The two-time cancer survivor enlists the help of a psychologist for a reader from North Carolina
I have always been a sucker for Meg Ryan romantic comedies, psychics, the Magic 8 Ball, The Steve Harvey Show and for reading old “Dear Abby” posts. I realized the common thread in all of that is someone or something that gives you guidance on what to do, where to go or how to find your way when you feel you are lost.
Over the past three weeks I have been trying to engage a powerhouse of experts to be part of a cool twist on the advice column format. I love answering questions and giving advice on everything from how to fight through your illness to dating and relationships. However, I am in not a doctor, so I thought about creating a powerhouse group of experts – doctors, lawyers, accountants etc. – so that when a question is asked that’s beyond my reach, one of these experts could jump in and provide professional answers … without an appointment!
This leads me to an email I received last week (at AskDiem@MedGift.com) from a woman who called herself “Suffering Mama” in North Carolina. I was so moved by her words but I was at a loss on how I could help her. So I called Manhattan psychologist Dr. Joseph Cilona to see if he could help. And, boy, did he ever!
Here’s her story, and Dr. Cilona’s amazing insight.
I’ve been suffering from really deep depression lately. I’ve always suffered but not this bad. I have trouble getting up, staying up, and have gained 60 pounds in the last two years. In those two years I had several surgeries that finally led to a complete hysterectomy. Then I had to have knee surgery. I’m only 36 years old and I can’t find anything that can help me get better. I have a 9-year-old little girl that basically sees her mom sad and unhappy all day, everyday. My question to begin with is, am I doing the right thing by taking the antidepressants, mood stabilizers and all the other handfuls of meds? They don’t help. Nothing helps. What do I try next?
Suffering Mama, N.C.
Dear Suffering Mama,
I’m sorry to hear you have been having such a tough time. I have some concerns about your current treatment, particularly about the medications you are taking for psychiatric symptoms. I would strongly recommend that you go to a psychiatrist for management of the medications, if you’re not seeing one already. Your psychiatric medications should not be prescribed by a general practitioner or by any other physician that is not a psychiatrist.
Even if a psychiatrist is prescribing your psychiatric medications, it sounds like you should definitely seek out at least one, and ideally two other opinions. Antidepressants can be very helpful for some people, but not for everyone. Some research indicates that they only help about half of the people who take them. It often requires dosage adjustments over time and trying out different medications to find what works for a specific individual.
If you’re taking antidepressants and your symptoms are persisting for more than two to three months without any improvement, the prescribing physician should be making adjustments or changes over time until something works, or take you off the medications. They should also be keeping very close watch on how the medications are impacting your symptoms, and any side effects. This often means more frequent visits until your symptoms start to subside (not just once a month or even less frequently), and they should also be asking you a lot of detailed questions about the severity of your symptoms and any side effects. If this is not happening, I would strongly encourage you to find another doctor.
In addition, because of your hysterectomy, it’s very important to get a full workup by an endocrinologist as hormonal changes can very often trigger or exacerbate clinical depression. If you’re seeing one already for any hormone replacement therapy, be sure they know about the depressive symptoms, and again, seek out several other options and consider the recommendations carefully. Also, be sure that all of your treatment providers are in communication with each other.
I’m not sure if you are in therapy or have been in the past, but given the severity of your symptoms and the length of time they have persisted, I would strongly encourage you to think about therapy. Medications address the symptoms you’re having, but not the underlying causes.
Working with a therapist you can also learn other strategies to help manage your symptoms in addition to the medications, and you can also work with a therapist on how to address your daughter’s needs while you’re going through this tough time. For example, it’s very important to explain to your daughter in age-appropriate language that you’re not feeling like yourself, and that you are talking to doctors to help you feel better.
Finally, there is one simple and powerful thing you can do to help yourself feel better quickly, and that’s exercise. Cardio has very immediate and powerful antidepressant effects. I understand that there are days when you are having a tough time finding the energy to get out of bed, and the thought of exercise might be very challenging, but it doesn’t take much to help make you feel better quickly.
This is what you need to do to get the antidepressant effects of cardio: Determine what the target heart rate zone is for someone your age. There is a chart on most treadmills that will tell you this, or do a quick Google search. Then start getting your heart rate up. You need to maintain your heart rate in the target zone for 20 to 25 minutes to get the antidepressant effects of cardio. If you do this three times a week, you will quickly feel an improvement in your mood symptoms.
If you’re unable to do the cardio in this way, try to work up to it. Even a walk will help a little, and any amount of cardio will have some benefits. Don’t worry if you have trouble. Just do what you can. Any amount of exercise will be helpful.
Don’t lose hope or think you’ll always feel the way you’re feeling. Depression can be extremely difficult and challenging, but it is treatable and you can feel better.
After reading Dr. Cilona’s advice to Suffering Mama I asked psychotherapist Dr. Karen Ruskin where people reading this could find a therapist without breaking the bank and – voila! – she came through with this gem of knowledge:
“Mental Health America provides links to where she can get affordable care in her area, whether she has insurance that covers it or not.”
I’m really excited about this 3.0 version advice column. If you have questions for any of the experts on this panel or myself please email me at AskDiem@medgift.com, subject line “Ask Diem.”