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No Protection from Depression – Part 2, the Plan

When dealing with life threatening events we try to take action. If someone is losing a lot of blood we don’t sit around and ponder if we should see a doctor, we hurry and get one immediately. If someone is having an allergic reaction we don’t think ‘well, maybe a supplement will help.’ If someone is having a heart attack we don’t take a wait and watch how this goes approach. We recognize the danger and we take action to save life. Depression can be as dangerous as any of these other scenarios but it is a tricky devil. First of all most of us don’t know what it looks like. Second we are thinking we are dealing with a rational mind when a loved one says “It’s not that bad; I don’t need a doctor,” and the worst mistake of all is once you’ve identified the devil and beaten him back to the door—not having a plan in place for if (and when) he returns.

It’s not easy for me, as a clinician, to make these assessments. Another problem we have in this society is thinking that once we’ve identified a problem we can then move right on to the solution. Mental illness is not so clear cut. There are degrees of depression and there are degrees of suicidal thinking and feeling. The scary news is that even in my profession there are rarely clear-cut scenarios. If someone says “I can’t live any longer. I have a gun in my car and when I leave here I’m going to kill myself,” I know what to do and probably so do all of us—call 911 and don’t let the person leave. The far trickier and murkier yet more common scenario is full of variables. The truth is we don’t hospitalize people who are severely depressed who may say “I have thoughts of ending my life” we don’t hospitalize people who say “Last week I had a plan to kill myself but I don’t feel that way today.” It’s good that we don’t hospitalize people for having a thought or for changing their suicidal plans but the reality is that these people are at risk and we don’t have great treatment for such in-between folks.
In my last post I described an ideal world with treatment centers and medical teams tailored for dealing with mental illness. In reality there is no such scenario. The next best thing is still tough and though not perfect is the best we can strive for.

First we must be able to identify severe depression: severe hopelessness, sadness, lack of energy or enjoyment in things the person used to enjoy, problems with eating or sleeping or suicidal thinking.

The other key factor is time. If someone is feeling this for a couple of days or if they’re grieving it may not be the same as someone who’s been experiencing this for weeks. If this is a recurrence then you hopefully have a plan in place.

People are much easier to reach when they aren’t at the bottom of the crisis.

Unfortunately the best treatments we have for depression still take time to work–oftentimes weeks—and, trust me, a time of crisis is not the best time to search for a therapist and a psychiatrist. If someone suffers from recurrent mental illness such as depression my plan for them would look like this:
First, education for the client and the family. People still don’t understand that you don’t snap out of severe depression that it may require weekly therapy for a period of time and possibly medication. It would help tremendously if we would take a team approach when trying to treat people. Research has repeatedly shown that the best treatment for depression is a combination of medication and talk therapy.
So ideally a person has a therapist that they have a relationship with and a psychiatrist. Getting medications from primary physicians can be fine for less serious cases but if someone is prone to suicidal thoughts and severe depression then go to a doctor who specializes in mental health treatment. If you had memory issues you would go see a neurologist wouldn’t you? Not to knock primary care doctors, I have heard many people who have been put on antidepressants or, worse, anti-anxiety medications by doctors who’ve never talked in a comprehensive way about the need for therapy.

Medications can be wonderful and very effective but they do not take the place of therapy.

Therapy can do lots of things medication alone cannot. Therapy can be a source of hope and support, it can help with coping strategies, and it can be another set of eyes on a client as they are starting medication. If I am seeing someone for 45 minutes one or two times a week I may have a lot more information than a doctor with whom they may spend 15 minutes or so every couple of weeks. The best doctors and psychiatrists I know value therapy and want to hear from therapists about their impressions of how their patients are doing. Therapy can also be a support to the family dealing with a loved one’s depression. Dealing with depression is draining for all involved. If the burden can be shared with a professional then do it! It can be comforting for family members to know they are not alone, that someone else with training and experience can help carry to load.

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