Depression Needs Therapy

Last week, writing in the New York Times, columnist David Brooks told of the death of one of his lifelong friends from suicide. Their friendship started in childhood. The man was a talented person, an accomplished ophthalmologist with loving friends and family, yet he became mired in a depression that he could not lose. He tried therapeutic options over the years; some worked better than others, but none was lasting. I believe everyone should read this article. You can find it here:

Brooks speaks about his friend and the ways he tried to make him feel better. He would remind Pete of his skills as a surgeon, his family, and all the good things in his life, but as he said, those were the wrong actions to take. The depressed person cannot see those things when their mind is cluttered with feelings of trauma and inadequacy or their body lacks the energy to even get out of bed.

Jen, Pete’s widow, noted that when she had cancer treatment, a group of clinicians planned her care, but when one has a mental illness, no such committee is in place. Friends and co-workers urge the affected person to “just snap out of it, and to look at all that they have going for them.” But, when that person feels unworthy or unmoored from daily reality because all they think are negative thoughts, those words cannot help. Some have described these feelings as looking at their life through a fog that obscures all that is good and magnifies the negatives.

Brooks further describes his dilemma: “Every case of depression is unique, and every case is to be fought with as much love and endurance and knowledge as can be mustered. But in this particular case, the beast was bigger than Pete; it was bigger than us.”

He spoke of his frustration in trying to converse with his friend. I commend Brooks for continuing to try, and for not giving up because depression is a condition of loneliness. The afflicted believe that nobody can understand their pain.

He described it thus: “Time and again Pete would talk about his great fear that he would someday lose his skill as a surgeon, that he would cease to be a healer, that he would lose his identity and self.

As Pete spoke of his illness, it sometimes seemed as if there were two of him. There was the one enveloped in pain and the other one who was observing himself and could not understand what was happening. That second self was the Pete I spoke to for those three years. He was analyzing the anguish. He was trying to figure it out. He was going to the best doctors. They were trying one approach after another. The cloud would not lift.”

Brooks was also a friend of the Washington Post columnist, Michael Gerson, who died last year from cancer. Before his death, he, too, suffered from a depression that tested him and his faith. Gerson spoke about his depression in a speech he gave at the National Cathedral. Brooks quotes Michael in his article:

“Depression, he said, was a “malfunction of the instrument we use to determine reality.” Then he talked about the lying voices that had taken up residence in his mind, spewing out their vicious clichés: You are a burden to your friends, you have no future, no one would miss you.”

As most of you know, my profession is nursing, and I spent my entire career in healthcare. I know that the healthcare industry does not adequately treat mental health conditions. We sometimes describe depression as a chemical imbalance in the brain. A recent medical blog from Harvard discusses the complexities of the condition below and reviews how two people in similar situations may have drastically different responses:

“It’s often said that depression results from a chemical imbalance, but that figure of speech doesn’t capture how complex the disease is. Research suggests that depression doesn’t spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, and stressful life events. It’s believed that several of these forces interact to bring on depression.

To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.

With this level of complexity, you can see how two people might have similar symptoms of depression, but the problem on the inside, and therefore what treatments will work best, may be entirely different.”

The Mayo Clinic defines depression as:

“Depression is a mood disorder that causes feelings of sadness that won’t go away. Unfortunately, there’s a lot of stigma around depression. Depression isn’t a weakness or a character flaw. It’s not about being in a bad mood, and people who experience depression can’t just snap out of it. Depression is a common, serious, and treatable condition.”

It further discusses some causes:

“While there’s no single cause of depression, most experts believe there’s a combination of biological, social, and psychological factors that contribute to depression risk. Biologically, we think about genetics or a family history of depression, health conditions such as diabetes, heart disease, or thyroid disorders, and even hormonal changes that happen over the lifespan, such as pregnancy and menopause. Changes in brain chemistry, especially disruptions in neurotransmitters like serotonin, that play an important role in regulating many bodily functions, including mood, sleep, and appetite, are thought to play a particularly important role in depression. Socially stressful and traumatic life events, limited access to resources such as food, housing, and health care, and a lack of social support all contribute to depression risk. Psychologically, we think of how negative thoughts and problematic coping behaviors, such as avoidance and substance use, increase our vulnerability to depression.”

Depression has also been in the news this week, as Senator John Fetterman announced he was entering Walter Reed Hospital for treatment of clinical depression. It has been public knowledge that during the mid-term primary season, Fetterman suffered a severe stoke and was also diagnosed with an ongoing cardiac condition. Fetterman is a large man, six feet, eight inches tall, and who admits that he worried little about his health, despite medical advice. He was famous for his wardrobe of Hoodies and shorts and for his tattoos. As with many men, his wife had to convince him to get check-ups. When he had his stroke, it was she that recognized the symptoms and got him to a hospital; she probably saved his life by doing this.

The most important fact about strokes is that they can be best treated if treatment is received within the first hour. After his stroke, he returned to the campaign trail as soon as he could, again against medical advice, because he had an election to win. The stroke left him with a lingering aphasic condition that affected his ability to process conversations. He now uses a device that translates for him and changes words into text. He can speak, but sometimes has a problem finding the correct word.

According to Healthline, depression after a stroke is quite common and usually affects more women than men. Healthline notes that strokes with aphasic components lead more frequently to depression. Aphasia is a loss of cognitive functions in communication, such as the ability to speak and hear or process what is heard or said.

They describe the after-stroke depression as:

” Every case of post-stroke depression can have different symptoms and duration. Most symptoms appear between three to six months after a stroke. However, the onset can be as early as a month and as late as several years after a stroke. This difference in onset times may be due to two factors — biochemical changes that occur in the brain following a stroke and changes in mood and personality that occur over time.”

About half a century ago, Senator Thomas Eagleton was selected to be the Vice-Presidential candidate on the Democratic ticket with Senator George McGovern; when the news was released that he had been treated for severe depression with shock therapy, McGovern dropped him from the ticket. (There were not the ranges of therapeutics now available, such as SSRIs, SNRIs, MAOIs, or others then.) As Eagleton described it, he had been pushing himself too hard and became exhausted and could not continue when he was diagnosed and treated. The stigma of the treatment alone, in that era, despite the effective way he served as a Senator, was too great to allow someone with that condition to be this close to the president. Eagleton served several terms as a respected Senator from Missouri, following this incident. A few years ago, this issue was reviewed by NPR.

I certainly hope that in 2023, we have come a long way toward understanding depression better. Certainly, Fetterman has been receiving encouragement from both sides of the aisle as others told their stories of depression. However, we have not come that far in preventing severe depression or preventing suicides that result from this condition. We have not done very well in addressing familial or cultural tendencies toward depressive illness. As a society, we must do better.  About one out of every six Americans will be treated for depression; we must remove the stigma and find effective treatment.

Now for a few PSAs!

Signs of a stroke: Think of the acronym: BEFAST

Loss of Balance, headache, or dizziness?

Eyesight changes?

Face drooping?

Arm weakness?

Slurred Speech?

Time to call 911

Don’t sit around and wait to see if the feeling will go away.

Remember, strokes can often be reversed if one receives treatment in the first hour. NIH notes that treatment within one to three hours is imperative.’ Time is brain’, as they say. A stroke deprives the brain of necessary oxygen.

Suicide Lifeline:

If you or a loved one is suicidal or has expressed thoughts of suicide, there is now a national three-digit number to call that, just like 911, is available 24/7/365  and is staffed by trained counselors. That new Lifeline number is 988. The old number  (1-800-273-8255) is also still operative.

That’s all for now.

“Til next week-Peace!