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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on August 12, 2006, at 12:55:06
In reply to Is Kramer right?, posted by Dinah on August 12, 2006, at 11:57:21
I am not riding the bandwagon promulgating the notion that exercise is as effective as medication and CBT to treat MDD and BD, but it can be helpful to maintain cognitive abilities.
http://www.dr-bob.org/babble/health/20060610/msgs/675668.html
- Scott
Posted by Dinah on August 12, 2006, at 13:25:01
In reply to Re: Is Kramer right?, posted by SLS on August 12, 2006, at 12:55:06
I probably should exercise for a multitude of reasons.
Although I've had at least three episodes of major depression, I'm officially diagnosed with cyclothymia. While I certainly get very low, it rarely lasts long enough for an AD to take affect.
I do a lot of work managing the stress and anxiety that drive my mood dips. And since two of my bouts of major depression were hormonally driven, I'm trying to be vigilant about perimenopause.
But I have had cognitive difficulties since my bout with postpartum depression. It's hard to pinpoint a cause with the purely physical components thrown in, but it's very discouraging. Provigil helps a bit, since sustained concentration seems to be one of the biggest problems.
I suppose Peter Kramer is trying to make a point, and has the best of intentions. It's just that he's depressing the heck out of me. Perhaps I should take the positive step of walking away from the book. :)
Thanks, Scott.
Posted by SLS on August 12, 2006, at 13:56:43
In reply to Re: Is Kramer right? » SLS, posted by Dinah on August 12, 2006, at 13:25:01
> Although I've had at least three episodes of major depression, I'm officially diagnosed with cyclothymia. While I certainly get very low, it rarely lasts long enough for an AD to take affect.
Lamictal would be an interesting drug for you to try as a maintenance treatment. It acts as a prophylactic against depressive episodes in bipolar I disorder. It might have a similar effect in cyclothymia.
- Scott
Posted by laima on August 12, 2006, at 16:59:40
In reply to Is Kramer right?, posted by Dinah on August 12, 2006, at 11:57:21
I'm no expert, but I've heard a lot about the brain being "plastic" and resiliant. One person who insists it the most is a friend in a psychiatry grad program. The fact that many of us develop toelerance to various medications is, in a twisted way, to me some kind of evidence that perhaps the brain does adapt. I hope Kramer is guilty of being overly dramatic, though I confess I haven't read his book.> I'm reading his book "Against Depression" which seems to deal a lot with the long term irreversible damage done to the brain from depression. It's really upsetting me, as I retain hope that my cognitive fogginess will one day disappear.
>
> Is he overstating the case?
Posted by laima on August 12, 2006, at 17:01:42
In reply to Re: Is Kramer right?, posted by SLS on August 12, 2006, at 12:55:06
Just wanted to add, didn't they just recently discover that adults do indeed grow new brain cells? They used to think that a person had only so many brain cells, and that was it.
Posted by willyee on August 12, 2006, at 17:06:49
In reply to Is Kramer right?, posted by Dinah on August 12, 2006, at 11:57:21
> I'm reading his book "Against Depression" which seems to deal a lot with the long term irreversible damage done to the brain from depression. It's really upsetting me, as I retain hope that my cognitive fogginess will one day disappear.
>
> Is he overstating the case?I know of him but i choose not to read neiter book book the one pro prozac,and con,ir any of those books,but what your saying grabbed my attention.
I have and still do work out very hard,since age 16,i got sick at age 19,i still work out,if im laying in bed ill actualy get out in increments and work out a little,although its a minor rush,its far from any real relieaf.Although id imagine if i werent in good pyhsical shape i doubt i could have taken the stress ive put on my body and the stress the depression puts one me,i owe a lot to my psyhicaly stentgh im sure,more than i prob give credit.
That aside,do you have any type of qoute,or close to,are you saying he is telling us the damage done from depression is ireversable,and thats it ,period?
This is quite a terrifying idea,since you i assume read the book,can you clarify if hes giving any alternatives to healing,or simply and clearly saying the damage is permaneant,regardless of no drugs,excersise,etc.I feel pretty upset hearing a professional think this,scared acutualy.
Posted by notfred on August 12, 2006, at 17:13:57
In reply to Re: Is Kramer right? » Dinah, posted by laima on August 12, 2006, at 16:59:40
>
> I'm no expert, but I've heard a lot about the brain being "plastic" and resiliant.It can be if the depression remits.
