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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by SLS on April 20, 2023, at 20:55:33
Depression: A Spectrum
There is a spectrum along which different ratios of psychological and biological factors produce a depressive disorder. With people who have a biological vulnerability to depression, a single severe psychosocial stressor, such as the death of a loved one, can trigger a biologically vulnerable brain to stop operating properly. People whose systems are resilient will not remain sad beyond the grieving process, regardless of the severity of the psychosocial stress applied. Depression can also emerge when the stressors are of less intensity, but are present chronically over a long period of time. Quite simply, a vulnerable brain breaks down and must be reset to a more functional dynamic.I think it is helpful to think of the causes of depression as lying along a spectrum of relative contributions. At one end of the spectrum is a depression wherein the only causative factor, and the one that perpetuates the depression, is 100% psychological, and without any contribution by a biological counterpart. At the other end of the spectrum, is a depression for which there is no psychological counterpart. It arises without the presence of psychosocial stress. Most cases of unipolar depression - Major Depressive Disorder (MDD) - are the result of, and dependent upon, a combination of both the biological and psychological. Over some period of time, both contributions feed off each other in what's called a positive feedback loop. Stress leads to depression. Depression leads to a reduced capacity to manage stress, as the depression skews thinking, emotions, judgment, and function in society. More psychosocial stress leads to a greater degree of biological stress that in turn impels a greater degree of brain dysfunction, which in turn...
Bipolar Depression is a different beast with a different set of biological abnormalities that cause it. The depressive symptoms it produces seem to be a hybrid of the symptomatology of the two MDD subtypes: Melancholic (morbid thoughts and weight loss) and Atypical (loss of energy and motivation along with weight-gain). Very often, bipolar disorder emerges at a much younger age than unipolar depression does. Bipolar Disorder can emerge by age 10 without any psychosocial stressors to trigger it. Often, the first symptoms of bipolar disorder in young children is mania rather than depression. Unipolar depression is more often than not the result of combinations of environmental stressors and a psyche devoid of being able to promote healthy and positive thinking.
Regardless of how depression gets started, it is abnormal brain function that keeps it going. This biological fact offers an opportunity to treat the depression biologically. This can include drugs, electro-convulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), ketamine infusions, magnetic seizure therapy, deep brain stimulation (DBS), Transcranial Direct Current Stimulation (tDCS), vagus nerve stimulation (VNS), monitored psilocybin drug treatment, and psychotherapy.
Why would psychotherapy help treat a depression that is driven by a biological anomaly? Since one of the major goals of psychotherapy is to reduce psychosocial stress, doing so will help remove the stress that triggered the depression in the first place. This allows biological treatments to work better and longer.
I hope you found this helpful. With all of the new treatments that have emerged in the last 20 years, you aren't stuck taking drugs that offer more side effects than they do a therapeutic response.
* Just don't listen to anything that Scott says. He'll never understand your pain, and he has absolutely no idea how to get you well.
- Stupid.
Posted by undopaminergic on April 22, 2023, at 12:17:41
In reply to Depression: A Spectrum, posted by SLS on April 20, 2023, at 20:55:33
I don't think you mean to say all stressors are psychological, but your presentation seems to imply that there is a brain/biological *vulnerability* that combines with a psychical *stressor*.
I descended into depression through burnout syndrome from too much work and too little rest. I would consider those to be predominantly *physical* stressors. If my psyche was involved, it was through my demanding too much of myself and my body. I did not have any notable psychosocial setbacks or other events at the time.
-undopaminergic
Posted by Jay2112 on April 26, 2023, at 20:14:27
In reply to Depression: A Spectrum, posted by SLS on April 20, 2023, at 20:55:33
Hey Scott:
I'd argue that the nature/nurture argument has been around since the beginning of human kind, and will continue to be, because there are still millions of questions nobody can answer. As one scientist explained, in a post on cognitive science, our brains just very well might not be smart (and developed) enough to fully comprehend our existence.
But, science still points to a blend of nature and nurture. (Children learn through imitation, and thrive or not, through regulated hormone release. BUT, hormone release can be impaired (type 2 diabetes, for example) by environmental factors.Hormonal regulation relies heavily on glucose metabolism.
Stress alone can trigger diabetes, hypertension, pain tolerance...and even possibly cancer.(Excellent article on links between stress and cancer https://rb.gy/pypmc ) and even possibly sets the stage for dementia.(stress affects the immune system, and cortisol, which seems to be a common denominator in mental health, especially)
I agree ALL mental illness might exist on a spectrum. A lot of what people describe as depression is actually anxiety. We long for the comfort of the womb, and fear and mourn our coming demise. A lot of what schizophrenia looks like involves anxiety impulses and responses, to an extreme. AD(H)D looks like a very bored person, similar to the apathy of depression. Bipolar disorder looks like, in mania, anxiety combined with compulsiveness. The depression looks like flat-out MDD, with sprinkles of other elements.
Jay
This is the end of the thread.
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