97 replies to this topic

[IMResident]

>The numbers indicate otherwise, the numbers point more towards therapy alone or therapy AND drugs, >but not therapy OR drugs. Drugs only cover up a symptom. Without finding the cause you are just asking >for trouble. That cause could be chemical or could be phychological or both.


I think this is something we can both agree on. Therapy and drugs are equally effective, but only therapy relieves depression in the long term and treats the underlying cause. Many patients however go into remission after drug therapy. By the way, I wasn't aware lactose intolerance is linked to depression, or did you mean fructose intolerance.

Depression is rarely the only symptom of malnutrition. For example B12 deficiency produces megaloblastic anemia before it produces depression. Thiamine deficiency produces paresthesias, angina, peripheral neuropathy. So I guess my point is that when there are physical causes of depression (which is uncommon), they always produce other charatherisitc signs besides just the depression and can be easily identified in the vast majority of the cases.

>Oh, and prove this to me "Most of the time depression is just depression without a physical cause." I bet >you can't. Especially given how little we really do know about the brain and body.

Actually I can prove it. Most patients, about 65-70%, who are depressed improve significantly with their first antidepressant trial or therapy. 35% do not improve significantly with one antidepressant and for these agumentation therapy has been used. Also switching to another class of antidepressants is also helpful. This reduces the number of people who are treatement resistant to about 5% or less. These people (the 5%) usually have physical causes of depression.

[Jestgar]

Therapy and drugs are equally effective, but only therapy relieves depression in the long term and treats the underlying cause. Many patients however go into remission after drug therapy.

Depression is rarely the only symptom of malnutrition. For example B12 deficiency produces megaloblastic anemia before it produces depression. Thiamine deficiency produces paresthesias, angina, peripheral neuropathy. So I guess my point is that when there are physical causes of depression (which is uncommon), they always produce other charatherisitc signs besides just the depression and can be easily identified in the vast majority of the cases.

Most patients, about 65-70%, who are depressed improve significantly with their first antidepressant trial or therapy. 35% do not improve significantly with one antidepressant and for these agumentation therapy has been used. Also switching to another class of antidepressants is also helpful. This reduces the number of people who are treatement resistant to about 5% or less. These people (the 5%) usually have physical causes of depression.

Can you cite references for these?

[mle_ii]

By the way, I wasn't aware lactose intolerance is linked to depression, or did you mean fructose intolerance.

http://www.ncbi.nlm....l=pubmed_docsum
Full text here:
http://www.jpgn.org/pt/re/jpgn/fulltext.00...#33;8091!-1

Depression is rarely the only symptom of malnutrition. For example B12 deficiency produces megaloblastic anemia before it produces depression. Thiamine deficiency produces paresthesias, angina, peripheral neuropathy. So I guess my point is that when there are physical causes of depression (which is uncommon), they always produce other charatherisitc signs besides just the depression and can be easily identified in the vast majority of the cases.

I don't agree, but that's ok.

Actually I can prove it. Most patients, about 65-70%, who are depressed improve significantly with their first antidepressant trial or therapy. 35% do not improve significantly with one antidepressant and for these agumentation therapy has been used. Also switching to another class of antidepressants is also helpful. This reduces the number of people who are treatement resistant to about 5% or less. These people (the 5%) usually have physical causes of depression.

All you proved to me was that Drs know how to cover up problems by taking care of the symptoms with drugs. Something I already know. Plus this is all subjective, perhaps folks just gave up on therapy because they weren't being helped and told the Dr they were cured. Give me a measurement one way or the other and I'll agree, otherwise you can't prove it.

Also, you do know that 2 of the top foods in the american diet are dairy and grains. I bet you also know that those two foods are broken down by the body to produce opioids. What happens when you give someone opoids or take them away, or take them chronically? What organs does this affect? What is this doing to our bodies long term? Can one get addicted to the opioids in these foods? If addicted to these foods does this explain why some folks cannot stop eating them? Is this addiction physical or mental? When this addicted person overeats, gets overweight and then depressed is this physical or mental?

Where does physical stop and mental begin? Again we don't know enough to say.

Mike

[mle_ii]

And here's another. Why do folks get depressed or sad during the fall/winter? Is this physical or mental?

[CarlaB]

Also, you do know that 2 of the top foods in the american diet are dairy and grains. I bet you also know that those two foods are broken down by the body to produce opioids. What happens when you give someone opoids or take them away, or take them chronically? What organs does this affect? What is this doing to our bodies long term? Can one get addicted to the opioids in these foods? If addicted to these foods does this explain why some folks cannot stop eating them? Is this addiction physical or mental? When this addicted person overeats, gets overweight and then depressed is this physical or mental?

