April 2007 Archives

This is why I need to be in touch with people currently battling the demons of depression: they remind me of where I was, so that in the event I find myself in that massive pile of animal waste again, I'll remember how to climb out and get rid of the smell.

One rule comes from a bumper sticker I read yesterday: "Don't Believe Everything You Think."

Intelligent people think (and read) many things. And all my readers, I suspect, would perform very well on IQ tests. But this intellectual curiosity and inquisitive disposition can also be a backstabbing boyfriend (or girlfriend...so I don't get in trouble with my male readers) when it comes to mood disorders. The acronym TMI (too much infomation) rightfully fits a smart depressive.

Information is your ally when choosing a doctor--because you'll waste less time with a bad one (like I did). You won't say to yourself for four months (like I did), "I think I am getting worse, but he knows best because he is the professional." With research in hand, you can challenge your physicians, which will piss off the ones with ego issues and impress the ones actually working for your health.

But the more you read, the more crap you'll come across, and the more lies that will sneak into your consciousness like termites attacking healthy wood (couldn't resist...I am married to an architect). You may become confused, disillusioned, or desperate. Sound familiar?

My very intelligent friend, Ellen, just wrote me this e-mail last night:

"I'm reaching out for one of those cyber hugs today. Been spending too much time surfing the 'net and finding horror stories about depression/anxiety/meds and people not getting better. Why the hell do I read this stuff? I know full well that I've been here before and gotten better. There is no reason to believe that I won't get better this time, right? Right!"

God love her (actually, He already does). Because she summed up in those five sentences (six if you count the second "right") my brain for about 18 months of my climb out of the diaper pail (of the family of septuplets who chow down on real food, not slurp breastmilk).

I called my mom. She said, "It WILL pass. I promise."

I called my friend Michelle. She said, "You will feel better."

I called Mike. He said, "You won't always feel like this."

I called my guardian angel Ann. She said, "Dump that pea-brained doctor, and get to Johns Hopkins. THEN you will get well."

I had trouble believing any of them. But they were right. Absolutely right.

Consider this paragraph from William Styron's "Darkness Visible," which I read most days of my depression:

"If depression had no termination, then suicide would, indeed, be the only remedy. But one need not sound the false or inspirational note to stress the truth that depression is not the soul's annihilation; men and women who have recovered from the disease--and they are countless--bear witness to what is probably its only saving grace: it is conquerable."

I get goose bumps every time I read his words, and I feel like I'm jogging to the "Rocky" theme song.

So I will write this down in my journal today as a reminder for the days when I'm doubting the whole happy-ending thing: "Don't Believe Everything You Think" and "Depression Is Conquerable."

I just shared my belief that depression is conquerable. But how? Here are some treatment facts, according to "The Johns Hopkins White Papers 2007: Depression and Anxiety" by Karen L. Swartz, one of the physicians who evaluated me in Spring 2006. (I must assign a lot of power to her because I dreamed last night she was Vice President of the United States. I assisted with her campaign.):

"These days, medications are the most common form of therapy for depression. Any given antidepressant has up to a 70 percent chance of working in a particular person. Psychotherapy alone can work as well as antidepressant medications with fewer side effects but requires more time.

"Severe cases are depression are best treated with medication. (That statement is important. Those contemplating suicide are suffering from severe depression.) In the most extreme cases, electroconvulsive therapy may be recommended. Up to 90 percent of extremely depressed people improve with electroconvulsive therapy when it is used as a first-line treatment. However, the therapy is usually used only after other therapies have failed. When used as a last resort, the response rate drops to 50-60 percent.

"Combination therapy (medication plus psychotherapy) has been shown in some research studies to be more effective than either therapy alone for mild to moderate depression. Recent research suggests that combination therapy may prevent or delay relapses and recurrences of depression.