Posted by linkadge on August 12, 2006, at 18:03:27
In reply to Re: Is Kramer right?, posted by notfred on August 12, 2006, at 17:13:57
Most of the theory around depression these days seems to suggest that the illness is both the result of, and the cause of specific regional brain atrophy.
I think the main reason for defining the problem as such, is to bring attnetion to the idea that the disease is infact a physical disease who's origins are just as real as those of heart disease etc.
Many of the current treatment modalities have been shown to have a favorable impact on neural placticity, ie they seem to have the ability to produce either repair or to induce compensatory adaptive capailities of the brain.
Some treatments however, seem to produce a greater effect on the disease progression.
Patients with a family history of unipolar or bipolar both show significant reductions in glial density and volumentric reductions in certain areas of the fronatal cortex.
Another consistent finding is reduced hippocampal volume, which can influence sensitivity to stress. Stress in turn can influence the volume of the hippocampus, so it is a catch 22 type of situation.
The brain does have the capability to repair itself, to an undetermined degree, and there are **many** many factors which can infuence the rate of repair and recovery.
Medications are only one tool. Other tools exist such as exercise, diet, mental exertion etc. Active minds are linked to brain growth. Learning itself promotes neurogenesis, as does social interaction. Stress reduction also will have a very favorable impact on neural placiticy.
I could go on and on.
In terms of medications, lithium and valproate are probably the most neuroprotective, and lithium the most neurotrophic, (but it may or may not be wise to choose a medication strictly based on these findings.)
Most antidepressants seem to have the ability to influence neurogenesis.
--------------------------------------------Agents with favorable impact on brain placticity
1. Fish oil, (DHA promotes neurogenesis, membrane integrity etc)
2. Anthocyannins, (agents found in blueberries)
3. Exercise, (growth factor increase)
4. Fasting (fasting enhances neurogenesis and neurorepair)
5. Antidepressants
6. Lithium, depakote,
7. ECT
8. Vitamins, esp: folic acid, b12, vitamin D, Niacin
9. NMDA antagonists, zinc magnesium etc.
10. Hormones, DHEA, estrogen, etc.
11. 5-ht1a agonists, dong quai, ginkgo, buspar,
12. 5-ht2a antagonists, ginkgo, atypicals, TCA's
13. Stress/Cortisol reduction: theanine, vitamin c, phosphatidly serine
14. Social interaction, learning, enriched environment.
15. Statins,
16. Agents capable of increasing BCL-2 expression: melatonin, estrogen, depakote, lithium, zinc
17. Agents capable of increasing BDNF
18. Growth factors: endothelial growth factor, GAP-43, BDNF, GDNF, BCL-2, NGF, NT-3, (dozens)The list goes on and on.
Linkadge
Posted by laima on August 12, 2006, at 18:56:36
In reply to Re: Is Kramer right?, posted by notfred on August 12, 2006, at 17:13:57
> >
> > I'm no expert, but I've heard a lot about the brain being "plastic" and resiliant.
>
> It can be if the depression remits.
Hope so--I'm hoping for that plasticity--if Kramer is asserting that's not possible, I think that would be a tad irresponsable of him. After all, there ARE people who manage to overcome their depression or at least keep it in remission or under control. Again, haven't read any of his books- but I'm bewildered what, other than sensationalism, would motivate anyone to write anything remotely along the lines of 'depressed people are all doomed due to permanently damaged brains'- if that is what he's saying. It almost seems that believeing something like that could in itself be a predictor of staying depressed. I'm more interested to take a closer look at Lindage's list about neurogenesis, and do anything I can, whenever I can manage, to go against atrophy.
Posted by notfred on August 12, 2006, at 19:14:13
In reply to Re: Is Kramer right?, posted by linkadge on August 12, 2006, at 18:03:27
> Most of the theory around depression these days seems to suggest that the illness is both the result of, and the cause of specific regional brain atrophy.
>
> I think the main reason for defining the problem as such, is to bring attnetion to the idea that the disease is infact a physical disease who's origins are just as real as those of heart disease etc.
>
I think we are saying the same thing, Link. Treat the underlying cause and the CNS recovers. Remission is the goal.I like your list. I have been in remission for over 20 years. While I do well on AD's I have found some other things are important, at least for me.
