Friday, January 31, 2014

Dealing with depression

I was going through my old, old posts on this blog and feel I need to update the Dealing with depression part of that post.

I have been diagnosed with a mild case of major depression disorder. I know that sounds strange, minor/major but it is mostly procedural. You need the MDD diagnosis code to get treatment covered by insurance.

Dealing with Depression

If you are like me, and (according to some news sources) like over thirty percent of the population in the United States, you deal with depression on (sometimes) a daily basis. These feelings usually manifest themselves in the form of feelings of hopelessness or you might feel tired all the time.
What not to do.

Drugs are NOT the Answer.
When I say drugs I am describing anything from prescription drugs like Prozac to binge drinking. Drugs are only a temporary solution to the problem and usually make things worse. I have seen some co-workers on the drug Prozac and they are both psychos, one step away from full-out fruitcake. I have family members on different prescriptions and they aren't any better. One has been on various prescriptions for twenty (yes, 20) years. The physicians just keep giving him the line "let's try this one". These quacks have no idea what they are doing, they just continue to milk the system. One of my friends smoked marijuana (i.e. pot, reefer, weed) to escape his depression. That loser is still depressed and now half his tenth-grade brain is gone. The common thread is that all of these people are still taking drugs and they are all still just as depressed, if not more than they ever were.

There have been at least three new classifications of anti-depression drugs that have entered the market since this was written. There is a blood test to determine levels of monoamine neurotransmitters (dopamine, norepinephrine, and serotonin) in your body and DNA tests to determine which drugs will work (or not work). A good, modern psychiatrist will offer at least the blood test; maybe the DNA test but both test are expensive and not all insurers are covering them yet. Once the results are in the psychiatrist will prescribe the best drugs to help with your depression. Drug affect people differently. What might work for one individual might be a nightmare for another. When starting most drugs expect the first week to four weeks to be hell – insomnia, diarrhea, anxiety, weight gain, weight loss, etc. After that breaking in period the medication should start working. I still believe there are plenty of quacks out there that simply a drug from the short list of what has worked best for their patients, hope it works, if it does not they try another one until some combination of the forty or so of these drugs work. The goal of the blood and DNA tests are to take the guesswork out of the equation (so insurance – would you rather pay for the tests and get it right or pay for a dozen quack visits).

Shrinks are NOT the Answer
If you a rock star or some wealthy Hollywood name, then a "shrink" might work for you. For the rest of us that need to work for a living, you might as well just stop someone on the street or sit next to someone at a fast food joint because you are likely to get the same answers. Basically you pay a "shrink" to listen and make observations but every single session boils down to a prescription (see above). They do not have the answers or if they do they are canned answers you could probably get from a box of cereal or Miss Cleo. I saw a psychiatrist once, and that was enough. There are no easy answers to anything, but there is something that can be prescribed.

Shrinks are necessary. The psychiatrist prescribes the drugs and the psychologist does the talk therapy. You usually need a psychologist referral to see a psychiatrist. My opinion on psychologists is still mostly the same. A therapist is good for three or four sessions before the information, dialogue and time off from life, etc. start becoming repetitive and in my opinion not of much use. If your employer has a wellness program for therapy sessions then by all means use them. First session should include doing paperwork to refer to a psychiatrist. If you suffer from chronic depression you likely need medication so get this started as soon as possible so you can have medical and verbal therapy working at the same time. The psychologist cannot prescribe medication. Use the first session to get all of your history with depression and any trauma at any point in your life in the open so the psychologist can assess your situation and then give you some first steps. The following sessions should clarify your situation and your psychologist should give you "tools" you can do to help your situation. Try doing what your psychologist says. Yes they are guessing but they work in what is common solutions to common problems; fix what is most common then work on the particulars. Eventually though, in my opinion, things start getting repetitive and the therapy starts getting beyond the scope of the psychologist. Obviously, if you have suffered a major trauma in your life do not listen to me and do therapy until you do not need it even if it takes decades. I speak for dealing with typical depression.

Another route is dealing with a family doctor first and then let your doctor do the referral if needed. I do not have the professional training to tell otherwise but here is what your doctor will do. They will prescribe one of the most commonly used generic medications first (Prozac, etc.). If that does not work they will either add second medication (effect a different neurotransmitter) or switch you to whatever brand medication they are being asked to pimp out (you will be given samples, a coupon card and a Rx). You might also be placed on Abilify (currently, a very popular add on drug; not sure if it is at the pimp stage at family practices yet but I wouldn't doubt it). If you are still depressed then you get the referral to a shrink. In my opinion, do the therapy route. Family doctors are great for keeping you healthy but there are reasons why there are specialists.

Is God the answer?
Maybe… Part of the problem with religion or other social groups is that they remove your self-esteem by placing everything in someone else's hands. Instead of depending upon yourself, being responsible, and understanding your strengths and weaknesses, everything is now controlled by an external entity (i.e. God or insert religious icon here). It works for you if you can completely give yourself. For most people it works temporarily until that first bout of doubt sets in, then there is the possibility (finishing my incomplete quote) for relapse and you might need to go to doctors anyways.

I really have no evidence to support or refute. My history with religion is personal and will not be discussed here. Best advice would be to not solely rely upon a deity for fixing depression. If you need medication for depression then see the right people and get on it; unless your deity is going to fix your brain chemistry for you.

My Solution?
Be depressed.
Seriously. Believe it or not, depression is a completely normal state of being just as happiness, sadness, ecstasy, and indifference are. It's okay to be depressed. If you are depressed, chances are good there is a reason why you are depressed. A couple of days later, you might still be depressed or you might do a one-hundred percent turn-around and be glowing with joy. It might even take a month or a year or your entire puberty. It's part of life. Depression makes happy days happier but can be overwhelming at times. Most people that "suffer" from depression have succumbed to it. Don't succumb to it. When the day is done, go over to the calendar and mark off the day because it's over.

Wow, that was a simple solution. I still believe the first part. Depression is normal and for most people it is not necessary to be happy all the time. If you had a rough day at work, had a family member leave or pass away, then you should feel depressed. That is natural. When depression overwhelms the day to day then it is time to look to therapy and medicine. Depression can require medication to cure. I still believe the second part because I think way too many people let depression (anger, anxiety, etc.) overwhelm them and they immediately go to something other than their own built in mechanisms for dealing with depression. I also think many people want that quick fix

I would also like to apologize for trivializing a lot of my previous statements. Depression is a serious condition. I was able to overcome depression in my early years through realization that occasional depression is acceptable as part of life, chances are good that most of what is making you depressed is out of your control and no medication or therapy is going to fix what you cannot control, and when I was depressed I should have been depressed. After dealing with friends and family dealing with depression, suicide, and attempted suicide I have come to learn a lot more about depression. Depression is a health issue and all people are not fruitcakes. Most of them suffer from mental health issues and are in treatment and with successful treatment are competent members of society.

The state of mental health in central Ohio is not good. There are not enough facilities, emergency facilities and treatment options available to individuals with mental health issues. Recently, one patient had to spend three days in an ER hallway waiting for a bed to open in the mental health ward. I had to wait six months to get into a psychiatrist office.

Here is a link I found useful during my life with depression:

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