Between 5% and 10% of people in the United States will, at some point in their life, have a bout with depression severe enough to be of clinical significance.
It is estimated that only a third of all those who are clinically depressed receive adequate treatment. It is not unusual for a therapist, or physician, to recommend a trial on an anti-depressant medication when a patient first reports the symptoms of depression. Some doctors and therapists prefer a trial of psychotherapy first. Sometimes talk therapy is all that is needed to alleviate depression. However, antidepressant drugs take three to six weeks to “work,” so it is often prudent to start the medication at the same time as you start psychotherapy. The longer you put it off, the longer you’ll have to wait for results.
Antidepressants such as Prozac, Zoloft, Paxil, Celexa, Serzone, Effexor, Lexapro and others work in a rather elegant fashion because they actually don’t add anything to the brain chemistry to achieve the positive mood changes. What they do is improve the way that brain receptors (neurotransmitters) process crucial brain chemicals, most notably serotonin. The medication, when it works, essentially “readjusts” the way the brain functions back to its optimal condition. Wellbutrin works in a different way but is equally effective.
It shouldn’t be too difficult to determine if you’re depressed; but even your physician may have missed it. In part this is because you didn’t mention it during your last physical, but also largely because he or she didn’t ask the three questions all physicians are being admonished to ask by their professional organizations:
In the past year have you had two weeks during which time you felt sad, blue or depressed; or when you lost all pleasure in things you usually cared about or enjoyed?
Have you had two or more years in your life when you felt depressed or sad most days, even if you had some periods when you felt okay?
Have you felt depressed or sad much of the time in the past year? (Questions validated through the University of Arkansas for Medical Sciences.)
Although not validated through studies yet, a fourth question should be asked, particularly of men who may not recognize, or admit to the other symptoms. That is: have you been or had others tell you that you seem depressed or are more irritable than you used to be?
There are many more thorough scales for evaluating the level of depression and making a more precise diagnosis, but I like a simple list devised by Michael J. Norden, M.D. He calls it Apes Swim. I’ve adapted it added a second “I” and a third “S”. Here it is:
Appetite – recent weight gain or loss, eating too much or too little
Psychomotor (moving your body) problems, i.e., lethargic or jittery
Energy loss, fatigue, tired, not feeling like doing anything
Sleep: too much or too little, unable to fall asleep, waking in middle of night and not being able to fall back asleep;
Suicidal ideas or thoughts, preoccupied with deaths or ways to kill yourself, frequently thinking life isn’t worth living, and
Self-medicating with alcohol. Taking alcohol, a central nervous system depressant, to combat depression, is a common but self-defeating way to handle depression.
Worthless feelings, feeling excessive or irrational guilt (guilt is worthy of it’s own letter but it doesn’t fit in with Apes Swim) – Relevant to cranberry growers: are you blaming yourself for a crisis not of your own making?
Irritability, on edge, blowing up easily, often making life miserable for yourself and family: and Interest in work or pleasure reduced or not there at all
Mental ability lessened, difficulty planning, concentrating or making decisions.
“I don’t even take aspirin” is a common phrase voiced with pride when I bring up the subject of taking anti-depressant medication with many police officers. Without going on an unnecessary rant, I think we all recognize in ourselves or others the notion that it is a sign of weakness to take medication for what we perceive a psychological problem. Modern medicine has established that mood disorders are caused by biological imbalances in our brain chemistry, which are often due to genetic predisposition’s. Some of us are destined by the nature of our genetic makeup to become depressed no matter what happens in our lives, and others are simply programmed to react with depression when difficult situations arise or after traumatic experiences. The prevalent “anti-medication attitude,” especially about mental health medicines, is a big problem in convincing those in so-called “macho professions” like law enforcement to give anti-depressant medication a try.
My own family doctor tells me he’s found one way around this problem with these depressed patients if they smoke and want to quit. He prescribes Zyban, which cuts down on the craving for nicotine. After a month or so, whether or not they are succeeding in cutting down on cigarettes, he has them back to evaluate how they are feeling. They often report that regardless of their success with smoking cessation, they are feeling better than they have in years. It is then that he reveals that Zyban is exactly the same drug as an effective anti-depressant called Wellbutrin. If there’s one thing that proves you were clinically depressed, it is when an anti-depressant is effective and you and those around you notice a marked improvement in your mood and sometimes your behavior.
Some police officers are willing to give anti-depressants a try, but are concerned about department policies about officers reporting when they are on mental health medication. Tranquilizers (anti-anxiety drugs) may cause sedation and effect reaction time and coordination, and should be used with caution until you know how you react to them Anti-depressants rarely have such side effects. It is understandable why a police chief would be concerned about sending an officer onto the street when he or she has just started to take a medication like Valium, Klonopin or Xanax. But these drugs are used for anxiety, and not for depression. Anti-depressant drugs have been used safely for decades, and there is no medical reason why officers shouldn’t be unable to perform at their usual levels when taking them.
What do you do if you want to try an anti-depressant and your department has a formal policy that you must report when you are prescribed a mental health drug? My answer when confronted with this situation has been to help clients make a judgment as to whether they trust their superiors to be both fair and scientific in reaching a conclusion about whether taking this medication would impair job performance.
Unfortunately, departmental policies are sometimes rooted in ignorance and prejudice. It is preferable to have an officer on the job whose depression has successfully been relieved than one who is depressed. I don’t think it takes a leap of faith to conclude that there are many officers working today who are depressed, and who could and should be treated with medication.
An officer to who would be expected to report taking Wellbutrin for depression, and for whom this would mean being put on desk duty or worse, could ask his doctor for a prescription for Zyban (the exact same drug as noted above) to help stop smoking instead. I’m not suggesting doing this, but rather I’m using this as an example of how outmoded some department policies are.