Training with depression? Long term prognosis? Training with depression? Long term prognosis? - Page 3

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Thread: Training with depression? Long term prognosis?

  1. #21
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    Quote Originally Posted by jfsully View Post
    Current diagnostic criteria distinguish between Major Depressive Disorder vs. Depressive Disorder Due to Another Medical Condition (which would include low T). I am not sure where you got the term "biological depression," as all psychiatric conditions have biological (brain) correlates. Maybe you want to distinguish between sadness or grief (normal adaptive responses to circumstances) and depression (an illness that interferes with function and can shorten and/or reduce quality of life)? The illness of Depression, by definition, may be a natural phenomenon like disease states in general, but it is not useful.

    I'm going to leave it alone after this (hopefully) but my agenda in this thread is to encourage OP to work with his psychiatrist to find a med or med combination that works for his depression and psychosis without causing intolerable side effects, start or continue psychotherapy, and keep training.

    The OP has reported having Psychotic Depression, which has a specific definition (ie, it's not just Really Bad Depression), and is a fairly distinct subtype of Major Depressive Disorder. It is not like sadness, being bummed, or feeling wrung out from low T. Untreated, or with inadequate or improper treatment, it can be dangerous and destructive. To give uninformed medical advice, or to suggest changing to an alternate class of medications, like MAOi, without any rationale other than "works for me" is potentially harmful to OP. This is probably not a helpful place to advance theories about the nature of mental illness or whether the drug companies overmedicalize normal experiences for profit, though that stuff is definitely worth discussing.

    Sorry to be on a bit of a high horse, but this is an area that is important to me personally and professionally, and I have expertise to share. When it comes to strength training, I'm a grateful student around here and mostly read and learn, so I try to contribute when I do have an informed opinion. As a psychiatrist, I feel able to pull rank in a discussion like this, just as a professional barbell coach can and should school me all day about barbell technique and programming.
    I understand your position, I appreciate your expertise, and your time. Have you had a bad experience with prescribing testosterone for a clinically depressed patient?

  2. #22
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    Quote Originally Posted by Mark Rippetoe View Post
    I understand your position, I appreciate your expertise, and your time. Have you had a bad experience with prescribing testosterone for a clinically depressed patient?
    Thanks, Rip. I have not had a bad experience prescribing T because I don't prescribe it. I also haven't seen a patient have a bad outcome from TRT, although we know there are small but real risks with that treatment. I've had a few guys who stopped coming to see me after starting TRT. I have, however, seen more guys who came to me for depression after TRT was insufficient, even if it helped somewhat.

    Testosterone is not a factor at all for the majority of my patients. That being said, it is possible that I am missing some low T or patients with T resistance that would benefit. If a patient has more prominent somatic/physical signs of depression: fatigue, sleep disturbance, loss of libido, and increased body fat/sarcopenia, and they are a middle-aged guy and I therefore suspect low T, I will suggest they discuss with their PCP or consider a urology visit or a "healthy aging clinic" (which is like a medical marijuana clinic but for testosterone) if they are really interested in T and their PCP is skeptical or resistant to testing. As a psychiatrist I don't prescribe or manage testosterone therapy. I have had a few patients do great with T and they don't need to come back to see me. Much more often, if they've already had bad enough depression to see me, they have partial benefit from TRT but still have residual depression. I have found that patients with depressive symptoms like continuous low mood, persistent and unrealistic negative thoughts, suicidal ideation, psychosis, etc. generally have Major Depressive Disorder and need psychiatric treatment. They may also need TRT, but that doesn't really do the trick by itself when you have the illness of depression.

