Best of P-Mag: An Open Letter for Those Trying to Understand Depression

We asked the writers to share their choices for Best of P-Mag; this one was recommended by Sara Habein.

If depression is creeping up and must be faced, learn something about
the nature of the beast: You may escape without a mauling. ~ Dr. R. W.
Shepherd

Recently, a good friend of mine had something of a breakdown that culminated with a week-long stay at a psychiatric facility. While she was in the hospital, some other friends and I did what we could to make sure nothing fell apart while she was recovering, and one of the tasks that fell to me was talking to her boss and keeping him updated about when she might be able to come back to work. In one of our conversations, he told me that he had never really known anyone who was depressed and he didn’t know how to handle it. In retrospect, I’m glad he said something and asked for advice; at the time, though, I was just totally flabbergasted. How is it possible to become an adult professional (in the health care industry, no less) and know nothing about depression?

I gave him an idea about what to expect when she got back to work and some advice about how to talk to her, i.e. it’s better to say the wrong thing once than be forever walking on eggshells around her, she’ll know you are doing it and it will be stressful for both of you. As soon as I got off the phone with him, I called my aunt to vent for a while. She told me that it is entirely possible to grow to adulthood with no idea about how to treat a depressed person, she has seen it too many times. In the course of our conversation, she offered to write something up for him about depression in the workplace, based on research and her own personal experience. The result was, IMHO, excellent and so I am sharing it with you, on the off chance you are in a position where you need to explain depression to someone who just has no freakin’ clue, but is willing to learn.

Without any further ado, here are AuntieB’s pearls of wisdom:

I have lived with major depressive disorder for 40 years. It runs in the family and I got the worst of it. The first and last advice I give anyone suffering from depression is to get treatment from a medical provider (I am not one). Talk to your doctor if you or a loved one show signs of depression. A (preferably board-certified) family practitioner, internist, or psychiatrist can prescribe medications and often help you find a therapist. Insurance companies have virtually eliminated talk therapy from psychiatrists’ practices.

What is depression?

Depression is a serious illness caused (it is theorized) by an imbalance of neurotransmitters in the brain. A predisposition may be inherited and it may result from or worsen due to a traumatic event or extreme stress. Whatever the factors that cause it, the apparent imbalance is a physical change in the brain’s chemistry that frequently requires medical treatment.

Mental illness carries a stigma that prevents some sufferers from seeking treatment. That depression is common and information about it is readily available have increased awareness and the number of people treated for it. Some say that it is over-diagnosed and others that it’s not real. It’s real, and it can be deadly.

As the medical community has learned over those 40 years that I have been ill, depression manifests in nearly countless ways. It shares components with and treatment is similar for many other conditions — PTSD, OCD, and anxiety disorder to name a few. Based on my personal experience, they are nearly all different flavors of the same underlying condition, albeit (particularly in the case of PTSD) with unique challenges. I have had numerous diagnoses and nearly all of the symptoms I will list.

Depression is more than a sad mood. It ranges in severity but none should be ignored. People with mild depression might go decades without treatment, which increases the risk of major depression and Alzheimer’s (also linked to cardiovascular health). Studies have shown that talk therapy alone can rebuild neural pathways in the brain and improve brain health. Early intervention can prevent later problems and the need for medication. Psychotherapy is a critical part of any treatment plan.

What are the symptoms of depression?

Symptoms of depression vary from person to person. The behaviors typically apparent are forgetfulness, absenteeism or tardiness at work, fatigue, irritability, frustration, and/or poor job performance. A person suffering from depression may suddenly find their usual tasks tedious or difficult, take no interest in them, or fail to do them at all. He or she may be very negative. [Depression is a more common diagnosis in women than men but the statistics are still somewhat skewed. Historically doctors are quicker to recognize depression in women, and women are more likely to seek treatment.]

Other symptoms include low self-worth; negative self-talk; agitation; aggression; trouble falling or staying asleep (waking up one or more times during the night 2 to 5 hours after going to bed — at my worst I could sleep only 45 minutes at a time); mood swings; anxiety; difficulty concentrating; facial tics; eating disorders; chronic pain; difficulty swallowing; hiccupping or burping (from swallowing air); obsessive thoughts; repetitive behaviors; isolation and lack of interest in social events; a poorly kept home environment; and inability to deal with changes in routine or stress.

Work provides people with a sense of purpose and a depressed individual generally copes better in public settings (except for those that raise anxiety). If a person you know has depressive symptoms is weeping on the job, they are probably in crisis and need medical attention – definitely if they talk of harming themselves or others. An emotional breakdown in front of colleagues or at a low-stress social event can mean they are in real trouble.

Understanding depression

People with mental illness often feel trapped in their own bodies. They know there is a healthy person in there somewhere and are frustrated that their illness prevents them from being who they really are. They obsess over their poor social skills. They have a hard time making small talk while dealing with the runaway and unwelcome activity in their head. This is keen in individuals with bipolar disorder (BPD). BPD is a severe condition that manifests as swings between mania or hypomania and depression that vary in length and amplitude by individual. Some medications are used in treatment of both depression and bipolar disorder but the medication regimens for the two are generally different.

