Looking for literature on depression
I've suffered from depression and anxiety disorders for a while now. I take medication daily and I am seeing a therapist. However, I feel that I should know more about the disease. I think it would be useful for when I'm talking to my therapist and psychiatrist for example.
Recently I had a healthy debate with my therapist because she believes I am too young to be dependent on meds and that I should aim to get out of them long-term. I explained her that before I started taking drug mix that (kinda) works for me, I was falling into an abyss. I couldn't function, I couldn't be independent. And, with my current knowledge and experience, I think I will be a chronic user of medication.
So I got the impression (I might be wrong on this and we will discuss it more in the future) that my therapist believes in some kind of separation of the brain from the biological world. For example, if someone is diagnosed with a heart disease and starts taking meds, no one bats an eye. When it comes to psychiatric drugs people get concerned. I am skeptical of this double standard.
I also believe that the current umbrella of depression will be revised in the future. I think for some people it is caused by a life event but for others, the brain just isn't working well and we can't (yet) identify a source for the depression. My therapist doesn't like this theory. She thinks that it all comes down to your emotional and behavioral landscape, both in the present and in the past. Now, I know that the brain is a "special" organ because, unlike the heart, we use it to think and feel. So there is definitely SOME relationship between depression and what you feel and act, but I think that is a simplistic way of seeing things. I have done brain exams before and nothing was found. But did someone test my brain chemistry for example? No. So There is probably much more to learn with regards to the disease.
So I guess this was a long way of reaching my request: I am looking for up to date and thorough literature on depression, mostly on it's causes, treatments and current undergoing research. I want to be more informed so that I can better communicate with my caregivers. I want to know what the hell is wrong (at least, most likely) with me. I want to know that there is hope in current research.
This literature can be books, papers or another medium.
I would like to finish by saying that I like my therapist a lot and the objective of this post is not to bash her. It's about explaining the context for my request.
Thanks.
I went through a TGC course (book) on cognitive behavioral therapy that I liked a lot. It alternated between theory and implementation with patients, and it had a lot of references to literature/worksheets.
My notes (and some of the referred literature) from what it said on depression and medication were:
The source of depression doesn't preclude it from being treated with therapy, it just means that some therapies that would focus on addressing those specific life events wouldn't be relevant.
For instance, your brain might "not work well" by being more inclined to anxiety, or you may have those issues because of an abusive relationship. In both cases you might treat the anxiety with drugs (benzos or anti-depressants), with behavioral interventions (avoiding anxiety-inducing situations), or with cognitive interventions (reality testing, relaxation techniques, somatic quieting).
Mind-body dualism is arguably a dead theory. There are plenty of examples of how the mind is what the brain does, and many people may need to be medicated for life. Radiolab had a nice piece on such a person who needed lithium.
That said, I think therapists bump into something of a paradox. There are many reasons to believe people don't ultimately have free will (or that there are limits on therapy adjusting brain chemistry/organization), but outcomes for people that believe they have agency/control over themselves are better than those that don't.
Not knowing your therapist, I think a charitable view of a lot of therapists in similar situations is that they want to avoid a sort of psychological dependence on medication because it may interfere with you cultivating a belief in your own agency. They want to try interventions that won't require lifelong medication first.
Best of luck!
I agree with you about my therapist and we did talk about it a bit. If I believe the therapy works, then it is more likely it will work.
I'm now on a 3 day rut where I can barely do anything so yes I am skeptical of non-medication treatments for my particular case. I will still go to therapy because I think understanding myself is of great value.
I think a healthy way to treat medication is that of a crutch. When you can't walk because your legs are injured you get one to help you walk. Then you go to therapy to relearn how to walk and to train your muscles and support structure to be able to walk without that crutch. Without a crutch, it can be difficult to attempt to walk or to build those muscles.
However, recognition of drugs as a crutch must also simultaneously come with the recognition that some people are born in different bodies and some people may never be able to walk without a crutch. Whether they decide to walk with a crutch for the rest of their lives or whether they decide to get a wheelchair instead or operate in a walking world without themselves walking, is a personal choice. A medical professional should be there to assist you in reaching your desired state, whatever it is.
I think it's appropriate to push back on your therapist and let them know that you're in a rut and you're not feeling like you're able to devote the time or mental energy towards therapy and would like the assistance of a medication that makes it easier.