A light just went off in my head ... I have felt bad ever since I eliminated casein, which I showed a sensitivity to. So, now I'm off all opiods. Am I feeling this bad for the past three months from withdrawal? Can it take that long?

[jcc]

For example B12 deficiency produces megaloblastic anemia before it produces depression. .

That is incorrect. Are they still teaching that in medical school? It is a dangerous, although common, misperception that keeps people from being diagnosed while their neurologic disease progresses.

Interestingly, hematologic and neurologic manifestations are occasionally dissociated. An inverse correlation in the severity of both manifestations has been suggested. In patients with neuropsychiatric abnormalities, 28% lack anemia or macrocytosis. eMEdicine on Vitamin B12 Associated Neurological Disease

The diagnosis of vitamin B12 deficiency has traditionally been based on low serum vitamin B12 levels, usually less than 200 pg per mL (150 pmol per L), along with clinical evidence of disease. However, studies indicate that older patients tend to present with neuropsychiatric disease in the absence of hematologic findings.5,6 Furthermore, measurements of metabolites such as methylmalonic acid and homocysteine have been shown to be more sensitive in the diagnosis of vitamin B12 deficiency than measurement of serum B12 levels alone.3,10-14

In a large study10 of 406 patients with known vitamin B12 deficiency, 98.4 percent had elevated serum methylmalonic acid levels, and 95.9 percent had elevated serum homocysteine levels (defined as three standard deviations above the mean). Only one patient out of 406 had normal levels of both metabolites, resulting in a sensitivity of 99.8 percent when methylmalonic acid and homocysteine levels are used for diagnosis. Interestingly, 28 percent of the patients in this study had normal hematocrit levels, and 17 percent had normal mean corpuscular volumes. The AAFP on Vitamin B12 Deficiency

Also, you may want to read the full text of this article, 1999, but very good.
Laboratory Diagnosis of Vitamin B12 and Folate Deficiency
A Guide for the Primary Care Physician
Christopher F. Snow, MD
Arch Intern Med. 1999;159:1289-1298.

And from 2006:
http://www.ncbi.nlm....l=pubmed_docsum

Disorders of cobalamin (Vitamin B12) metabolism:
Emerging concepts in pathophysiology, diagnosis
and treatment , Lawrence R. Solomon *

"The spectrum of neurocognitive abnormalities in Cbl
deficiency is broad and the findings on MRI and electrophysiologic
examinations are diverse.36–45 Moreover,
neurologic changes often occur in the absence
of hematologic abnormalities.37,41,45,46 "

"Since cobalamin, methylmalonic acid and homocysteine levels fluctuate and neither predict nor preclude responses to cobalamin, cobalamin therapy is suggested for symptomatic patients regardless of the results of these diagnostic tests."

The differential diagnosis is quite extensive for a physical cause of depression....according to eMedicine on Depression. Let's not forget depressoin can be a side effect of several perscription drugs, as well. You can check the eMedicine on Depression for that.

Not to say that antidepressants wouldn't sometimes help even when there is an identifiable cause, but isn't it usually best to find and treat the underlying cause whenever possible (hopefully resulting in resolution of the symptoms), rather than just treat the symptom~ allowing the underlying disease process to progress?

That isn't to deny that antidepressants can be most useful and necessary for some patients, but how about as a last resort, not a first resort.

IM, Your mother is an adult with a mind of her own, and she was under the care of many physicians for many years. Responsibility for her health decisions lies between her and her doctors...nobody else.

Many of us know all too well how difficult it is to watch loved ones suffer and refuse the treatment we believe would help them. Having an alcoholic mother, I am familiar with this on an intimate level. The bottom line is we have no control over other people's decisions and choices, even when we love them dearly. My young adult daughter also refuses a gluten free diet that I believe would benefit her greatly. I've learned to accept that. Her life, her choice.

I, for one, applaud your mother for getting out and looking for possible underlying causes for her depression and any other symptoms that her doctors were unable to help her with. I'm not convinced she isn't gluten sensitive, or that she wouldn't possibly benefit from a variety of nutritional supplements, but my opinion bears no weight whatsoever in her case.

You said she saw about 10 different doctors in about a year, and all of them told her that she had anxiety or depression. Did she actually refuse treatment for depression, or didn't they offer treatment? And even if she refused treatment she was offered, it was her choice to do so.

My mother refused treatment for her alcoholism for a decade, and until it nearly killed her... three times. She suffered lifelong depression as well, and the doctors were happy to refill her prescriptions for valium and whatever else was popular in her day, but they didn't finally acknowledge and offer to treat the alcoholism (of course they 'knew') until the first time it almost killed her. Depression/ Alcoholism...another chicken/egg scenario.

