Depression

December 14, 2007

Depression in Modern Times

Since depression is perceived in the brain, it makes sense that the pharmaceutical industry has targeted altering the chemicals in the brain that affect mood to treat it. Neurotransmitters are the chemicals that are secreted between the end of one nerve cell and the beginning of the next, thereby creating a connection between the two not unlike an arc of electricity between two wires.

Different parts of the brain are responsible for different actions, and these actions are under the influence of specific neurotransmitters which take an active part in rendering the specific brain activities--from doing math problems to throwing a football, from debating an issue to appreciating Beethoven, from loving to hating.

And from happiness to depression.

Depression is often overlooked, because it's quite normal to be bummed out if you're at the receiving end of some bad news or tragic event.  True pathology, however, must be suspected when depression is inappropriate, out of proportion for a given situation, or chronically present for no reason at all. The mood disorder of depression is different from the psychosis of depression, and it's the mood disorder type I speak of here.

We now recognize depression as a type of imbalance of neurotransmitters, principally one called Serotonin.  But this is an oversimplification.  We still don't understand the brain very well.  While we've scratched the surface in detailing how this neuron connects to that neuron (like the proverbial shin bone connects to the knee bone) and how that connection is activated by neurotransmitters like serotonin, still there is a long way to go before we understand how all of the different, seemingly unrelated parts of the brain still act together as this vague consortium to influence and direct specific areas.

What this means is that although we've made great strides in taking apart the neurotransmitter space between cells and seeing what makes them tick, we still can't address feelings like depression in the multilevel ways this illness deserves.  We know that even seasons or dark rooms can affect depression, so the process is definitely multifaceted.  But even though playing with neurotransmitters is only a solitary way to deal with depression, it nevertheless represents a major quantum leap in treatment.

Treatments

Selective Serotonin Resorption Inhibitors (SSRIs) prevent rapid resorption of serotonin, allowing it to hang around a bit longer in the neurotransmitter area between nerve cells, because once a neurotransmitter is released by a cell, the process of recycling kicks in by resorption.  Serotonin is a "feel good" neurotransmitter.  Nerve cells have receptor sites on them for serotonin to fill, different receptor sites responding by relieving depression.  The serotonin is selectively spared reabsorption at different sites to achieve the desired effects.  (Some serotonin receptor sites affect appetite, so the newer diet drugs like the old defunct Redux and the newer, safe Meridea are drugs which have been prescribed for weight loss.)

Prozac and Zoloft are probably the most popular anti-depressants to have taken advantage of this technology.  Now newer drugs are arriving to add to the list, tweaked in their designs so as to lower the amount of side effects like sleepiness or sexual dysfunction.

The treatment of depression has traditionally been an unintentional turf battle among psychiatrists, family doctors, and gynecologists.  Since women primarily see their gynecologists for the usual check-ups, OBGYN doctors usually are the ones in turf battles with most specialties.  And every time a specialist addresses an illness, there's usually a prejudice to think of a complaint as being related to that flavor of specialty.

For instance, if a woman complains of depression to her OBGYN, he or she will probably "think hormone" till proven otherwise.  But a good OBGYN will not let a patient walk out without wondering whether there is a psychological component or even a medical component, like thyroid disease.

In our practice, we always screen for thyroid dysfunctions before changing any hormones, birth control pills, or prescribing SSRIs.  Once these other causes have been ruled out, we might attempt playing with different hormones in birth control pills for younger women or different types of hormone replacement for women who are menopausal.  If it's not a hormonal problem, easily verified by the trial and error of prescription changes, it then may be time to consider SSRIs.  It's understood that a gynecologist not deal with serious psychosis, for looking at serious depression too casually can lead to the tragedy of suicide.  Such severity bumps the problem exclusively into the psychiatric/psychology arena.

Depression has always been with us, whether it's been the masochism of the downtrodden or the common postpartum blues.  But the safety of the SSRIs have made treatment easy and readily available.  Is there more depression today than hundreds of years ago?  That's hard to answer, because the subjective nature of depression is hard to measure and record.  Perhaps the distraction of leading many lives at the same time (homemaker, wage-earner, party person, etc.) has overwhelmed our ability to stop and smell the serotonin.

 

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