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Depression's Upside - Jonah Lehrer, NY Times


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Depression's Upside, Jonah Lehrer

 

Does anyone know this Psychiatrist? Interesting theories.

 

ANDY THOMSON IS a psychiatrist at the University of Virginia. He has a scruffy gray beard and steep cheekbones. When Thomson talks, he tends to close his eyes, as if he needs to concentrate on what he’s saying. But mostly what he does is listen: For the last 32 years, Thomson has been tending to his private practice in Charlottesville. “I tend to get the real hard cases,” Thomson told me recently. “A lot of the people I see have already tried multiple treatments. They arrive without much hope.” On one of the days I spent with Thomson earlier this winter, he checked his phone constantly for e-mail updates. A patient of his on “welfare watch” who was required to check in with him regularly had not done so, and Thomson was worried. “I’ve never gotten used to treating patients in mental pain,” he said. “Maybe it’s because every story is unique. You see one case of iron-deficiency anemia, you’ve seen them all. But the people who walk into my office are all hurting for a different reason.”

 

For Thomson, this new theory of depression has directly affected his medical practice. “That’s the litmus test for me,” he says. “Do these ideas help me treat my patients better?” In recent years, Thomson has cut back on antidepressant prescriptions, because, he says, he now believes that the drugs can sometimes interfere with genuine recovery, making it harder for people to resolve their social dilemmas. “I remember one patient who came in and said she needed to reduce her dosage,” he says. “I asked her if the antidepressants were working, and she said something I’ll never forget. ‘Yes, they’re working great,’ she told me. ‘I feel so much better. But I’m still married to the same alcoholic son of a *****. It’s just now he’s tolerable.’ ”

 

The point is the woman was depressed for a reason; her pain was about something. While the drugs made her feel better, no real progress was ever made. Thomson’s skepticism about antidepressants is bolstered by recent studies questioning their benefits, at least for patients with moderate depression. Consider a 2005 paper led by Steven Hollon, a psychologist at Vanderbilt University: he found that people on antidepressants had a 76 percent chance of relapse within a year when the drugs were discontinued. In contrast, patients given a form of cognitive talk therapy had a relapse rate of 31 percent. And Hollon’s data aren’t unusual: several studies found that patients treated with medication were approximately twice as likely to relapse as patients treated with cognitive behavior therapy. “The high relapse rate suggests that the drugs aren’t really solving anything,” Thomson says. “In fact, they seem to be interfering with the solution, so that patients are discouraged from dealing with their problems. We end up having to keep people on the drugs forever. It was as if these people have a bodily infection, and modern psychiatry is just treating their fever.”

 

This line of research led Andrews to conduct his own experiment, as he sought to better understand the link between negative mood and improved analytical abilities. He gave 115 undergraduates an abstract-reasoning test known as Raven’s Progressive Matrices, which requires subjects to identify a missing segment in a larger pattern. (Performance on the task strongly predicts general intelligence.) The first thing Andrews found was that nondepressed students showed an increase in “depressed affect” after taking the test. In other words, the mere presence of a challenging problem — even an abstract puzzle — induced a kind of attentive trance, which led to feelings of sadness. It doesn’t matter if we’re working on a mathematical equation or working through a broken heart: the anatomy of focus is inseparable from the anatomy of melancholy. This suggests that depressive disorder is an extreme form of an ordinary thought process, part of the dismal machinery that draws us toward our problems, like a magnet to metal.

 

But is that closeness effective? Does the despondency help us solve anything? Andrews found a significant correlation between depressed affect and individual performance on the intelligence test, at least once the subjects were distracted from their pain: lower moods were associated with higher scores. “The results were clear,” Andrews says. “Depressed affect made people think better.” The challenge, of course, is persuading people to accept their misery, to embrace the tonic of despair. To say that depression has a purpose or that sadness makes us smarter says nothing about its awfulness. A fever, after all, might have benefits, but we still take pills to make it go away. This is the paradox of evolution: even if our pain is useful, the urge to escape from the pain remains the most powerful instinct of all.

 

Another interesting article I'll link here until I review:

 

http://jandersonthomson.com/wp-content/uploads/2009/10/Fisher_Thomson.pdf

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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And, if escaping from the pain remains the "most powerful instinct of all", why don't more depressed people try harder to get well? For me that would be exercising, socializing, getting more involved in life, seeking various therapies that I've never tried but have thought about, and on and on... somehow, this doesn't make sense to me.

 

 

Charter Member 2011

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James Anderson Thomson, Jr., M.D.

1224 West Main Street

Seventh Floor

Charlottesville, Virginia 22903

(434) 296-2801

e-mail: jat4m at virginia.edu

www.andersonthomson.com

 

http://www.jandersonthomson.com/work/cv/

 

~Some interesting publications and teachings from an Evolutionary and Forensic Psychiatry perspective~

(abbreviated list)

 

TEACHING

2002–present “Bad Brains,” one month, fourth year University of Virginia School of Medicine elective in forensic psychiatry, with Barbara Haskins, M.D.

