[rich d]

Can there be trigger events that make the depression worse or start a downward progression? Brother in law is having a really hard time at the moment and just wondered on people with more experience of this opinions.
Cheers Rich

[Falling Down]

Oh absolutely yes.

[r-man]

It's good to see Depression being discussed.  I read a great editorial this morning that included the sentence (or I paraphrase) "you don't get depression about something in the same you don't get diabetes about something".

I saw something similar on the net. Worth quoting the exact phrase as it's well worded:

"Please remember that ‘What are you depressed about?’ makes no more sense than ‘What are you diabetic about?’"

[Oldmanmatt]

Can there be trigger events that make the depression worse or start a downward progression? Brother in law is having a really hard time at the moment and just wondered on people with more experience of this opinions.
Cheers Rich

Well, yes... But.

To put it in basic terms, as I understand it.

It's not primarily a psychological condition; it's a chemical imbalance. That results in a brain that doesn't function quite as it should.

The condition is something which has evolved to assist in our risk perception, within the predator/prey, fight/flight context (a little paranoia keeps you alive in the wild).

One of the (many) things which can trigger depression would be prolonged exposure to stress.
Some people are just more prone than others.

As for complications like addiction/psychiatric disorders etc, it seems to me (from the explanations of "professionals"); that it a "Chicken and Egg" question, only much harder to answer...

[rich d]

thanks for the answers.
Rich

[JamieG]

My own personal experience of physical health problems becoming mental health issues.

I have always been a worrier and a bit OCD. I often check the door is locked three or four times, especially when stressed. These, however, were only minor annoyances in the grand scheme of things, until I got very bad food poisoning. It left me with a very sensitive stomach that meant I felt sick a lot of the time, and struggled to eat much. After several months of losing weight, not feeling like getting out to the pub or crag as much as usual, I think the actual stomach problem had gone but it had been replaced with paranoia and angst about feeling sick. This then morphed into depression resulting in me having to take time off work, going onto antidepressants (which was hard to accept) and having CBT.

After a couple months I felt massively better, was eating normally and the depression had mostly gone. Overall the last few years, however, I've tried to come off my antidepressants several times and it always results into a slow descent back into depression (which I'm now very scared of!!!). So for the meantime I am just taking my drugs and trying to be ok about it. I'm not sure if I'll ever fully be able to come off them now, which is hard. Especially, since I feel there is stigma about depression. In fact I've thought about posting on this thread before but always wimped out. I don't always feel comfortable about discussing my illness (I'm sure I'd be the same if I had other illnesses like diabetes, maybe not), but hopefully this will help some other people.

Now having experienced the illness I feel a lot more sympathetic for other people with depression (and other mental health issues). Whilst never thinking that people should 'just cheer up', I don't think I fully understood how hard and debilitating it is, until I experienced it. Apparently this is very good for understanding depression http://www.depressionquest.com/ , although I haven't personally played it.

I think this is a great thread. Thanks for starting it. It has helped me before. I probably should have plucked up the courage earlier to post. But there we go.

[Falling Down]

Matt's right, to some extent, as external factors are often the root cause (but not always) of mild and moderate Depression/Anxiety.  The reactions to stress and fight/flight responses slowly deplete levels of serotonin and other things until the body just can't produce enough and buckles.  SSRIs medication then stop the brain reabsorbing serotonin until it re-establishes the levels it's supposed to be at.  Steadying the ship so to speak.

Severe debilitating Depression is a different case entirely and I couldn't comment.

I meant to post on here some time ago as I tapered off Citalopram over the last six months of 2013 and am now OK, I had a few up/manic episodes after coming off completely in January but all's well now.  Sleep like a log and am more aware of managing anxiety and other stuff that I know isn't good for me.

[Sloper]

Until recently I've in effect being doing >2 stressful full time jobs (down to just one now I've managed to recruit a manager to take some of the weight off my shoulders) and in my experience it's interesting to see how the abnormal can be normalised and thus not seen as a 'problem' with all sorts of side effects.

[psychomansam]

Can there be trigger events that make the depression worse or start a downward progression? Brother in law is having a really hard time at the moment and just wondered on people with more experience of this opinions.
Cheers Rich

Well, yes... But.

To put it in basic terms, as I understand it.

It's not primarily a psychological condition; it's a chemical imbalance. That results in a brain that doesn't function quite as it should.

That really makes me want to get philosophical. But, to spare you too much of that, just consider that the main reason us philosophers have so much to say about the mind is that science really hasn't fully 'got' it yet. For instance, you draw on a dichotomy between mind (psychological condition) and brain (chemical imbalance). But of course that dichotomy, and (almost) every other attempts at explaining the mind/brain, end up being nonsensical.

Perhaps more directly helpful to the OP is this: if you do want to think of it as a mind/brain dichotomy, then it's best to visage that causation works both ways - your psychological state can effect your chemical balance as well as vice versa.

