I seem to be starting most of my sparsely spaced posts because I’ve been going through changes as you will also go through changes as you break depression.  For 9 months I have been holding out on writing about two new therapies that I am doing that are amazing.  I was so eager to tell you about them and I have written multiple posts, all unfinished, all unpublished because I wanted them to be perfect, I wanted to be perfect, and I didn’t want to write about depression while I was breaking free of it day by day, week by week, month by month.  I have seen more change in myself over the last year than I have ever seen in any year or any five years of trying to break depression.  But nothing is perfect.  I am not perfect.  But it is time to say something.

I have spent nearly three decades fighting Depression in a very active fashion.  I was diagnosed with Major Depressive Disorder (MDD) in the late 80s and after a suicide attempt.  I had to go on antidepressants and see a psychiatrist daily for some period of time to make sure that the meds were working and that I was thinking straight.  In those days we went to psychiatrists for both our medication and our therapy.  Nowadays most of us get our medication from a psychiatrist or a psychopharmacologist, and our therapy from a psychologist, a social worker, or some other alternative method that hopefully works for us. For those of you who see a regular family doctor/Interest/etc. take my words seriously.  It is my strong, laypersone, opinion that except for very rare cases, primary care physicians lack the knowledge of how to diagnose and treat depression and other mood disorders and personality disorders in a responsible fashion.  There are just too many variables and most of these doctors probably do not have the time necessary to monitor a patient that is dealing with serious depressive episodes or with clinical diagnosis of Depression (MDD, Manic Depression, Bi-polar Disorder, Borderline Personality Disorder, PTSD, etc.)  And if someone is maybe just going through a rough time in their lives, popping a pill can cause serious long-term depression or other problems, so the decision shouldn’t be taken lightly.

Most primary care physicians probably proscribe whatever few medications that the pharmaceutical reps bring around.  Ask people who are do not have a diagnosis of MDD, Manic Depression, Bi-Polar II, of MPD what antidepressants they have been proscribed and you will hear the same two to four medications that are the current fad.  For a while it was Prozac, then Zoloft, then Paxil, then Cymbalta, Lexipro, Celexa, etc.  Get the idea?  These are not all of the options out there and I might not have my order exactly right but this is the general way things have moved in around the last 15 years.  And I’ve been on every one of these medications and many more, so I know a little bit about what they can do based on experience.

Antidepressants don’t make people happy, the best they can do is pull people out of the muck and mire of a sever depressive episode or out of clinical Depression to at least give them a chance of doing the other work necessary to break Depression, or they have an abreaction and commit suicide because there doctors weren’t monitoring them closely enough, and were stepping out of their areas of expertise – in my humble opinion.  And that’s if the physician is gets the right medication for the patient right away.  Psychopharmacology is a complex field that is based on diagnosis that are a cluster symptoms that the patient seems to best fall into.  This is not like diagnosing problems with organs that can be cut into and physical problems within them can lead to diagnosis, prognosis, and treatment.  This is is more of an art than a science and it takes a lot of experience to be good at it.

These days the field of psychopharmacology is even more complex than it ever was because of the DSM-V and the other kinds of medications that were not FDA approved for these mood and personality disorders, but are proscribe legally “off label” by doctors treating Depression.  Most are anti-seizer and neurological pain management medications that are often just referred to as mood stabilizers.  Read the labels.  And then there is the heavy artillery that they bring out for Manic Depression, Bi-Polar II (Hypomanic Depression, Post Traumatic Stress Disorder (PTSD), and for personality disorders, as opposed to mood disorders.  These powerful drugs can destroy lives.  Believe me when I tell you this because I know from my own experience.  Due to a doctor mis-diagnosing me with Bi-Polar II (Hypo-Manic Depression) I lost four years of my life to being placed into a horrific state of constant agony and constant suicidal ideation mixed with being zoned out in an almost comatose state.  I’m telling you, Hell is not a place you go.  Hell is a state of mind that I wouldn’t wish on my worst enemy.  My family and eye lost many years to this and they can never be resurrected.  Thank God that episode began to end in late 2010 when I found a new psychiatrist who figured it out right away, but so much damage was done.

As Depression is now being linked to the immune system and inflammatory diseases  we are beginning to see allergy medications being proscribed for Depression.  I’m not saying that this is good or bad.  I have no idea how for this area of study has gone, but it makes sense.  The body and the mind are not separate.  We do not have a body and a mind, we have a body-mind or mind-body. I don’t know if both of these terms are accepted but at least one of them is. I’ll leave it to you to look into.  It’s a chicken and an egg kind of thing.  Did the Depression cause the chronic inflammation or other immune system problem or did was the source of the immune dysfunction due to Depression?  I think it’s a two way street.  These things are connected, and I think we will see that chronic illness can be cured by curing Depression and vice versa.

And this doesn’t even begin to scratch the surface of other types of antidepressants, sedatives, stimulants, and mood stabilizers that are out there often to be proscribed with other medications to make some very complex and potentially dangerous cocktails.  Now don’t get me wrong; I am not against medications being used to treat serious depressive episodes due to biochemical changes that occur as the result of glandular dysfunction, puberty, postpartum depression, menopause, or other dysfunctions of major traumas that can send someone without clinical Depression into a death spiral.

The period of time I spent from 2011 on has been spent by me working on trying to get back to some sense of happiness and functioning.  I was in bed for years prior to this.  My world was primarily my bedroom.  My days were spent either in therapy of one kind or another, reading 100s of books about psychology, self-help, religion, spirituality, alternative approaches, and trying just about all of them.  I have made a lot progress in my recovery.  This is what I want to talk about next.  Right now I need to go to sleep.



Who Should Prescribe Antidepressants and Mood Stabilizers?

