Monday, September 19, 2011

Is This Depression?

Over on KevinMD, an anonymous doctor has post up called the Absence of Joy about his own problems with depression.  He writes:

For ten years I fought against the feeling that for long periods of time I was abnormally unimpressionable.  Not all the time, but certainly for moments. I was neither incredibly happy nor depressingly sad.  I put all this down to the stresses of making ends meet by moonlighting in ER’s, working impossible hours, studying for interminable exams, followed by the stresses of looming loan repayments, cash flow crises, parenting and marriage demands as my practice struggled to find its feet.

During moments of reflection I would question my condition, briefly consider depression as a factor, and then disregard it completely.  I was sleeping well.  I was not miserable.  Just stressed, like many of my colleagues.  Burn out was the diagnosis I chose for myself, and there seemed to be no easy option to deal with that.

But as the joy withdrew from my life, I was unable to identify the cause within.  I looked for other causes.  If the reason was not internal, it had to be external.  I found subtle fault with everyone around me, my wife, my kids, my career, my patients, my staff.  I considered changing my situation, leaving all of these, building another life, because this one did not appear to make me happy.
My wife saved me from myself.  Some ultimatums later, I was presented with a diagnosis of subclinical depression and began taking an SSRI.

He goes on to talk about how much better he feels and how much less labile his moods are.  He mentions things rolling off him like they'd roll off a duck's back, and of course we Shrink Rappers are big into ducks. 

So why am I writing about this blog post?  I think because I wasn't so sure I would have offered this patient medications.  Of course it's only a snapshot, and sometimes a recounting of symptoms on paper does not match the distress that a live person can convey, but the writer does not describe clinical major depression, what we think of as an illness.  He does a great job of describing existential angst, and makes no mention of whether he's had psychotherapy.  Perhaps he describes dysthymia (a low grade chronic depression that depletes the patient) but I wasn't totally sure.  I almost had the sense while reading that he's taking a happy pill that moves him to complacency. But the writer describes a huge relief, satisfaction with his outcome, and who am I to second guess? 

Just thought it might make for some good conversation here on Shrink Rap.  Do check out the whole post over on KevinMD by clicking here.