Keep stress low and get good sleep. You produce
some of these factors while asleep & stress has a negative effect on some of these factors:10. Hormones, DHEA, estrogen, etc.
13. Stress/Cortisol reduction:
16. Agents capable of increasing BCL-2 expression:
17. Agents capable of increasing BDNF
18. Growth factors: endothelial growth factor, GAP-43, BDNF, GDNF, BCL-2, NGF, NT-3, (dozens)These are my mainstay supps:
1. Fish oil, (DHA promotes neurogenesis, membrane integrity etc)
8. Vitamins, esp: folic acid, b12, vitamin D, Niacin
9. NMDA antagonists, zinc magnesium etc.I take Lopid:
15. Statins
Posted by notfred on August 12, 2006, at 19:20:35
In reply to Re: Is Kramer right? » notfred, posted by laima on August 12, 2006, at 18:56:36
if Kramer is asserting that's not possible, I think that would be a tad irresponsable of him.
I do not know the specific context for where he said this. But in general I think Kramer sees the brain
as "plastic". At least that is the impression I get from his writings I have read.
Posted by laima on August 12, 2006, at 19:26:51
In reply to Re: Is Kramer right?, posted by notfred on August 12, 2006, at 19:20:35
Oh- I actually don't know what he's saying, since I never read anything he wrote. Neither this book, nor that older one about "cosmetic psychopharmacology" grabbed me. Just gathered a sentiment here that was going in a very bleak direction.> if Kramer is asserting that's not possible, I think that would be a tad irresponsable of him.
>
>
> I do not know the specific context for where he said this. But in general I think Kramer sees the brain
> as "plastic". At least that is the impression I get from his writings I have read.
>
>
Posted by Dinah on August 12, 2006, at 20:36:40
In reply to Re: Is Kramer right? » notfred, posted by laima on August 12, 2006, at 19:26:51
What he's actually saying, to paraphrase as best as I can understand, is that people prone to multiple bouts of depression are people who have a defect in brain repair. That's simplifying it a lot. He refers to it as the "failed resilience model of depression".
"Depression is characterized by frank abnormalities in the nervous system, such as the changes observed by Rajkowska and Sheline. These defects arise from failures in protection and repair of cells in critical brain regions." is one excerpt.
He's clearly familiar with neuroplasticity and the growth of new cells.
On the other hand, I think the one thing we know is that they don't know much yet. I've been listening to "A Short History of Nearly Everything" which is basically a story of science changing its mind an awful lot.
Yes, his point is that depression is a disease, with physical symptoms like other diseases.
I just wonder if he's overemphasizing it.
On the other hand, I don't have the brain I used to. :(
Posted by Dinah on August 12, 2006, at 20:39:19
In reply to Re: Is Kramer right?, posted by SLS on August 12, 2006, at 13:56:43
I'm actually on a very low dose for migraines. I wouldn't mind increasing it, as I haven't felt any ill effects. If I get up my nerve enough, maybe I'll mention it to my pdoc. (I'm more than a bit scared of my new psychiatrist, but there isn't a lot of choice out there.)
It doesn't make you stupid does it? I've lost enough IQ points as it is.
Posted by Phillipa on August 12, 2006, at 21:22:59
In reply to Re: Is Kramer right? » SLS, posted by Dinah on August 12, 2006, at 20:39:19
Dinah maybe now isn't the right time to read this book? Maybe a romance or mystery instead? I know all about the stress thing it's become my life and I don't like it one bit. I won't watch scarey movies either. Love Phillipa
Posted by SLS on August 12, 2006, at 21:46:43
In reply to Re: Is Kramer right?, posted by Dinah on August 12, 2006, at 20:36:40
> What he's actually saying, to paraphrase as best as I can understand, is that people prone to multiple bouts of depression are people who have a defect in brain repair.
As opposed to a defect in brain regulation?
I think the latter is closer to the truth.
- Scott
Posted by SLS on August 12, 2006, at 22:27:29
In reply to Re: Is Kramer right? » SLS, posted by Dinah on August 12, 2006, at 20:39:19
> I'm actually on a very low dose for migraines. I wouldn't mind increasing it, as I haven't felt any ill effects. If I get up my nerve enough, maybe I'll mention it to my pdoc. (I'm more than a bit scared of my new psychiatrist, but there isn't a lot of choice out there.)
