Hello dear psychonauts !
Today we are going to put you in a great atmosphere by speaking to you about a disease
which affects a person on 20
and which represents the first medical cause of incapacity in the world: depression.
You are right, this is going to be jolly cheerful.
Now that there is good sound he is inventing problems.
We do not understand when you speak Chris.
You know I took my precautions, since we are going to speak about a subject
which excites all the guests of anti psychiatry.
We are going to speak about medicine, we are going to speak about antidepressants
then we are going to speak about a whole bunch of things which risk to irritate more than one.
Well Chris you exaggerate, we are on the Internet.
After all people are kind and measured on the Internet.
This being said we just wanted to open a bracket
to tell you that we are greatly satisfied
with the content of a great majority of the comments
which are polished for the greater part, respectful, curious and intelligent.
Thus thank you because we know well that it is not like that everywhere. End of the bracket.
Well then : sucking up to the subscribers: it's done.
Bullshit number one: it’s just a little down phase it’ll pass
That it is one of the worse sentences than a person suffering from depression can hear.
Firstly that makes him feel guilty of not being able to get better in spite of all his efforts
and then that cultivates the myth that depression is not a disease.
Thus telling it’s just a little down phase is to waste time
and to delay a potential access to psychological medical care.
A good illustration of this confusion remains in the difference between what we call
depression and blues, two terms which are often used as synonyms.
Blues is exactly meant to designate this famous down phase
which can be completely reactive, physiological, that is to say normal.
Yeah, roughly blues is the temporary state of mind which more or less comes under difficult circumstances.
To give you an example, it is the state in which Jeff is when I put on an armor or when I sing France Gall.
Exactly !
While depression is something very intense,
there is a before and an after, it really puts the person in an unusual situation.
It’s intense, lasts for a long time and it’s accountable for an effect on the family, the social or the professional life of the person, a madly effect
But let’s see in detail how this shit reflects itself.
Depression is a mood disorder, meaning it primarily affects our capacity to experience feelings such as joy or sadness.
It is reflected by three big groups of symptoms:
The group of emotional symptoms, such as pathological sadness, or emotional dulling which combines with difficulties of feeling pleasure or joy.
It is what we call anhedonia. And that's not all, it can be associated with anxiety.
The group of psychic and motor symptoms led by the psychomotor down slowing.
The people who suffer from depression literally work in slow motion, they reflect, speak, move and are often very tired.
Among the psychic in particular cognitive symptoms we can find the disorders of attention, concentration, memory but also the rumination of negative ideas widely fed by anxiety.
And finally the group of physical symptoms such as appetite disorders (loss of the appetite or on the contrary an increase of the appetite),
libido breakdown, and very importantly sleeping disorders, typically difficulties of falling asleep or early awakening or even of night-awakenings.
Well it is a little bit summarized but you got the idea.
But some of you could wonder how a shrink can decree that a sadness is pathological and that it is a little bit subjective
so be aware that in a depression the sadness is such, that we speak about moral pain. Yes, our patients tell us they are in pain
and it is not all : this sadness goes on, grows, intensifies and brings the person in a loop which pulls him little by little towards the bottom
To understand better we are going to use the example of mourning: if you learn that your father or your mother dies, it is normal, physiological, to feel sad during a while
but that does not mean that this sadness is going to be transformed into depression. Most of the time you digest this tragic event, adapt and find a new balance.
Except sometimes, but we will talk about this later on with a great guest. Thus, roughly summarized, depression is not blues, and it is really different from mourning
But that’s not all : let us turn our interest for two seconds to the thoughts of the patients suffering from depression
In fact, we could summarize it in a sentence: they see everything in black. It is a way of saying that pessimism and negative ideas invade them.
It's as if cognitive bias who exist for everybody would completely gather in the service of depression. In particular the confirmation bias.
To learn more about this famous confirmation bias, we invite you to go see a video which was made on the subject. You will find the link on the description above.