"By themselves antidepressant drugs usually produce a significant improvement by four to six weeks, although it may take up to 12 weeks on a therapeutic dose to see the full benefit. If a person's depression responds fully to medication after this period, treatment moves on to the continuation phase, which lasts for six months to one year at the same dosage level. Those who have improved somewhat but still have a few symptoms after six weeks should be reassessed six weeks later. At the reassessment, the physician may adjust the dosage to improve response.

"When a drug does not work, a doctor may prescribe an antidepressant from a different class of medications, because drugs in the same class tend to work similarly. When a drug from one class is producing good results but causes unacceptable side effects, switching to a different medication within the same class can often help. In 20-50 percent of patients, adding the drug lithium can help boost the action of an antidepressant."

Read on for new studies into treatment-resistant depression.

Also from "The Johns Hopkins White Papers 2007":

"If you're on an antidepressant and it's not working, don't give up on it: You may need a higher dose, a longer duration of therapy, a different drug altogether, or a combination of medications. That's the important lesson to learn from a large, six-year, four-step government study called the Sequenced Treatment Alternatives to Relieve Depression trial, or STAR*D. In fact, the researchers found that systematically trying these treatment options can lead to a remission in symptoms in up to half of severely depressed, treatment-resistant patients.

"The study, which looked at the use of popular antidepressants in people with chronic depression (lasting, in some cases, 15-16 years), is the first to provide 'real world' scientific data on what to do when someone doesn't respond to a particular drug, has severe depression, or suffers from multiple mental and physical ailments. These types of treatment-resistant patients are not typically included in antidepressants drug trials sponsored by pharmaceutical companies (which is probably why I never heard about it from most of my doctors, especially doctor number three, who aspired to be Lilly's primary shareholder)."

Take-Home Messages from STAR*D:

• One antidepressant treatment does not fit all. You may need to try several medications to find a drug regimen that works for you. What fits one person may not fit your particular biology.

• Persevering through several different treatment attempts, as arduous as that may be, can improve results for many people.

• At standard doses of the most commonly used class of antidepressants--selective serotonin reuptake inhibitors (SSRIs)--30 percent of patients with severe depression achieve remission with the first medication prescribed.

• It often takes 12 weeks to achieve an adequate response to medication, not the standard four to eight weeks that most doctors and mental health specialists were previously using to guide decisions.

• If the first choice of medication does not provide adequate symptom relief, switching to a new drug is effective about 25 percent of the time.

• Switching from one SSRI to another is almost as effective as switching to a drug from another class.

• If the first choice of medication does not provide adequate symptom relief, adding a new drug while continuing to take the first medication is effective in about one-third of people.

• For people who don't respond to first-line therapy with an SSRI, adding a second drug to the SSRI drug regimen appears to be slightly better than completely switching medications.

• For those who don't respond to switching a new drug or adding a second drug, trying a third medication can still help about one in five people.

Click here to read a fascinating interview on "Medscape Today" with Helen S. Mayberg, MD, Professor of Psychiatry and Neurology, at Emory University in Atlanta, Georgia, about her groundbreaking research into the neurophysiologic loci of depression and the benefits of Deep Brain Stimulation (DBI) for patients with treatment-resistant depression.

Three word conclusion: There is hope.

Thanks to Reader Peg, who posted the following comment on the "The Happy Ending" post:

"My current medicine of choice for myself is smoking about ten cigarettes a day. Before I get the health lecture, I quit twice for four years when my kids were small. I have tried antidepressants without success. I now realize after listening to you and others that they very well may need more time to work, but I am sensitive to changes in my body and when I got constipated or just felt like my brain/thinking was encased in something, I quit the meds. I didn't feel like I was spontaneous on meds. Now I don't have the extreme symptoms of depression that you describe, more of a low grade type. I've gone to counseling for help on a short-term basis several times. My Catholic faith has helped me a great deal and I need it very much.

