Sad, grieving or depressed?
Sad, grieving, or depressed, that is the question. Everyone knows sadness, it has many sources. The frustration of not having what we want or being able to make significant progress toward achieving our dreams or follow through on plans generate sadness. Sadness is a normal reaction and somewhat of a sanctuary until we are ready to try again or change plans.

Grieving is about loss; usually most painfully about the loss of love or a loved one. Even small losses may result in the emotional pain known as grieving. Sadness and grieving respond well to therapy and are most likely to dissipate on their own overtime. These states are often diagnosed inaccurately as depression, they are not. Nor will they respond to antidepressants, because there is no significant chemical imbalance, for the antidepressant to address.

Depression is a whole different thing. Depression may eventually result from multiple underdressed grief and sadness issues that have rotted for so long they have become the homeostatic condition of the biochemistry of individual. In this case antidepressants and therapy are both appropriate. But that’s not the only kind of depression there is. Many people, usually the descendents of biochemically depressed individuals are born biochemically depressed individuals. All the therapy in the world will not do any good. If the person is fortunate they may find antidepressants or a combination of antidepressants that effectively lift their mood and allow them to operate on a whole different, non-depressed, level. These people could also benefit from significant therapy after the depression has lifted, but not until then. Why therapy after the depression has lifted? Because a person who is primarily depressed and has always been primarily depressed will be confronted with whole new ways of being in the world that would benefit from and be supported by a therapeutic relationship. This is the best way to prevent relapse. Rarely is a person who has been depressed for a significant amount of time, that is years or decades, in a financial position to maintain the medication and therapy necessary to stay well.

25 years ago, when I was being treated for depression, I had excellent insurance. I worked for the County of Santa Barbara psychiatric inpatient unit and had access to the best psychiatrist, the best resources. I had the privilege of being a patient of Dr. Joseph Johnson, who would on a weekly basis, spend an hour with me. At that time, that was the standard. I had the best medications and excellent therapy. Consequently, it was one of my most “well” periods. Then came managed care. Dr. Johnson was permitted 15 minutes per patient. He could no longer do psychotherapy; he could no longer even do a decent medication assessment. He went from being a very happy appearing person to being a very frustrated, border on angry appearing, person. Just before resigning from the clinic, he briefly expressed to me that he could no longer work under those conditions, that wasn’t fair to his patients. Nothing has been the same since managed care and as far as I can see none of it is good.

Recently in the New York Times there have been several articles on the inability of antidepressants to address mild and moderate depression. Some of that information is provided in the post just prior to this one. I will be commenting on that for the next couple days. I will say, at this time, the issue of depression has become much too simplistic. Saying “depression” is like saying “cancer”. There are hundreds if not thousands of types, severities and causes. In general, every successful treatment starts with an accurate diagnosis. Spare no cost in getting an accurate diagnosis, it is your life you are wasting if you don’t.

Now here’s the challenge, if I’m treated for a disorder someone needs to get paid. If there is going to be a payment through some type of insurance, there must be an ICD code, specifically a selection from ICD-9 codes 290-319: mental disorders, in the case of a mental illness. This code does not contain sadness or grieving, consequently, anyone who is sad or grieving will be given a depression or anxiety code. We are now comparing apples to oranges in any study and getting poor inaccurate results.
Let’s take a look at this on a very basic level. I’m running antidepressant trial. Included are 6 individuals who are really sad, 10 individuals who are grieving, and 15 individuals who are truly clinically depressed. Just to complicate matters, five of the 15 depressed individuals actually had a bipolar disorder, which is usually first diagnosed as depression. In short form, the result of my trial will be useless. The result of a meta-analysis based on a number of such trials will be just as useless. You begin to see why we have made such poor progress with the treatment of depression in the past 50 years.

