7 ms·

> Or if you are outside for a long time in the cold with no jacket, upon feeling very cold, you don’t say that you have "a coldness disorder". A better example

> Or if you are outside for a long time in the cold with no jacket, upon feeling very cold, you don’t say that you have "a coldness disorder". A better example for anxiety or depression would be standing inside in a warm room, and despite everyone else in the room being comfortable, you are unable to warm up at all. When you complain, you are told that "everyone gets cold sometimes". This article doesn't seem to have any new information, it's just repeating the old ideas that depression and anxiety are the same as temporary sadness and worry due to legitimate problems.

golemotron 10y ago
That's better than the unsubstantiated theory that depression is a serotonin disorder.
- jolux 10y ago
  How do you mean unsubstantiated? If you mean it's less than certain than sure, but SSRIs and SNRIs and NaSSAs and such improve depression greatly for many patients. That at least says something about serotonin levels in patients with depression.
  - themgt 10y ago
    "Opiates improve pain-in-arm symptoms greatly for many patients. That at least says something about opiate levels in patients with pain-in-arm."
    - TeMPOraL 10y ago
      And by studying how they work we learn about how pain works. Compare to alternative, "keep smiling and find better friends". Fuck that. Even if it was relevant (it probably isn't), I can't smile or talk to people, because I'm constantly in agony because of my arm. I'll stick to opiates because they let me live.
      - themgt 10y ago
        The point in the analogy though is, the pain is a symptom. Understanding how pain is transmitted through nerves and how to block it is certainly useful in the treatment of broken bones, but far more important is understanding that the pain is caused by the broken bone. The pain itself is not the problem, even if makes sense to ameliorate; focusing on the pain instead of the break can lead you to masking and failing to treat the underlying problem, allowing it to worsen.
        TeMPOraL 10y ago
        Yeah, I get the point of the analogy, but I think in reality, the "social" approaches to solving depression are closer to curing broken bones by telling patients to change friends / sleep more / find God. And I say this as a person who had depression and anxiety issues for a long time. Yes, some parts of it are affected by my life conditions, but sadly I can't wish my way out of sudden, random anxiety attacks.
    - jolux 10y ago
      Indeed. And if you take an SSRI for pain-in-arm and realize it doesn't do shit, then perhaps pain-in-arm isn't related to serotonin levels?
  - DanBC 10y ago
    Depression is different for different people. It's an umbrella term that captures many different types of illness. Anti depressants do work very well for some people; not so well for others; and not at all for others. Some people may have to try different meds. We know there's a genetic factor with effectiveness too. But it's useful to have other approaches to treatment, and that's where the good psychologists come in. There is always a bit of a kerfuffle between psychologists ("It's all psycho-social!") and psychiatrists ("It's all chemistry!") (the analogies with computer language flame wars are obvious) and the truth probably lies somewhere in between.
    - 0xcde4c3db 10y ago
      Indeed. It blows my mind sometimes how much people, including people who really ought to know better, grasp at the ideal of having the One True Explanation and One True Treatment for depression. It's not even just the division between biological and psychosocial approaches; I've seen some very troubling, almost childish bickering among adherents of various psychotherapeutic schools (some of the more esoteric and old-school types denounce CBT in much the same terms that they denounce drugs), and have learned the hard way that if I ever hear my psychiatrist tell me that something is "a really good drug", I need a new psychiatrist.
- fucking_tragedy 10y ago
  Reminder that for panic disorder, OCD and severe major depression, SSRIs are effective. I am not suggesting that depression is a 'serotonin disorder', just that this class of medication does work for some with this disorder and others. The other side of this is that exercise, MAOIs, CBT, ERP etc are effective as well.
jolux 10y ago
Real depression comes out of nowhere, hits you like a ton of bricks, and makes you wish you weren't alive.
- smegel 10y ago
  I agree with this, but I also think a lot of "non-real depression" is too easily diagnosed as the real thing. A lot of depressed people could be "cured" by just changing circumstances in their life (not that it is always easy, but saying there is stuff in your life you can't change and it is making you depressed, doesn't make it a mental illness). But you have worn out doctors facing a tough choice: do the near impossible and try and help someone change their life, or take 40 second to prescribe a pill from a billion dollar drug company that is paying for him to go on a conference in the Bahamas next month.
