We know most of my friends are still medicated and, the other day, I was concerned when I read an article claiming that most depressive people on daily maintenance medication will have seven major episodes over the arc of their lives.  The demarcation between depressive events was notched as major changes in medication.  Some of my young friends have had only a couple of events.  Some of my older friends are deeper into their modes of seven.

I know the psychiatric community doesn’t like to label disease or suggest that everyone who is majorly depressive will have seven episodes, but it seems like seven is the average.  Some people will have fewer medication changes while others will fall beyond the seven.

I also understand doctors don’t want a young person, facing their first round of medication, to be overwhelmed with the notion that there may be more than two changes.  Withdrawal symptoms can be prolonged and punishing.  Sometimes it takes up to six weeks to even test to see if a new medication is working or not. If not, you start the step-down and ramp-up process all over again.

It must be beneficial, though, on some level, for all patients to realize no medication is a permanent cure-all.  People change, brains change, physiologies change, and there’s no shame in stopping one medication to try another — or two or three until the right fit is found.  Keeping patients in the dark about the spectrum of their depression doesn’t really help them anticipate that things may change in the future and that is not necessarily a bad thing.

There is no shame in being medicated.  Brain chemistry is a tricksy thing to try to divine, and doctors can be just as in the dark as their patients when it comes to predicting the how and what of what will and will not work in particular bodily circumstances.

One must never give up trying to win the dark fight over depression — if you’re on the first level, or passing the seventh — there is always something new and untried waiting to be exampled within, and that’s why it is always important to keep the lines of mood and thoughts open between patient and doctor and friends —  even against the overwhelming world spinning around that sometimes feels heavier, and darker, than it ever really should be.

Posted by David Boles

David Boles was born in Nebraska and his MFA is from Columbia University in the City of New York. He is an Author, Lyricist, Playwright, Publisher, Editor, Actor, Designer, Director, Poet, Producer, and Boodle Boy for print, radio, television, film, the web and the live stage. With more than 50 books in print, David continues to write 2MM words a year. He has authored over 25K articles and published more. Read the Prairie Voice Archive at Boles.com | Buy his books at David Boles Books Writing & Publishing | Earn the world with David Boles University | Get a script doctored at Script Professor | Touch American Sign Language mastery at Hardcore ASL.

29 Comments

  1. It is sad to know that even maintenance medication does not prevent majot episodes. Was there any indication as to external factors triggered the need for change.

    I would also love to know why some people get depressed and why some people can avoid it.

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    1. Well, it seems the longterm effects of medication are destined to eventually wear off. You keep taking the same pill every day to change your brain chemistry and, as you age, or your body changes in other ways, the meds just stop working. Sometimes it’s a quick realization. Sometimes it can take years to realize the depression is back.

      As I understand it, depression tends to run in families and it is really all about how the brain processes information. Chemicals in the brain help determine how that information is filtered and, in some people, that filtering is a little skewed too far into sadness and disconnection.

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  2. So the body becomes immune to the chemicals after a while ……….. a bit like other drugs . I can understand that – I have to change my digestion meds around so it does not get used to them.

    I was wondering if it was nature or nurture – seems that it is probably a mix of the two.

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    1. Yes, it’s sort of a getting used to that you know will one day arrive, and that depresses one even more. Even on medication, it’s still a struggle for many to remain alert and capable. The most common depressive tendency is to want to sleep and be alone.

      Clinical depression is definitely a medical condition and not one of being unloved or ignored.

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      1. Pete had it very badly – thankfully he is doing well at the moment after a changr in medications and a good course of counselling. I dipped into it once and escaped by sheer will and no medications – thankfully. Really love the image.

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        1. Counseling can be a big help — some “old pros” know what’s up and prefer to just self-manage with a change in meds with the help of an MD.

          We all dip into and out of depression — but those with special brains have trouble getting out of it on their own and need a little boost. It isn’t about willpower or “pepping up” or putting on a sunny face. They’re just incapable of shrugging it off and the sad things around them tend to overwhelm them.

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  3. repressed anger, stress and unresolved issues are major problems I am told. I know there is a happy chemical that people can lack or run out of at times ………… seratonin. There is a huge difference between those that dip in and ut and those that never escape.

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    1. Good points all around, Nicola. It can be difficult to find a good way out of the darkness.

