Major Depressive Disorder Quotes

If I had to define a major depression in a single sentence, I would describe it as a "genetic/neurochemical disorder requiring a strong environmental trigger whose characteristic manifestation is an inability to appreciate sunsets.

depression in its major stages possesses no quickly available remedy: failure of alleviation is one of the most distressing factors of the disorder as it reveals itself to the victim, and one that helps situate it squarely in the category of grave diseases.

When I was first aware that I had been laid low by the disease, I felt a need, among other things, to register a strong protest against the word "depression." Depression, most people know, used to be termed "melancholia," a word which appears in English as the year 1303 and crops up more than once in Chaucer, who in his usage seemed to be aware of its pathological nuances. "Melancholia" would still appear to be a far more apt and evocative word for the blacker forms of the disorder, but it was usurped by a noun with a blank tonality and lacking any magisterial presence, used indifferently to describe an economic decline or a rut in the ground, a true wimp of a word for such a major illness. It may be that the scientist generally held responsible for its currency in modern times, a Johns Hopkins Medical School faculty member justly venerated -- the Swiss-born psychiatrist Adolf Meyer -- had a tin ear for the finer rhythms of English and therefore was unaware of the semantic damage he had inflicted for such a dreadful and raging disease. Nonetheless, for over seventy-five years the word has slithered innocuously through the language like a slug, leaving little trace of its intrinsic malevolence and preventing, by its insipidity, a general awareness of the horrible intensity of the disease when out of control.

The defining feature of a major depression is loss of pleasure. If I had to define a major depression in a single sentence, I would describe it as a “genetic/neurochemical disorder requiring a strong environmental trigger whose characteristic manifestation is an inability to appreciate sunsets.

Let me stop here and correct a very common misconception: personality disorders are not the same classification of mental health disorders, such as Bipolar Disorder or Major Depressive Disorder.

They say there’s so much beauty in the world, but I don’t see it. Perhaps that’s my problem. Am I crazy for having major depressive disorder, or is the rest of the population crazy for not having it? How do you even define sanity? Is it the will to live another day in spite of a lifetime of failures? Or is it the desire to keep going after you’ve lost everything you really, truly cared about?

There was another epidemic that was not talked about much, a silent scourge—the explosion of mental illness: major depression, psychosis, schizophrenia, manic-depression, personality disorders, grief response, post-traumatic stress disorder, anxiety disorders, etc.—on a scale none of us had ever witnessed.

However, several studies have now revealed a “genetic overlap” in psychiatric disorders, especially among bipolar disorder, schizophrenia, major depressive disorder, and attention-deficit/hyperactivity disorders. “The

I think it's important to explain that major depression is not even peripherally related to "sadness". Depression is the absence of emotion. I never cried during my darkest periods of depression. Crying would have been A HOLIDAY. It would have been FUCKING CHRISTMAS. A fight or a feeling of anger would have been AN EASTER EGG HUNT AT DISNEYLAND. I am vocal about my depression now because it was so fucking Satanically awful that I view it as one my life's primary missions to help other people understand and overcome it. Depression kills people because in the normal weather patterns of human emotion over a day or a week or a decade, actual unipolar major depressive disorder doesn't appear. It's like The Nothing in The NeverEnding Story. It eats your anger, your sadness, your happiness, your testicle and/or ovaries.

Stress and glucocorticoids have inverted-U effects here as well. Moderate, transient stress (or exposure to the equivalent glucocorticoid levels) increases spine number in the hippocampus; sustained stress or glucocor-ticoid exposure does the opposite.7 Moreover, major depression or anxiety—two disorders associated with elevated glucocorticoid levels—can reduce hippocampal dendrite and spine number. This arises from decreased levels of that key growth factor mentioned earlier this chapter, BDNF. Sustained stress and glucocorticoids also cause dendritic retraction and synapse loss, lower levels of NCAM (a “neural cell adhesion molecule” that stabilizes synapses), and less glutamate release in the frontal cortex.

Let’s incorporate behavior. If someone has extensive frontocortical damage, how predictable is it that you’d note something odd about them, behaviorally, after a five-minute conversation? Something like 75 percent. Now let’s consider a broader range of behaviors. How predictable is it that this person with the frontal damage will do something horrifically violent at some point? Or that someone who was abused repeatedly as a child will become an abusive adult? That a soldier who went through a battle that killed his buddies will develop PTSD? That a person with the “montane vole” polygamous version of the vasopressin receptor gene promoter will have numerous failed marriages? That a person with a particular array of glutamate receptor subtypes throughout their cortex and hippocampus will have an IQ above 140? That someone raised with extensive childhood adversity and loss will have a major depressive disorder? All under 50 percent, often way under.

I now believe that virtually all my problems could be attributed to my brain’s being configured differently from those of the majority of humans. All the psychiatric symptoms were a result of this difference, not of any underlying disease. Of course I was depressed: I lacked friends, sex, and a social life, because I was incompatible with other people. My intensity and focus were misinterpreted as mania. And my concern with organization was labeled as obsessive-compulsive disorder.

