In our previous post, we (meaning me, myself, and I) looked at antidepressants for two seconds and then looked at:
- how bipolar can look like "regular" unipolar depression
- how antidepressants can make bipolar depression worse
- how antidepressants can induce rapid cycling in people with bipolar
- how antidepressants can triple the number of days per year that someone with bipolar ends up being depressed
- how it can be challenging to recognize bipolar
- how people who have had manic episodes may not even know it
- how people who have had manic or hypomanic episodes may know it but be reluctant to admit it
- how some people may mistakenly think they are bipolar and tell you they are "manic" when it is not so
- how sometimes those people who seem to be mistakenly claim to be bipolar might actually be partially bipolar or on the "bipolar spectrum" after all
- how this is all a pretty big issue since between a third and half of the people seeking help for "depression" actually have bipolar disorder
- how most people with bipolar who seek treatment when depressed go unrecognized as bipolar
- how the median person with bipolar sees several doctors or other practitioners many times and up to eight to ten years of mental health treatment on average before being correctly identified as bipolar
- how most practitioners misdiagnose most of the people who actually have bipolar disorder with just depression
- how new practitioners starting out may be very confident in their ability to do so even though many other doctors who have gone before them have a very poor track record overall of accurately recognizing bipolar disorder
- zero text in bullet points, whatsoever
- and took a lot more words than here to explain it all than used here in this post.
... It depends.
Dang it!
Can't things just be simple?
Well, we already looked at how simply giving antidepressants to someone with "depression" can be a huge minefield and actually make them much sicker, depending on factors that are pretty hard to figure out and that most of the pros fail to figure out in a timely way most of the time.
First, you need to decide if your "medication" will be a pill, or a therapy, or something else. The standard antidepressants that most doctors will prescribe first and that most authorities recommend to try first, are the SSRIs. These are the largest class of newer antidepressants that includes Prozac, Zoloft, Lexapro, and several others. (For the uninitiated, SSRI stands for selective serotonin reuptake inhibiter, which is a name so long that not even doctors and scientific types like saying it, thus the much catchier "SSRI." Serotonin is one of the main neurotransmitters that our brain uses in its work of regulating our mood.) (For the initiated, my apologies for the parentheses and for the unnecessary explanations.) (For everybody, my apologies for so many parentheses.)
As good modern Westerners, we are often quick to run to a pill to fix our problems. Ah, Westerners. (The rest of the world shakes its head sadly.)
But there are several ways that are shown by research to improve mood just as much as antidepressant medications do. (Wait for the angry mob of conspiring pharma companies come and try to burn down my blog for preaching the truth.)
What? As good as meds? Well ... yes, for depression. But not as good for making money. Meds are much better for that. Not money for you or me of course, we are talking about money for the big pharmaceutical companies who probably don't care if you live or die as long as they can make a buck off of you. (Just look at insulin, which has been around "forever" and whose discoverers literally sold the patent to it for ONE DOLLAR so that it would be forever affordable to all humans. It's pretty dirt cheap to produce, and yet they sell it for a few hundred dollars a bottle, while the average person with diabetes needs multiple bottles per month, and will get sick and die considerably sooner if they don't pony up the cash ((my apologies to non-native English readers: that means, "find enough money")) to pay for it. Sounds pretty much like the mafia: You will pay us whatever we ask, or you will die. Simply because we can get away with it.)
So here are the non-pharmacological "medications" that work as well as SSRIs:
None!
Just kidding. There are some. Drum roll please.
Exercise!
Getting sunshine!
Skipping a night of sleep! (This one sounds like a bad joke, but believe me or not, right now I am not badly joking. At least not in this paragraph.)
Exercise is a great one that if you are able to have the discipline to do it, it lifts your mood pretty effectively, and most of the "side effects" are positive. (A psychiatrist friend of mine once told me when I mentioned this concept to him, "I can't even motivate myself to exercise. How am I ever going to motivate my patients to do it?")
Getting sunshine refers to light therapy. Most practitioners, if they recommend it at all, usually suggest using a special light that you purchase and sit in front of for certain lengths of time. A special light works, but many times you can just go outside more and get the light that way without blowing $100 on a lamp and then spending a bunch of time sitting right in front of it with it only a foot away from your face.
Skipping a night's sleep is honestly pretty counterintuitive to my simple (OK, I'm feigning humility there) mind. If I skipped a night of sleep I am pretty sure that I would be pretty darn irritable. I'm not sure though because I've always crashed out before I get that far. But researchers have shown repeatedly that getting people to stay up all night and through the next day and not sleeping again until bedtime the following night actually boosts mood pretty much immediately and has an effect that can last for weeks. Of course, how are you going to charge for that though. Or, as a practitioner you might get stuck staying up with them all night to fully do the procedure, so not very time-efficient for the doctor. So, it is not brought up much as an option for patients. It works though so you should know about it and recommend it to appropriate persons.
I think it is worthwhile to bring these options up to your patients. Some patients will like them, many may not, but plenty of patients will appreciate you being willing to think outside of the (pill) box.
There are some more alternative treatments for depression as well but I will cover them elsewhere.
Now on to the meds themselves ...
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