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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by stjames on October 25, 2000, at 3:45:16
Posted by GLYN on October 25, 2000, at 12:11:56
In reply to Men and Depression, posted by stjames on October 25, 2000, at 3:45:16
Thanks for pointing that out. What I liked was the personal point of view the article came from, however, I do have a few concerns with this guy's tack.
He seems to attempt to counteract macho notions of depression and other emotional illnesses (YES I do believe it is predominately an emotional problem which in turn kicks off a vicious spiral where emotions affect brain chemicals and vice versa) through adding weight to the recent trend to attempt to explain the origins of depression in purely chemical terms. I agree that an imbalance in brain chemicals perpetuates depression and prevents recovery yet I personally believe that the cycle is started by unresoloved emotional issues which for some reason we are unable to find peace from and so the feelings of sadness, lethargy and ultimately despair are effectively "locked in for the rot" as one guy described it.
Claiming a purely chemical or genetic source of depression and anxiety disturbs me for a number of what I consider to be rather important reasons. Firstly, it may be safe to assume that the reason why more women than men appear to suffer from depression is that women are altogether more willing to talk to a doctor about it and men may fin other means of control such as agression, sexual indiscretion or even addictions. Also, many men may still feel that it is a man's position to be strong and a leader of the family and that work is not an option for them and so they some how manage to go on regardless - even in a post feminist age there are some men who have these values I'm sure.
The question is, are we really helping these men by allowing there notion that any kind of emotional problem is a form of weakness or inadequacy? (Remember in The Sopranos how Tony wanted to avoid the stigma of being a "mental midget" - I love that show!) and enabling them instead to think of it as a medical problem in which chemcals are to blame and pills are the solution. I mean, what are the long term effects on our society if emotional problems are seen as illnesses and we invent further drugs to counteract them without at least also combatting the stigma which macho culture has attached to expression of emotion. Thats why I consider TV shows such as The Sopranos to be of immense value since we see a rare (but more realistic) blen of typical male tough guy and a Woody Allen type complex.
In all, I believe AD's to be of tremendous value in counteracting the destructive cycle of depression but I only wish I saw an equal emphasis on decostructing the destructive genderized notions of what it is to be a "good person" or "proper" man or woman. I have absolutely no evidence at all other than my own subjective experiences and perceptions of the world to make this claim but I suspect that, for men at least, further depressive episodes can more avoided by a radical re-think of how men are allowed to behave and whether expressing the full spectrum of emotions is reasonable and acceptable for the "man's man".
The other objection I have I will refrain from labouring too much for fear of causing offence to people on this site and would like to fist state that each of us needs to search ourslves and validate our "illness" without seeing ourself primarily as part of a "depression culture". In accepting depression as a purely chemical illness we are in danger of thinking of ourselves as a victim of it. I would imagine that it is rare for diabetics to challenge themselves to see if their illness was in some way caused by the society they live in and are "justified" by and wonder if their own notions of what it is to be a man or a woman havge in some way started off the problems and prevented them from being resolved to such a state that full on diabetes ensued. Of course, it would be ridiculous for them to suspect this and would be a sign that they failed to understand the genetic causes of the illness. HOWEVER, by attributing such causes to depression we may make it easier for people to seek out help and admit to their illnesses (and maybe even save lives) but we dont really challenge the ideas, values and social roles which may well be the root of the problem and possibly result in further episodes in life.
I might be wrong and I might be right but one thing is for sure, asking questions and pushing the boundaries of popular belief is not nearly as dangerous as being afriad to.
If, as usual, I have offended anybody, please forgive me and instead think of my opinions as a an expression of my screwed-up-ness and I urge you - no beg - to find your own answers and if they make you happy then seize the day as nothing lasts for ever - especially happiness. My mum used to say that "happiness depends on 'happenings' but joy and peace makes good and bad into a life well lived" - I confess I have no idea what the old bird meant but it sounded good to me.