I think you need to accept that your mother's life and health decisions are her own, and let it go. It is a hard thing to do, but the right thing to do.

Cara

P.S. I saw eight different types of specialists over 3-5 years. My PCP did think I was nuts because I kept coming back with more bizarre complaints, and almost nothing showed up on any of the tests, except maybe my harmless PVC's. In any case, she sent me for a neuropysch evalution, and I went because I had nothing to lose. All of my symptoms were subjective complaints..things I felt, but they couldn't see. Lucky for me, it was THIS doctor who found my B12 deficiency. I also found a new PCP because when I asked WHY I might be B12 deficient, she shrugged her shoulders and said, "some people just are".

[mle_ii]

A light just went off in my head ... I have felt bad ever since I eliminated casein, which I showed a sensitivity to. So, now I'm off all opiods. Am I feeling this bad for the past three months from withdrawal? Can it take that long?

What do you mean by feeling bad? What are your symptoms?

As far as how long, 3 months seems like too long for withdrawal symptoms, but this isn't something I know much about.

Here's more on what I'm taking about:
http://en.wikipedia..../Opioid_peptide

[CarlaB]

What do you mean by feeling bad? What are your symptoms?

As far as how long, 3 months seems like too long for withdrawal symptoms, but this isn't something I know much about.

Here's more on what I'm taking about:
http://en.wikipedia..../Opioid_peptide

Total fatigue. My doc thinks it's adrenal fatigue.

[daffadilly]

Carla are you taking B12?

Mike you have such great posts!!! Thank You

I can see with IMR...'s thinking how the medical profession is unable to do anything but push pills. I wonder what wonderful trip those anti-depressant pill manufacturers take them on? Oh, sorry, I forgot they do not go on trips, they are inconvenienced & have to travel to the conference destination. The hotels in Hawaii have huge conference and banquet rooms that has room for them all.

I have sat thru a few of those meetings myself and there was plenty of money that was spent on the event. Think of being entertained by some King & you get the idea. About 15 years ago the big thing was which drugs all the baby boom women needed to take for hormone replacement and menopause. Wow, those were some great speakers & you could see how their drug could help you alright. I was thinking of them for myself so you know what I did?
I started talking to the doctor's wives & you know which meds they were on?

They were not taking any meds, & remember they get all their meds free, so I thought, hummmm, guess I do not need them either. Thank goodness, after all the ill effects were published 15 years later, I had never taken hormone replacement. A lot of women that took hormones were left a lot worse health wise, or died.

A pity the medical profession seems to get a mind set by the time they get out of medical school. They have so many facts to learn and it seems that they have a set amount of choices for a given situation and are totally unable to think for themselves.

Yes, 36 years ago my doctor laughed at me because I was buying rice crackers for my baby that had diarrhea & yes, he told me that food was not making me sick, "that is just impossible", well I knew it was making me sick, so I quit going to him!!!!

[gfp]

>The numbers indicate otherwise, the numbers point more towards therapy alone or therapy AND drugs, >but not therapy OR drugs. Drugs only cover up a symptom. Without finding the cause you are just asking >for trouble. That cause could be chemical or could be phychological or both.
I think this is something we can both agree on. Therapy and drugs are equally effective, but only therapy relieves depression in the long term and treats the underlying cause. Many patients however go into remission after drug therapy. By the way, I wasn't aware lactose intolerance is linked to depression, or did you mean fructose intolerance.

Depression is rarely the only symptom of malnutrition. For example B12 deficiency produces megaloblastic anemia before it produces depression. Thiamine deficiency produces paresthesias, angina, peripheral neuropathy. So I guess my point is that when there are physical causes of depression (which is uncommon), they always produce other charatherisitc signs besides just the depression and can be easily identified in the vast majority of the cases.

>Oh, and prove this to me "Most of the time depression is just depression without a physical cause." I bet >you can't. Especially given how little we really do know about the brain and body.

Actually I can prove it. Most patients, about 65-70%, who are depressed improve significantly with their first antidepressant trial or therapy. 35% do not improve significantly with one antidepressant and for these agumentation therapy has been used. Also switching to another class of antidepressants is also helpful. This reduces the number of people who are treatement resistant to about 5% or less. These people (the 5%) usually have physical causes of depression.

Define "improve significantly"?
Certainly a large percentage of patients taking psyhctropics change significantly but that doesn't mean they improve. They probably certainly complain less and are probably less assertive with their GP but that doesn't mean they have "improved significantly".

Indeed some classes of anti-depressants carry a fairly well defined increased suicide risk and most of them carry high dependancy risks and withdrawal.

http://www.dailymail...in_page_id=1797

Britain's biggest drugs firm has caved in dramatically and revealed research which shows a leading anti-depressant can cause children to attempt suicide.