Things weren’t always as good as they are now. In school we learned that in the old days, the dark days, people didn’t realize how deadly a disease love was. For a long time they even viewed it as a good thing, something to be celebrated and pursued. Of course that’s one of the reasons it’s so dangerous: It affects your mind so that you cannot think clearly, or make rational decisions about your own well-being. (That’s symptom number twelve, listed in the amor deliria nervosa section of the twelfth edition of The Safety, Health, and Happiness Handbook, or The Book of Shhh, as we call it.) Instead people back then named other diseases—stress, heart disease, anxiety, depression, hypertension, insomnia, bipolar disorder—never realizing that these were, in fact, only symptoms that in the majority of cases could be traced back to the effects of amor deliria nervosa.

Narcissistic personality disorder and other personality disorders are different than psychiatric patterns considered more “syndromal,” like major depression. Personality disorders are patterned ways of responding to the world and of responding to one’s inner world. Under times of stress these patterns become even stronger. Because they are patterns, they are also predictable. These patterns reside in the narcissist, not you, but their patterns cause a great deal of disruption in their relationships with everyone around them.

Modern researchers have identified one or more major mood disorders in John Quincy Adams, Charles Darwin, Emily Dickinson, Benjamin Disraeli, William James, William Tecumseh Sherman, Robert Schumann, Leo Tolstoy, Queen Victoria, and many others. We may accurately call these luminaries “mentally ill,” a label that has some use—as did our early diagnosis of Lincoln—insofar as it indicates the depth, severity, and quality of their trouble. However, if we get stuck on the label, we may miss the core fascination, which is how illness can coexist with marvelous well-being. In

Because of media portrayals, clinicians may believe that dissociative identity disorder presents with dramatic, florid alternate identities with obvious state transitions (switching). These florid presentations occur in only about 5% of patients with dissociative identity disorder.(20) How ever, the vast majority of these patients have subtle presentations characterized by a mixture of dissociative and PTSD symptoms embedded with other symptoms, such as post-traumatic depression, substance abuse, somatoform symptoms, eating disorders, and self-destructive and impulsive behaviors.(2,10)

There is no major psychiatric condition in which sleep is normal. This is true of depression, anxiety, post-traumatic stress disorder (PTSD), schizophrenia, and bipolar disorder (once known as manic depression).

To begin with, there is an almost compulsive promiscuity associated with homosexual behavior. 75% of homosexual men have more than 100 sexual partners during their lifetime. More than half of these partners are strangers. Only 8% of homosexual men and 7% of homosexual women ever have relationships lasting more than three years. Nobody knows the reason for this strange, obsessive promiscuity. It may be that homosexuals are trying to satisfy a deep psychological need by sexual encounters, and it just is not fulfilling. Male homosexuals average over 20 partners a year. According to Dr. Schmidt, The number of homosexual men who experience anything like lifelong fidelity becomes, statistically speaking, almost meaningless. Promiscuity among homosexual men is not a mere stereotype, and it is not merely the majority experience—it is virtually the only experience. Lifelong faithfulness is almost non-existent in the homosexual experience. Associated with this compulsive promiscuity is widespread drug use by homosexuals to heighten their sexual experiences. Homosexuals in general are three times as likely to be problem drinkers as the general population. Studies show that 47% of male homosexuals have a history of alcohol abuse and 51% have a history of drug abuse. There is a direct correlation between the number of partners and the amount of drugs consumed. Moreover, according to Schmidt, “There is overwhelming evidence that certain mental disorders occur with much higher frequency among homosexuals.” For example, 40% of homosexual men have a history of major depression. That compares with only 3% for men in general. Similarly 37% of female homosexuals have a history of depression. This leads in turn to heightened suicide rates. Homosexuals are three times as likely to contemplate suicide as the general population. In fact homosexual men have an attempted suicide rate six times that of heterosexual men, and homosexual women attempt suicide twice as often as heterosexual women. Nor are depression and suicide the only problems. Studies show that homosexuals are much more likely to be pedophiles than heterosexual men. Whatever the causes of these disorders, the fact remains that anyone contemplating a homosexual lifestyle should have no illusions about what he is getting into. Another well-kept secret is how physically dangerous homosexual behavior is.

The results of decades of neurotransmitter-depletion studies point to one inescapable conclusion: low levels or serotonin, norepinephrine or dopamine do not cause depression. here is how the authors of the most complete meta-analysis of serotonin-depletion studies summarized the data: "Although previously the monoamine systems were considered to be responsible for the development of major depressive disorder (MDD), the available evidence to date does not support a direct causal relationship with MDD. There is no simple direct correlation of serotonin or norepinephrine levels in the brain and mood.' In other words, after a half-century of research, the chemical-imbalance hypothesis as promulgated by the drug companies that manufacture SSRIs and other antidepressants is not only with clear and consistent support, but has been disproved by experimental evidence.

The criteria of agency and ownership distinguish structural dissociation from other manifestations of insufficient integration such as intruding panic attacks in panic disorder or intrusions of negative cognitions in major depression.

In the 30 years following Prozac, the field has not flourished but fizzled out. There have been no major new advances in drug treatment, or psychological treatment come to that, for depression or any other mental health disorder, since about 1990.

