A friend of mine went to the doctor last week, complaining of continuing pain following a back operation. She came out with a script for Effexor. She doesn’t have a history of depression, nor symptoms that would trouble a depression inventory. But she wept during the appointment.

[Added later: The prescription was for treating depression, not part of her pain management strategy.]

In June last year the well known Lancet journal published a review of studies on GPs diagnosing depression. The review included 42 past studies and over 50,000 patients. It found that GPs correctly diagnosed depression in less than half of all cases, and incorrectly diagnosed it in 19% of the healthy patients.

What’s going wrong?

I have personal experience too. I was diagnosed with depression by my GP in 2001. He recommended treatment with an anti-depressant. “They’re all pretty much the same” he said, “and I’ve got some samples. I haven’t tried this one in a while – let’s give it a go!” For the briefest of moments I admired his Lilly rep.

2 years later I had my treatment reviewed by a psychiatrist, who picked bipolar very quickly. Not only was my treatment wrong, but for 2 years I was taking drugs at a sub-therapeutic level. As many of you know from hard experience, an extra 2 years of mental illness is a big loss. I still grieve those years. How I wish my doctor had referred me.

And my relative? Her specialist sorted it out quick smart. Her pain and cholesterol drugs were interacting.

There are so many problems in our health systems and I don’t pretend to know any answers. But GPs are on the front-line of psychiatric care, and it’s not about to change. Less than 50% is poor when people have lives to live. Somehow the bar has to be raised.

Your thoughts?

Yes!

If you don’t mind a laugh at the expense of Big Pharma, then a post by Vaughan at Mind Hacks is worth a look.

Havitol has my vote. “The first and only treatment for Dysphoric Social Attention Consumption Deficit Anxiety Disorder. When more is not enough.”

As for any blockbuster drug, Havitol has it’s own website, complete with online store and merchandise. On another site a very satisfied customer gives her testimony.

Read more at Mind Hacks.

The study hits on some home truths for me. After being diagnosed with depression by my family doctor, I spent two or three years trying different anti-depressants without success. It was an awful period of my life. My doctor labelled me “treatment resistant” and explained that the medicines were “pooping out”.

After persevering for far too long I decided to see a psychiatrist. Not more than a few minutes into my first appointment with him, he said that “poop-out” doesn’t really exist. What appears to be “poop-out”, he explained, is more likely the result of incorrect diagnosis and inappropriate treatment. He was on the mark. His diagnosis of my illness was bipolar disorder not depression, and I enjoyed a significant improvement in health following appropriate changes to my medications.

The conclusion of the study is that people with bipolar disorder that are misdiagnosed as having major depression have a poorer quality of life than those with correctly diagnosed major depression or bipolar disorder. This makes sense to me. If the diagnosis is wrong then the treatment can be ineffective, or even counterproductive. Over time a person’s frustration and sense of hopelessness will only increase as the prospects for getting better appear to be vanishing.

It’s an important fact that bipolar disorder is hard to diagnose. The average length of time from onset to correct diagnosis is over 10 years and perhaps as high as 15. It was more than 10 years for me, and it never occurred to me once that I had bipolar. That is, until after diagnosis when my wife and I scrutinised my past behavior. Hypomania, which is more common than mania, can be hard to detect, especially if you aren’t on the lookout for it.

What to look out for? The symptoms of hypomania are many and varied, but some of the common ones are racing thoughts, a reduced need for sleep, increased energy, inflated self esteem, lack of concentration, an excessive sense of well-being and reckless behaviour. I have experienced all of these. Often the person with hypomania will enjoy their symptoms, as will their partners when they renovate the house while everyone is asleep. Unfortunately what goes up tends to come back down, and in my experience hypomania can spiral out of control and end badly.

The conclusion to this? If you are suffering from severe depression, but you aren’t making progress with your treatment, then it may be worth your while to have a second opinion. You might also think about whether you’ve had exuberant periods in your life as well as depression.

Research from Eli Lilly and Company (NYSE: LLY) has demonstrated that up to 17% of dogs in the U.S. are suffering from separation anxiety.

What?

That’s nearly one in every five dogs in your street, burdened with a debilitating mental disorder. Or two dogs for every person in your street who has depression. Now that’s an impressive market.

Where there’s a problem the forces of supply and demand will find a solution, and this is the void into which Lilly stepped with its anti-depressant drug Reconcile (or Prozac by any other name). As a first foray into pet-pharmaceuticals, Reconcile followed hot on the heels of Pfizer’s diet drug Slentrol launched earlier in the year.