    I assume that there are lots of guys who see their PCP with low mood and other complaints, get put on T, and never have to come see the psychiatrist in the first place . In fact, most patients with depression don't see a psychiatrist ever, and we know that most SSRI prescriptions are written by PCPs. There are multiple ironies in this. Most of the patients managed for depression by PCPs have mild depression, which has much less benefit from SSRIs compared to severe depression. This means that many don't get much better, which leads to the public and PCPs themselves wondering why SSRIs are so overprescribed and useless, and blaming the psychiatry/big pharma nexus, and wondering if depression is really a thing that needs treatment at all. For the most part, the people who make it to the psychiatrist have bad enough symptoms that meds are useful. Currently, I work at an inpatient psych hospital, and see the most severely depressed patients, among other things. You will have to trust me that the vast majority of the depressed patients I see look markedly different from the guys who show up in your gym who have lost their mojo. If these folks somehow got it together to make it to your gym, you'd quickly see that they were too depressed to train properly and tell them to come back after getting their depression treated.

    In other words, the fact that I don't refer for TRT very often is not because I think it doesn't work, but is more a function of the patient population who makes it in to see me. Think of it this way: most guys who have no history of depression and have never had mental illness, but now feel low and draggy know they're not "crazy" and they will resist a referral to psychiatry because they intuitively know that it's not mental illness. They may or may not be right, but they usually are, and most of them are more likely to go see a doc about TRT or come see you to get strong than they are to come see me. And if I'm honest, most people with mild depression don't need a psychiatrist nearly as much as they need a therapist, a good barbell coach, better work/life balance, and a good night's sleep.

    OP, as far as I can tell, is one of the guys who should be in the psychiatrist's office (in addition to doing everything else too).

    For the people who are reading this and thinking that depression is just a normal fluctuation of mood and not an illness, you're not entirely wrong, it's just that you are not seeing the depression that I am seeing. Sure, lots of people look for a pill not to treat an illness but to provide self-efficacy, and a good psychiatrist keeps their prescription pad in the desk, smiles, and sends them to psychotherapy. Just like when someone wants to get strong and healthy and asks you about "one weird trick," and you smile and hand them SS:BBT3. It's just that we have come to use the word "depression" to describe ennui or malaise in addition to using it to describe an illness that is a major cause of disability and suffering. It's like describing both a back tweak and a vertebral burst fracture as "back pain." Sort of correct, but really misses the mark, and it's not helpful to tell the spinal fracture patient "hey, everybody gets back pain, I had a bad back myself for a while. Try stretching." I was on a surgery rotation once, where one of the surgery residents was presenting a patient to the attending, and when asked about the patient's medical history said "just depression." The senior surgeon said "Just depression, huh? What do you think would be worse, a stroke that gave you weakness on the whole left side of your body, or a stroke that damaged your brain so that you lost the ability to enjoy anything at all?" Pretty much everybody agreed we would choose the hemiplegic stroke, except for one miserable bastard that already didn't enjoy anything (and who probably needed an SSRI). That's not a bad way to think about the illness of depression.

    Ok, enough of my soapbox. Time to stop thinking about depression and go train or get some sleep.

  3. #23
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    How big is the risk of infertility with TRT?

  4. #24
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    Thanks, JF. We appreciate your insight.

    Quote Originally Posted by dpinsen View Post
    How big is the risk of infertility with TRT?
    Very significant, which is why it is not indicated for men under the age of 45, or men trying to get the old lady settled.

  5. #25
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    Quote Originally Posted by jfsully View Post
    I will suggest they discuss with their PCP or consider a urology visit or a "healthy aging clinic" (which is like a medical marijuana clinic but for testosterone)
    If someone has a poor quality of physical life and some aspects of mental depression or sluggishness and they think TRT is the answer, why not? This is not a challenge to your thoughtful and expansive contribution to this subject. In general, I don't like the use of drugs for enhancing performance in the gym or some other athletic endeavor, if that is the primary reason for resorting to them. Just like I don't like supportive equipment in powerlifting like bench shirts and squat suits.

    The cropped and quoted remark above though is a gem. After my first year of competing (at age 62) I had done 3 meets. A local meet in April, another local meet in September, followed by the good fortune of having qualified for IPL Worlds in November, a mere 7 weeks after the September meet. I was overwrought for that last meet being unable to sleep or eat well for over a week prior to and up to a day or two after the event. Fatigue, depression, and a general sense of malaise put me in a mental and physical funk for the remainder of that year.