  - jolux 10y ago
    Incidentally a lot of antidepressants (like the one I'm taking) have generics available that make this kind of thing less likely. I gotta say though, life with antidepressants for me is a life I haven't experienced in a very, very long time, in fact I can't remember when the last time I felt this way was.
  - noxToken 10y ago
    > A lot of depressed people could be "cured" by just changing circumstances in their life (not that it is always easy, but saying there is stuff in your life you can't change and it is making you depressed, doesn't make it a mental illness). I believe what you're largely referring to is Adjustment Disorder. You're stuck in a situation, and but if the situation changes to something more favorable, the depressive mood (with time) goes away. In my experience, a lot of people in the military with a depression diagnosis tends to be Adjustment Disorder. The PT almost always ceases to display depression symptoms once their contract has expired. This is why (I believe) people tend to say, "Just cheer up, man. It's not that bad!" Others will see that changing something (smiling, going to a movie, visiting friends) can cure a case of the blues. Note that I am not minimizing the effects that the depressive mood can have on person with Adjustment Disorder. I am just highlighting the difference between Major Depressive Disorder (change the situation, relatively same symptoms) and Adjustment Disoder (change the situation, no symptoms).
themgt 10y ago
The problem with using a purely neurochemical explanation like this is the rates of these disorders differ dramatically between societies and within societies geographically, demographically and over time. It is clear that the United States in particular is, especially in recent years, churning out unprecedented numbers of severely psychologically ill individuals. The idea this is solely due to previously undiagnosed individuals or otherwise not representative of a sickening society is difficult to support. Frankly we have spent too long acting as if mental disorders could not possibly have anything to do with ones surroundings, upbringing and life in general, when it's beyond obvious that they have very much to do with those things, as well as genotype/phenotype/etc. We've used this idea that it shames individuals to suggest that the actual problems they deal with could contribute to mental damage in much the manner they can physical damage, which is simply dogma masquerading as science. In fact, using purely neurochemical explanations denies people's humanity and lived experience, denies that we are sentient humans not some organic robots that need an serotonin oil change and some dopamine transmission fluid.
- dilemma 10y ago
  Medication is essentially victim blaming by society unto the individual reacting against its conditions. And the medical health specialists are agents of society, not the person they're ostensibly helping.
  - pzone 10y ago
    Not trying to contradict you, but it's also one of the precious ways offering a shot at helping people overcome depression.
- sowhatquestion 10y ago
  > It is clear that the United States in particular is, especially in recent years, churning out unprecedented numbers of severely psychologically ill individuals. Is it clear? Or have we gotten better at diagnosing conditions that people have been experiencing all along? (Not to mention reducing stigma and making people more likely to admit to having these conditions.) In any case, citation needed.
lotyrin 10y ago
I disagree, this is pretty different from depression-is-just-sadness. The article is not shortcutting to a non-solution, it's pointing out that there can be overlooked root causes beyond the symptom, and this can be a very valuable thing to point out to people, leading to actionable solutions to their problem. I was diagnosed depressed for many years, and it turned out I simply had the expected affect given I was not socializing enough, exercising enough, or sleeping well enough given an undiagnosed case of sleep apnea and a bit of a spiral from obsessing about trying to stay employed despite that affect. Talking myself in circles, messing around with serotonin, none of this got me anywhere because it wasn't solving the actual problems. I didn't need any of that, I needed a machine that pushes air into my face at night and another one that pulls a belt below my feet in the morning, but the professionals I visited failed to prescribe these. People have no basis of comparison when it comes to their direct subjective experience with long-lived habits so someone who exercises regularly can say "if I couch-potato too hard, I'll start to feel gross", but someone who doesn't can't as easily observe "I feel gross all the time because I never exercise enough". Likewise with hygiene, regular social exposure, sleeping properly, eating properly. It's important to think of mood as a complex function with many inputs and a good amount of feedback and delay. Certainly it can be the case that depression is its own root cause, and one should not reject talk therapy or prescriptions to help with it, but I definitely recommend people search for something they may have overlooked. Maybe there are good psychiatrists and therapists which will find these kinds of things, but I haven't met any. Patients should be aware they need to consider them.
