Depression
Questions Received:
Responses:
My father contracted a virus after swimming in the sea many years ago. It caused him to have hallucinations and he was subsequently treated for a mental disorder and depression. He had a blood transfusion for a stomach ulcer years later and said that for the next few weeks he felt better than he had felt for years but then gradually the anxiety and depression returned. He attributes his problems to the virus he picked up in the sea. He continues to take medication and occasionally has attacks that end up with him in hospital.
The doctors only treat the mental problems but don't seem concerned with what my father sees as the cause. They dismiss the blood transfusion episode. We would like him to try a complete blood transfusion to see if this would help him. Nobody seems to take him seriously but we think this may help. Advice please.
7th June 1999
There are several possibilities here. The first is that your father is correct
in his belief that a viral infection many years ago resulted in the problems of
anxiety and depression that he has experienced since, and that a blood
transfusion can provide him with temporary relief. The second is that there is
some other organic (physical) cause of his suffering that has not yet been
detected. The third is that the anxiety and depression stem from psychosocial
factors rather than organic causes - a mental rather than a physical basis. The
fourth alternative is that both physical and psychological factors are involved.
The one indisputable observation is that your father’s suffering is very real,
regardless of which of the above explanations is correct. So it is unfortunate
if nobody in the medical profession appears to take him seriously. For you and
other members of his family this must all be very distressing and disheartening.
Modern medicine is effective in treating some conditions, but less so in relation to others. For example, with our present understanding of the biological processes involved, it is very difficult to treat a viral disease that has become established. In the early stages of a viral infection there are strategies available that might help the immune system to fight off the infection, but those strategies do not work with established viral infections. (You will be aware of the difficulty of treating people infected with HIV.) This is because the genes of the virus become incorporated in amongst the normal genes of the person’s cells, and if you want to eradicate the viral genes you have to kill every infected cell. Unless the infected cells are very few in number and relatively unimportant to the normal functioning of the body, this would be very difficult to achieve without endangering the person’s life, even if it was possible to find all the affected cells. Quite a few viral infections lie dormant for long periods before producing any effects, or lie dormant after an initial acute phase. A good example of the latter is the virus that causes chickenpox - after infection during childhood the virus remains in nerve cells and may create the painful condition called shingles later in life. So for members of the medical profession the identification of a viral causation for a particular problem does not usually enable them to provide a cure, only palliative treatment. This might partially explain why they appear unenthusiastic about seeking a possible viral causation for your father’s condition, because they know that even if one can be identified - and the process might involve risk for your father and considerable expense - they would then only be able to offer the same palliative treatments that he has already received.
With regard to blood transfusion: for some conditions this treatment can be very effective or even life-saving. However, in your father’s case the picture may not be so clear. We do not have full information about that period when your father was being treated for a stomach ulcer, but there may have been other aspects of the treatment he was receiving that contributed to him feeling better. If the stomach ulcer healed successfully at that time then that in itself would make him feel better and take away some of his anxiety. And then you have to remember that the effects of a transfusion, even an exchange transfusion in which most of the blood is replaced, would be only temporary since the transfused cells would be gradually broken down in your father’s body and replaced by blood cells made in his bone marrow as per normal. It will be worthwhile to discuss this option with a sympathetic clinician, but from what you have told us it seems unlikely that it will produce the desired long term effect. Even if he felt better for a while after being given a transfusion, it could be argued that the change was evidence of a placebo effect rather than being due to a biological improvement. Also, blood transfusions are not without risk, so you would need to be aware of those before making a decision of this sort.
It is possible that your father is suffering from depression for which there need not be a physical cause. The psychological explanation would be something like this: when he was given the blood transfusion he came into close contact with members of the health team, making him feel valued and wanted once again. His self-esteem rose and then, as his physical condition improved, the close contact that he was benefiting from was withdrawn, with the result that he became depressed once more. By this interpretation it would be worth carefully considering whether your father is experiencing deep-seated feelings of loneliness and isolation. The problem with this explanation is that in some cultures mental suffering is seen as less important or less real than physical suffering, and many physicians for example will feel less able to help. It also seems to put some of the blame on the patient, which is very unhelpful. To repeat the point made earlier, your father’s suffering is real, regardless of the underlying causes. (For an insight into the dilemmas faced by medical practitioners when confronted by conditions with an unknown cause, see Barsky and Borus, 1999.)