But I do also think that it's worth bearing in mind that this dichotomy is essentially bullshit. At best, it's an explanatory tool for us to be able to talk about the mind/brain. At worst, it's a highly misleading one.

Just for the sake of contrast, consider another way of explaining the mind/brain - one that has as many problems but as much validity as the above dichotomy: the mind and the brain are one and the same. They just represent two ways of talking about the same thing. They could perhaps be seen as different levels of explanation. Your psychological state is one and the same as the chemical balance of your brain.

This can also be a helpful tool for explaining the mind/brain. But both of these attempts at explanation of the mind/brain (by dichotomy and as identical) are essentially just useful bullshit.

That's enough philosophy - here's an anecdote from personal experience. I've had the rare experience of taking and then coming off an SSRI while mentally healthy. Despite good mental health, the withdrawal was horrendous for about a week (and was fine shortly after). During withdrawal, I had no energy. A short walk would result in me shaking and sweating. I lay awake at night with palpitations and night-sweats. More interestingly, I couldn't be happy. I couldn't enjoy anything. I felt blank. Joyless. Emotionally void. But I wouldn't say I was depressed while in that phase of withdrawal because I could reflect on my condition and could explain it as being due to a chemical imbalance - a lack of serotonin. More importantly I didn't have cycles of negative thoughts. Conversations with doctors at the time clearly betrayed their concern that I might be a suicide risk. This seemed very strange to me, and in a way it still does.

Depression, as a part of our mind/brain experience, is something we just don't properly understand. I suspect it frequently consists of a chemical imbalance resulting in a greater or lesser form of the above symptoms and also of the presence of cyclical and negative thought patterns. I suspect one can lead to the other. We know that we can use talking therapy/CBT to help 'think' our way out of depression, and chemical therapy to help dose our way out of depression. Perhaps some people are more genetically prone to chemical imbalances and thus for them drugs are more appropriate, while as other people are depressed more due to the effects of negative thought cycles and thus for them talking therapies/CBT are more appropriate.
 
Or perhaps some people are more genetically prone to negative thought cycles and others are just unfortunate enough to think themself into a chemical imbalance.

There's no answers here. It's all bullshit. But some bullshit is helpful and at the very least I know that, for me, realising just how little we really understand about the mind/brain and thus about the finer details of how depression works is helpful in accepting it as a very real, serious and common problem.

[iain]

This then morphed into depression resulting in me having to take time off work, going onto antidepressants (which was hard to accept)

I had the same reaction, there's a part of me that felt like taking drugs is admitting a weakness or a failing. Took a long while to realise that was bollocks. Most of us are willing to take drugs for infections, long term physical illness etc, there's no difference in doing it for mental health reasons.
(The first time I admitted I had a real problem and saw my GP I opted for talking therapies and declined drugs, then promptly bought St John Wort at the chemist so I wouldn't have to say I was on anti-depressants. No paradox there eh  )

Overall the last few years, however, I've tried to come off my antidepressants several times and it always results into a slow descent back into depression (which I'm now very scared of!!!). So for the meantime I am just taking my drugs and trying to be ok about it. I'm not sure if I'll ever fully be able to come off them now, which is hard. Especially, since I feel there is stigma about depression.

My GP wouldn't let me do this over the winter (too many relapses generally) but I've been very gradually dropping the dose since the spring, even chopping up pills to reduce it in small enough increments. I tried coming of them before in prescribed doses but it didn't work.
There's also nothing wrong with staying on them long term, or even only using them when things are more difficult, like taking anti-histamines during pollen season. I can see myself going back on them over the winter.

[Bubba]

Overall the last few years, however, I've tried to come off my antidepressants several times and it always results into a slow descent back into depression (which I'm now very scared of!!!). So for the meantime I am just taking my drugs and trying to be ok about it. I'm not sure if I'll ever fully be able to come off them now, which is hard. Especially, since I feel there is stigma about depression.

My GP wouldn't let me do this over the winter (too many relapses generally) but I've been very gradually dropping the dose since the spring, even chopping up pills to reduce it in small enough increments. I tried coming of them before in prescribed doses but it didn't work.
There's also nothing wrong with staying on them long term, or even only using them when things are more difficult, like taking anti-histamines during pollen season. I can see myself going back on them over the winter.

 

After many years of serious deprssion I had several unsuccessful attempts at coming off antidepressants before managing to live life without them. The first time I slipped back to serious depression and on subsequent attempts I saw the signs checked the decline earlier.  Don't feel disheartened if it doesn't work the first few times; it probably just means that you're not ready yet. Also it can give you valuable insight into recognising the resurgence of your depression and keeping it in check in the future.