- oconnore 10y ago
  > I didn't need any of that, I needed a machine that pushes air into my face at night and another one that pulls a belt below my feet in the morning, but the professionals I visited failed to prescribe these. What sort of therapy is that?
  - DanBC 10y ago
    Air in face is APAP for sleep apnea. Belt under the feet is a treadmill for exercise.
deleted 10y ago
[deleted]
Fordrus 10y ago
Let me just take a moment to register monumentally huge agreement with your modification of the the metaphor at hand. The problem here is that huge numbers of other people are living in almost exactly the same circumstances - or ones that are objectively worse - and they register no depression. And here, by objectively worse, we're talking, risk their lives daily on a shoestring lifestyle that barely keeps them from not having a roof over their heads and rice or beans enough not to starve to death. Do those who risk their lives have something the comparatively wealthy depression cases lack? Are the kinds of pressure the relatively wealthy depression cases experience particularly likely to create this kind of response? What's the difference? What's the root cause?! If we had actual, good root causes, then we'd be golden, but the problem, the HUGE PROBLEM that the paradigm espoused in the article faces, is that we DON'T have a kind of 'smoking gun' need that is not being fulfilled for people with depression. MANY, MANY people with deep depression really do have fantastic lives compared to those who suffer no depression- and moreover, admonishing people with depression to 'figure out what need is being unfulfilled in your life, and fill it' is highly toxic advice, at least in its way- based on my experience with depressed individuals, if you effectually tell depressed people to figure out what's wrong in their life and fix it- well, it's one way to obliquely encourage suicide.
- danharaj 10y ago
  Different people have different needs. There is no standard for what an awesome life is. Having an awesome life in some ways can still be miserable in other ways, and only for particular people. An "fantastic life" where one is depressed is not fantastic. Psychological diversity is a precious resource, and a society that is too inflexible to accommodate those who are particularly sensitive or have exceptionally different needs is a bad society. Depression and anxiety, and a host of other mental disorders for that matter, are an epidemic in too many countries, too many countries that are supposed to have high quality of life. > if you effectually tell depressed people to figure out what's wrong in their life and fix it- well, it's one way to obliquely encourage suicide. Kind of a straw man don't you think?
  - Fordrus 10y ago
    No, I don't think it's a straw man at all, I think it's absolutely correct in the sense that severe depression at a clinical level virtually precludes people just "figuring out what they're missing" or excising the things that suck from it - it will feel literally the same as when people assert that those suffering depression need to "buck up and face life." I'm saying that your assertion that it might be a strawman is indicative of a deep, insidious skew to your worldview on the matter - seriously. I think this is all excellent advice for healthy people who have NOT fallen into clinical-level depression, but once depression has asserted itself, this immediately becomes horrible advice that, similar to "just get over it," encourages those who are depressed to take the most direct route to relief of their symptoms (suicide).
stephenboyd 10y ago
The author makes his point clearer in his follow-up article: https://www.psychologytoday.com/blog/theory-knowledge/201603/clarifying-the-nature-anxiety-and-depression https://www.psychologytoday.com/blog/theory-knowledge/201603... His position is that investigating the practical causes of depression and anxiety should be the first approach to diagnosis, not that it should be the only approach. It's not that cases of depression without another cause don't exist; he's just saying those cases are less common. To compare it with physical pain, saying that most cases are symptoms of something else doesn't mean that the pain shouldn't be treated, nor that cases of unknown or genetic origin would be any less legitimate.
tim333 10y ago
>it's just repeating the old ideas that depression and anxiety are the same as temporary sadness His main argument seems to be that depression is a symptom of mucked up relationships. Googling "depression symptom relationships" his is the only article arguing that in the first 40 results. So it seems at least somewhat original.