If you want to go a little further to understand how these negative feelings settle down little by little we advise you to go have a look at Depression Quest, a serious game which puts you in the skin of a person suffering from depression
The graphics may not be very sexy and the music unrelaxing, but this game designed by the talented Zoe Quinn is an experience close to the real-life experience of the person suffering from depression. That can help you communicate your real-life experience and especially give clues of how to go get away from it
All of this to say that depression does not amount to sadness, but that it comes along with a number of symptoms which are going to increase, and take more and more space and which are going to ruin the life of the person
One no longer succeeds in having pleasure in the activities he makes, ruminates all day long, is anxious, loses the appetite and loses the sleep,
and this without taking into account the physical symptoms one can feel : pains, digestive disorders.
In brief, depression is a real crap
Bullshit number two: depression is not a big deal
Yeah, a disorder which can lead to the suicide, it doesn't matter
Especially as it affects a load of people : in fact, to give you an idea, we consider that if we gathered all the people suffering from depression in the world, we could fill the whole United States.
And in France, this crap affects approximately 5 million people, yes, 5 million.
The consequences of depression can be quickly dramatic:
If only on a professional level, the psychomotor slowing down and sometimes the irritability can seriously affect the performances and the relations with his colleagues
I repeat because it is crazy, but it is the first medical cause of incapacity in the world. Yeah, more than cancer, more than stroke, more than cardiovascular diseases.
On the family level it is often the same thing, because the close ones, when they are distraught and especially powerless, will at best fall into indifference and at worst into rejection
On a personal level believing that you are not worth much and that everything is your fault is a bit difficult to live with.
Then you comfort yourself as you can, and one of the refuges is alcohol. Thus you imagine the consequences of depression with a chronic consumption of alcohol, on the caregivers, on the personal and professional environment
Lastly when you are miserable, when you see no solution, it’s rather usual that suicidal ideas appear.
We are going to give you another crazy figure : 10 % of the people suffering from depression die by suicide. Thus, acting on depression is also acting on suicide
Yes, moreover we have already shown it with the Gottand experience
Gottland is a tiny piece of earth beaten by winds near Sweden, you know, the other country of meat balls
Briefly, on this island, the rates of suicide were particularly important in the end of the 80s. As a result, some people said it was necessary to do something.
Thus a program was set up with the general practitioners, consisting in raising awareness in screening and treating depression
As a result : a better adequacy of the prescription of psychotropics, an early detection of mood disorders, and more importantly a reduction in the deaths by suicide.
Bullshit number three: depression, it’s in the head
It’s in the head, this it a stupid idea. It really does not mean anything
You have a brain tumour, it is in the head, thank you Sherlock. Obviously that takes place in the head, obviously depression takes place in the brain. But isn’t brain by any chance a part of the body ?
And if we take our good old bio psycho social model, which is just a little reductive but very practical at the same time, and we apply it to depression, it helps us take into account all dimensions of the disease
In the psychosocial dimension we find obviously the quality of our family, friendly, socio-professional environment
Being unemployed, or on the contrary working in a company with hostile management, living in Alepp, being a widower, one does not need to have graduated from Saint-Cyr to know that they are risk factors
In the psychological dimension we find all aspects relative to our development. For example did we undergo traumas which left a sustainable record in our psyche, even in our brain, even in our biology.
And finally the biological dimension is completely as important as the others. To start with, sex: depression is a sexist disease. Indeed, women have twice more risks than men to develop a depression
Then, there is a fact of suffering from a physical disease. Especially as it is chronic. That is a major risk factor. Cancer, cardiovascular diseases, neurological diseases are hotbeds for depression.
Search in this domain is only beginning. But the first tracks which we explore are really fascinating.
