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Treatment-Resistant Depression, Part One

Our individuality is our blessing and our -- well, curse is too strong a word, but it can be pretty challenging. And I know full well the overwhelming feelings of desperation and helplessness when you think you've tried everything.
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Treatment-resistant depression is a subject close to my heart. Too close. My own episode lasted from 2005-2007, during which I tried a dozen different medications, along with homeopathy, herbs, supplements, bodywork, and assorted other interventions before finding a successful cocktail that includes Lamictal, Cymbalta, regular workouts, a couple of IPAs a night, and the occasional nibble of Klonopin before bed as a nightcap. Say what you will... it's worked for more than five years.

The definition of treatment-resistant depression is so subjective that it could catapult Noah Webster into a full-blow psychotic episode. According to some people, it means you have tried taking one antidepressant at the full therapeutic dose for the minimum length of time (typically 4-6 weeks). To me that just qualifies you for "time-to-try-something-else depression."

Even if you've had a complete medical workup, sampled at least a few antidepressants under the guidance of an experienced psychiatrist, and explored various combinations of treatments and supplements under the guidance of experienced alternative practitioners, I think you're still "just" suffering from some variety of "maybe-the-next-one-will-work depression."

But after the months, and sometimes years, drag on... and you've given all these therapies a reasonable trial... then, in my book you have definitely met the diagnostic threshold for treatment-resistant depression, if not staggered hopelessly across it.

There are countless articles and blogs that offer hopeful, helpful -- and often positively perky -- suggestions for dealing with depression. Hell, I've written some. But to casually ask someone who's seriously enmeshed in the long-term darkness, "Have you tried?" is often only adding insult to injury. To be positively perky at the same time is enough to send a treatment-resistant depressive looking for the nearest rock -- to crawl under or bash his head against.

So what do you say? I certainly won't tell you that something will eventually work... but, I can explain why there's reason to hope that eventually something might.

Mental illness is not just a disease of the mind. It also puts down roots throughout your body, emotions, and spirit -- implicating every organ and system. Sometimes your thoughts weigh on you; other times your heart is heavy, your throat is wired, and/or you sense that life has no meaning. At its worst, all of the above.

The mind-body connection is real. And it goes every which way. Constantly. Which means that every part of you is implicated in your condition. A fact that's humbling but also empowering. Because while it explains why there's no panacea, it also explains why different kinds of treatments can work for different people at different times.

Say you have weak adrenals, thanks or no thanks to some DNA that waded into your gene pool a few generations back. And that those adrenals have been further stressed by environment, diet, or 60-hour work weeks. If those weak adrenals are one of the proximate causes of your mania and/or depression, you may be helped by anything from bodywork to taking licorice root. If, however, some childhood trauma is constantly pumping out jagged memories into your system, no amount of bodywork or licorice root is going to provide a long-term cure.

On the other hand, if your adrenals are totally shot, maybe some of that bodywork will help heal them while you're doing the therapy you need to do to release those childhood traumas. Or, if you're binge drinking you may have to go to Alcoholics Anonymous to get a handle on that first or else you'll keep missing your therapy appointments. Or, maybe you can't deal with any of this until you find a medication that lowers your cortisol levels... or an antidepressant(s) that raises your serotonin and norepinephrine levels enough to convince your adrenals to chill out instead of firing at the slightest provocation.

In other words, the issue isn't necessarily figuring out what's going to work, it's finding the most effective way to begin untangling your personal tangled web.

Some people with mental illness might be helped by a prescription antidepressant and/or anti-anxiety medication; others, drugs and a therapist; others, an herb and acupuncture; others, blood-pressure medication and a two-week vacation; others, a regular meditation practice; and others, the spiritual/karmic purging of their choice. Or any of the many combinations of the above.

Then again, maybe when you get through that adolescent or menopausal hormonal rampage, things might settle down on their own. Or, you might have a minor traffic accident, whack your head against the windshield, and wake up totally free of depression. I'm not encouraging you to drive without your seatbelt on. But I have heard of this and other spontaneous cures.

Our individuality is our blessing and our -- well, curse is too strong a word, but it can be pretty challenging. And I know full well the overwhelming feelings of desperation and helplessness when you think you've tried everything.

But, remembering that our minds and bodies are incredibly complex and in constant flux may provide some solace.

What do you say to someone who's heard everything and tried most of it? I'm still thinking about this. It's an important issue. I'll write more.

Until then, try to hang in there. Or, as Harriet Tubman allegedly said: "Children, if you are tired, keep going; if you are hungry, keep going; if you want to taste freedom, keep going."

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