    I consulted a urologist to have my testosterone tested. He interviewed me at some length to get a sense of what and why I thought I might be in need of TRT. At that point, I was only interested in knowing where my T levels were at rather than resort to a shotgun TRT approach, and I told him so. He was somewhat amused and said he doubted my T levels were low, given my early competition history. He added that he could tell I wasn't simply looking for a boost to my lifting totals. So a test it was that very afternoon. It came in borderline, and he had me retest with an early morning fasting blood draw.

    The result of the second test was that my T was above normal, not a lot above normal for a geezer, but above the average. This process lasted into the middle of January of the new year, and between getting some rest and the reassurance of something more than my "feelings" on my state of being, I pulled up and out of the Slough of Despond my overamped ambitions had imposed on my body and my brain.

    The urologist said throughout this process some things that mirror your take on "healthy aging clinics" although his comparison was to traveling botox shows. Your remark simply jogged my memory about this, and it is one well worth making.

  6. #26
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    Quote Originally Posted by Mark Rippetoe View Post
    Thanks, JF. We appreciate your insight.



    Very significant, which is why it is not indicated for men under the age of 45, or men trying to get the old lady settled.
    How well does HCG work for mitigating this effect?

  7. #27
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    Quote Originally Posted by Mark E. Hurling View Post
    I consulted a urologist to have my testosterone tested. He interviewed me at some length to get a sense of what and why I thought I might be in need of TRT. At that point, I was only interested in knowing where my T levels were at rather than resort to a shotgun TRT approach, and I told him so. He was somewhat amused and said he doubted my T levels were low, given my early competition history. He added that he could tell I wasn't simply looking for a boost to my lifting totals. So a test it was that very afternoon. It came in borderline, and he had me retest with an early morning fasting blood draw.

    The result of the second test was that my T was above normal, not a lot above normal for a geezer, but above the average. This process lasted into the middle of January of the new year, and between getting some rest and the reassurance of something more than my "feelings" on my state of being, I pulled up and out of the Slough of Despond my overamped ambitions had imposed on my body and my brain.
    Amazing! Test levels vary diurnally! Who would have known this without Hurling's always-valuable take on the situation? And that means that the average test level is the value we must consider!! I think I speak for the rest of the board when I say that we don't ever want your Test levels above the average between borderline low and "normal" for a geezer, because a man of your experience, wisdom, and masculine capacity -- both as a Law Enforcement Officer and a Martial Artist -- would undoubtedly make the rest of us look like fools, not to mention the existential danger posed to DB 24/7/365. We can already just barely imagine the existential danger you once posed to nogoodnick criminals during back-alley takedowns on your way home from Gung Fu/Wing Chung/Hopkido classes during which you masterfully contributed by teaching 80-year-olds to safely fall, with your testosterone levels just above average for a man in his 20s, 30s, or even 40s or 50s.

    Gentlemen, try for a few seconds to envision Mark E. Hurling striding the earth with his test level at 745, and then tell me if you want that as even a remote possibility. Why, NO ONE would ever be able to get testosterone again, because the Medical Community would see the example of Mark E. Hurling, striding the earth, bringing shame and yet simultaneously reassurance to all other men, and tell us that if This Man is the average man, then the average between borderline low and "normal" for a geezer is plenty good enough for us all.

  8. #28
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    I always enjoy this banter. To be fair, Hurling
    Is a pretty good sport about it.

  9. #29
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    Quote Originally Posted by jfsully View Post
    I am not sure where you got the term "biological depression,"
    Sorry to be on a bit of a high horse, but this is an area that is important to me personally and professionally, and I have expertise to share. When it comes to strength training, I'm a grateful student around here and mostly read and learn, so I try to contribute when I do have an informed opinion. As a psychiatrist, I feel able to pull rank in a discussion like this, just as a professional barbell coach can and should school me all day about barbell technique and programming.
    We are in agreement on this issue.

    The term "biological depression" came from the post above mine and is what prompted my response. I also disliked the term, because of its potential for misinterpretation.

  10. #30
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    starting strength coach development program
    I can only conclude that a satirist took over Hurling's SS profile.

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