When I finally did it I had been well for at least six months (probably longer but can't remember exactly) and chose to reduce the dosage to coincide with the onset of late spring/summer.  I halved the daily dose for several months, then took the half dose every other day for a further few months. There's no rush...and you may have to experiment a few times to find out what works for you.

[JamieG]

Cheers for the advice. I'll agree that if it was drugs for something that seemed more physical, I'd maybe find it easier. Also, if it was someone else struggling with metal health issues, I be much more understanding. Especially after experiencing it myself.

But, it so much easier to give yourself a hard time. And see this all as a character flaw, no matter how much you know it is a chemical imbalance in the brain.

I have to admit. I have a very supportive family and wife, which makes a massive difference. Must be much harder if you are struggling on your own!

[Jaspersharpe]

I meant to post on here some time ago as I tapered off Citalopram over the last six months of 2013 and am now OK, I had a few up/manic episodes after coming off completely in January but all's well now.  Sleep like a log and am more aware of managing anxiety and other stuff that I know isn't good for me.

After 10 years of dealing with Mrs S's massive mood swings and treading on eggshells constantly in an attempt to not trigger one, she started taking the same drug a few weeks ago.

I can't explain what a difference it has made except to say that I now have the person I love with me all the time rather than half the time.

It's actually much more than that as the depression permeated every aspect of our lives and it's only now that I can truly admit and appreciate that (as I'd have crumbled if I'd thought too much about it previously).

She's had no side effects apart from drowsiness in the morning (which supposed to recede) and we've just had the best holiday ever where numerous minor stress incidents would previously have turned into disasters but instead were dealt with normally.

It's taken her ages to get to the stage where she felt ok with the idea of taking drugs for it but is now 100% certain it was the right thing to do. As am I.
   

[Oldmanmatt]

I meant to post on here some time ago as I tapered off Citalopram over the last six months of 2013 and am now OK, I had a few up/manic episodes after coming off completely in January but all's well now.  Sleep like a log and am more aware of managing anxiety and other stuff that I know isn't good for me.

After 10 years of dealing with Mrs S's massive mood swings and treading on eggshells constantly in an attempt to not trigger one, she started taking the same drug a few weeks ago.

I can't explain what a difference it has made except to say that I now have the person I love with me all the time rather than half the time.

It's actually much more than that as the depression permeated every aspect of our lives and it's only now that I can truly admit and appreciate that (as I'd have crumbled if I'd thought too much about it previously).

She's had no side effects apart from drowsiness in the morning (which supposed to recede) and we've just had the best holiday ever where numerous minor stress incidents would previously have turned into disasters but instead were dealt with normally.

It's taken her ages to get to the stage where she felt ok with the idea of taking drugs for it but is now 100% certain it was the right thing to do. As am I.
   

I do hope certain people do not read the following comment, but....

After being on the pill, for most of her adult life, a very close friend has just discovered that it has been having a devastating effect on her depression. After a month off it, she is a totally different person.

There were so many other things to point to as a root cause (primarily PTSD), that it never crossed anyone's mind that it may be hormonal (partially) and for any man to address any Female mental health issue from a hormonal perspective is a bit of a minefield...

[psychomansam]

I meant to post on here some time ago as I tapered off Citalopram over the last six months of 2013 and am now OK, I had a few up/manic episodes after coming off completely in January but all's well now.  Sleep like a log and am more aware of managing anxiety and other stuff that I know isn't good for me.

After 10 years of dealing with Mrs S's massive mood swings and treading on eggshells constantly in an attempt to not trigger one, she started taking the same drug a few weeks ago.

I can't explain what a difference it has made except to say that I now have the person I love with me all the time rather than half the time.

It's actually much more than that as the depression permeated every aspect of our lives and it's only now that I can truly admit and appreciate that (as I'd have crumbled if I'd thought too much about it previously).

She's had no side effects apart from drowsiness in the morning (which supposed to recede) and we've just had the best holiday ever where numerous minor stress incidents would previously have turned into disasters but instead were dealt with normally.

It's taken her ages to get to the stage where she felt ok with the idea of taking drugs for it but is now 100% certain it was the right thing to do. As am I.
   

I do hope certain people do not read the following comment, but....

After being on the pill, for most of her adult life, a very close friend has just discovered that it has been having a devastating effect on her depression. After a month off it, she is a totally different person.

There were so many other things to point to as a root cause (primarily PTSD), that it never crossed anyone's mind that it may be hormonal (partially) and for any man to address any Female mental health issue from a hormonal perspective is a bit of a minefield...

Mirena coil. Low-dose localised hormones, with very little effect on the body/brain more widely. 

[Oldmanmatt]

I meant to post on here some time ago as I tapered off Citalopram over the last six months of 2013 and am now OK, I had a few up/manic episodes after coming off completely in January but all's well now.  Sleep like a log and am more aware of managing anxiety and other stuff that I know isn't good for me.