golemotron 10y ago

That's better than the unsubstantiated theory that depression is a serotonin disorder.

jolux 10y ago
How do you mean unsubstantiated? If you mean it's less than certain than sure, but SSRIs and SNRIs and NaSSAs and such improve depression greatly for many patients. That at least says something about serotonin levels in patients with depression.
- themgt 10y ago
  "Opiates improve pain-in-arm symptoms greatly for many patients. That at least says something about opiate levels in patients with pain-in-arm."
  - TeMPOraL 10y ago
    And by studying how they work we learn about how pain works. Compare to alternative, "keep smiling and find better friends". Fuck that. Even if it was relevant (it probably isn't), I can't smile or talk to people, because I'm constantly in agony because of my arm. I'll stick to opiates because they let me live.
    - themgt 10y ago
      The point in the analogy though is, the pain is a symptom. Understanding how pain is transmitted through nerves and how to block it is certainly useful in the treatment of broken bones, but far more important is understanding that the pain is caused by the broken bone. The pain itself is not the problem, even if makes sense to ameliorate; focusing on the pain instead of the break can lead you to masking and failing to treat the underlying problem, allowing it to worsen.
      - TeMPOraL 10y ago
        Yeah, I get the point of the analogy, but I think in reality, the "social" approaches to solving depression are closer to curing broken bones by telling patients to change friends / sleep more / find God. And I say this as a person who had depression and anxiety issues for a long time. Yes, some parts of it are affected by my life conditions, but sadly I can't wish my way out of sudden, random anxiety attacks.
  - jolux 10y ago
    Indeed. And if you take an SSRI for pain-in-arm and realize it doesn't do shit, then perhaps pain-in-arm isn't related to serotonin levels?
- DanBC 10y ago
  Depression is different for different people. It's an umbrella term that captures many different types of illness. Anti depressants do work very well for some people; not so well for others; and not at all for others. Some people may have to try different meds. We know there's a genetic factor with effectiveness too. But it's useful to have other approaches to treatment, and that's where the good psychologists come in. There is always a bit of a kerfuffle between psychologists ("It's all psycho-social!") and psychiatrists ("It's all chemistry!") (the analogies with computer language flame wars are obvious) and the truth probably lies somewhere in between.
  - 0xcde4c3db 10y ago
    Indeed. It blows my mind sometimes how much people, including people who really ought to know better, grasp at the ideal of having the One True Explanation and One True Treatment for depression. It's not even just the division between biological and psychosocial approaches; I've seen some very troubling, almost childish bickering among adherents of various psychotherapeutic schools (some of the more esoteric and old-school types denounce CBT in much the same terms that they denounce drugs), and have learned the hard way that if I ever hear my psychiatrist tell me that something is "a really good drug", I need a new psychiatrist.
fucking_tragedy 10y ago
Reminder that for panic disorder, OCD and severe major depression, SSRIs are effective. I am not suggesting that depression is a 'serotonin disorder', just that this class of medication does work for some with this disorder and others. The other side of this is that exercise, MAOIs, CBT, ERP etc are effective as well.

jolux 10y ago

Real depression comes out of nowhere, hits you like a ton of bricks, and makes you wish you weren't alive.

