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The Biomedical Engineering blog is the place for conversation and discussion about topics related to engineering principles of the medical field. Here, you'll find everything from discussions about emerging medical technologies to advances in medical research. The blog's owner, Chelsey H, is a graduate of Rensselaer Polytechnic Institute (RPI) with a degree in Biomedical Engineering.

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Treatments for Depression, Part 1

Posted January 05, 2016 12:00 AM by Chelsey H

Did you know that nearly half of Americans are affected by some sort of mental disorder at some point in their life? Suicides, 90 percent of them among the mentally ill, take 40,000 Americans every year and since 2005, the suicide rate among U.S. war veterans has nearly doubled.

At the same time, treatment for mental disorders can be woefully ineffective. Thirty-three percent of patients don't respond to any drugs at all. And when they do work, they are slow - a dangerous risk, given the number of suicides each year.

The treatments don't work well because scientists don't really understand what they do. Serotonin, the most common target for current antidepressants, is a neurotransmitter, a chemical that carries messages in the brain. In early studies of serotonin, researchers thought a lack of serotonin was the cause for many disorders. Iproniazid was the first of a class of medicines (called monoamine oxidase inhibitors (MAOIs)) that block an enzyme from breaking down serotonin as well as dopamine and norepinephrine, two other neurotransmitters. The chief downside of these drugs is that they require a strict diet which often causes patients to not take the drug. Deviating from the diet can cause deadly spikes in blood pressure. Tricyclic antidepressants work by blocking the re-absorption of serotonin and norepinephrine but they come with side effects including, dry mouth, weight gain, erectile dysfunction, and loss of libido.

Research today is starting to find that just adding or subtracting serotonin in a person doesn't change his or her mood. For example, Prozac raises serotonin levels within hours yet doesn't change mood for weeks, and when a healthy person's brain is depleted of serotonin it doesn't make him or her sad. Serotonin is not just a feel-good chemical. As it falls short of explaining depression, a most likely candidate is emerging.

The next article will discuss the effect of stress on the brain and how it relates to depression.

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#1

Re: Treatments for Depression, Part 1

01/05/2016 6:09 AM

Very depressing...

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#2

Re: Treatments for Depression, Part 1

01/05/2016 6:15 AM

Nearly half? As little as that?

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#15
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Re: Treatments for Depression, Part 1

01/07/2016 9:02 AM

Nearly half? As little as that?

They are on the imperial system...1/2 = almost 1 somehow...

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#3

Re: Treatments for Depression, Part 1

01/05/2016 7:31 AM

Mental health is still in the dark ages compared to other practices in medicine.

Unfortunately, psychotropic drugs are dolled out like candy and the side effects are becoming a real problem.

The problems are mostly fueled by:

1. Failure of patient to medicate as instructed
2. Poor processes to evaluate the correct drug and dose
3. Alcohol and drug abuse

The spike in mass murders over the last three decades has a curious association with mental illness and prescribed drugs.

That's not a damning condemnation on psychiatric drugs, but it does raise some questions about treatment, compliance, and substance abuse.

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Re: Treatments for Depression, Part 1

01/05/2016 3:34 PM

About ten years ago, my oldest daughter was having all sorts of 'issues'. She was defiant, rebellious, vindictive, non-communicative, in short being a typical teenager who thought the world should revolve around her and her whims fueled by a society where parents try to be friends to their children and have no spine to set any kinds of limits. Apparently, my wife and weren't cool like the other parents who host under-age drinking parties, co-ed sleep overs and other innocent activities. Believe me, I was not a perfect angel as a teenager, but I knew I had limits and there would have been serious consequences if I ever got caught.

When we discovered she was cutting herself (along with drug use, truancy, promiscuity, etc.), we started down the path of therapists, psychologists and eventually a psychiatrist. We fired the first and last therapist after a few separate and joint sessions because that stupid 'itch thought we should just give in and let her do stupid stuff to get peace in the family. God only knows where she got her PhD because I want to go to that school and jack-slap the dean.

