R There 2 Types of Depression - Intrinsic & Circumstantial?

Discussion in 'Mental Health Disorders' started by Tegularius, Feb 26, 2008.

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  1. Tegularius

    Tegularius Member

    I have been struck by the fact that there seems to me to be 2 very different types of depression. One that comes upon people no matter what is happening in their lives and one that depends very much on what is happening in their lives.

    One person may be rich, successful and have 'everything a person could desire' but the Black Dog hounds them relentlessly, randomly and mercilessly. Another may be a farmer plagued by years of drought who thinks about ending his own life every day, then the rain comes, he gets a bumper crop and all thoughts of suicide disappear like they had never existed.

    These seem to indicate 2 fundamentally different types of conditions to me although both of them are given the same name under the current medical paradigm, they are both called simply 'depression', treated identically, and there seems to be no clinical differentiation between them.

    I think these are actually 2 entirely different disorders and I would like to know if anyone else feels this distinction is valid.
  2. Joshuwah

    Joshuwah Well-Known Member

    Valid.. Very valid
  3. Feared.Desire

    Feared.Desire Well-Known Member

    When you say it like that it sounds as if it could legitimately be labeled as two different illnesses. But so long as both are chemically and scientifically equivalents then the medication has no need to differ from one to the other. That would also explain why they’re both classified as the same disorder.
    I’m not actually sure about this, though, I’m just speculating.
  4. Tegularius

    Tegularius Member

    Thanks for raising that point - I think that since just about everything that goes on in the mind is 'chemically mediated' that a different disorder probably has a different 'chemistry' and that therefore may respond differently to different 'medication'.

    One reason I raised this particularly is that I have 'circumstantial' type depression and I have found Cannabis to have a really positive effect however I have noticed that with people who have the 'intrinsic' type Cannabis seems to have a negative effect.

    When I have tried to talk to my shrink about it he says 'results are inconsistent for Cannabis' however I have pointed out to him that if you differentiate between the 2 types of depression the results are actually very consistent, ie it works for circumstantial but not for intrinsic, however as he refuses to differentiate the 2 the results of trials are conflated and therefore 'inconclusive'.

    I have tried to get him to mount a trial himself but the anti-cannabis hysteria in Australia is at fever pitch thanks to an 11yr concerted misinformation campaign mounted by a fear mongering conservative and he probably risks professional censure if he even proposes it, even using the synthetic Dronabinol.

    BOLIAO Guest

    i think what you are trying to say is that there are two types of depression, one is clinical and the other one is reactional/situational. Both results in chemical imbalances in the brain and if left untreated will become worse.
  6. Not sure what the remedy is, if there is one...but I do know it used to frustrate the HELL out of me, trying to get relief from several avenues, and often receiving very much the same reaction - that it was "merely a chemical imbalance".

    REPEATED TRAUMAS (which I endured) SINCERELY FUCK YOU UP!!!!! And if a "chemical imbalance" (!!!) ensues because you literally cannot take anymore of those circumstances (going so far as to wish to die as the only option to escape), there aint' NO fucking DRUG that's gonna change that!

    God I hate people with their one-size-fits-all solutions!!!!
  7. Feared.Desire

    Feared.Desire Well-Known Member

    That’s actually a very good point… about the ‘it helping one type but not the other’. I’ve never even considered that, and you may very well be right.
    I wonder if there are any studies done on that. If not, there should be.
  8. ToHelp

    ToHelp Well-Known Member

    :D This is good. I actually wrote a short paper about the distinction debate as it began brewing in the late eighties into early nineties. The short answer for the OP is that the model (of distinction) is becoming obsolete in psychiatry for practical purposes--diagnosis and treatment.

    What everyone is trying to say is endogenous versus exogenous depression.

    The latest thinking in the field is that this dualistic approach towards depression is becoming obsolete, in no small part because of the following example. If a close relative dies or one suffers some traumatic event (exogenous causation) and they go on an AD, it's well established now that they have a statistically equivalent chance of seeing benefit either way.

    Okay, so on to pot. Semantics annoy me, and I prefer to just to say what the hell it is. Cannabis is marijuana is pot. It enjoys a multi-billion dollar distribution and helps support a criminal underworld.

    Dronabinol (Marinol in the states) is a synthetic derivative of THC (delta-9-tetrahydrocannabinol), prescribed for many ailments now ranging from glaucoma to nausea. Wiki :))) even says there is a spray approved for multiple sclerosis patients in Canada.

    Downside? These formulations have proven more abusable than pot as traditionally smoked, inducing a strong psychoactive effect. This creates a black market potential, which is why Marinol is so darned hard to get prescribed.

    My stand on pot is the same as with MDMA or ecstasy. In most parts of the Western world, is illegal to even possess, making the entire discussion a bit irrelevant as to real-world solutions--unless we in encourage illegal activities on here.