1999–present Annual series of lectures on psychopharmacology—psychology internship program, Counseling and Psychological Services, University of Virginia Student Health Services

1979–present Supervision of Psychiatric Residents, out-patient psychotherapy cases

 

RECENT INVITED PRESENTATIONS

 

The Upside of Down: Depression as an Adaptation to Solve Complex Social Problems -

Grand Rounds, Department of Psychiatry, Drexel University College of Medicine,

Philadelphia, PA., September 23, 2010.

 

Placebo Is Not a Four Letter Word: The Evolution and Neuroscience of the Placebo

Response – Grand Rounds, Department of Psychiatry, University of Virginia School of

Medicine, March 10, 2009.

 

The Comedy of Errors: The Use of Humor in Psychotherapy – Grand Rounds, Western State

Hospital, Staunton, Virginia, December 6, 2006.

 

Mad, Bad, or Sane: The Dynamics of Suicide Terrorism – Grand Rounds, Department of

Psychiatry, Drexel University College of Medicine, Philadelphia, PA.,

March 23, 2006.

 

Everything You Ever Wanted to Know About Prozac but Were Too Depressed to Ask:

Update on Psychopharmacology – Central Virginia Academy of Clinical Psychology,

Three Hour Workshop, Charlottesville, Virginia, June 11, 2005.

Edited by Altostrata
masked e-mail address

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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And, if escaping from the pain remains the "most powerful instinct of all", why don't more depressed people try harder to get well? For me that would be exercising, socializing, getting more involved in life, seeking various therapies that I've never tried but have thought about, and on and on... somehow, this doesn't make sense to me.

 

He advocates psychotherapy strongly before meds. He isn't saying that the underlying problem shouldn't be addressed but that depression is a signal, like fever, that there is a problem to be addressed and that the depressive state and withdrawal enhance our concentration to solve the problem. ADs, he theorized, may mask the problem, dulling us into non-action like the woman who didn't divorce the alcoholic *** husband. Then she had even greater problems to deal with b/c the ADs left her complacent and unable to take action. This is all my paraphrasing, although I can relate to the accumulated baggage - "I got alot of luggage in my name...". :unsure:

 

There are different perspectives and opposing theories in full article. Rumination is the flip side of the enhanced concentration and problem solving.

I just pulled out a few points from the main story so please don't judge based on my exerpts. It's food for thought from 'the other end of the spectrum'. As with anything, the 'truth' or rational approach is likely somewhere in the middle.

The one Forensic Psychiatrist I've heard venture an opinion on SS/NRIs said this same thing: that serotonin just dulls and causes us to not care about things. In a criminal setting (which this one is in), that is an understandable use. He believes the meds are way overused in community/non forensic setting.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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This is a very interesting article Barb. I always like to see the flip side of things. I believe there is always a silver lining, even if we haven't found it yet.

Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.

Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)

My Paxil Website

My Intro

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ADs, he theorized, may mask the problem, dulling us into non-action like the woman who didn't divorce the alcoholic husband. Then she had even greater problems to deal with b/c the ADs left her complacent and unable to take action.

 

*Yup.

 

 

 

As with anything, the 'truth' or rational approach is likely somewhere in the middle.

 

 

 

*Yup.

 

 

The one Forensic Psychiatrist I've heard venture an opinion on SS/NRIs said this same thing: that serotonin just dulls and causes us to not care about things. He believes the meds are way overused in community/non forensic setting.

 

*For sure!

 

 

Charter Member 2011

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Please guys, mask any e-mail addresses you post, unless you wish spam on that person!

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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I must have missed something. There are emails on most studies.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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  • 2 months later...
  • Moderator Emeritus

I noticed this dulling of my wits when I was on Lexapro. Things that would normally be upsetting weren't, and I worried that problems would grow because it was so easy to ignore them. It was truly a happy pill for me - until the stress level dropped at my retirement. After that it was like being on speed of some sort.

 

Now I'm more like my former self, two months off of the drug, but I'm still having withdrawal symptoms - hypersensitivy to light and sound, insomnia, irritability, digestive upsets. I could barely stand being in A.C. Moore a week or so ago. There were so many young mothers with noisy kids it was hard to pick out what I wanted and go through checkout rather than leaving the store with nothing. (I think A.C. Moore is an East Coast thing, so for those of you who live elsewhere, it's an arts and crafts store.)

 

Drugs are drugs, whether you got them from the friendly neighborhood pusher or your doctor.

Psychotropic drug history: Pristiq 50 mg. (mid-September 2010 through February 2011), Remeron (mid-September 2010 through January 2011), Lexapro 10 mg. (mid-February 2011 through mid-December 2011), Lorazepam (Ativan) 1 mg. as needed mid-September 2010 through early March 2012

"Never attribute to malice that which is adequately explained by stupidity." -Hanlon's Razor


Introduction: http://survivingantidepressants.org/index.php?/topic/1588-introducing-jemima/

 

Success Story: http://survivingantidepressants.org/index.php?/topic/6263-success-jemima-survives-lexapro-and-dr-dickhead-too/

Please note that I am not a medical professional and my advice is based on personal experience, reading, and anecdotal information posted by other sufferers.

 

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