Google the word “depression”and you will have 78,500,000 websites to look at. Most aren’t worth the photons on the screen. Some have to do with economics. Most want to sell you something. Millions of trees have been sacrificed for multi-volume, dust gathering tomes written about the many faces of the depression. How can I do justice to the topic on a blog?
I can’t. Here goes:
THERE IS MORE THAN ONE KIND OF DEPRESSION
There is bipolar depression, postpartum depression, depression associated with major medical conditions (heart attack, cancer), grief reaction, depression as a side effect of certain medications (birth control pills, others), depression associated with substance abuse or withdrawal, depression associated with lack of sunlight (Seasonal Affective Disorder, or SAD – psychiatry’s greatest acronym), depression associated with vitamin and nutritional deficiencies, etc.etc.
DEPRESSION OCCURS IN A SPECIFIC CONTEXT
The doctor or therapist must determine the specific cause of depression. Additional problems such as anxiety and other chronic diseases must be addressed. It is absolutely essential that the patient’s social situation and support network be explored. Are alcohol or other recreational drugs involved? Is the depressed person subject to verbal or physical abuse? What has the patient tried on their own to overcome their depression? Are suicidal thoughts creeping in?
TREATMENT MUST BE INDIVIDUALIZED
If the patient is suicidal, inpatient admission is required — even if it means an involuntary 72 hour hold. Depression is, unfortunately, at times, lethal. If a specific cause is identified, this must be addressed as well. Other mental health problems should be confronted head-on. For example, if the diagnosis is SAD, light therapy is the treatment of choice.
BIPOLAR DEPRESSION IS DIFFERENT
It has been my experience that unless the topic is purposefully explored, the diagnosis of bipolar disorder (old term = manic depressive illness) will be missed. Bipolar patients usually do not think they need to go to the doctor when high, or manic. No. They go to the doctor during the depressive phase and often (intentionally?) fail to mention the mania. This distinction is extremely important. If a bipolar individual is put on an SSRI, THEY WILL GET WORSE. (SSRI = Serotonin Specific Reuptake Inhibitor, i.e. Prozac, others) These patients need a mood stabilizer. Once the right mood stabilizer at the right dose is in place, then and only then can an SSRI be started and even then, only if needed.
Once bipolar disease has been ruled out, the doctor should offer the patient medication. There are many different kinds of antidepressants on the market. It may take some trial and error before the right medicine, the right dosage, or the right combination of medicines is found. Also, these medications usually takes 4 to 6 weeks to work. Be patient. Don’t give up too early.
DRUGS ALONE ARE NOT ENOUGH
In addition to medication, counseling is often useful. Cognitive behavioral therapy may help. Exercise is a natural antidepressant. Diet and nutrition often need attention. Abuse situations must be corrected – sometimes by involvement of the police and courts, if necessary. Often it is necessary to involve family in the treatment of the depressed individual.
FOLLOW UP FOLLOW UP FOLLOW UP
I recall an elderly gentleman some years ago. His depression stemmed from age, the loss of his wife, and some physical infirmities. He received counseling. He was placed on state-of-the-art medicine. At our last visit, he was improved and had a brighter outlook on life, was relaxed, and knew what he wanted to do. A few days later, I read in the paper that he had shot and killed himself. My point here is critical: In the first few days of emergence from a serious depression, the patient may have just enough energy to carry out a plot which they have kept a closely guarded secret. This is a very delicate time for the patient and the patient’s family. It is at this time, when all involved start to see the light at the end of the tunnel, that patients are often discharged from the hospital. Unless the patient is closely followed up, disaster might ensue.
Depression is real. Do not ignore the signs and symptoms. If someone you know is depressed, or looks depressed, or you even think they look depressed, do them a favor and ask. Talk to them. Get help. You may save a life.
COPYRIGHT TIMEWISEMEDICAL 2010
