Over the years I have frequently compared the illness of depression to the illness of diabetes. I have done this because no one questions the biochemical or physiological basis of diabetes as a medical condition but people often do not see depression in the same biochemical way. I hope this explanation will make this point.
Diabetes has two components. First is the mild type of diabetes. We call this type of diabetes the non-insulin dependent diabetes mellitus (NIDM). This type does not require insulin but can be controlled by one of two factors. It can be controlled by a person taking medicines referred to as oral hypoglycemics which act like insulin in helping the storage of sugar. These are medicines like Glucophage. Secondly, diabetes can be controlled by what I refer to as behavioral interventions. This means there are things the patient can do to bring their blood sugar under control such as restricting sugar intake, going on an American Diabetes Association (ADA) diet or exercising. In most patients either approach will work in reducing the problem. Sometimes both medicine and behavioral intervention is required. Comparatively speaking, this form of diabetes is mild, can be easily controlled and doesn’t have to become much of a problem.
The second type of diabetes is insulin dependent diabetes mellitus. This is the type of diabetes most people think of when they hear about diabetes. In this type of diabetes, medicine in the form of injected insulin is absolutely essential for the person to be well. Interestingly, however, it is also imperative the patient engage in behavioral interventions which include weight loss and the ADA diet. Here is the interesting fact: If a patient does one of these components without the other, they remain ill. So, for example, if a person watches their insulin perfectly, giving the right units at the right time, but continues to eat Hostess Twinkies, they will be sick. Similarly, if the patient loses weight, exercises and eats a perfect 1600 calorie ADA diet but doesn’t take insulin, they will still be sick. In order for the person to reach maximum improvement, it is necessary to perform both components, medicine and behavioral intervention, before they can get well.
In many ways, I think depression is almost identical. For example, there is a mild form of depression referred to as the “Oprah Depression.” There are hundreds if not thousands of recommendations made for people with an Oprah Depression. These are the people who get better by reading a book, going to a movie, stopping to smell the flowers, practicing yoga, getting in touch with feelings, expressing feelings, journaling, self-affirmation and similar recommendations. There is nothing wrong with these behavioral interventions and they do work... when used with a mild depression. Just like with the mild type of diabetes, sometimes medicine is used and can be quite effective.
Most of the depressions I see, however, are like the insulin dependent diabetes in which medicine and behavioral interventions are necessary. There are some patients lucky enough that all they have to do is take an antidepressant and the depression essentially resolves. In this day and age it is rare for me to see that type of depression in my office as the primary care physicians are generally good at assessing depression and will catch and effectively treat depressions for which medication alone will resolve the depression. In most cases of depression I see, a combination of both medication and behavioral intervention is required. If a person takes their medication but continues to argue with their spouse, drink heavily, not spend time with family, always comments on the things they don’t like in a relationship but never on the things they do, or a million other items, the depression will not get better. Similarly, there appear to be depressions in which one does the appropriate interventions, but doesn’t take the medication; then they too will not get better.
In summary:There are some depressions which can simply be treated with either medication or some behavioral interventions. However, the majority of depressions require a combination of both treatment modalities. When both are working, the patient can expect the maximum benefit from their treatment.
Robert Sammons, M.D., Ph.D.
Mesa Behavioral Medicine
Co-Founder & Medical Director - TMS Solutions
If you or a loved one are depressed; if current treatment isn't giving the desired outcome or quality of life, you may be a candidate for TMS Therapy for the treatment of depression. Check out the "About TMS Therapy" page and other resources at www.tmssolutions.com
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