who is starting a new thread, due to a major change in his life. Much of the relevant stuff is extremely private, so I will not be as open as I were in the past. Still I am accumulating and discovering interesting information which I think I should share with you all as it might be interesting and useful to some of you at least.
During the night following my 70th birthday, I packed a few thing including my trusty laptop and drove to my son's apartment in a town about 50 miles from my home. I left a letter telling my family that I need some privacy to think things over and to feel better mentally and physically. In reality I felt entrapped and began to realize that instead of helping my wife (who was diagnosed with clinical depression two years ago) or my daughter (whose fibromyalgia was getting worse instead of leveling off or getting better) I am also feeling gradually worse and worse.
I started to feel better after a few days so I made an appointment and went to see my wife's ex-doctor. It took him about 5 minutes to diagnose me with major depression. Bursting into tears in his office I most likely helped to establish that diagnosis.
He put me on Remeron a tetracyclic antidepressant.
Mirtazapine (Remeron) is a structural analogue of the off-patent mianserin (Bolvidon). It is a comparatively new drug - a so-called NaSSA. By blocking the inhibitory presynaptic alpha2 adrenergic autoreceptors and stimulating only the 5-HT1A receptors, mirtazapine enhances noradrenaline and serotonin release while also blocking two specific (5-HT2 and 5-HT3) serotonin receptors implicated in dark moods and anxiety. By contrast, stimulation of the 5-HT2A receptors accounts for the initial anxiety, insomnia and sexual dysfunction sometimes reported with the SSRIs; stimulation of the 5-HT3 receptors causes nausea. Mirtazapine is a potent blocker of the histamine H1 receptors, too. So it tends to have a somewhat sedative effect. This profile may be good for agitated depressives and insomniacs.
I was surprised at his diagnosis. I am sure I appeared unhappy at the moment as I did not feel too hot about deserting my family, but I was not sure I had clinical depression. But again I was not quite sure about the definition and the diagnostic methods of depression.
So I went back to the apartment and started to research it. First I took several depression tests. One was as follows:
Depression Symptoms
• Feelings of sadness and/or irritability x
• Loss of interest or pleasure in activities normally enjoyed
• Changes in weight or appetite
• Changes in sleeping pattern x
• Feelings of guilt, hopelessness, or worthlessness
• Inability to concentrate, remember things, or make decisions x
• Constant fatigue or loss of energy x
• Observable restlessness or decreased activity
• Recurrent thoughts of suicide or death
In addition, look for at least three of the following symptoms, which could indicate the manic phase of manic-depression:
• Inflated ego, envisioning of grand schemes
• Increased energy and decreased need for sleep
• Inappropriate excitement or irritability
• Increased talking and/or moving
• Sexual promiscuity
• Disconnected and racing thoughts
• Impulsive behavior and poor judgment
Comment: This is only four positive answers and two of them: changes of sleeping pattern may be explained by the diagnosis of RLS/PLMD and so is the fatigue and loss of energy. That leaves only two positive answers and to be depressed would take at least 5.
I also took an on-line questionnaire that printed out a letter to one's doctor. Here is the reply I received:
Your Final Report
According to your answers on the Depression Test, the concerns that you have about your health are not the result of an depression problem. However, it is important to remember that the Depression Test is not a substitute for professional advice and the Depression Test Final Report is not a diagnosis.
If you have serious concerns about your health, we strongly encourage you to talk to your doctor about them.
So according to these test I did not have clinical depression. From time to time I could have at least some the symptoms but with one major difference. For example:
Yes, I feel in a situation that is hopeless. But it is hopeless or at least I am unable to find a solution.
My chronically ill daughter needs me and would get worse if she thought I am abandoning her.
Anyone can be made to feel worthless if verbally abused long enough, even if logic tells otherwise. It is tough when one cannot please the loved ones no matter how hard one would try. Would that cause depression?
or only simple unhappiness? Are they the same?
Briefly the question is: if one has an identifiable reason for one's unhappiness, is it depression or not. It is now known that unhappiness, drastic loss (death in the family) can cause the same chemical imbalance in the brain and the CNS than depression can (low serotonin levels). Mourning however is a natural process....
http://www.clinical-depression.co.uk/program.html
Then I found a website "uncommon knowledge" that opened my eyes and taught me things about depression (see link above):
Today it is generally believed that depression is caused by chemical imbalance in the brain and the CNS and thus is a disease.
However, after careful analysis, it appears that it is the other way around:
[b]Depression causes the chemical imbalance in the brain, so it is a symptom rather than the cause of the affliction.[/b]
So what is depression? Can we understand it?
Understanding Depression
THE first step towards overcoming depression is understanding it. What it is, how it works, and what it does to us.
UNTIL NOW, it has been difficult to link the psychological elements of clinical depression to the physical symptoms.
Now, however, a new breakthrough so profound has changed our ideas of what depression actually is.
And this breakthrough makes depression much, much easier to treat.
It shows us exactly what we have to do to halt depression in its tracks.
And precisely what will stop it coming back.
It removes all uncertainty, and most of the fear from depression.
