Does depression exist? Nobody understands why therapy works.

[C C]

https://unherd.com/2021/11/does-depression-exist/

EXCERPT: . . . In their understandable desire to get on with trials that might help people who are suffering, many researchers have sidestepped the question of what depression actually is.

Instead, they’ve simply agreed on a definition and stuck to it. The Beck Depression Inventory is a questionnaire routinely used to diagnose and define depression [...] It’s named after Aaron Beck, one of the most important figures in the history of psychiatry (who died aged 100 on November 1st this year). He came up with 21 questions that cover ... common depressive complaints.

The problem is that the medical profession, and psychiatry researchers, might be relying a little too much on that list of symptoms. Indeed, in an odd, unintentional, circular move, they might have actually turned lists of symptoms into the very definition of depression. An essay by the eminent psychiatrist Kenneth Kendler argues that this is a fundamental mistake: the number of boxes a patient ticks on the list of symptoms that get you a diagnosis isn’t the same as “depression” (nor is their Beck Depression Inventory score) — even if psychiatrists and researchers often act like it is.

The Inventory is very often used as the criterion for improvement in studies of treatment: if you achieve a 50% drop in symptoms as measured on his questionnaire, you count as having been positively affected by the treatment. But these criteria are a decent index of many of the common symptoms — not all of them. We know anxiety commonly comes alongside depression, Kendler notes, but it’s not on the standard diagnostic list. If we confuse the disease itself with a useful-but-limited list of its manifestations, we’ll find it harder to truly understand patients’ experiences.

Some researchers have gone a step further: should we stop using the concept of “depression” entirely? One study of thousands of depression patients found over 1,000 unique combinations of symptoms that all still count as “depression”. Maybe it’s time, argue some, to focus on understanding subtypes, or even just specific symptoms, rather than the monolithic entity of “depression” itself.

In some senses — and perhaps ironically — this accords with Beck’s philosophy: he was known for being sceptical of focusing on the ultimate, root causes of mental illness. Which brings us to the other major contribution for which he is remembered: Cognitive Behavioural Therapy. Beginning in the 1960s, Beck [...] began to doubt that depression symptoms were always caused by childhood traumas and unconscious repression. Some of the Freudian theories were rather far-fetched — as Tony Soprano says to his psychoanalytic therapist, after she suggests ... he might be harbouring some Oedipal desires: “I don’t wanna f_ck my mother! I don’t give a sh_t what you say — you’re never gonna convince me!”

Instead, Beck suggested a much more proximal reason for the disorder: depression patients (and those with other disorders) are suffering from “thought distortions”. For example, they might catastrophise, blowing minor unfortunate occurrences in life out of all proportion. They might overgeneralise, thinking that a fallout with one friend means that they’re hated by everyone they know. As well as focusing his Depression Inventory on these kinds of thought patterns, Beck argued that therapy should target them and train patients out of them, rather than looking for some underlying explanation for all their symptoms.

Beck won the argument: although psychodynamic therapy still exists, CBT has now become the most popular — and by far the most studied — type of psychotherapy... (MORE - missing details)

[Syne]

There's some validity in doing away with many modern classifications of mental illness, such as depression. Giving people a disorder, with a name and description, actually facilitates them postulating it as a mental state they can inhabit. Many thinking disorders, under such umbrella terms, have no other reality than the belief that they exist.

But causes for the individual symptoms are not proximal. "Thought distortions" causing people to "catastrophise," "overgeneralise," etc. do not result from proximal stimuli. They are patterns of thought established by some past experience and repeated, like a virus replicating. Granted, in terms of therapy, it is much better to focus on training new thinking patterns than the therapist telling a person what they think is the underlying cause. One person cannot evaluate for another, as people are apt to adopt an external evaluation in lieu of their own, hindering their ability to sort out their own thinking patterns. This is why a good therapist will only ask questions and not evaluate for you. The problem with psychiatrists (and doctors who prescribe drugs for mental disorders) is that they have to diagnose to justify prescriptions.


For the same reason that a diagnosis can get a person to postulate and inhabit a mental state, a rationale for recovery can get a person to postulate a mechanism for actual recovery, even if the method isn't itself really efficacious. The ultimate goal of any classification/diagnosis needs to aligned with the goal of treatment. If the classification scheme doesn't aid recovery, or actually exacerbates mental disorders by giving them a ready label to adopt, the diagnosis can work against any treatment, thus keeping people on the treadmill of mental healthcare.

[Magical Realist]

Depression Brain Scans

People with depression have a new opportunity for understanding their condition and getting helpful treatments with the technological breakthrough of brain scans.

https://www.therecoveryvillage.com/menta...ain-scans/

As experts look for new ways to better understand, diagnose and treat depression, they are increasingly turning to brain scans for guidance. Depression brain scans, including PET scans and MRIs for depression, can provide images of the brain of someone with depression or another mental health disorder.

By comparing depression brain scans to the scans of people without depression, researchers can look for similarities and differences in an effort to gather more information. With new data, experts hope to design better medications and therapeutic interventions.