"I would like to get off the nicotine, but find when I try, I go into panic mode. I no longer feel that weight gain is the greatest problem from quitting that I would encounter. I am afraid that some of the anger that I am suppressing will come out. I already have a tendency to anger and fear temper. I want to grow up but it is so much easier to find comfort in the nicotine when I feel stressed or sorry for myself. My heart sinks when I go to buy a pack of cigarettes and that tells me I really don't want to do it. Any suggestions?"

First of all, Peg, who gave you my diary? (Oh yeah, it's online.) And would you like to have Thanksgiving at our house? Because you would fit in so well with my family.

Okay, your question. Here's what I would say if I were a woman with normal wiring and brain chemistry, enlightened and grounded, free of all vices and addictions (a person so boring that she wouldn't have enough material--personal strife and issues--to cover one blog post, much less two to four posts a day, like moi): pray about it, use the patch (or some other seen-on-TV technique), and offer it up (the withdrawal symptoms and everything) to God (while doing charity work).

You won't get a health lecture from me because if you came and stayed with my family for a night, you could give us an even longer one before you left. Although I'm Catholic, I'm not big on hypocrisy, and I know better to throw stones from my house of stained-glass windows. My two cents wouldn't be found on WebMD, but here it goes:

Yes, smoking is bad for you. Every idiot knows that. But so are obesity, alcohol abuse, bad relationships, and every other kind of addiction. They all raise your blood pressure, weaken your immunity, increase your chances of heart disease and diabetes, and eventually kill you. You've just got to know which addiction will kill you the fastest.

After years of dancing with the devil in his many disguises, I know my killers (listed here in their order of most threatening to least threatening): depression (intense suicidal thoughts), alcoholism, toxic relationships, nicotine, sugar, caffeine, and Internet abuse.

Each morning presents an opportunity to live addiction free. And each morning I decline that invitation, hanging on to at least three from that list. Because come on, we all have crutches, and anyone without them are as dull as David's scissors (they don't cut anything--and their only purpose is to trigger temper tantrums from preschoolers).

For example, today was a success: I inhaled a rather large Hershey chocolate bar (milk chocolate and almonds, from the vending machine at the bowling alley), drank four large cups of coffee, and checked my e-mail and Beyond Blue messages constantly. That's fantastic considering the bad boys I avoided--booze, lung rockets (cigs), and dys rels (dysfunctional relationships).

I guess I just try to be pragmatic in my recovery, which (if I'm truly honest) is a four-story apartment (forget the interior castle that Teresa of Avila writes about): The ground floor is survival--literally keeping myself alive; the second level, staying out of the psych ward; the third deck is status quo, meaning not getting worse; and the final tier is moving toward health (yeah!! That's what I'm shooting for.)

What that means: When I was severely suicidal a year ago, getting drunk wouldn't have been the WORST thing I could have done. Killing myself would have been. On many days, I contemplated getting hammered, if only to escape the pain for an hour. I knew, on some level, that getting plastered wasn't a permanent solution and would make me feel even worse. But still, it would have been better than taking the twenty bottles of pills stashed in the garage that I was seriously considering.

At very difficult times in my sobriety, I have gone on smoking binges. That's not healthy behavior (thank you, I know that), but it beat the bottle (for me a box of Marlboro Lights was much less dangerous than a shot of vodka), and it got me through the acute craving for alcohol and back to level three (status quo).

There have been a few days in my life (maybe five?) that have been addiction-free, hours that I have lived like Jesus, and the Buddha, and Mother Teresa. During these spells, I was sun bathing on level four--blasting to a healthy new me. And then I accidentally walked into some pile of animal waste and I grabbed for the coffee or the computer or the Kit Kat. Oh well. Not a huge deal, in the big picture.

But before you think I rationalize every bad behavior I have, and it's okay for you to smoke your ten cigs a day, read on for the dozen addiction zappers and depression busters I try to implement into my life in order to stay on the upper two levels of recovery.