For example the studies of brain imaging allow to see differences between the functioning of the brain of somebody who suffers from depression and a healthy person
in particular regarding the structures involved in the emotional regulation which spin wildely, as well as the structures involved in the cognitive capacities, and these dysfunctions of cerebral regions involved in the regulation of the thought, are probably at the origin of the negative ruminations
Small bracket on this matter: neuro-imaging, no more than other approaches in psychology or in psychiatry, should not be set up as absolute proof
The progress made in the domain allows to build models which try to report functionings and observed dysfunctions
And it is moreover the error collectively made by our profession: confuse the model and the reality.
The example of psychoanalysis is caricatural, but the definitive words which we find in certain media is one other
In brief, it is necessary to remain modest and clear-sighted
Yeah, but turning back to our good old bio psycho social model, there is a criticism made to the medical model of depression, which is the following
roughly, depression is rather a social problem, a social suffering which we wrongly try to provide with medical care and transform into a health model
Some accuse the doctors of transforming a medical societal suffering, of giving medicine instead of changing the conditions at the origin of the suffering
And here we have to be honest: we have no definitive theory on depression, its origins, and its mechanisms today
This is why some prefer to speak about disorder and no of disease. In a way, that allows to recognize that there is a suffering and a dysfunction but that we do not know very well why.
But frankly, it is enough to have suffered from depression or to have been close to somebody suffering from depression to understand that this crap is a true mortiferous pathological state
Bullshit number four: what you need is a good kick in the ass (or a hug
You have also heard that one. At best it is useless, at worst it strengthens the feeling of incapacity of the person suffering from depression
Going to the movies when you have a blow of lung is cool. Going to the movies when you suffer from depression is just hell.
It is necessary to spread a considerable energy to go out, and follow a whole movie when you have disorders of the attention is really a hassle. Moreover it is necessary to make efforts to pretend to be well  in order to not break the atmosphere
Consequently you feel exhausted by all these efforts or you feel guilty because you were not in capacity to make them, which can be responsible for a progressive isolation that maintains a little more the problem
If love cannot cure depression, that does not mean that it is not important to be there, to maintain the link with his close friend who suffer from depression. Hence the importance of being well informed when we are a helper
Learn to find his place, to learn not to advise too quickly, to make the difference between the disease and the person, and especially not to play the shrink. In fact you see, it is difficult also for the caregivers
Hence the importance to be honest with yourself and to recognize that something smells fishy. 
The following stage to start with, being to ask for help your general practitioner,
and to visit a psychiatrist if it is not sufficient, or if your general practitioner is not enough formed to look after depression
Bullshit number five: depression, when you saw one, you saw them all
We gave you a rather wide, unrefined portrait of depression. In reality, it would rather be necessary to speak about depressions in the plural, because the presumed causes and the way they express themselves can be very very different
Well to start with we can classify depressions according to the intensity of their symptoms, we speak then about depression of light, average or severe intensity. Obviously, we do not use the same therapeutic artillery according to the intensity
And a word about severe depression: it is fortunately a less frequent form of the disease. I say fortunately because people who suffer from it cross hell and risk of suicide is often very importan
Sometimes, there are even delusions in the severe forms, the suffering person can have the impression to be guilty of a crime which he did not commit, to be financially ruined or to be cursed
The most spectacular form of depression is what we call the Cotard syndrome. In this disease the subject has the impression to be an undead with its organs inside which decompose
Not cool
Fortunately treatments work generally very well in the severe depression. Phew!
Then the evolution in time is very important. Most of the time we speak about a depressive episode in the sense where there is a beginning and an end,
but if we speak about episodes, it means that others can occur. If you suffer from more than two depressive episodes in your life, we speak then about recurring depressive disorders. Logic
. While if depressive symptoms, without completely disappearing stay for a long time we speak then about dysthymic disorders
We do not have time to list all the types of depression, but know that some very closely depend on the context, as for example the post-partum depression, which has absolutely nothing to do with the baby blues
The baby blues is almost physiological, and bound to all the hormonal but also existential revolutions, the fact of becoming a mother, which follow childbirth
The post-partum depression is a disease which it is necessary to identify very fast and to look after to avoid noxious consequences.