About half of patients with pure anxiety disorders develop major depression within five years. Insofar as depression and anxiety are genetically determined, they share a single set of genes (which are tied to the genes for alcoholism). Depression exacerbated by anxiety has a much higher suicide rate than depression alone, and it is much harder to recover from. “If you’re having several panic attacks every day,” says Ballenger, “it’s gonna bring Hannibal to his knees. People are beaten into a pulp, into a fetal position in bed.

...the vast majority of these [dissociative identity disorder] patients have subtle presentations characterized by a mixture of dissociative and PTSD symptoms embedded with other symptoms, such as posttraumatic depression, substance abuse, somatoform symptoms, eating disorders, and self-destructive and impulsive behaviors.2,10 A history of multiple treatment providers, hospitalizations, and good medication trials, many of which result in only partial or no benefit, is often an indicator of dissociative identity disorder or another form of complex PTSD.

Autism, dyslexia, language delay, language impairment, learning disability, left-handedness, major depressions, bipolar illness, obsessive-compulsive disorder, sexual orientation, and many other conditions run in families, are more concordant in identical than in fraternal twins,

MOOD DISORDERS BY THE NUMBERS If you’re overwhelmed with anxiety, depression, anger, or other emotions, you’re certainly not alone. Among adults in the United States: •Nearly 29 percent will have an anxiety disorder at some point in their life, including phobias (12 percent), social anxiety disorder (12 percent), generalized anxiety disorder (6 percent), and panic disorder (5 percent). •As many as 25 percent will experience major depressive disorder during their lifetime. •In a given year, more than 44 million will experience an anxiety disorder and more than 16 million will experience major depressive disorder.

Our brain scanning experiments in healthy individuals offered reflections on the relationship between sleep and psychiatric illnesses. There is no major psychiatric condition in which sleep is normal. This is true of depression, anxiety, post-traumatic stress disorder (PTSD), schizophrenia, and bipolar disorder (once known as manic depression).

That question became even more salient to me as I began my clinical work with troubled children. I soon found that the vast majority of my patients had lives filled with chaos, neglect and/or violence. Clearly, these children weren’t “bouncing back”—otherwise they wouldn’t have been taken to a child psychiatry clinic! They’d suffered trauma—such as being raped or witnessing murder—that would have had most psychiatrists considering the diagnosis of post-traumatic stress disorder (PTSD), had they been adults with psychiatric problems. And yet these children were being treated as though their histories of trauma were irrelevant, and they’d “coincidentally” developed symptoms, such as depression or attention problems, that often required medication.

Autism, dyslexia, language delay, language impairment, learning disability, left-handedness, major depressions, bipolar illness, obsessive-compulsive disorder, sexual orientation, and many other conditions run in families, are more concordant in identical than in fraternal twins, are better predicted by people’s biological relatives than by their adoptive relatives, and are poorly predicted by any measurable feature of the environment.

Many people still don’t understand what I have since learned: that ECT, when properly administered, is the fastest, most effective treatment for depression and bipolar disorder when medications have failed to work. Up to 90 percent of people with major depression for whom nothing else worked find relief in days or weeks, and the effects on memory are usually ( but not always) modest. It is also sometimes given soon after the onset of schizophrenia.

Medications used to treat psychiatric disorders are commonly referred to as psychotropic drugs. These drugs are commonly described by their major clinical application, for example, antidepressants, antipsychotics, mood stabilizers, anxiolytics, hypnotics, cognitive enhancers, and stimulants. A problem with this approach is that these drugs have multiple indicators. For example, selective serotonin reuptake inhibitors (SSRls) are both antidepressants and anxiolytics, and the serotonin-dopamine antagonists (SDAs) are both anxiolytics and mood stabilizers.

ME/CFS is not synonymous with depression or other psychiatric illnesses. The belief by some that they are the same has caused much con- fusion in the past, and inappropriate treatment. Nonpsychotic depression (major depression and dysthymia), anxiety disorders and somatization disorders are not diagnostically exclusionary, but may cause significant symptom overlap. Careful attention to the timing and correlation of symptoms, and a search for those characteristics of the symptoms that help to differentiate between diagnoses may be informative, e.g., exercise will tend to ameliorate depression whereas excessive exercise tends to have an adverse effect on ME/CFS patients.

depression in its major stages possesses no quickly available remedy: failure of alleviation is one of the most distressing factors of the disorder as it reveals itself to the victim, and one that helps situate it squarely in the category of grave diseases. Except in those maladies strictly designated as malignant or degenerative, we expect some kind of treatment and eventual amelioration, by pills or physical therapy or diet or surgery, with a logical progression from the initial relief of symptoms to final cure. Frighteningly, the layman-sufferer from major depression, taking a peek into some of the many books currently on the market, will find much in the way of theory and symptomatology and very little that legitimately suggests the possibility of quick rescue. Those that do claim an easy way out are glib and most likely fraudulent. There are decent popular works which intelligently point the way toward treatment and cure, demonstrating how certain therapies—psychotherapy or pharmacology, or a combination of these—can indeed restore people to health in all but the most persistent and devastating cases; but the wisest books among them underscore the hard truth that serious depressions do not disappear overnight. All of this emphasizes an essential though difficult reality which I think needs stating at the outset of my own chronicle: the disease of depression remains a great mystery. It has yielded its secrets

