- What is the Significance of a Depression Diagnosis?
- Am I just sad or is it really a disease?
- Why am I depressed?
- Should I take antidepressant medications?
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What is the Significance of a Depression Diagnosis?
When we go to a psychiatrist and receive a diagnosis of depression, or dysthymia, or major depressive disorder, or treatment-resistant depression, or double depression, or some other disease, we may feel a sense of relief.
Why is that?
It could be stage IV terminal brain cancer and we still feel this peculiar sense of relief: Now I know what’s wrong with me!
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The relief may be because the diagnosis explains why we are the way we are; we are no longer labeled sad, or lazy, or stupid. Instead, we are a person who has the disease of depression.
A light goes on in our head: It’s not my fault that I am sad! It’s not my fault that I am unmotivated! I have depression.
Knowing we have a disease also gives us hope and expectation. Now that we know what disease we have, there is the expectation that the doctor can fix us.
The diagnosis relieves us of personal responsibility. All we have to do is take the medication as the doctor prescribes.
Healing, it seems, can begin immediately.
We are told, we MUST take the pills as prescribed, and we MUST not stop taking them without the doctor’s permission.
If we do so, our disease will return.
The real underlying cause of our mental illness becomes a distant second in importance to following the doctor’s orders.
In fairness, there may be a vague suggestion by our doctor that we exercise, eat a healthy diet, or get some counseling, but in my experience, there was never an emphasis on exposing causative factors or implementing lifestyle changes.
The assumption seems to be that we need not radically change anything. We can go on eating the foods that we crave, we can live in the same sedentary ways that we live, we can ignore our lack of social connectedness, and we can go on allowing ourselves to be exposed to a multitude of social and biological toxins.
We basically can ignore our situation — both past and present.
Just take the pills!
Taking the medication without investigating what is wrong with us is in effect ignoring our mind and body’s urgent warnings.
Many will tell us that what we have is a chemical imbalance in our brain. The drug companies have reinforced this through advertising.
I believed it.
The formula was simple: taking the medications will balance the chemical imbalance. Without the medications, we will become unbalanced again.
This is an unproven hypothesis. According to an increasing number of experts, it is also a debunked theory.
Rather than the depression being treated as a wake-up call that is telling us that something is fundamentally wrong in our lives, we blindly trust the “science.” We assume that the “science” backs up the hypothesis and that the “science” must be right because the FDA approves the drugs.
Because the antidepressant drug isn’t treating the underlying cause, it isn’t making us better. The underlying problems will likely not go away as a result of taking the drug. The problems will remain, be delayed, or manifest in other ways.
We need to take responsibility — not pills.
I understand some of us are not responsible for the circumstances we are in. We may not be in a position to make the needed changes.
We are where we are for reasons beyond our control. This could include our upbringing, a lack of financial resources, traumatic experiences, cognitive disability, or poor choices made due to a lack of knowledge.
If we are dependents, or we are committed to a hospital, we may not even have a choice in whether we take the medications.
This doesn’t mean the drugs will remedy our situation; they will, in my opinion, only numb the pain — or delay it for a while.
There are short-term crisis situations in which it may be best to medicate. When we break a leg we wear a cast, but when the leg is healed we take the cast off.
We should look for an early exit from the use of antidepressant medications because they can be harmful when used over the long term. Rather than medicate, we would be wise to look for and deal with the causes of our depression — if it is in our power to do so.
Depression is an opportunity to reevaluate our lives and to seek out health and happiness.
Don’t miss the opportunity!
(I almost did.)
Every situation is different. I am not a mental health professional. Do not abruptly discontinue your psychiatric medications on your own. Doing so can be difficult and dangerous. Please read this blog site’s Reader’ Alerts! and the Disclaimer before taking any action.
Am I just sad or is it really a disease?
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies mental health disorders into categories that are used by the mental health profession to diagnose diseases of the mind.
It is a book of taxonomy.
Pin a specimen on your board.
I half-joke that the DSM-5 is the sales manual for the pharmaceutical industry. It pigeon-holes us into certain categories to which certain pharmaceuticals can be marketed.