The part you do not get to see-my depression:
The back of my head, my neck, my spine feel like they’re in a clamp. I can’t see the windows from where I am lying on the mattress on the floor. I don’t know if it’s day or night. There is a bright light beyond the sliding doors to my room. I can see the light through the crack. I may have been in bed for days. I have no idea. Time doesn’t exist inside my head when I’m this depressed. Except for that crack of light, the rest of the room is black and the pain in my back and neck are becoming unbearable. I have to send it someplace else, separate myself from it. I pull my elbows back and under me and rest my forearms on the bed, forming a high arch between my lower back and the back of the head. I close my eyes and pretend all that energy clamping down on my back and neck is running down my body down my legs out my feet and through the crack in the doors, where it is keeping the light on in the living room. I channel the energy and my neck begins to loosen. I keep channeling and my back starts to relax, the pain is decreasing. I continue to channel the pain away with the energy, until I can pull my arms out from behind me, collapse and sleep some more. Diane

Lifting the Curtain on Depression         By BENEDICT CAREY

via Depression – Reporter’s File – Lifting the Curtain on Depression – NY Times Health.

In Brief:

Each patient experiences depression differently, and the symptoms can vary significantly from case to case.

Available treatments do not work for as many as half of chronically depressed patients.

Researchers have long focused on the role of serotonin, but new therapeutic paradigms are needed.

Recent brain imaging studies may have uncovered surprising targets for intervention.

Depression is no monochromatic black veil, no shared melancholy, as is often claimed. Instead, the disorder is more like a virus that amplifies each sufferer’s particular vulnerabilities, whether anxiety, helplessness, self-doubt, anger or some combination of these. The subjective experience varies from person to person, yet treatment is far from personalized.

Progress has slowed as researchers grapple with one of the most difficult aspects of the disorder: it is impossible to predict who will respond to what therapy, and many sufferers find no relief from anything now available, including medication. While depression appears in many forms, therapeutic options remain worryingly limited.

“We’re at a point where we need to find new treatments, because it’s very clear that the old ones simply don’t work well for many people,” said Dr. Thomas Insel, director of the National Institute of Mental Health. “Our thinking about depression has to change, and it is changing.”

Some people are genetically predisposed to react more strongly than others to life’s inevitable blows. Scientists have traced this susceptibility in part to how the body processes a neural messenger called serotonin, which is linked to mood, and helps cells learn and communicate. For the past 20 years, depression researchers have focused heavily on this connection, both to understand the disorder and find better treatments. A serotonin “deficit” or “imbalance” has become synonymous with depression itself in the public consciousness, an easy catch-all explanation reinforced in drug ads and awareness campaigns.

But it is increasingly clear that serotonin is only one piece of the puzzle. Even when used aggressively by psychiatrists, selective serotonin reuptake inhibitors like Prozac and Zoloft, which prolong the action of the neurotransmitter in the brain, speed recovery in only about half of seriously afflicted patients. In a small number of young people, these drugs seem to backfire, making patients more likely to harm themselves or to think about it.

Indeed, many sufferers of moderate depression may be more likely to recover with talk therapy, particularly cognitive behavior therapy, in which patients learn techniques for defusing their own reflexive, self-defeating thoughts.

Despite the clear need, better therapies for depression have been slow coming. Newer alternatives, like Effexor and Cymbalta, are not S.S.R.I.’s but so-called S.N.R.I.’s; they prolong the activity of a brain messenger called norepinephrine, as well as serotonin. But this extra effect does not seem to make much difference for most patients, and experts consider these drugs to be essentially an extension of S.S.R.I. therapy, not a real departure.

“We really need to find better, more precise targets” for depression drugs, Dr. Insel said.

Assaults on depression based primarily on serotonin have hit a wall, in effect, forcing psychiatrists and researchers to explore entirely new notions about the causes of the disorder and possible options for treatment.

Recently investigators have explored the role of the hippocampus, an area deep in the brain critical to memory formation, in severe depression. They have looked more closely at the activity of the glutamate system, a brain messenger that jump-starts activity along neural networks. And they have used brain imaging to try to pinpoint areas in the brain that flare up or go quiet when people are suffering from spasms of despair.

Brain imaging has already paid off in an unexpected way. In a series of brain-imaging experiments performed at the University of Toronto and at Emory University in Atlanta, Dr. Helen Mayberg, a neurologist, has found that activity in a part of the brain known as Brodman area 25 is strongly associated with the experience of despair.

