“There are wounds that never show on the body that are deeper and more hurtful than anything that bleeds.” ― Laurell K. Hamilton
Recently, we read of the suicide of Chester Bennington, lead singer of Linkin Park. Know that depression is a mental illness that does not discriminate, which is so very true. It can affect anyone. It does not matter if you are black or white; rich or poor; or whether or not you are a well-known celebrity. In addition to Chester Bennington, other famous people who have taken their own lives include, Ernest Hemingway; Kurt Cobain; Chris Cornell of Soundgarden; and Robin Williams, just to name a few.
People close to me suffer from Major Depression, which is also known as Clinical Depression. Major Depression is an illness, which still carries a stigma. Because it is a mental illness as opposed to a physical illness, it is often looked upon as being a weakness and something people have the power to control without treatment. Anyone who believes this is clueless has very limited insight or is not knowledgeable about mental illness. Other than being a mental illness, depression is no different than having cancer, diabetes, or any number of medical illnesses or diseases. Treatment is extremely necessary and without it, could lead to death by one’s own hand.
Depression is often hereditary. People with depression due to genetics, likely have a chemical imbalance in the brain that if left untreated could lead to suicide. My depression is due to there being a history of it in my family.
Depression does not always occur due to hereditary reasons. People who suffer from major depression have the following symptoms over a long period of time: feeling hopeless and powerless; loss of appetite or excessive eating; insomnia or sleeping too much (difficulty in getting out of bed); loss of interest in pleasurable activities; isolation (wanting to be alone and not around others); losing the ability to function (which affects their job performance; relationship with others, their marriage and ability to act as a parent to their children); not having the desire or ability to leave the house; feeling they are a burden to others; passive death wishes; suicidal thoughts, which can lead to a suicide plan, which can lead to suicide attempts and/or the taking one’s own life.
This is important to remember because many times there are arguments about the right and wrong of suicide. I think it is fair to say that suicide is a selfish act, but that does not necessarily mean the person who commits it is selfish. As pointed out, the mind can have a strong pull on our decisions and in many cases, we end up at war and sometimes lose that battle with our minds during high anxiety, depressive and even bullying and abuse issues.
Another type of depression is Dysthymia. This is a milder form of major depression. People with dysthymia likely experience some symptoms of major depression. They always see the glass half empty. They believe their negative thoughts and feelings are a normal part of life. They can still function in society (i.e. do their job adequately).
People close to me were diagnosed with dysthymia in their late teens and major depression in their early adult years. Many people with dysthymia later develop major depression.
Another type of depression is situational depression, which occurs when one experiences a tragic event such as the loss of a loved one, the loss of a job, the end of a marriage, being traumatized (i.e. being the victim of a crime; being involved in a serious accident; having survivors guilt, and being diagnosed with a serious medical illness).
I would be shocked if any of us have not experienced situational depression in our lives. In most cases, people who do not suffer from major depression and experience situational depression are eventually able to recover. The major difference between having major depression and situational depression is that major depression is chronic.
The good news is that all types of depression are treatable. The most common treatment for depression is antidepressant medication and/or psychotherapy. Antidepressant medication is often prescribed by a physician, nurse practitioner (NP) or physician’s assistant (PA) who practices internal medicine. This type of medication is also prescribed by psychiatrists.
More times than not, anxiety often accompanies depression. One can also have anxiety and not be depressed. Medical professionals will often prescribe anti-anxiety medication in addition to antidepressant medication. For those who have anxiety without depression, some antidepressant medications may be prescribed because they have been shown to be effective in treating anxiety.
People with major depression will also experience situational depression several times over the course of their lives. It is imperative that what ever type of medical professional who is following them be aware of this, as their depression could worsen and additional treatment/changes or additional treatment may likely be needed.
Some people who have no history of major depression who experience situational depression may be able to improve on their own and not require treatment, especially if they have a large social support network (which includes family, friends, clergy, and coworkers they are close with).
From those experts I have talked to in the clinical psychology world, the effective treatment for people that suffer from major depression is being treated and followed by a psychiatrist. Someone close to me has been followed by the same psychiatrist for over 25 years, who has been able to treat their depression effectively. Their psychiatrist is a dinosaur. He sees his patients for one hour sessions. Most psychiatrist today see patients for 15 minutes for medication management and follow-up.
Many recommended psychiatrists are no longer in network, meaning that they do not take health insurance and require full payment up front. Many insurance companies cover a small percentage of what out of network psychiatrists charge. Some out of network psychiatrists will send a claim to the patient’s insurance company stating the date and fee for the session. Many others do not submit claims for the patients and it is up to the patient to do this. In order for the patient to be able to submit a claim on their own, they need a statement from their psychiatrist indicating the date and cost of the session.
The sad fact is that many people who suffer from depression and who need treatment cannot afford the cost. I hope this has decreased since the Affordable Care Act (also known as Obama Care) has existed. Even with the Affordable Care Act, many people can still not afford the cost of insurance. Also, if they can afford insurance, they likely need a referral from their primary care medical practitioner who may not believe they have depression and/or choose to follow the patient themselves and prescribe them medication if they deem it is necessary. They, therefore, do not refer the patient to a psychiatrist. They also likely do not follow the patient at least once a month for their depression, which is the minimum a patient should be followed up.
It is very sad that health care insurance plays a major role in providing the necessary treatment that one needs who suffers from major depression. For that matter, any type of medical or mental health care that one requires. Also because so many psychiatrists are no longer in network, patients have to choose the ones who are in network. Often psychiatrists in network have a very large caseload and in many instances are not able to take new patients.
People as fortunate as my friend, who suffers from major depression are able to get the treatment they need and improve significantly. Since most psychiatrists today, only see patients for 15 minutes, it is extremely important for most patients (who suffer from major depression) also receive psychotherapy from a trained professional (psychologist, social worker, mental health counselor). It is also very important that the mental health professional following them have regular communication with their psychiatrist, to ensure the patient is receiving to report how the patient is functioning and whether or not changes or additions to their medications is needed.
Although treatment for major depression is essential, the majority of the population who suffer from this illness are likely not able to afford both a psychiatrist and psychotherapist and many are not able to afford either.
People who suffer from major depression are not alone. Because it carries a large stigma, many feel ashamed and embarrassed. They, therefore, do not confide in family/friends and do not seek treatment.
Education and awareness about depression have improved tremendously over the years. However, we still have a long way to go. In my opinion, just like sex education and other important topics, depression needs to be taught in elementary schools.
In closing, my close friend wanted to share that they believed it was necessary to reveal that they suffer from major depression. They struggled long and hard about revealing this here. But we both agree that the stigma of mental illness must be broken. What they have is no different than that having any other type medical condition that requires treatment, other than it being a mental illness. If they did not receive the proper treatment, they would suffer a great deal. Who knows, they may have even committed suicide as I described how this happens in my book Crossing the Line. Fortunately, at their worst, they have had passive death wishes. They have never seriously considered suicide. They have never come with a plan to do harm to themselves and have never made an attempt to harm themselves. But there are too many others that do all of these things. Treatment has made be able to function and live a productive life, which they and I are so very much appreciative of.
If you struggle with suicidal thoughts around depression or any other illness, there is a 24-hour helpline in the US. Call 1-800-273-8255 at any time.
Editor’s Note: The bulk of this blog was written by my close friend who suffers from severe depression, but is also a person with a Masters in Social Work that has been studying this issue for over 30 years. They wish to remain anonymous, but the power of their words was so important, we both agreed to co-publish it. I am very proud of my friend for sharing this. ~Alan Eisenberg