Depression is hard to shake. Talk therapy, support groups, exercise, and healthy living can make a tremendous difference, even (or especially) in cases of severe depression. Although a person may seem to cope well, what you see is only part of the story. Think of it this way. You have a sprained ankle. Everything you do on it hurts, but you must tend to some things in your life. So you rest when you can and endure the pain when you must. All day every day is painful for people with depression. The illness itself erodes their ability to make healthy choices, their judgment, and their hope. Your sprained ankle will get better more or less on its own. Depression feeds on itself and gets worse without intervention.

People who are depressed may harm themselves for the same reason that anyone in constant pain does: they can’t stand the suffering any longer. Once in an emergency room visit, I was asked what they could do for me (this is common). I replied, “Make me unconscious.” They didn’t go for that. I had my second breakdown after my son was born and told that doctor there was nothing they could do for me. I had been sick for a long while, rapidly deteriorating as the post-partum depression took me down, and I was ready to die. What saved me was ECT, which they started right away.

Treatment

Seeking treatment for depression from a medical professional is vital; unfortunately the illness impedes that as well. Waiting for an appointment a week, or a month, or three months away; finding a doctor to call; making the call — all are obstacles. Intervene if you must — do not let a loved one with impaired judgment be defeated by steps that are simpler for you, or decide for themselves that they don’t need help.

The main purpose of hospitalization for patients in crisis is to reconnect them with reasons to live. Most of what happens there is talking — the staff will do whatever it takes to get the patient to talk. Life problems can’t always be solved, but there are social workers to help. Great hospitals go at it from every angle, looking for ways to reduce stress in the patient’s life and improve their coping skills. It’s a tall order on the budget most insurance companies allow, but these folks are good at what they do. They will insist upon and help arrange aftercare, and engage the family in outpatient planning as appropriate.

ECT is generally used only when there is an imminent threat to life and medications will take too long to kick in, or when they cannot be tolerated. ECT is swift and effective but not permanent; if medication is an option it is administered after the course of ECT is finished for long-term treatment. ECT is more humane than movies would have you think although I will allow as how my memory is not quite what it was after two series of treatments. Life is full of difficult choices and ECT literally saved my life.

The usual course of treatment is a combination of medication and talk therapy. Sometimes medication can be stopped after a while; a person with moderate to severe depression may require long-term administration. Symptoms can get noticeably worse at certain points in a woman’s menstrual cycle. Additional medications can be used during those times if the doctor knows about the difficulty.

The way back

Successful management of depression is highly likely with commitment on the part of the patient, good doctors, and support from friends and family. If a patient does not improve under the care of a physician, it might be time to find a new one. Ongoing care and social interaction are critical as the patient unlearns how to be sick and relearns how to be well. Coping mechanisms that arise from the illness must be replaced by better ones.

The best way to help a person with depression is to behave normally. Listen when they talk, don’t press them if they don’t want to (that’s their therapist’s job), and be considerate of their feelings. Make a few allowances, especially in the beginning and after hospitalization, but expect of them what they know that well person they want to be can do. If they behave inappropriately, tell them (gently). Aside from not being forced into situations that are very stressful for them, they don’t need special treatment. They need what should be our policy with everyone; namely, courtesy, kindness, and constructive feedback.

Be watchful for danger signs, respect what they are going through, and respect them as a person. They are ill, not feeble-minded. Interacting with them as you would (should) anyone else reinforces normal for them. And more than anything else, they desperately want normal.

References

Supplements I take

[Talk to your doctor before adding any supplements, especially about SAMe, which can cause problems for patients prone to mania, hypomania, or are taking anti-depressants.]

Many of these were recommended by a doctor. Some are for cardiovascular health, linked to brain disorders. Depression also negatively affects the immune system.

Multivitamin/mineral supplement 1/day
B-complex 2/week
Vitamin C 500mg 1/day
Vitamin D-3 400 IU 1/day
Vitamin E 400 IU 3/week
Garlic 1000 mg 3/week
Flaxseed oil 1200 mg 1/day
Fish oil 1200 mg 3/week
Nature Made SAM-e 200 mg 1/day

SAMe

(from Health.com)

What it is: S-adenosylmethionine (SAMe), a naturally occurring compound that affects neurotransmitters, including serotonin and dopamine. In the United States, SAMe has been sold over-the-counter as a tablet since 1998.

The evidence: Lower levels of SAMe have been associated with depression. In studies, SAMe has been shown to be roughly as effective as tricyclic medications (an older generation of prescription antidepressants). But in many of those studies, the SAMe was injected, and it’s unclear whether orally ingested SAMe capsules have the same effect.

A 2002 review of the research on SAMe and depression conducted by the federal Agency for Healthcare Research and Quality concluded that SAMe was more effective than placebo at relieving the symptoms of depression and no better or worse than tricyclics. The report noted that more research on oral forms of the compound and research comparing SAMe to newer antidepressants (such as SSRIs) was needed.

The bottom line: SAMe has proven to be useful for the treatment of depression, but questions about its overall effectiveness and delivery methods remain. SAMe does have some side effects. Most notably, it can exacerbate mania or hypomania in people with bipolar disorder, so you should not take SAMe without consulting a physician.