Category: General

As I write this post, we are starting the month of May.  In the United States, there are months and days for everything it seems, and one of the designations for May is Mental Health Month.  This has been happening for many years, and green is the color that has been chosen to go along with it.  As you can imagine, May will be a month in which there will be a lot of attention drawn to mental health, and people may see more ad campaigns and commercials on it.  Although I willingly signed up for the email lists, my inbox was flooded today from a variety of mental health organizations calling the month to my attention.

Sometimes I wonder why we need to call out issues with a special day or month.  After all, shouldn’t we be working on these things every day?  But, I understand it.  Of course, we are working on issues every day.  However, when we think particularly about May being Mental Health Month, it creates an extra layer of attention and effort towards the cause.  Simply bringing up the fact that “May is Mental Health Month” could be the beginning of many insightful conversations.  Ad campaigns and commercials may just be the inspiration that someone needs to seek help.  There are also probably many other ways that a heightened awareness can help people, and that is important.

If you are struggling with depression, maybe hearing about Mental Health Month will give you more hope than you currently have.  Maybe it will help you see that people really do care, not just in May, but every day of the year.  Were you aware of Mental Health Month before reading this post?  Regardless, are you interested in learning more?  I hope that the fact that Mental Health Month has become a major part of the calendar gives everyone some comfort that progress is being made.

Although we are making progress, we still live in a world where there is a lot of stigma associated with depression and/or other types of mental illness.  Stigma can create a lot of shame for people who are suffering from depression and can keep them from getting the help they need.  Stigma can also ultimately reduce quality of life and may lead to premature death.  For the most part, I think that a lot of us understand the major aspects of stigma.  But what about the more subtle forms of it?

As an example that I have shared with many people, several years ago I was at a Motley Crue concert with my husband.  Alice Cooper was the opening act, a guy I consider to be a big “shock rocker” of the 1970s.  His set was going fine until he came onto the stage wearing a straightjacket, and he was trying to fight his way out of it.  People seemed to be entertained by it, but I was physically repelled.  A straightjacket?  This was not funny to me at all.  However, it occurred to me that even 10 or 20 years ago I wouldn’t have thought much about it.  Here was a more subtle form of a stereotype that was being perpetuated at a rock concert.

Some other examples come to mind.  Ever been to a haunted house that was portrayed as an “insane asylum”?  Ever used expressions such as “that’s crazy”, “that’s insane”, or “you’re crazy”?  Whether we realize it or not, there are subtle ways that the stigma of mental illness is still perpetuated.

Now, I’m not here to become the “stigma police” and shame people for these activities.  However, I want people to at least realize what these examples and others can mean.  Does it continue the idea that mental illness is scary and something to be feared?  Does it create more of a burden on people who want to seek help but are worried about how they will be seen?  Again, my ask here is to at least think about the subtle ways in which stigma is still alive and well in our society.  After all, recognition is usually the first step in solving an issue.

A few posts ago I wrote about tapering antidepressants.  Right after I wrote this, there was a very good article in the New York Times on April 7, 2018, about withdrawing from antidepressant medications.  The article is entitled “Many People Taking Antidepressants Discover They Cannot Quit” by Benedict Carey and Robert Gebeloff.  As the title suggests, the article highlights people who have had issues with stopping antidepressants.  In fact, some people have had such trouble with stopping the medications that they have chosen to remain on them instead of dealing with the withdrawal symptoms.  What really struck me was that the term “discontinuation syndrome” was used.  Isn’t that just a fancy way of saying withdrawal?

Regardless of what you call it, there are many people who struggle with stopping antidepressants, even if the drug may not really be giving much of a benefit to the individual.  There is some research being done on tapering protocols, but the article also mentions that many people have taken tapering into their own hands and have tried to make it work for them without any help from a medical professional.  Of course, drug companies don’t necessarily have any strong desire to work on protocols to help people safely stop the medications they are selling.

I think this article is yet another call to think about what works for you as an individual, assuming you are taking antidepressants.  Can you stop an antidepressant without any issues?  Would you prefer to try a taper instead?  Perhaps the taper may take months or even over a year to complete – is that alright with you?  What side effects are you willing to accept and how long are you willing to accept them?  This article is further proof that antidepressants may not necessarily be the wonder drugs many people think they are.

While I have lived with someone who has had depression, I have not had depression myself.  Because of this, I can only speculate what it feels like to experience depression.  Also, I learn about it from the experiences of those who have went through it or are currently experiencing it.  Add to that that every person is unique and has different experiences.

One thing that I have found interesting is the stories of someone with depression talking about how they learned so much from the depression.  Is it possible that depression can teach you life lessons?  It may seem impossible or difficult when the depression is at its worst, but I believe that depression can give you lessons and gifts along the way.  Now, I am not saying this is a preferred way of learning about life, but I am inspired by the stories of those who have taken their history of depression and turned it into lessons learned and/or looked at some parts of it as a gift.

Again, I can only speak as someone who has seen depression but has not lived it, but from my angle I have learned a lot along the journey too.  Lessons about trust, loyalty, autonomy, dignity, compassion, and gratitude are just a few of many things I have really had to struggle with and grow as a person.  They did not come easy, and again, it would not have been the way I would have chosen to learn those lessons, but they are there and make me who I am today.  Although arguably easier for me to do, I have taken those experiences and tried to make myself and my world a better place in spite of it.

How about you?  Do you see depression as a way to learn?  Do you see that depression could be a gift in some way?  It may seem odd to think about it this way, but perhaps depression can give us some positives too.

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.