I received this message today:

Hi, you probably answer this quite a bit. I’ve been depressed for as long as i can remember.

Ive been on the ssris, snris, amphetamines and methylphenadate but none of these have worked as well as opiates. (Certainly short term,I don’t take for long periods of time). But have you ever used suboxone or oxymorphone for depression?

Depression is probably a broad term, for what may be multiple conditions. For example, some people become depressed almost as if it is part of their nature— they will get episodes of depression even when everything in life is going well, in spite of good marriages, healthy children and an absence of significant baggage from the past– at least baggage that is visible.

Other people will present with depression that has developed after a series of blows to their sense of self or self-worth— after a health scare, job loss, divorce, death of a child, or perhaps from carrying around guilt or shame from abuse that occurred during their childhood.

Does it matter whether the depression is more like the first or the second category? I think so, but I have no proof that my perception is accurate. I will see different responses to medications by people with different types of depression, but I’m always challenging that perception, realizing how easy it is to be ‘fooled by randomness’, to copy a phrase from a book title.

In my experience, the second person is more likely to bounce back, providing the negative onslaught eventually stops. But the people in the first group are more difficult to treat, especially if the depression becomes part of how a person defines him or herself— as it is very difficult to change self-perception.