September is Suicide Prevention Month.
When I got online to do some research for this post I was astonished when I looked at the statistics for suicide. It is #2 cause of deaths in those 10-19 years of age, second only to accidents.
My “day-job” is in healthcare. I’ve been a nurse practitioner for 18+ years, and I’ve treated everything from diabetes, hypertension, Crohn’s disease, hepatitis C, and HIV and a slew of other medical diseases, including depression.
Depression is not a weakness or a failing on the part of an individual, and yet I hear patients tell me ALL THE TIME that they are “fine” or “managing” when they are presenting to my office with gastrointestinal symptoms secondary to the biochemistry of depression.
I remember sitting in my pharmacology class in grad school and hearing a psychiatrist tell us that if we worked in gastroenterology that more than 70% of what we’d see would be secondary to depression and anxiety. I remember thinking WHAT? He was right.
But the conversation I want to have today is about how we TALK about depression.
If you, or someone you loved, had the flu, or hypothyroidism, or diabetes, or—heaven forbid—cancer, you would NEVER tell them “be stronger”, or “work through it”, or “fake it til you make it”.
Now, disclaimer, I’m not talking about dysphoria here which is a depressed mood or bad day (or two).
I’m talking depression which has gone on for weeks and is bad enough to affect activities of daily living. I’m talking depression that has altered your weight, changed your appetite, affected your sleep, robbed you of the pleasure of things you normally love (anhedonia), and makes you feel like you’re worthless. I’m talking about depression—that will change the chemicals in your brain such that harming yourself seems reasonable, desirable, or even a mercy to you and/or your loved ones. In medicine we call this suicidal ideation. When depression is evaluated the provider should always ask if there is suicidal ideation and if yes, if the patient has a plan, and if yes, if the patient has the intent to move forward on the plan. Suicidal ideation—with plan and intent—is a medical emergency, just like diabetic coma. I have called 911 for suicidal ideation more times than I care to count.
Depression is no more under an individual’s control than ANY other disease. Are there things you can do for it—absolutely. And not all treatments are drugs. But just like you would tell an individual with diabetes to take their insulin, or a person with hypothyroidism to take their synthroid (levothyroxine), an individual with depression is MISSING a VITAL chemical messenger in their body. And just like the previous mentioned diseases, the individual needs to be willing to adhere to treatment. But in the case of depression, there is a double whammy—because their cognitive ability is affected.
And depression can be a symptom as well as problem in its own right. We know chronic disease increases the risk for depression. Depression is a symptom of hypothyroidism. Chronic steroid use often induces depression, as does stress (probably because chronic stress forces our adrenal glands to pump out cortisol-a steroid).
It’s too late to make this a short post—but I don’t believe a short post could’ve said everything I wanted to anyway.
If you, or someone you love, is suffering with depression, please seek help.
I would say the same thing about ANY medical disease—and the healthcare profession has spent too many years talking about “mental” health as if it were separate, instead of embracing the fact that physical health encompasses mental health—it is all part of the “whole” health of an individual.
Take care of you. Take care of those you love—reach out, be honest, ask questions, and if you know someone needs help—please help.
But at the end of the day, I remind myself, I can only control me, and hence I am only responsible for the decisions I’ve made. You can’t force someone to adhere to their medication, their exercise, their diet, or anything else—so don’t beat up on yourself for the choices of others—and since you can’t change the past, don’t bother with beating up on yourself either. If you need better coping skills, see a counselor—that’s their job: to teach YOU or your loved ones better skills.
Disclaimer: this post is not meant to diagnose or treat any medical condition, but is merely my opinion.
If you or someone you love is suffering with depression, please seek professional help.
Suicide Prevention Lifeline: https://suicidepreventionlifeline.org/
Society for the Prevention of Teen Suicide: https://www.sptsusa.org/not-my-kid/
The Trevor Project: Crisis Counseling for LGBTQI+ youth: https://www.thetrevorproject.org