Depression. iv b: “All that glitters is not gold”.

Antidepressant drugs, as we have already seen, are basically designed to target and to deal with biogenic or chemically-induced, depression. Notice that although Angela (see my most recent blog) felt low and “depressed”, as she described it, “most of the time”, it did sometimes lift in the evenings and when receiving company. In other words, she was not experiencing depressed mood and sadness incessantly and unremittingly. Nor – as became increasingly more evident from our conversation – was she devoid of a sense of warmth or joy or pleasure in life. (Remember these two key symptoms of biogenic or chemically induced depression?) It therefore seemed highly probable that her depression was not so much biogenic as psychogenic (caused by recent events, happenings and circumstance in life, all of which, nevertheless required prompt attention and ‘treatment’). Sometimes in such circumstances, anxiolytic (anti-anxiety) and sedative type drugs will help, but do remember that at best, they are confined to the relief of symptoms rather than causes. Adjustment, of the kind required concerning Angela’s changed lifestyle, is the domain and function of psychotherapy (using that term in possibly the broadest possible sense) and not drug therapy.

In Angela’s case therefore, it seems likely that behavioural and psychologically orientated approaches might be both preferable and more beneficial. Indeed, it was unlikely – on the basis of fairly substantial experience of depressed patients – that medication in this instance would help at all. In the event, Angela agreed to promptly attend my Cognitive Behaviour Therapy (CBT)• and Relaxation Training clinics, with the desired help and hoped-for improvement very much in mind. As it happened, this suggested course, not only proved to be very successful, but Angela also took renewed confidence from the acquisition of her own ‘on-board’ skills, which she was now able to ‘tap’ into and which would be available to her, on demand, in days to come.

What has been provided here is, in reality, no more than the briefest of resumes on a universally acknowledged human condition, which is almost certainly as old as man himself. Truth to tell, depression is a complex, controversial and in certain ways, obscure and disabling human condition, which at times, is no less baffling than ever it was, being subject as it is to different emphases and interpretations.The increasing evidence of research is unerringly pointing to the conclusion that depression is vastly more than a chemical imbalance. Certainly it is the case that serotonin depletion figures largely and as we have seen, provides a substantial part of the rationale for antidepressant therapy. However, other evidence – for example emerging from ‘state of the art’ brain imaging techniques – is increasingly suggesting that endogenously* depressed individuals at any rate may well be affected by for instance, different regional patterns of brain function. Thus a new and exciting neurobiology of depression is steadily coming to the fore. Moreover – and although in its early stages – this entirely ‘new slant’ on differences in the brain which ‘colour’ our view of the world, e.g. the impact of positive or negative experiences causing us to view things optimistically or pessimistically etc., is also ‘fuelling’ a radical revision of the orthodox “chemical imbalance” view of depression.

“Endogenously” – arising frm within the body; e.g. constitutional effect(s) or a side-effect of drugs.”Exogenously” – arising from outside the body: e.g. the effect on the person of loss though illness; job loss; devastating disappointment etc.

To all Readers.
For some while now, several of you have sought to make contact with http://www.coalfacecaring.com expressing interest in and commenting on the weekly postings. Let me take this opportunity to thank you for your comments and, from time to time, kind words of support/encouragement. I am glad to know that our efforts with the website are proving to be useful and worthwhile. Ideally one would prefer to have in place a regular and direct line of communication. However – and as I am sure you will readily appreciate (being as I now am i. e. in my early ,eighties’ and partially disabled) – this would simply not present a practical way forward. Rather do I perceive what we are attempting here, as amounting to a viable, practical and informed selection of ‘pegs’ upon and around which one might profitably ‘hang’ and assemble relevant, manageable and conducive thoughts. Please note that reference(s) to or quotation(s) taken from these internet publications in any form; must in each and every instance be clearly acknowledged and referenced. See “About”: penultimate para, last line. S.B.

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