The danger in understanding that depression often includes an element of mental impairment is that people will despair and assume that the mental impairment is permanent. The mental impairment which can accompany depression is reversible, unless the patient was born mentally impaired,
Paula is proof of this. She has recovered her baseline mental function. We think that all depressed patients can. We consider serious depression to be a syndrome of quiet delirium which has become chronic. We think that measuring vital signs, especially obtaining minute ventilation or at least measuring resting respiratory rate, is the best way to detect the underlying problem causing this syndrome.
The best way to treat this syndrome is to treat the underlying problem [which Dr Emile Kraepelin thought was a respiratory injury limiting one’s ability to respond to a respiratory acidosis or alkalosis, based on his careful studies of vital signs of seriously depressed patients].
Dr Kraepelin’s studies need to be replicated; today we know that respiratory rates at rest vary from about 12-15 breaths per minute, even more. It is possible, that people with depression AND this type of ventilatory defect or injury, have a lower range of breathing rates at rest than people who function normally. It is also possible, that these patients are aware that their breathing takes effort at rest [which is abnormal-breathing act rest should be effortless and natural]. It is also possible that, like Paula, they assumed that their manner of breathing is normal and that everyone has to work to breath at rest and so never mention it. It is also possible that, like Paula, these patients are not aware of when they are short of breathe because breathing slowly at rest with shortness of breathe is unusual and not as visible as normal shortness of breathe when breathing too fast.
We think that all seriously depressed patients with cognitive impairment should be carefully examined for signs of hypercapnia or hypocapnia. The effects of hypercapnia and/or hypocapnia [with or without lung issues] are reversible!
Kraepelin’s study’s and Paula’s experience suggest hypercapnia;
- naturally depressed breathing [with use of abdominal muscles for active exhaling in Paula’s case].
- sympathetic activation [from the stress of even more effortful breathing during an extra health challenge or chronic exposure to higher levels of CO2]
– sympathetic activation causing blood pressure to rise, heart rate to rise, cortisol to rise, and intermittent arrhythmia’s and murmurs .
- mental dullness [reversible]
- psychomotor retardation
- cool, pale extremities
- mild hypothemia
- inner sensation of inexplicable distress [which accompanies dyspnea] and inner agitation [hidden by lethargic behaviour].
As Paula got better, all of the above signs [except for the naturally depressed breathing] went away, including her quiet chronic delirium or depression.
How did we accomplish this?
How did we restore Paula’s health? Especially when no doctor listened to any of what she or I had to say and did not even realize how mentally confused she really was.
We will tell you in the next post.