Tuesday, January 12, 2010

To Medicate or not to Medicate, that is the Question 3

I should like briefly to return to this question of medication versus talk therapy for the "cure" or at least alleviation of the pain of Depression, that most misinterpreted ailment - it is as much misinterpreted as one of its polar opposites, namely love. Well, what brought me back to this topic at all? Quite simply, the other day I chanced to visit my mum, who is in a nursing home. I had called at an earlier time than usual, and as she was being changed, I sat down at the communal table just at the nurses' station. On the table lay a copy of the daily Irish Independent. I refer to the issue of this paper for Friday 8th opf January, 2010. As I leafed through this paper my eyes caught the photograph of beautiful lady sitting in the lotus position on her sumptuous and comfortable double bed. The beautiful and beguiling smile belonged to that of the popular Irish writer of "chic lit," namely Marian Keyes.

As I have a keen interest in this subject, I read this article with great attention. Indeed, it was written by one of my favourite Irish psychiatrists, Professor Patricia Casey. (I have many favourite psychiatrists as those of you who read these rather eccentric and "sui generis" postings will note. I am quite taken with the quip made about C.P. Snow - I'm not so sure who made it - that "all his geese were swans," - I believe it is the same with me, I find it quite impossible not to praise, and, indeed, I possible do over-praise and over-estimate what is just good as being very good and excellent. However much I admit to this fault, Professor Casey's article was riveting for me. She had a rather long title to the piece, but nonetheless quite effective, viz., "Sometimes words are not enough to lift depression." You can read this article here:

Patricia Casey

Casey makes very well the points that I was attempting to make in my other two posts. This most important point is: There are two distinct versions of Depression, namely (i) Endogenous Depression and (ii) Reactive Depression. These terms, Casey informs us, are the more tradition terms for demarcating two very different realities one from the other. The first category may be termed variously, but they all mean the one thing, namely a CHEMICAL IMBALANCE in the brain. Hence we may designate this form of depression as being: Endogenous, Chemical, Biological or Clinical Depression - you may choose your own preferred term. The second form of depression may be called by various names too, viz., Reactive Depression or Situational Depression. Hereunder are the words of Professor Casey in describing the first and worse kind namely Clinical Depression:
[it is a]depressive illness, so incapacitating that physical functions cease; eating, reading, moving, washing, talking all seize-up in a state of almost frozen emotional and physical paralysis. In psychiatric jargon, this is called psychomotor retardation. For some, life itself may end when the emotional pain and hopelessness become too engulfing and no light is visible, no joy foreseen and no love apparent.
I found one very helpful book on this form of depression, the clinical or endogenous variety and it really appealed to me. It was called Malignant Sadness by the atheistic biologist and a wonderful scholar, Lewis Wolpert. I cannot remember if I reviewed that book in these pages as I read it some ten or more years ago. It is full of science and explains the whole psychiatry thing in a biochemical fashion. I loved it, because Lewis Wolpert writes with scientific knowledge and a passion and a certainty I did not find in other books. He also describes therein my own peculiar symptoms, which I share with him, in precise detail. I also learned that many patients spend years trying to get a proper diagnosis because, while there are many common early symptoms, there are also ones peculiar to the personal chemistry of this or that individual. Anyway, psychopharmacological intervention helped me and continues to do so. It's at my peril that I discontinue my medication...

As a sufferer from this type of depression and having gone through two severe bouts of it, I totally and completely concur with Professor Casey, and indeed with Marian Keyes whose blog Brofessor Casey quotes. Needless to say I found Marian's webpage and found some quotations therefrom. Let's listen to her words too:
My dear amigos, happy new year to you all and I hope your festive season was not too unpleasant. I’m very sorry but this is going to be a very short piece because I am laid low with crippling depression. Regular readers know that I’ve been prone to depression on and off over the years but this is in a totally different league. This is much much worse. I know I’m leaving myself open to stinky journalists saying ‘What has she got to be depressed about, the self-indulgent whiner, when there are people out there with real troubles?’ so I won’t go on about it.

All I will say is that I’m aware that these are terrible times and that there are people out there who have been so ruined by the current economic climate that they’ve lost the roof over their heads and every day is a battle for basic survival and I wish I could make their pain go away. But although I’m blessed enough to have a roof over my head, I still feel like I’m living in hell. I can’t eat, I can’t sleep, I can’t write, I can’t read, I can’t talk to people. The worst thing is that I feel it will never end. I know lots of people don’t believe it, but depression is an illness, but unlike say, a broken leg, you don’t know when it’ll get better
See this link here, and do read the wonderful pieces of wisdom she writes there at the end of her entry for that day: they are nuggets of gold garnered from different authors from a range of traditions and places: Marian Keyes

Reactive Depression or Situational Depression as Professor Casey terms it is indeed a far different creature which does not share the depth of distress exhibited by the clinical or chemical variety of the complaint. Now I am going to copy here probably too much of Professor Casey's wonderful words. However, I advise you, if you have an interest to read her article in full and follow all the links given on the page. Also reading Marian Keyes' contribution is also recommended - I have given both links above. Now I'll quote Professor Casey once again and leave this gripping topic there:
...the same word, 'depression', is used to describe two different phenomena. One is a mood state that arises in response to life circumstances, which I will refer to as situational depression, while the second describes an illness that can arise spontaneously due to changes in brain chemistry that are independent of life events. This is often termed clinical depression or depressive illness. Formerly, these different emotional states were called reactive and endogenous depression. Interestingly, those who suffer with clinical depression rather than situational depression can distinguish the two mood states as being very different.

With one there is a total lack of joy, a feeling of flatness, an inability to respond to or to experience love. With the situational variety, the person can be distracted from their low mood and tearfulness, they can interact and react to their surroundings and be responsive to those in their lives.

Changes to the way depressive illness is diagnosed have resulted in the two being conflated -- with those who are unhappy due to life circumstances being misdiagnosed as having a clinical depression and receiving antidepressants. The appropriate criticism of the use of medication in these circumstances has caused many with clinical depression to refuse lifesaving antidepressants.

Those with depressive illness find it difficult to engage with talking therapies due to their physical inability to even concentrate, let alone act, on advice. Engaging in pleasurable activities is physically impossible as the whole psyche seems to shut down.

Indeed, therapists who attempt to carry out these therapies with those who are severely depressed will often speak of their clients as not being 'reachable' or emotionally accessible. Those who, when well, are capable and decisive become needy and indecisive.

(These comments are accessible at the above given link)
Above, a picture of the sky in the Phoenix Park. I took this photo in June 2009.

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