Brodman area 25 is uncharted territory; before these studies appeared, no one suspected it was linked to depression. But the researchers went one step further, implanting electrodes into the brains of severely and chronically depressed patients in an effort to quiet this area. The results were encouraging. Depression this severe can seem unbreakable, but most of the patients treated — more than a dozen have had the surgery — have improved enough that they have been able to return to work and to reconnect with family, friends and children. Most continue on drug therapy, as well.

It is a radical experiment, but it has made the darkness of depression visible, a first for psychiatry. If there are many different permutations of depression, then imaging techniques like these should soon help doctors differentiate them. Dr. Mayberg’s work already suggests that depression looks different in the brains of people who respond to talk therapy, compared with those who do well on antidepressants.

Scientists also are rethinking the pharmaceutical approach to depression, and in striking ways. Ketamine, a narcotic better known in nightclubs as “Special K,” has shown antidepressant effects in animal studies, but because of its reputation as a street drug it was never taken seriously as a potential therapy.

But last year scientists at the National Institutes of Health reported in a small study that some severely depressed patients recovered within hours after taking the drug intravenously. Most of them remained in improved condition for more than a week. Now the N.I.H. is running a large-scale study to determine how long the therapeutic effect lasts, and in whom.

The sudden scientific interest in ketamine has been criticized as a desperate stab at what has been an unsolvable medical puzzle, the treatment of chronic depression. But there is hope in the paradigm shift that has led to ketamine’s re-evaluation, and a welcome sign of change. The research already has scientists scrambling to find related compounds that don’t have the side effects of ketamine, as well as drugs that could sustain its effects once the initial treatment was stopped.

After reporting results from the 2006 ketamine study, the lead author, Dr. Carlos Zarate, chief of the mood and anxiety disorders research unit of the National Institute of Mental Health, summed up the findings this way: “What the study tells us is that we can break the sound barrier.”

He wasn’t just talking about breaking the hold of a devastating chronic disorder. He was talking about the science of depression itself, which was badly in need of a shake-up.

This kind of thing makes me sick, it makes me afraid of our “experts” and it’s all too typical.  Not only in terms of denial and avoidance of responsibility, but arrogance, dismissal of people in dire need, insensitivity, stigmatization, marginalization, devaluation….I too thought they were full of crap-lazy, avoidant, whiney-until my symptoms started getting worse and worse…

Op-Ed ContributorA Case of Chronic Denial Sign in to Recommend

by HILLARY JOHNSON

Published: October 20, 2009

EARLIER this month, a study published in the journal Science answered a question that medical scientists had been asking since 2006, when they learned of a novel virus found in prostate tumors called xenotropic murine leukemia virus-related virus, or XMRV: Was it a human infection?

Health Guide: Chronic Fatigue XMRV is a gammaretrovirus, one of a family of viruses long-studied in animals but not known to infect people. In animals, these retroviruses can cause horrendous neurological problems, immune deficiency, lymphoma and leukemia. The new study provided overwhelming evidence that XMRV is a human gammaretrovirus — the third human retrovirus (after H.I.V. and human lymphotropic viruses, which cause leukemia and lymphoma). Infection is permanent and, yes, it can spread from person to person (though it is not yet known how the virus is transmitted).

That would have been news enough, but there was more. XMRV had been discovered in people suffering from chronic fatigue syndrome, a malady whose very existence has been a subject of debate for 25 years. For sufferers of this disease, the news has offered enormous hope. Being seriously ill for years, even decades, is nightmarish enough, but patients are also the targets of ridicule and hostility that stem from the perception that it is all in their heads. In the study, 67 percent of the 101 patients with the disease were found to have XMRV in their cells. If further study finds that XMRV actually causes their condition, it may open the door to useful treatments. At least, it will be time to jettison the stigmatizing name chronic fatigue syndrome.

The illness became famous after an outbreak in 1984 around Lake Tahoe, in Nevada. Several hundred patients developed flu-like symptoms like fever, sore throat and headaches that led to neurological problems, including severe memory loss and inability to understand conversation. Most of them were infected with several viruses at once, including cytomegalovirus, Epstein-Barr and human herpesvirus 6. Their doctors were stumped. The Centers for Disease Control and Prevention, the nation’s presumed bulwark against emerging infectious diseases, dismissed the epidemic and said the Tahoe doctors “had worked themselves into a frenzy.” The sufferers, a C.D.C. investigator told me at the time, were “not normal Americans.”

