How to Heal Depression

Thirty-nine: Choose a Doctor

The health professional to diagnose and medically treat depression is the physician (an M.D.).mental health practitioner. In this part of the book, we are looking at medical diagnosis and treatment.> As we shall explore shortly, other physical illnesses can have symptoms similar to depression, or may be the cause of depression itself. It is one of the doctor's jobs to rule out these illnesses when symptoms of depression are present.

Psychiatrists are the physicians best suited to diagnose and treat depression. Psychiatrists are, first and foremost, medical doctors. They have, in addition, three years of training in the workings of the brain and mind. Many psychiatrists now specialize in treating depression.

According to a 1993 survey performed by the RAND Corporation, fewer than half the general practitioners ("family doctors") treating depressed patients had spent more than three minutes discussing their patient's symptoms before determining if the patient had a depression. While diagnosing depression usually takes no more than one or two fifty-minute consultations, three minutes is obviously far too brief. This may explain why general practitioners fail to diagnose depression accurately about half the time. (They tend not to find a depression when one, in fact, exists.)

More and more general practitioners, however, are becoming well versed in the treatment of depression and are taking the necessary time to do a proper diagnostic evaluation. The psychiatrist, then, is certainly not the only physician who can successfully diagnose and treat depression.

Most important, you want to find a competent physician with whom you feel comfortable, someone you can trust with the most intimate details of your life. You must give thorough, complete information about all aspects of your life if the doctor is to make an accurate diagnosis and prescribe the most effective treatment. In addition, the physician you choose to work with you must provide emotional support, encouragement, and guidance. It's important that you can feel his or her compassion and caring.

If your family doctor or healthcare professional does not specialize in the diagnosis and treatment of depression, he or she will probably be able to recommend a psychiatrist who does. There is no need to choose the first recommendation. Sometimes "interviewing" two or three prospective psychiatrists is in order.

Macbeth: Canst thou not minister to a mind diseased, Pluck from the memory a rooted sorrow, Raze out the troubles of the brain, and with some sweet oblivious antidote Cleanse the stuffed bosom of that perilous stuff Which weighs upon the heart? Doctor: Therein the patient Must minister to himself. SHAKESPEARE

Forty: The Diagnosis of Depression

If this essential core of the person is denied or suppressed, he gets sick sometimes in obvious ways, sometimes in subtle ways, sometimes immediately, sometimes later. ABRAHAM MASLOW

Diagnosing depression--from the patient's point of view--is an uncomplicated, straightforward procedure.

There will probably be forms to fill out (aren't there always?) concerning your medical and personal history.

Because depression tends to run in families, you may be asked to answer a few basic questions about your family medical history.

Your doctor might also perform what's called a medical workup, to rule out physical illnesses that can first appear as a depression. These can include low thyroid, mononucleosis, anemia, diabetes (half of the fifteen million people with diabetes in this country don't know they have it), adrenal insufficiency, and hepatitis, among others. (Most of these can be determined by a simple blood test.)

You'll be asked about medications you are taking or have recently taken. Certain prescription drugs (for example, high blood pressure medications, birth control pills, or steroids) and over-the-counter drugs (such as diet or sleeping pills) can sometimes cause depression.

It's also a good idea to provide your diagnosing physician with a complete list of all vitamins, minerals, herbs, amino acids, or recreational drugs you may have taken in the past year. (Understandably, you may not want to write down some of the illegal substances, but do tell your diagnosing physician when in the privacy of your consultation.)

Your medical exam should include a physical, especially if you haven't had one recently.

Mostly, though, arriving at a diagnosis will involve talking. You'll tell the doctor which symptoms of depression you think you have. You can ask the doctor whether what you are experiencing qualifies as a symptom or not. The doctor will also ask you some questions, which, of course, should be answered as frankly and completely as possible.

After reviewing your personal, family, and medical history, and the results of all tests, your doctor may diagnose depression.

Rather than feeling dread, most people diagnosed as depressed feel relieved. Finally, there is a single, medical explanation for a great many frustrating, debilitating problems.

At this point, your doctor will recommend a course of treatment. In most cases, this will include antidepressant medication and short-term psychotherapy.

Psychiatry is the art of teaching people how to stand on their own two feet while reclining on couches. SIGMUND FREUD

Forty-one: Antidepressant Medications

There are roughly a dozen antidepressant medications from which you and your doctor can choose. As previously mentioned, none of them is addictive or habit-forming. They are generally safe when taken as prescribed.