In brief there is not a depression but depressions
Bullshit number six: treatments are useless
Well there, it becomes delicate. What about antidepressants, then? The least we can say is that they have no very good press
ineffective, suppliers of suicide, they are accused of all the troubles on the background of world conspiracy orchestrated by pharmaceutical companies
Ideas strengthened by truncated, even dishonest publications
So what’s the official word? A thing which we know is that the arrival of antidepressants coincided with a reduction in the rate of suicide in the world
A report which we wanted to verify by a lot of studies
The conclusion which was brilliantly summarized in a literature of 2006, is that the rate of suicide is much lower after a treatment of antidepressants than before a treatment of antidepressants
On the condition of treating the very people who suffer from depression.
There is a whole lot of people who are looked after for depression, and who do not suffer from depression
France is often pointed for its excessive consumption of psychotropics, and it's true, it is a reality
But on the contrary, you should not forget that 30 % of the people suffering from depression do not receive appropriate treatment.
In brief if we wanted to summarize, we could say that we give antidepressants to people who do not need it, and that we do not give it to the people who would well need it
And their efficiency on the pit of depression, the humor. Well, it is complicated
In fact, if the efficiency of antidepressants is not questionable on the stress factor of depression, nothing says that they act on the humor
Especially from the point of view of the mechanisms of action, we are far from understanding what really happens
Then indeed, the speech which consists in saying that depression is a problem of serotonin, a neuromediator very important for the cerebral level
and that antidepressants exactly act on serotonin, is a very reductive speech, which is widely fed by pharmaceutical companies
Yeah, a marketing speech, in a way. But attention, that does not mean that it does not work, that certainly means that it does not work as we think
and there, we are telling that we are going to need make a video on the mechanisms of antidepressants. Well you are used to it, you know we shall eventually make one some day to come
In the meantime, remember that antidepressants are prescribed in the average and severe forms of depression, and that they are accompanied with other therapeutic strategies, as psychotherapies
Psychotherapies are of a major importance in the treatment of depression, because it’s only  psychotherapy which allows to go to the sources of the problems which were at the origin of depression
to analyze the risk factors, and especially to develop skills which allow to avoid the relapse once you got out of it
And the psychotherapies which indisputably showed their ability of efficiency are the cognitive-behavioral therapies
There are other forms of therapies, with a level of lower proof, but which can nevertheless be useful, as the therapies of psychoanalytical inspiration
the therapies of acceptance and commitment, the mindful meditation, etc…
You can even heal yourself by playing video games. It is what showed a New Zealand team by creating a game specially designed to treat depression and this game is named Sparks
Sparks is a serious game which proposes to every player through seven doable levels in 20 minutes each, to develop a number of skills to fight against stress and bad self-image
You may find that anecdotic, well no, because this game was tested on about 200 teenagers with an efficiency identical to a usual psychotherapy
and with a much better acceptability rate.
It is rather easier to play a video game than to follow a psychotherapy
You see we can make really nice things in psychiatry
And still we did not speak to you about therapies using virtual reality for phobias, or therapies using avatar for schizophrenia
Hey yes, there are also geeks in psychiatry
In brief medicine and psychotherapies act on depression because they act on the brain of the people in pain
To take a medicine or to make a psychotherapy modifies your brain
But know that sometimes shrinks use other ways to act on the brain of their patients. By electric or magnetic stimulation
but that we will need to speak to you about it in a dedicated video, moreover what we have to say about it will probably amaze you
A big file loaded in clichés to be deconstructed. J'adore
As you understood, speaking about depression allows to approach many subjects which every time would deserve dedicated videos. Stay in touch because that is going to come
Here we are, we hope that this little top of bullshits and other myths on depression pleased you, and we look forward to your reactions
In the meantime, well do not forget that madness is sometimes the best way to face reality
