Placebo: What Your Brain Can Do for You

The placebo effect is the measurable, observable, or felt improvement in health not attributable to treatment. This effect is believed by many people to be due to the placebo itself in some mysterious way.

So states this article on placebos and depression from the Skeptic's Dictionary, and appropriate resource. Like this UCLA article about placebo usage, it discusses how, when a patient is told they are receiving a placebo, the effectiveness often goes away. Is this because the treatment was all in their heads? Or that the depression was?

Many studies try to compensate for the "placebo effect." Others, more recently, have specifically studied this factor as a healing process. A study by Dr. Arif Khan showed, according to the New York Times, that:

It turns out that the more severely depressed people are, the less likely they are to respond to a placebo. And people with more mild depressions get better with just about all treatments, including placebos. Since most clinical trials enroll less severely depressed patients, the observed difference between the response to an antidepressant and a placebo can be misleadingly small.

Other studies, including one by Dr. Irving Kirsch, suggest that medications are nearly useless because the placebo effect is so high in depression treatment. Meanwhile, doctors wrestle with the ethics of "tricking" patients with placebos.

I think the point is not quite being realized by the scientific community. Depression is a disease that is has an effect upon the body as well, because the brain controls all things. Placebo is the brain's natural ability to repair damage to all the human systems. This process is easily interrupted by doubts and limiting beliefs. At this point in our development we have identified the process, and we recognize that it can be encouraged by presenting patients with a physical talisman, if you will, of healing; the pill. More severely depressed people need more than a sugar pill because they are so very sick their limiting beliefs extend deep into the unconscious, metastasizing like cancer. They need medications to bring them to the point where the placebo process can recover enough to even try to work.

I foresee a time when the scientific community will focus serious research on placebos, not to remove them as a variable or identify what is "in a patient's mind," but to determine how to harness our own healing ability and hone it. This research will not be conducted by drug companies, because it would not be advantageous to cure such a lucrative market for maintenance medications. It will be research into areas currently sidelined as psychology or superstition, and will tap into the true potential of the human brain.

The lucky depression patients have found other avenues to unlock these secrets, either through sugar pills or prayer or exercise or therapy, and they have been given a chance at true healing, y allowing their brains to overcome depression naturally. It's time the scientific community figures out a way to give the rest of the victims that opportunity.

Self-Care Options

This article reinforces my position on the paradox of depression: you aren't going to get better if you can't learn to do it yourself, but depression keeps you from believing that this is possible. Drugs and therapy can be important tools for recovery, but neither of them will succeed without your help, and neither of them should be considered for a lifetime. If you plan for a day when you won't need them you're much more likely to reach that day.

Either of those treatment options may give you the needed push to get to a point where you can do something for yourself, crawl just far enough out of your own personal pit that you can take at least a small amount of responsibility for your own recovery. If they can't get you to that level, and you aren't functional enough to make it there without further help, you should find that help. Never forget that the worst symptom you have is the belief that you are going to stay this way, that nothing you do can change it, that it's pointless to even try. Don't give in to that crap, because if you expect the worst you're rarely disappointed. Do you have anything to lose by trying for more? Can it really get worse than it is? Really?

Some thoughts on the five suggestions given:

• Keep Active: yep, I've mentioned how important even a little bit of exercise can be. Don't want to get out of bed? Consider having a friend drag you out if necessary.
• Eat well. A well-balanced eating strategy will help you feel better now and later. Good thought. I've had comments here from depression victims that eat like crap, and it shows in the writing that they're just making things worse. Your body needs good fuel to do a good job.
• Get adequate sleep. I would modify this to say, "Get appropriate sleep." Insomnia is a symptom of depression, but I was more prone to the fourteen-to-sixteen-hour power nap. I psychiatrist I knew said that the best way to regulate sleep is to get up at the same time, every day, without fail. Your body will take care of the rest.
• Control stress. Coping with depression is stressful enough, so try to limit other sources of stress. And depression does a marvelous job of amplifying the other stress, doesn't it?
• Stay connected. Make relationships a priority. Social ties give you a sense of purpose and meaning in life. I can't emphasize this more. You need to be around people, even if you don't feel like it, because even if you believe you're alone in a crowd it is better than being alone alone. Do it even if you don't want to.
  

Fun and Games

My post on gifts for a depressed person has been really well-received, so I know I hit a nerve there. I thought I would follow up with some talk about board games, why you should buy them, give them, and play them.

Board games are a really wonderful way to bond with other people, even people with which you (think you) don't have anything in common. As an angry young teenager I would willingly play Trivial Pursuit with all sorts of people that I thought were absolutely horrible, even my parents. I learned that Dad, even though he was a complete idiot, was really pretty smart, and so was my brother-in-law and even my grandmother. Better still, I learned that I was pretty smart, too.

Board games depend somewhat on chance, so there's a good possibility of doing well even if your heart isn't in it. I think the games that require teams are best, because you reinforce belonging as well as accomplishment. Team board games are also especially good at bringing people together across age barriers.