It does more than that, however. It serves useful purposes among professionals and service providers. It gets everyone speaking the same language and using the same terminology.
The manual provides a standardized set of codes to help coordinate the efforts of diagnosticians, health care providers, and medical billing specialists.
The codes are then used for collecting money from health insurance companies.
It’s easy to see that a wrong diagnosis could be damaging. We may be:
- prescribed medications inappropriately or unnecessarily,
- misunderstood and discriminated against by anyone who learns of our diagnosis,
- or we may self-identify with our diagnosis and internalize it — making our recovery more difficult.
We may even be given a medical diagnosis for normal human behavior like grief or discouragement.
Using the DSM-5 our psychiatrist may diagnose us as having major depressive disorder, moderate: code #F32.1, or we may have persistent depressive disorder: code #F34.1, or antidepressant discontinuation syndrome, initial encounter: code #T43.205A.
You can decipher your mental health diagnosis from the coding on your bill using the free online version of the DSM-5.
Taxonomic classifications are good for distinguishing dogs from cats, border collies from chow-chows, brown chow-chows from black ones and short haired black chow-chows from long-haired black chow-chows.
But these classifications give us only a vague idea of the unique and complex animal that is our family dog.
The dog is Pinterest friendly.
Psychiatric taxonomies are used to distinguish:
- mentally stable people from mentally ill people,
- people with anxiety disorders from people with depressive disorders,
- and, for our example, people with disruptive mood dysregulation disorders, from people with unspecified depressive disorders.
These diagnostic classifications do not reveal the complexity and uniqueness of the person that is us, and most often they do not identify what is actually causing our mental illness.
They are a classification of our symptoms and once the diagnosis is made there is a tendency for a one-size-fits-all pharmaceutical fix.
The DSM-5 divides mental disorders into nineteen groups. For example, these groups include the anxiety disorders and the depressive disorders and seventeen others.
In the depressive disorders group, there are twenty-two coded classifications of disorders, as of the 2013 publication.
These include disorders such as persistent depressive disorder and substance/medication-induced depressive disorder as well as various subgroups of these disorders. Diagnosticians are asked to further specify certain other criteria when making the diagnosis such as anxious distress or seasonal pattern.
The chapter on depressive disorders begins on page 155 of the manual.
Each section specifies the diagnostic criteria for each disorder. These read like a book of “rules and regulations” that must be met to “qualify” for each of the depressive disorders. For example, major depressive disorder lists nine symptoms with particulars; in order to qualify, you must meet five or more of these criteria and particulars. One of these symptoms, for example, is diminished interest or pleasure, a particular might be nearly every day.
In my own experience, depression was being stuck in a narrow band of negative emotions.
What the antidepressant medications did for me, initially, was to shift this limited range of emotions to another narrow section on the wide spectrum of possible emotions.
The medications did not restore my normal range of emotions but left me emotionally flat. As a result, I was withdrawn from meaningful connection with others and I lived with a number of unpleasant side effects.
Over time the drugs became ineffective at shifting the emotions out of the darkness and into the narrow center. In the end, I was on large doses of medication without relief from depression.
My Experience with Depression and Medications
Normal range of emotions.
The blues, moderate depression.
Extreme depression, a mental health crisis.
Antidepressants shifted my emotions to center leaving me with a flat affect; lacking normal grief or joy.
For a person with bipolar disorder, they may experience emotions at alternating ends of the emotional scale.
Why am I depressed?
Because depression is not caused by a lack of antidepressant drugs in our diets, it is advisable to request that your doctor test for potential underlying causes before beginning a lengthy regimen of medications.
There may be many reasons why you are depressed. If possible, you need to discover what those reasons are and correct them.
They may not be what you think!
My own depression was caused by a variety of factors; not just one.
While seemingly mysterious, the reasons might be identifiable by medical testing — if that is available to you.
If your medical doctor or psychiatrist is not willing to order these tests, a functional medicine doctor or a naturopath may be more inclined to have them done.
Insurance may not pay for all of the tests.
If you have access to neither a functional medicine doctor, a naturopath, nor a cooperative family physician, or if you are without insurance and have no access to a doctor at all, don’t give up.
