For those who don’t know, clinical depression is very different from the “bad mood” that most people call depression. It’s driven by bad brain chemistry, and won’t just “go away,” no matter how hard the depressed person tries to be cheerful. Such depression is usually genetic, or at least physiological, and as such, requires certain drugs to combat. Talk therapy (as with a councilor or psychologist) can help, but typically only once the underlying chemical problem is dealt with; the therapy seems to be in the role of cleaning up the aftermath of life-long pain, rather than that of a primary cure (in most cases).
There are many drugs that try to treat depression, including SSRIs (Prozac and others), tricyclic antidepressants (like Tryptomer), SNRIs, NDRIs, and about a dozen other categories. Often, taking a dose of antidepressants won’t help, and such drugs must be combined with other types of medicine, such as atypical antipsychotics, which sometimes function as “enhancers” to whatever else is already being used. Most people with severe clinical depression (like myself) are saddled with taking 6 or more psychiatric drugs every day, for life, only to find that after a while, the drugs cease working and make the depression worse, instead of better. To top it all off, nearly all psychiatric drugs have serious (and sometimes life-threatening) side effects, including major weight changes, chronic fatigue, possible organ damage, sexual dysfunction, endocrine imbalance, and even (counter intuitively) life-threatening depressive episodes.
To be perfectly clear: severe clinical depression is an excruciatingly painful, life-threatening disease. It never goes away, and the pain of it–both mental and physical–can be more than enough to drive a person quite literally insane. It should be no surprise, given this, that many people who have this torturous disease decide that continuing to live in endless, agonizing pain is not a decent prospect. (Those who rail against severely, chronically depressed people who commit or attempt suicide only show their ignorance about how awful the disease is. Of course, I don’t recommend any such attempts, but I can absolutely understand the need to end the pain of living.)
At this point, it’s worth noting that psychiatric drugs are only effective in about 40% of depression patients (according to the numbers I’ve seen). This means that for most people, treatment for depression–while essential–involves a long and drawn-out process of trial-and-error while the doctors scratch their heads and (basically) try random-ish stuff until they find something that seems to work. Those who are familiar with this process become acutely aware that medical professionals have basically no idea why the brain does what it does, or even why psychiatric drugs work when they do. If you don’t believe me, watch a commercial for antidepressant medicine, and listen for phrases like, “it is believed that <drug name> works by…” Even the names of the drugs (e.g. Selective Seratonin Reuptake Inhibitor–SSRI) are purely speculative, since it’s only reasoned that they do what their names imply.
Finally, in order to see if a given treatment regimen will do what the doctors hope it will, one has to take the medicines religiously, for at least one month (sometimes longer), before enough of the drug is in the patient’s system to do anything at all. Of course, at that point the drug will either work (perhaps enough, perhaps not), not work at all, or make the symptoms even worse! Thus, many people with depression eventually (or quickly) decide to give up on treatment and do their best to otherwise not be miserable–or kill themselves.
For completeness, I’ll outline a sample of what such treatment regimens cost. Without insurance, back when I was taking about 8 medicines each day, prescriptions alone (that is, not counting doctor visits) would have cost me upward of $2,000 every month. WITH insurance at a premium of about $470 per month (yes, you read that right–nearly $500 for just me), the co-pays for my prescriptions lingered around $500 per month. So, to be able to take a large number of drugs that kind-of worked sometimes, and made things worse the rest of the time, and which also destroyed parts of my body (and which created very nasty withdrawal symptoms–including shaking, pain, hot and cold flashes, etc.), and to attend doctor visits in order to change the regimen, hoping for better results, I paid around $1,300 every month with insurance in order to attempt to treat my depression.
Eventually, my symptoms (and the economy) caused me to lose my job and be unable to get another one. I therefore was abruptly without medicines (and facing withdrawal), and without income or health insurance of any kind. I’m not entirely sure how I managed to stay alive until I managed to impress upon the government that I needed financial aid. Ultimately, though, I was given disability benefits (SSI and Social Security; don’t ask me why they’re two separate things from the same agency; I don’t understand it), and Medi-Cal.