smegel 10y ago
I agree with this, but I also think a lot of "non-real depression" is too easily diagnosed as the real thing. A lot of depressed people could be "cured" by just changing circumstances in their life (not that it is always easy, but saying there is stuff in your life you can't change and it is making you depressed, doesn't make it a mental illness). But you have worn out doctors facing a tough choice: do the near impossible and try and help someone change their life, or take 40 second to prescribe a pill from a billion dollar drug company that is paying for him to go on a conference in the Bahamas next month.
- jolux 10y ago
  Incidentally a lot of antidepressants (like the one I'm taking) have generics available that make this kind of thing less likely. I gotta say though, life with antidepressants for me is a life I haven't experienced in a very, very long time, in fact I can't remember when the last time I felt this way was.
- noxToken 10y ago
  > A lot of depressed people could be "cured" by just changing circumstances in their life (not that it is always easy, but saying there is stuff in your life you can't change and it is making you depressed, doesn't make it a mental illness). I believe what you're largely referring to is Adjustment Disorder. You're stuck in a situation, and but if the situation changes to something more favorable, the depressive mood (with time) goes away. In my experience, a lot of people in the military with a depression diagnosis tends to be Adjustment Disorder. The PT almost always ceases to display depression symptoms once their contract has expired. This is why (I believe) people tend to say, "Just cheer up, man. It's not that bad!" Others will see that changing something (smiling, going to a movie, visiting friends) can cure a case of the blues. Note that I am not minimizing the effects that the depressive mood can have on person with Adjustment Disorder. I am just highlighting the difference between Major Depressive Disorder (change the situation, relatively same symptoms) and Adjustment Disoder (change the situation, no symptoms).

themgt 10y ago

The problem with using a purely neurochemical explanation like this is the rates of these disorders differ dramatically between societies and within societies geographically, demographically and over time. It is clear that the United States in particular is, especially in recent years, churning out unprecedented numbers of severely psychologically ill individuals. The idea this is solely due to previously undiagnosed individuals or otherwise not representative of a sickening society is difficult to support. Frankly we have spent too long acting as if mental disorders could not possibly have anything to do with ones surroundings, upbringing and life in general, when it's beyond obvious that they have very much to do with those things, as well as genotype/phenotype/etc. We've used this idea that it shames individuals to suggest that the actual problems they deal with could contribute to mental damage in much the manner they can physical damage, which is simply dogma masquerading as science. In fact, using purely neurochemical explanations denies people's humanity and lived experience, denies that we are sentient humans not some organic robots that need an serotonin oil change and some dopamine transmission fluid.

dilemma 10y ago
Medication is essentially victim blaming by society unto the individual reacting against its conditions. And the medical health specialists are agents of society, not the person they're ostensibly helping.
- pzone 10y ago
  Not trying to contradict you, but it's also one of the precious ways offering a shot at helping people overcome depression.
sowhatquestion 10y ago
> It is clear that the United States in particular is, especially in recent years, churning out unprecedented numbers of severely psychologically ill individuals. Is it clear? Or have we gotten better at diagnosing conditions that people have been experiencing all along? (Not to mention reducing stigma and making people more likely to admit to having these conditions.) In any case, citation needed.

lotyrin 10y ago

I disagree, this is pretty different from depression-is-just-sadness. The article is not shortcutting to a non-solution, it's pointing out that there can be overlooked root causes beyond the symptom, and this can be a very valuable thing to point out to people, leading to actionable solutions to their problem. I was diagnosed depressed for many years, and it turned out I simply had the expected affect given I was not socializing enough, exercising enough, or sleeping well enough given an undiagnosed case of sleep apnea and a bit of a spiral from obsessing about trying to stay employed despite that affect. Talking myself in circles, messing around with serotonin, none of this got me anywhere because it wasn't solving the actual problems. I didn't need any of that, I needed a machine that pushes air into my face at night and another one that pulls a belt below my feet in the morning, but the professionals I visited failed to prescribe these. People have no basis of comparison when it comes to their direct subjective experience with long-lived habits so someone who exercises regularly can say "if I couch-potato too hard, I'll start to feel gross", but someone who doesn't can't as easily observe "I feel gross all the time because I never exercise enough". Likewise with hygiene, regular social exposure, sleeping properly, eating properly. It's important to think of mood as a complex function with many inputs and a good amount of feedback and delay. Certainly it can be the case that depression is its own root cause, and one should not reject talk therapy or prescriptions to help with it, but I definitely recommend people search for something they may have overlooked. Maybe there are good psychiatrists and therapists which will find these kinds of things, but I haven't met any. Patients should be aware they need to consider them.

