Thought Becomes Deed

I arrived at the diner and pulled my keys from the ignition with the same motion that had turned the vehicle off. As I slid out of the seat I slipped my hand into my pocket, confirming that my wallet was within. It wasn't.

I checked my other pockets, and then the spare pair of pants I had in my bag - although I hadn't worn them. I opened the glove compartment, checked under and behind the seats, and in all the pockets of my bag. The wallet just wasn't there.

Panic rose in my throat. Had I left it at work? Work was half an hour's drive, and closed for the night. Further, this was Sunday night, so they wouldn't be open again until Friday. It would really have been problematic if I had left my wallet there.

I took a breath, released it slowly. No, I decided, you left your wallet on the desk at home. I smiled, and grabbed the ten dollar bill I had discovered when I had been searching, and brought it with me. I had to be careful how much I ordered, but it was a fun time with my coworkers.

I found my wallet on my desk the next morning - it was half buried in a small pile of papers.

What am I getting at here, anyway?

Blue Monday

This won't be a full post because my internet connection is spotty right now.

Today is Blue Monday, statistically the most depressing day of the year. Holiday bills, bad weather, and failed resolutions all combine to make it so.

So congratulations, no day this year will be as bad as this one!

Migraines and Depression

I suffered from migraines as a child, and I became depressed as an adolescent. I would have thought it just bad luck, but a study suggests migraines and depression may both be linked to serotonin levels. I suppose I should have seen it coming, since it's kind of a dummy smack. My own anecdotal experience, now that I look at it, suggests a link between the worst headache ever invented and depression.

SSRIs are being prescribed as migraine preventatives in response to this area of research. The research suggests a link (47% of Migraineurs experience clinical depression as opposed to just 17% of the general population), but is not yet clear on whether one causes the other or not, or perhaps both are caused by the serotonin levels. I wouldn't be surprised if the serotonin imbalance itself was eventually proven to be a symptom only; however, I don't anticipate that being proven easily by science because of the difficulty of the scientific community in overcoming the body/mind link that depression and related illnesses straddle.

Solutions for SAD sufferers

I found this amazing article about SAD suffering, which is reaching its peak now as the stress and joy of the holidays falls away, leaving us with cold, dark, and dreary (or, if you live in the Northeast, unseasonably warm, dark, and dreary). I was particularly interested in the supplement SAM-e, which I have heard of in passing only. It's refreshing when a medical site recognizes that non-drug treatments can be useful for addressing depression. This particular post gave me the impression that there was some commercial reason for the supplement's promotion, but I am going to do more research on my own and see if the research bears out the claims from this article.

My misgivings notwithstanding, I'm glad to see real research on treatments that may have less side effects. Of course not all options will work for all victims, but that's why I advocate for a variety of treatment options being made available, so the best ones can be found for the individual.

As I side note, I really hate the term "feeling blue" in this context. I think it minimizes the seriousness of depression and sends a message that it's a disease that is not taken seriously.

Fish Oil is not Snake Oil

Studies have not shown if fish liver oil helps with depression. Science sometimes fails to be like the thing that it studies; that is, slow-moving and focused. I have not the slightest idea if fish oil has any impact on depression (although it is probably as effective a placebo as anything else out there), but I'm pretty sure that you aren't going to get fast results out of a natural phenomenon.

Any scientific study must be funded, and most funding comes from the companies that profit from research - the ones making products that they can sell. Sunlight, plants you can pick from your own garden, and air just aren't going to be studied as serious treatments for anything since they're free and plentiful (unless a marketing person can find a way to sell us what we already have, a la pet rocks); things like fish oil and cow pies and cat hair are all common enough that it would be tough to charge a lot for treatments derived from them, also discouraging the really big research bucks. We aren't likely to see long-term studies on depression treatments that nobody can make money from.

There have been some amazing breakthroughs for treatments of all manner of diseases through new drugs. That doesn't mean that every drug is wonderful, nor does it mean that every disease's cure is in pill form. Well-trained pharmaceutical representatives earn a great living convincing doctors to prescribe their products, and no one is out there equally passionately pitching St. John's wort, taking a walk every day, fish oil, getting a puppy, copper bracelets, and believing in God (at least in doctor's offices). Plenty of alternative therapies may be effective, but the medical community isn't designed to find out.

