Hacker News Reader

I think that your criticism of the classifications is misguided. Certainly, depression and anxiety are different disorders, caused by different chemical mechanisms. And, bipolar is certainly different. And, I'm extremely glad that medicine has evolved and can now treat these diseases differently. With new dopamine agonists, sufferers are able to achieve normality. Unfortunately, there are a good portion of the population that suffer from this disease and others. And, 'categorizing' it helps both in diagnosis and treatment.

Biploar is different from depression, which is generally treated with SSRIs. I'm neither a chemist, or a molecular biologist, but I infer, from reading, that depression is caused by different chemistry, related to different parts of the brain. Depression and bipolar may have similar symptoms, at times, but the biological origins seem to be unrelated.

There's a strong body of evidence that bipolar is correlated with schizophrenia, autism, and ADHD. Again, this isn't my field, but each of these diseases relate to the dopamine pathways. And, there are quite a lot of genes that take part in and/or affect tyrosine-dopamine production. I also infer that the gradients of these diseases are caused by combinations of genes, in each individual. So, it makes sense that biploar I is treated differently than bipolar II. Once scientists have better understandings of genetics, treatments will become more granular and targeted. But, currently, if you're a sufferer, you must take a cocktail of drugs, in different doses, until you get the 'right one'. It's not the best way, but it's the best that we have today.

As an aside, I find the original article very surprising because it's widely known that multiple genes and SNPs are involved in incurring risks for developing schizophrenia (and bipolar and ADHD). To me, who continues to research the topic, I had just assumed that the results of the research were true. But, I'm glad that they were able to take controlled studies to help verify something that is deductive.

its scary when we talk about these disorders / behavior problems that we immediately go to prescribing a cocktail of drugs to 'cure', especially in light of ‘benzos’ being linked to alzheimers and such. drugs have their place, but i think they have over stepped it, where behavior modifications could do a lot more good with a lot less side effects like - destroying the brain.

> The number of types of clinical depression, for example, is absurd. It's not merely depression, it's bipolar disorder. It's not merely bipolar disorder, it's bipolar disorder type II. Seriously? Decades from now we're going to regard this approach as highly primitive and bordering on pseudo-scientific.

I doubt it. What we'll most likely do is view it as highly primitive in the same way that early developments in most fields are, and that the initial categorizations are systematizations of observations without even a strong hypothesis behind them. Its not pseudo-scientific, though, its part of what has to happent to start doing science. You have to define what the observed phenonmena are that you are trying to explain scientifically. (And, that being said, there is science that has been done based on it without, often, being heavily involved in exploring causes -- empirical exploration of how things in the category respond to environmental conditions is still science. We also have run into the fact that its often of limited utility and ambiguous results, likely because the categorization based on symptoms doesn't reflect the underlying mechanisms well, which is why we need more.)

Depression is not a single illness; it's likely to be several different illnesses that fall under a single umbrella diagnosis.

Please don't make the mistake of thinking bi-polar is in anyway similar to depression. They are very different illnesses with different treatments.

And, again, as we learn more about bi-polar we may find that it's a bunch of different illnesses that get given the umbrella diagnosis of bi-polar.

Your example of ADHD being treated with the same meds is just a function of our lack of knowledge of ADHD. So we might not always use the same meds for treatment.

In the future we'll have genetic testing to determine what meds will be useful or which meds are unlikely to work.

You're treating the term "illness" as if they are actual objects, rather than just labels we give sets of symptoms and causes to make them convenient to discuss, research, and treat.

What?

I think you're agreeing with him?

What? Depression is very similar to bipolar. Depression is a phase in most bipolar. The same meds often work for both, with mood stabilizers added for bipolar patients to try to arrest the manias.

That's not true.

You don't use the same meds for bi polar and depression - it is dangerous to do so.

People with depression should be given access to CBT with an anti depressant if needed.

People with BiPolar should not routinely take antidepressants, especially not if they are starting a manic phase. They should be taking lithium, valproate, or olanzipine.

http://www.nice.org.uk/guidance/CG38/chapter/Key-priorities-...

Huh. You're right. I guess the protocols have changed since I learned about them. Good to know!