The New Treatment
Not long ago, my mother showed me an NPR article, online, that outlined a new kind of treatment for depression, using drugs previously thought to be completely unrelated. The article is here:
To summarize, the street drug, “Special K” (ketamine–a schedule 3 pain reliever) has been in common use as a “self-medicating” drug amongst those with depression. Of course, ketamine has some powerful and potentially harmful side effects, including addiction, so it’s not ideal–especially for self-administration.
Researchers of depression eventually took notice of this and conducted some trials. It was soon found that ketamine can, indeed, relieve depression better than any of the other drugs commonly used for this illness, and a whole lot faster, too. Patients reported remarkable changes to their mood within hours or days, rather than months, and it proved highly effective in treating cases that had been resistant to all other treatments. Soon, it was discovered that Riluzole (used to treat Lou Gehrig’s Disease) and Scopolamine (for motion sickness and surgical nausea) also worked just as well, and weren’t nearly as dangerous. Patients who underwent these treatments reported lasting, remarkable improvements in their moods, and the sudden ability to start doing the things they loved and needed to do. It should be noted that Riluzole and Scopolamine both have potential side effects, but that their side effects are pretty manageable, compared with ketamine, or depression, itself. (If you’re interested, this relief seems to be a result of increasing the level of glutamate in the brain, so theoretically, any drug that does this, like those above, may provide a like benefit.)
So, shortly after reading this article, I asked my doctor (a physician’s assistant, technically) to look into prescribing me one of these drugs. After a week of looking into it, he prescribed me Scopolamine patches (transdermal, 1.5mg), and told me to discontinue use and contact him if I experienced mania, deliriousness, excessive fatigue, hallucinations, very severe dry mouth, major dizziness or other symptoms. Of course, all but fatigue, dizziness, and dry mouth are very rare, and only tend to surface among those with a predisposition for them (e.g. those with bipolar disorder, schizophrenia, etc.), but the responsible thing was to warn me, so he did so. As it turns out, the biggest symptom I have from it is dry mouth (which is a bit irritating to my asthma, but not unmanageably so), and I mitigate it with sugar-free chewing gum. I do sometimes get tired for no apparent reason, but it’s rare, and since my depression made me exhausted nearly all the time (I also happen to have fibromyalgia, which the treatment is also helping me against), I’m overall a lot more energetic than I’ve been in years. More than that, I’ve been able to renew my interest in music (guitar, theory, and composition), creative and philosophical writing (as evidenced…), learning about various sciences (including electronic theory), designing a RPG gaming system and campaign setting, etc. All in all, this has been an amazing improvement to my quality of life.
I still don’t feel well enough to work reliably (partly, I think, because the Scopolamine patch only comes in one dose, and I don’t think it’s large enough), and as such, it’s unlikely that I’ll be able to earn my own living at any time in the foreseeable future, but I’m now able to volunteer a bit in answering Linux-related questions, teaching music theory, and other things that I deem to be of at least some benefit to society. In short, I no longer feel like quite so much of an outcast. Maybe someday, I’ll find a way to fully and truly re-join society and the workforce thereof, but in the meantime, I’m at least not in much pain–which is a major step in the right direction.
If you or someone you know has been struggling with a “resilient” case of depression (or fibromyalgia), please feel free to contact me via this blog. It’s possible that I’ll be able to get my doctor to send over some anonymized data to the acting health professional, so that he/she can make a better assessment on whether such a treatment would work well in your case. Several medical professionals where I live have taken an interest in this new treatment as a result of my using it, and I expect that it can help a lot of people, if only those in charge of health care were to learn about it.
One final note: Scopolamine (and Riluzole) aren’t cheap. Scopolamine comes in packs of 4 patches (3 days of use, each), and each pack costs between $50 and $75 (usually $75, depending on where you buy them). Thus, one ends up paying that amount every 12 days. My doctor was able to get Medi-Cal to pay for them, so now I get them at no charge (thank goodness!); otherwise, I wouldn’t have been able to afford more than the first couple weeks’ worth. So, if your insurance doesn’t pay for it, initially, bug them until they do! Medi-Cal’s authorization process seems to work based on flipping a coin, so if at first you don’t succeed, a good strategy is to have your doctor give you another (conventional) drug to try, and then, when it doesn’t work, re-apply for the authorization, citing that the latest treatment was also inneffective, and that you therefore “really do need Scopolamine (or Riluzole).” Rinse and repeat.