A possible next step would be to consult somebody in the health care professions who takes a holistic view of complex health problems and is prepared to consider all aspects of your father’s health problem with the seriousness that it deserves. Finding such a person will not be easy - it may be a clinician or it may be someone specialising in one of the alternative systems of therapy. You could begin the search by asking your own doctor for a recommendation, or by asking other practitioners or friends that you know and respect.
Reference
Barsky, A.J., and Borus, J.F. (1999) Functional somatic syndromes. Annals of Internal Medicine, 130(11), 910-921 (Jun 1).
Further to my message of July 1999, my father is still suffering terribly from depression. He has been treated with several different anti depressants, none of which have helped him. He is now desperate. However, we have noticed a pattern. Each time he is coming off one drug to change over to try another, he has a few really good days after a reduction or cessation of the previous drug. This feel good factor does not last though and then he feels worse than ever.
Can you explain why this might be happening and possibly suggest how he might retain the feel good factor that he is so desperate for.
16th November 1999
Mood disorders, of which depression is one, are not always easy to treat. This is particularly so in the elderly and some of the drugs that may be used do take time to act. The tricyclic antidepressants for example can take up to two weeks before benefit may be experienced. Serotonin re-uptake inhibitors such as Prozac take several weeks to improve mood. A possible reason for this slow response was described at last week’s meeting of The Society for Neurosciences in Miami Beach - the Prozac seems to enhance the production of new cells in the hippocampus, a part of the brain concerned with learning and memory (New Scientist, 1999), and time is required for them to mature and form connections with other neurons. Another variable that has to be determined is the dose level so that the person is not under-treated or over-treated, and careful follow-up is required.
Have you been able to fully discuss the management of your father's illness with the doctor who is treating him? It will be valuable to hear, first hand, what the outlook is for your father. At the same time the point about him feeling marginally better when he is coming off one drug and starting another could be made - it is possible that the transient feelings of improvement are due to him feeling less sedated when he comes off one drug and before taking the next. You will also be able to ask what other forms of therapy might be used if your father's depression is resistant to drug therapy. The causes of mood disorders like depression generally fall within two categories - exogenous and endogenous. Exogenous implies that some sort of external event has triggered the depression, while endogenous implies that there is some innate predisposition to depression. It will be worthwhile to ask your father’s doctor which category your father might belong within, since this might help you to get a better understanding about the causes of depression and the interventions that are tried.
Reference
New Scientist (1999) The more the merrier. New Scientist, 6th November, 6.
I am a pre-nursing student completing anatomy and physiology at a small college in Colorado. I will be giving a presentation on the effects of depression on homeostasis in a couple of weeks and am looking for suggestions on where I might find material. I would appreciate any advice you care to lend.
7th April 2005
You have an interesting but complex question to work with there. There is a lot of discussion about whether depression is a cause or an effect of homeostatic changes, so no doubt you will come across some contradictory statements as you do your research.
I wonder, do you have access to this book?
Allostasis, Homeostasis, and the Costs of Physiological Adaptation, edited by Jay Schulkin, Washington: Georgetown University (2005), ISBN-10: 0521811414, ISBN-13: 9780521811415
It looks at the relationship between homeostasis and a variety of disorders such as depression, stress, anxiety and addiction, so could be useful to you.
I think some discussion of the hypothalamus will be relevant to your presentation. It has been suggested that many cases of clinical depression are due to imbalances in hormonal levels and linked with the hypothalamo-pituitary-adrenal axis. The hypothalamus is a collecting centre for information concerning the internal well being of the body, and controls secretions of the pituitary gland. The hypothalamus oversees homeostasis by regulating factors such as blood pressure, body temperature, fluid balance, electrolyte balance, and body weight. It influences emotional responses, behaviour, sex drive, sleep cycles, and thus psychological factors such as mood.
As well as doing Google searches on the Internet, you may also try searching PubMed for relevant research: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? (This will open a new browser window.)
The problem here will be to find a relevant paper from the long list that you are provided with, but once you have found one, click on the Related Articles option and you will be given a list of more appropriate papers. Most of them will have abstracts, which are useful, and some will be available free online as full-text articles. Another trick is to add the word review at the end of your list of search terms, as this will come back with broader reviews of the subject rather than research papers addressing narrow topics.
I hope these pointers will help you prepare for your presentation.