Monday, January 31, 2011

"Her best friend's name is Zoloft"

My world currently revolves around a company that markets drugs for mental disorders in general, anti-psychotics and major depressive disorders in particular. It has been the reason why I have learned more about depression than I could have ever learned in medical school or in my psychiatry rotations during clerkship or internship.

Depression is not the same as sadness. There are days when we are down and out and perhaps from time to time feel sad. This is not unusual. Sadness is a normal reaction to life’s struggles, setbacks, and disappointments. Many people use the word “depression” to explain these kinds of feelings, but depression is much more than just sadness.

Depression is more than just sadness. It engulfs your daily life. People who suffer from clinical depression are hampered with interference of normal activities of daily living. Feelings of helplessness and hopelessness dominate most of their daily lives. While clinical depression varies from patient to patient, common signs and symptoms include the following:

1. Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.
2. Loss of interest in daily activities. No interest in former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.
3. Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.
4. Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia).
5. Irritability or restlessness. Feeling agitated, restless, or on edge. Your tolerance level is low; everything and everyone gets on your nerves.
6. Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.
7. Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.
8. Concentration problems. Trouble focusing, making decisions, or remembering things.
9. Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.

Depression has many faces. Younger patients have a different clinical presentation from the elderly. Men compared to women have a different presentation as well. Though women are at higher risk for depression, men who present with depression have a higher risk of suicide. Depression also takes various forms - major depressive disorder, atypical depression, dysthymia (recurrent, mild depression), and seasonal affective disorder. Then again, depression may be part of a bipolar disorder, presenting as only one side of the coin.

There are many causes to triggering clinical depression - loneliness, lack of social support, traumatic life experience, financial problems, relationship disagreements, early childhood trauma or abuse, health problems, unemployment - to name a few. Finding the key trigger is vital in the treatment of depression. Unfortunately, identifying the exact cause is difficult as many of them stem from complex factors and the contributing factors are like going through the spider's web.

Acceptance plays a key role in recognition of depression.

When my mom was diagnosed to have clinical depression, I knew that aside from having to take the daily pills to control her hypertension and blood sugar problems and dealing with life in the elderly, there would be a need to provide stronger family support. And while the latter is given to her on a silver platter, her dysthymia is something we need to live with.

There are various treatment options - which include psychotherapy, changes in life style, emotional building skills and drugs.

While I know that there are those who rely on self-help and googling the internet for answers to questions they don't know, studies have shown that the internet is not a reliable source for finding answers to questions that even science has no answers to. The internet will provide a whole conundrum of pros and cons on drugs and self-help aides to combatting depression.

The key here is identifying the cause and using appropriate resources including drugs in helping treat the problem.

Like all drugs and diseases, life style changes are mandatory. Hypertensive patients need to watch their diet and stress factors. Diabetic patients need to change their eating habits. I tell my mom that we are all patients eventually. Drugs may not be the solution to the problems of our lives and they will not change the underlying condition to why we eventually become afflicted with the illness - whether it is hypertension, cancer, diabetes or mental disorder. If you're in such a rut because you have a dead end job or that you're stuck in the worst kind or relationship or that you fear dying because you're aging, one needs to get out of this rut by exploring other options in treatment aside from the drugs.

For those that are already on antidepressants, it is a known fact that only 30% of patients who are already on anti-depressants go into full remission after therapy. The greater majority will need to: continue their medications sometimes for life, change their medications, combine other drugs to the current one they are taking or increase the dosage of their current medicines. While I fully understand those who refuse to continue taking the pill, we need to face the reality that we are all not born perfect. Eventually, some of these physical and psychological frailties take a toll on us and expose our illnesses - whether it is mental or physiological.

Like all drugs, there is no drug that does not have a side effect. Side effects of most newer antidepressants are generally mild, but can be bothersome in some people. They include stomach upset, sexual problems, fatigue, dizziness, insomnia, weight change, and headaches. One must remember, however, that taking drugs is a risk:benefit decision. If the benefits outweigh the risk of complications of the disease process, then the drug is worth the risk of the side effects which are mostly minor and inconsequential.

Depression recovery begins with positive daily lifestyle choices. If you cultivate supportive relationships, challenge negative thoughts, and nurture your physical health, you can help yourself, slowly but surely, overcome your depression.

I guess it is easier to discuss about depression than be in the same shoe as the patient who experiences it. Like all disease states were are in, we need to challenge ourselves on the road to recovery. I blog from an outsider's perspective and I guess all the self-help guides are onlookers as well. We encourage people to seek help and to help themselves. We serve as the cheering squad for those whom we care for and love.

At the end of the day, my mom will always have a best friend with her even when I am not around 24/7 to watch over her. Her best friend is with her in both good and bad times. Sticks to her and listens to her when she feels deep down shitty. And when fears overcome her, sometimes creeping into her skin in the middle of the night, her best friend allows her to forget some of the pain and anxiety so that she can continue her normal activities of daily living. Like many other people in this world, she shares her best friend with them.

Her name best friend's name is Zoloft.

[For more information on depression -;
Help information for lay -]

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