Glyn
Posted by stjames on October 25, 2000, at 20:01:07
In reply to Re: Men and Depression, posted by GLYN on October 25, 2000, at 12:11:56
For me I did therapy b4 AD's and while the therapy
was a great learning experience we did not uncover any great issue that caused my depression
nor did my6 depression lift because of the therapy. We did solve some issues. However I dwas not able to use what I learned in therapy till I started AD's.Otherwise I found therapy like going to the hairdresser, I left there feeling great but the next day i could not get my brain to work that way. Once I was on AD's I could really use what I
learned in therapy.james
Posted by TomV on October 26, 2000, at 11:19:51
In reply to Re: Men and Depression, posted by GLYN on October 25, 2000, at 12:11:56
I agree wholeheartedly with your entire view. In the which came first , chicken or the egg scenario, I believe emotion always precipitates depression. Even if it isn't apparent to the patient. Can a brain go bad on its own, without a negative emotional experience? Of course. But I think thats a very small amount of the population. One thing I do know for sure... men that suppress their emotions eventually land on a therapist's couch...
Posted by GLYN on October 26, 2000, at 11:45:14
In reply to Re: Men and Depression » GLYN, posted by TomV on October 26, 2000, at 11:19:51
Tom,
I, of course, am also one of those men desperate to "get in touch" with myself. I dont think I have too much of a problem on a day-to-day process but I sure find it hard to get in touch with past childhood events. My mother was a chronic alchoholic and a total neurotic and my father left me when I was 18 months old and even though he visited his mother who lived just half a mile from us he never bothered to see me in the last 28 years - nor has his mother. How do I feel? Angry? Sad? Rejected? I wish!!!! Although I operate quite well in relationships now and experience the whole spectrum of emitions (sometimes within the space of a minute) I just can't feel anything other than philosophical about my childhood but I am aware of this terrible fear and bleakness lurking just below the surface and this is definitely the source of all of my depression and a extreme anxiety. If only I could grab hold of those emotions at the source but alas I doint know how. I can talk about the past and even admit it was horrible and I have forgiven both parents (WELL TRIED ANYWAY).
Have you or anybody else got ideas how to tap into the garbage from the past. I reckon if I can just touch it I'll start to be able to face the demons in my life now which appear just out of reach. Pretty scary thought but better to face the monster than spend a lifetime running away from it.
How do I do it without spending a fortune on therapy?
Posted by MarkinBoston on October 26, 2000, at 14:53:51
In reply to Re: Men and Depression, posted by stjames on October 25, 2000, at 20:01:07
> For me I did therapy b4 AD's and while the therapy
> was a great learning experience we did not uncover any great issue that caused my depression
> nor did my6 depression lift because of the therapy. We did solve some issues. However I dwas not able to use what I learned in therapy till I started AD's.
>
> Otherwise I found therapy like going to the hairdresser, I left there feeling great but the next day i could not get my brain to work that way. Once I was on AD's I could really use what I
> learned in therapy.My experience has been somewhat similar. Happy thoughts and half-full glasses really have not helped me much. My major episodes have all be preceeded by stress, and no meds have fixed my baseline dysthymia. Even now, while I feel good, my cortisol levels are at the upper edge of normal. This predisposes me to depression and all the other symptoms of Cushing's syndrome. I'm begining to think something physical is causing the Cushing's rather than depression causing a pseudo-Cushing's state. Now I can go back to the endocrinologist and say that I feel good - now tell me why my cortisol is still high. Another chicken-egg situation.
By the way, panic (especially) and depression and hypertension and hypogonadism and weight gain are all related to high cortisol (hormone released mainly in response to stress) levels. High estrogen levels (even for a man) exaggerates cortisol release and likelyhood of panic and would explain why women experience depression more than men.
Social withdrawl is one behavior where an individual with high cortisol or high cortisol response is adapting by reducing stress factors.