Win or lose you generally have fine in spite of yourself. If your team loses and you, the depression victim, tries to blame yourself, the fun of the game usually trumps the desire to win and you find that your teammates won't let you blame yourself. Now if you are friends with a serious competition junkie and poor sportsman, this won't be the case. We can talk about self-esteem and destructive relationships another time, however. I'm talking about normal human beings here.

If you're still at a loss for how to spend your holiday budget, I think a good board game like Apples to Apples should appear beneath your tree, or wherever your gifts are stored until opening time.

Recruitment!

Depression Stinks would like to find out more about how depression affects all people. If you are a current or former depression victim, or work with depression victims on a regular basis, and have a blogger account, please leave a comment if you would be interested in becoming a team member of this blog.

Application comments should include:

• The type of experience you have had with depression (personal or professional)
• Areas of treatment of particular interest to you
• Any types of depression that you have a particular knowledge about
• A stated commitment to a minimum posting frequency (although daily would be tremendous, honesty would be preferred)

Team members will be expected to chronicle experiences, comment on research, and discuss the cultural, political, and religious issues that affect and are affected by depression.

Cleaning House

Is a messy home a caused by depression, or is depression caused by a messy home? I've heard passing references to a link between disorganization on the outside and fogginess on the inside, but I wasn't able to find any research on the subject. I know that I'm no stranger to having a bit of untidiness in my life, and there are plenty of other people I know who fall into both the categories of "depression victim" and "house cleaning challenged."

However, as my mother would say, "Dull women have immaculate homes."

There might be some wisdom to the axiom linking an orderly environment with an orderly mind, but until someone does a study I'm not making any pronouncements. However, I think it's fair to say that a messy home feeds really well into the cycle of I'm-not-good-enough that depression creates and builds upon. If you don't have the energy or focus to clean, it's pretty certain you'll put it off. As the mess builds, so does the guilt. The problem gets bigger as the guilt feeds the depression, which diminishes the energy levels and reinforces how impossible the task is. You know the drill, you've probably done it to yourself. Charming little cycle of self-recrimination and self-fulfilling prophecies. You expect that you can't clean the place up, and your mind works overtime to make sure that it doesn't make a liar of you. Didn't think you had that much mental energy, did you?

As with everything depression-related, small victories add up. Commit to not adding to the mess today. You will not create another dirty dish without washing it. One dish isn't so tough. And those socks? Just force yourself to put them in the hamper; you'll be glad you did. Keep up on not adding to the mess, and you'll see you can control your world after all. Then you'll be ready to take a step or two towards the bigger mess.

I would keep making small victories. Don't try to clean every dish in the kitchen, but do try to wash all the ones in the sink. Maybe picking up all the dirty laundry is a bit much right now, but how about just the stuff that you piled on your bed? Each time you succeed you're teaching yourself that you are capable and you are in charge.

Who Is Terence?

I've been asked to talk a little bit about who I am and what I'm doing with this blog.

I suffered off and on from depression from before puberty until my early thirties, with periods of suicidal thoughts. I have tried treatments ranging from therapy to drugs to prayer to exercise to pets to, most effective for me, belief in myself. I'm amazed to this day that a disease that has had such a profound effect upon my life was able to insinuate itself without me noticing.

Depression Stinks is my way of giving a gift to other victims. I know that this disease can be conquered and I want to help others find the right way for them.

Depression is a disease that encourages solitude, and I hope that this blog makes people realize that they're not alone. I also welcome contributors to share their own experiences and viewpoints in posts of their own as well as comments; there is no one correct treatment any more than there is just one way to suffer from this insidious disease.

Memory Loss

If being depressed isn't enough with the lousy attitude, lack of desire to act, and complete disinterest in doing just about anything, a lot of victims have to deal with memory loss as well. It came to my attention just last night that a lot of people aren't aware of this complication from depression; perhaps they're just forgetting? What a sick and twisted thing to have happen . . . a symptom that prevents itself from being noticed!

I found a study on depression and anxiety for starters, so I was quickly able to confirm that there has been research in this area. It's interesting that the study found that while anxiety alone does not have an effect on memory, it can significantly compound with depression. It suggests that other studies that did not control for anxiety levels were frustrating to analyze.

I then discovered that there is a newsletter devoted to memory loss, and they had a wonderful article specifically addressing memory loss and depression a few years back. Salient points include:

• Memory loss, like motivation and focus, are likely affected by the levels of neurotransmitters in the brain.
• The mind filters memory to match mood; depressed people are much more likely to remember times when they're sad than they are to recall happy experiences. "It also reinforces the person's drab and negative view of life, fueling the depression."
• Long term memories are not actually being lost so much as they are never forming at all due to the lack of focus and attention.
  
• Treatment of the depression alleviates the memory problems.
  

I'm able to wrap my mind around the memory loss more comfortably now. Essentially, depression victims aren't able to pay enough attention to form as many memories, and the depression filters those so that the ones that reinforce the disease come more easily to mind. It's one more way that this disease becomes invisible, comfortable, and usual in the mind of its victims.

Goal for today: write down a good thing as soon as it happens. Many treatments suggest some sort of journal; if you want to make this part of one then by all means go ahead. If not in a journal, put it someplace you will see it, like on your refrigerator. You're experiencing happiness despite your depression, and you deserve to know about it.