Friday, May 23, 2014

Erica Rivera On Veterans and Depression

When it comes to mental health, the consequences of mismanaged care can be fatal. Twenty-two veterans take their own lives every day. Couple that with the recent allegations that VAs have been stonewalling veterans seeking treatment, and you have an epidemic.

The other day on Fox News (which I only watch because it's what's on at the gym), a widow came on the show to tell the story of her late husband, a veteran who was turned away from the VA in Texas when he presented with suicidal ideation. He'd been diagnosed with depression previously, and his treatment had consisted of appointment after appointment with different psychiatrists. After the VA turned him away, he committed suicide.

I don't know what makes me more upset--that the veteran was denied treatment or that the VA's idea of "treatment" is psychiatry. I do not believe depression can be healed solely by psychiatrists. They have medical degrees. They approach mental illness from a different standpoint than psychologists. Psychiatrists are drug dealers. Their purpose is to push pills and play with chemistry. They schedule appointments in 15-minute increments. They do not look for the root of mental illness; they focus on symptom management.

Seeing a psychiatrist for severe depression is like sending someone with a broken bone to massage therapy or shooting them up with morphine: Some people will experience relief some of the time with prescription drugs, but they are not a cure-all. They are certainly not a tourniquet in an emergency situation. They're not even a Band-Aid because medication can take weeks to change a person's chemistry-- if it works at all.

Even pharmaceutical companies know that their drugs' efficacy is bogus. Listen to television ads closely and you'll hear disclaimers like "Antidepressants may worsen depression or cause suicidal ideation in children, teens, and adults." That sounds to me like a drug that should never have been green-lit to go on the market, given that it can exacerbate the condition it was meant to treat.

When a veteran--or anyone else for that matter--shows up in an emergency room with suicidal thoughts, a hospital's response should not be to schedule an appointment with a psychiatrist. What they need to do is put on their listening ears and give that person their full attention. It takes a hell of a lot of courage for anyone who suffers from depression to ask for help. I imagine it takes twice that much courage for a member of the armed forces, who's been trained to be "tough," to come forward and admit they can't fight their demons anymore.

When people are in so much pain that death is their next best option, what they need is not a waiting list or an appointment in the future. (Depression has an uncanny way of manipulating time. Even two days can seem like an insufferable eternity.) What people need is a safe place to release their pain and a compassionate person to act as an advocate and a guide during that process. And they needed all that long before they finally asked for help. Showing up in the E.R. is like the last-ditch attempt before detonating.

I'm not saying drugs can't be one of the weapons used in the arsenal against depression. They can be. But there are plenty of other factors that can change a person's brain chemistry in a more natural and cost-effective way. Exercise, nutrition, support groups, yoga, and meditation are just some of the ways to relieve depression. Psychologists and counselors should be the first professionals consulted, not psychiatrists. Psychologists specialize in talk therapy, relationship building, and other techniques to help people overcome their pain and give them tools to not only survive, but thrive.

My belief that medications are not the best way to treat depression comes from personal experience. Some time after my second daughter was born, I became depressed. I was initially put on Zoloft, which completely obliterated my sex drive and made it impossible for me to orgasm, which, when you're married, can cause more damage to a relationship than depression does! Over the years, I later switched to Prozac, which made me completely incapable of feeling anything--good or bad--and caused weight gain.

Finally, I found a doctor who would prescribe Wellbutrin, which is contraindicated for those who've had eating disorders because it could cause seizures. Given how depressed I was, I would have rather had the slight seizure risk than the overwhelming certainty that life was not worth living. I improved greatly on Wellbutrin. I had energy again. I lost the weight I gained on Prozac. My sex drive was back to normal--and sometimes, I thought, even higher than normal!

So medication was a magic bullet...until my insurance company decided it was no longer going to shell out the big bucks for brand-name Wellbutrin. I was force to choose between paying hundreds of dollars a month for the brand-name or to switch to a generic called Bupropion. I couldn't afford the former, so I "chose" the latter. Within a few weeks after making the switch, my shiny happy attitude was gone. I felt exactly like I'd had before trying any drugs at all. For a while, I thought it was all in my head. I wondered what I'd done wrong to make myself feel so awful again. I did some research and guess what? Even the FDA admits that Bupropion is not as effective as brand-name Wellbutrin.

My doctor and I began the Russian roulette of antidepressants. I went through several brands in a few months' time. All of them had noticeable side effects. Effexor made me sweat profusely, and made me shake--both unacceptable given that I was working in catering at the time and was expected to look calm, cool, and collected as I circulated through a crowded room, balancing a tray of champagne glasses or a stack of plates on my hand. The last antidepressant I took, Lexapro, made me fantasize about killing myself even when things were going well.

In February 2011, I took my last antidepressant pill. I had a sinus infection, was terribly depressed, and my then-boyfriend had gone on vacation without me. I figured I couldn't possibly feel any worse off the medication than I did on it. I quit cold turkey (which I've since learned you're not supposed to do, though why should we believe anything the drug companies recommend?), spent a week crying miserably, then began feeling better, little by little, without drugs. By using the aforementioned alternative therapies and educating myself about my condition, I've reached a place in my life where I experience depressive episodes one or two days every couple of months. It's manageable, if unpleasant. I'm doing so well, I haven't even seen a therapist (who I would previously see up to two times a week) in two years.

That's a long-winded way of saying: It can get better. And the health care system can do better. It has to do better, for our veterans and for everyone else struggling with mental illness.

A while back, I wrote about the importance of speaking up if you see someone struggling. Today, I want to complement that post by emphasizing the importance of listening. The downfall of our high-tech society just might be an unwillingness and inability to have meaningful conversations face to face. If you see someone in pain--and especially if they ask for help--listen to their needs. Then do whatever you can to make them feel supported and safe.

This Memorial Day, let's remember those who didn't get the help they deserved--and let's vow not to let any more veterans slip through the cracks.