Author: Dawn_2ol6

For a lot of people with depression, medications are a part of any attempted treatment or alleviation of symptoms.  However, I think there are some important considerations when taking medications for depression that may not always come up with other types of medications.  One of those considerations is tapering.  Tapering can go two ways – a dose can be gradually increased or “tapered up”, or it can be gradually decreased or “tapered down”.  Of course, with a gradual decrease the medication may ultimately be stopped.

Why do I think tapering is important for depression medications?  First of all, I think tapering up is good to help watch for both side effects and effectiveness.  If you start at a high dose and have side effects, you might have not had the side effects at a lower dose.  Also, the medication may work at a lower dose just as well as at a higher dose, so taking the least amount needed is better in my opinion.  As many people have heard, the advice is to “start low and go slow”, and I think that is critical for a lot of medications, and definitely for any used for depression.

Tapering down medications is also important.  I think we need to give our bodies time to adjust to changes in the medications we are taking, so again taking it slow is key here.  Tapering down too fast can also cause side effects, and I believe we should do everything we can to minimize those.

So, if you are taking any medication for depression, consider asking your doctor about tapering the medication.  Can you “start low and go slow”?  Can you try tapering down to see if a lower dose is just as effective?  Each person is unique, and tapering can look different for each person, but I encourage you to think about the tapering process when it comes to taking medications.

Most of the time, when you think about going to a health care provider you think of a face to face visit.  Some of that is important if a physical exam is needed, and there is just something about the close human interaction between a patient and provider.  However, the idea of absolutely having a face to face visit every time has changed.  There are a lot of “virtual” visits going on today, where the interaction takes place over video or some form of telehealth.  Your provider could be hundreds or thousands of miles away but still be able to give you care.

Are there telehealth visits for depression?  Yes, there are.  I remember back in 2011 when my dad was depressed – his psychiatrist worked locally and at an office hundreds of miles away.  Some of his appointments were by telehealth video, and honestly at the time I found it appalling.  Telehealth is not the same as a face to face interaction, and it seemed especially odd in psychiatry, where I feel that people who are depressed and/or mentally ill really need that human connection.  Despite not liking the idea all that much, what I settled on was that telehealth services were better than no services.  Unfortunately, that is the decision my dad had to face, and he chose to try something over nothing.  I’m proud of him for that.

So, have my thoughts on telehealth changed since then?  Yes and no.  In an ideal world, everyone would get that face to face interaction.  However, I do applaud the telehealth movement as a solution to help more people get access to providers.  Telehealth no doubt helps us to reach a wider range of people, and it can be done from almost anywhere.  There is also work being done to make telehealth interactions as realistic as possible, so I am excited to see where that leads.  In all, if the choice is telehealth or nothing, I would likely choose telehealth.

As I mentioned in my last post, I was getting ready to attend a training, and now that training has been completed.  As usual, anytime I learn something new or have multiple “aha” moments I can say it was well worth the time and effort.  Being around others can definitely give you some new ideas to think about too.

What did I learn?  Honestly, a lot of the stuff that we want to share with providers wasn’t very new.  Most of the material I had either heard before, read before, or spoken before.  What really got me thinking was the perspective of the provider.  We had some physicians in the class, and even as a pharmacist I hadn’t really considered a lot of their thoughts and feelings when they are treating patients.  They really have a lot on their plate.  There are many legal and ethical rules they have to abide by, and they are humans too.  They also can be traumatized by what they see and experience.  Overall, everyone needs to be cared for in any medical situation.  Regardless of your role, you have to take care of yourself first before you can take care of anyone else.  As a result of this training, I feel like I have a better understanding of how physicians navigate the health care system they work in.

While some of the lessons were very powerful for me, there were additional benefits.  I got to meet new people and/or spend time with those I had met before.  It was also great to take some days out of the regular routine and think about things that are bigger than my little issues at home.  It was refreshing.  If you ever get the chance to go to a training or class to learn more about depression (whether the main topic or part of a larger discussion), I encourage you to do so.

At the time of this writing, I am just a few days away from a NAMI (National Alliance on Mental Illness) Provider Program training.  It will be two days of learning how to teach health care providers about working with those who suffer from mental illness.  What specifically is involved in the training?  I don’t know much about that yet.  However, I have no doubt that it will be very educational and uplifting experience.

I could not be more excited about working on one of my biggest areas of concern when it comes to depression.  As a pharmacist and a family member, I have seen depression on both sides.  One of the experiences that still haunts me is how my dad was treated by health care professionals, especially when they were concerned about a physical issue that he had.  Now, I have no doubt that most practitioners are well meaning, and I understand they are very busy with paperwork and many other demands.  However, there were so many times that I felt that we were literally begging for help regarding my dad’s depression, yet it seemed that there was a deaf ear to it most of the time.  It was heartbreaking.  All humans are more than just a physical body.  We are also mental, social, and spiritual beings.  And, depending on how you define it, there may be more than that.  We need our providers to take care of the whole person and to understand why that is important.

I can’t go back and change my dad’s experiences, but I can do my part to help make sure others don’t have the same issues.  No doubt there will be lessons there for me as a pharmacist too.  I think we are always looking at ways to do better, and my hope is that this training will allow me to help other providers understand some ways to do just that.