One of the psychologists was mildly helpful for a time, but quickly got to the point where no more improvements were being made so we stopped going there. Next was the psychiatrist. Unfortunately, that doctor thought she could fix all problems with just chemicals. That quack had my daughter so screwed up with meds that even my daughter knew it wasn't right. We have familiarity with psychiatric drugs (SRUI's etc.) that we knew it takes time, many weeks or even months before you can accurately assess the efficacy of these kinds of drugs but this doctor was putting my daughter on different drugs every month.

We got to the point where we just told my daughter that it was time to slowly wean her off these meds by progressively reducing the dosage over time. We stopped going to that quack. My daughter agreed to do that because she was tired of all the side effects of the drugs. We got her off all the meds eventually but she was still nasty. Finally, just before her 18th birthday, my wife caught wind that she was going to sneak away yet again (wonders of electronic snooping) and my wife confronted her and just said, "Why are you trying to sneak away? There's the door, just leave."

It was hard to do, but the right thing at that time. No cell phone, no job, no car, nothing but a few clothes in a gunnysack. We were away about 200 miles away from home at that point, but near some of my wife's family. My daughter managed to contact one of her cousins who would help her get 'home' to her 'friends who cared'. They rode trains, buses, slept on benches in bus stations etc. on their journey back home. We were just horrible parents.

After about three months of bumming around, sleeping on who knows who's couches, scraping by for food and shelter, she decided she was going to join the Army Reserve and get her independence. Apparently it was OK for a drill sergeant to tell her how to wipe her ass, but we couldn't tell her she had to be home by midnight. She told us that because the Army was paying her it was OK.

Long story, short. She talked to a recruiter, took the ASVAB and got a 98. She was always smart, but didn't apply herself well in school. She finished basic just fine and went off to Ft. Sam Houston to train up to be an EMT and LPN over the next two years of training. Now she's going back to school to get her RN so she can be a commissioned officer. A couple years ago, she thanked my wife and I for holding the line and not giving up on her in high school. I was shocked as I was expecting decades to pass before hearing that, if at all.

Bottom line is this, mental illness is very difficult to treat, especially in adolescents. Hormonal changes during that part of life can wreak havoc on treatment plans. Psychiatric drugs take a long time to come to full effect. Patience is absolutely required when determining what works and what doesn't. No one really knows which one is going to work in each case. It is a process of trial and error. And lastly, psychiatric drugs are most effective when paired with therapy appropriate for the mental condition being treated.

For anyone facing these challenges, my best wishes in your quest.

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#6
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Re: Treatments for Depression, Part 1

01/05/2016 5:30 PM

Great story! Glad it worked out.

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Re: Treatments for Depression, Part 1

01/05/2016 7:20 PM

I agree with AH. I'm glad your daughter got herself together.

Ironically, it's parents (siblings, or basically family) that are the most powerless in this kind of situation because of "baggage". A stranger, in this case the drill sergeant, without a prior relationship, has a better chance of interacting on an objective level.

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Re: Treatments for Depression, Part 1

01/06/2016 5:08 AM

There's also an element of fear of the unknown (drill sergeant)..this is healthy in my opinion. I believe that mostly, there are no bad children, just bad parents !

However, when a child really needs a good slap to bring them back to reality, then wail away...only did my kids good. One of them actually called to thank me a few months ago, as I had changed her insight into difficulties she now had to face alone, and given her the moral fibre necessary to overcome all the negatives facing her.

In any case, well done Sir Robin!

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Re: Treatments for Depression, Part 1

01/06/2016 7:58 AM

Mental illness is real and some children, like adults, have this disease.

The problem is that we really don't have a good handle on mental illness and as such our diagnostic abilities and subsequent treatment programs are not up to the job.

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Re: Treatments for Depression, Part 1

01/06/2016 9:09 AM

Yes, agreed...that's why I stated "mostly". I also didn't mean that I raised my hand to my kids overly much..there were other means available to change behaviour or reward refusal to stick to the rules! My favourite was to wait until they were all dressed up and raring to go out on a weekend, and then step into the deep end of the pool with them draped over my shoulders. Maybe considered bad by others, but the objections, resistance and resulting tumult still brings a smile to my face! They had to laugh when they come up for air, as I was having a fun time and let them know it !