>
> It doesn't make you stupid does it? I've lost enough IQ points as it is.It can, but it is infrequent. However, when it does happen, it usually doesn't appear until one reaches dosages of 300mg and higher. 200mg seems to be the average effective dosage for bipolar disorder. No guarantees. You have to try it and see. Lamictal became popular, in part, because it was considered to be relatively free of cognitive side effects compared to the other anticonvulsants. I found that it produced some memory problems early in treatment that dissipated with continued use. I began to experience cognitive side effects at 300mg. At 150mg, I suffer no memory or cognitive impairments at all.
If you have the bad luck to be in the minority, and you find yourself getting really stupid, all you have to do is reduce the dosage. Nobody is going to hold a gun to your head. After being at 300mg for months, my head cleared within 48 hours after reducing the dosage to 200mg. Very few people on Psycho-Babble complain of cognitive side effects with Lamictal.
- Scott
Posted by linkadge on August 12, 2006, at 22:36:51
In reply to Re: Is Kramer right? » Dinah, posted by SLS on August 12, 2006, at 22:27:29
Fortunately, I see that there is going to be a lot of overlap in such research. For instance, parkinsons and alzheimers are two other diseases involving brain cell loss and atrophy.
Emerging drugs with neuroprotective and/or neurotrophic potential, may find their way into the armorarium of doctors for depressed patients.
Linkadge
Posted by laima on August 12, 2006, at 23:08:21
In reply to Re: Is Kramer right?, posted by Dinah on August 12, 2006, at 20:36:40
Now I understand better- makes sense, what he says. And I'm with you, I've been rather dismayed to not quite have the same brain as I did when I was much younger, too. Now I've got some memory of reading an interview with Kramer- he seemed to be arguing against people who romanticized or somehow belittled depression and other mental illness? Is that right? If that is the case, no wonder he would be heavy with his points. Maybe I'll go look for a copy of this book at the library after all.> What he's actually saying, to paraphrase as best as I can understand, is that people prone to multiple bouts of depression are people who have a defect in brain repair. That's simplifying it a lot. He refers to it as the "failed resilience model of depression".
>
> "Depression is characterized by frank abnormalities in the nervous system, such as the changes observed by Rajkowska and Sheline. These defects arise from failures in protection and repair of cells in critical brain regions." is one excerpt.
>
> He's clearly familiar with neuroplasticity and the growth of new cells.
>
> On the other hand, I think the one thing we know is that they don't know much yet. I've been listening to "A Short History of Nearly Everything" which is basically a story of science changing its mind an awful lot.
>
> Yes, his point is that depression is a disease, with physical symptoms like other diseases.
>
> I just wonder if he's overemphasizing it.
>
> On the other hand, I don't have the brain I used to. :(
Posted by laima on August 12, 2006, at 23:09:29
In reply to Re: Is Kramer right? » Dinah, posted by Phillipa on August 12, 2006, at 21:22:59
> Dinah maybe now isn't the right time to read this book? Maybe a romance or mystery instead? I know all about the stress thing it's become my life and I don't like it one bit. I won't watch scarey movies either. Love Phillipa
Phillipa, you may have a good point here.
Posted by SLS on August 13, 2006, at 5:33:45
In reply to Re: Is Kramer right?, posted by linkadge on August 12, 2006, at 22:36:51
> Fortunately, I see that there is going to be a lot of overlap in such research. For instance, parkinsons and alzheimers are two other diseases involving brain cell loss and atrophy.
I still like to think that the atrophy is due to the disuse of neurons not being called upon because of dysregulation and that any cell loss might be due to reactions secondary to the stresses placed upon the system.
> Emerging drugs with neuroprotective and/or neurotrophic potential, may find their way into the armorarium of doctors for depressed patients.
I really don't know what role such specialized drugs will play. They might occupy more of a supportive and maintenance role to drugs that produce more direct changes in neurotransmission. Both types of drugs should act synergistically to produce a more robust healing effect. That's what I would imagine, anyway.
- Scott
Posted by SLS on August 13, 2006, at 5:54:53
In reply to Re: Is Kramer right?, posted by SLS on August 13, 2006, at 5:33:45
> > Fortunately, I see that there is going to be a lot of overlap in such research. For instance, parkinsons and alzheimers are two other diseases involving brain cell loss and atrophy.