    That said, I definitely concede the benefits *and* that the laws are simply FUBAR bass ackwards in having booze legal and the rest, not. :laugh:

    Nonetheless, it is what it is and Johnny Law has marijuana on a freaking Schedule III in the states--highly illegal to possess. The larger the quantity the bigger the mess for the person caught in possession. (Just ask anyone who has been there... court systems, probation, the WHOLE nine yards ...ain't worth, they'll tell you.)

    * * * * *​

    Tegularius I think you have a gift for prose. :thumbup: "One person may be rich, successful and have 'everything a person could desire' but the Black Dog hounds them relentlessly, randomly and mercilessly."

  9. smackh2o

    smackh2o SF Supporter

    My doctor said to me that my depression kicked off by circumstance and was event driven. But that i've had depression for so long, he thinks it has developed into intrinsic, meaning even if I sort out my orginal problems I might still be depressed!
    Just my two cents...
  10. ToHelp

    ToHelp Well-Known Member

    Good post Smack. You segue, or dovetail, straight into the fact that whether there exist "two types" of depression is academic because the net result the same: Trauma.

    FAL1 takes the cake, though. "Not sure what the remedy is, if there is one...but I do know it used to frustrate the HELL out of me, trying to get relief from several avenues, and often receiving very much the same reaction - that it was "merely a chemical imbalance," pointing out that repeated traumas take their toll.

    It has also been pointed out on here that a severe depression, even once it is overcome, is a trauma that person has endured in their lives.

    It's fiction, btw., that depression results from a "chemical imbalance," and FAL1 nails that one, too. The buzz words "chemical imbalance" is just ad fodder for public consumption in an attempt explain why and how pills might work.

    The brain remains an organism so complex that (get this) the area of neuropharmacology (researchers; the lab-rat people in the white coats) is still largely trial-and-error. We think we have a handle on certain direct mechanisms of action for many psychiatric drugs, but we still have to try and try and try again, starting with animals, progressing to human trials, and finally marketing for mass prescription.

    We are getting there though.

    Quite in contrast to the rate at which technology is proceeding (Moore's law dictates chip processor speed will double every eighteen months), we'll still need another century or two before we can actually eradicate depression in people. Want a really compelling read? Check this here thing there out. In particular, just click on the first one, called The Hedonistic Imperative.

  11. ggg456

    ggg456 Guest

    I see what you mean but they might not be 2 fundamentally different types of depression. There's the assumption that the rich, successful "everything a person could desire" person is suffering from something that is independent from their lives, something deeply pathological, because why wouldn't they, as they've got it all? There are a lot of underlying, insidious things going on in the lifestyle/social life of that person, or in the history of that person which might make their depression and their feelings of helplessness understandable. They might seem to live in a world of opportunity but they might be in their own hellish cell full of conflict between what they want to do and the limitations imposed by their environment. Being rich financially doesn't mean you're free or feel free.

    I can remember in hospital I was sickened by a nurse telling a woman on Section 3 and receiving ECT, who was very strongly wanting to die and had a very turbulent childhood, about a past patient who had also received ECT. This nurse couldn't understand that this past patient, being "blonde, very pretty, had a husband and children and had a philosophy degree" could ever be so low. "She was the lowest I've ever seen and I couldn't understand it, she had it all." I ended up running out of that dormitory in disgust. I was always running out of that dormitory feeling sick at what I was hearing. Why? Because firstly she was talking to a suicidal woman so insensitively but also because of assumptions. She seemed to be blind to the fact that this past patient was a woman, a complex human being and not cardboard cut out from a magazine as she couldn't figure out why she felt bad. She insinuated that there's a type of heirachy in terms of how mental health professionals look at people from different social backgrounds, how they clearly don't understand people, which reflects a lot of society's attitudes of doomed hopeless cases if you're not ABC. People look at me and think that I diagnosed with a psychotic illness am going to be sitting around saying, "Yeah I agree, I'm doomed I have to take this medication which will suck me of all my energy, but I'm not." No way. I've gone through a lot of horrific things all through my life. People might think, "Why isn't she dead, why isn't she sad, you're supposed to be sad, you've lost everything your family, your home, your university place, you live your life wandering from one house to another, very fragmented." But I'm not sad. I feel fucking great. People don't understand how much they are responsible for holding such ideas- if you're surrounded by people always saying or giving you messages "This is where you belong, down there, you can't move, you can't think" you are going to feel trapped.
    Last edited: Feb 29, 2008
  12. ToHelp

    ToHelp Well-Known Member

    :thumbup: Great post GGG. You "get it." I agree with everything you said.
  13. ggg456

    ggg456 Guest

    Thanks. :smile:
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