“Refractory Depression, or Bipolar Disorder?”
My adventure in the world of psychiatry began in 1996. After feeling suicidal several times (although I had felt that way periodically, all my life), I called my doctor and reported that I thought I had clinical depression. After a visit, he confirmed this, and I started both my treatment for clinical depression, and an ongoing education in the the field of mental health generally.
After a hospital stay in early '97, I improved slowly but steadily. But then, rather suddenly, I dived into another depression, and was hospitalized in October of that year. Even after leaving the hospital, I stayed in rather poor shape, although I was functional, then suddenly began to do better ...
... and on and on it went. Depressive episodes came and went, not like clockwork, yet with devastating suddenness. I went in and out of the hospital as if through a revolving door. Between my depressive episodes, I had periods in which I did quite well, seemingly without regard to what medication I was taking, my therapeutic progress, or my life circumstances; I was just happy, for no apparent reason, even if only a few weeks before, I had been ready to "cash in."
My diagnosis, through all of this, remained as "major depression," but as "recurrent type." This is a form of refractory depression, or treatment-resistant depression. Many patients suffer from this, and psychiatrists are usually at a loss to do anything about it. They mostly try a varied array of strategies, from trying new antidepressants, to trying multiple antidepressants, to augmenting antidepressants with other drugs, such as lithium or thyroid medications. Sometimes ECT (electroconvulsive therapy, known sometimes by the pejorative phrase "electro-shock therapy") is tried, or perhaps the patient is enrolled in a clinical study of a new medication or other treatment. (This isn't easy to do, as many studies do not accept patients with refractory depression.)
Psychiatry really has not yet come to grips with refractory depression. Too often these patients are labeled as "trouble patients" and not treated with the dignity they deserve; nor are the causes for the persistence of their depression examined. They're simply said to have "depressive personality traits," which is psychiatry-speak for "that's just the way s/he is." There are some studies being done, and some hospitals, clinics and psychiatrists who do their best to give such patients the best care possible — but overall, the industry has neglected them, and until the entire industry wakes up to the problem, and accepts it as "real" rather than as the collective hysteria of difficult patients, refractory depression will never be properly treated.
This was not news to me, of course. I was labeled as having "depressive personality traits," which doomed me to being considered a "difficult patient." But there was little I could do about it. In fact, I wondered if there wasn't something wrong with me, that made my depression so persistent. What had I done wrong, or what was I failing to do right? This, of course, only made my depression worse.
Finally, though, something happened which even I hadn't expected. I went through a time in which my thoughts were fast, I couldn't sleep, I prattled on as though my mouth had sprung a leak, I was buying things I didn't need, and so on. I reported this to my mental health providers, who took an interest in this. After a couple weeks of it, they finally decided that I was having a hypomanic episode. I was actually bipolar!
That, of course, floored me. But it was also a revelation: My resistance to treatment, to that point, was now explained! It's wasn't me, after all! My periodic depressive episodes, were due to the bipolar (not depressive) physiology of my brain. That was why my depressions came and went without regard to my treatment or what was happening in my life. It all made perfect sense.
Now ... this all came to mind, when I heard an ad on the radio, sponsored by the Eli Lilly pharmaceutical company. It talked about how many depression patients don't seem to get better, despite getting treatment, and the reason? Because they actually have undiagnosed bipolar disorder. This happens, the ad claims, because while depression often shows up in doctor's offices, mania and hypomania sometimes don't. It suggests that listeners go to the Web site, BipolarAwareness.Com to find out more about it.
For many reasons, I'm not in favor of pharmaceutical companies selling prescription drugs to the general public. But I am thrilled that my own scenario has proven to be common enough, that a drug company would advertise to it! There must be a lot of refractory-depresion patients out there, if Lilly is spending good money (radio ads aren't cheap) trying to reach them. Note, not every patient with refractory depression will benefit from this, but some (like me) will, and that's what's important.
Perhaps, at long last, psychiatry will begin taking refractory depression seriously, and begin delving into the reasons why depression persists, in some people. It's high time!
Note: The aforementioned is not an endorsement by me, or the Depressive & Bipolar Alliance of Northwest Connecticut, of Eli Lilly or any of its products.