Lilly’s companion-animal division is now poring through the molecules in its library of compounds, looking for other streams of income from this undeveloped market.

Some quotes that I’ve read:

“Dogs affected may bark, chew household items, or urinate in inappropriate locations when left alone”.

“Anxiety may cause the dog to engage in inappropriate behavior, such as destruction, excess vocalization and inappropriate elimination.”

Our kids do the same if we neglect them for long enough.

‘My animal is a member of the family, and I am willing to pay the cost of drugs that were developed for humans.’

So what is your view? Is a dog more likely to need an SSRI or a long walk and some love and attention?

For a more thought-provoking post:
http://www.furiousseasons.com

For a satirical look:

http://ahrp.blogspot.com

http://www.cbc.ca/ (scroll down to “Pet Prozac”)

For lots of airbrushed dogs on the Lilly pet site:
http://www.lillypet.com/

It is important to remember, when working through a resource list like this, that some things may work for you and others may not – a treatment for depression should start with professional help. Irrespective of this, it’s important to be involved in learning about your illness, including the treatments available. It seems that those who actively participate in their treatments have the most success in maintaining good health. Good luck!

THE BIG PICTURE

Large Website Resources
National Institute of Mental Health
National Alliance on Mental Illness
Medline Plus
MayoClinic.com
Blackdog Institute

Comprehensive PDF publications
National Institute of Mental Health
Mental Health Foundation – Dealing with Depression
HereToHelp – Depression Toolkit
Understanding Major Depression and Recovery

PDF Fact Sheets
Mind (National Association for Mental Health)
National Institute of Mental Health
SANE Australia
Black Dog Institute
Beyond Blue

Staying Well Plans
National Mental Health Information Center – Self-Help Guide
SANE Australia – Mental Illness and Keeping Well
Black Dog Institute – Ways of Staying Well
Sarah Russell – “Staying well with bipolar disorder”
(5th article from the top. Very applicable to depression.)

EVERYDAY LIFE

Exercise
MayoClinic.com – Depression and Exercise
Better Health – Depression and Exercise
MIND – The Mind Guide to Physical Activity
Mental Health Foundation UK – Up and Running!

Food
Mental Health Foundation – Healthy Eating and Depression
MIND – The Mind Guide to Food and Mood
MyPyramid.gov – Healthy Diet Plan

Stress Management and Relaxation
MIND – The Mind Guide to Managing Stress
MIND – The Mind Guide to Relaxation
Families for Depression Awareness – Coping With Stress

Sleep
HelpGuide – Tips for a Good Night Sleep
National Sleep Foundation – All About Sleep

TRUSTED BOOKS (links to Amazon)

Dealing with Depression: A Commonsense Guide to Mood Disorders

Living Well with Depression and Bipolar Disorder: What Your Doctor Doesn’t Tell You…That You Need to Know (Living Well)

The Relaxation & Stress Reduction Workbook

A Lifelong Journey: Staying Well With Manic Depression/bipolar Disorder

Loving Someone With Bipolar Disorder

PHYSICAL TREATMENTS

Medicines
National Alliance on Mental Illness – Information on Specific Medicines
Drug Digest – Information on Specific Medicines
National Institute of Mental Health – Detailed Information on Types of Medicines
Beyond Blue – Brief Introduction to Types of Medicines
MayoClinic – Brief but Helpful video on Understanding Antidepressants

Electroconvulsive therapy
MayoClinic.com Overview
MayoClinic.com Video
infrapsych

Vagus Nerve Stimulation
MayoClinic.com – VNS: A New Depression Treatment Option

Transcranial magnetic stimulation
National Alliance on Mental Illness – TMS
MayoClinic.com – TMS: An experimental depression treatment

PSYCHOLOGICAL TREATMENTS

Overview
APA – How Psychotherapy Helps People Recover From Depression
APA – How to Find Help Through Psychotherapy
Mental Health Foundation – We Need to Talk PDF

Cognitive Behavior Therapy (CBT)
National Alliance on Mental Illness – About CBT Treatments
National Association of Cognitive-Behavioral Therapists
MoodGym program – free online CBT course
Living Life to the Full – free online CBT course
liveandworkwell.com – Steps to Change: free online CBT course

ALTERNATIVE, COMPLEMENTARY AND SELF-HELP TREATMENTS

Overview
Healthy Place
National Mental Health Information Center
New Hope – Natural Remedies for Depression
Introduction to Dietary Supplements

