Treating depression: What to expect

Third in a three-part series on depression.

I consider depression a systemic disease affecting both mind and body. Adequate treatment can lead to better life choices, medication compliance, pain control and sleep; faster recovery from heart attacks, chemotherapy or a simple cold.

But lumping all depressions as a single disease is like calling everything you got on your birthday, a gift: the speeding ticket, the hangover headache, a gift certificate to a cooking class (your family can only hope). 

Upon diagnosing depression, I offer both drugs and counseling, but not all experts agree with this approach. 

For patients with mild to moderate depression, it isn’t clear if drugs and/or counseling work better than placebo – about one-third of these patients respond to treatment. My patients have a big say in the initial planning. For severe depression, the combined therapies work well. 

Antidepressants work by increasing one or two of the many “happy” chemicals that float among neurons in our brains. 

But unlike other happy chemicals like marijuana and alcohol, antidepressants – nonaddictive being the operative word – may take weeks to months to achieve their full effect. I tell my patients if it feels like I’m experimenting on them, it is because I am. “Trial and error,” I say. “Please, be patient.” 

My problem, you see, isn’t deciding if, how, which or when treatment would work. My biggest problem is finding a qualified counselor who can see new patients in a timely manner – or figuring out who’ll pay, and for how long.

Upon diagnosing severe depression, I call JB, my psychiatrist colleague. He gets it. He stays here even though he dreads Cleveland winters. He’s on his third marriage. And doctors, as he readily points out, have the highest suicide rate among all professionals. A seasoned psychiatrist, he skillfully manages in areas where I fall short, such as addiction, bipolar disorder, uncontrolled anxiety and suicidal ideation; he fine-tunes medications and offers options like electroconvulsive therapy (ECT) when appropriate. 

Through counseling, he provides mental tools that help to stop the endless looping of negative thoughts and to proactively handle stressful situations. Looking at the glass half-full instead of half-empty.   

Pills and talk can help. I also strongly believe in exercise. 

I know it’s hard, if not impossible, to drag yourself to the gym when you don’t even feel like washing your hair. But think of exercise as the all-purpose, mental laxative. A good workout is a better sleeping pill than anything I can offer. 

In anticipation of a long, trying day, here’s how running helps me cope. 

After a mile, I’m less angry. After two miles, I have not just one, but three snappy comeback lines for the naysayers. At two miles and a half, I’m laughing, no choking, at my own brilliant comeback lines. After three miles, I’m poised to solve the North Korean missile crisis. 

The goal of treating depression isn’t about chasing some elusive happy feelings. Only puppies and greenhouse plants live in unimpeded, true content. Success is regaining adequate control of one's life.