Anthropologists like Kohrt, Hoffman, and Abramowitz have identified three factors that seem to crucially affect a combatant's transition back into civilian life. The United States seems to rank low on all three. First, cohesive and egalitarian tribal societies do a very good job at mitigating effects of trauma, but by their very nature, many modern societies are exactly the opposite: hierarchical and alienating. America's great wealth, although a blessing in many ways, has allowed for the growth of an individualistic society that suffers high rates of depression and anxiety. Both are correlated with chronic PTSD. Secondly, ex-combatants shouldn't be seen -or be encouraged to see themselves - as victims... Lifelong disability payments for a disorder like PTSD, which is both treatable and usually not chronic, risks turning veterans into a victim class that is entirely dependent on the government for their livelihood... Perhaps most important, veterans need to feel that they're just as necessary and productive back in society as they were on the battlefield... Recent studies of something called 'social resilience' have identified resource sharing and egalitarian wealth distribution as major components of a society's ability to recover from hardship. And societies that rank high on social resilience...provide soldiers with a significantly stronger buffer against PTSD than low-resilience societies. In fact, social resilience is an even better predictor of trauma recovery than the level of resilience of the person himself.

Who Suffers? If you have social anxiety, you are not alone. The National Comorbidity Study found social phobia to be the third most common psychiatric disorder, after major depression and alcohol dependence. Experts believe that millions of people suffer from it. It is difficult to get exact numbers because the nature of social anxiety often makes it difficult for people to seek help. Many people who appear confident and strong suffer silently for years before telling anyone how they feel. In the general population, social anxiety appears to affect more women than men. This may be due in part to the social norms that determine that women should be less aggressive and more reserved than men. However, more men seek treatment, possibly because social anxiety has more of an impact on the jobs traditionally held by men. As gender roles in society continue to shift, these statistics will probably change.

Thus polyvictimization or complex trauma are "developmentally adverse interpersonal traumas" (Ford, 2005) because they place the victim at risk not only for recurrent stress and psychophysiological arousal (e.g., PTSD, other anxiety disorders, depression) but also for interruptions and breakdowns in healthy psychobiological, psychological, and social development. Complex trauma not only involves shock, fear, terror, or powerlessness (either short or long term) but also, more fundamentally, constitutes a violation of the immature self and the challenge to the development of a positive and secure self, as major psychic energy is directed toward survival and defense rather than toward learning and personal development (Ford, 2009b, 2009c). Moreover, it may influence the brain's very development, structure, and functioning in both the short and long term (Lanius et al., 2010; Schore, 2009). Complex trauma often forces the child victim to substitute automatic survival tactics for adaptive self-regulation, starting at the most basic level of physical reactions (e.g., intense states of hyperarousal/agitation or hypoarousal/immobility) and behavioral (e.g., aggressive or passive/avoidant responses) that can become so automatic and habitual that the child's emotional and cognitive development are derailed or distorted. What is more, self-integrity is profoundly shaken, as the child victim incorporates the "lessons of abuse" into a view of him or herself as bad, inadequate, disgusting, contaminated and deserving of mistreatment and neglect. Such misattributions and related schema about self and others are some of the most common and robust cognitive and assumptive consequences of chronic childhood abuse (as well as other forms of interpersonal trauma) and are especially debilitating to healthy development and relationships (Cole & Putnam, 1992; McCann & Pearlman, 1992). Because the violation occurs in an interpersonal context that carries profound significance for personal development, relationships become suspect and a source of threat and fear rather than of safety and nurturance. In vulnerable children, complex trauma causes compromised attachment security, self-integrity and ultimately self-regulation. Thus it constitutes a threat not only to physical but also to psychological survival - to the development of the self and the capacity to regulate emotions (Arnold & Fisch, 2011). For example, emotional abuse by an adult caregiver that involves systematic disparagement, blame and shame of a child ("You worthless piece of s-t"; "You shouldn't have been born"; "You are the source of all of my problems"; "I should have aborted you"; "If you don't like what I tell you, you can go hang yourself") but does not involve sexual or physical violation or life threat is nevertheless psychologically damaging. Such bullying and antipathy on the part of a primary caregiver or other family members, in addition to maltreatment and role reversals that are found in many dysfunctional families, lead to severe psychobiological dysregulation and reactivity (Teicher, Samson, Polcari, & McGreenery, 2006).

Inflammation is the body’s natural response to invaders. I already discussed this problem and how “leaky gut” will lead to weight gain. It may be more important to note that “leaky gut” will lead to major health issues because it causes chronic inflammation. Cancer, asthma, headaches, allergies, arthritis, auto-immune disorders, heart disease, diabetes, depression, Alzheimer’s, and osteoporosis are all caused by chronic inflammation.