What Does the Depressed Brain Look Like?
In most cases, a static brain scan of a depressed person looks the same as the brain scan of someone without depression. If visible differences do exist, they are usually seen in the frontal cortex or hippocampus. On rare occasions, someone could have a structural issue that results in depression, like a tumor or brain cyst. In these situations, a tumor may push on other structures in the brain to disrupt normal functioning.

Depressed Brain vs. Normal Brain Scan
Neuroimaging continues to become more advanced as time progresses. At first, researchers only had access to static images from X-rays, CT scans or MRIs to compare one brain to another. Now, experts can obtain data from PET scans, SPECT scans and functional MRI scans. These tests not only show the structure of the brain, but can also reveal how the brain functions in real-time.

Researchers find that significant differences exist between a depressed brain and a neurotypical brain through functional brain scans. Rather than only focusing on the two regions that appear differently with static images, these functional images show additional variations in the:

Prefrontal cortex
Anterior cingulate gyrus
Amygdala
Hippocampus
Striatum
Thalamus

Scans have demonstrated that the functioning in the above areas is different in people with depression when compared to people without depression. Sometimes, the regions show overactivity, while they are underactive in other samples. These segments of the brain work in harmony, so if one area is not performing well, depression may present.

Brain Imaging Identifies Different Types of Depression
People may believe all cases of depression are the same, and that each person with depression has all the same symptoms and will respond similarly to all available treatments.

In reality, depression varies by symptoms displayed and symptom intensity. Treatment must be tailored to the type of depression for the best results.

Different types of depression may include:

Depression with anxiety distress
Depression with psychotic features
Depression with seasonal pattern
Depression with melancholic features

According to Helen Mayberg, professor of psychiatry, neurology and radiology at Emory University School of Medicine,

“All depressions are not equal and, like different types of cancer, different types of depression will require specific treatments. Using these scans, we may be able to match a patient to the treatment that is most likely to help them, while avoiding treatments unlikely to provide benefit.”

To some extent, brain imaging can identify different types of depression according to the part of the brain affected. With the information compiled by numerous brain scans, researchers can find common themes in brain structure, brain function and mental health symptoms among people with depression.

The Future of Brain Scans For Depression Treatment
Brain scans that show what type of depression a person has can also help inform the best style of treatment. Brain scans can separate clients who will likely respond well to medications from those who will respond better to therapy.

In some cases, brain scans can even pinpoint what kinds of medications will be most beneficial to a person’s depression. People with frontal cortex issues tend to do well with a selective serotonin reuptake inhibitor, while those with dysfunction in other regions of the brain may respond to a medication that interacts with another brain chemical.

With brain scans, the future of depression treatment looks brighter. Unfortunately, these diagnostic tools remain very expensive, so the average person seeking help will probably not be able to undergo a brain scan for depression treatment.

If you know someone who has been using alcohol and other drugs as a way of coping with depression, they may need professional addiction treatment from a reputable facility like The Recovery Village. Our center provides evidence-based care for co-occurring addiction and depression. Reach out to a representative today for more information.

[Syne]

Aside from structural issues, neuroplasticity fully explains difference between depressed and normal brains. Otherwise, we'd be able to predict the onset of depression through brain scans.
So the person's beliefs and distorted patterns of thought change the brain in the same mechanism as learning the piano. Experience and learning forming patterns that alter the brain.

[Magical Realist]

LOL So you're saying a normal brain neuroplastically changes into a depressed brain thru what?--wishful thinking? Unless you have some studies supporting it, that's pure bs.

Oops..and then there's this:

https://news.yale.edu/2021/05/27/roots-m...complexity

[confused2]

Going with "there's many sorts of depression.". In the year it took my mother to die of cancer she complained of 'depression' - I had sympathy but not empathy - under the circumstances it didn't seem surprising that she was depressed. Some years later I discovered a variation on the theme of depression for myself. To be given an injection of pure fear might make sense, nothing to see, nothing 'real' but you have fear running through your body whether you like it or not. Substitute an injection of 'dread' - your worst nightmare but all the time - awake and no actual threat but the 'dread' drug is ever present - the nights and the actual nightmares being by far the worst. Happily neither customers nor Mrs C2 noticed I wasn't really with them.
Whatever brain fart caused it it burned out after a few weeks. If the gods were playing a game with me - I'd be very pleased if they didn't do it again.

[Syne]

LOL So you're saying a normal brain neuroplastically changes into a depressed brain thru what?--wishful thinking? Unless you have some studies supporting it, that's pure bs.

Not sure why you bother asking for supporting studies, as you always completely ignore anything that doesn't affirm your existing belief (fixed beliefs being a factor in depression*).

A brain changes through the normal ways learning and experience change the brain. There's a reason I mentioned playing piano.

The finding was in line with a growing number of discoveries at the time showing that greater use of a particular muscle causes the brain to devote more cortical real estate to it. But Pascual-Leone did not stop there. He extended the experiment by having another group of volunteers merely think about practicing the piano exercise. They played the simple piece of music in their head, holding their hands still while imagining how they would move their fingers. Then they too sat beneath the TMS coil.

