The nature of depressive illness

www.theguardian.com/media/2018/jan/07/johann-hari-depression-brain-lost-connections-book-interview

I've made the link work

In the Guardian today there’s a very unfavourable piece about this written by someone with clinical experience I think. It made interesting reading but I can’t find it now...duh!

I was just coming here to say the same thing Mollie.

I read the article yesterday and almost ordered the book. I had a look for Hari's TED talk and watched it. Then I got distracted (nothing new there) and didn't order the book in the end.

Today though in the Guardian is an article taking issue with what Hari's has to say, not about the effectiveness of antidepressants, but about the impression Hari gives of the current approaches to Depression.

I thought posters might be interested in the second article.

Johann Hari and Depression

Thank you for that Wilma. Having just read the short critique of the extract I am shocked by Hari’s take on grief and depression.

My problem with Hari's stance is that one size does not fit all. He's also not portraying current approaches to depression accurately. Drs don't think pills are the only answer or option. The effectiveness of antidepressants on a long term basis has been under discussion for at least 10 years. There were other things that rang warning bells for me. But having listened to his TED talk, he is a good speaker. Very believable. I just think he seems to be doing the same thing that he's criticising others for - saying pills aren't the answer, making connections with other human beings is. My experience is a toolkit of different tools is the answer and each person's toolkit is unique.

This author seems to like courting controversy. He made waves a few years ago questioning approaches to drug treatment:

www.nytimes.com/2015/02/15/books/review/chasing-the-scream-by-johann-hari.html

Wilma, please could you summarise your toolkit for us?. I find I do get low at times. Haven't ever suffered from a true clinical depression but am aware that it could happen.
What things do people find helpful? I find too that I get guilty and depressed about being depressed. That I should not indulge in that luxury and should pull myself together but can't.
So any ideas would be helpful.

An interesting discussion. As someone who suffered a sudden and serious depression after surgery, and who still continues to take an anti-D and have occasional dips, I am clear that there is a biological element to this. Mine occurred when my whole family and community of friends were falling over themselves to help me post-surgery - so no lack of human connection.

However I do think life stress is a big factor and that this can trigger the illness in someone who has a biological susceptibility. Initially in my case it was surgery; currently it is my carer's role.

What really concerns me about the article is that, by fostering a one-sided and unbalanced negative view of anti-Ds, it might feed depression in some individuals who read it. Suddenly going off medication can have fatal results. Also, those who are reluctant to try medication because they see it as a weakness to "give in" to this, may lose out on the possibility of a significant improvement in their lives.

Understanding depression is in its infancy - I certainly was at a complete loss to understand what was happening to me; indeed I was extremely frightened by this life-changing bolt from the blue.

I am not sure his contribution to the debate is at all useful. He is playing with fire for his own self-aggrandisement and to the detriment of others.

By the way, I am very happy for the use of anti-Ds (and indeed any other treatment) to be scutinised and challeneged - I would expect no less. But it needs to be done in a rigourous and scientific way.

This is a general comment, not in response to Lucky above.

Scientific rigour is great, but add the human factor as in my extended family where one sister was put on anti-depressants (she was caring for her mother who had Alzheimer's). She found the "happy pills" (her term not mine, so great, that she told everyone about it and before long two of her sisters had a script from the same doctor. So - not very scientifically applied.

As I understand it, anti-depressants were not developed for long term use. There is evidence that coming off them has a "bounce" effect of original symptoms reappearing (because the patient has developed tolerance, rather than dependence), which then make people panic, and they go back to the GP and are re-prescribed.

I feel rather silly for enthusing about Hari's opinions and rushing out to buy the book. Still, I think that my own emotional upsets were caused by environments that did not suit me. My best friend for eight years was someone with lifelong bipolar. He was on lithium, otherwise he would have been dead. However he was a very intelligent man who read widely and thought deeply. He believed that the feeling of powerlessness sometimes expressed as not belonging or anomie was a main contributor to depression. I think he was right.

Alexa I don't think you are not silly for buying the book. We are all learning.

I do think that there is something about connection that impacts on depression and other conditions (for want of a better word). Much has been written about substance misuse or other addictive behaviours being related to a lack of connection, porn addiction being an obvious one.

I agree with some of his views not all.

He had counselling for fourteen years , majority with depression get about 5 - 10 minutes with the GP, if counselling is available there is a long wait and then there is a set number of appointments , certaintly not 14 years.

Prescribing medication has changed thank God,

anti depressants have their place, I was a victim of the tranquilliser decades, mothers little helpers, they were dished out like smarties, now if needed then about five days for patients. Also prescribed with these were tricyclics antidepressants and sleepers.

Come the eighties the tranquilliser addiction was exposed, Ativan and Valium being the two most widely prescribed .

Then came Prozac, the miracle cure, the sunshine cure, took some time for it to be recognised these were driving some to taking their lives .

When my husband died forty years ago I was given tranquillisers and anti depressants within 30 minutes of being told of his death, followed by repeat prescriptions.

