Depression: A Way Through, Part I

According to a 12 month study published by the Substance Abuse and Mental Health Services Administration (SAMHSA), over eight percent of the female population and nearly five percent of the male population of the United States had a depressive episode in 2014. Among that population over 65% were diagnosed as severe. Depression is the fifth leading cause of disability in the U.S.A.

It has been a year and nine months since my last severe depressive episode. This is my longest stretch of relative stability since becoming clinically depressed in 1999. Although I am no expert I would like to share with you some of the things that have helped me along my journey.

Admit that you have a problem.

Studies indicate that the number of major depressive episodes a person has is a predictor of future episodes. There is a 50-60% chance that a person with one major episode will have another. That number increases to 70% for those who have had two episodes. And for those who have had three or more episodes there is a 90% chance that they will have another.

After 14 years, four major depressive episodes, and four hospitalizations, I was still mostly in denial that I had a long-term illness. When I was well enough to get going again I always returned to the same old lifestyle and pressures that contributed to my depression. Nothing changed. By just sheer will and determination I thought I could handle it. Counseling was sporadic and I used a family doctor instead of a psychiatrist for medication adjustments and refills. It was not until I faced the reality of my illness that I began to take steps toward stability.

The events leading up to my last hospitalization scared me enough to face facts. Suicidal ideations came on so strong that they nearly overwhelmed me. Broken, powerless, with no internal resources left, I stumbled into an emergency room and admitted I had a need I could not handle anymore. You may think this sounds like the first step of Alcoholics Anonymous (AA) (We admitted we were powerless over alcohol – that our lives had become unmanageable.) and you would be correct. Perhaps the first step toward wellness of any mental illness, disease, or addiction is coming face to face with the wall that alone is unclimbable.

Get on the right medications.

See a psychiatrist. Family doctors are notorious for under-medicating their mentally ill patients. Also, your family doctor, however great s/he may be, does not have the expertise nor does s/he keep up with the medications available with the same intensity or proficiency that a psychiatrist does. Find one that you can trust and with whom you can have a rapport. If you are like me and have to see the psychiatrist that is available at your local mental health agency, do not be a sheep. Take charge of your care and do not settle for what s/he is giving you until the medication(s) you are taking works for you.

During my effort to find the right medication I have taken Zoloft, Paxil, Effexor, Prestiq, Wellbutrin, Trazadone, Lithium, Abilify, and Brintellix; and a multitude of dosage changes. It was not until the fall of 2014, 15 years past my initial major depressive episode, that I found a cocktail of medications that worked. Persistence and a psychiatrist that was willing to work with me paid its dividends.

Do not expect medication alone to have you clicking your heels and living a happy life. Depression is a journey hundreds of miles in length. The best medication can do for you is get you out of bed and perhaps into the car. The rest of the trip depends on you.

Go to professional counseling regularly.

Attending regular one-on-one counseling sessions and professionally led support groups is essential to stabilizing and living with your depression. Find a counselor who is knowledgeable about mood disorders and stays current with his/her field. Choose one who is compassionate and understanding, but is not afraid to confront you with your “stinkin’ thinkin’,” to borrow a phrase that Zig Ziglar made famous. And, believe me; we that have a major depressive disorder can have any number of false beliefs. As with a psychiatrist, do not settle for the first counselor you meet until you know for sure that that person is helping you wade through your morass.

I paid the price for not going to counseling on a regular basis. My work suffered, my marriage fell apart, my family was uncertain, and more. Often I would see a counselor once or twice and quit. “It’s too far to travel,” “I do not have the time,” or “I can do this on my own;” were some of the excuses I used. For nearly 15 years I started and quit, started and quit, started and quit. In May of 2014, after admitting I had a lifetime problem, I started with a counselor and have not quit. Ask for weekly sessions at first, twice monthly sessions if that is what you can get, or a minimum of once a month. You do not have to settle for less.

Find a gender specific, professionally led depression group. Gender specific, because it is easier for men and women to discuss their issues and feel understood and accepted when in a single sex group. Professionally led, in order that s/he will help the group stay on task, guide the discussion, and recognize when one particular member needs the support of all.  Peer led groups are good and worthwhile, but I have found that a professionally led group is far more focused. Personally, I attend a men’s group twice a week. Contact your local mental health agency or your local NAMI chapter for information on groups in your area.