7 Thoughts From a Chronically Unhappy Person

From The New York Times, Diana Spechler writes, “My depression habits include avoiding pain and courting diversion.  During every bout of depression, I grasp – at yoga, therapy, medication, romance – and hope that my tiny firefly of pleasure won’t wriggle from the cup of my palms.”  Read the News

When Medication Isn’t Helping Your Depression

As many people know all too well, clinical depressions do not always improve after the first attempt at treatment. One in three people with depressions (I’ll explain the plural in a bit) find they have not gotten back to “normal” even after four different courses of standard treatment.

Depression is considered “treatment-resistant” if symptoms have not improved after two or more courses of well-established treatments of a sufficient dose and length of time, whether those treatments are evidence-based medications, psychotherapy, or other therapies that have been proven effective.

That “or more” can be problematic. The longer your depression persists, the greater the risk of financial costs, job loss, family stress, marital problems, and even possible brain changes. That’s why it’s a good idea to discuss a diagnosis of treatment-resistant depression with your practitioner after two failures of treatment. The earlier you address it, the better.

There are a number of reasons why your depression might not respond to a particular treatment. For one thing, there is no single type of depression; there are multiple causes.  That is why it is actually most accurate to use the plural term (depressions), and why “one-size treatment” will never fit all.

For another, effective treatments that are not followed cannot work. If a person is not taking the doses of medication as prescribed or doesn’t stick with the recommended treatment, a depressive episode should not be considered “resistant.”

 If my depression resists treatment, what are my options?

It’s easy to get discouraged when the treatments you’ve tried haven’t helped you reach recovery. (And remember: Better but not well is not good enough.) Above all, don’t give up hope. Here are some things to consider.

  • Simply switching from antidepressant to antidepressant may not be useful. As shown in the STAR*D study, the largest American study of treatment-resistant depression, more proactive steps appear to be needed once treatment resistance has developed.
  • Returning to a medication that worked in a previous depressive episode may be more effective than switching to a new one. If it doesn’t work as promptly as before, remember that it may do the job at a (safe) higher dosage taken for a longer time period.
  • Give treatments a chance to work. While the typical time frame for good response to a medication is stated as four to six weeks, for many people it can take 8 to 12 weeks to see improvement.
  • If medications or psychotherapy have been ineffective on their own, consider trying them in combination. Medications plus cognitive behavioral therapy, interpersonal therapy or dialectical behavior therapy traditionally outperform either treatment used alone.
  • Augmentation of your antidepressant with an adjunct or “add-on” medication, often an atypical antipsychotic, may be helpful if you’ve had partial response to a treatment.
  • Other “augmentation” agents that pro-vide benefits for some people include nutrition supplements such as Vitamin D, Omega 3, and folate.
  • Electroconvulsive therapy (ECT), commonly known as shock therapy, has long been stigmatized in popular culture. It is an extremely safe procedure, acts rapidly, can be life-saving, and is sometimes the only effective treatment. It does produce memory problems for some.
  • Other “neurostimulation” treatments, such as Transcranial Magnetic Stimulation (TMS), are coming into wider use. TMS is a non-invasive procedure that typically can be delivered in about an hour each day in an office setting.

Once you find something that works, don’t change a thing. Just as someone with diabetes requires ongoing treatment, most people who have developed chronic, recurring depression need to continue treatment indefinitely.

By John F. Greden, MD.  Dr. Greden has been practicing psychiatry for 35 years. His clinical specialties include treatment-resistant depression and maintenance of wellness. The Rachel Upjohn Professor of Psychiatry and Clinical Neurosciences at the University of Michael Medical School, he is also the founder and executive director of the UM Comprehensive Depression Center (depressioncenter.org) and the founding chair of the National Network of Depression Centers.

The Deadzone of Depression

There is a zone in a depressed person’s life where nothing seems to happen — except the pain of the absence of everything. 

Kay Redfield Jamison, M.D., in her book, Night Falls Fast, writes:

I wish I could explain it so someone could understand it. I’m afraid it’s something I can’t put into words. There’s just this heavy, overwhelming despair – dreading everything. Dreading life. Empty inside, to the point of numbness. It’s like there’s something already dead inside.