Not only did she find that the survivors in her study produced less cortisol, a characteristic they can pass on to their children, she notes that several stress-related psychiatric disorders, including PTSD, chronic pain syndrome, and chronic fatigue syndrome, are associated with low blood levels of cortisol.2 Interestingly, 50 to 70 percent of PTSD patients also meet the diagnostic criteria for major depression or another mood or anxiety disorder.3

One of the first studies to demonstrate this benefit recruited patients with major depressive disorder who had been taking antidepressants but were not responding. The patients provided a blood sample so researchers could determine how inflamed they were. Then, the patients were assigned to one of two exercise interventions: high-frequency exercise or low-frequency exercise.29 The high-frequency group completed (or exceeded) the recommended physical activity guidelines of 150 minutes of moderate to vigorous aerobic exercise each week, for a total workload of 16 kcal/kg body weight/week. The low-frequency group completed only a quarter of the recommended physical activity guidelines each week, for a total workload of 4 kcal/kg body weight/week. Workouts were done on a treadmill or stationary bike at a self-selected intensity for 12 weeks, and depressive symptoms were assessed at the end of each week. By the end of the 12 weeks, everyone benefited from the exercise, but the inflamed patients benefited the most. Exercise not only reduced their depression symptoms, but it also downgraded the symptoms from moderate to mild — a clinically significant change in symptom severity that was similar to the relief that responders get from antidepressants.30 The best part? Both the high- and low-frequency exercisers benefited equally.

The problem is not merely theoretical. A psychiatrist in training concluded a grand rounds case presentation by saying, “This patient has sleep problems, low interest, low energy, poor concentration, low appetite, and a seven-pound weight loss, so she qualifies for a diagnosis of major depression. We will begin antidepressant treatment.” When asked, “What set this all off?” the young doctor replied, “Family problems.” “What kind of family problems?” “Her husband left her.” Did she see warning signs about his leaving? Don’t know. Was this her first marriage? Don’t know. Does she have a relationship with another man? Don’t know. Was she abused in childhood? “I didn’t ask about those things because they aren’t relevant. The diagnosis is major depression, and the treatment plan follows established evidence-based guidelines for this brain disorder.” The excessive confidence in and commitment to a narrow ideology were as breathtaking as the willful ignorance about the patient.

When is it best to give up on a major life goal? Early in my career, I always encouraged patients to keep trying, keep trying, don’t let your depression symptoms fool you into thinking you can’t succeed. Often that was good advice. Some applicants get into medical school the fourth time they apply. Some singers land a gig with the Grand Ole Opry after their fifth year in Nashville. But more become increasingly despondent as failure follows failure. Sometimes a five-year engagement turns into marriage. Sometimes staying another year in LA trying to break into film pays off. But not often. Sober experience combined with my growing evolutionary perspective to encourage respecting the meaning of my patients’ moods. As often as not, their symptoms seemed to arise from a deep recognition that some major life project was never going to work. She was glad he wanted to live with her, but it looks increasingly like he will never agree to get married. The boss is nice now and then and hints at promotions, but nothing will ever come of it. Hopes for cancer cures get aroused, but all treatments so far have failed. He has stayed off booze for two weeks, but a dozen previous vows to stay on the wagon have all ended in binges. Low mood is not always an emanation from a disordered brain; it can be a normal response to pursuing an unreachable goal.

Desperate to join the medical mainstream, psychiatry recognized that its diagnostic system was grossly inadequate. For instance, in the 1968 second edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-II), depressive neurosis was defined as “An excessive reaction of depression due to an internal conflict or to an identifiable event such as the loss of a love object or cherished possession.”4 Is moderate depression a week after the loss of a favorite cat “excessive”? One diagnostician would say, “No, not at all, people love their cats”; another, “After a week, it is obviously excessive!” Such disagreements made psychiatry’s scientific aspirations laughable. The solution was a radical revision, DSM-III, published in 1980.5 Written by a task force of the American Psychiatric Association under the leadership of psychiatry researcher Robert Spitzer, it purged psychoanalytic theory from DSM-II and replaced its 134 pages of clinical impressions describing 182 disorders with 494 pages of symptom checklists that defined 265 disorders. “Depressive neurosis” was eliminated. The definition of a new diagnosis, “major depressive disorder,” said nothing about internal conflict; it only required the presence of at least five of nine possible symptoms for at least two weeks. Every diagnosis was now defined by a checklist of necessary and sufficient symptoms. DSM-III transformed psychiatry.6 It made possible standardized interviews that epidemiologists could use to measure the prevalence of specific disorders.

A group of researchers at Columbia University analyzed data from two large, multicenter discontinuation trials encompassing 673 people diagnosed with major depressive disorder and who were taking fluoxetine (generic Prozac) for twelve weeks.47 After those three months, they were told that they’d be randomized to either a placebo or continued fluoxetine. So while they all knew they were taking the antidepressant in the first three months, they didn’t know if what they were given afterward was an active antidepressant or a sugar pill. The results spoke for themselves: both groups—the ones still taking the fluoxetine and those on the placebo—experienced a worsening of depressive symptoms. This outcome suggests two significant interpretations: (1) the initial effect during the first three months was attributable to placebo, as all patients knew they were receiving treatment; and (2) the worsening of symptoms upon the mere possibility of getting just a placebo is indicative of the undoing of the placebo effect, what’s sometimes called the nocebo effect.