When, by 1987, the supposed hysteria failed to evaporate and indeed continued erupting in other parts the country, the health agency orchestrated a jocular referendum by mail among a handful of academics to come up with a name for it. The group settled on “chronic fatigue syndrome” — the use of “syndrome” rather than “disease” suggested a psychiatric rather than physical origin and would thus discourage public panic and prevent insurers from having to make “chronic disbursements,” as one of the academics joked.

An 11th-hour plea by a nascent patient organization to call the disease by the scientific name used in Britain, myalgic encephalomyelitis, was rejected by the C.D.C. as “overly complicated and too confusing for many nonmedical persons.”

Had the agency done nothing in response to this epidemic, patients would now be better off. The name functioned as a kind of social punishment. Patients were branded malingerers by families, friends, journalists and insurance companies, and were denied medical care. (It’s no coincidence that suicide is among the three leading causes of death among sufferers.) Soon the malady came to be widely considered a personality disorder or something that sufferers brought upon themselves. A recent study financed by the C.D.C. suggested that childhood trauma or sexual abuse, combined with a genetic inability to handle stress, is a key risk factor for chronic fatigue syndrome.

Many people don’t realize how severe this illness can be. It is marked by memory and cognition problems, and physical collapse after any mental or physical exertion. The various co-infections that occur only make matters worse. Many patients are bedridden. And recovery is rare. A significant number of patients have been ill for more than two decades.

Dr. Nancy Klimas, an immunologist at the University of Miami School of Medicine who treats AIDS and chronic fatigue syndrome, remarked in The Times last week that if given the choice she would prefer to have AIDS: “My H.I.V. patients for the most part are hale and hearty,” she said, noting that billions of dollars have been spent on AIDS research. “Many of my C.F.S. patients, on the other hand, are terribly ill and unable to work or participate in the care of their families.”

Congress has appropriated money for research on chronic fatigue syndrome, too, though in far smaller amounts, but the C.D.C. has seemed unwilling to spend it productively. A decade ago, investigations by the inspector general for the Department of Health and Human Services and what was then called the General Accounting Office revealed that for years government scientists had been funneling millions meant for research on this disease into other pet projects.

As public health officials focused on psychiatric explanations, the virus apparently spread widely. In the new study, active XMRV infections were found in 3.7 percent of the healthy controls tested. Roughly the same degree of infection in healthy people has been found in the prostate research. If this is representative of the United States as a whole, then as many as 10 million Americans may carry the retrovirus.

It is estimated that more than a million Americans are seriously ill with the disease. (Not everyone infected with XMRV will necessarily get chronic fatigue syndrome — in the same way that not all of the 1.1 million Americans infected with H.I.V. will get AIDS.)

Hints that a retroviral infection might play a role in chronic fatigue syndrome have been present from the beginning. In 1991, Dr. Elaine DeFreitas, a virologist at the Wistar Institute in Philadelphia, found retroviral DNA in 80 percent of 30 chronic fatigue patients. The C.D.C. went so far as to try to replicate her effort, but refused to follow her exacting methods for finding the virus. In addition, the centers’ blood samples became contaminated, and some people at the agency said that administrators ended the research prematurely. Rather than admit any such failure, the C.D.C. publicly criticized Dr. DeFreitas’s findings.

That episode had a chilling effect on other researchers in the field, and the search for the cause was largely abandoned for 20 years.

Now, Judy Mikovits, the retrovirus expert at the Whittemore Peterson Institute, in Reno, Nev., who led the recent study, has revisited the cold case. Not surprisingly, the institute is private, created by the parents of a woman who suffers from chronic fatigue syndrome. But Dr. Mikovits collaborated with scientists at the National Cancer Institute and the Cleveland Clinic.

When she began her work on this disease in 2006, Dr. Mikovits, a 22-year veteran of the National Cancer Institute, knew little about chronic fatigue syndrome. But she was intrigued that an unusually high number of patients being followed by a Nevada doctor were suffering rare lymphomas and leukemias; at least one had died. And she was also impressed that the doctor, Dan Peterson, had built an extraordinary repository of more than 8,000 chronic fatigue syndrome tissue samples going back as far as 1984.

