because Kraepelin followed the same patient for decades [ in the days before medication] and found that they all had periods of spontaneous recovery, although it might take decades. They never became permanently demented. Since patients spontaneously remitted, he also understood that treatments might be invented in the future to help them recover faster and more effectively.
Paula is proof of this.
We used Paula’s sudden but chronic loss of personal details as a marker; specifically- we tested her every day, at different times of the day to see if she could remember her own address.
The doctor started her on Paxil [Paroxetine]. It took more than 2 months to begin to work. We did not know what to expect, but she began to remember her own address some of the time, so we took this as a good sign.
Our main concern was getting her personal memory back.
The Paxil was helpful, but her memory for her address [and her thoughts ] would come and go during the week. Still, we tracked it often. She was not normal but she was better. She progressively and slowly improved.
She had to be given lithium when, after a year or so, she suddenly became manic, as a result of the Paxil. In retrospect, she could feel the mania coming on rapidly and her breathing rate increase naturally. We learnt to decrease the dose of the lithium in order to maintain her stability and keep improving her memory.
We had no other tools besides the Paxil and then the lithium, and of course-our Marker.
The doctor tried her on other medications but they did not work and her memory worsened.
Every time she went off the Paxil to try something else, she relapsed and went back on the Paxil, which took 2 months to begin working once more.
Paxil was the only medication which began to return her personal memory to her.
It took 10 years [of Paxil] to stabilize her personal memory [using her address as a Marker] and her baseline intellect [they seemed related] to her baseline level of mental function.
It took 10 years to get her mental function as good as it was before her illness. As her body adjusted to the Paxil, over the 10 years, she no longer became manic or even hypomanic and did not need the lithium .
We could not have accomplished this without tracking her intellect and memory using a marker in order to understand which medication could help.
We think that recovery of memory and mind is possible with medication such as Paxil and with better understanding of long episodes of respiratory failure due to ventilatory limitations.
Paula and I had Kraepelin’s studies to help us understand the pattern of physical signs- including the mental dullness and the depressed respiration. Paula and I had Kraepelin’s studies to help us understand that patients could recover their mental capabilities [and mood] completely, which is all patient’s really care about.
We think that it is possible that with additional research and supportive medical support of ventilation [breathing] , reversible mental dullness and dyspnea [internal sense difficulty breathing] and depression [anguish and distress] can be treated much more quickly.
This can be accomplished the way Paula and I did, by identifying a significant memory marker to evaluate treatments.
And we can also medically evaluate patients more completely in order to identify difficult to spot features such as spontaneously depressed breathing [no yoga, no opioids] , episodes of respiratory failure and hypercapnia/hypocapnia [with normal lungs, regular blood tests will be normal] and sensations of difficulty breathing or shortness of breathe [difficult to see if breathing is also depressed].
It is time to take depression more seriously as a medical syndrome, despite the temptation to explore it as a psychological problem.
It is also time to look at unknown undiscovered and unlooked for physical stressors more carefully and to realize that chronic stress is always due to organ dysfunction of one kind of another and organ dysfunction takes decades often, to appear on regular blood tests.
Chronic stress and especially mental dullness and mental confusion [cognitive deficits] are a signal to begin examining the pattern of vital signs in search of physical illness, blood loss, undernutrition and deficiencies, muscle weakness and atrophy and other non specific but important signs of poor health.
If the doctors refuse to listen and refuse to look for the underlying physical signs and symptoms of major depression, bipolar depression, and even what we assume to be dementia instead of a possible treatable chronic delirium [including episodes of manic depressive insanity] than we, as concerned friends and family, should begin to obtain the patient’s vital signs, including respiratory rate at rest, geriatric history, medical history and should start thinking about treatable conditions which often accompany ill health, undernutrition and injury.
This is what I did when Paula could not do it for herself.
And I am nobody, simply a concerned friend, who likes detective stories and scientific puzzles .
Of Sound Mind 
Paula’ had straight up depression? Or depression and something else? I’m a bit confused…
I saw a documentary set in a mental hospital and a woman came in saying constantly, “I don’t know who I am anymore, I don’t know my name” they diagnosed her with some dissociative disorder, gave ECT, her memory came back. But they never said she was depressed (she didn’t seem that happy either, it has to be said.)
I just posted up an article on depression so you’re welcome to come by
https://zadenzane.wordpress.com/2021/09/10/a-long-history-of-depression/
I’m interested to know how good or crap people think it is. I started reading Emil Kraepelin and his writings are quite interesting, especially the lectures on psychiatry where he wheeled out the patients in front of a room full of medical students, people with every affliction from schizophrenia to morphine addiction. if you’ve never read that book it’s worth a look. It’s called Lectures on Clinical Psychiatry or something v similar.
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I think that scientists need to work up a possible depression by looking at the basic vital signs the [unmedicated] patient has at rest; blood pressure, heart rate, body temperature an especially respiratory rate. Kraepelin, in his book on Manic Depressive Insanity, found abnormal respiratory rates in his patients. The hypothesis of possibly depressed respiratory rates in bipolar depression and of irregular respiratory rates in mania [and anything in between in mixed states] suggests the possibility of mechanical injuries affecting the motor act of breathing and the ratio of air being inhaled and exhaled. Why is this important? Because it is involuntary and invisible and unconscious [like all the vital signs at rest] and because the ratio of air inhaled and exhaled from healthy lungs will affect mood and one’s native intelligence naturally. The same way inhaling psychedelic substances will change mental abilities and mood, the same is true for the air in our bodies. This may be why respiratory rate is the most sensitive of ll the vital signs in signalling impending deterioration in health yet everyone takes the motor act of breathing for granted. Kraepelin measured respiratory rate at rest, a strong physical sign of the autonomic nervous system-yet completely dependent on skeletal muscle to move air. Paula has an unknown unconscious unseen respiratory depression which affects her mind and mood abnormally only under conditions of illness, poor physical health and/or exposure. The cells of the body continually produce carbon dioxide as a natural product. The brain carefully controls the ratio of gases in the body and exhaling is the only way to control the ratio of carbon dioxide. Gases, even from our own metabolism or from the air can be asphyxiants, intoxicants depressants, stimulants, or they can be present in the air and in our bodies in productive amounts. Some forms of depression or depressed behaviour or strange behavior such as what you describe in that documentary could be due to failure of some part of the the “brain stem/nerves/skeletal respiratory muscles ” necessary to help even normal lungs regulate gases [internal and external] inside the body. Carbon dioxide, being a normal product of our cells seems to be the key. It is an important cerebral vasodilator, meaning it controls pressure inside the skull-which is difficult for us to measure. Even mildly abnormal pressure inside the skull will press on the brain tissue and can affect both stereotypic behavior [depressed, excited] and mood [unpleasant, pleasant.] These are possible hypothesis generated by both Kraepelin’s work with vital signs of patients during bipolar depressive and manic reversible episodes and by the study of Paula and her “broken” breathing. I think that this is pretty cool. Thanks for your comment. I will try to get Kraepelin’s Lecture on Psychiatry for more insights.
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