Lest my readers think that I'm contracted by the Dark Side (sorry, watching too much "Star Wars" lately) to encourage addictive behavior and rationalize all weakness, here are a dozen addiction zappers and depression busters I use in deficient moments...

Even as my dad's behavior was hurtful at times, he was easy to love--he could made me laugh in the middle of an argument with a sarcastic and hilarious aside--but I can think of a few people in my life...

The post about my dad was my third revision. In my first draft, I hurt the feelings of a family member whom I very much love. So I revised it. And then I realized that the second revision could hurt...

Here's one clue that I might be heading back into the black abyss of depression: deciding between Ranch or Italian salad dressing has taken me longer than the time it took for the table next to Eric and me to...

In order to make a decision, you have to perceive a situation correctly. Which is why I'm unable to deliberate when I'm depressed: I can't see. With the amygdala and hippocampus regions of the brain suffering cell shrinkage and death--spreading...

I know I've been writing a lot about the Virginia Tech tragedy, and I promise to move on very soon, but today I can't stop thinking about it because, for me, it points to how ignorant most people are with...

Of course, even if we had done our best to treat Cho and killers like him, we may have seen the same outcome. Because our hands would have been tied legally.That's why everyone I know in their twenties wants to...

I sent my "Mentally Ill, Psychopath, or Evil? I Need to Know" post to a hundred or so of my closest friends. I invited my former theology professors and past and present colleagues in Catholic publishing to weigh in on...

Medical intuitive and renowned author Caroline Myss and I have a few things in common: we both have studied theology, and we were both taught by nuns. But when it comes to interpreting sacred texts, like Teresa of Avila's classic...

Click here to read an interesting interview with Caroline Myss by Beliefnet's Valerie Reiss. Myss talks about her new book, "Entering the Castle," and says you don't have to profess poverty, chastity, and obedience to live a deeply spiritual life....

Was Cho Seung Hui--the shooter identified in the Virgina Tech killings--mentally ill or irreparably evil? Did he suffer from a treatable mood disorder, or was he a psychopath unable to be helped?It's a theological, psychological, and sociological riddle--an ugly one....

Here's how some prominent writers and scholars weigh in on the topic of evil versus mental illness. Thanks to freelance religion writer Andrea Useem for collecting some of these on her blog, ReligionWriter.com.The "National Review Online" published these responses:From Matthew...

This gallery of prayers offers solace, healing, and support from several world traditions.And you can post your own prayer for the lost and bereaved of Virginia Tech on Beliefnet's prayer circle....

Dr. Remen, who spends her life comforting sick people, wrote this in her chapter "Just Listen" (part of "Kitchen Table Wisdom"):"One of my patients told me that when she tried to tell her story people often interrupted to tell her...

Harold Kushner explains what NOT to say to a grieving family in his classic "When Bad Things Happen to Good People" using as an illustration the story of Job (the faithful, righteous, and pious man who loses his livestock, house,...

I'm grasping for words today. What do you write the day after the deadliest shooting in U.S. history? I can barely look at the front page Washington Post photo of the wounded being carried from Norris Hall, an academic building...

Yesterday I mentioned my wise theology professor, Keith Egan. In an article entitled "Banishing Anxiety," he wrote the following about hope:"Hope is a call to choose life and to choose it to the full, to live vibrantly knowing that Jesus...

The deadliest killing spree in U.S. history happened this morning: at least 32 people killed and more than two dozen others injured during the shooting rampage at Virginia Tech (according to the latest "Washington Post" story).I'm afraid to read the...

My hair is in place, but boy am I having a bad compassion day!This is where I went wrong: I read an op-ed entitled "Self-Help's Slimy 'Secret'" by Tim Watkin in the "Washington Post." Not a smart activity given that...

This beautiful prayer by Mother Teresa articulates for me what pure compassion looks like. If it were shorter, I'd have it memorized. (But my spiritual hard drive has very little memory--thus, the post-its and clutter around my desk.)Dear Jesus,Help us...