A little amateur sleuthing may uncover the likely causes of your depression.
Some conditions that contribute to depression may be detected by a lab test. 16th-century painting.
Some conditions that contribute to depression and that may be detected by a lab-test include:
- The health and balance of the microbiome in your intestinal lumen.
- A lack of vitamin B-12, possibly from a vegetarian diet or an absorption problem related to an out-of-balance microbiome.
- An imbalance of hormones including thyroid or the sex hormones.
- Inflammation in the body that may be caused by an intolerance to certain foods like wheat or dairy.
- A vitamin D deficiency and a lack of sunshine.
- Being low in Omega 3’s from a lack of wild caught cold water fish and certain other whole foods in your diet.
- Fluctuations in blood sugar levels that could relate to the consumption of refined foods, including sugar and flour.
- Toxins in our system like lead, mercury, or certain exposures to mold
Most of the deficiencies or problems can be addressed without the tests by eating a healthy diet and living a healthy lifestyle; no tests required.
My health insurance pays for the fasting glucose test in my annual physical exam. My psychiatrist consented to order a thyroid test prior to my discontinuation of her services. Otherwise, the rest of these tests have been out of my reach.
If your income is very limiting you may be better off spending your money on good whole-foods than on tests.
In addition to lifestyle and diet, you may need to look at life experiences and situations that may be contributing to your depression. You may find talk therapy to be helpful in this regard.
Should I take antidepressant medications?
Prescribing medications for depression will often be a seat-of-the-doctor’s-pants trial and error process.
Different dosages and different types of medications are prescribed, until one medication, or a cocktail of several, are found that “work.”
But, there is no guarantee any of them will work. In fact, the success rate of antidepressants is low.
This trial-and-error process may go on for years, as it did with me, with nothing really working. Meanwhile, you may be spending important years of your life in a medicated or depressed state.
You may receive temporary reprieve with each new medication trial (possibly from the placebo effect or possibly for complex biochemical reasons) only to be let down again when you realize the medications are no longer working.
Time magazine recently had a headline that read 13% of Americans Take Antidepressants.
Antidepressants can cause a deterioration of health and a host of side effects including harmful effects on unborn and nursing children. It is not known what the long-term effects will be when they are prescribed to children whose minds are still developing.
They are also linked to an increased risk of suicide.
Would I take antidepressant medications again? Knowing what I know now — no.
I realize my saying this is a little akin to me biting the hand that may have saved my life.
I took antidepressant medications for over a period of 31 years without good lasting results and with plenty of unpleasant side effects.
Taking several medications at one time can have hidden dangers called polypharmacy. It is especially troublesome as we age. Polypharmacy can cause dementia-like symptoms.
I am fortunate that I am now free of all antidepressant medications. They have done their damage, but I am hopeful of a continued recovery.
A wholesome and sustainable approach that does not include medications, by all early indications, is leaving me stronger, healthier, and happier!
For those who cannot, or will not, make the needed changes in their lives, antidepressants may be the only choice.
Weigh your options carefully and make your own informed decision.
Longterm antidepressant use can lead to chronic untreatable depression resulting in the prescribing of larger doses and add-on drugs, without achieving remission of the depression.
This is what happened to me.
A study published in the Journal of the American Medical Association concluded that for patients with mild to moderate depression the benefits of taking an antidepressant medication may be minimal to non-existent.
There was a benefit reported for those with very severe depression. If you find yourself in a severe mental health crisis, then you and your emergency room doctor may wisely decide medications are your best option for the duration of the crisis.
I am happy that antidepressants are no longer my only option. Far from it!
For that I am grateful.
We have been frequently advised to leave this decision about medications up to our psychiatrist. Fair enough. They are doctors of mental health. But, when taking advice from a modern psychiatrist always remember these are people who have been trained to prescribe medications. Unless they stray from the protocol, that is what they do!
There are a few notable and honorable exceptions who prefer psychotherapy (talk) over medications.
In my experience, healthier, more wholesome options are generally not among the tricks in the psychiatrist’s black doctor’s bag.
Should you take an antidepressant medication?
I am not qualified to do so.