Thursday, March 23, 2006

A View Behind The Magic Pill

"Pay no attention to that man behind the curtain."
-Professor Marvel, Wizard of Oz, 1939

We all go in search of answers to the problems that trouble us. Often the answers are right in front of us but we can't see them. We go for the flash, the sizzle, the sexy new thing, only to be disappointed when we discover it's all smoke and mirrors - a man behind the curtain pulling the phony levers and pushing the phony buttons - because we know the hard work is ahead.

I thought about that man behind the curtain and the answers in our own backyard when I read this story on the MSNBC website about how a recent study found that anti-depressant medications fail to cure the symptoms of major depression in half of the patients with the disease - even when they receive the best care available.

Half of all patients with symptoms of major depression fail to receive relief from their medications. That's a lot of people seeking relief from a debilitating illness. That's a lot of people being told that a pill will cure all that ails them. That's a lot of people whose hopes are crushed when they see the man behind the curtain and discover their answer is, for them, merely smoke and mirrors.

Don't worry, I'm not about to get all Tom Cruise on you and say that all anti-depressants are phony. Not in the least bit. Tom and his Scientology cronies are free to have their opinion, however wrong it may be. The article discusses how patients who had their first pharmaceutical treatment fail did respond better with a second round of medication, switching to a new form of anti-depressant, or some sort of combination of medications to supplement their work with a psychiatrist or psychologist. It also discusses how depression in any form, and there are several, is caused by chemical imbalances in the brain, though these imbalances are more complicated than originally thought.

In other words, it's going to take more than, "Take two vitamins and a read this copy of 'Dianetics', then call me in the morning," to cure someone of depression. The disease is organic in origin, not just a "blue mood" that will go away in time.

This topic struck me personally because I was treated for depression for years. The story of how my depression came to be will be part of another post, but during my treatment I was prescribed a low dosage of Prozac for a period of about nine months. I remember resisting the prescription from my therapist at the time because of my shame in having the disease, the flurry of reports about how Prozac was damaging and possibly more harm than good to those who used the treatment, and by the idea that my problems had to be medicated away instead of talked out. That was the depression talking, of course, not rational thought. I eventually took the medication and, with some intensive short term therapy, made it through.

I was lucky. My form of depression, called dysthymia, is a mild form of the illness and I've been relatively free of any depressive symptoms for several years. That doesn't mean that it won't come back, or even get stronger. When I went for treatment, I was very close to going into a major depressive episode. Depression is kind of like alcoholism - one can overcome the illness, but it never entirely goes away. One trigger and it can come back if one is not prepared to work hard and not let it overtake oneself. This article made me think of those who aren't as lucky as I was. Those who barely found the strength to seek help only to get the impression that their treatment may be a sham. Those who can't afford repeat treatments. Those whose illness is so debilitating, they can't fathom having to take another pill because their current treatment has failed them - like so many other aspects of life.

This quote from the article says it best:

"...Thomas Insel, director of the National Institute of Mental Health, which funded the study, emphasized that patients should seek -- and stick with -- treatment. 'The glass is half full from our perspective,' he said. But 'the glass is half empty in that we need to come up with better treatments in the future....'"

Let's hope that we can take that man behind the curtain and make him powerful enough to help all those out there who need help. Read that guide in the article about the symptoms of depression and reach out to anyone you know who shows any of those signs. Encourage them to talk, to get out and do things - anything productive - no matter how much it may exhaust or overwhelm them. If you know someone being treated and they feel it's not working, encourage them to keep asking for help, and when they receive it to keep asking until they feel better. They may be one of the 50% discussed in this article who need follow-up care because their current course of treatment isn't completely right for them. If you see yourself in any of those symptoms, go get help. There's no shame in depression - the shame comes in not talking about it or pretending it's not there.

Be a man behind the curtain to whom attention should be paid - one with more than smoke and mirrors at your fingertips - and help those who need more than smoke and mirrors to find the right man behind the right curtain.

More to come later.

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