To really grasp the fact that depression is not a disorder primarily rooted in the brain, look no further than some of the most demonstrative studies. When scientists purposefully trigger inflammation in the bodies of healthy people who exhibit no signs of depression by injecting them with a substance (more on this shortly), they quickly develop classic symptoms of depression.17 And when people with hepatitis C are treated with the pro-inflammatory drug interferon, as many as 45 percent of those individuals develop major depression.18

l There are two broad types of mood disorders: depressive disorders and bipolar disorders. l Depressive disorders include major depression and persistent depressive disorder, along with the newer diagnoses of premenstrual dysphoric disorder and disruptive mood dysregulation disorder. Bipolar disorders include bipolar I disorder, bipolar II disorder, and cyclothymia. l Bipolar I disorder is defined by mania. Bipolar II disorder is defined by hypomania and episodes of depression. Major depressive disorder, bipolar I disorder, and bipolar II disorder are episodic. Recurrence is very common in these disorders. l Persistent depressive disorder and cyclothymia are characterized by low levels of symptoms that last for at least 2 years. l Major depression is one of the most common psychiatric disorders, affecting 16.2 percent of people during their lifetime. Rates of depression are twice as high in women as in men. Bipolar I disorder is much rarer, affecting 1 percent or less of the population.

Clinical descriptions and Epidemiology l There are two broad types of mood disorders: depressive disorders and bipolar disorders. l Depressive disorders include major depression and persistent depressive disorder, along with the newer diagnoses of premenstrual dysphoric disorder and disruptive mood dysregulation disorder. Bipolar disorders include bipolar I disorder, bipolar II disorder, and cyclothymia. l Bipolar I disorder is defined by mania. Bipolar II disorder is defined by hypomania and episodes of depression. Major depressive disorder, bipolar I disorder, and bipolar II disorder are episodic. Recurrence is very common in these disorders. l Persistent depressive disorder and cyclothymia are characterized by low levels of symptoms that last for at least 2 years. l Major depression is one of the most common psychiatric disorders, affecting 16.2 percent of people during their lifetime. Rates of depression are twice as high in women as in men. Bipolar I disorder is much rarer, affecting 1 percent or less of the population.

Major depressive disorders can perniciously disable the patient in supposedly carrying out their normal functions. There are those who suffer the disabling effects in only a single episode. However, there are those whose have recurrent episodes.

Almost every major infectious epidemic, such as smallpox, polio, and the plague, happened after the Agricultural Revolution began. In addition, studies of recent hunter-gatherers show that although they don’t enjoy surpluses of food, they rarely suffer from famines or serious malnutrition. Modern lifestyles have also fostered new noncommunicable but widespread illnesses such as heart disease, certain cancers, osteoporosis, type 2 diabetes, and Alzheimer’s, as well as scores of other lesser ailments, such as cavities and chronic constipation. There is good reason to believe that modern environments contribute to a sizeable percentage of mental illnesses, such as anxiety and depressive disorders.2 The

Another well-known study, led by Nancy Andreasen, used structured interviews and matched control groups to examine thirty writers at the prestigious University of Iowa Writers’ Workshop. Eighty percent of the writers met formal criteria for a major mood disorder, compared with thirty percent of controls matched for age, education, and sex.

To differentiate between symptoms of depression and anxiety secondary to ME/CFS and psychiatric disorders, ask the patient what they will do the next time they have a “good day”. A patient with ME/CFS will have a long list of ideas whereas a patient with major depressive disor- der will say they can not think of anything they enjoy any more. Patients with an anxiety disorder will have a list of reasons why they won’t be able to do or enjoy the activities.

SOME MONTHS LATER, in July 2003, Rose Firestein was browsing the official Web site of the Food and Drug Administration when she suddenly reared back in surprise. She blinked and looked again. Buried in the third paragraph of an FDA press release, dated June 19, 2003, was this sentence: “Three well-controlled trials in pediatric patients with MDD [major depressive disorder] failed to show that [Paxil] was more effective than placebo.” The reference to these negative findings about Paxil mystified Firestein. Why would doctors so readily prescribe Paxil (making it by 2003 the second most widely prescribed antidepressant for those under eighteen years old) if the results of drug tests were uniformly negative?

A major depressive episode, often called “depression” or “clinical depression,” means that you have felt down or sad, or much less interested in things than usual, for most of the day, nearly every day, for at least two weeks. In addition to feeling sad or less interested in things, you have at least four other depressive symptoms

A few tips to help you further distinguish hypomania is to remember that hypomania is abnormally high or irritable mood, meaning different from what a person usually experiences when happy or upset/irritable. Hypomanic episodes also last for at least four consecutive days. Thus, this abnormally high or irritable mood persists for several days and is accompanied by at least three (or four, if the mood is irritable) of the manic/hypomanic symptoms in table 1.1 for the same four days. Finally, in order to be diagnosed with BPII, you must have also experienced a major depressive episode at some time in your life.

