Dueling with depression, part duex

I sat patiently in a well-lit waiting room surrounded by white, banal walls with elevator music leaking out of the ceiling speakers. I was feeling a little anxious, and perhaps a bit surly. I was asked to fill out a questionnaire before seeing a therapist, and the questions were clearly plucked right out of the Diagnostic and Statistical Manual of Mental Disorders.

Do you experience feelings of sadness or worthlessness most of the day?

Yes. That’s why I’m here.

Have you experienced lack of interest or pleasure in your activities?

Yes. That’s why I’m here.

Have you ever felt suicidal?

Not until I started filling out this questionnaire.

The therapist wasn’t amused by my answers and was unsettled that I would joke about suicide. (We lasted only a few sessions.)

Humor has always been a bastion for me, as it sometimes loosens depression’s firm grip. Comedian Patton Oswalt has a great bit about blowing his head off in the frozen-foods section of a supermarket with Toto’s song “Africa” leaking out of the store’s speakers. “It was the combination of 11am on a Tuesday, Lean Cuisines, and Toto’s Africa. I have never felt more peacefully, effortlessly, joyously suicidal.”

I find refuge in humor because when medications don’t work, you’re forced to wade through a massive maelstrom of studies, professional declarations, and outright bizarre claims on how to “cure” depression.

And it’s really depressing.

Author A.B. Curtiss is a cognitive behavioral therapist who argues in her book, Depression is a Choice, that you can’t overcome depression using medications or psychoanalysis. “We have to consider how we think, because the problem of depression lies in the very gears of our thinking process.”

There is, of course, a plethora of psychiatrists who argue that depression is a chemical imbalance in the brain, a genetic misstep of biological wiring that you have no control over, regardless of your thinking process.

Dr. Neel Burton is a psychiatrist who teaches at Oxford and argues that depression is actually good for you. “From an existential standpoint,” he writes in Psychology Today, “the adoption of the depressive position obliges us to become aware of our mortality and freedom, and challenges us to exercise the latter within the framework of the former.”

Then there’s Scientology, where apparently I can be depression-free if I clear out my engrams.

Whatever the cause, one thing for me is certain — the medications didn’t do squat. Which is depressing.

Especially when you take into consideration that medications do help some people, many of whom have told me that if it weren’t for antidepressants, they’d be dead.

So what the hell is wrong with me?

“Over the past 20 years, we’ve seen a huge increase in the amount of treatment and services we’re providing,” says Dr. Stephen Ilardi, Associate Professor of Psychology at the University of Kansas. “We haven’t moved the needle at all in terms of the overall lifetime prevalence rate. It looks like the rates of depression are going up, especially among young people.”

He adds that it’s frustrating to witness this trend, “and alarming once you consider that clinical depression is the leading cause of disability for Americans age 45 and under.”

So it seems I’m not alone in my frustration, as Ilardi has worked with patients struggling with depression for which medications have had zero impact. “I tell them, ‘Look, the medications at best help about 1 out of 2 people, and that’s in the short term. It’s a lower number in the long term.’ And their jaws drop, and they say, ‘My God, I had no idea.’”

Ilardi argues that depression falls into the same pattern as other illnesses which are sometimes referred to as diseases of modernity. “These are diseases endemic to the developed, industrialized, westernized parts of the world, and largely non-existent among aboriginal groups.”

In other words, depression has more to do with how we’re living. “Which is, of course, not to say that there are neurological substrates of depression,” he adds, “it’s just that I don’t believe they’re happening randomly.”

Ilardi developed a treatment program called Therapeutic Lifestyle Changes (TLC), consisting of six strategies including regular aerobic exercise, light exposure, and Omega-3 intake to help combat depression.

Why Omega-3?

Ilardi contends that there’s evidence to suggest that a depressed brain is also an inflamed brain. Omega-3 is an anti-inflammatory, essential fatty acid which our bodies cannot produce, which means we need to ingest it. But the typical American diet takes in far too many Omega-6 fatty acids, which are inflammatory (usually ingested in the form of processed foods).

Although Ilardi warns that not everyone with depression has high levels of inflammation in the brain, “meta-analysis has been consistently showing that if you look at the randomized trials, there is a particular species of Omega-3 molecules that is actually a pretty powerful anti-depressant. It’s called EPA, which stands for eicosapentaenoic acid.”

And Omega-3 EPA doesn’t just work because of its anti-inflammatory qualities. “There’s some evidence that they help with signaling fidelity in circuits that use serotonin and dopamine.”

After working with about 150 patients, Ilardi asked them to identify which TLC element was the most effective. “One of my patients will say, ‘Within 3 days of taking the Omega-3, it was a major turning point for me. It was almost like my body was craving that.’ While others will say, ‘As soon as I started using the light box,’ or others who will say, ‘Within the first week or two after I started exercising.’

Which for me is the point. Though many of the symptoms of depression overlap, the causes (and therefore the treatments) are varied.

It’s all about navigating that maelstrom and finding the right combination of treatments and strategies that work for you — like planning a blitzkrieg attack on a merciless enemy.

In the meantime, just stay out of the frozen-food section of the grocery store on Tuesday mornings, especially if they’re playing Toto.

° ° ° ° °

If you’re struggling with your mental health and need help, contact the Colorado Crisis and Support Line at 844-493-TALK (8255) or visit their website at ColoradoCrisisServices.org