Although various types of antidepressants work in different ways, the overall effect is the same: balancing the neurotransmitters in the brain, thus restoring harmony to brain functioning.

Antidepressant medications become effective gradually. Although some people notice an improvement within days, some take as long as eight weeks to feel the maximum benefits. During this time, patience and perseverance are the key.

Some patients decide after a few days or weeks, "This isn't working for me," and stop. Others experience side effects, fail to tell their doctor about them, and stop. Either of these responses is a mistake.

Communicate all effects--especially problems--to your doctor. If the problem is especially troublesome, call at once.

Don't wait until your next appointment. Your doctor may then prescribe a different antidepressant. If, however, your doctor suggests continuing with the medication as prescribed, please do so. Most side effects disappear within two to three weeks, or, when compared with the positive results of medication, eventually seem minimal.

The human body experiences a powerful gravitational pull in the direction of hope. That is why the patient's hopes are the physician's secret weapon. They are the hidden ingredients in any prescription. NORMAN COUSINS

Forty-two: Side Effects

Most people who take antidepressants experience few, if any, side effects. Those who do have mild side effects. This is especially true of the newer antidepressants (Prozac, Paxil, Zoloft, and Effexor).

Your physician will let you know which side effects to look for with the particular antidepressant(s) you are taking.

As previously mentioned, most antidepressants' side effects disappear on their own within two or three weeks.

Seldom are side effects severe enough to necessitate switching medications. If you do need to change, however, take heart: there are several other antidepressants equally effective, but without the same side effects.

Most important, do not change your medication or dosage on your own. Contact your doctor.

Do not take any additional drugs--either over-the-counter, prescription, or recreational--without first checking with your healthcare provider. Drugs that, when taken alone, are relatively harmless can become dangerous--even deadly--when taken with some antidepressants. Always check with your doctor.

Whatever the side effects may be, it is usually more harmful to have a depression than to take antidepressant medication.

How to gain, how to keep, how to recover happiness is in fact for most men at all times the secret motive of all they do, and of all they are willing to endure. William James

Forty-three: The Prozac Rumors

It seems that whenever the subject of depression and antidepressant medications arises, the discussion turns to Prozac. Frankly, Prozac has "a bad rep."

It is completely undeserved. Since its release in 1987, ten million people have taken Prozac. The vast, vast majority of them have found it to be an effective treatment for depression, with few side effects. (In fact, Prozac has fewer side effects than almost any other antidepressant.)

Naturally, in studying a group of ten million people doing anything, some aberrant behavior is likely to be found.

A certain religious group for whatever reason decided to "get" Eli Lilly, the manufacturer of Prozac. The group spent millions of dollars publicizing the aberrant behavior (murders, suicides) of a handful of those ten million.

Since then, elaborate studies reported in everything from the American Journal of Psychiatry to "60 Minutes"--show that Prozac, in and of itself, does not cause a greater likelihood of aberrant behavior.

It is estimated that ten million people around the world have taken Prozac, five million of them right here in the United States. That's more than the total populations of Idaho, Montana, Wyoming, North Dakota, South Dakota, and Nebraska. OPRAH WINFREY "THE OPRAH WINFREY SHOW" March 7, 1994

Forty-four: The Right Medication and Dosage

Due to the delay between starting antidepressants and seeing results, it may take a while for your doctor and you to arrive at the proper medication and dosage for you.

Be patient with this process. During the initial phase of treatment, you may require more frequent consultations with your doctor.

People respond differently to specific antidepressants. One person may find antidepressant A highly effective, while another person may find it only marginally effective. The other person, however, may find that antidepressant B works wonders, while the antidepressant A fan finds antidepressant B ineffective.

The same is true of side effects. Antidepressant A may work fine, but have a disagreeable side effect, while antidepressant B may work just as well, and have no side effects.

Although it may take a while, when you and your doctor discover the antidepressant and dosage that work best for you, it will be worth it.

Instant gratification takes too long. CARRIE FISHER

Forty-five: "You're Not Dealing with Your Pain!"

Some people seem morally opposed to antidepressant medication. They have a firm belief that pain must be dealt with, experienced, analyzed, categorized, and, at all costs, must not be avoided.

These people, it seems, are confusing antidepressants with tranquilizers or painkillers.

Antidepressants do not numb the body, mind, or emotions. On the contrary, they usually make a person more perceptive and aware of feelings.

The suffering of depression is not the ordinary occasional pain of living. Suffering, in fact, interferes with the processing of, and taking appropriate action about, pain. Pain is a signal that something is not right. Far from covering this pain, antidepressants help you deal with it more effectively.