As I have mentioned before, I am a pharmacist.  However, over the years I have come to realize that medications do not take care of everything.  They may help, but when it comes to depression they are probably not the end all be all of treatment.  One of my hopes with this blog is that I introduce people to other possible treatment modalities, and that is the topic for today.

A possible treatment (or complimentary treatment) for depression that I would like to mention today is related to energy healing.  Have you ever heard of auras?  Chakras?  Energy fields?  Using crystals?  Reiki?  These are probably some of the more widely used terms out there related to energy healing, but no doubt there are other ones used.  What is energy healing?  Well, it can be difficult to describe, but it is related to some ideas about the energy in you and around you.  In this arena, depression can be thought of as an imbalance of energy, and I suspect that this description makes a lot of sense for people.  Energy healers work to restore that balance.

Is energy healing right for you or worth a try?  I have tried a reiki session many years ago, and I did feel better afterwards, but it is hard to fully explain why.  I can’t guarantee it will help you, but if you are interested you can learn more about it and look for practitioners in your area.  A lot of these healers are not regulated by anyone, so it can be hard to determine who is legitimate, but there are energy healing groups you can find online to help in your search.  As with most things in life, do your research to make sure you are seeking help from a professional in the field.  Overall, energy healing may just be the added treatment that can help alleviate your depression.

No matter what your relationship to depression is, living with it or around it can present difficulties.  One of those challenges is about what activities you can and can’t do because of the depression.  You may find yourself saying, “I will take that class when so and so is feeling better”, or “I will go on the trip once my depression has lifted”.  In some cases, those statements may make a lot of sense, but today I want to challenge anyone affected by depression in some way to really look at what they want to do and decide if the depression has to stop them from doing so.

Here’s the thing – life is short, and there is not much value to pretend to make plans for something that is not going to happen.  Worried about leaving a depressed family member so you can travel?  Could that family member go with you?  Are there other friends or family that could look after the person while you are gone?  Are there respite services available that you could use?

If you are depressed yourself, can you imagine things you have always wanted to do?  If not, that is ok.  If you can, however, what does that look like?  Although you may not be feeling the best right now, can you begin taking some steps to make it happen once you are feeling better?  Could part of what you want to do involve different treatments for your depression that may work better than what you are doing now?

I understand that my view might be seen as overly optimistic, but when my dad was depressed I know we hesitated to do anything – travel, celebrate anything, or even enjoy ourselves around him.  I know now that this hesitation was not fair to anyone.  Life has so much to offer, and we need to continue to make those experiences happen.  Hesitate less and live more.

As a pharmacist, I spend a lot of time thinking about the side effects of medications.  Unfortunately, they come with the territory of taking medications, but as you know not all side effects are equal.  Someone may be able to live with some constipation or nausea, but the medications that list death as a possible side effect are a very different story.  Even more disheartening is that medications affect individuals differently, so what may be safe for one person could be a disaster for someone else.  There are a lot of gray areas, and it is messy at best.

So, you may wonder – is suicide a side effect?  Some medications, especially antidepressants, will come with a warning of increased suicide risk.  Recently there has been media coverage that Tamiflu (used for the flu) has led to suicide as well.  Not all medications come with a warning for increased suicide risk, but for those that do I think it is important to take it seriously.  For example, the idea with suicide and antidepressants is pretty straightforward.  Before someone starts an antidepressant they are too depressed to act on any suicidal feelings.  However, if the medicine starts to work but has not been on board long enough for the patient to feel better, that may just give the person enough ability to act on any suicidal thoughts.  Again, I think it is important to take any medication warnings about suicide seriously.

In general, medications are very powerful things.  They can do some great things, but they can also be harmful.  No matter what medication you take, if it is new to you try to be extra aware and see if you are noticing any changes in behavior, mood, physical changes, etc.  Side effects can and do happen, and while I don’t want people to overreact, I want everyone to have a healthy respect for the medications they are putting into their bodies.

I would like to think that my blog is a journey that I take with you as readers of the blog.  With that in mind, my hope is that together we learn more and more about depression and how to better understand, live with, and treat it.  Sometimes it can be difficult to find credible information on the internet, and ultimately it is up to you to decide how you will use the information you have seen.  Today I want to list some resources that I’ve come across that might be worth some additional research.  They are in no particular order, and this is by no means an exhaustive list of what is out there.  I wanted to give you some ideas of what is available in terms education, information, advocacy, research, and support.

NAMI – I talked about this organization in the last post – www.nami.org

AFSP (American Foundation for Suicide Prevention) — www.afsp.org

Bring Change 2 Mind — bringchange2mind.org

One Mind — onemind.org

Crisis Text Line — www.crisistextline.org

OK2Talk — ok2talk.org

Kelly Brogan — kellybroganmd.com

Daniel Amen –- danielamenmd.com

Another point here is that as far as I know these are on a national (United States of America) level.  I know for sure that NAMI has state and local organizations, and I am sure there are also many local organizations out there.  Typically a Google search will help you find what might be available to you in these areas.

While today I have focused on some overall ideas for resources, I am also hoping to bring some scientific research and evidence to my blog.  As a pharmacist, one of my considerations is whether there is evidence out there to support certain treatments and certain findings.  One thing I have discovered in my research so far is that medications are not the end all be all for treating depression.  That may be surprising to hear from a pharmacist, but there is so much research going on, and I’m excited to share new ideas that could help treat depression in different ways.