Spreading Hope!

By Matt Goldenberg D.O.
@docgoldenberg 
“You treat a disease, you win, you lose. You treat a person, I guarantee you, you'll win, no matter what the outcome.” 

I whole-heartedly agree with that statement. However, I cannot take credit for those words. Those are the words of Robin Williams, or more specifically, the words of his character in Patch Adams.

I want to discuss the disease called depression. I will start by first discussing the diagnosis and the signs and symptoms of depression. I will then follow up with my thoughts on the various treatment options for depression and the strategies I employ with my patients to improve their outcomes. None of my thoughts and suggestions should serve in place of a formal consultation with a mental healthcare provider. However, I hope shedding light on mental health diagnoses like depression will lift the veil and social stigma on these chronic diseases that impact so many people.

Psychiatry has come a long way in the last decade. This is a time of continued discovery and increasing public awareness. The leaders of our professional organization, the American Psychiatric Association (APA), have suggested that we as mental health professionals are under a microscope. I agree that we are and I also strongly believe that we are up for the challenge. School shootings and celebrity suicides and overdoses have increasingly put a focus on mental health. Psychiatry has significantly improved the outcomes, treatment options and the prognosis of patients with mental illness. However, we still are unable to decrease the prevalence of the diseases we treat or prevent them. We know that the brain changes during an episode of depression and our treatments help it to return to normal (see the image below). Although we are getting closer, we still currently do not have widely accessible blood or imaging tests that can confirm our diagnosis or localize the area of disease.

I can say with certainty, however, we are able to accurately diagnose patients. We are able to identify medications, psychotherapies and other treatments that patients with a specific diagnosis or cluster of signs and symptoms often benefit from. There is strong evidence that our treatments decrease symptomatology and disability and improve quality of life, clinical outcomes and a patient’s prognosis.

Psychiatrists are trained to view the patient as a “whole person”. Psychiatry is a field of medicine whose assessment by definition includes all of the biological, psychological and social aspects of a patient’s life. We listen for the psychological and social factors that can contribute to disease. Oftentimes, the “whole story” can be more telling than only focusing on specific symptoms of a given disease. There is a saying, throughout all fields of medicine, that “most patients have not read the textbook.” In other words, patients usually do not present exactly as the textbook says they should. Stress and psychological factors can mimic chest pain, shortness of breath, gastrointestinal problems and a whole host of other diseases. If we do not step back and get the whole story, we can miss the root cause or the exacerbating factors of many manageable diseases which are of the mind.

Many of the diseases we treat, such as depression, are chronic illnesses which require lifelong treatment. Our treatments can improve a patient’s mental health and coping skills and decrease their symptomatology and substance use. We know through decades of research that these are modifiable risk factors for suicide. Therefore, Psychiatrists have the training and tools necessary to decrease a patient’s risk of attempting suicide. Our treatments have the potential to not only significantly improve the lives of our patients, but also the lives of their families and everyone who comes into contact with them. Anyone who tells you otherwise is misleading, misinformed or both.

I hope this information and the blogs to follow will give you hope. Mental illness can include symptoms which can be devastating and complications which can be life-threatening. However, it is important to state again, these are treatable diseases. If you or someone you know, would like to talk to someone, call your primary care doctor or your insurance company for a referral to a Psychiatrist. A true multi-disciplinary team also includes therapists, psychologists, nurses and social workers. You are never alone. You can call the national suicide helpline 24 hours a day, seven days a week (1-800-273-TALK (8255) or visit www.suicidepreventionlifeline.org). There are also local crisis lines likely available in your area and are an internet search away. If you are ever feeling unsafe, or fearing for the safety of a loved one, you can call 911 or go to the nearest emergency department.

It is time for everyone to understand that there is no shame in getting help for depression, much as there is no shame in getting help with diabetes or high cholesterol. Even if you have never suffered from depression, there is a lot you can learn.

Together we can raise awareness and spread truth and hope. I know that if we spread knowledge, and ignore the misinformation, we will overcome the complacency and ignorance that is so pervasive today. That is how we can best honor those we have lost. That is how we can best prevent the next death from mental illness and addiction.

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