When my daughter died my son in law was prescribed five days of the lowest dose of Valium, I refused medication, I learned forty years ago medication does not cure grief, grief is not depression.

I agree with him that depression can be brought on by such things as isolation, loss of a job etc. That is reactive depression but there is depression caused by chemical inbalances in the body.

Sorry, that doesn't make sense! I meant to write I don't think you are silly for buying the book.

Alex I don't think you should feel silly. You might find something in Hari's book that makes buying it worthwhile. I might still read it, although I am not going to buy it just now.

Today's antidepressants are designed for long term use. However, that does not mean that they will remain effective for everyone. Valium is not an antidepressant.

I'm sorry, but I'm not comfortable with discussing this subject here. It's too personal for me and I am not able to separate my own experience to take part in the discussion on a general level.

This book was reviewed in the Sunday Times and the reviewer ended up saying they were not going to stop taking their meds.

It is a very difficult subject as many people say they are depressed when really they are sad or reacting to a difficult time in their lives. I think the current focus of the media on this will increase the number going to their GP with depression and it must be difficult for the GP to diagnose correctly which need help and which don't.

I have a dear friend who always seems to have a lot of things wrong with her, she is in her 40s. When I met her mother I realised why, she is 'sensitive' to so many different foods and has lots of ailments so my friend must have been brought up to expect to have lots of things wrong. My friend thinks she is depressed but won't go to her GP because she once took some anti-depressants and didn't like the effect they had on her. IMO if she was really depressed she would go back and try again. She is in a good job and a good relationship and her 'depression' doesn't seem to stop her doing anything. I just say this to illustrate how hard it is to define 'depression'. For me it is a very debilitating thing and not a mild annnoyance.

Yes I said Valium was a tranquilliser, it wa the miracle drug of the sixties , perhaps these today's antidepressants will in time prove as previous prescribed drugs have proved to be, addictive,

I do think that only someone who has had serious can make the distinction between being "down" or "sad" or dealing with grief and a depressive illness.

This is how I felt when I was so unwell:
- unable to focus my brain, forgetfulness, problem finding words
- a desperate sense of ill-being that is very hard to describe - it started as a "sinking sensation" in my guts, a feeling of total doom. A feeling so utterly dreadful that you just wanted to cease to be so you did not have to deal with it.
- uncontrollable weeping for no obvious reason
- physical weakness and lethargy

In the context of a normal outgoing personality these were extraordinarily frightening symptoms and had nothing at all to do with being sad - I neither felt sad not had anything to be sad about when it descended on me.

It is a bizarre and inexplicable cluster of symptoms that is poorly understood, but a very significant cause of morbidity and mortality.

Hari's approach is simplistic and dangerous. There is nothing about how I felt that could be talked away. I gradually got better with anti-Ds - an old fashioned tricyclic in my case. I am thankful they were available - I would not still be here without them; and anything that causes those whose life has been saved by them to feel bad about taking them is, to my mind, a very bad thing indeed. Hari needs to think before he writes.

I too am against the idea of over-use of anti-Ds in situations where it is not appropriate, but a blanket condemnation of them is equally inappropriate.

"had a serious depression" - don't know what happened there!

They have their place Luckygirl and have brought suffers of deep depression away from the brink of a complete breakdown

I’ve had bouts of what I considered depression through the years and it’s been interesting, in hindsight, how the different GPs dealt with it. Three gave me antidepressants, one said I’d be on them for the rest of my life, another refereed me for other help and the last made it for a fixed term and I came off them successfully within the time. A fourth refused to give them to me. Today, I’m drug free but can see that all my depressive episodes were reactive and with a lot of effort on my part I feel able to cope. However, if I had listened to that first GP I would now be in my 25th year of taking anti depressants and no nearer understanding my problem. He was too busy to take time to understand my problem, reluctant to refer me on and I was too ignorant of the issues to push for help. With that experience I can see why so many people become reliant on pills when they might not be the answer. But, every person is different so I don’t think my experience is THE answer.

I've never been offered anti depressants as a matter of course. I have had to ask for them. They did the trick, too. I took them for as long as I felt I needed to, and stopped them of my own accord.

Reading this thread it's made me think of 'different' depressions I've had, if that makes sense?
There was what could be called 'low level' which I had going through the menopause.
Then there was the one I had when going through a rough time in my personal life. Even though I was working, good social life etc I got to the stage where I was working out (very calmly) how I was going to kill myself. I knew I was in trouble then. Thank God for the Samaritans.
Then there is the one that was caused by a trauma last year.
That is completely different to the others. This manifests itself physically. My Dr explained it as having similar to PTSD.
What I did learn many years ago,is, if I wake up and know it's there, I tell my OH, and leave it at that.

Luckygirl - your explanation of clinical depression is very clear - so, how does someone who is sad or appropriately unhappy due to their reaction to perhaps transient circumstances, know that is what is is, if they have not experienced what you describe (so have no comparison), and they are (perhaps) given a script for antidepressants because that is one way of getting them out the door in 10 minutes?