DEPRESSION REVISITED

The number of my friends who suffer with depression is staggering.  The number of my former colleagues (physicians) who are depressed is also staggering!  I find myself wondering whether this is a new phenomenon or tied to Covid, politics and the media’s new role (BREAKING NEWS scrolling across our TV and computers every 15 minutes).  Whatever the cause, depression should be treated aggressively.  Unfortunately, most depressed individuals will neither admit to depression nor treat it.

Are you depressed?  I once asked a patient that very question.  Her answer was an emphatic, “NO!”  She had all the signs of depression as well as a multitude of depressing problems, yet she appeared angry that I would suggest such a diagnosis.  Her response was a typical one.  Depression is accompanied by an ancient stigma.  Admitting to depression is like admitting to a character flaw or weakness.  A diagnosis of depression can have a significant, negative impact on your career and inter-personal relationships. This particular patient was deeply entrenched in her denial.  I gave her a choice.  “Mrs P., your choice is to be depressed or insane.  Your story is so sad that it depresses me.  If you are not depressed, then you must be insane.  Any sane person I know would be depressed given your circumstances.”   She chose the diagnosis of depression and eventually accepted treatment.  (She’s doing well.)

As a physician, I can tell you that once you’ve gotten a patient to accept a diagnosis of depression, you then have to get them to accept therapy (medication, counseling, etc.)  Making the diagnosis is fairly simple.  Getting the patient to accept the diagnosis is difficult.  Getting the patient to accept help and treatment is nearly impossible.

When my doc told me I was depressed my response was, “DUH!”  Hurdle number one was easy, diagnosis made and accepted.  When she offered pills and counseling, she hit a wall. I was already on a shitload of pills with a host of side effects.  Further, I explained that I had spent 30 years counseling patients and didn’t think counseling was going to be worthwhile.  Ultimately, I gave in and started on meds and in counseling. I ended teaching the counselor.  The meds I agreed to take did not help.

What I’ve found is the best antidepressant in the world is time spent with my grandchildren and their parents.  Second best is cruising North Carolina country roads on sunny days in a convertible.  Third best on my list is eating.  Unfortunately, the side effects of eating are weight gain and obesity which then lead to more depression (in my case, anyway).  Certainly, treating the underlying disease would be helpful (if successful).  Parkinson’s is a mean adversary.  Fourth on my list of non-medicinal therapies is watching my garden grow.

In March, I’m scheduled for DBS (neurosurgery) in a final attempt to slow the ravages of Parkinson’s.  My garden guru will plant my vegetable garden and tend to it while I recover.  Renee will drive me around with the top down while I recover.  Luckily, she’s a racecar driver, taking curves at max speed and making every excursion an exciting experience.

If you are depressed, talk to your doc.  Certainly, meds and counseling can help.  What works for me may not work for you and what failed me may help you.  The important thing is being open to help.

Here’s today’s joke:

I was having issues in my personal and professional life. I hated everyone. I was on the brink of a mental breakdown and depression. I decided to see a therapist about it. The therapist suggested that I should write letters to the people I hate and then burn them. I must admit I feel much better…

But now I don’t know what to do with the letters.