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    Posted December 27, 2013 by
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    Is Depression Really Real?


    CNN PRODUCER NOTE     AtheistMD is an emergency physician who has Major Depressive Disorder, otherwise known as depression. He was inspired to write this essay after losing his job during the summer due to the effects of depression and his medication. 'Everything I have ever accomplished has been with a big weight holding me back. Honestly, I experience very little joy in life. One of the only things that makes me feel better is helping others, and I had that taken away from me with the loss of my job,' he said. 'I wanted people to understand how depression affects people.' Currently still out of work, he says he is trying to increase awareness about depression. 'I want people with depression to know that they are in for a tough ride, but if they hold on, their life can improve dramatically,' he said.
    - Jareen, CNN iReport producer

    My name is Michael Merrell and I am a physician who has trained and practiced in the United States, with specialties of Family Medicine and Emergency Medicine. Both of these specialties diagnose and treat depression and other mental health disorders on a very regular basis, so we are required to stay on the cutting edge of diagnosis and treatment options currently available. Books and journals, however, just don’t teach everything we need to know about depression since these sources can’t explain what it is like to have depression and they can’t make someone understand the life ramifications that often inflict those with this illness.

    How then do we get the best information and treatment? Do we ask someone like Tom Cruise, who claims to be an expert in the field? Unfortunately, there are many people who purport to be experts on a subject when they have inadequate training/experience to back up their assertions. These charlatans will give their understanding of depression and then explain why their “quick fix” pill, treatment, etc., will cure you. They may even tell you that depression doesn’t exist, despite mountains of evidence to the contrary, sometimes advising people to throw away their medications with possibly disastrous results. Even many physicians lack the necessary empathy to diagnose and treat depression as aggressively as needed to attain the best clinical improvement. In my judgment, the best person to look for would be an individual with the background scientific knowledge and an intimate understanding of what it is like to live with the condition. A physician with depression seems to be the ideal candidate.

    I was first diagnosed with major depressive disorder at the age of 13 after I became plagued with nearly constant suicidal thoughts and depressed mood. This greatly affected my performance at school as well as my interactions with friends and family, which served as a great reinforcement of my lowering self-esteem. Imagine believing…truly believing that you were so worthless that you shouldn’t be allowed to live and that your life only impacts others in horribly terrible ways. The belief is so pervasive that any contradictory evidence is instantly deemed to be false, regardless of how persuasive it may be to others. This is why simply telling the person how important they are or discussing how their death would be catastrophic to friends and family, will be met with immediate consternation/disbelief. In addition, the difficulties the patient is having really do affect families negatively, which serves to validate the original premise. Ultimately, the patient usually feels sure there is no hope for improvement and they believe that as long as they are alive they will suffer. Sometimes the only way people can see to stop this pain is to end their own lives.

    Early and aggressive treatment is generally the best way to combat mental illness, but there still exist many barriers which make this difficult. First, there is still a significant stigma associated with mental illness, which make people less likely to get help. The perception that only weak or “crazy” people get depression is still very prevalent in most societies and advice of “just pick yourself up by your bootstraps” is still too common. Others assert that if you are strong enough then you can defeat your depression. Unfortunately, during a depressive episode much of the brain’s function is altered, so this condition not only causes its telltale symptoms, but it also affects the brains ability to fight back.

    Another barrier to good care is simply the large range of symptom severity. In other words, depression can be anywhere from relatively mild to absolutely incapacitating and diagnosis may depend on the expertise of the practitioner. Mild cases will certainly affect life satisfaction and general wellbeing, but the patients often come in with physical complaints instead of mental ones. Chronic headaches, bowel problems, generalized pain syndromes, insomnia (difficulty sleeping) or hypersomnia (sleeping too much), and decreased libido often accompany depression, and patient’s may be very adamant that they do not have any form of mental illness. This often creates very extensive and expensive workups which are usually inconclusive (nothing could be found on tests to explain the patient’s symptoms). Patients with severe depression will often have these physical symptoms, too, but the classic symptoms should be sufficient to make the correct diagnosis.

    The last barrier to treatment I will discuss is the expense in both time and money. Let’s face it, doctor visits can be very expensive and proper treatment will include very close follow-up until the patient is stabilized. This means many visits to family doctors, psychiatrists, and psychologists, which often cause time missed at work or other activities. In addition, medications are often expensive, may take weeks to start working, and may have side effects that are difficult to tolerate. Still, clinical studies overwhelmingly show medication and counseling are the best combination to decrease depressive symptoms and allow patients to return to their normal lives. These treatments, however, are not a magic panacea and patients still have to work very hard to get better.
    The evidence for the condition called Major Depressive Disorder (depression) is massive and incontrovertible. There is still much to be learned, of course, and active research continues to find better ways to diagnose and treat this affliction.

    I will address a more personal view on how it feels to have depression in my next article.
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