I’ve been diagnosed with different variants of depressive disorders over the last twenty years—major depressive disorder (MDD), dysthymia, and depressive disorder NOS (Not Otherwise Specified). (Depending on your provider’s intent, this latter diagnosis could mean anything from ‘bipolar-ish’ to ‘I’m not sure what the hell’s going on but you’re definitely depressed’ to ‘this is the only way I can ensure any off-label prescriptions are covered by insurance’.)
I used to think I knew what to make of that. I really don’t, though. But I do have experience with recurrent lows—sometimes severe—and many of the medications indicated to treat that.
A few things in this thread I’d like to address, because I notice they come up fairly often in this ongoing conversation (and belated thanks to @SeamusBellamy for its most recent bump):
I see this kind of ‘vehement agreement’ a lot and often the true difference of opinion is not ‘either/or’ (and neither Matthew nor Marc have take such a dichotomous view) but rather how long the scaffold of medication should remain in place after remission has been achieved and sustained with lifestyle changes like those @MarcVader describes (all of which are essential to achieving remission).
The problem is with that term: remission. Remission is gradated and some of those diagnosed with recurrent depression find, over the years, that partial remission seems like the best they’re ever going to get. This becomes a source of insidious doubt. Am I really better? Was I ever? Is it that I’m not on the right meds? What if none of the meds that exist actually target the proximal cause for depression? Do we even know anything about this curse they call an ‘illness’? Is this as good as it gets?
This is why I’m so heartened that Wheaton mentioned meditation because that, along with some solid cognitive-behavioral therapy (CBT), can go a long way in approaching that last question.
Now that I try to imagine this happening to my mom, I’m beginning to understand your ‘basics first’ outlook. That would be something very difficult for me to handle.
For the sake of those that might deny themselves seeking help that might prove necessary, I will caution that ‘psych med’ is a broad term. Some psych meds, in particular first and second-gen antipsychotics, can hit people very hard in just the way you describe. Others, like lamotrigine, are quite gentle. It tears me to think that the medication your mom is taking is the only such med(s) she can rely on to get by—and if that’s truly the case, I hope there’s a med around the corner that can help her reclaim her life without diminishing it in the process.
I agree, though I’ll add one gradation here: telling people they have to use meds indefinitely is potentially damaging; suggesting they might benefit from short-term pharmacotherapy, however, is not unreasonable (provided it’s concurrent with psych counseling), especially if it seems like it might be the only sturdy scaffold on which to build a more connected, engaged, and healthy lifestyle.
They really are.
