Miles Jackson wrote:
>
>
> Again, your reasoning is not based on data. Meta-analyses show that
> cognitive-behavioral therapy is as effective as or more effective
> than SSRIs for the treatment of depression (Dobson, 1989; Shea, 1992).
> In fact, changing a person's maladaptive thinking and behavior is
> a useful, cost-effective therapy with few side effects.
>
> It's interesting to me that reasonably intelligent people are so
> enthusiastic about this naive "if you're mentally ill it must be
> brain chemistry" shtick. I really have to hand it to the ad
> wonks in the pharma industry.
For some sufferers from depression, the "it's all brain chemistry" is an effective placebo. Whenever I mentioned to my classes that I suffered from depression, there would be a flurry of students showing up in my office to discuss _their_ depression or the depression of family members or friends. Often they would introduce the conversation by saying (a particular example) "my fiance has a problem with brain chemistry." Look at that as a sort of half-way house to dealing with it.
Quite a substantial proportion of people I know who suffer from unipolar affective disorder have backgrounds of abuse as children, and another group are combat veterans or abused wives. There are some interesting case histories of the latter in the book, _Achilles in Vietnam_. I would suppose that some who are neither abuse victims nor combat veterans have suffered other traumas. I'm fairly certain that I was suffering from depression before my first wife died or I almost got fired, but it's equally true that those kinds of trauma can certainly be (at least part of) the source of depression.
The last I knew, there was a great deal of agreement that there was a large element of genetics in bipolar affective disorder. I'm not familiar with recent research on schizophrenia.
I would presume that whatever the "causes" of a given case of mental illness, it has to take the form of a changed brain chemistry. Migraine is an interesting mixture. Zanaflex brought my migraine under pretty complete control, though I would occasionaly have what I called "shadow migraines" in the morning -- not much pain and they would go away as soon as I was up and about. I mentioned this to my neurologist, and also mentioned that I seldom for such headaches took the backup capsules (Midrin) that he had prescribed. (Zanaflex I take every day; Midrin only if a headache is developing.) He suggested that I use it, his reason being that Migraine could be (very roughly) like piano playing: one's brain "learned it." Hence it was a good idea to stop quickly even unbothersome headaches to interfere with the "learning" process.
One other thing. Doublt-blind tests can compare a med to a placebo, but how do you compare therapy to a placebo? And how does one check _any_ treatment, placebo, therapy, or med, against spontaneous recovery? After all, many people have one (more or less lengthy) seige of depression, then never are bothered again, without treatment. And fewer but still some have more than one seige, and then are never bothered again.
Post-partum or post-surgical depression (I think?) often or usually go away on their own, or even if they do require treatment, don't reoccur -- but sometimes they do become chronic. I've often wondered if (like piano-playing, migraine, drumming one's fingers, or poor posture) depression can become a habit (i.e., brain channels become established for it).
Carrol
>
> Miles
>
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