oconnore 10y ago
> I didn't need any of that, I needed a machine that pushes air into my face at night and another one that pulls a belt below my feet in the morning, but the professionals I visited failed to prescribe these. What sort of therapy is that?
- DanBC 10y ago
  Air in face is APAP for sleep apnea. Belt under the feet is a treadmill for exercise.

deleted 10y ago

[deleted]

Fordrus 10y ago

Let me just take a moment to register monumentally huge agreement with your modification of the the metaphor at hand. The problem here is that huge numbers of other people are living in almost exactly the same circumstances - or ones that are objectively worse - and they register no depression. And here, by objectively worse, we're talking, risk their lives daily on a shoestring lifestyle that barely keeps them from not having a roof over their heads and rice or beans enough not to starve to death. Do those who risk their lives have something the comparatively wealthy depression cases lack? Are the kinds of pressure the relatively wealthy depression cases experience particularly likely to create this kind of response? What's the difference? What's the root cause?! If we had actual, good root causes, then we'd be golden, but the problem, the HUGE PROBLEM that the paradigm espoused in the article faces, is that we DON'T have a kind of 'smoking gun' need that is not being fulfilled for people with depression. MANY, MANY people with deep depression really do have fantastic lives compared to those who suffer no depression- and moreover, admonishing people with depression to 'figure out what need is being unfulfilled in your life, and fill it' is highly toxic advice, at least in its way- based on my experience with depressed individuals, if you effectually tell depressed people to figure out what's wrong in their life and fix it- well, it's one way to obliquely encourage suicide.

danharaj 10y ago
Different people have different needs. There is no standard for what an awesome life is. Having an awesome life in some ways can still be miserable in other ways, and only for particular people. An "fantastic life" where one is depressed is not fantastic. Psychological diversity is a precious resource, and a society that is too inflexible to accommodate those who are particularly sensitive or have exceptionally different needs is a bad society. Depression and anxiety, and a host of other mental disorders for that matter, are an epidemic in too many countries, too many countries that are supposed to have high quality of life. > if you effectually tell depressed people to figure out what's wrong in their life and fix it- well, it's one way to obliquely encourage suicide. Kind of a straw man don't you think?
- Fordrus 10y ago
  No, I don't think it's a straw man at all, I think it's absolutely correct in the sense that severe depression at a clinical level virtually precludes people just "figuring out what they're missing" or excising the things that suck from it - it will feel literally the same as when people assert that those suffering depression need to "buck up and face life." I'm saying that your assertion that it might be a strawman is indicative of a deep, insidious skew to your worldview on the matter - seriously. I think this is all excellent advice for healthy people who have NOT fallen into clinical-level depression, but once depression has asserted itself, this immediately becomes horrible advice that, similar to "just get over it," encourages those who are depressed to take the most direct route to relief of their symptoms (suicide).

stephenboyd 10y ago

The author makes his point clearer in his follow-up article: https://www.psychologytoday.com/blog/theory-knowledge/201603/clarifying-the-nature-anxiety-and-depression https://www.psychologytoday.com/blog/theory-knowledge/201603... His position is that investigating the practical causes of depression and anxiety should be the first approach to diagnosis, not that it should be the only approach. It's not that cases of depression without another cause don't exist; he's just saying those cases are less common. To compare it with physical pain, saying that most cases are symptoms of something else doesn't mean that the pain shouldn't be treated, nor that cases of unknown or genetic origin would be any less legitimate.

tim333 10y ago

>it's just repeating the old ideas that depression and anxiety are the same as temporary sadness His main argument seems to be that depression is a symptom of mucked up relationships. Googling "depression symptom relationships" his is the only article arguing that in the first 40 results. So it seems at least somewhat original.