Depression – Coming Out of the Dark

depressed man

People talk about physical fitness, but mental health is equally important. I see people suffering, and their families feel a sense of shame about it, which doesn’t help. One needs support and understanding. I am now working on an initiative to create awareness about anxiety and depression and help people.
~Deepika Padukone

Editors Note: This post might look familiar because a few weeks ago, I collaborated with my brother-in-law, Charles Brilliant, to publish a post that he mostly wrote, but didn’t want his name attached. In the interim, Charles has decided, as many of us have, that if we are truly going to break the stigma of mental illness, we must share honestly. He asked me to put his name on the post. So, I welcome Charles to the Bullying Recovery team and now share his post with his name attached as the author. He will be adding his voice here in the future as well. Please welcome him and his important and educated voice to Bullying Recovery. ~Alan Eisenberg

My brother-in-law (Alan Eisenberg) recently spoke about the suicide of Chester Bennington, lead singer of Linkin Park in one of his posts. He also mentioned 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.

I, myself 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.

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).

I was diagnosed with dysthymia in my late teens and major depression in my 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 anti-depressant 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 co-workers they are close with).

In my opinion (which is not meant to criticize general medical practitioners), the most affective treatment for people that suffer from major depression is being treated and followed by a psychiatrist. I have been followed by the same psychiatrist for over 25 years, who has been able to treat my depression effectively. My psychiatrist is a dinosaur. He sees me 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.

I am extremely fortunate as my psychiatrist is in network and negotiates his fee with my insurance company. All I am required to do is pay my psychiatrist the copay that is determined by my insurance company.

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 myself, who suffer 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. Even though my psychiatrist sees me for an hour, I also see a social worker for psychotherapy. I am again fortunate, as my psychotherapist is in network. Like psychiatrists, many psychotherapists are not in network.

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, I would like to say that I believed it was necessary to reveal that I suffer from major depression. I struggled long and hard about revealing this on Facebook. As you all know, whatever you say on Facebook, email, texts, and all types of social media is out there forever. However, if I had cancer or some other type of medical condition, would I be conflicted about sharing this? The answer is no. What I have is no different that having any other type medical condition that requires treatment, other than it being a mental illness. If I did not receive the proper treatment, I would suffer a great deal. Who knows, I may have even committed suicide. Fortunately, at my worst, I have had passive death wishes. I have never seriously considered suicide. I have never come with a plan to do harm to myself, and I have never made an attempt to harm myself. Treatment has made be be able to function and live a productive life, which I am so very much appreciative of.

For the few of you who read this incredibly long post, for which I have seriously violated Facebook etiquette, thank you very much. Please feel free to reply/comment on anything I stated.

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About Charles Brilliant

He is a retired Licensed Certified Social Worker-Cinical (LCSW-C), who still maintains his license. He had a successful 25.5 year career with the Veterans Administration (VA). He held a number of positions, with the VA, to include working in the Substance Abuse Program; working in Acute Medicine; working in Rehabilitation Medicine; and working in Long-Term Care. He currently volunteers twice a week at an Outpatient Cancer Treatment Center, as well as adds his voice through this website.
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One Comment

  1. A highly insightful article!

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