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Re: Treatments for Depression, Part 1

01/06/2016 11:28 AM

Mental illness is very real. Fortunately, it seems for adolescents, that some cases of mental illness are temporary (at least the worst of it) as in the case of my daughter. She's not completely out of the woods, but anyone who knows her now and didn't know her in the dark ages, would not think that anything had ever been wrong.

You are absolutely right that mental illness is very difficult to treat. There are no blood tests, x-rays, CAT scans, MRI',s etc. that can be effectively used to say, "Yes, here's the problem."

Treating mental illness is very much an art and a process of careful and deliberate observation and constant interaction with the patient. The process is very difficult even with patients who are cooperative and motivated to improve their condition. I can't imagine how difficult it must be to treat those patients who are not cooperative.

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Re: Treatments for Depression, Part 1

01/06/2016 2:31 PM

"Treating mental illness is very much an art"

One might argue that it may just be closer to voodoo.

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#19
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Re: Treatments for Depression, Part 1

04/23/2018 9:30 AM

I just came across this, I just wonder if mental illness, which has always been around, but is acerbated and more prevalent now with the onset of instant media like facebook, where there isn't a sense of empathy, (more then just thoughts and prayer's BS) to more pseudo empathy where it's just becomes an empty phase with no meaning.

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Re: Treatments for Depression, Part 1

06/11/2018 5:53 AM

If your depression is not allowing you to lead a normal life, don't hesitate to seek help. There are many effective treatments from therapy to medication to healthy lifestyle changes that can help you get better. One can also take some advice from Voyance Direct to get out of the problems of depression. Get social support: start sharing your problem with your friends, family or you can even join some support groups.

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Re: Treatments for Depression, Part 1

06/11/2018 7:03 AM

First post, congratulations, and welcome to CR4,...

Considering the recent suicides of prominent people (celebrities), this thread may get legs again and start running...

My post you replied to, though somewhat good suggestions, it can still be difficult initially recognizing it. I posted that todays environment as a contributor of a higher degree of Depression.

as I explain, imo,... I believe depression has always been around and is part of life like other emotions like Happiness, Sadness, Love, Anxiety and Humility. But it's balances to where it keeps the individual leveled.

But with todays environment such as using social media, it cultivates the darker emotions such as depression from what should be a normal emotion to a preeminent mental illness.

The difficulty is recognizing it, some of it is outward, such as irrational, actions or speech, that may be more easily recognized when it is persistent. While the more difficult in recognizing it is the inward where their is given no sign of depression.

And the reason for the out of balance emotions is many, but can be triggered by one incident.

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Re: Treatments for Depression, Part 1

01/06/2016 4:33 PM

Thanks for sharing, I am so glad things worked out.

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#4

Re: Treatments for Depression, Part 1

01/05/2016 7:55 AM

I read that 1 out of 4 people have mental problems. Check 3 of your friends. If they're OK, you're it.

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Re: Treatments for Depression, Part 1

01/06/2016 8:00 AM

My best friend is my dog. She is definitely mentally ill, so I can breath easier now.

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#16

Re: Treatments for Depression, Part 1

01/07/2016 9:31 AM

We don't understand why some (most?) psychotropic drugs work. Remember the CR4 discussion a few weeks back about a different drug or class of drugs whose mechanisms we don't understand? I don't say this as a criticism of antidepressants or those who take them, but it does rather bring one up short.

Thanks to Chelsey H for this blog post. I'm looking forward to part 2.

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Re: Treatments for Depression, Part 1

01/08/2016 1:39 AM

I think it is safe to say that all of these medications result in loss of libido as a side effect....no wonder so many sufferers remain depressed!

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Re: Treatments for Depression, Part 1

01/08/2016 10:21 PM

Sometimes the cure is worse than the disease.

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