When the scientists compared the TMS data on the two groups--those who actually tickled the ivories and those who only imagined doing so--they glimpsed a revolutionary idea about the brain: the ability of mere thought to alter the physical structure and function of our gray matter. For what the TMS revealed was that the region of motor cortex that controls the piano-playing fingers also expanded in the brains of volunteers who imagined playing the music--just as it had in those who actually played it.
http://content.time.com/time/magazine/ar...38,00.html

This has been know since at least 2007.

Neural plasticity, a fundamental mechanism of neuronal adaptation, is disrupted in depression. The changes in neural plasticity induced by stress and other negative stimuli play a significant role in the onset and development of depression.
https://www.hindawi.com/journals/np/2017/6871089/

* Mindset is about more than learning and performing. A new paper by Seo, et al. (2020) shows how the relationship between a fixed mindset and internalizing symptoms (such as depression) comes about.
http://www.progressfocused.com/2020/10/h...ed-to.html

The basic idea behind the “growth mindset” is that we have the capacity to change and improve ourselves over time. This is in contrast to a “fixed mindset,” where we often believe that the way we are right now is the way we are always going to be – and there’s no hope to ever change that.

According to a fascinating new study published in The Journal of Child Psychology and Psychiatry, even just one quick 30 minute lesson about “growth mindset” can help young teens with symptoms of depression and anxiety.
https://www.theemotionmachine.com/lesson...n-anxiety/

Oops..and then there's this:

https://news.yale.edu/2021/05/27/roots-m...complexity

Unless genetic studies also control for the person being raised by someone with depression (this one doesn't), they are finding correlation, not causation. Genetic correlations are not one-for-one nor completely predictive of major depression. And even though many of us were taught that genetics are immutable throughout our lifetime, more recent science has demonstrated otherwise.

Many of us learned in high school biology class that genetic traits are passed down to us from our parents. We were taught that we have brown, blue, or green eyes because a parent did, we’re thin or fat because a parent was, and so on. Recent research expands this idea in a way that would have seemed inconceivable a few decades ago. We know the traits we pass down to our children can not only change based on our life experience. But we also know we can continue to alter our children’s pattern of genetic activity after they’re born. This area of genetics research is called epigenetics. It’s the study of alterations in gene function caused by changes in gene expression rather than in the genetic code.

This could all seem a bit disheartening to those of us dealing with anxiety, depression, anger issues, or other mental health concerns. If we’re depressed because of our parents’ experiences or how they treated us when we were babies, what hope is there for us? But if we couple epigenetics with research into cognitive behavioral therapy and neuroplasticity (the brain’s ability to form new neurons and glial cells and forge new connections), we have reason to be hopeful.

In 2010, scientists at the University of Copenhagen fed male rats a diet high in fat and then watched as their offspring gained more weight than the babies of rats fed a regular diet. If traditional theories about genetics had been true, the diet of a rat’s parent shouldn’t have affected the weight of their offspring. The old thinking about genetics—that either you’re born with a gene that predisposes you to obesity or you’re not, and nothing you do in your life changes what gene you pass onto your children—is, according to studies like the Copenhagen one, incorrect.
https://www.goodtherapy.org/blog/can-peo...bt-0426184

[Secular Sanity]

In the year it took my mother to die of cancer she complained of 'depression' - I had sympathy but not empathy - under the circumstances it didn't seem surprising that she was depressed.

What's the difference between 'sympathy' and 'empathy'?

Sympathy, constructed from the Greek sym, meaning "together," and pathos, referring to feelings or emotion, is used when one person shares the feelings of another, as when one experiences sadness when someone close is experiencing grief or loss. Empathy is a newer word also related to "pathos." It differs from sympathy in carrying an implication of greater emotional distance. With empathy, you can imagine or understand how someone might feel, without necessarily having those feelings yourself.

What do you think the difference is, C2?

In Paul Bloom’s book, "Against Empathy," he uses them interchangeably. He writes, "The word "empathy" is used in many ways, but here I am adopting its most common meaning, which corresponds to what eighteenth-century philosophers such as Adam Smith called "sympathy." It refers to the process of experiencing the world as others do, or at least as you think they do. To empathize with someone is to put yourself in her shoes, to feel her pain."

I feel their pain. I can’t help it. I’ve tried to change, but it’s impossible, and my sense of their suffering may not even be accurate.

[Syne]

So some people can't understand how someone might feel without also feeling what they perceive them to feel? That would be like full-time method acting. Doesn't sound healthy at all.

[Magical Realist]

Nobody questions that learning a new skill changes the brain in a functional sense. What is in question and is patently absurd is the claim that normally functioning brains change themselves into depressed brains just by thinking they are depressed. There is simply no evidence for such bs. That would be comparable to claiming one would be able to play piano just by believing one can play a piano. The symptoms of depression are totally based on brain dysfunctions.