After 10 years of dealing with Mrs S's massive mood swings and treading on eggshells constantly in an attempt to not trigger one, she started taking the same drug a few weeks ago.

I can't explain what a difference it has made except to say that I now have the person I love with me all the time rather than half the time.

It's actually much more than that as the depression permeated every aspect of our lives and it's only now that I can truly admit and appreciate that (as I'd have crumbled if I'd thought too much about it previously).

She's had no side effects apart from drowsiness in the morning (which supposed to recede) and we've just had the best holiday ever where numerous minor stress incidents would previously have turned into disasters but instead were dealt with normally.

It's taken her ages to get to the stage where she felt ok with the idea of taking drugs for it but is now 100% certain it was the right thing to do. As am I.
   

I do hope certain people do not read the following comment, but....

After being on the pill, for most of her adult life, a very close friend has just discovered that it has been having a devastating effect on her depression. After a month off it, she is a totally different person.

There were so many other things to point to as a root cause (primarily PTSD), that it never crossed anyone's mind that it may be hormonal (partially) and for any man to address any Female mental health issue from a hormonal perspective is a bit of a minefield...

Mirena coil. Low-dose localised hormones, with very little effect on the body/brain more widely. 

Yes. That looks like the most likely answer. There is a Polycystic ovaries issue, so awaiting GP's final opinion...

[Oldmanmatt]

This is novel, at least to me.

http://discovermagazine.com/2014/julyaug/9-depressions-dance-with-inflammation

Another benefit to low dose Aspirin?

[duncan]

This is novel, at least to me.

http://discovermagazine.com/2014/julyaug/9-depressions-dance-with-inflammation

Thanks for this, a good read. Inflammatory cytokines are a family of chemicals, some of whom appear to be mediators in persistent pain, not just in pain related to inflammation. Persistent pain and low mood (and poor sleep) so commonly coexist that they might as well be considered a single condition and treated as such.

For now, Pariante talks with his recovering patients about the importance of exercise and eating a balanced diet, which also can help maintain normal levels of inflammation. 

Look after yourself and climb Easy Trad.

Another benefit to low dose Aspirin?

It's a bit more nuanced than that. NSAIDs might be helpful or unhelpful according to circumstance and blood chemistry. NSAIDs were originally developed for inflammatory arthritis and, speculating, they might theoretically exacerbate depression where there is pain but minimal inflammation (most climbing injuries for example).

One recent analysis of more than 1,500 people found that those who took an anti-inflammatory drug along with an antidepressant were less likely to overcome their depression than those who only took an antidepressant.

[psychomansam]

Can there be trigger events that make the depression worse or start a downward progression? Brother in law is having a really hard time at the moment and just wondered on people with more experience of this opinions.
Cheers Rich

http://www.health.harvard.edu/newsweek/what-causes-depression.htm

[tomtom]

Its interesting (and please don't take this as a criticism) that we always try and think of what might be causing depression. It strikes me that there are a multitude of chemical, physical and especially contextual issues that can lead to it happening - and on top of that there are many many shades of grey as to how it manifests itself.

So, surely far easier progress can be made in getting people to understand what it means - so we can appreciate, adapt, accommodate and support those who may get depression?

[DAVETHOMAS90]

 Good phone-in on radio 5 live at the moment folks. The S word.

I'll look for the podcast after, and post that up if available.

[lagerstarfish]

worth looking at - some helpful stuff

http://www.nhs.uk/Conditions/stress-anxiety-depression/Pages/low-mood-stress-anxiety.aspx

(it's mental health awareness week)

[Oldmanmatt]

Is it just me?

Or does insomnia suck big hairy ones?

Why is it that when it's most needed, when the opportunity finally comes to bag a decent quota; that sleep becomes the most elusive?

Why, at 2am (and despite a hefty slug of the Talisker) does the voice insist on running over every bloody issue, problem, niggle or worry?

On a Friday night?

With no possible hope for even a hint of resolution before Monday?

Why does it chime back in, despite reading until the eyelids droop; right at that moment when the book drops?

Despite all those relaxation techniques you've practiced?

And why does some moment, long forgotten in the light of day; become an indelible stain of regret in the early hours?

Why?

Because bollocks, that's why.

Half the time I can't remember why I came up stairs or why I picked up the phone, in the daylight.

At frickin 2 am, I remember every little screw up,  everything, all things and nothing.


Sent from my iPad using Tapatalk

[tomtom]

Hope you got some shut eye Matt....

[andyd]

That's shitty Matt. I've had a moderate dose of the same recently. Despite not thinking about it much when I'm trying to go to sleep, I'm pretty convinced that work is the route cause. If I sort out things that need attention, sleep tends to resume business. That's probably not very useful for a self employed gent such as yourself... Could you supplement with an afternoon bit of sleepy? Or are you actually tired? Maybe a bit more playing out is called for!