I'm glad you are feeling better but while some people's problems do come from emotional sources, please don't act like the chemical imbalances in the brains of other people aren't a disorder. I promise you, I and others like me have tried our damndest to "feel better".
OP is not telling you to "feel better" - he is saying he was only able to tackle his depression after taking a more holistic approach to monitoring and changing his brain operation.
Emotions are, quite literally, certain chemical states in animals with nervous systems of at least a certain complexity. That's where the "chemical imbalance" mantra falls apart - at best, it adds no information, and even worse, its used to peddle drugs which are developed without coherent and predictable models of the neurology involved in the symptoms/diseases they're supposed to treat.
Medical doctors get at least one objective measure of your blood pressure before prescribing blood pressure medicine. When was the least time you heard of a psychiatrist only prescribing meds after performing an MRI?
What new information would current state fMRI give them?
If I'm not mistaken, a person that is depressed due to environment will have similar fMRI as a person who has messed up biology (not just neurotransmitters btw).
Also, even with acute depression, antidepressants may help to get the patient on track.
The objective outcomes differ with different treatments even in cases of subjective success. The specific neurology (protein levels, chemical ratios, etc) should determine how exactly you intend to alter it.
Psychiatrists (well, ER doctors, usually) do, in fact, perform MRI's before prescribing meds. This happened to me when I was first diagnosed with bipolar disorder, and I assumed it's not an uncommon practice.
It's easy to think of psychiatry being wishy-washy when all you're considering is mild to moderate depression and the like, but it becomes much harder when you consider the entire spectrum of mental illness. Full-blown mania, psychotic depression, or untreated schizophrenia scream illness in a way that is hardly subjective.
This isn't like a reprimand or anything, just to point out that this problem cuts both ways. Having been entangled with the mental health system for 20 years, I say the lion's share of attention and advice, from everywhere and everybody, comes from the chemical imbalance / illness / disorder perspective. And this really, really does leave those of us who don't respond to drugs and are fundamentally unhappy with our lives very frustrated and without anywhere to turn. Yeah, therapy's a thing, but it's commonly perfunctory and treated as secondary. Treating depression like it's just one thing can harm sufferers on both "sides".
A big reason drugs are preferred to therapy is that the drugs are far cheaper. 6 months of antidepressants can be like $80, 6 months of bi-weekly therapy $5,600.
My understanding is that mental health therapy should be covered by most insurance plans these days so the out-of-pocket shouldn't be that high. While it's a sample size of only one, my wife sees her therapist bi-weekly and I think the co-pay is $20 per session. A month's supply of Duloxetine (generic Cymbalta) actually costs us more per month at $45.
Not only is therapy expensive, it is non-existent. We live in a decent-sized city and have tried numerous psychologists for our daughter and they all suck. I've decided that outside of psychiatry, as in, someone who is actually an MD, the rest of the field is utterly worthless. And the psychiatrists only want to medicate. Honestly, we've gotten better outcomes from just our family pediatrician.
Not to mention the potential cost of missing work to go to therapy. Some people don't have PTO or a flexible schedule and getting to therapy appointments is a real pain in the ass.
I'm out of my depth here so apologies if I'm stepping into some Very Bad Anatomy but my point is that neither one can come first because they are the same thing, that those chemicals are your emotions and vice versa.
They don't map one to one. There's a thousand variants of emotions, and just a few neurotransmitters.
Also, even with all the chemistry being fine, there can be certain receptors messed up, or parts of brain not functioning properly.
A story I read in "Listening to Prozac" was about a patient that for years couldn't get over his low self esteem issues. He worked through all of them, but the feeling persistent, and there were no other issues with his mood aside from that.
He was finally put on antidepressants, and that issue was fixed. Unfortunately, whenever he tried to get off them, the issue - and only that issue - kept coming back.
The theory is that something made that part of his brain resistant to serotonin. There are many kinds of serotonin receptors, and perhaps a genetic problem messed up one of them. Or there was an issue with serotonin not being delivered where it should've been. Or who knows what.
In the end, increased serotonin levels fixed that. A blunt tool, but no other one worked.
Similarly with attention deficit (which comes with anxiety and sleep issues quite often) - the original theory was that it was due to dopamine issues, because increasing dopamine levels helped most people.
The current theory is that in many cases it may a whole class of issues - from a mechanical damage to prefrontal cortex to allergies, magnesium processing issues, tyrosine processing problems, or even a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!)
Also, in most cases it's probably more than issue at root. The problem is that it's difficult to figure it all out, and many cases medicine is simply not there yet.
> a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!)
My doctor actually recommended nicotine for that exact reason. My family's history with heavy tobacco use combined (my father in particular) and my experiences with nicotine in the past were positive, so the doctor suggested trying a strong nicotine patch for a while. It worked reasonably well, and more importantly it didn't have the (many) problems the usual SNRI or NDRI. Nicotine definitely does have its own problems, but it's an interesting option that deserves more research.
(We had also discussed briefly the idea of trying a very small dose of one of the acetylcholinesterase inhibitors used for Alzheimer's, but eventually decided against it, because they can be somewhat dangerous drugs.)
For decades, research on the nicotinic acetylcholine receptors was limited (probably tanks to the tobacco industry). Research in this area is improving a lot, but it will take time to make up for the lost time.
I'm not quite sure how to respond to this, so I apologies in advance if it comes off wrong.
I would say it's not about trying to "feel better", you can't just force yourself to not feel depressed, the brain is too complex for that. There are, however, many rigorously proven methods for tackling depression that can work in replacement of or in addition to medications. The one I think has the most merit is mindfulness based cognitive behavioral therapy. The idea is to build up a new set of habits, coping skills, and behavior patterns that let you life your life without getting sucked into depression. Depression is vastly more complex than simply "a flaw in brain chemistry", that's very reductive reasoning but it's been a relatively successful one for the psychiatrist business and pharmaceutical industry. That brain chemistry is as much a symptom as it is a cause though. And with enough work it's possible to make yourself more resilient to potentially depressing circumstances and thoughts. It's possible to train yourself to recognize and change the constantly running background narrative of negative self-talk that gets you down, the rumination, the trains of thought that seem so unavoidable, and so on. And then on top of that to build better habits, to tackle your problems, that you're in control of, and prevent them from growing out of control, to regularly exercise, etc.
Of course, it can be difficult if not near impossible to do all that, or, really, anything whatsoever, if you're deeply depressed. Which is why for many people it's necessary to begin anti-depressants before starting therapy, making behavioral/cognitive changes, etc. The problem the parent poster is talking about is the tendency today to just shove people into the top of the process and call that done. It's now expected that most people who have experienced major depression should just take anti-depressants for their entire life and that's the "cure" for their problems. With only a token concern for building up the skills, habits, and coping mechanisms that people actually need. You see the same thing with a lot of other things like ADHD or anxiety, with a tendency to look for the chemical answer first and foremost and call that good enough.