For me, when contracting, I lowered stress by only working 20 hr./week. That was all I needed to work to pay the bills and didn't want to work more than that, and didn't save any money away during those years.I wish I could find a Dr. that had cross training in psychopharm and endocrinology. For me, they are tightly coupled. Only in the last year or so have papers come out suggesting anti-glucocorticoid (cortisol reduction) use as part of treatment for depression. Those drugs are a mixed blessing of positives and negatives and its really much less trouble on an endocrinologist to tell you to go see a pdoc than work up a cocktail with lots of blood tests and maintanance. Like me, you won't find yourself well recieved going this route showing journal papers to docs who haven't read in years and only get 15 minute follow up payments from HMOs.
Posted by Bradley on October 26, 2000, at 20:29:55
In reply to Re: Men and Depression » stjames, posted by MarkinBoston on October 26, 2000, at 14:53:51
I would also like to see an psychopharm/endoc, but quite rare I'm sure. Many years ago I suspected an endocrine disorder as the cause of my depression. I'm convinced now a low level of a hormonal protein called inhibin causes my circadian rythmn to shift out of its proper phase.
One of these years researchers will begin makeing the breakthroughs on the likely endocrine problems that at the root of many forms of depression. and PD's. They both will deal with a thyroid problem, but beyond that fagetaboutit.
This big gulf exists now between endocronologists
Posted by SLS on October 26, 2000, at 22:41:11
In reply to Endocrine causes for depression(Mr Boston), posted by Bradley on October 26, 2000, at 20:29:55
Dear Bradley,
> I would also like to see an psychopharm/endoc, but quite rare I'm sure.Dr. Oren at Yale. He is particularly interested in disturbances in circadian rhythms. Pineal gland stuff among others.
Also, you may want to go on medline and do a literature search for a Dr. Thomas Wehr (NIMH). He is probably one of the most highly regarded researchers of circadian rhythms with regard to affective disorders.
> Many years ago I suspected an endocrine disorder as the cause of my depression. I'm convinced now a low level of a hormonal protein called inhibin causes my circadian rythmn to shift out of its proper phase.
Can you tell me more about inhibin? A friend of mine suffers from a rare circadian disorder that I believe is known as hypernycthemeral syndrome. It is also a disturbance in the maintenance of phases. I don't recall if it is X or Y clock related. I would love to know where I can find out more about it so I can help him out.
Sorry. Gotta go. Mets 9th inning.
Thanks.
Sincerely,
Scott
Posted by stjames on October 27, 2000, at 1:01:41
In reply to HOW DO I FACE MY DEMONS ? TOM, posted by GLYN on October 26, 2000, at 11:45:14
How do I do it without spending a fortune on
therapy?james here....
Who said it costs a fortune ? Even small towns have sliding scale fee
therapy, public clinics, other agencies offering cheap or free services.
Ask your doc or local mental health agencies what services are in your area
and price range. There is always a way, you just have to ask and beat the bushes.james
Posted by noa on October 27, 2000, at 6:39:52
In reply to Endocrine causes for depression(Mr Boston), posted by Bradley on October 26, 2000, at 20:29:55
Go for the endocrine evaluation! As I have been saying lately, "leave no stone unturned."
Posted by Bradley on October 27, 2000, at 12:35:02
In reply to Re: Endocrine causes for depression(Mr Boston), posted by noa on October 27, 2000, at 6:39:52
> Go for the endocrine evaluation! As I have been saying lately, "leave no stone unturned."
Unfortunately psychs and endo's have left so many stones unturned. The more I learn about the endocrine system the more I see that it is poorly understood. The timeing of all our biological processes are set by the endocrine circadian rythmn, but it is not understood. Incredible as it sounds, it is true. As long as 30 years ago some depressive patients were shown to respond positively to one night of sleep deprivation. Through all these years studies have tried to identify what mechanism in the endocrine system causing this and all have failed. The last one I read by Dr. Wehr failed also, but felt the changes
in endocrine system were responsible for the postive response.
Posted by noa on October 27, 2000, at 15:48:08
In reply to So little is known, posted by Bradley on October 27, 2000, at 12:35:02
There used to be a doc at NIMH, Dan Oren, who studied melotonin, circadian rhythms, depression, light, etc. Now I think he is at Yale.