Bibliotherapy
Holistic Online – Bibliotherapy

Omega-3
Medline Plus
Black Dog Institute – The Role of Omega-3 Fatty Acids as a Treatment for Bipolar Disorder
(Online presentation also applicable to unipolar depression)

Vitamin B6
National Institute of Health – Dietary Supplement Fact Sheet
Medline Plus

Vitamin B12
National Institute of Health – Dietary Supplement Fact Sheet
Medline Plus

SAMe
Drug Digest – Article on SAM-e

DHEA
Medline Plus – DHEA Overview
MedPage Today – DHEA Effective for Midlife-Onset Depression

Ginkgo Biloba
Medline Plus – Ginkgo Overview
NCCAM – Herbs at a Glance: Ginkgo

St John’s Wort
National Center for Complementary and Alternative Medicine – St John’s Wort
Drug Digest – St John’s Wort

Light therapy
MayoClinic – Seasonal Affective Disorder
PsychEducation.org – Light Therapies for Depression

Yoga
Better Health Channel – General Article on Yoga
The MIND Guide to Yoga

Aromatherapy
Holistic Online – Depression Remedies
Wavelengths Natural Therapy – How to use Aromatherapy for Depression
depression-guide.com – Depression and Aromatherapy

Massage therapy
National Center for Complementary and Alternative Medicine
Medline Massage Therapy Interactive Tutorials

Spirituality
Mental Health Foundation – The Impact of Spirituality on Mental Health

Creative Therapies
American Art Therapy Association
American Music Therapy Association
American Dance Therapy Association

Acupuncture
National Center for Complementary and Alternative Medicine
Acupuncture.com – Depression and the Five Elements

Meditation and Relaxation
National Center for Complementary and Alternative Medicine
MayoClinic online meditation video
MayoClinic Relaxation Techniques

Progressive Relaxation, Guided Imagery and Autogenic Relaxation
Calming.org
McMaster University – Relaxation: Physical and Mental

Ecotherapy
Mind (National Association for Mental Health)

Keep this list expanding! If you have another resource that you’d like to share please add it in the comments.

Firstly, I’ll give you a bit of background.

When my life caved in some years ago, a concerned friend told my wife that I probably had depression. Not long after that, my friend’s diagnosis was confirmed by our family doctor. While admitting that he was lacking in experience, he prescribed one of the older SSRIs, because he “hadn’t tried that one in a while”. He was an excellent, wonderful, gentle, nice doctor, but mental health was a weakness.

Over the next 2 years while under his care I tried a succession of anti-depressants, but with little success. It became apparent that I was “treatment resistant” and the anti-depressants were “pooping out”. I held out little hope for an effective treatment.

Around this time I read a journal article written by a well-known and respected Australian psychiatrist. I was impressed by the article, and there were snippets of information that seemed relevant to my illness. Not backward in being forward, my wife promptly made an appointment to see him, for a treatment review.

Being diagnosed as having bipolar was somewhat of a relief. He told me that I wasn’t treatment resistant, and that he doesn’t believe in “poop out” at all. My treatment just wasn’t suitable for my condition in the first place. (As an aside he noted that the anti-depressant I was taking was prescribed at way below “a therapeutic level”.)

Receiving the correct diagnosis is not a cure-all for getting well, but it certainly is a start. It took me another 2 years of trial and error to find a treatment that was “satisfactory”, I guess. I’d say it’s about 80% to 90% right (so non-medical stay-well strategies play an important part).

Enough about me…but keep in mind that my experience is fairly common.

Should you seek a second opinion?

Seeking a second opinion, or a specialist opinion, for a proposed treatment is very common. It is not an insult to your doctor, and they are very unlikely to receive it in that way. It is normal so don’t feel uneasy.

It makes sense to have a second opinion if you’ve been receiving treatment and you don’t think you’re getting any better. Just be sure to consider whether it’s because the treatment plan is not effective or because you’re not following the treatment plan designed for you.

Another reason to seek a second opinion is if you aren’t comfortable or are dissatisfied with your current health provider.

What do I stand to gain from seeking another opinion?

Here are some clear benefits:

Any cons?

There are benefits with staying with your original health provider and not chopping and changing if you have a long relationship with them and they know your medical history well.

Once you have settled on a treatment make sure that the person treating you gives you a timeframe over which you can expect to see improvements so that you have realistic expectations.