Over the past 20 years drug manufacturers have been actively marketing antidepressants and now mood stabilizers like Abilify to the general public via television commercials and pushing doctors to prescribe them. This is very dangerous. It is dangerous for the people out there who clearly do not need to be on these powerful medications. It is dangerous for people who may need to use these medications but through the high likelihood of a bad experience in trying them with close their minds to that potential solution to their problem. And it is especially dangerous for children.

Prescribing antidepressants and mood stabilizers is much more an art than a science. A doctor who will be prescribing these medications needs to have specialized training, has to have time to consistently follow up on at least a weekly basis with their patients, has to know about all of the side effects and contraindications of these medications, and should have the view that medication should only be utilized when there are no viable, save alternatives to try first. There is not an antidepressant or mood stabilizer that does not have a litany of side effects from dry mouth and loss of libido to inducement of psychotic behavior, to causing depression that could potentially lead to suicide, and even allergic reactions that can cause death. If you think that I’m making too than Google “antidepressants and death” or “antidepressants and Stevens Johnson Syndrome”.

Medications that treat mood disorders a basically prescribed the same way mental illness is diagnosed, which is by going over a list of symptoms and then making the diagnosis and choosing a medication that claims to help with the symptoms mentioned. Additionally the medication prescribed may often just be the one that the doctor is most familiar with, who’s drug rep gives him lots of free samples and takes him out for nice dinners, or one that the patient heard worked very well for her friend.

Unlike the diagnosis of something with a physical problem that can be objectively measured or seen, mental illness has to be diagnosed that way I just mentioned. We just don’t have the luxury of cutting into someone’s brain the way we can cut into their body and fix a physical problem like a defective heart valve or remove something physical like a tumor of cancerous cells. Doctors have to work with symptoms and behaviors that are shared among various medical causes that may or may not be a mental illness.

So with all the above said, doesn’t it seem clear to you that only a very well trained psychologist or psychopharmacologiest should be prescribing medications for mental illness? Now psychologists and psychopharmocoligists’ main tool for treating depression is medication so that’s great right? Well, yes and no. Yes because these doctors have the training and experience to prescribe these medications and no because since that is what they do, they may be too quick to use medication when other modalities of treatment may be just as effective and with less side effects, complications, and addictive qualities.

IMHO, unless someone is in imminent danger of hurting themselves or others due to mental illness, then they should first see a General Practitioner to rule out a physical problem (never to prescribe medications for mental illness) and psychologist to try to see if there may be non-pharmaceutical solutions to the problem. The severity and duration of the symptoms, as well as an understanding of the patient’s current life style, diet, exercise, environment, and life circumstances are just some of the many things that can be causing depression or depression like symptoms. And if you can feel better by changing your diet and eating right then it will be cheaper and healthier for your and it puts the power to take control of your situation into your own hands. I doubt that there is a depressed person alive who doesn’t wish they had the power to take control of their illness and feel the satisfaction of surmounting it. That is something that is built into us as a species. We want to survive and we want to evolve. And when an illness take away our personal power in those two areas, that is reason enough to be depressed. It sucks, and I am tired of idiots out there who don’t know better.

Finding a good psychologist is an issue. It’s a big issue. Personal referrals are best, and again what one person’s experience with any doctor dealing with mental illness is not going to be the same as any other’s. This is a real crap shoot that requires research, conversations, trial and error, time, money, etc. For someone in a state of depression, this may be all too much for them to do themselves. They need support. The importance of a good support network for people with depression cannot be understated. I know people with less of a support network that I have who have done as well or better than I have. But I also know that there is a lot more that could have been done to help me earlier on that may have avoided me being where I am today. There are doctors and treatments that cost a lot of money, but perhaps they would have helped me. At the very least I would have felt unconditionally loved and sure that I and my support team did all that we could. I am not happy where I am in my life. My plans were big. My dreams were big. I still feel small.

As I have been saying, the diagnosis of mental illness is generally not very sophisticated. There are some doctors out there on the bleeding edge of the field that may be getting very close to being able to really diagnose well through the use of brain scans and years of study and data like Dr. Amen. But many of us do not have the freedom of time, financial resources, of support of our families that would enable us to go to be treated by someone like Dr. Amen. Then the question of introducing the right amount of the right medication to just the effected part of brain is making someone depressed. It don’t think we’re anywhere near there yet. Perhaps genetic engineering will be a more direct and effective means to diagnose and treat mental illness in the future? Time will tell.

General practitioners and internists who prescribe anti-depressant medications
Even people who have actually gone through short periods of depression will soon forget have bad it is because it’s gone, and we humans have a natural ability to forget pain after some time. I know someone who was having some trouble with anxiety and depression. It was very hard for that person, but didn’t have suicidal ideations. I certainly felt sympathy for him. I tried to offer whatever I could in terms of listening or advice from my experience. Eventually this person went to his General Practitioner for antidepressants. DING! DING! DING! DING! DING! WARNING! DANGER! DANGER! ASS HOLE GP DISPENSING ANTIDEPRESSANTS! That should be illegal and now I have a subject for another of my rants. Not all of my posts are rants. Rants hopefully will only be a small part of this blog, because I am looking to give you useful thoughts. But what’s a blog without some rants? So my friend was proscribed a SSNRI (serotonin and norepinephrine reuptake inhibitor) at the “recommended dose”. Basically the doctor used a sledge hammer instead of a the proper tool. So my friend got into serious depression. After coming out of it, he expressed to me that he now understood the pain that I had been in and now felt that to see me live for some many years like that is not something he wanted to see. He could not understand and accept if I were to end my own live at that time. I’m sorry that my friend had to endure that pain, and thank God he got off of those meds. However, unfortunately he is now too scared of antidepressants and will resist trying anything reasonable from a trained professional with a proven track record of treating Depression, anxiety, and other mood disorders.