“My hypothesis was, ‘This is a retrovirus,’ and I was going to use that repository to find it,” Dr. Mikovits told me.

What she found was live, or replicating, XMRV in both frozen and fresh blood and plasma, as well as saliva. She has found the virus in samples going back to 1984 and in nearly all the patients who developed cancer. She expects the positivity rate will be close to 100 percent in the disease.

“It’s amazing to me that anyone could look at these patients and not see that this is an infectious disease that has ruined lives,” Dr. Mikovits said. She has also given the disease a properly scientific new name: X-associated neuroimmune disease.

For patients who have been abandoned to quackish theories and harsh ideologies about their illness for 25 years, the dismantling of “chronic fatigue syndrome” can’t come soon enough.

What shape might the life of a person who has significant anhedonia, who does not recognize or respond to reward, take? Mine seems to have become an exercise in pain avoidance. I recall so many times closing my eyes and seeing myself as a bumper car that bounces off pain. It makes life so random, hitting pain at various angles and ricocheting who knows where, just to repeat that time and again. And then of course I try to avoid the avoidance by avoiding anything I associate with pain. But it doesn’t stop there I go into meta- mode avoid the avoidance I’m avoiding to avoid the pain. After while there are really only two things in the world, avoidance and pain. That doesn’t sound very good and it’s pretty much as bad as it sounds. No direction, lots of anxiety, hyper alert and every decision, appears to me to be some kind of blow, just choices between ways to lose. Sometimes I feel that beat up just by the process of living.
I could buy a house then I’d have a house. If I don’t buy a house I have to continue to live and have my business in rented space. Rented space can be abandoned in a snap. Houses, in any kind of intelligent escape need to be sold and that takes time. Anything that takes time isn’t a proper escape – and I have no idea what I would escape from but I’ve done it many times. Maybe I’m just escaping from feeling trapped.
My dogs are old. I have a home for them more than any other reason. Sometime that reason will be gone. I have to wonder if I’m trying to make a transition by being so concerned that my employee keeps his job. Could I be making him the new reason to keep going? I don’t seem to be able to do hardly anything just for myself. No problem doing for someone or something else -but never for myself.
As you can see I’m depressed again already, it’s Sunday, it’s cold, it’s raining. A little while ago I laid down on my bed and tried to adjust my mind. After that I took the console for the NordicTrack elliptical trainer apart and repaired it. It’s been sitting there for a couple months waiting to get fixed. I’m deciding to feel good about that.

“THE HEDONISTIC IMPERATIVE

A B S T R A C T

This manifesto outlines a strategy to eradicate suffering in all sentient life. The abolitionist project is ambitious, implausible, but technically feasible. It is defended here on ethical utilitarian grounds. Genetic engineering and nanotechnology allow Homo sapiens to discard the legacy-wetware of our evolutionary past. Our post-human successors will rewrite the vertebrate genome, redesign the global ecosystem, and abolish suffering throughout the living world.

Why does suffering exist? The metabolic pathways of pain and malaise evolved only because they served the inclusive fitness of our genes in the ancestral environment. Their ugliness can be replaced by a new motivational system based entirely on gradients of well-being. Life-long happiness of an intensity now physiologically unimaginable can become the heritable norm of mental health. A sketch is offered of when, and why, this major evolutionary transition in the history of life is likely to occur. Possible objections, both practical and moral, are raised and then rebutted.

Contemporary images of opiate-addled junkies, and the lever-pressing frenzies of intra-cranially self-stimulating rats, are deceptive. Such stereotypes stigmatise, and falsely discredit, the only remedy for the world’s horrors and everyday discontents that is biologically realistic. For it is misleading to contrast social and intellectual development with perpetual happiness. There need be no such trade-off. Thus states of “dopamine-overdrive” can actually enhanceexploratory and goal-directed activity. Hyper-dopaminergic states can also increase the range and diversity of actions an organism finds rewarding. Our descendants may live in a civilisation of serenely well-motivated “high-achievers”, animated by gradients of bliss. Their productivity may far eclipse our own.