Since it is now the Easter Season (according to the church year), I thought I'd mention some words spoken by the Risen Lord that help me with my anxiety and depression:"Do not be afraid." (Matt. 28:9)"Woman, why are you weeping?"...

The following passage from J. Raymond DePaulo Jr.'s book, "Understanding Depression," was helpful to me in knowing what to look for in a doctor, and when to go for a second (and third, and fourth, and fifth, and sixth, and...

Here's a great article by Barron H. Lerner, "Doctors Examine Themselves: Books Explain How Errors Happen, How Patients Can Cope," about two new books--"Better: A Surgeon's Notes on Performance" by Atul Gawande, and "How Doctors Think" by Jerome Groopman--that ran...

Thanks to readers Patricia and Lanette for asking for a conclusion to my Good Friday post. I think I've been reading too many fairy tales to Katherine before bed, because I'm annoyed with happy endings. That's why I left mine...

One of my many book ideas: "The Psychiatric Guide to Annapolis: An Atlas of Shrinks in the Sailing Capital of the World." Do you like it?My research was quite painful. Having a medical file with almost all of the head...

What do you guys think about this op-ed piece in the "New York Times" today by Maia Szalavitz? I have an opinion, but I want to hear yours first....

I fully support Katherine's pacifier habit. Even though her preschool teachers, grandparents, and dentist say, at age three and a half, it's definitely time to pull the plug, part of me thinks I should let her suck away on the...

Here are some addiction-breaking aphorisms that Halpern lists in his book, "How to Break Your Addiction to a Person." They are helpful for me not only in ending dysfunctional friendships, but in trying to stop any kind of destructive habit--like...

Whenever I am in "Infant Time," thinking a person, place, thing, or situation will bring peace to my restlessness, I always hear my mom saying, "No person, place, thing, or situation can disrupt your serenity. That is up to you...

As a graduate student pursuing a degree in theology twelve years ago, I took a course called Systematic Theology--by far my toughest class--by a brilliant professor who was dying of bone marrow cancer. No one knew she was dying. She...

I was moved by David Kuo's blog post about cancer (and all illness), his reaction to the news about Tony Snow's cancer returning and spreading. David, a fellow Beliefnet blogger, has battled his own illness--a brain tumor--and speaks so candidly...

Good Friday and the narrative of the Lord's passion will always be connected to the story of the hemorrhaging woman in the Synoptic Gospels (Matthew, Mark, and Luke) for me, because just as I yelled out to God in the...

Back in February, I mentioned that one of my New Year's resolutions was to surround myself with people I admire. The person on the top of my list was Mike Leach, my writing/editing partner on several books, and a dear...

Last night's dinner conversation:"I wonder if Mike and Vickie will want to go to church with me on Friday when they're here," I said (as I reviewed all the services at St. Mary's for Holy Week)."But, Sweetie, you go to...

I'll be on Sirius radio, on the Catholic Channel, to discuss my Beliefnet article, "My Husband, the Reluctant Catholic," about Eric's (forced) conversion to Catholicism. If you're up and alert, tune in for it on Monday at 6:40 a.m....

I have good news and bad news. The good news is that many more people are tuning into "Beyond Blue" and posting comments on the message boards (yeah!). The bad news is that my filing methods have not yet made...

Another Reader Question: one reader asked if she should leave her husband of 30 years (did I get that right?) because he is unsupportive of her depression. (Feel free to fill in the gaps of the situation on the message...

Americans work longer hours and take fewer vacations than most other workers around the globe. According to the Families and Work Institute, the average full-time worker spends approximately 48 hours a week at their job. I wonder how many of...

Question of the day: If you were a holiday letter, what would you say? (In other words, who do you want to be?) Eric's answer: "My house is a mess, my wife stayed out of the nuthouse, and my kids...