Depression and Anxiety: What If Medication Doesn't Work?

Gayathri Ramprasad wrote "Depression, Anxiety: What Worked for Me" from inside her own illness, and she does not soften it. For years anxiety and depression left her barely functional. Medications gave her little. Therapy gave her little. Even electroconvulsive therapy failed to touch symptoms severe enough to put her in the hospital and drive her to attempted suicide. What she would not let go of was the idea that relief might exist somewhere outside the prescription pad, and she set out to find a way through without drugs. The medications, she felt, made things worse rather than better, a complaint that shows up again and again among people living with these conditions. With a doctor overseeing the process, she stopped taking them and turned toward a more whole-person way of looking after herself.

Someone suggested transcendental meditation. The first attempt did not look like peace. "Ironically, it was an American teacher, Pat, who taught me this life-affirming practice that had originated in India, my country of birth," she writes. "I still remember sitting cross-legged on a Persian carpet across from Pat, in the dining-room-turned-shrine in her home. While Pat sat still, Buddha-like, eyes closed, breath steady, body relaxed, face serene, my breath was erratic, my eyelids fluttered like the wings of a hummingbird, and my 'monkey mind' ran amok." Practice changed that. She slowed down, found her breath, grew still. "There, I discovered an oasis of energy, creativity, and restful calm. In time, meditation offered me a sacred space to reflect on my life, and taught me to become an observer of my thoughts and emotions instead of getting entangled in them." That last part matters. Stepping back from a thought, rather than being swept into it, is one of the ways meditation loosens the grip of stress, depression and anxiety and returns a person to the present moment.

Movement came next. On advice to use physical activity for her mood and general health, she enrolled in exercise classes and took up yoga. Yoga in particular left her feeling loosened and renewed across mind, body and spirit, and it restored some of the physical and mental energy her illness had drained.

Counseling was the piece she resisted longest, though she tried it anyway. Cognitive behavioral therapy rests on a simple premise: thought, feeling and action are linked, so changing how you think can change how you behave. "Dr. Lin, my therapist, explained how our thoughts, feelings, moods and behavior were interwoven, and taught me how to identify negative, self-defeating thoughts and replace them with positive, life-affirming thoughts," she recalls. Dr. Lin also taught her breathing exercises for anxiety and worked on the self-talk she needed to push back against suicidal thinking. One book she was pointed toward, "Feeling Good" by Dr. David Burns, turned out to help a great deal.

Depression is common. Healthline puts the figure at roughly 1 in 10 people over the course of a lifetime. Some of it is the ordinary weight of a hard stretch: a death in the family, illness, money trouble, a lost job. Clinical depression is a different animal from a bad week. A 2012 report from NAMI, the National Alliance on Mental Illness, found that about 6.7 percent of American adults, around 14.8 million people, were living with major depression. Anxiety disorders (panic disorder, OCD, PTSD, generalized anxiety, phobias) affected roughly 18.1 percent, about 42 million people. Another 9.2 million adults carried both a mental health condition and an addiction at the same time.

As these numbers climb, more people are reaching for holistic or alternative approaches, sometimes instead of medication and sometimes alongside it. Meditation, exercise, yoga and cognitive behavioral therapy all belong on that list of workable options. Ramprasad's recovery stands as evidence that they can treat depression rather than merely occupy the time. Written by Kim B.

A note of full disclosure: I am writing this from the waiting room of an urgent care facility. If you want a living oxymoron, start with the phrase "urgent care," because there is remarkably little urgency in the room. This place happens to be good at what it does, which is why I keep coming back. Third visit in ten days, two different children of mine involved; four visits in a month if you count all three kids. I am holding out for some kind of loyalty reward. Not my favorite office to work from, but the Wi-Fi is free.

My honest read on American culture is that we are overmedicated and overprescribed. A drug often does not work, so a second or a substitute gets added, and the regimen starts over. The cycle sets in and sometimes never breaks, with little attention paid to how the chemicals interact with each other or how the body reacts when it would rather reject them. Pile on the sheer volume of FDA-approved pharmaceuticals, over-the-counter remedies and supplements, and you get a confused, self-medicating, badly depressed population.

Part of what drives this is money: the multi-billion-dollar sway that pharmaceutical companies hold over treatment protocols in medical practices and hospitals nationwide. If there is one corner of American life that could use more government oversight and less political interference, the medical and drug sectors might be it. Calling them industries at all may be half the trouble. Those arguments belong to another day and a different Congressional hearing.

The family doctor who looked after the whole household seems to be gone. Physicians today often cannot, or will not, treat the whole person. Specialization built a more profitable business model, and the resulting maze of care gets so tangled that people walk away from it. Do not mistake my point: I want skilled, well-trained specialists who know their field cold. But plenty of people have quit the hoop-jumping that the modern system demands. The cost, I suspect, is millions of Americans walking around with undiagnosed physical, mental and emotional conditions, going untreated, leaning on a "what doesn't kill me makes me stronger" posture to get by.

Some depressions respond to medication. Many do not. When the pills fail, is that the end of it? No. Other kinds of treatment exist, some pharmaceutical and some therapeutic, delivered one-on-one or in groups. The thing I most want someone to carry away from this is blunt: do not let yourself go undiagnosed, and whatever you do, do not go untreated.

Reference: Ramprasad, Gayathri; Aubrey, Allison (March 5, 2014). Depression, anxiety: What worked for me. Retrieved from http://www.cnn.com/2014/03/04/health/ramprasad-depression/