Monday, March 3, 2014

Not Waving But Drowning: What Can You Do To Stay Afloat When Depression Strikes?

"The statistics on sanity are that one out of every four Americans are suffering from some form of mental illness. Think of your three best friends. If they're okay, then it's you." (Rita Mae Brown)

Clinical depression is truly dreadful, a curse on the soul.

Nor, as Ms. Brown acidly points out, is it kind enough to be rare. In fact, Thomas Insel, MD, director of the National Institute of Mental Health, claimed in 2007 that depression is the "leading source of nonfatal medical disability among people ages 15 to 44 in developed countries like the U.S. and Canada. It is the leading cause by far. Nothing else is even close. In the whole world it is the second or third greatest cause of disability."

So how do we even begin to deal with an illness that is so prevalent, so life-draining--and, at times, so difficult to see?

One of my favorite British poets, Stevie Smith, wrote a poem "Not Waving But Drowning." I copy it in full below because it speaks to me--and, I believe, will to others--of how the person suffering from depression calls out for help--and, it seems, the response is all wrong:

"Nobody heard him, the dead man,

But still he lay moaning:

I was much further out than you thought

And not waving but drowning.

Poor chap, he always loved larking

And now he's dead

It must have been too cold for him his heart gave way,

They said.

Oh, no no no, it was too cold always

(Still the dead one lay moaning)

I was much too far out all my life

And not waving but drowning."

It seems like every quarter drug companies come out with a new medicine--or re-invent an old one, so they can put it on patent again--to assist those suffering from depression, and I've found in my practice that many people are helped by these drugs, and they can be life-saving.

But what of those who are aren't significantly helped by their anti-depressant medication, perhaps aren't helped at all? It's not as uncommon as you think.

M. Fava's article "Diagnosis and Definition of Treatment-Resistant Depression" in a the April 2003 publication of Biological Psychology define treatment-resistant depression rather loosely, with a patient qualifying after inadequate response to only one antidepressant trial "of adequate doses and duration." [Others will insist a person cannot be defined as treatment-resistant until rather more meds have been tried and failed.] But they note that treatment-resistant depression "is a relatively common occurrence in clinical practice, with up to 50% to 60% of the patients not achieving adequate response following antidepressant treatment." [italics mine]

As disheartening as it is to the depressed patient to 'fail' an antidepressant trail, there are many more choices out there. There are numerous medications that can be tried in a variety of permutations-and not just antidepressants, but also mood stabilizers and the atypical antipsychotics. Transcranial magnetic stimulation is up and coming and holding promise. And, as much as it scares people and reminds them of Nurse Ratchett, I've seen tremendous turn-arounds with ECT.

But I'm not a psychiatrist and don't prescribe, so I just wanted to address the three components of mental health that are in all of our hands, and that we now knowdo make a difference in the treatment of depression: diet, exercise, and getting enough sleep.

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