Cognitive Behaviour Therapy has a good evidence base. People tend to find that a combination with the right meds is more useful for them. Personally, I detest therapists who tell people to come off meds. They're clearly working well outside their competence.
https://www.rcpsych.ac.uk/mental-health/problems-disorders/depression
https://www.rcpsych.ac.uk/mental-health/problems-disorders/depression-and-men
https://www.nice.org.uk/guidance/cg90
The evidence section for the NICE guidance has a lot of technical detail: https://www.nice.org.uk/guidance/cg90/evidence
The third link you provided is quite nice because it tells you when the info was last updated and when a new update is expected to occur. The kind of thing I'm looking for in order to keep up to date.
I've been under treatment for almost 20 years. I have been through all that. Sure, it can be helpful to get scientific information regarding depression, the brain, etc. But that won't give you much solace. It's like reading an anatomy book to cure a broken leg.
It is advisable to be with a therapist that works in consonance with the psychiatric treatment, and not against it. It would be quite irresponsible to take you off meds that they did not prescribe since psychotherapists are generally not qualified to manage the severe consequences such a radical change could have. That's probably reason enough to seek another professional.
And after 20 years, how are you doing? How were you treated or are being treated?
This question requires a long, intricate response. Please forgive me for being concise instead, anxiety takes the best of me these days. If you're still curious after reading this comment, I'd be happy to answer more specific questions. They're easier to answer.
Before starting treatment, I spent at least a decade with something my doctor at the time called a "sub-depression", a state is not depression itself but prepares the terrain for it, so to speak. The word melancholy comes to mind.
I remember spending time at a girlfriend's very high apartment with huge windows and thinking non-stop about throwing myself out of the window, the image of my falling body vivid on my mind. It's crazy that I could have these thoughts without realizing I was sick.
Years later I was with another girlfriend. She was moving to another state for a medical residence. I didn't have a penny on me and decided to go to said state ahead of time to try and get a job and stay with her. I couldn't find any job. There was some work available, but I was stupid, proud, and arrogant, and wouldn't accept anything I believed was beneath me. After two weeks, suicide was my only thought. I tried purchasing medication to kill myself by overdose, but the pharmacist wouldn't give it to me without a prescription (thank you, Mr. Pharmacist! I wouldn't be here without you :*).
I had no choice but to swallow my pride and admit that I needed help. I had no money to spare, so I waited for the day of my return ticket. I was afraid I would commit suicide if I went out, so I barely left my bedroom for the next two weeks and cried every day in the shower. When I got home, I went from the airport straight to the psychiatrist. I read some pamphlets in the waiting room about depression, and I had every single symptom described there. The doctor was nice, prescribed me some strong stuff that I needed.
The problem was that my correct diagnostics is/was not depression, actually, but rather bipolar depression. And, if a bipolar is not taking a mood stabilizer, antidepressants often cause manic episodes. And that did happen a lot. It would take a few hours for me to describe all the craziness that ensued for many many years. So I won't :P. Suffice to say, after starting on lithium I became a much better human being.
I also have ADHD, which causes me way more problems than bipolar disorder nowadays.
I'm doing fine. Not excellent, but fine. My main difficulty now is not living, but being a productive member of society.
My darkest days are definitely behind me, but, barring some unforeseen development of modern psychiatry, I will require medication and professional supervision till the day I die. I am now in my third doctor, and he is great. He's kind of a geek, doesn't rely much on subjective impressions. Everything with him is about actual symptoms, he will interview me to understand all the details of my feelings and behavior in order to determine the treatment. Because of that, his success ratio is much greater than other doctors. It is not easy to find a great psychiatrist, at least in my region.
I also do psychotherapy, which is essential for my well-being. I don't think psychotherapy can actually address most of my symptoms, but it helps to deal with their psychological and existential implications. And that is very important.
Regarding psychiatric medications themselves, they are often necessary but they do take a toll on our bodies. They have side effects, weird effects, and many are not cheap. I do not encourage someone to take psych meds without a strong need and medical supervision -- like some people do for recreation, or to ace a test. They're advisable when required for you to survive and function as a happy productive human being. By all means, if you really need it, do take those meds. They can literally save your life, or make it way more bearable. But, if you think there are other options, maybe in some cases it is worth exploring them first.
Could you elaborate on what your current issues are? I feel we are kind of on the same page as I also struggle with being a productive member of society.
I'm much better than I used to be a few years ago. And, like you, a good psychiatrist was the answer.