Psychiatry Advisor: Addressing depression in ME/CFS, 2018, Cindy Lampner

[alex3619]

So on the one hand, you reject the idea that ME/CFS is psychogenic. But when it comes to depression, you argue the reverse, promoting the idea the depression has a psychogenic basis.

Not at all. Emotional and experiential events induce brain changes. Brain changes can lead to things including depression. Brains do react to stimuli, including internal stimuli. Nobody questions this. It is NOT the same as psychogenic disease. It is also not valid to claim that a disease is psychogenic if we don't know what causes it.

Psychological and social factors do modify disease risk. It is not the same to claim they cause disease. They can also modify disease expression, how a patient reacts. Again, not causal for the disease.

For example, cultures that use fingers for family eating risk increased H. pylori transmission. Sharing salt has long been known to do this. Salt does not cause those gastric ulcers, nor does sharing food. However these things do modify expression and risk.

 

[Cheshire]

So on the one hand, you reject the idea that ME/CFS is psychogenic. But when it comes to depression, you argue the reverse, promoting the idea the depression has a psychogenic basis.

I don't have a strong opinion about what causes depression but your argument doesn't stand. If an illness is not caused by something, it doesn't mean this something is not causing something else. Your sentence is like stating: diabetes is not caused by viruses, I don't understand why you'd say Ebola is.

As someone who suffers from comorbid depression, to me it seems very clear that my own depression is biological in its basis, and not psychogenic.

What you feel about something doesn't make it true, nor does it make universal.

Edit: to make it clear, I don't think the psychogenic theories are of any value, be it for ME or depression. That doen't mean that environmental factors can't affect our mood and be a factor in depression.

 

[alex3619]

If you take "mind" out of the discussion, and focus on brain, stimuli, brain changes, physiological changes, you can avoid the traps psychogenic thinkers leave in their muddled claims. I put the hypothesis out there, not for the first time, that all so-called psychogenic diseases are physical diseases. Every. Single. One.

Maybe there is some disease that is truly psychogenic, but they have failed to prove it in any disease at all.

 

[James Morris-Lent]

I think this exchange just further illustrates that calling something 'psychogenic' does not actually rise to the level of being categorized as either correct or incorrect.

It is not clear what exactly it's supposed to mean and when deployed it is wrenched into one of myriad meanings depending on the particular circumstance in which somebody is trying to score points for it.

 

[Barry]

The reason for the high prevalence of depression in patients with ME/CFS has not yet been fully explained

Try it and see, then the explanation will be clear to you. It makes you feel like sh*t anyway, but then add onto that the burden of not being believed, of certain arrogant psychiatrists thinking they can fix something they completely misunderstand, of the medical profession in general being very uncaring about pwME, etc. ... all pretty depressing really. Maybe you folk should seriously investigate those things.

 

[Trish]

I think the problem may be that the word depression is used for everything from low mood to life changingly awful major depressive disorder.

And it includes endogenous depression with purely biochemical/brain causes that is not affected by external environment or events, and also includes depression brought on by difficulties in circumstances, including being chronically sick. And then there is the overlap where a physical illness may also lead to biochemical changes that affect mood.

It's a minefield of confusion, but I think important to recognise that one person may be depressed by circumstances, and another have a depressive illness that seems unrelated to circumstances.

 

[Sly Saint]

This is the NHS self-assessment test for depression:
https://assets.nhs.uk/tools/self-assessments/index.mob.html?variant=42

There was a program on BBC a while ago, where the presenter/doctor did the test and it recommended he seek medical help.
(The test was developed with funding from Pfizer).

(haven't done it so have no idea what the questions are).

 

[Snow Leopard]

Those suggesting depression in ME/CFS is due to the limitations the illness places on your life:

You are in effect saying that your depression has a psychogenic cause. That is, you are saying the depression is caused by events and limitations in your life, rather than thinking the depression might have a biological cause in the brain.

So on the one hand, you reject the idea that ME/CFS is psychogenic. But when it comes to depression, you argue the reverse, promoting the idea the depression has a psychogenic basis.

I find that paradoxical, although such views are common in ME/CFS patients.

What are you talking about? How is it radical to believe social and psychological factors influence depression?