How are psychiatric and neurological disorders different? At the moment, the most obvious difference is the symptoms that patients experience. Neurological disorders tend to produce unusual behavior, or fragmentation of behavior into component parts, such as unusual movements of a person’s head or arms, or loss of motor control. By contrast, the major psychiatric disorders are often characterized by exaggerations of everyday behavior. We all feel despondent occasionally, but this feeling is dramatically amplified in depression. We all experience euphoria when things go well, but that feeling goes into overdrive in the manic phase of bipolar disorder. Normal fear and pleasure seeking can spiral into severe anxiety states and addiction. Even certain hallucinations and delusions from schizophrenia bear some resemblance to events that occur in our dreams.

In the largest effectiveness study to date, with more than four thousand patients with major depressive disorder in primary care and community settings, only 31 percent were in remission after 14 weeks of optimal treatment. In most double-blind trials of antidepressants, the placebo response rate hovers around 30 percent . . . The unfortunate reality is that current medications help too few people to get better and very few people to get well.

While the symptoms of CTE can include difficulty with math or memory, some common early symptoms also include disorientation, dizziness, headaches, irritability, outbursts of violent or aggressive behavior, confusion, speech abnormalities, and major depressive disorder (McKee, et al., 2009). A large number of CTE symptoms have very little to do with how “smart” you are, and CTE can make daily life or maintaining simple human relationships extremely difficult. A disproportionately large number of retired athletes with CTE commit suicide, including Chicago Bears defensive back Dave Duerson, who texted his family to ask that his brain be used for research into the disease before fatally shooting himself in the chest in 2011.

Women are more likely than men to have higher disgust sensitivities, which fits with their greater sensitivity to smells generally, though this does not result un differences in perception or consumption. Other individual differences include proneness to mood dysregulation, like bipolar disorder and major depression, such that more intense and prolonged periods of negative affect -sadness and fear- are experienced.

During the depersonalisation or derealisation experiences, reality testing remains intact. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or other medical condition (e.g., seizures). E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.

Reduced levels of ATP have been found in a wide variety of disorders, including schizophrenia, bipolar disorder, major depression, alcoholism, PTSD, autism, OCD, Alzheimer’s disease, epilepsy, cardiovascular disease, type 2 diabetes, and obesity.

In one study, James Blumenthal, a clinical psychologist at Duke University, assigned sedentary adults with major depressive disorders to one of four groups: supervised exercise, home-based exercise, antidepressant therapy, or a placebo pill. After four months Blumenthal found that patients in the exercise and antidepressant group had the highest rates of remission. In his conclusions, he stated that exercise has more or less the same effect as antidepressants.

People increasingly can no longer reach out to a friend, change their life, talk to a trusted individual, change their diets, rebel against industrialized and oppressive society, or question those in authority. Just like religion, the people in charge know something no one else can and the evil within us must be quelled. Rather than exorcism, Prozac or Abilify can finally cast out our demons. In addition to these widely discussed problems, so, too, does the mental health field resort to claims of conspiracy and personal attacks against those in disagreement with the status quo and relies heavily on subjective measurement and tautological reasoning. Again, using the example of depression, this subjectivity and circular reasoning becomes evident. If a person seeks help for feeling sad, lethargic, unmotivated, and experiencing changes in sleep, this person might receive a diagnosis of MDD, a purported brain disease requiring life-long treatment. How does one know that this person “has” MDD? Because they feel sad, lethargic, unmotivated, and has changes in sleep. If the person wants to be really sure, a validated measurement might be given to said person which asks, essentially, if the person is sad, lethargic, unmotivated, and has had changes in sleep patterns. This process is akin to saying “I have a headache”, to which a doctor responds “Ah, yes, you have Major Headache Disorder”. If asked “How do you know I have Major Headache Disorder?” the answer is “Because you have a headache”.

David Kent’s story shows that regular exercising improves, not only your physical well-being, but also your mood. Studies have shown that exercising can treat mild to moderate depression as effectively as antidepressants. In one study, James Blumenthal, a clinical psychologist at Duke University, assigned sedentary adults with major depressive disorders to one of four groups: supervised exercise, home-based exercise, antidepressant therapy, or a placebo pill. After four months Blumenthal found that patients in the exercise and antidepressant group had the highest rates of remission. In his conclusions, he stated that exercise has more or less the same effect as antidepressants.

Most recently, the DSM-5 has been shown to have unacceptably low inter-rater agreement for several common disorders, including major depressive disorder (Regier et al., 2013

Major depression also appears to have become unusually widespread in the late Renaissance. This disorder is diagnosed when a person shows a severely depressed mood, a loss of interest and motivation, and withdraws from usual activities. In Elizabethan Malady, Lawrence Babb analyzes references to melancholy in diverse literary works, finding that while they are almost nonexistent in the early Renaissance, by the 1600s they are a principal theme in prose, drama, and biography. Babb concludes that the late Renaissance was characterized by “an epidemic of melancholy.” The poet John Donne, who offered sonnets to the “Holy Sadness of the Soul,” provided a vivid description of this malady, which he himself knew well: “God has seen fit to give us the dregs of misery, an extraordinary sadness, a predominant melancholy, a faintness of heart, a cheerlessness, a joylessness of spirit.

On average, we spend far more of our time in depression than we do in mania or hypomania—by a ratio of three to one for those with bipolar I, according to a major 2003 study. Estimates go much higher for those with bipolar II.