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      1. theree is no one way out – each person has to find their own way – sadly some never do

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        1. I think some people have idea they are depressed. They learned to cover it well in childhood and have good survival skills. It’s only when they get out of their genetic circle that they begin to see how other live and behave and question what they once thought was the norm.

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  4. @ David – that sort of answers one of my ponderings – can people be born with depression ?

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    1. As I understand it, the answer is “yes.” Clinical Depression tends to be genetic and runs in families.

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  5. sounds like that should be an avenue for genetic research

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    1. I agree! I believe there is an effort afoot to do that!

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  6. that would be worthy of a nobel prize ………………………..

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  7. Thanks for the reading material

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    1. You are quite welcome! It is a fascinating topic. How do we think? How do we feel? Can we control our minds? Or are they set in motion by genetic predestiny before our first thoughts are formed?

      http://www.webofstories.com/play/53977

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  8. Finding the right medication is extremely difficult, and it is sad that the wrong types bring stress or possible fluctuations in personality to people who are already struggling. I have a friend who went through many trials before finding a solution that did not make him nauseous and/or zombified… and it took him thirty-odd years to get to this point. Unfortunately his family was very hesitant in accepting that his struggle was deeper than simply needing to “cheer up.”

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    1. That’s exactly right, Emily! It can take decades to find medication that works — and it’s often a slurry of many meds, not just a single pill — to bring the person back from the sad mind.

      Few people understand, or even tolerate, the depressed.

      http://goo.gl/brrbf

      As much as I don’t like linking Wikipedia, this is a fascinating list:

      http://en.wikipedia.org/wiki/List_of_people_with_major_depressive_disorder

      You reminded me of my — “No Word for Depression” — article published here in 2008:

      https://bolesblogs.com/2008/10/14/no-word-for-depression/

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      1. Thanks for the wiki list. It’s incredible how many artistic, talented people suffer from depression.

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        1. One of the few places the clinically depressed can find solace is in the Arts. They feel safe there, and not judged, in pretending and creating and they are often able to find similar minds with shared solutions.

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  9. Gordon Davidescu April 22, 2013 at 11:10 pm

    Finding the right medication is important — but also important is always remembering to use it and to not decide that one is above taking it or that one has been cured by some miracle!

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    1. That’s a good point, Gordon. Many depressives reluctantly go on meds, feel better, and think they’re fine now, and they go off their meds when it was the meds that made it all better.

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  10. […] article on Seven Depressions yesterday brought an old friend back in touch who shared with me that he has been suffering from […]

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  11. I think getting the right meds is important and staying on them is key. I think some do go off meds because they feel better and think they can handle things on their own. However, though meds have greatly improved over the years – they do have side effects sometimes even the good effects can be a hinderance to feeling complete in life. It might not be the feeling better that makes people go off their meds, but the not being able to feel at all that may make them stop taking meds.

    In my search for happiness I sat in the car one day at a red light and wondered to my self “what is wrong with me?” My life is good – healthy kids, kind, supportive husband, bills are paid, food to eat – why don’t I feel “HAPPY”? then I realized… This is happiness (all the things I just mentioned) and I thought “It’s so over rated”. Not to be funny or make light about this but I think it was at that moment I realized my brain is just not hard wired for happiness. Well – I could go into more details, but I don’t want to hijack the post…
    FYI though – I have been on and off a few anti depressants since about the age of 15 (30 years) so I’m not trying to say that people just need to accept their unhappiness at all. Depression SUCKS! with meds, counseling, supportive families hopefully people will have more light in their lives than darkness. I urge people to get help if they think they are depressed.

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    1. Excellent comment, thanks!

      You remind me of my “Happiness is Overrated” article —

      https://bolesblogs.com/2005/05/30/happiness-is-overrated/

      — and the “Duty as the Moral Imperative” follow up:

      https://bolesblogs.com/2006/12/06/duty-as-the-moral-imperative/

      I agree with your take on depression being a process. Some people don’t even know they’re depressed because so many people around them are in the same pool.

      Sometimes people think they’re depressed when they’re just experiencing melancholia:

      https://bolesblogs.com/2006/12/22/the-necessity-of-melancholia-and-black-bile/

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  12. […] you are on maintenance medication for depression or your heart or some other long-term illness, one thing you should always be aware of when taking […]

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  13. […] 22, 2013 — Seven Depressions — was a special article because I never before realized there was a predictable genetic code […]

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