 

[dangermouse]

It's difficult to explain. Especially with a fogged up mind .. but I'll try:

I don't get what I understand of as clinical depression, I tend to experience a fluctuation of mood. My mood (brain chemistry) is definitely affected by my fluctuating hormones and I can normally tell that kind of event (for want of a better word). When I get a bad spell (ME wise) and my energy is rock bottom and fatigue so bad that I can barely function my mood is affected, it feels similar to my hormonal events - I am not aware of thinking about it, it just is as it is .. it ties in with being completely debilitated.

I don't know if I'm making sense because none of this makes sense to me and it confuses the life out of me.

I am aware, during ''flat as a pancake'' times that I have nothing at all to give. There's nothing going on in my head. I'm like a zombie without any ability to think, or talk properly or sentence form etc. Empty.

Likely, not made sense here but hey, I tried.

 

[Barry]

That is, you are saying the depression is caused by events and limitations in your life, rather than thinking the depression might have a biological cause in the brain.

A good friend/colleague of mine died a while back from cancer. He was by nature an extremely optimistic and positive person, as is his wife. Towards the end however, when the inevitable finally hit home, they could not escape the deep depression that comes with it all, no matter how much help they had.

On the other hand there are forms of depression that very likely do have biological causes (as I once long experienced with a member of my family), within or influencing the brain.

I cannot understand why you suggest the two forms are mutually exclusive; that believing in one form means disbelieving the other.

 

[dangermouse]

Just a point of interest as to how mood can be affected etc:

A good friend recently had a bereavement, she is normally one of the happiest and bouncy (Tigger-type) people that I know but this bereavement shook her and changed her - in a bad way. She had intense sessions with mental health team and had to have anti-depressant medication because she scored so high on the depression questionnaire that the team conducted.

Since then she tells me she is not as she was, not yet. She's improving but definitely not where she was before the bereavement. They told her that part of the grieving process is depression.

 

[Arnie Pye]

I think the problem may be that the word depression is used for everything from low mood to life changingly awful major depressive disorder.

And it includes endogenous depression with purely biochemical/brain causes that is not affected by external environment or events, and also includes depression brought on by difficulties in circumstances, including being chronically sick. And then there is the overlap where a physical illness may also lead to biochemical changes that affect mood.

It's a minefield of confusion, but I think important to recognise that one person may be depressed by circumstances, and another have a depressive illness that seems unrelated to circumstances.

My "dissatisfaction" with the whole depression issue is that doctors decide that if a person has disease X or illness Y and they have also become depressed since developing disease X or illness Y, that fixing the depression will also cure the disease or illness.

This is absolutely ridiculous but happens all the time to a wide range of patients, no matter what disease X or illness Y actually is. It's as if doctors have decided that it is inconvenient to have effect following cause, so they are going to unilaterally declare that cause follows effect because it makes their lives so much easier, and patients so much easier to dismiss.

 

[alex3619]

I cannot understand why you suggest the two forms are mutually exclusive; that believing in one form means disbelieving the other.

My current suspicion, not yet a proper hypothesis, is that depression is best thought of as a symptom spectrum ... a range of related things. Its not a disease entity as we understand it, but will contain many disease entities within it, and be a symptom of many recognised disease entities, with many not discovered yet.

Much of the cognitive shutdown in ME I would not class as depression, but these symptoms often lead to diagnoses of depression because the rules for diagnosis are about assigning people to the depression pigeonhole. One day we may have enough understanding to give people with what we label depression a real diagnosis, and treatment or cure based upon real understanding. That is my hope.

In the case of late stage cancer depression there is so much going on that all we will have without a lot more research is a vague diagnosis. Immunobiology, chemotherapy, other drugs, social circumstances, the way the brain reacts to dire anticipated events ... these are all mangled together. Antidepressants might help but these are very blunt instruments. We wont get better treatment tools without major advances in the science.

I don't want to confuse ME with depression, they are different but may have many things in common, but advances in technology to study depression might help in studying ME, and vice versa. New instruments for investigation can totally change the picture, and transfer to many diseases.

 

[Hip]

Emotional and experiential events induce brain changes. Brain changes can lead to things including depression.

Sure, but I am trying to make the distinction regarding the source of depression. Neurological illnesses often induce depression, and I am calling that type of depression biologically caused. And we know that bad life events can cause depression too, which I am calling psychogenically caused.

I am just using those terms to distinguish between internal and external sources of depression. Of course you could have both together: some biologically caused depression which is worsened by bad life events.

 

[Hip]

Edit: to make it clear, I don't think the psychogenic theories are of any value, be it for ME or depression. That doen't mean that environmental factors can't affect our mood and be a factor in depression.

I did not really understand the first paragraph of your post.