In an astonishing u-turn, Glaxo-SmithKline finally published full details of nine scientific studies and two clinical reviews which expose the dangers posed to under-18s who take Seroxat.

Children on Seroxat are twice as likely to have suicidal thoughts than those on a dummy pill, it emerged.

Alarmingly, one study showed six youngsters on Seroxat wanted to kill themselves, compared to just one taking a placebo pill.

The drug was also linked to distressing side effects including hostility, insomnia, dizziness, tremors and emotional irritability.

I think jcc already covered B12 deficiency but

when there are physical causes of depression (which is uncommon)

As Mike said, is SAD physical?
Indeed I find it hard to beleive any cause of depression does not occur due to a chemical inbalance which is physical. Just because we don't understand the physical mechanism doesn't mean its not physical.

100 years ago (and less) we used physical lobotomies and today we use chemical ones.
We are still only incrementally closer to understanding the human brain than we were 100 yrs ago.

Anti-depressants "cure" all sorts of diseases because a patient without the energy to actually get out of bed doesn't continue calling thier GP.

[IMResident]

>Define "improve significantly"?
>Certainly a large percentage of patients taking psyhctropics change significantly but that doesn't mean >they improve. They probably certainly complain less and are probably less assertive with their GP but that >doesn't mean they have "improved significantly".

Improve significantly means a 50% or more improvement in the symptoms of depression as measured by the depression questionaire I think it's called BDM or BDI. This is an objective improvement. Patients actually improve in the assetivness category.

>As Mike said, is SAD physical?
>Indeed I find it hard to beleive any cause of depression does not occur due to a chemical inbalance which >is physical. Just because we don't understand the physical mechanism doesn't mean its not physical.


How do you explain then that psychotherapy is equally effective to antidepressants and cure about 60% of depressed patients. Psychotherapy, for example cognitive-behavioural therapy tries to modify the negative thinking patterns of depression, for example the "I can't do it, so why even try" mentality that is so prevelant in people with depression. A large part of what's going on in the body is controled by the mind. for example sadness, and anxiety or even negative expectations about the future lead to the production of hormones in the hypothalamus/pituitary that have significant detrimental effects on everything from the immune system to the bones.

>I can see with IMR...'s thinking how the medical profession is unable to do anything but push pills. I >wonder what wonderful trip those anti-depressant pill manufacturers take them on?

Although most GPs prescribe pills, there's also psychotherapy, and for people who don't like putting synthetic things into their body there are natural amino acids that are equally potent antidepressants without many of the side effects of tradtional antidepressants, such as SAMe, 5-htp and the herb St. John's Wort.

P.S. I have to confess somtimes I go to drug company lunches.

[CarlaB]

Carla are you taking B12?

Yes, both subligually and in my b-complex.

[ravenwoodglass]

Anti-depressants "cure" all sorts of diseases because a patient without the energy to actually get out of bed doesn't continue calling thier GP.

They don't call from prisons either.

Drugs should be the last resort not the first. Talk therapy can be very helpful for many also, but...... I wasted years in therapy at $160 a pop 2 times a week. The end result being that my shrink pronounced me saner than he was after over 2 years and we then got referred to a endo because because the decision was that I had a metabolic problem. I was diagnosed with a sub illeal seizure disorder and put on meds that sure did 'cure' the depression. I went so manic that in the space of 6 months I left my DH, changed jobs twice, bought not 1 but 3 different cars (the last a clunker cause I wrecked the 2ond thinking I could go for a country drive in an ice storm, real pretty drive not another car track on the roads) and a house that should have been torn down. All on a $10 an hour job. But I wasn't depressed. It's too bad they didn't look for the cause of those seizures, celiac, they just marveled at how a person who consumed lots of fatty food could have such a low cholesteral level. And of course my D was 'normal' and was related to my periods. And just think my childrens experiences with doctor prescribed psychotropic drugs was even worse but I won't go into those.

I repeat, drugs should be the last resort not the first as they commonly are in this country. We are a country that thinks it knows everything and we concentrate on symptom relief and an instant fix. Some things take a little bit of searching and unfortunately the quick reach for a prescription pad, especially with our children is disgraceful.

[whoknows]

OH Pleeeezzz...!!!
I won't even waste my time going to an MD anymore.  After wasting years, feeling like $&*@, and spending $$$$ I've had it.  Countless meds and many many docs who do not listen made my decision easy.   I ordered Enterolabs complete panel today.  When the medical profession has failed and we are forced to take matters into our own hands then someone like Dr. Fine needs to be recognized if for nothing else....the fact that gluten intolerance does exist.  I have been gluten-free for 3 weeks and feeling better each day.    Hopefully IMResident will be a better doc by exposing himself to forums and threads like this one.