Training with depression? Long term prognosis? Training with depression? Long term prognosis? - Page 8

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Thread: Training with depression? Long term prognosis?

  1. #71
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    Quote Originally Posted by jfsully View Post
    I'm a psychiatrist.

    I think you can see the difference between being "bummed after losing your dog" and "your life stops and you feel paralyzed and helpless for 4 years after losing your dog." (I paraphrase) One is a normal reaction, not mental illness. The other could be considered illness, ie a depressive episode triggered by a profound loss, and in your case probably exacerbated or perpetuated by low T. It's academic at this point, but I think you may have met criteria for depression (in the clinical sense) at that time. It may have been that in your case you were at risk of a depressive episode (in the clinical sense) and that the loss of your dog and/or the drop in T were tipping points that led to something more severe than normal grief.

    The point, obviously, is that there are normal experiences of sadness/fatigue/loss that in some ways resemble depressive episodes as part of a mood disorder, but are clearly not an illness that would need medical treatment. My point did not have to do with whether losing your dog qualified you or disqualified you from being described as depressed.

    If your T levels were far below normal, and taking supplemental T restored you to your normal level of function (or maybe allowed you to continue to function with a normal instead of a superhuman effort to do so), then I don't think it's debatable whether the testosterone helped you, or whether the low T caused or at a minimum significantly contributed to your difficulties. Both are clearly true.
    I am so sorry for the late reply. Thank you for clarifying to me your qualifications and viewpoint. I understand your assessment and respect it greatly. I realize there is a much bigger picture for those whose life gets derailed, than just T levels.

  2. #72
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    Quote Originally Posted by jfsully View Post
    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.
    JT, honest question, how does the psychiatric community scientifically explain the much higher incidence of medicating for mental illness in the States, vs. throughout the rest of the world??

    Is it actually possible that all these other countries have unmedicated crazy people roaming the streets, or are psychiatrists just "in" on the game that it's beneficial to convince so many Americans that they need medication?

  3. #73
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    Quote Originally Posted by Nicholas Laureys View Post
    JT, honest question, how does the psychiatric community scientifically explain the much higher incidence of medicating for mental illness in the States, vs. throughout the rest of the world??

    Is it actually possible that all these other countries have unmedicated crazy people roaming the streets, or are psychiatrists just "in" on the game that it's beneficial to convince so many Americans that they need medication?
    An uneducated guess here: It’s because when life becomes too easy, people worry more about their feelings. With an abundance of resources, the majority of us Americans can survive pretty easily and as a result have more time to feel sorry for ourselves.

    I wonder if depression was a problem for primitive man or if they were just elated to survive another day of getting chased by lions and shit.

  4. #74
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    Quote Originally Posted by Nicholas Laureys View Post
    JT, honest question, how does the psychiatric community scientifically explain the much higher incidence of medicating for mental illness in the States, vs. throughout the rest of the world??

    Is it actually possible that all these other countries have unmedicated crazy people roaming the streets, or are psychiatrists just "in" on the game that it's beneficial to convince so many Americans that they need medication?
    It would be helpful to know the rates of treated vs untreated mental illness in various countries. It sounds like you may have those numbers. Please share some citations.

    When we hear about “crazy people roaming the streets” we are usually thinking of people with schizophrenia, not depression. I do know that the rate of schizophrenia is about 1% across many countries and cultures, no matter how hard psychiatrists or other people try to convince those suffering that they do or do not have a mental illness. There’s a biology there that is mostly unaffected by direct-to-consumer advertising. Other mental illness like depression or anxiety disorders may be more “culture-bound” in how they are experienced, expressed, and treated. It would be a mistake to assume that the rates of prescription correlate tightly with the rates of diagnosable illness, as there are issues such as stigma and lack of access that are confounding factors.

    Psychiatrists are “in on the game” of trying to help people who seek us out, with the tools we have available, including medication. We have more work than we can handle, and if you’ve ever tried to get an appointment with a psychiatrist, you’d know that we have no need to do outreach. We’re booked up. That’s why you’ll find that most SSRIs (first-line antidepressants) are prescribed by generalists, not psychiatrists. GPs may be a little quick to prescribe, but they’re probably trying their best to help with the little time they have with each patient.

    You may be mistaking us for the pharmaceutical industry.

  5. #75
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    Quote Originally Posted by jfsully View Post
    GPs may be a little quick to prescribe, but they’re probably trying their best to help with the little time they have with each patient.
    That's very charitable, Sully.

  6. #76
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    Quote Originally Posted by Mark Rippetoe View Post
    That's very charitable, Sully.
    Well, look, we have our share of assholes, like every profession, but most of the problems I’ve personally seen in medicine can be traced to decent people working in a ridiculous system, trying to do the right thing, often with inadequate support and very high stakes. So shit happens.

  7. #77
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    Doc, that was a great post. I’ve seen about everything (well, probably not). There are a LOT of problems in medicine. I’ve seen some amazing docs and nurses. I’ve also seen some that make used car salesmen look like Sunday School teachers. As for pharmaceutical companies...I’ve heard horror stories on some that I bet would make even our good doctor here pause.

    This has been a fascinating thread to follow. Thanks Doc for spending some time here with us. Thanks Rip for a great discussion.

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