The quote above seems a little self contradictory: you don't believe psychogenic factors are valid as causes of depression, but then you say that environmental factors can be a factor in depression. By environmental factors I presume you mean social environment and life events, which are psychogenic factors.

 

[Hip]

What are you talking about? How is it radical to believe social and psychological factors influence depression?

I think almost everyone knowledgable about depression would agree that both biological and psychogenic factors can cause or contribute to it. I would say depression is one of the very few illnesses where the biopsychosocial theory applies.

But what I am talking about is the fact that time and time again, when I have seen ME/CFS patients taking about depression on forums, the cause of depression in ME/CFS patients automatically pinned on psychogenic factors: the limited life and limited social life that ME/CFS patients have.

And ME/CFS patients will often claim that the depression researchers are stupid (or words to that effect), as it should absolutely obvious to everyone that the depression some ME/CFS patients is due to the said psychogenic factors.


But I don't think that is obvious at all. I am not denying that psychogenic factors may be involved; however, ME/CFS is a neurological disease that affects the brain. We know in the case of other neurological diseases (eg Parkinson's, MS) that biological depression arises, presumably as a result of the biological illness processes occurring in the brain.

So you might think that patients with ME/CFS would also consider that their depression may well arise from biological illness processes in the brain. But no, in previous discussions like these, ME/CFS patients always pin the depression down to psychogenic factors.

Which I find strange, especially given that as a group, we are all quite circumspect of psychogenic explanations.

 

[Hip]

A good friend/colleague of mine died a while back from cancer. He was by nature an extremely optimistic and positive person, as is his wife. Towards the end however, when the inevitable finally hit home, they could not escape the deep depression that comes with it all, no matter how much help they had.

I cannot understand why you suggest the two forms are mutually exclusive; that believing in one form means disbelieving the other.

I am sorry to hear about the loss of your friend.

As mentioned above, depression is one of the few conditions where the biopsychosocial model does actually apply: depression may be caused by both biological factors and psychogenic factors.

Nobody can know for sure why your friend started to experience depression towards the end, but because cancer also triggers inflammation, and inflammation is linked to depression, it's possible that as the cancer progressed, the increased inflammation it caused brought about this depression, in an otherwise extremely optimistic and positive person. This paper discusses how inflammation in cancer may cause biological depression.

 

[Cheshire]

I did not really understand the first paragraph of your post.

I was using your logic.

The quote above seems a little self contradictory: you don't believe psychogenic factors are valid as causes of depression, but then you say that environmental factors can be a factor in depression.

No. I think depression can be caused by environmental factors (and have biological factors too), but I won't use ther term "psychogenic", because of all the wrong theories that are linked to this term and also the fact that it simply omits social factors and put all the blame on the person.

 

[Trish]

I did not really understand the first paragraph of your post.

The quote above seems a little self contradictory: you don't believe psychogenic factors are valid as causes of depression, but then you say that environmental factors can be a factor in depression. By environmental factors I presume you mean social environment and life events, which are psychogenic factors.

Perhaps this confusion highlights the problems with the bio-psycho-social model of illness.

I'm sure we all agree that there are biological factors that lead to depression, either as endogenous depression without other physical illness, or biological effects of physical illness.

There are also social factors that can cause depression, such as loss of a loved one, loss of job, being bullied at work, gaslighting of ME patients by doctors, and many more.

But what about psychological factors. In the case of ME that is supposedly stuff like 'false illness beliefs', 'fear avoidance of exercise', 'catastrophising' etc. In other words it's about the patient's way of thinking, which is supposedly amenable to therapy. I'm not sure what 'psychological factors' would be in the case of depression. Can 'wrong thinking' cause depression? I have no idea.

 

[Arnie Pye]

Nobody can know for sure why your friend started to experience depression towards the end,

Err... The man knew he was going to die. Isn't that enough? Aren't people allowed to be depressed for any reason now without being told they are mentally ill and should be treated or dismissed, according to the whims of a doctor or therapist? In my opinion depression is a normal (i.e. not sick) response to many shitty circumstances in life. It doesn't necessarily mean that someone is mentally ill.

Whenever someone questions the reasons behind depression I start to imagine the depressed person as happy as a puppy, smiling, joking, laughing. I would say that person was in denial, in the case of someone dying of cancer, and that is far worse than being depressed.

People aren't supposed to have emotions any more without being diagnosed with something, presumably so someone can make or save some money somewhere along the line.