        Two hundred years ago, before the development of potent synthetic pain-killers or surgical anaesthetics, the notion that “physical” pain could be banished from most people’s lives would have seemed no less bizarre. Most of us in the developed world now take its daily absence for granted. The prospect that what we describe as “mental” pain, too, could one day be superseded is equally counter-intuitive. The technical option of its abolition turns its deliberate retention into an issue of political policy and ethical choice. ”

OKaaaaaay every one has an opinion…        I’m entertained, are you entertained?  There appeared to be more where this came from.   I will read it some day when I am in an alternate mood state.  I offer it now in the name of diversity, perhaps to illustrate the down side of diversity.   Diane

via   The Hedonistic Imperative – Abstract.;

Sometimes I wonder if it’s all about being afraid of feeling good.  I’ve been away for a few days, a few days of trying to have a good time and a few days of trying to get back on track.  I need to overcome some of my reluctance to let anyone in the house hear, what I’m saying, after all they could go online and read it all, but probably wouldn’t.  Some of the turmoil I experience and fast mood swings, accompanied by entirely divergent states of mind are probably much more revealing and interesting ‘fresh’, before I have had the opportunity to try to explain them to myself and adjust them.

I took a friend on a mini vacation to the coast for his birthday.  I found a delightful place to stay called Wild spring, charming cabins set in a forest on a hill above Port Orford, on the Oregon coast. It was an absolutely ideal atmosphere by nearly any standard; rich sumptuous eclectic decor a big bed like a cloud with a thick down comforter, two fat soft upholstered chairs nearly the size of loveseats, candles everywhere, a high A-frame ceiling, lightly embroidered transparent fabric covering the lower half of the Windows only- not to interfere with the view of sunlight streaking down through the forest and in the corner, a small crystal chandelier, the list goes on.  Just out the door to the right a stone lined walking labyrinth had been constructed.  A two-minute walk through the forest and past the main lodge, we enjoyed a huge deep jacuzzi with a wonderful ocean view (which you can’t see in the dark, LOL).  I find I’m enjoying it much more thinking about it than I did when I was there. 

I have to wonder if I enjoyed it as much as anyone would.  I have to wonder if I would be okay if I lived there.  Then I have to come back to reality.  It might be okay to not be able to feel happy, if it didn’t feel like such a huge weight.  I feel like I’m disappointing the whole world, and that’s ridiculous, but I don’t know how to stop feeling that way.

Sometimes I see little glimpses of how I might be afraid to feel good.  It makes it hard to talk, that thought makes me cry a little, like right now.  If I felt good, disappointment, the slide into pain would be longer, the crash harder, the damage more.  Or is that just my rationalization for being stuck in “Everything is nothing”.  However, everything is not nothing, in addition to nothing, all those negative emotions exist and I’m certainly privilege to their full experience.

Many years ago, when I was first in a recovery, from alcoholism, I was involved in a program where everyone was responsible for helping others, as they had been helped.  That was supposed to be one of the keys to feeling well and staying sober.  Under any circumstances, I have always been a great ‘others helper’ and I took the opportunity to help others night and day.  The point of course was to stay sober and I did that.  I followed all the directions to the best of my ability, over and over, but I didn’t feel any better.  Whenever I would try to express some of my distress to other ‘program people’, looking for some kind of direction or help, I would always get the same answer. “Work with a newcomer.”  “Get out of yourself.”  So I worked with newcomers, dozens of them, for years.  As soon as they felt better, I couldn’t relate to them anymore, they had moved on to a different world and I was left behind to find another newcomer with whom to empathize and commiserate.  I stayed sober so I could feel the pain, mine and everyone else’s, with nothing with which to balance it or anesthetize it. After 11 years I became imminently suicidal. I went and got the anti-depressants that were unacceptable in “the program”. The whole thing still makes me feel confused.

I recall having an interview with a psychiatrist at one time.  He asked me if I felt confused.  The question was too confusing for me.  After some time, I said.  “I don’t know.”  I’ll bet he wrote very confused, and he certainly would’ve been correct.  Having everyone around me, appear to be experiencing pleasures and comforts I can’t touch, is a very confusing.