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Depression Should Be Treated As Any Other Chronic Illness


“I guess it’s true when people say, ‘You don’t know what’s it like to have a mental illness,’” said the voice on the other end of the phone. “It’s like, we’re all depressed, but I’ve got fucking work to do, you know? I would love to lay in bed for three weeks but that alarm goes off and I have to go to work.”

This is the problem when it comes dealing with depression and other mental illnesses. We’ve taken to using “depressed” when we mean sad or “anxious” when we’re just stressed out. So when somebody is actually depressed, especially as men, we are so quick to say something like, “Sack up, be a man, and pull your shit together.”

I used to say stuff like that too, and it almost killed me.

I’ve been in treatment for depression and anxiety for 13 years now. Most of that time, I’ve been under the care of a psychiatrist, who both provided therapy and managed my medication regimen. But for some of that time, including the last couple of years, my treatment has been managed by my primary care physician. You know, my regular doctor.

And for many of the 8 million people who seek treatment for depression from their primary care physicians, they may not be getting the care they need. Often, primary care doctors don’t discuss with their patients how to manage their treatment, and don’t provide the follow up care that they need to see how effective the treatment is (or, often, isn’t). This is especially important because there is a shortage of mental health providers that is profound in many areas.

I experienced this firsthand when I moved with my family to Tennessee and struggled to get an appointment with a psychiatrist. In my two previous homes, San Francisco and New Haven, CT, I had no problem finding a specialist. Here, I called and left messages with four practices’ answering services that were listed on my insurance company’s website; one of them called me back. The earliest appointment available was in two months.

During that time, my depression was worsening. I did everything I could not to leave the house, waiting for everyone else to leave so I could crawl back in bed and try to nap because I was exhausted from not sleeping well the night before. When I did go into the small office I rented downtown, I would curl up under my desk, moving away the empty Jimmy John’s bags (I also gained a ton of weight) to make room on the floor so I could lie there. My wife surprised me one afternoon and was shocked by the scene. I sat there, finishing up my conference call, humiliated while she cleaned up the trash.

I’m lucky, because I have good insurance and resources and a support structure; and even then, I almost didn’t make it: months later, after my new treatment regimen was in place, I was going through some files on my computer and found a suicide note I must have written in a black out because I have no memory of having written it. But there it was, evidence of my deep despondency.

The facility I initially received care at is the kind of place whose literature bullet points their mission, including addiction recovery services, but also jail re-entry, sex offender treatment, and federal probation mental health services. All of these are vital, of course, but it also deepened my alienation to my new surroundings, it making me uncomfortable to be in a crowded waiting room full of desperate people, some of them coerced by the law into being there. Then of course, I felt guilty, because I was desperate: desperate for relief, and understanding, and a way out of my suffering that didn’t involve dying. And I did get that relief and understanding: I was diagnosed with Bipolar II, and prescribed Seroquel XR. It changed my life.

I saw a psychiatric nurse once a month to ask how my new medication was working, and an earnest social worker for therapy who was full of practical advice but didn’t seem to know what to make of me, since I had no court orders or urine tests to discuss. And because they were understaffed and overwhelmed, it took a long time for a callback if I had questions about my medications, like when I was going through Zoloft withdrawals, which left me dizzy and nauseated.

Eventually I had my regular doctor take over, and I’m fortunate that he does follow up with me regularly and is available for consultations if I need them. He also referred me to a therapist who I worked with for six months, and specialized in Cognitive Behavior Therapy, which taught me to recognize my anxiety triggers, and to recognize when I’m entering a depressive episode so that I can work through it without getting overwhelmed.

But when people say stuff like, “Everybody’s depressed,” it just shows how far we have to go. Everybody is not depressed. Some people are just sad. Depression is a clinical diagnosis, characterized by disturbed sleep, loss of interest and enjoyment in usual activities, reduced energy and decreased activity, ideas of guilt and unworthiness, and suicidal ideation. I was able to fake it with people I didn’t see every day, but each of those encounters left me even more exhausted and wishing it would just end. I often fantasized, while lying in bed not able to sleep, that I maybe if I could just get to sleep, I wouldn’t wake up, and it would be over. I have a beautiful, successful wife who loves me, two daughters who adore, but even so I found myself wishing, as Allie Brosh puts it so perfectly, “that nothing loved me so I wouldn’t feel obligated to keep existing.”

Saying “I wish I could stay in bed for three weeks, but the alarm goes off,”  implies that we’re lazy, and faking our depression to avoid work or responsibilities. This is what stigma looks like. It prevents people from seeking treatment because we’re embarrassed, and we don’t feel like we’ll be taken seriously. Could you imagine saying to someone with cancer, “Oh you’re just making that up because you don’t want to get out of bed.” Of course not. It’s ridiculous and insulting.

I’m lucky in that I have the resources and support to get help. Not everyone is in the same privileged position I am, and until we recognize that depression and anxiety and bipolar disorder are real and treat them like the chronic medical issues they are, many people will continue to suffer silently.

How do you manage your mental health? Let us know in the comments. And if you’re hurting, there’s hope.

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