Wednesday, October 8, 2014

Diagnose Anything But Depression, Please!


Is the stigma of being mentally ill again rearing its ugly head?

Take Robin Williams as a case in point. All we know at this point is that he had multiple medical conditions. These included: lifelong severe depression, lifelong substance abuse concerns, heart disease, and recent Parkinson's Disease related illness. A month before his suicide he was inpatient at Hazelden for an alleged substance abuse "checkup" although the field is not known for hospital based "checkups".

What was he doing in a substance abuse clinic when he so clearly needed a mental hospital instead? Even if he was using drugs or alcohol again, wasn't the severe depression coupled with the Parkinson's, and mixing medications for both, the bigger danger? His substance abuse could have even been self medicating attempts for faulty treatment of the depression coupled with the Parkinson's. Depression is the most likely cause of suicide, not substance abuse, especially a suicide by hanging.

When Catherine Zeta-Jones went into the hospital for treatment of her bipolar disorder, the media was saying she had "gone into rehab". When Robert Downey Jr. was in prison, a psychiatrist challenged the state of California by asking what was an obviously untreated bipolar disorder patient doing in prison for substance charges.  Why hadn't he been committed to a mental hospital instead for treatment of his psychiatric condition? Shortly after that he was released and presumably got some much needed treatment.

There is still more of a stigma to being diagnosed as mentally ill than there is to admit to being a substance abuser or alcoholic. This isn't just confined to depression vs. substance abuse though. It can show up in other medical diagnoses as well too.

Some years ago a friend of mine was practicing geriatric psychiatry. Often she had to diagnose between Alzheimer's and depression, both of which the elderly get. If the final diagnosis was depression instead of Alzheimer's, the patient's family was often mad at her and left in a snit. Explaining to them that this was good news, that she could probably get the patient in a closer to normal state within thirty days or so with the right drugs, did her no good. 

I have had unipolar depression since I was a teenager. I take daily 200mg of zoloft and it is boosted by a dose of buspar. These medications only work if taken every day and it takes at least thirty days to see a difference. I have had one hospitalization of one week in my early 30s. I have not had electroshock but I would take it if I needed it.

As difficult as this has been to handle all of my adult life, it is nothing as to someone's encouraging me in the belief that I have some other condition entirely. 

For example, I am horrified to even imagine what a misdiagnosis would cost me if I were being treated for substance abuse when I had depression. How would I get better without being put on the correct medications and given the corresponding talk therapy to handle the depression mindset? Plus the best results in substance treatment seem to be coupled with a belief in a higher power. No such belief is necessary with treating a psychiatric problem. And substance abusers are supposed to reach a point where they go and atone with people who have suffered as a result of their addictions. A person with depression would probably finally cross over to becoming suicidal if he or she had to go apologize to people for being mentally ill. Finally, you must take a substance to combat depression not refrain from taking one.  Could there be any more glaring difference between the two conditions? That now brain scans may help in making the right diagnosis, as shown above, is encouraging but only if these tests are actually being used.



If you ever have doubts about depression, there is one source whom everybody "counts". William Styron, the author and Pulitzer Prize winner, got depression later in life and while in its grip he wrote about it, exactly what it feels like when you are in its grip. No one else has ever been able to do this. He caught it brilliantly and so anyone who suspects he or she has this disease, generally reads the book. It is a slim volume so it is no big effort to do so plus it is brilliantly written. Excerpt:

“In depression this faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come- not in a day, an hour, a month, or a minute. If there is mild relief, one knows that it is only temporary; more pain will follow. It is hopelessness even more than pain that crushes the soul. So the decision-making of daily life involves not, as in normal affairs, shifting from one annoying situation to another less annoying- or from discomfort to relative comfort, or from boredom to activity- but moving from pain to pain. One does not abandon, even briefly, one’s bed of nails, but is attached to it wherever one goes. And this results in a striking experience- one which I have called, borrowing military terminology, the situation of the walking wounded. For in virtually any other serious sickness, a patient who felt similar devistation would by lying flat in bed, possibly sedated and hooked up to the tubes and wires of life-support systems, but at the very least in a posture of repose and in an isolated setting. His invalidism would be necessary, unquestioned and honorably attained. However, the sufferer from depression has no such option and therefore finds himself, like a walking casualty of war, thrust into the most intolerable social and family situations. There he must, despite the anguish devouring his brain, present a face approximating the one that is associated with ordinary events and companionship. He must try to utter small talk, and be responsive to questions, and knowingly nod and frown and, God help him, even smile. But it is a fierce trial attempting to speak a few simple words.” 
― William StyronDarkness Visible: A Memoir of Madness


Michael Jackson might seem like an unlikely subject to wind up a discussion on depression. However, the fact that he could not sleep is the symptom that most of us experience who have unipolar depression. It is also the symptom which only gets worse as the days pass. I went without sleep for one week at my worst stage and I never felt worse in my life, even with severe chemotherapy decades later. 

This extreme sleep deprivation is why Jackson turned to Propofol, the anesthetic, to solve his sleeping problems. Nothing else worked on him. He'd tried everything else. He tried to get two other medical people to give him Propofol for his insomnia before he got Dr. Conrad Murray to agree to do it. Both his internist and nutritionist refused to supply him with the anesthetic. 

With his producers willing to pay a doctor to live with him so he could perform for This Is It, he finally found Murray. Murray desperately needed the money so he took the job and gave him the Propofol every night for months until he died. Apparently no one said that he might have a mental illness and that the extreme insomnia was a symptom, not the disease. I suppose he would have fired them if they had said so and they did not want to lose a VIP patient. (To read more about this VIP patient problem, go read this article at the New York Times: "The Famous Can Present a Minefield for Doctors. Joan Rivers's Treatment Seen as Possible Example of V.I.P. Syndrome.")

“For there is nothing quite so terror-inducing as the loss of sleep. It creates phantoms and doubts, causes one to question one's own abilities and judgment, and, over time, dismantles, from within, the body.” 
― Charlie HustonSleepless

3 comments:

  1. Brilliant, Carol--thanks for this, and for the literary references and celebrity examples--so helpful in understanding why we do the things we do.

    ReplyDelete
  2. This is brilliant. This is something that anyone with depression and self medicating to TRY to feel better, and waiting for God to fix them should read. Thanks! "if I were being treated for substance abuse when I had depression. How would I get better without being put on the correct medications and given the corresponding talk therapy to handle the depression mindset? Plus the best results in substance treatment seem to be coupled with a belief in a higher power. No such belief is necessary with treating a psychiatric problem. And substance abusers are supposed to reach a point where they go and atone with people who have suffered as a result of their addictions. A person with depression would probably finally cross over to becoming suicidal if he or she had to go apologize to people for being mentally ill. Finally, you must take a substance to combat depression not refrain from taking one. Could there be any more glaring difference between the two conditions?" You have figured out a deep hidden key that people spend years of loss and wasted time not knowing.

    ReplyDelete
    Replies
    1. All of us who have suffered from depression need to say it loudly and often that depression is a real disease and we will not tolerate being steered into treating other less stigmatized diseases. The latest news about Robin Williams shows his paranoia, depression and other mental illness problems were even more advanced that at first thought. That he was being treated at a substance abuse center instead of a mental hospital I find outrageous. Thanks for the comment! carol

      Delete