Depression, Dreaming and Exhaustion:The New Link
How your thoughts affect you physically
"Depressed people dream up to three times as much as non-depressed people."
This is a startling, and illuminating fact. And when combined with a recent breakthrough in dream and depression research by Joseph Griffin of the European Therapy Studies Institute, it gives us a clear understanding of the how depression affects us physically.
The cycle of depression starts with depressive thinking style. On the negative aspects of things, and depressing thoughts one would keep ruminating. This brings about stress that is not ressolved. These open loops have to be ressolved by the brain which it does during extensive REM periods at night. This is hard work for the brain and it occurs at the expense of the deep, relaxing sleep phases. So one wakes up exhausted and fatigued in the morning, or early in the morning.
The continued stress shows up in increased cortisol level in one's blood (the stress hormone).
The Key Understanding about Dreams and Depression is thus:
When unfulfilled emotional arousal remains in the brain's limbic system at sleep onset, the brain creates scenarios that allow those loops to complete. We call them dreams.
The dream acts out, in metaphor, a situation that will allow the emotional loop to be completed and therefore 'flushed' from the brain.
In other words, an imaginary experience whose pattern resembles the 'real life' one closely enough to create the same emotional reaction.
For example, during the day you worry about what someone has said to you, thinking that they were perhaps criticising or making fun of you. That night you have an anxiety dream where someone stabs at you with daggers and you try to run away. The dream allows your system to complete the loop started by the emotional arousal.
Depressive thinking styles mean more arousal
Depressive thinking styles will tend to cause more negative emotional arousal, and therefore more dreaming. This extra dreaming is to try to 'clear the brain' for the next day, but because our negative arousals are excessive when depressed, our natural rhythms find it hard to cope with this "over-dreaming":
Why is over-dreaming bad for me?
Basically, because dreaming is hard work.
Dreaming itself is not a restful activity. Dreaming is called 'paradoxical sleep' because brain wave patterns are similar to those of the brain when completely awake.
Dreaming is a state of arousal.
As far as much of your brain is concerned, your dream is real. So adrenaline and other stress hormones in your system will be active in the body.
This is a double edged sword, because over-dreaming, as well as using up these hormones and energy, is actually making it harder for the body to make more. As you try to flush out the incomplete emotions, you spend more time in REM sleep, and therefore less time in deep sleep, when your body should be recuperating in preparation for producing these hormones for the next day.
So if you are over-dreaming you're not resting but flooding your system with adrenaline and other stress hormones. If most of your sleep consists of dreams, your body and mind will begin to feel very tired during the day. Depressed people often report that the worst time of day is first thing in the morning.
Sometimes a depressed person may start waking up early in the morning and not be able to get back to sleep. This may be a way of the body trying to cut down on over-dreaming in order to try and lift depression.
Yes, I started to wake up at 4 am, then 2-3 am at night and felt wide awake.
In the meantime I went to see my neurologist, Dr. G. to whom I delivered a bunch of materials from the National Meeting of RLS. She has been treating me for Restless Leg Syndrome. I asked her whether it is true depression if someone has a readily identifiable reason to be depressed which is real (as opposed to be imagined). G. commented that depression can often result in anger, hostility, irritability. This hostility then often is aimed at the person closest to us.
The material I delivered to her (including my discovery of frequency reversal between sensations and pain going from location legs then arms, to lower back and feet). Now she realizes that there can be pain in RLS that goes away with movements, and also pain that does not evolve from paresthesia, typically lower back pain. So now finally she asked me how much hydrocodone I would want (she refuses to prescribe it before). One small victory!
Interestingly once I started on Remeron I have moderately severe lower back ache. Doctor A did not want to prescribe Wellbutrin because it makes one hyper, and I am hyper enough. BTW one of the rare side effect of Remeron lower back ache.
How to treat depression or depression-like symptoms?
Antidepressants
If you're taking or considering taking depression medication, there are important things you need to know.
"Regarding depression as 'just' a chemical imbalance wildly misconstrues the disorder. It is not possible to explain either the disease or its treatment based solely on levels of neurotransmitters," says Yale University neurobiologist Ronald Duman, PhD
Yet this is exactly how antidepressants purport to work - by treating levels of neurotransmitters. By understanding how antidepressants work, we can see how they treat a symptom of depression, not the root of the depression, and are therefore ineffective in one to two thirds of sufferers.
We also saw another reason that antidepressants sometimes work, thanks to a recent discovery in the field of dream research.
This also explains why antidepressants have such a high rate of relapse, compared to other effective therapies for depression.
However, one does not have to be anti-drug, just has to realize its limitations so one can choose the best treatment for oneself.
So what else is there that works for depression?
I will discuss it in my next post as I am now trying this other path!
By the way, until recently I thought that my secondary RLS was triggered by change in medications that have been taken for literally decades. Now I am wondering that depression can also cause RLS instead of the other way around?Do you all remember the guy who was "cured" of his RLS after he bought a memory foam mattress AND after his wife left him?
I apologize for the length of this initial post of this thread. I hope it makes some sense to some of you.
!