Such anguish is so overwhelming that every other concern is squashed in its wake.  Our capacity for willful actions seems to be gone; we can’t “figure it out.”  We are stuck.

I have learned a lot about the zone over the years and how to handle it.  It’s really like surfing a giant wave.  To handle these waves, you study them and prepare yourself for when the next big one rolls in.

When I feel I’m entering a Dead Zone, I start a deliberate and kind conversation with myself that is practiced and rehearsed.  I don’t let the toxic voice of depression drown me out.  It’s important to empower ourselves in whatever ways we can during these times because depression will lead you to falsely conclude that you’re helpless to lift your dark mood.  This conclusion is one of the central tenets of depression; one of its main “themes”.  We need to create – and we can – different and healthier themes for our lives.

Start with a three-by-five index card.  Use it to create your own deliberate and kind script of themes for yourself that day.  Here’s is an example of what I had written on one of my cards:

— This depression isn’t forever. It will pass.

— I have handled it in the past. I will handle it now.

— Get out of my head – don’t sit around and ruminate.

I usually write a new card out every morning.  When depression is absent (and there are long periods of time when it is), the theme of the card might be more celebratory or grateful:

— I appreciate all of the goodness in my life.

— Thank you God for all of the wonderful people you’ve put in my life.

— I am happy that I am not experiencing depression today.

According to psychologist, Deb Serani, Psy.D, there are both emotional and psychological reasons why this is so:

So, why do these gratitude experiences boost happiness and alleviate depression? Scientists say that these techniques shift our thinking from negative outcomes to positive ones, elicit a surge of feel good hormones like dopamine, serotonin and oxytocin, and build enduring personal connections.

The insight and reflection of counting these moments is what makes the practice of gratitude so powerful. But the key to combating depression is making these positive experiences part of the fabric of your life.

Try this for a while and see if it helps you. Don’t wait until you are in the zone of depression to construct the cards because your thinking during such times will be distorted.

Doing this is a healthy and self-empowering step that you can take today.

By Daniel T. Lukasik, Esq.

 

The Person I’m Supposed to Be: One Person’s Depression Journey

There’s a wretched place depression drags me off to after taking control of my thoughts and feelings. It’s the place where the longing for relief mutes every other desire, even the desire to wake up in the morning. There are days when I wonder if I’ll lose everything: my job, my relationships, my last stitch of sanity. It feels as though I’m breathing hot black smoke.

Yet I believe the same depressions that pin me to the mat so often also serve a bigger purpose in my life. They don’t come empty-handed. I believe the purpose of suffering is to strengthen us and help us understand the suffering of others.

At 16, my first episode hit me hard enough to think I’d literally gone to hell. Now, at 35, when I start dreaming of haunted houses and worrying uncontrollably about the future, I know another episode is looming. I’ve got a week’s notice, maybe two. And then it’s as if I’m drifting off to exile inside myself with only a shell remaining.

It used to be that rising from the ash after the depression cleared was like resurrection. The burial over, I’d catch myself laughing or looking forward to the next day. I’d pig out at my favorite deli. But now, when I look closely, I find mental illness leaving other significant gifts in its wake — things I didn’t discern when I was younger.

The discovery is like that scene from The Matrix when Neo finally comprehends his identity. Through the whole film, he’s been beaten up by evil agents. But the fighting transforms him into a warrior. And at the right time, he understands and uses his power. He’s peaceful, even when confronting an enemy. I believe my own years of struggling with depression have left me with similar gifts: inner strength and calm I can rely on, diminished fear and compassion.

I believe the painful nights that close in on all of us in some form are the cocoons from which we might shed our weaknesses. I believe pain tells us something critical about ourselves and life: that developing strength and empathy and bravery is more essential than our personal comfort. And when I think of it like that, I’m more willing to accept suffering on its terms.

That’s important, because if my pattern holds consistent, my next episode is due to arrive soon. I live with this reality, but I’m no longer afraid of it. The depression has, in the end, equipped me for its next visit — and that’s enough. Of course, I’ll take my medicine. I’ll talk to my gifted psychiatrist. But when the dark does come, I’ll stand up and breathe deeply, knowing I’m becoming the person I’m supposed to be.

 

By Andy Blowers.  This piece first appeared on National Public Radio’s All Things Considered.

 

 

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