically-driven cases evolve as the result of chronic psychosocial stress? I don't know. Possibly the majority. What percentage of these psychosocially-induced cases were born with or developed a biological template vulnerable to the precipitation of depressive biological abnormalities? I don't know. My guess is the majority.
>
> As best as I can surmise, at worst, 40% might represent the rate at which any *one* antidepressant effectively alleviates 100% of the depression in any one individual. The rate at which any one individual properly diagnosed with endogenous unipolar depression fully responds to any one, or a combination of all the available antidepressants is probably more like 80%. If this figure is accurate, treating depression with antidepressant drugs is manifestly effective and often necessary. There is no smoke and mirrors when the details of these statistics are detailed and parsed accurately and meaningfully. In addition, combining somatic therapies and psychotherapies for an individual is sometimes more effective than somatic therapy alone.
>
> > Hence they are only dealing with the manifestations of stress and not the root causes.
>
> I passionately believe the following statements (not that this means anything), and consider their validity to be self-evident and supported by the proponderance of published and unpublished scientific evidence.
>
>
> 1. Stress can cause depression, although it is obviously not a causative factor in all cases.
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> 2. Depression causes stress. Stress can therefore be a manifestation of depression without depression being a manifestation of stress.
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> 4. Biological and psychological contributions to the evolution of a depressed state are not mutually exclusive. However, either can be sufficient.
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> 5. Biological depressions usually require biological intervention for rapid resolution. Biological intervention is sometimes necessary for any resolution.
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> 6. Using the full armamentarium of antidepressant drugs to treat each properly diagnosed case of major unipolar depression, the rate of achieving a robust remission is at least 80%.
>
>
> - Scott
Scott - I agree with alot you say altho I clearly don't have the scientific expertise of you and dj. However, I question the 80% robust remission statistic. Particularly given the great difficulty people seem to have coming up with the right drug or combinations of drugs. What do you think it means that these remissions are only temporary even when you're on maintenance medication?
poster:ksvt
thread:40133
URL: http://www.dr-bob.org/babble/20000708/msgs/40472.html