Posted by Cam W. on June 10, 2000, at 5:32:27
In reply to Re: Once a depressive, always a depressive?, posted by JohnL on June 10, 2000, at 4:52:28
Libby & Cari - John said it rather well [John, you getting residuals on that book, man ;^)]. Some depressions are reactive, in response to an extreme stress (the death of someone close for instance) and others do seem to have genetic features.It is thought that an uncoupling (breakdown) of the body's defense against stress (the HPA axis) is a major causitive factor in depressive states. This breakdown can be initiated an number of ways, depending upon what part of the HPA axis is broken. All of the neurotransmitters (serotonin, norepinephrine, dopamine, peptides, amino acids, etc) are all closely linked; the change in level of one will change the levels of all of them (usually in an effort to compensate for the lack of one of them). Like John said it depends on which neurotransmitter is malfunctioning, as to which antidepressant (and/or mood stabilizer) one should use. This is probably why some people have horrible reactions and increased depressions when taking some antidepressants.
Also, like John says, the drugs are only treating a few of the issues involved in depression. You will not get well (have your depression go into remission) with drugs alone. You have work with the drugs in order to attain remission. Even most people with severe, genetically-linked depressions can achieve remission if treated properly (both medications AND psychotherapy). Some people will only need one or the other. Going into remission does not mean that you are "cured" of your depression. There will always be a risk of relapse. Some people need to take antidepressants for life to avoid remissions. Most people with a reactive depression will not remit if they are adequately treated on the initial depression. This may not be so for people with a genetically-linked depression.
I look at depression like this. We are all born with a bar (like a high jump bar) that determines the amount of stress needed to uncouple the HPA axis (set off a depression). Some people have a very high bar (good air traffic controllers) and some have a very low bar (bad postal employees). This bar will be adjusted as you age (especially until your mid-twenties, but probably beyond). Environmental factors come into play. A stressful childhood (physical or psychological abuse) will lower the bar; a healthy nuturing atmosphere will raise the bar. This is known in the biz as the stress/diathesis model of mental disorders and seem to apply to many disorders (eg depression, bipolar disorder, schizophrenia). Diathesis is just a fancy word for environment (sort of).
Hope this helps - Cam.
P.S. - Scott, don't give me sh** for posting. I just can't sleep and need something to do. To everyone else, I will be posting a response to your wonderful outpouring of sympathy for my family sometime next week. We really do appreciate it, but right now I would not be able to give an adequate response to your postings. Thanks much. (Oh, by the way, the funeral is on Tuesday at 3:00pm MDT. For everyone who wants to do something for my family, just keep us in your thoughts that day. Thanks again.) - Cam
poster:Cam W.
thread:36729
URL: http://www.dr-bob.org/babble/20000610/msgs/36811.html