People being treated for depression often find that the clarity of mind, relief of emotional suffering, and increased energy allow them to clear up problems--mental, physical, and emotional--that had been festering for years.

Antidepressant medications, then, are not an escape, a cover-up, or a short circuit for life's difficulties. They are a medicine to heal disease and end suffering.

They often make psychotherapy more effective.

Some patients feel guilty about achieving recovery with medication. They have been thoroughly indoctrinated in the idea that emotional disturbance must reflect psychic ills, and they expect the treatment to require a prolonged, painful search of their unconscious. NATHAN S. KLINE, M.D.

Forty-six: A Good Night's Sleep

Go to bed--What you're staying up for isn't worth it. ANDY ROONEY

So many people with depression experience difficulty in sleeping that--as with many other symptoms of depression--it's hard to tell whether insomnia contributed to the depression or depression contributed to the insomnia. The answer, in many cases, is both.

Many people find that as treatment progresses they return to normal sleep cycles. This is healing in itself.

If, after taking antidepressants for a while, you find your sleep has not returned to normal, it may be that the particular antidepressant you take has the unwanted side effect of insomnia. You may want to discuss with your doctor the possibility of a bedtime dose of an antidepressant (such as Trazadone) that has sleepiness as one of its side effects. These antidepressants are not sleeping pills. When taken at bedtime, however, the side effect of sleepiness--which can obviously be a detriment during the day--becomes an added blessing.

Sleeping pills can be easily abused and are particularly dangerous for a depressed patient. Sedatives actually disrupt your normal sleep patterns and can quickly become addicting.

If you are already taking an over-the-counter or prescription sleeping medication, ask your doctor if it's advisable to switch you to an antidepressant at bedtime. These are often not only more effective for the depressed person, but allow him or her to avoid sleeping pills, which can interfere with the successful treatment of depression. As always, check with your doctor.

Sleep is a significant part of the healing process--it is the time for your body, emotions, brain, and mind to rejuvenate and restore themselves to proper functioning.

Sleep is the guardian of health.

How do people go to sleep? I'm afraid I've lost the knack. I might try busting myself smartly over the temple with the nightlight. I might repeat to myself, slowly and soothingly, a list of quotations beautiful from minds profound; if I can remember any of the damn things. DOROTHY PARKER

Forty-seven: Nutritional Supplements

Everything you see I owe to spaghetti. SOPHIA LOREN

Good nutrition, plus taking vitamin and mineral supplements, supports the healing of your brain and body. A nutrition-conscious doctor can test you for nutritional deficiencies and treat these appropriately.

Consider taking a vitamin B-complex twice daily. Deficiencies of B1, B2, or B6 can cause depression. Vitamin B12 deficiency can cause depression, neurological problems, and anemia. (You may need to take the B12 under your tongue or as a "B12 shot" because this vitamin is absorbed poorly from the diet.)

Vitamin C twice daily helps combat stress and strengthens your immune system.

A daily multimineral supplement is also helpful because a deficiency of zinc, iron, magnesium, or manganese can contribute to depression.

Excess sugar, white flour, alcohol, and caffeine deplete your energy and can contribute to depression.

Especially among the elderly, deficiencies of vitamins and minerals contribute to not only depression, but less-than-optimal mental performance.

In general, vitamin/mineral supplements are better purchased at a health food store than the corner drug store.

And... drink lots of water--at least eight 8-ounce glasses a day.

Forty-eight: Treat Your Body Well

Anything you've learned that promotes the strengthening, flexibility, and endurance of your body will almost invariably support your overall healing and well-being.

Exercise--particularly aerobic exercise--produces endorphins, which are among the body's natural antidepressants. Bicycling, swimming, or even a good brisk walk can do wonders.

Other physical activities--such as yoga, stretching, dancing, tai chi--are excellent ways to loosen the body, relieve stress, and get energy moving again.

It's hard to overestimate the healing powers of a hot bath. If you're a typical "shower power" American, making that a ten-minute hot bath could have soothing results.

Even more deeply relaxing is massage.

Do more of whatever activities you personally find nurturing and enjoyable: walks in nature, viewing art, listening to good music, watching your favorite movies, gardening.

One of the most common outcomes of a depressive illness is a mistreated body. Now is the time to treat your body well. The more you learn to treat yourself well now, the less treatment you'll need down the road.

My grandmother started walking five miles a day when she was sixty. She's ninety-five now, and we don't know where the hell she is. ELLEN DEGENERES