In her 2016 book, River of Time: My Descent Into Depression and How I Emerged With Hope, country singer Naomi Judd opened up about her painfully severe depression to help increase the public’s understanding of mental illness and give hope to those who suffer from it. She wrote, “I’ve told my story. And you can tell yours. You’re not alone. I’m still here.”
Naomi Judd is, sadly, no longer here. Her death by suicide on April 30, just one day before she was to be inducted into the Country Music Hall of Fame, has left her family, friends, and millions of fans bereft. Her losing battle against depression is especially painful and frightening for those who suffer from the malady.
Depression is the mental health scourge of our time. An estimated 21 million adults in the United States have had at least one major depressive episode, a number representing 8.4 percent of all U.S. adults. One of the signs of depression is hopelessness, and those who are paralyzed with depression (and that is usually what it feels like) will point to incidents of suicide to reinforce their conviction that they can’t be helped.
There is nothing further from the truth—and they need to know that.
Vast Array of Medications and Modalities
Depression is a devastating condition. Yet we are fortunate to live at a time where there are an enormous number of treatments and treatment combinations that can help people become not only undepressed but also transformed into their best selves.
It’s vitally important for those suffering from depression and their loved ones to be reassured that the array of psychiatric medications and psychotherapeutic modalities has never been more vast and, when integrated into a treatment plan, can be life-saving and life-enhancing. Psychotropic drugs can be targeted to specific symptoms of depression and, if combined and dosed correctly, be effective without the experience of side effects. Numerous psychological approaches are used to great success as well, including evidence-based cognitive-behavioural therapy. And there is increased recognition and scientific research about the benefits of yoga, meditation, and other mind–body practices in regulating mood. For those who are categorized as “treatment resistant,” there are alternative approaches being studied and used, including ketamine, transcranial magnetic stimulation, and electroconvulsive therapy.
Trial and Error
The range of treatments does not mean that the first approach is going to work or that it won’t take some trial and error to find the right formula. There is no one cure-all for depression. Depression is one name for a condition that can have many disparate symptoms. It may require using several medications in order to target different symptoms. But what those suffering from depression—and their loved ones—must know is that depression is treatable. Even when faced with loss, mourning, and/or family and work challenges, depression is never inevitable.
Feeling depressed must be taken seriously. Depression can be a deadly disease, like cancer, diabetes, or a heart condition. Yet the majority of Americans with depression see primary care doctors rather than psychiatrists who have expertise in how to select, augment, combine, and tailor treatment for optimal results. Primary care doctors prescribe 79 percent of antidepressant medications and see 60 percent of people being treated for depression in the United States. In a study of 1,000 primary care doctors published in Health Affairs in 2016, the majority reported that they failed to follow best practices when treating mental health issues, although they do so when treating other chronic conditions, like asthma, diabetes, and congestive heart failure. Less than 10 percent of the doctors surveyed educated patients about their condition and how to manage their care or monitored their progress to ensure that medications and their doses were appropriately adjusted. Fortunately, there is a trend toward a collaborative care approach in which primary care includes the participation of psychiatrists. This expands patient access to specialists and effective mental health care, including expertise in psychiatric medication management and behavioural therapies.
A recent study published in JAMA Network Open showed the first evidence of a significant decrease in public stigma against depression. That is encouraging news. The importance of being vigilant and alert to the signs and symptoms of depression is crucial. So is having a health provider who takes the time to explain the diagnosis of depression, outline the roadmap for treatment, monitor treatment and tweak it when necessary, and give plenty of reassurance. These are keys to having a successful recovery from depression.
So is taking an active role in being one’s own health advocate. Given the lethargy that someone suffering from depression has, family and friends may need to get involved to ensure good care. Depression is a family affair. It has a ripple effect. The message for all involved is this: Don’t give up. In the crucible of crisis, rest assured that hope lies in the treatment of depression.