Of course, I can't say that I would like the idea of being accosted by fish-oil salesmen.

Placebo: What Your Brain Can Do for You

The placebo effect is the measurable, observable, or felt improvement in health not attributable to treatment. This effect is believed by many people to be due to the placebo itself in some mysterious way.

So states this article on placebos and depression from the Skeptic's Dictionary, and appropriate resource. Like this UCLA article about placebo usage, it discusses how, when a patient is told they are receiving a placebo, the effectiveness often goes away. Is this because the treatment was all in their heads? Or that the depression was?

Many studies try to compensate for the "placebo effect." Others, more recently, have specifically studied this factor as a healing process. A study by Dr. Arif Khan showed, according to the New York Times, that:

It turns out that the more severely depressed people are, the less likely they are to respond to a placebo. And people with more mild depressions get better with just about all treatments, including placebos. Since most clinical trials enroll less severely depressed patients, the observed difference between the response to an antidepressant and a placebo can be misleadingly small.

Other studies, including one by Dr. Irving Kirsch, suggest that medications are nearly useless because the placebo effect is so high in depression treatment. Meanwhile, doctors wrestle with the ethics of "tricking" patients with placebos.

I think the point is not quite being realized by the scientific community. Depression is a disease that is has an effect upon the body as well, because the brain controls all things. Placebo is the brain's natural ability to repair damage to all the human systems. This process is easily interrupted by doubts and limiting beliefs. At this point in our development we have identified the process, and we recognize that it can be encouraged by presenting patients with a physical talisman, if you will, of healing; the pill. More severely depressed people need more than a sugar pill because they are so very sick their limiting beliefs extend deep into the unconscious, metastasizing like cancer. They need medications to bring them to the point where the placebo process can recover enough to even try to work.

I foresee a time when the scientific community will focus serious research on placebos, not to remove them as a variable or identify what is "in a patient's mind," but to determine how to harness our own healing ability and hone it. This research will not be conducted by drug companies, because it would not be advantageous to cure such a lucrative market for maintenance medications. It will be research into areas currently sidelined as psychology or superstition, and will tap into the true potential of the human brain.

The lucky depression patients have found other avenues to unlock these secrets, either through sugar pills or prayer or exercise or therapy, and they have been given a chance at true healing, y allowing their brains to overcome depression naturally. It's time the scientific community figures out a way to give the rest of the victims that opportunity.

Self-Care Options

This article reinforces my position on the paradox of depression: you aren't going to get better if you can't learn to do it yourself, but depression keeps you from believing that this is possible. Drugs and therapy can be important tools for recovery, but neither of them will succeed without your help, and neither of them should be considered for a lifetime. If you plan for a day when you won't need them you're much more likely to reach that day.

Either of those treatment options may give you the needed push to get to a point where you can do something for yourself, crawl just far enough out of your own personal pit that you can take at least a small amount of responsibility for your own recovery. If they can't get you to that level, and you aren't functional enough to make it there without further help, you should find that help. Never forget that the worst symptom you have is the belief that you are going to stay this way, that nothing you do can change it, that it's pointless to even try. Don't give in to that crap, because if you expect the worst you're rarely disappointed. Do you have anything to lose by trying for more? Can it really get worse than it is? Really?

Some thoughts on the five suggestions given:

• Keep Active: yep, I've mentioned how important even a little bit of exercise can be. Don't want to get out of bed? Consider having a friend drag you out if necessary.
• Eat well. A well-balanced eating strategy will help you feel better now and later. Good thought. I've had comments here from depression victims that eat like crap, and it shows in the writing that they're just making things worse. Your body needs good fuel to do a good job.
• Get adequate sleep. I would modify this to say, "Get appropriate sleep." Insomnia is a symptom of depression, but I was more prone to the fourteen-to-sixteen-hour power nap. I psychiatrist I knew said that the best way to regulate sleep is to get up at the same time, every day, without fail. Your body will take care of the rest.
• Control stress. Coping with depression is stressful enough, so try to limit other sources of stress. And depression does a marvelous job of amplifying the other stress, doesn't it?
• Stay connected. Make relationships a priority. Social ties give you a sense of purpose and meaning in life. I can't emphasize this more. You need to be around people, even if you don't feel like it, because even if you believe you're alone in a crowd it is better than being alone alone. Do it even if you don't want to.