Posted by rogdog on October 27, 2000, at 20:02:53
In reply to HOW DO I FACE MY DEMONS ? TOM, posted by GLYN on October 26, 2000, at 11:45:14
Hi Glyn, as far as facing demons, you can dredge up shit from the past until the cows come home! and try to "solve" the past, or recall some tramatic event so that then! you can let it go and be happy. i have seen many people (including myself) spend time and effort "trying" to let go or face the past. the only way to do that is to look at today, accept yourself as a person who DOES have control and has the ability to be as happy as you want and to say to hell with the demons! today is today, and the past is the fricken past! amen! god bless, Rogdog
Posted by R.Anne on October 29, 2000, at 16:11:47
In reply to HOW DO I FACE MY DEMONS ? TOM, posted by GLYN on October 26, 2000, at 11:45:14
Therapy is a good idea and so are self-help books. I found that even in therapy I could not feel at times but later at home (where I felt more safe) I would feel things. There are plenty of books that help with childhood trauma, especially those by John Bradshaw. JB also has tapes available and he is excellent in dealing with being the child of a person who abuses alcohol. Keeping a journal can be helpful, too. Whenever some feelings arise express them to someone who understands (this is important)and you will gain support. There are also groups for children of alcoholics and possibly groups for abandoned persons as well. Local community mental health agencies would have lists of them. I truly know the pain of what you have been through as I have been there, too. I am truly sorry that you had to suffer that way and hope you find the sources that will help you get in touch and heal the wounds. You need people to support you and care about your needs-you can find them here and within your community. Best wishes! r.anne
********
> Tom,
>
> I, of course, am also one of those men desperate to "get in touch" with myself. I dont think I have too much of a problem on a day-to-day process but I sure find it hard to get in touch with past childhood events. My mother was a chronic alchoholic and a total neurotic and my father left me when I was 18 months old and even though he visited his mother who lived just half a mile from us he never bothered to see me in the last 28 years - nor has his mother. How do I feel? Angry? Sad? Rejected? I wish!!!! Although I operate quite well in relationships now and experience the whole spectrum of emitions (sometimes within the space of a minute) I just can't feel anything other than philosophical about my childhood but I am aware of this terrible fear and bleakness lurking just below the surface and this is definitely the source of all of my depression and a extreme anxiety. If only I could grab hold of those emotions at the source but alas I doint know how. I can talk about the past and even admit it was horrible and I have forgiven both parents (WELL TRIED ANYWAY).
>
> Have you or anybody else got ideas how to tap into the garbage from the past. I reckon if I can just touch it I'll start to be able to face the demons in my life now which appear just out of reach. Pretty scary thought but better to face the monster than spend a lifetime running away from it.
>
> How do I do it without spending a fortune on therapy?
Posted by MarkinBoston on November 1, 2000, at 17:23:37
In reply to Re: Endocrine causes for depression(Mr Boston), posted by noa on October 27, 2000, at 6:39:52
> Go for the endocrine evaluation! As I have been saying lately, "leave no stone unturned."
One annecdote from when I went through endocrine evaluation:
I was given 1 mg. of dexamethasone to take at 11pm and then have a blood draw at 8AM the next morning. This is the short DMT (dexamethasone suppression test) used to screen for a primary cause of Cushing's Disease, where your cortisol level remains high and the feedback system isn't working. Dex is a cortico-steroid that looks enough like cortisol to your hypothalmus that it cuts back on signals to make the real thing, but not close enough to fool all the receptors in your body.
Bottom line: I felt GREAT that day - energetic, cheery, and social! Unfortunately, it and other drugs in their class, like prednisone are undesireable consequences for long term use. No MD has been able to explain why I felt so good, but a Pubmed search revealed a couple things: 50% of melancholics are DMT suppressors, and the other half not, and that melancholics supress less beta-endorphin than non-depressed people when given dex.
Hey, shouldn't this experience be some sort of clue to a MD?
Oh, and thanks for nickname - same as that old bottom shelf liquor and mixology guide. I'm honored :-)
This is the end of the thread.
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