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Aswad -> RE: More Than a Bad Mood: From the Inside Out (12/11/2008 3:56:02 AM)
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ORIGINAL: lovingpet
What makes up a bad emotional experience versus a full on diagnosible problem?
Edit: My reply is concerned with unipolar depression, although I imagine there are commonalities with depressive phases of other conditions. And DesFIP is correct that there is a genetic component, as well as there being definite issues with spending much time in close relationships with people who are affected, but there is also a response which will tend to trigger when certain brain systems are deprived of the feedback they need for proper function, normally associated with a decoupling of effort and response in such a way that things are consistently too negative and without any perceived positive consequences to any course of action, regardless of expended effort.
If you truly wish to comprehend this, there are at least two viable routes:
• Sign up to care for animals that are used in depression research. The animal model of depression shows you the traits you are looking for in humans, the ones that differentiate a bad experience from the conditions we call depression. You can also spend a lot of time living with someone who suffers from chronic depression without anxiety (the anxiety, a very common feature, will just distract you from the core symptoms, and would make it harder to differentiate depression from anxious depression; the latter is usually far easier to treat, as the depression responds to improvements in the anxious thought patterns, which can be realized with CBT or pharmacological interventions).
• If you are licenced to prescribe medications, or your state classifies you as medical personell, then the standards of medical ethics in research that were established after Nuremburg will allow you to experiment on yourself. Enlist the aid of a cardiologist and a psychiatrist to monitor your physical and mental health, respectively. Start on a low dose of reserpine, and slowly titrate it up until your Montgomery-Åsberg score reaches 25-35 or your vital signs contraindicate an increase in dosage. Stay on that dose for a short time, and then taper off. You will experience hypotension throughout the regimen. At some point, clinical depression will set in. Supplement your diet with tyrosine, phenylalanine and 5-hydroxytryptamine for a few days after stopping the reserpine. Then add 10mg/day tranylcypromine. Increase the dose by 10mg/day per two days until orthostatic hypotension sets in. There will be a period of 1-4 weeks from that time until remission has been achieved, after which time you should taper off slowly (no faster than 10mg/day per week, and sleep disturbances indicate you're going too fast). Divide the doses evenly, up to TID, the largest dose given in the evening if you can sleep with that, in the morning otherwise. Dietary restrictions can be relaxed about two weeks after cessation. Supplementation may be useful, primarily tyrosine.
The former approach gives you a point of reference that more closely isolates what you're looking for, but requires the ability to stand by while others are suffering, since that's sort of inherent in animal research. You will probably not want to be present during experiments or result analysis. Being able to bond with the animals somewhat will probably be a plus in terms of noticing the more subtle cues.
The latter approach causes depletion of vesicular monoamine stores, inducing a depressive condition that is usually readily reversed by restoring the same stores, something which is most effectively achieved with a regimen of supplementation and monoamine oxidase inhibition (although the two can't occur at the same time, unless you have access to continuous monitoring, including ECG, as the physical side effects will be significantly exacerbated by the tranylcypromine). There simply is no substitute for first-hand experience, but it is by definition unpleasant, to say the least. Oh, and you'll probably crave chocolate for a while afterwards, and should do it at a stable point in your life, with the support of friends and family. The latter will also provide invaluable data on how your patients' interactions with theirs can be.
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What one considers managable may be considered utter misery to another.
Certainly. At one point, my definition of "tolerable side effects" had the doctor asking me how I had been able to walk unaided to his office, given that most people should be silently expiring from respiratory depression, aspiration and loss of consciousness with the titration rate I had found tolerable. Prior to that, my M-Å score had been in the fifties, on a scale that ends at 60; we switched to that scale because Hamilton's scale doesn't go that far, so there was no means to quantitatively measure the improvement otherwise.
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Is it more in terms of consequences? Action? Perception?
Your questions reveal that you are nowhere near the correct ballpark; in fact, it looks suspiciously like a pool table.
That is not criticism- it is rare to have appreciable insight without first-hand experience or very extensive second-hand experience.
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What are the overall factors that bring you or a loved one to finally seek help?
The realization that I could not provide an acceptable standard of care for my home and those in it.
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What are the things that make this situation no longer bearable?
The onset, and everything that follows, up to the point of remission.
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What things have fed into this (ex.: hormonal shifts, certain illnesses, etc)?
View it as a pyramid between biology, psychology and environment. The three feed into each other, and once something is thrown too far out of whack, you've started a downward spiral, the negative feedback from some factors tearing into the others, rapidly making the situation more difficult to deal with and recover from. In treatment, it is useful to work on all three factors at the same time; the cart is easier to move by pushing on one end and pulling on the other, to use another analogy.
As for specifics about hormones, keep an eye on prolactin and testosterone, at least. Those are part of the dopaminergic regulatory system, which is essential for motivation, drive, perceived costs and benefits of activities, memory, cognitive ability, awareness, acuity, and a number of other critical aspects of functioning. It is not an accident that many instances of drug abuse have started after the onset of a depressive illness; unfortunately, the majority of readily available drugs of abuse tend to have a long-term detrimental effect on biology (monoamine depletion, rebound, desensitization), psychology (learned helplessness, reliance on a crutch, dysfunctional feedback systems) and environment (cost, stigma, legality and social circles). Hence, self-medication is not a route for anyone who isn't licenced to prescribe proper drugs for this purpose, certainly at least not in the west.
Hope this helps.
Health,
al-Aswad.
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