However, since nearly everybody in the world carried the comfort gene, they believed that many people probably suffered from genetic anomalies involving the gene. For example: People who were overly desirous of joining the majority—that might prove to be a genetic disorder. And people who felt depressed when they were alone, by themselves—conceivably, another disorder. People who joined protest marches, went to sports games, who sought out situations where they would be surrounded by lots of like-minded people—a potential genetic disorder.

experiential avoidance.” Experiential avoidance means the ongoing attempt to avoid, escape from, or get rid of unwanted thoughts, feelings, and memories—even when doing so is harmful, useless, or costly. (We call this “experiential avoidance” because thoughts, feelings, memories, sensations, etc., are all “private experiences.”) Experiential avoidance is a major cause of depression, anxiety, drug and alcohol addiction, eating disorders, and a vast number of other psychological problems.

Synapsin Synapsin is a major immunoreactive protein found in most neurons of the central and peripheral nervous systems. It is a brain protein involved in the regulation of neurotransmitters (brain hormones). These antibodies to your brain cause demyelinating diseases (like MS) and numbness and tingling anywhere in your body. Synapsin also will inhibit the release of neurotransmitters and can cause lupus as well as mood disorders and depression.

Given that recent research has demonstrated the complex psychopathology of DID, equating the disorder with one specific but broadly denned behavior (multiple identity enactment) is clearly unwarranted. The latter should be conceptualized as one observable behavior that may or may not be related to a feature of the disorder (identity alteration). As an analogy, equating major depressive disorder with "acting sad" would be similarly unwarranted because the former is a complex depressive disorder characterized by a clear group of depressive symptoms, whereas the latter is one specific behavior that may or may not be related to one of the symptoms of the disorder (sad affect). One could also easily generate a list of factors that affect whether one acts sad that would have little relevance to the complex psychopathology of depressive disorders.

Antidepressants have also been associated with an increased acute risk of suicide in younger patients while they may decrease the risk of suicide in older patients or with longer-term use. Also, all major classes of antidepressants have been associated with unpleasant (and sometimes dangerous) symptoms when they are discontinued abruptly. Discontinuation of antidepressants is associated with relapse and recurrence of MDD (Major Depressive Disorder). In a meta-analysis, this risk was shown to be higher for antidepressants that cause greater disruption to neurotransmitter systems . . . [And] there is a growing body of research suggesting that when they are used in the long term as a maintenance treatment, antidepressants can lose efficacy, and may even result in chronic and treatment-resistant depression. Such reactions may be due to the brain’s attempt to maintain homeostasis and a functioning adaptation in spite of the medication.

Our brain scanning experiments in healthy individuals offered reflections on the relationship between sleep and psychiatric illnesses. There is no major psychiatric condition in which sleep is normal. This is true of depression, anxiety, post-traumatic stress disorder (PTSD), schizophrenia, and bipolar disorder (once known as manic depression

Major consequences for denying our angry feelings range all the way from psychophysiological disorders, such as headaches and ulcers, to character disorders, such as passive-aggression, to the inability to work, to serious depression and panic. Any way you look at it, denying anger keeps one from getting problems solved.

Yehuda discovered similar low cortisol levels in war veterans, as well as in pregnant mothers who developed PTSD after the World Trade Center attacks, and in their children. Not only did she find that the survivors in her study produced less cortisol, a characteristic they can pass on to their children, she notes that several stress-related psychiatric disorders, including PTSD, chronic pain syndrome, and chronic fatigue syndrome, are associated with low blood levels of cortisol.2 Interestingly, 50 to 70 percent of PTSD patients also meet the diagnostic criteria for major depression or another mood or anxiety disorder.3 Yehuda’s research demonstrates that you and I are three times more likely to experience symptoms of PTSD if one of our parents had PTSD, and as a result, we’re likely to suffer from depression or anxiety.4 She believes that this type of generational PTSD is inherited rather than occurring from our being exposed to our parents’ stories of their ordeals.5 Yehuda was one of the first researchers to show how descendants of trauma survivors carry the physical and emotional symptoms of traumas they have not directly experienced.

The specific psychiatric disorders in which mitochrondrial dysfunction has been identified include the following: schizophrenia, schizoaffective disorder, bipolar disorder, major depression, autism, anxiety disorders, obsessive-compulsive disorder, posttraumatic stress disorder, attention deficit/hyperactivity disorder, anorexia nervosa, alcohol use disorder (aka alcoholism), marijuana use disorder, opioid use disorder, and borderline personality disorder. Dementia and delirium, often thought of an neurological illnesses, also included.

According to the National Alliance on Mental Illness, 1 in 17 people in America lives with a serious mental illness such as schizophrenia, major depression, or bipolar disorder.  Approximately 20% of youths ages 13 to 18 experience a severe mental disorder in a given year.  The community services available for these people are disappearing at an alarming rate.

Major depressive disorder is a disease caused by features of the contemporary Western lifestyle: social isolation, limited physical activity, chronic stress and unhealthy food.

Major depressive disorder starts, ostensibly, when clusters of symptoms cause serious, protracted impairment. How serious, how protracted does that impairment have to be for you to qualify as depressed? There's no surefire way to tell.