> I still like to think that the atrophy is due to the disuse of neurons not being called upon because of dysregulation and that any cell loss might be due to reactions secondary to the stresses placed upon the system.I forgot to say that the reason I like to think of depression this way is that this model renders the atrophy and cell loss as being secondary processes and reversible upon successful treatment. They are not the primary disease process and are not necessary to precipitate the illness. I could be wrong, but this is the way things make sense to me right now.
- Scott
Posted by llrrrpp on August 13, 2006, at 8:41:24
In reply to Re: Is Kramer right?, posted by laima on August 12, 2006, at 17:01:42
> Just wanted to add, didn't they just recently discover that adults do indeed grow new brain cells? They used to think that a person had only so many brain cells, and that was it.
yep, recently it has been discovered that adults add new brain cells to the hippocampus, an area of the brain involved in memory processes, learning spatial directions and regulating long term stress. There are many theories of depression that cite the possible role of the hippocampus in the symptoms and perhaps the cause of depression. People under chronic stress often have a somewhat atrophied hippocampus. Also, it's thought that the SSRI's may induce a change in neural plasticity within the hippocampus (possibly even by adding new neurons to the hippocampus), which might explain why they take weeks to kick in.
-ll
Posted by Dinah on August 13, 2006, at 8:54:45
In reply to Re: Is Kramer right? » Dinah, posted by laima on August 12, 2006, at 23:08:21
Yes, that's him.
I *think* the main point of the book is that our society romanticizes depression and values the symptoms of depression. While it's really a disease that needs to be treated.
Maybe I haven't reached the optimistic part of the book yet.
Posted by llrrrpp on August 13, 2006, at 9:01:39
In reply to Re: Is Kramer right?, posted by SLS on August 13, 2006, at 5:54:53
> > > Fortunately, I see that there is going to be a lot of overlap in such research. For instance, parkinsons and alzheimers are two other diseases involving brain cell loss and atrophy.
>
> > I still like to think that the atrophy is due to the disuse of neurons not being called upon because of dysregulation and that any cell loss might be due to reactions secondary to the stresses placed upon the system.
>
> I forgot to say that the reason I like to think of depression this way is that this model renders the atrophy and cell loss as being secondary processes and reversible upon successful treatment. They are not the primary disease process and are not necessary to precipitate the illness. I could be wrong, but this is the way things make sense to me right now.
>Yes, I agree with this. The other thing that is important to consider is that "stress" is a phenomenon that is dramatically influenced by psychology. That is- two people who undergo the same stressful procedure can have dramatically different physiological reactions, depending on how they were primed to interpret this stressful procedure.
I kind of like to think of the hippocampal-pituitary-adrenal axis theory of depression as follows: Some of us interpret our environments differently, and this leads to increased stress, which leads to physiological changes, eventually affecting the structure and responsivity of the stress system, which then leads to responding to stress differently... and so on.
And of course there are many other areas of the brain that become affected by the out of kilter stress-regulation system, like sleeping, appetite, attention and memory... etc. And these malfunctions also affect how resilient we are to stress.
With such a complicated system, it's nearly impossible to nail down cause and effect. It's also possible to create dramatic changes in behavior and functioning by changing only one part of the system, for instance, by blocking the reuptake of serotonin. Also, the way that the individual interprets his or her enviroment, and reacts to it can be dramatically affected by talk therapy, which in turn can create physiological changes in the brain.
In my experience with depression, I was able to pull out of the first bout with exercise, a major cross-country move and starting a new job. The second bout led me to (my current dabblings in psycho-babble), psychotherapy and psychopharm treatments. I think I'm doing much better since I am able to recognize what I'm feeling and perhaps adjust my expectations and reactions to my environment.
I'm glad that Kramer has decided to interpret depression as an illness. Certainly there are behavioral and psychological components too, but this is true for many illnesses- for example colon cancer. Do we blame people and call them weak and freakish for eating a low fiber low nutrient diet and avoiding regular colonoscopy screenings? Not nearly as much as a depressed person is silently blamed for having brought the illness upon herself and having lack of will power to 'snap out of it'
okay, enough of my ranting.
I'm going to clean my place today. That's my goal. one room at a time.
-ll
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